In the UK, researchers are working on a rapid and saliva-based test that could help identify stroke patients who require urgent treatment to prevent irreversible brain damage.
The GHoST study aims to identify biomarkers in bodily fluids, such as blood, urine, or saliva, that could replace the current system of symptom checklists used by medical staff to assess suspected stroke cases and distinguish them from other conditions like seizures or migraines.
Once an ischemic stroke is confirmed, immediate treatment with thrombolytic drugs like alteplase (tPA) or a thrombectomy procedure is necessary to dissolve clots blocking blood vessels and restore blood flow to the brain. However, the window of opportunity to administer tPA is narrow—ideally within four and a half hours of stroke symptoms starting—according to UK guidance. Unfortunately, only about 12% of stroke patients meet the criteria for tPA treatment, and studies indicate that only an additional 10% of patients survive and live independently after receiving clot-busting therapy.
Currently, patients with suspected strokes are referred for a full assessment, usually at a hyper-acute stroke unit, and then transferred to a specialized neuroscience unit for treatment if necessary. This process can add around an hour to the diagnosis time.
The GHoST study seeks to discover biomarkers that enable rapid diagnosis, allowing patients to be directed straight to the most suitable treatment center. Paramedics will collect samples of saliva, blood, and urine from patients with suspected strokes within the first hour after symptoms appear, and further sampling will continue while patients receive standard clinical care at the hospital. Results from the study are expected in 2026.
Professor Antonio Belli, a neurosurgeon at the University of Birmingham’s Institute of Inflammation & Ageing, is leading the study, which is funded by the Stroke Association. The project also involves the West Midlands Ambulance Service and Midlands Air Ambulance Charity, University Hospitals Birmingham NHS Trust, and industry partner Marker Diagnostics.
“Our previous studies detected ultra-early biomarkers and cellular responses that had never been reported in human studies before and resulted in a non-invasive diagnostic test that could change the way concussion is managed. In conjunction with our industry partner Marker Diagnostics, we’re now looking to repeat this success with stroke.”
– Prof Belli, neurosurgeon at the University of Birmingham’s Institute of Inflammation & Ageing
Previous work by scientists in Prof Belli’s lab identified small non-coding RNA (sncRNA) biomarkers in saliva that rapidly change after a traumatic brain injury (TBI). These biomarkers were discovered during a three-year study called SCRUM, which investigated concussion in top-flight rugby players. GHoST will also attempt to identify biomarkers for hemorrhagic strokes caused by brain bleeding, accounting for around 20% of all cases, but inappropriate for clot-busting therapies.
In parallel, another UK project is taking a digital approach to stroke diagnosis, using artificial intelligence to interpret brain scan images after patients have been admitted.
