Rapid restoration of circulation in acute ischemic stroke (AIS) and early treatment in hemorrhagic stroke are critical to recovery and require early recognition of stroke type. However, AIS is not observed on 40% of initial CT scans, and brain imaging is frequently unavailable to assess acute intracranial bleeds. Furthermore, the inflammatory cascade triggered immediately by ischemic and hemorrhagic stroke, with activation of microglia, production of cytokines and chemokines in the brain, and recruitment of peripheral monocytes across the blood-brain barrier, is poorly understood and largely untreated in hyper-acute stroke care. Preclinical studies have identified miRNA in blood and exosomes to diagnose AIS and metabolomic markers of the cerebral inflammatory cascade. This knowledge is lacking in humans. Moreover, up to 25% of strokes represent a recurrent event, demonstrating the crucial role of unraveling stroke etiology in order to select the appropriate secondary preventive medication. There is, thus, a need for basic science and clinical research on blood-based cellular and molecular biomarkers to diagnose stroke type quickly, restore cerebral circulation, modulate hemorrhage expansion, uncover stroke etiology, and to understand and prevent secondary damage from cerebral inflammation.

The proposed topic of blood-based biomarkers in AIS and hemorrhagic stroke encompasses cellular (exosomes), molecular (microRNA), neuroinflammatory (cytokines, chemokines, complement breakdown products), and metabolomic biomarkers related to stroke onset, diagnosis, and neuroinflammation. Neuroinflammatory modulator changes in AIS include microglia activation, chemokines (including CCL2 ligand, and CCR2 receptor), and cytokines. Biomarkers in stroke have attracted an extraordinary amount of research attention in recent years and this field is expanding, particularly regarding exosomes and miRNA. Of potential interest is ultra-early biomarkers, obtained within minutes of stroke onset, and in the acute and subacute stages of stroke progression. Cellular, molecular and metabolomic level research is likely to garner even more attention in the years to come, with stroke incidence increasing in both the aging population and in younger individuals. The goal is to identify a “troponin for the brain”, a biomarker or biomarkers obtained via a simple blood draw early in the stroke course. Correlation with concurrent brain imaging (CT and/or MRI) will provide potentially valuable information for new therapies for ischemic and hemorrhagic stroke, and to inform the design of basic science and clinical research studies.

We welcome submissions that report the role of stroke-specific biomarkers of cellular and molecular mechanisms in onset, progression, treatment strategies, and outcome in acute ischemic and hemorrhagic stroke. Manuscripts with the following themes are especially welcome:

- Exosomes in acute ischemic and hemorrhagic stroke

- MicroRNA in acute ischemic stroke.

- MicroRNA in intracerebral hemorrhage (ICH), hematoma volume and expansion, and cerebral edema.

- MicroRNA in spontaneous subarachnoid hemorrhages (SAH).

- Early neuroinflammatory modulators from circulating blood and cerebral spinal fluid (CSF) in cerebral edema and outcome in acute ischemic stroke.

- Exosomes as therapeutic transport vesicles in acute stroke.

- MicroRNA as therapeutic targets in acute ischemic and hemorrhagic stroke.

- Neuroinflammatory modulators as therapeutic targets for inhibition of cerebral edema in acute stroke.

- Specific marker for endothelial, arteriosclerosis, or cardiac injury as a diagnostic tool uncovering stroke etiology.

We encourage clinical or basic science research, in the form of Original Research, Opinions, Perspectives, or Reviews. Case Studies are no longer accepted in Frontiers in Neurology.

This is a Volume II, Volume I can be found here: https://shorturl.at/xyJPR

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Frontiers in Neurology

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