Biomarker Application for Precision Medicine in Stroke

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.

Keywords: 'omics'; big data; biomarker; clinical trials; hemorrhagic stroke; ischemic stroke; precision medicine.

Fig. 1

Phases of stroke-related biomarker study. The diagram outlines how biomarker studies should be tailored to both stroke subset (y-axis) and phase of stroke (x-axis). The phases include pre-stroke (blue), stroke (red) dependent on subtype, and post-stroke phase (gray). Current challenges for pediatric stroke biomarker trials are listed in the bottom row. SAH, subarachnoid hemorrhage; ICH, intracerebral hemorrhage; EBI, early brain injury; CV, cerebral vasospasm; DCI, delayed cerebral ischemia; ICU, intensive care unit

Fig. 2

Schematic for optimizing stroke biomarker trials. Biomarkers can be identified in each phase of stroke (pre-stroke, stroke, post-stroke) and stroke subtype (ischemic, subarachnoid hemorrhage, intracerebral hemorrhage) to support precision medicine for the individual patient. RCT, randomized controlled trial