Blood biologic markers of stroke: Improved management, reduced cost?
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Corresponding author Alison E. Baird, FRACP, PhD Stroke Neuroscience Unit, NINDS/NIH, 10 Center Drive, MSC 1294, Room 3N258, Bethesda, MD 20892-1294, USA. E-mail: [email protected] Current Cardiovascular Risk Reports 2007, 1:80 – 88 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2007 by Current Medicine Group LLC
Identifying blood biomarkers may be of particular value in neurologic disorders such as stroke because of the difficulty in directly studying the brain and its blood vessels. Markers of brain injury, inflammation, excitotoxicity, and oxidative damage have been evaluated for their value in stroke diagnosis, treatment, and management, but none has proved to be sensitive or specific enough for routine clinical use. However, new cellular and molecular profiling approaches using the peripheral blood offer the potential for identifying panels of genes and proteins by increasing specificity while maintaining sensitivity. Furthermore, the first biomarker for predicting stroke risk associated with atherosclerosis (lipoprotein-associated phospholipase A 2) was recently approved by the United States Food and Drug Administration. The ultimate aim for stroke biomarkers is to develop rapid, easy to use, widely available, and inexpensive diagnostic tests that can be used in the clinic and in clinical trials.
Introduction Stroke is a leading consequence of atherosclerotic vascular disease and is the third leading cause of death and the leading cause of adult disability in the United States and developed countries, and consequently impacts considerably on health care costs. The current stroke management paradigm relies heavily on clinical diagnosis [1]. The typical sequence of steps in managing a stroke patient is to 1) confirm the diagnosis of stroke; 2) determine what type of stroke it is (ischemic or hemorrhagic); 3) determine if treatment with recombinant tissue plasminogen activator (rt-PA) therapy is appropriate; 4) determine the risk of bleeding after rt-PA therapy; 5) determine the likely prognosis; 6) determine the stroke mechanism (eg, embolic); and 7) determine the risk
of stroke recurrence. However, the answers to some of these questions are imperfect at best [2]. Only about 70% to 80% of patients with an initial suspected diagnosis of stroke turn out to have a stroke [3,4]. The use of additional laboratory markers of these processes would be most welcome, especially if they could be proven to be accurate, rapid, and easily performed in clinical practice. This is particularly so in neurologic disorders such as stroke because of the inability to directly study the brain and its blood vessels. Biopsy is rarely available or acceptable. Neuroimaging techniques such as CT and MRI, magnetic resonance angiography, and ultrasound have proven to be invaluable for stroke diagnosis and for utility in prognosis and stroke risk. CT is particularly reliable for the diagnosis of acute intracerebral hemorrhage [5] and diffusion-weighted MRI for the diagnosis and prognosis of ischemic stroke [6], but these are time consu
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