Expanding precision medicine to stroke care

The stroke community needs a philosophical and paradigm shift as well as a higher level of care, argued Dr Svetlana Lorenzano (Sapienza University of Rome, Italy) in a focused workshop on precision medicine in stroke care [1]. Individualised treatments, based on prognostic prediction models incorporating precision medicine-based variables, represent the next frontier in stroke care.

Applying precision medicine to stroke care in order to identify diagnostic and prognostic markers is challenging but crucial. “Guidelines are essential to support the clinician's decision-making process, but in daily care they are not always helpful, particularly because we face the challenges posed by the heterogeneity of cerebrovascular disease phenotypes and the complexity of individual cases,” Dr Lorenzano said. Strong recommendations in guidelines are based on randomised controlled trials, which generally cannot fully consider the complexity of cerebrovascular disease pathophysiology for reasons of feasibility and study design. Exactly these shortcomings of trials could be overcome by precision medicine. The continuous forming and applying of large datasets, the growing collection of omics data (genomics/transcriptomics/proteomics/metabolomics), and the development of advanced neuroimaging techniques (including metabolic imaging, imaging of functional connectivity, and radiomics) have established a basis for precision medicine in stroke. Precision medicine can improve primary/secondary prevention, diagnosis, phenotyping, treatment, and prognosis.

Implementation of precision medicine into clinical practice is still far from being a reality, however, and healthcare disparities around the world may slow this down. Nevertheless, stroke patients already request personalised management. Multidisciplinary teams including clinicians, biostatisticians, and experts in omics, imaging techniques, computational science, digital health, and big data are needed. Multicentre collaborative efforts should be put in place through the establishment of consortia and adequate infrastructure for proper and standardised data collection.

In a down-to-earth conclusion of the session, Prof. Louis Caplan (Harvard Medical School, MA, USA) argued precision medicine and personalised medicine should be combined in daily practice [2]:

• Find out exactly what is wrong with each patient in as much detail as possible. (Here Prof. Caplan quoted Miguel de Cervantes, author of Don Quixote: “For when the cause of the complaint is unsure, ‘Twould be a miracle to find a cure.”)
• Get to know each patient and their circumstances: family situation, psychosocial and economic stress, thoughts, fears, biases, and wishes.
• Therapeutic decisions are made with, by, and for complex individuals.

1. Lorenzano S. Precision medicine in stroke – Current applications. FW08-1, EAN 2021 Virtual Congress, 19–22 June.
2. Caplan LR. Precision medicine or personalized medicine? FW08-3, EAN 2021 Virtual Congress, 19–22 June.

 

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Posted on 18 August 202118 August 2021