Cystatin C (CysC), a cysteine protease inhibitor, has been widely proven to be a highly
sensitive biomarker to predict the kidney function. The similarity of the renal and cerebral small
vessels has awakened a surge of studies suggesting that CysC plays a key role in various cerebrovascular
disorders. This review focuses on four major mechanisms of CysC in a variety of cerebrovascular
diseases. (1) The property of the CysC Leu-68-Gln (L68Q) variant to aggregate and
the property of the wild type CysC protein to co-aggregate with Amyloid-β (Aβ); (2) The disruption
of equilibrium between CysC and related cysteine proteases; (3) The function of CysC as an
inflammatory inducing factor; (4) The ability of CysC to induce autophagy. The combination of
these CysC properties provides a well-supported novel biomarker for cerebrovascular diseases.
Keywords: CysC, cerebrovascular diseases, cerebral amyloid angiopathy (CAA), cerebral aneurysms (CAs), subarachnoid
hemorrhage (SAH), ischemic stroke, cerebral small vascular diseases (CSVDs), vascular dementia (VD).
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