Biomarker Application for Precision Medicine in Stroke

Alexis N Simpkins,Ann M Stowe,Miroslaw Janowski,Gregory Bix,Jill Roberts,Helieh S Oz,Sylvain Doré

doi:10.1007/s12975-019-00762-3

Abstract

Stroke remains one of the leading causes of long-term disability and mortality despite recent advances in acute thrombolytic therapies. In fact, the global lifetime risk of stroke in adults over the age of 25 is approximately 25%, with 24.9 million cases of ischemic stroke and 18.7 million cases of hemorrhagic stroke reported in 2015. One of the main challenges in developing effective new acute therapeutics and enhanced long-term interventions for stroke recovery is the heterogeneity of stroke, including etiology, comorbidities, and lifestyle factors that uniquely affect each individual stroke survivor. In this comprehensive review, we propose that future biomarker studies can be designed to support precision medicine therapeutic interventions after stroke. The current challenges in defining ideal biomarkers for stroke are highlighted, including consideration of disease course, age, lifestyle factors, and subtypes of stroke. This overview of current clinical trials includes biomarker collection, and concludes with an example of biomarker design for aneurysmal subarachnoid hemorrhage. With the advent of “-omics” studies, neuroimaging, big data, and precision medicine, well-designed stroke biomarker trials will greatly advance the treatment of a disease that affects millions globally every year.

Highlights

Despite the advances in the care of patients, stroke remains one of the leading causes of death and long-term disability in adults [1–3]
Plasma drawn within 24 h of AIS; biomarkerbased CoRisk score was well-calibrated in validation cohort, for 3-month prediction of disability and death
Evaluation of vitamin D and other biomarkers over 12 months related to falls, injury, and functional outcomes, including strength, balance, and walking

Summary

Introduction

Despite the advances in the care of patients, stroke remains one of the leading causes of death and long-term disability in adults [1–3]. The age-adjusted incidence of stroke may be declining, the prevalence of the disease and the global health burden will rise as the size of the aging community increases. The prevalence of stroke is increasing in younger populations [4]. This will affect patients who would otherwise be a part of the workforce, with a potential loss of income from long-standing disability that impacts the family unit and the community as a whole [3]. Despite the most advanced acute interventions, a significant number of patients will suffer residual disability as a consequence of stroke. Stroke remains a formidable disease that will continue to impact society in the absence of effective prevention, new acute therapeutic modalities, and enhanced interventions for longterm recovery

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Conclusion