title: Apolipoprotein A-I and Paraoxonase-1 Are Potential Blood Biomarkers for Ischemic Stroke Diagnosis.
abstract: BACKGROUND
  Blood biomarkers for ischemic and hemorrhagic stroke diagnosis remain elusive. Recent investigations suggested that apolipoprotein (Apo), matrix metalloproteinase (MMP), and paraoxonase-1 may be associated with stroke. We hypothesized that Apo A-I, Apo C-I, Apo C-III, MMP-3, MMP-9, and paraoxonase-1 are differentially expressed in ischemic stroke, hemorrhagic stroke, and controls.
  
  
  METHODS
  In a single-center prospective observational study, consecutive stroke cases were enrolled if blood samples were obtainable within 12 hours of symptom onset. Age- (±5 years), race-, and sex-matched controls were recruited. Multiplex assays were used to measure protein levels. The Wilcoxon signed-rank test and the Mann-Whitney U-test were used to compare biomarker values between ischemic stroke patients and controls, hemorrhagic stroke patients and controls, and ischemic and hemorrhagic stroke patients. The 95% confidence intervals (CIs) for the difference of 2 medians were calculated.
  
  
  RESULTS
  Fourteen ischemic stroke case-control pairs and 23 intracerebral hemorrhage (ICH) case-control pairs were enrolled. Median Apo A-I levels were lower in ischemic stroke cases versus controls (140 mg/dL versus 175 mg/dL, difference of 35 mg/dL, 95% CI -54 to -16) and in ischemic stroke versus ICH cases (140 mg/dL versus 180 mg/dL, difference of 40 mg/dL, 95% CI -57 to -23). Median paraoxonase-1 was lower in ischemic stroke cases than in both ICH cases and matched controls. Median Apo C-I was slightly lower in ischemic stroke cases than in ICH cases. There were no differences between groups for MMP-3, MMP-9, and Apo C-III.
  
  
  CONCLUSIONS
  Apo A-I and paraoxonase-1 levels may be clinically useful for ischemic stroke diagnosis and for differentiating between ischemic and hemorrhagic strokes.
authors.affiliation: University of Cincinnati Neuroscience Institute, Cincinnati, Ohio; Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio. Electronic address: walshk4@ucmail.uc.edu.
authors.forename: Kyle B
authors.initials: KB
authors.lastname: Walsh
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Hart
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Susan
authors.initials: S
authors.lastname: Roll
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Matthew
authors.initials: M
authors.lastname: Sperling
authors.affiliation: Division of Hematology Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Dusten
authors.initials: D
authors.lastname: Unruh
authors.affiliation: Center for Lipid and Arteriosclerosis Science, University of Cincinnati, Cincinnati, Ohio.
authors.forename: W Sean
authors.initials: WS
authors.lastname: Davidson
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.affiliation: University of Cincinnati Neuroscience Institute, Cincinnati, Ohio; Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Opeolu
authors.initials: O
authors.lastname: Adeoye
mesh_terms: D000368:Aged; D016632:Apolipoprotein A-I / Q000097:blood*; D043303:Aryldialkylphosphatase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis*; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000097:blood* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000097:blood* / Q000175:diagnosis*
chemical_list: C505693:APOA1 protein, human; D016632:Apolipoprotein A-I; D015415:Biomarkers; D043303:Aryldialkylphosphatase; C468406:PON1 protein, human
keywords: Ischemic stroke; biomarker; diagnosis; intracerebral hemorrhage; plasma; proteomics