[Glial Fibrillary Acidic Protein in Patients with Symptoms of Acute Stroke: Diagnostic Marker of Cerebral Hemorrhage]

Overview

Journal Nervenarzt

Specialty Neurology

Date 2014 Jul 25

PMID 25057113

Citations 7

Authors

C Foerch

W Pfeilschifter

P Zeiner

R Brunkhorst

Affiliations

Soon will be listed here.

Abstract

Glial fibrillary acidic protein (GFAP) is a highly brain-specific protein that is expressed in large quantities in astrocytes and has important functions in terms of maintaining and stabilizing the cytoskeleton. Acute intracerebral hemorrhage leads to an immediate mechanical destruction of astroglial cells with the subsequent release of GFAP into the extracellular space and the bloodstream. On the other hand, necrosis, cytolysis and GFAP release does not occur before 6-12 h after symptom onset in ischemic stroke. Thus, in the early hours after stroke increased GFAP values could indicate intracerebral hemorrhage. This review article describes the underlying pathophysiology of the test and guides the reader through the available data. Potential implications regarding the prehospital triage of acute stroke patients are discussed, including the possibility to initiate hyperacute treatment, such as blood pressure reduction in patients with intracerebral hemorrhage. Other areas of interest for a potential GFAP test include traumatic brain injury and malignant gliomas.

Citing Articles

Prediction of clinical progression in nervous system diseases: plasma glial fibrillary acidic protein (GFAP).

Zheng X, Yang J, Hou Y, Shi X, Liu K Eur J Med Res. 2024; 29(1):51.

PMID: 38216970 PMC: 10785482. DOI: 10.1186/s40001-023-01631-4.

Blood GFAP as an emerging biomarker in brain and spinal cord disorders.

Abdelhak A, Foschi M, Abu-Rumeileh S, Yue J, DAnna L, Huss A Nat Rev Neurol. 2022; 18(3):158-172.

PMID: 35115728 DOI: 10.1038/s41582-021-00616-3.

A Longitudinal, Observational Analysis of Neuronal Injury Biomarkers in a Case Report of a Patient With Paraneoplastic Anti-CRMP5 Antibody-Associated Transverse Myelitis.

Mizenko C, Bennett J, Owens G, Vollmer T, Piquet A Front Neurol. 2021; 12:691509.

PMID: 34349723 PMC: 8328144. DOI: 10.3389/fneur.2021.691509.

Severe Traumatic Brain Injury (TBI) Modulates the Kinetic Profile of the Inflammatory Response of Markers for Neuronal Damage.

Schindler C, Lustenberger T, Woschek M, Stormann P, Henrich D, Radermacher P J Clin Med. 2020; 9(6).

PMID: 32492963 PMC: 7356222. DOI: 10.3390/jcm9061667.

A scoping review of pre-hospital technology to assist ambulance personnel with patient diagnosis or stratification during the emergency assessment of suspected stroke.

Lumley H, Flynn D, Shaw L, McClelland G, Ford G, White P BMC Emerg Med. 2020; 20(1):30.

PMID: 32336270 PMC: 7183583. DOI: 10.1186/s12873-020-00323-0.

References

Foerch C, Curdt I, Yan B, Dvorak F, Hermans M, Berkefeld J . Serum glial fibrillary acidic protein as a biomarker for intracerebral haemorrhage in patients with acute stroke. J Neurol Neurosurg Psychiatry. 2005; 77(2):181-4. PMC: 2077601. DOI: 10.1136/jnnp.2005.074823. View

Diaz-Arrastia R, Wang K, Papa L, Sorani M, Yue J, Puccio A . Acute biomarkers of traumatic brain injury: relationship between plasma levels of ubiquitin C-terminal hydrolase-L1 and glial fibrillary acidic protein. J Neurotrauma. 2013; 31(1):19-25. PMC: 3880090. DOI: 10.1089/neu.2013.3040. View

Wunderlich M, Wallesch C, Goertler M . Release of glial fibrillary acidic protein is related to the neurovascular status in acute ischemic stroke. Eur J Neurol. 2006; 13(10):1118-23. DOI: 10.1111/j.1468-1331.2006.01435.x. View

Pelinka L, Kroepfl A, Schmidhammer R, Krenn M, Buchinger W, Redl H . Glial fibrillary acidic protein in serum after traumatic brain injury and multiple trauma. J Trauma. 2004; 57(5):1006-12. DOI: 10.1097/01.ta.0000108998.48026.c3. View

Husain H, Savage W, Grossman S, Ye X, Burger P, Everett A . Pre- and post-operative plasma glial fibrillary acidic protein levels in patients with newly diagnosed gliomas. J Neurooncol. 2012; 109(1):123-7. PMC: 3715051. DOI: 10.1007/s11060-012-0874-8. View

Mondello S, Papa L, Buki A, Ross Bullock M, Czeiter E, Tortella F . Neuronal and glial markers are differently associated with computed tomography findings and outcome in patients with severe traumatic brain injury: a case control study. Crit Care. 2011; 15(3):R156. PMC: 3219030. DOI: 10.1186/cc10286. View

Missler U, Wiesmann M, Wittmann G, Magerkurth O, Hagenstrom H . Measurement of glial fibrillary acidic protein in human blood: analytical method and preliminary clinical results. Clin Chem. 1999; 45(1):138-41. View

Bukhari W, Barnett M, Prain K, Broadley S . Molecular pathogenesis of neuromyelitis optica. Int J Mol Sci. 2012; 13(10):12970-93. PMC: 3497307. DOI: 10.3390/ijms131012970. View

Lennon V, Kryzer T, Pittock S, Verkman A, Hinson S . IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel. J Exp Med. 2005; 202(4):473-7. PMC: 2212860. DOI: 10.1084/jem.20050304. View

10.

Broderick J, Palesch Y, Demchuk A, Yeatts S, Khatri P, Hill M . Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med. 2013; 368(10):893-903. PMC: 3651875. DOI: 10.1056/NEJMoa1214300. View

11.

Steiner T, Rosand J, Diringer M . Intracerebral hemorrhage associated with oral anticoagulant therapy: current practices and unresolved questions. Stroke. 2005; 37(1):256-62. DOI: 10.1161/01.STR.0000196989.09900.f8. View

12.

McMullan J, Knight W, Clark J, Beyette F, Pancioli A . Time-critical neurological emergencies: the unfulfilled role for point-of-care testing. Int J Emerg Med. 2010; 3(2):127-31. PMC: 2885257. DOI: 10.1007/s12245-010-0177-9. View

13.

Nylen K, Csajbok L, Ost M, Rashid A, Blennow K, Nellgard B . Serum glial fibrillary acidic protein is related to focal brain injury and outcome after aneurysmal subarachnoid hemorrhage. Stroke. 2007; 38(5):1489-94. DOI: 10.1161/STROKEAHA.106.478362. View

14.

Gladstone D, Rodan L, Sahlas D, Lee L, Murray B, Ween J . A citywide prehospital protocol increases access to stroke thrombolysis in Toronto. Stroke. 2009; 40(12):3841-4. DOI: 10.1161/STROKEAHA.108.540377. View

15.

Lumpkins K, Bochicchio G, Keledjian K, Simard J, McCunn M, Scalea T . Glial fibrillary acidic protein is highly correlated with brain injury. J Trauma. 2008; 65(4):778-82. DOI: 10.1097/TA.0b013e318185db2d. View

16.

Brunkhorst R, Pfeilschifter W, Foerch C . Astroglial proteins as diagnostic markers of acute intracerebral hemorrhage-pathophysiological background and clinical findings. Transl Stroke Res. 2013; 1(4):246-51. DOI: 10.1007/s12975-010-0040-6. View

17.

Aguilar M, Hart R, Kase C, Freeman W, Hoeben B, Garcia R . Treatment of warfarin-associated intracerebral hemorrhage: literature review and expert opinion. Mayo Clin Proc. 2007; 82(1):82-92. DOI: 10.4065/82.1.82. View

18.

Vos P, Jacobs B, Andriessen T, Lamers K, Borm G, Beems T . GFAP and S100B are biomarkers of traumatic brain injury: an observational cohort study. Neurology. 2010; 75(20):1786-93. DOI: 10.1212/WNL.0b013e3181fd62d2. View

19.

Anderson C, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C . Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013; 368(25):2355-65. DOI: 10.1056/NEJMoa1214609. View

20.

Ting J . Letter to the editors: the potential role for prehospital thrombolysis and time-critical stroke transfers in the northern Norway aeromedical retrieval system; In response to: Norum J, Elsbak TM: Air ambulance services in the Arctic: a Norwegian.... Int J Emerg Med. 2011; 4:45. PMC: 3158421. DOI: 10.1186/1865-1380-4-45. View