Consider the significance of a biomarker that could help prognosticate and be a target for intervention.  If we could measure levels of a protein after an acute stroke, and depending on the prognosis it portends, harness the tools of molecular biology to change its level to achieve good outcomes – that would be revolutionary. Angiopoietins are proteins with important roles in vascular development and angiogenesis. Animal models have suggested that Angpt1 protects against cerebral ischemia. In this article, Golledge and colleagues study the association of Angpt1 with stroke occurrence and outcome in humans.

To assess the association of Angpt1 concentration with ischemic stroke, plasma Angpt1 was measured in 336 patients who had experienced a recent stroke and 321 healthy controls without previous stroke. Median plasma Angpt1 was found to be 3-fold lower in patients with a recent stroke. To study Angpt1 association with outcome, 285 stroke patients were reassessed at 3 months and they found that plasma Angpt1 on admission was lower in patients who had severe disability or died at 3 months, compared to those with minor disability. The above results could mean that patients with lower circulating Angpt1 are at greater risk of incident stroke. To assess this, 4032 community acquired older men from a separate cohort, followed prospectively for 6 years were examined and plasma Angpt1 was not predictive of stroke incidence.

The study, of course, needs to be examined in larger cohorts, but it suggests that Angpt1 is down-regulated after ischemic stroke and that the degree of down-regulation is associated with overall stroke outcome. Consequently, will interventions to up-regulate Angpt1 improve stroke outcome?  Regeneration and repair is the next frontier in stroke, and post-stroke angiogenesis can indeed promote regeneration. Despite the abundance of basic science research, we still have few effective therapies in stroke. Lets hope that interventional targets such as Angpt1 will overcome translational roadblocks and make it from bench to bedside.