Ischemic stroke remains the leading cause of adult disability in developed countries.¹ Although clinical assessment is the key feature of patient management, additional tools such as biomarkers can be used to support a clinical diagnosis, identify patients at risk of disease, and help guide patient treatment and prognosis. In cerebrovascular disease, computed tomography (CT) and magnetic resonance imaging (MRI) are frequently used to confirm clinically suspected disease. However, there are several limitations to neuroimaging in acute ischemic stroke, with the CT brain scan often having subtle findings and MRI not always readily accessible. The limitations of CT and MRI make the development of other supportive biomarkers valuable in the care of patients with acute stroke. Peripheral blood biomarkers are very useful in clinical practice because they are readily available and low-cost, as shown by the use of troponin for myocardial infarction. Currently, no blood test for ischemic stroke is used in clinical practice, although substantial efforts are ongoing to develop such a test. This article presents a summary of this work, focusing primarily on the use of proteomics and genomics to develop a bloodbased biomarker of ischemic stroke.

Biomarkers and Pathophysiology
The identification of biomarkers for ischemic stroke stems from a growing understanding of stroke pathophysiology. Initial studies identified biomarkers specific to brain tissue, representing molecules that are released into the systemic circulation following ischemic injury to the brain. Biomarkers relating to the coagulation cascade have been associated with ischemic stroke, representing acute thrombus in cerebral circulation. Inflammation also plays an important role in ischemic stroke. A number of biomarkers relating to atherosclerosis and the inflammatory response to ischemic brain tissue have been identified. Finally, a number of biomarkers have been associated with ischemic stroke, although their links with its pathophysiology remain unknown.

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