Cerebral ischemia biomarkers: Their roles in early diagnosis and prognosis with potential clinical applications

Cerebral ischemia, caused by a disruption in blood supply to the brain, remains a significant cause of morbidity and mortality worldwide. Identifying reliable biomarkers for the early diagnosis and prognosis of cerebral ischemia is crucial for timely intervention and improved patient outcomes. This review aims to provide a comprehensive overview of the current knowledge on cerebral ischemia biomarkers, focusing on their potential role in early detection and prediction of clinical outcomes. Specifically, we discuss the current advances in the field of cerebral ischemia biomarkers, which serve as essential tools for early diagnosis and monitoring of ischemic stroke. We examine several promising biomarkers, including omics data, genetic (FOXF2 and ATP5H), physiological and neuroinflammatory biomarkers, neuroimaging markers, blood-based biomarkers (proteins, microRNAs, and metabolites), and newer modalities such as exosomes, microvesicles, and cell-free deoxyribonucleic acid (cfDNA). In addition, we highlight the challenges and future directions in translating these biomarkers into clinical practice. Standardization and reproducibility, methodological limitations, and cost and accessibility are critical challenges in the translation of biomarkers into clinical practice. Addressing these challenges requires multi-stakeholder collaborations and coordinated efforts to establish standardized protocols, improve analytical methods, and develop cost-effective biomarker assays. The use of point-of-care testing devices or miniaturized lab-on-a-chip technologies can reduce costs and improve accessibility, particularly in low-resource settings. Furthermore, collaborations between academia, industry, and regulatory agencies can facilitate the translation of biomarkers by addressing regulatory and reimbursement hurdles that affect the affordability and availability of these tests.