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We aimed to characterize peripheral blood gene expression profile of penumbra defined as  MRI  perfusion–diffusion mismatch (PD MM) in peripheral blood of patients with acute ischemic stroke. We studied 23 patients. Perfusion–diffusion mismatch volume was observed to be associated and significantly correlated with the expression of 34 genes including those related to inflammation,  SUMO ylation, and coagulation; while lipopolysaccharide inhibition was identified to be a candidate upstream regulator of these processes ( z ‐score −2.38,  P  = 0.04). Penumbral volume is correlated with a specific gene expression profile in the peripheral blood characterized by overlap of inflammatory and neuroprotective pathways that are regulated by lipopolysaccharide inhibition.

Molecular signature of penumbra in acute ischemic stroke: a pilot transcriptomics study