Introduction: Several serum based biomarkers for acute stroke have been identified, but the clinical values of these biomarkers have not been realized due to inadequate sensitivity and specificity in their measurements. 24S-Hydroxycholesterol is a stable metabolite of cholesterol synthesized by neurons of the CNS, and released to the serum at a constant rate.
Hypothesis: We hypothesized that serum 24S-Hydroxycholesterol would be an ideal biomarker for acute stroke.
Methods: Acute stroke patients presenting to ED were enrolled after informed consent. Serum samples were collected in ED and levels of 24S-Hydroxycholesterol were determined by mass spectrometry. We enrolled 63 patients from October 2015 to October 2016. Of these 63 patients, 60 presented within 8 hours from onset of symptoms. Patients were categorized as no stroke, ischemic stroke, and intracerebral hemorrhage. We compared serum 24S-Hydroxycholesterol levels in each group and the variation in 24S-Hydroxycholesterol levels with regard to presenting NIHSS.
Result: Out of the 63 patients enrolled, 22 did not have a stroke, 36 had ischemic stroke, and 5 had intracerebral hemorrhage. The mean 24S-Hydroxycholesterol levels were 54 ng/ml, 58 ng/ml and 75 ng/ml in the no stroke group, ischemic stroke group and intracerebral hemorrhage group, respectively. No correlation was observed between NIHSS and 24S-Hydroxycholesterol levels. Difference in 24S-Hydroxycholesterol levels between no stroke and intracerebral hemorrhage patients was statistically significant, but was limited by the small sample size (P = 0.047).
Conclusion: 24S-Hydroxycholesterol may be a useful serum biomarker for intracerebral hemorrhage. Analyses in a larger population is needed to determine the practical importance of this biomarker.