Discovery Proteomics Using Data Independent Acquisition-based Mass Spectrometry Nominate Biomarkers of Stroke Diagnosis
Shubham Misra1, Wooyoung Eric Jang1, Sebastian Sanchez Herrera1, Victor Torres-Lopez1, Pinar Caglayan1, Guido Falcone1, Lauren Sansing1, Srikant Rangaraju1
1Yale University
Objective:
We undertook an exploratory proteomics study to discover plasma biomarkers for stroke diagnosis.
Background:
Rapid stroke diagnosis is critical for timely, subtype-specific treatment.
Design/Methods:

We analyzed clinical and proteomics data from stroke patients aged ≥18 years enrolled in a prospective acute brain injury study (2014–2023, Yale University).  Our outcome was differential protein expression among patients with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), transient ischemic attack (TIA), and stroke mimics (MIM). Samples were collected within 24 hours of stroke onset before treatment. Plasma was depleted using High-Select Top 14 Protein Depletion Resin. We performed data-independent acquisition-based mass spectrometry (DIA-MS) proteomics on an Orbitrap Exploris 480. DIA-MS data were quantified using DIA-NN, log2 transformed, batch corrected using Combat function (sva package in R), imputed for ≤30% missing values using Perseus, and normalized by total area sum. To identify top group discriminators, we performed feature selection by sparse partial least squares discriminant analysis (sPLS-DA) using mixOmics R package. Regularized LASSO regression identified classifiers for each stroke subtype, and model performance was assessed by 10-fold cross-validation using receiver operating characteristic curves. Pathway analysis was conducted using clusterProfiler package.

Results:
We included 80 patients (mean age 67.9 years, 56.3% male): 20 AIS, 20 ICH, 20 TIA, and 20 MIM. DIA-MS quantified 19771 protein peptides, of which 7153 were analyzed after imputation. sPLS-DA nominated 72 protein peptides across 3 components that classified four stroke subtypes. LASSO regression yielded panels of 4 peptides for AIS (cvAUC: 0.91; 95%CI 0.83-0.99), 9 for ICH (cvAUC: 0.93; 0.84-1.00), 10 for TIA (cvAUC: 0.77; 0.63-0.91), and 8 for MIM (cvAUC: 0.87; 0.79-0.96). These proteins were primarily associated with complement activation and immune response.
Conclusions:
Our exploratory study highlights plasma proteomics as a valuable tool for discovering protein biomarkers of stroke diagnosis. Further research is warranted to validate these findings in larger, multi-center cohorts.
10.1212/WNL.0000000000215639
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