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NEUROLOGY 2009;73:393-399
© 2009 American Academy of Neurology
Special Article

Invited Article: Searching for oracles?

Blood biomarkers in acute stroke

C. Foerch, MD, J. Montaner, MD, K. L. Furie, MD, M. M. Ning, MD and E. H. Lo, PhD

From the Neuroprotection Research Laboratory (C.F., M.M.N., E.H.L.), Department of Neurology, Stroke Service (K.L.F., M.M.N.), and Clinical Proteomics Research Center, Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (C.F.), Johann Wolfgang Goethe-University, Frankfurt am Main, Germany; and Neurovascular Research Laboratory (J.M.), Stroke Unit, Department of Neurology, Vall d'Hebron Hospital, Barcelona, Spain.

Address correspondence and reprint requests to Dr. Christian Foerch, Department of Neurology, Goethe-University, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany foerch{at}em.uni-frankfurt.de

Emerging data suggest that a wide array of measurable biomarkers in blood may provide a novel window into the pathophysiology of stroke. In this review, we survey the state of progress in the field. Three specific questions are assessed. Can biomarkers augment the clinical examination and powerful brain imaging tools to enhance the accuracy of the diagnostic process? Can biomarkers be used to help triage patients for thrombolytic therapy? Can biomarkers help predict patients who are most susceptible to malignant infarction? Many encouraging molecular candidates have been found that appear to match the known cascades of neurovascular injury after stroke. However, whether these putative biomarkers may indeed have direct clinical utility remains to be quantitatively validated. Larger clinical trials are warranted to establish the sensitivity and specificity of biomarkers for routine use in clinical stroke.

Abbreviations: BBB = blood–brain barrier; BNP = brain natriuretic peptide; CRP = C-reactive protein; GFAP = glial fibrillary acidic protein; HT = hemorrhagic transformation; ICH = intracerebral hemorrhage; IS = ischemic stroke; MMP-9 = matrix metalloproteinase-9; NDKA = nucleoside diphosphate kinase A; NMDA-R = N-methyl-d-aspartate receptor; tPA = tissue plasminogen activator; VLP-1 = visinin-like protein-1; vWF = von Willebrand factor.

Supported by the Deutsche Forschungsgemeinschaft (DFG), NIH grants R37-NS37074, R01-NS48422, R01-NS56458, P01-NS55104, NS051588-MMN, NS052498-MMN, and a Bugher award from the American Heart Association (AHA).

Disclosure: Author disclosures are provided at the end of the article.

Received October 30, 2008. Accepted in final form May 1, 2009.






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