437different types of headaches. Most headache medications have more than one
component, e.g. combination of acetylsalicylic acid, acetaminophen and caffeine.
The major advantage of using such a fi xed combination is that the active ingredients
act on different but distinct molecular targets and thus are able to act on more sig-
naling cascades involved in pain than most single analgesics without adding more
side effects to the therapy. Multitarget therapeutics like combined analgesics
broaden the array of therapeutic options, enable the completeness of the therapeutic
effect, and enable personalization of treatment to the patient’s specifi c needs.
There is substantial clinical evidence that such a multi-component therapy is more
effective than mono-component therapies (Straube et al. 2011 ).
Personalized Management of Stroke
Stroke accounts for four and a half million deaths each year with an estimated 9
million stroke survivors annually. The overall incidence rate of stroke is 2–2.5 per
thousand adults with prevalence of ~5 per thousand and an estimated 5-year risk of
stroke recurrence of 15–40 %. Conventional risk factors for stroke include: increas-
ing age, hypertension, diabetes mellitus, smoking, increased body mass index, isch-
emic heart disease, heart failure, atrial fi brillation and lack of physical activity. Age
is the strongest risk factor for both ischemic and hemorrhagic stroke with its inci-
dence doubling for each successive decade after the age of 55 years. However, there
is a substantial portion of patients with signifi cant cerebrovascular disease who do
not have any of these stroke risk-factors, and it may be helpful to identify complex
genetic determinants such as multiple genes that play a role. There is no cure for
stroke but principle drugs used currently are antithrombotics and their effi cacy and
safely can be improved by using pharmacogenetics and pharmacogenomics (Billeci
et al. 2009 ). Personalization of stroke management should start at the stage of clini-
cal trials of various therapies. Stroke treatments may be neuroprotective in the acute
stage and neuroregenerative or neurorestorative in the subacute and chronic stages.
Various biomarkers and brain imaging can be used to guide clinical trials. Several
factors are taken into consideration for personalizing treatment of stroke.
Application of Proteomics for Personalizing Stroke Management
A pharmacoproteomic approach has been proposed for coping with major chal-
lenges in translation of stroke research to stratify risk, widen therapeutic windows,
and explore novel drug targets. Examples of challenges include thrombolytic treat-
ment for ischemic stroke and treatment for paradoxical embolic stroke related to
patent foramen ovale (Ning et al. 2013 ). In the future, such an approach may help to
improve patient selection, ensure more precise clinical phenotyping for clinical tri-
als, and individualize patient treatment.
Personalized Management of Stroke