Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Towards precision medicine in ischemic stroke and transient ischemic attack
First author：Yi LIN,Zixiao LI
Corresponding author：Yongjun Wang
essential_information
- Person in charge：Yi LIN,Zixiao LI
- Data Sources： OTHERS
- Number of papers：OTHERS20190179
- Published time：2018-03-01
2018-03-01
Published articles
Journal：Frontiers in Bioscience-Landmark
Publication type: Brief Reports
IF(IF): 4.009
PMID: 29293437 Link To Pubmed Full text Download
Background And Purpose
Precision medicine in ischemic stroke or TIA is still in its infancy, but there have already been changes in clinical care from a one-size-fits-all model to a more precise, individualized approach. However, further studies are urgently needed to bridge the gaps between clinical studies and precision clinical practice. The artical discuss here the advances and challenges for precision medicine in ischemic stroke or TIA at its current stage, focusing on genetic predispositions, pharmacogenetics, omics, brain imaging and big data.
Method
The entire implementation of precision medicine in ischemic stroke or TIA should be a three-stage progress (Figure 1). The first stage is the “discovery” stage. In this stage, the associations between potential novel omics, imaging, and phenotypic biomarkers with ischemic stroke or TIA should be documented in case-control or in cohort studies. The “replication” stage is the second stage. The biomarkers identified in the first stage should be replicated in a biomarker-tailored randomized controlled trial. Lastly, the “translation” stage serves to translate these practices to clinical practice by using point-of-care testing approaches or mobile medical devices.
Conclusion
Precision medicine would distinguish patients with ischemic stroke primarily based on genetics and imaging information, while considering other phenotypic and psychosocial characteristics. Studies of other “omics” have explored several potential novel biomarkers, which might provide critical mechanistic insights into key biologic processes of ischemic stroke or TIA. These biomarkers might be put forward to a new clinical subtype as substitute or modification for TOAST/OCSP classification in ischemic stroke.
Main results
To date, most of studies for precision medicine in ischemic stroke or TIA were in the first stage. The system integration of the 'omics’ data, phenotypes, exposome and microbiome would give us comprehensive insight into the development of ischemic stroke or TIA and the response variability to drugs, to which further study and analysis is needed in the future.