Inflammatory activation—particularly increased hsCRP and Cathepsin-S levels—was associated with reduced motor recovery and characterized individuals who subsequently had major adverse cardiovascular events during subacute stroke rehabilitation.
Increases in hsCRP during treatment were associated with less upper-extremity motor improvement from baseline to end-of-treatment.
Cathepsin-B, Cathepsin-S, and E-selectin were not significantly associated with FMA-UE motor improvement.
Four participants who later experienced major adverse cardiovascular events showed high levels of hsCRP and Cathepsin-S at baseline.
No significant associations were found between any biomarker and changes in cognition, depression, or quality of life.
The study was an exploratory substudy of the PRACTISE trial in which patients with subacute ischemic stroke received patient-tailored transcranial direct current stimulation (tDCS) or sham during four weeks of upper-extremity rehabilitation.
This research examined whether certain proteins measurable in the blood could help explain why some stroke patients recover better than others after rehabilitation. The study followed 24 patients with recent ischemic strokes who were undergoing upper-arm rehabilitation combined with either brain stimulation (tDCS) or a sham procedure. Blood samples were taken at the start, after four weeks of treatment, and at a 12-week follow-up to measure four biomarkers: two cathepsins (enzymes linked to inflammation and brain plasticity), E-selectin (a marker of blood vessel inflammation), and high-sensitivity C-reactive protein (hsCRP, a general marker of inflammation). The main finding was that patients whose hsCRP levels increased during the treatment period showed less improvement in arm and hand motor function compared to patients whose hsCRP did not rise. Additionally, four patients who later suffered serious heart or vascular events (such as heart attacks or strokes) had notably high levels of both hsCRP and Cathepsin-S at the very beginning of the study. The other biomarkers were not significantly linked to motor recovery, though there was a weak, non-significant trend suggesting E-selectin might relate to cognitive outcomes. This research suggests that measuring inflammation in the blood during stroke rehabilitation could provide useful information about both how well a patient is likely to recover and their future cardiovascular risk. Because the study was small and exploratory, the findings need to be confirmed in larger trials, but they point toward inflammatory biomarkers—particularly hsCRP and Cathepsin-S—as potentially valuable tools for personalizing stroke rehabilitation and identifying patients who may need closer cardiovascular monitoring.
Kolmos M, Sørensen N, Gandrup K, Larsson A, Dunø M, Kruuse C. (2026). Biomarkers of plasticity and recovery after stroke: Insights from the PRACTISE trial.. Clinical neurology and neurosurgery. https://doi.org/10.1016/j.clineuro.2026.109492