Acute ischemic stroke and intracerebral hemorrhage are two distinct diseases in immunology

Acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) are both cerebrovascular accidents where clinical management remains predominantly symptomatic, with few immunologically-targeted approaches. This cross-sectional study compared AIS (n = 73), ICH (n = 28), and controls (n = 31) in terms of demographic, clinical, laboratory, and immunological parameters, including regulatory T cells (Tregs), effector regulatory T cells (eTregs), CD4⁺ T cells, and cytokines. ICH patients showed lower total cholesterol (TCHO), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C) than both controls and AIS patients, whereas AIS patients had reduced high-density lipoprotein cholesterol (HDL-C) versus controls. Both stroke groups exhibited higher proportions of Tregs and eTregs versus controls. Correlation analyses revealed divergent immune networks: in AIS, the percentages of Tregs and eTregs positively correlated with interleukin-10 (IL-10), interleukin-1β (IL-1β), and interleukin-2 receptor (IL-2R), whereas in ICH, these percentages negatively correlated with tumor necrosis factor-α (TNF-α). We conclude that AIS features 'compensatory immune regulation', while ICH is characterized by 'uncontrolled innate immune inflammation', indicating two distinct immunological diseases with implications for subtype-specific therapy.