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Acute stroke biomarkers: Are we there yet?


Dagonnier, M and Donnan, GA and Davis, SM and Dewey, HM and Howells, DW, Acute stroke biomarkers: Are we there yet?, Frontiers in Neurology, 12 pp. 1-16. ISSN 1664-2295 (2021) [Refereed Article]

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Copyright Statement

Copyright © 2021 Dagonnier, Donnan, Davis, Dewey and Howells. This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License, (, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

DOI: doi:10.3389/fneur.2021.619721


Background: Distinguishing between stroke subtypes and knowing the time of stroke onset are critical in clinical practice. Thrombolysis and thrombectomy are very effective treatments in selected patients with acute ischemic stroke. Neuroimaging helps decide who should be treated and how they should be treated but is expensive, not always available and can have contraindications. These limitations contribute to the under use of these reperfusion therapies.

Aim: An alternative approach in acute stroke diagnosis is to identify blood biomarkers which reflect the body’s response to the damage caused by the different types of stroke. Specific blood biomarkers capable of differentiating ischemic from hemorrhagic stroke and mimics, identifying large vessel occlusion and capable of predicting stroke onset time would expedite diagnosis and increase eligibility for reperfusion therapies.

Summary of Review: To date, measurements of candidate biomarkers have usually occurred beyond the time window for thrombolysis. Nevertheless, some candidate markers of brain tissue damage, particularly the highly abundant glial structural proteins like GFAP and S100β and the matrix protein MMP-9 offer promising results. Grouping of biomarkers in panels can offer additional specificity and sensitivity for ischemic stroke diagnosis. Unbiased "omics" approaches have great potential for biomarker identification because of greater gene, protein, and metabolite coverage but seem unlikely to be the detection methodology of choice because of their inherent cost.

Conclusion: To date, despite the evolution of the techniques used in their evaluation, no individual candidate or multimarker panel has proven to have adequate performance for use in an acute clinical setting where decisions about an individual patient are being made. Timing of biomarker measurement, particularly early when decision making is most important, requires urgent and systematic study.

Item Details

Item Type:Refereed Article
Keywords:stroke, biomarker, review, microarray, acute
Research Division:Biomedical and Clinical Sciences
Research Group:Neurosciences
Research Field:Neurology and neuromuscular diseases
Objective Division:Health
Objective Group:Clinical health
Objective Field:Diagnosis of human diseases and conditions
UTAS Author:Howells, DW (Professor David Howells)
ID Code:146377
Year Published:2021
Web of Science® Times Cited:15
Deposited By:Medicine
Deposited On:2021-09-03
Last Modified:2021-10-14
Downloads:6 View Download Statistics

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