Ischemic Stroke: From Next Generation Sequencing and GWAS to Community Genomics? Michael Black, 1,3 Wenzhi Wang, 2,4 and Wei Wang 1,4 Abstract Stroke is a major cause of mortality and morbidity in both the developed and developing world. Next generation sequencing (NGS) and multi-omics integrative biology research offer new opportunities in the way we research and understand stroke. These biotechnologies also signal a shift from genetics to genomics of stroke, which is highlighted in this review. Stroke is a focal neurological deficit resulting from disruption of the cerebral blood supply. There are two main types of common stroke, ischemic stroke (IS), which comprises 80% of cases, and hemorrhagic stroke (HS) that accounts for about 20% of cases. IS is a complex multi-factorial disease with multiple environmental and genomic determinants. We discuss here IS from genomics and bioinformatics perspectives, including the highlights of the genome wide association studies (GWAS), NGS progress to date, and exome studies. While both ‘common variant, common disease’ and ‘rare variant, common disease’ ap- proaches need to be assessed in tandem, future studies into IS omics should also consider pedigree and/or community based sampling to take account of the complex diversity of IS genetics. We conclude by presenting an example of such community genomics research from China in an extended pedigree sample, and the ways in which the intersection of genomics and global society can usefully inform our understanding of IS patho- physiology and potential preventive medicine interventions in the future. Stroke and Public Health A ccording to the Global Burden of Diseases, In- juries, and Risk Factors Study 2010, deaths from non- communicable diseases rose by nearly 8 million between 1990 and 2010, and accounted for two of every three deaths (34.5 million) worldwide by 2010. Heart disease and stroke were collectively responsible for the deaths of 12. 9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990 (Lozano et al., 2012). Selected national statistics further highlight the growing problem that stroke is becoming for public health. In the USA, The National Center for Chronic Disease Prevention and Health Promotion reported that every year stroke is the cause of death of 130,000 Americans with 610,00 Americans suffering a new stroke (The National Center for Chronic Disease Prevention and Health Promotion, 2013). In the UK, The Stroke Association reports that there are approximately 152,000 strokes in the UK every year, or about one every 5 minutes, with 1.1 million stroke survivors living in the UK (Stroke Association, 2013). In Australia, a Deloitte Access Economics report on the economic impact of stroke on Australia reported that more than 1000 Australians sustain a stroke every week, of whom 40% die within 12 months (Deloitte Access Economics, 2013) (Table 1). Multi-omics data-intensive life sciences offer new vistas for neurological and mental health disorders (Goldenberg et al., 2014; Longuespee et al., 2014; Podder and Latha, 2014). Among these, stroke has been considered a disease caused by lifestyle and dietary behaviors such as increased energy intake, fat intake, and alcohol consumption, and de- creased physical activity and cigarette smoking. Constitutive factors such as genomics have recently gained increasing conceptual importance. One striking example of this is highlighted in a World Health Organization (WHO)-funded project called ‘In- cidence and trends of stroke and its subtypes in China’ ( Jiang et al., 2006). In these studies researchers collected medical diagnoses, genetic information, and blood samples from 3015 ischemic stroke patients in Beijing, Shanghai, and Changsha, 1 School of Medical Sciences, Edith Cowan University, Perth, Australia. 2 Beijing Neurosurgical Institute, and 4 Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China. 3 Centre for Comparative Genomics, Murdoch University, Perth, Australia. OMICS A Journal of Integrative Biology Volume 19, Number 8, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/omi.2015.0083 451