Abstract
There is a large unmet need for fast and reliable diagnostics in several diseases. One such disease is stroke, where the efficacy of modern reperfusion therapies is highly time-dependent. Diagnosis of stroke and treatment initiation should be performed as soon as possible, and preferably before arrival at the stroke center. In recent years, several potential blood biomarkers for stroke have been evaluated, but without success. In this review, we will go into detail on the possibility of utilizing extracellular vesicles (EVs) released into the blood as novel biomarkers for stroke diagnostics. EVs are known to reflect the immediate state of the secreting cells and to be able to cross the blood–brain barrier, thus making them attractive as diagnostic biomarkers of brain diseases. Indeed, several studies have reported EV markers that enable differentiation between stroke patients and controls and, to a lesser extent, the ability to correctly classify the different stroke types. Most of the studies rely on the use of sophisticated and time-consuming methods to quantify specific subpopulations of the nanosized EVs. As these methods cannot be easily implemented in a rapid point of care (POC) test, technical developments followed by prospective clinical studies are needed.
Highlights
Stroke is the second-leading cause of death worldwide and a leading cause of long-term disability [1].The most common type is acute ischemic stroke (AIS), which occurs in 85% of cases, with the remaining cases being hemorrhagic strokes dominated by spontaneous intracerebral hemorrhage (ICH) [2]
Van Kralingen and coworkers found that the elevation of miRNA-17-5p, miR-20b-5p and miR-93-5p and miRNA-27b-3p in stroke patients compared to stroke mimic patients were linked to their underlying chronic cerebral small vessel disease (cSVD) instead of their AIS [87]
Minimizing treatment delays in stroke patients is of utmost importance, as treatment efficacy is highly time-dependent
Summary
Stroke is the second-leading cause of death worldwide and a leading cause of long-term disability [1]. Clinical examination alone cannot reliably differentiate between AIS and ICH, making neuroimaging mandatory before treatment initiation [2]. There is an urgent need for fast and reliable acute stroke diagnostics to fully harness the effect of current reperfusion therapies and to allow future neuroprotective strategies to be started as soon as possible [6]. For this purpose, we hypothesize that blood-derived extracellular vesicles (EVs) can be used to discriminate between stroke types as well as give an indication of the current cerebrovascular disease state.
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