Glial Fibrillary Acidic Protein (GFAP): Neuroinflammation Biomarker in Acute Ischemic Stroke

Abstract

Introduction Blockage of the cerebral arteries due to thrombosis and embolism resulting in decreased blood flow to the brain, reduced oxygen supply to the brain, resulting in neuronal damage and causes astrocyte cells to secrete glial fibrillary acidic protein (GFAP). The objective of this study was to determine the correlation between GFAP levels serum and clinical outcome in patients with acute ischemic stroke. Methods This was observational with a cross-sectional design on acute ischemic stroke patients confirmed by CT scans and divided into large vessel occlusion and small-vessel occlusion. Clinical outcome was measured using the National Institutional Health Stroke Scale (NIHSS) tool. Statistical analysis uses Spearman’s rank correlation test and Mann Whitney’s test, significant if p < 0.05. Results After collecting 33 research subjects, we found 16 people with large vessel occlusion and 17 people with small vessel occlusion. Serum GFAP levels were 0.2–1.9 ng/mL, 9.1% with a mild neurological deficit, 45.45% were moderate neurological deficits, and 45.45% were severe neurological deficits. There was a significant positive correlation (r = 0.522; p = 0.002) between serum GFAP levels and the degree of neurological deficit in ischemic stroke patients. There was a statistically significant difference between serum GFAP levels in ischemic stroke patients with CT scan results of large artery occlusion compared to small artery occlusion (0.7 vs 0.4ng/mL; p = 0.001). Conclusion There was a positive correlation between GFAP level serum and NIHSS score on acute ischemic stroke. The higher the value of GFAP serum level, the higher the value for NIHSS and correlated with stroke severity and the extent of brain damage in ischemic stroke patients.

Biomarkers for prognostic functional recovery poststroke: A narrative review

“…GFAP is a monomeric filament protein found as the main component of the cytoskeleton of mature astrocytes in the central nervous system ( Amalia, 2021 ). Astrocytes react in response to injury or ischemic processes to maintain cell homeostasis through complex response mechanisms known as astrocytosis ( Liu and Geng, 2018 ; Cole and Einstein, 2019 ; Amalia, 2021 ). In ischemic stroke, high levels of GFAP detected in CSF and serum in samples taken within 24 h after symptom onset were correlated to higher NIHSS scores ( Amalia, 2021 ).…”

Stroke and Emerging Blood Biomarkers: A Clinical Prospective

“…When a stroke occurs, both the destruction of glial brain cells and the disruption of the blood–brain barrier result in the release of great amounts of GFAP into the bloodstream, within minutes in case of ICH. In contrast, the cell destruction process evolves slower in patients presented with an ischemic stroke, thus leading to a delayed release of GFAP (typically between 6–12 h poststroke) and differentiating between the two main types of stroke [ 33 , 34 ].…”

Mapping the research trends of astrocytes in stroke: A bibliometric analysis

“…Reactive astrocyte proliferation is characterized by GFAP and S100β and serves as vital biomarker ( Ding et al, 2021 ). Increased GFAP serum level corresponds with the higher value for NIHSS and correlated with stroke severity and the extent of brain damage in ischemic stroke patients ( Amalia, 2021 ). The astroglial protein S100B serum concentrations are measured at 48–72 h after symptom onset and are highly correlated to final infarct volume and functional outcome ( Luger et al, 2021 ).…”