The immune system and stroke: from current targets to future therapy

Area of Science:

• Neuroscience
• Immunology
• Pathophysiology

Background:

• Stroke remains a leading global cause of death and disability.
• Current treatments for acute ischemic stroke are limited, with tissue plasminogen activator being the only FDA-approved medication.
• The immune system plays a critical role throughout the stroke continuum, from initial injury to long-term repair.

Purpose of the Study:

• To review the multifaceted roles of the immune system in stroke pathogenesis and recovery.
• To explore the bidirectional communication between the brain and immune system following stroke.
• To identify promising avenues for future stroke immunotherapies.

Main Methods:

• This review synthesizes current research on the immune response to stroke.
• It examines the contributions of both innate and adaptive immunity.
• The influence of the gut microbiota and temporal dynamics of inflammation are considered.

Main Results:

• Stroke induces complex immune responses, with both neuroprotective and neurotoxic effects observed.
• Immune suppression post-stroke increases susceptibility to infection, a major cause of mortality.
• The gut microbiota influences the immune response to stroke, and immune mechanisms may underlie conditions like dementia.

Conclusions:

• The immune system is a critical, yet incompletely understood, factor in stroke outcomes.
• Timing and the local inflammatory environment significantly influence immune responses and treatment efficacy.
• Targeting immune pathways holds significant promise for developing novel stroke therapies.