Neuroanatomical correlates of stroke-associated infection and stroke-induced immunodepression

Urra, Xabier; Laredo, Carlos; Zhao, Yashu; Amaro, Sergio; Rudilosso, Salvatore; Renú, Arturo; Prats-Galino, Alberto; Planas, Anna M.; Oleaga, Laura; Chamorro, Ángel

doi:10.1016/j.bbi.2016.10.004

Cited by 48 publications

(41 citation statements)

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“…Besides the left superior longitudinal fasciculus, other left structures associated with poor functional outcomes even after considering the effect of total lesion volume were the insula, the rolandic operculum, and the superior temporal gyrus. The insula may be associated with poor outcomes through various mechanisms, including dysautonomia, cardiac complications or greater risk of stroke-associated infections, although the association of these complications with the left insula was not consistent in the past 13 , 44 , 55 . Lesions of the left superior temporal gyrus may cause disability due to its implication in speech comprehension and production 56 , 57 .…”

Section: Discussionmentioning

confidence: 99%

“…The cohort 1 (C1) included all patients with supratentorial ischemic strokes in the “Immunological Biomarkers in Patients with Acute Ischemic Stroke” study (Clinicaltrials.gov identifier NCT01894529) 44 . The cohort 2 (C2) included patients from the local revascularization database at Hospital Clínic that had a supratentorial lesion and a full imaging workup.…”

Section: Methodsmentioning

confidence: 99%

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Prognostic Significance of Infarct Size and Location: The Case of Insular Stroke

Laredo

Zhao

Rudilosso

et al. 2018

Sci Rep

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The prognostic relevance of strokes in different locations is debated. For example, insular strokes have been associated with increased mortality, but this association could reflect their greater severity. In two independent cohorts of patients with supratentorial ischemic stroke (n = 90 and 105), we studied the prognostic consequences of lesion size and location using voxel-based lesion-symptom mapping before and after volume control, which better accounts for total lesion volume. Strokes affecting the insula were larger than non-insular strokes (28 vs 2cc and 25 vs 3cc, p < 0.001 in both cohorts). A number of supratentorial areas (mainly in the left hemisphere), including the insula, were associated with poor functional outcome in both cohorts before (4014 voxels) and after volume control (1378 voxels), while the associations with death were greatly reduced after volume control (from 8716 to 325 voxels). Exploratory analyses suggested that the method of lesion volume quantification, the National Institutes of Health Stroke Scale hemispheric bias and patient selection can result in false associations between specific brain lesions and outcomes. In conclusion, death in the first months after stroke is mainly explained by large infarct volumes, whereas lesions of specific supratentorial structures, mostly in the left hemisphere, also contribute to poor functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prognostic Significance of Infarct Size and Location: The Case of Insular Stroke

Laredo

Zhao

Rudilosso

et al. 2018

Sci Rep

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“…Therefore, lower respiratory infection of DAS patients is correlated with guttural sensory disorder and weakened pharyngeal reflex 11 . Pulmonary infection is the most common complication of acute stroke, with the incidence rate of about 7%-21% 12 , and is one of the main reasons for deterioration of diseases and death of stroke patients. The aspiration pneumonia caused by post-stroke dysphagia is one of the main reasons for the death of stroke patients.…”

Section: Discussionmentioning

confidence: 99%

Study on the Correlation between Barium Radiography and Pulmonary Infection rate in the Evaluation of Swallowing Function

Sun

2018

Clinics

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OBJECTIVES:To compare the results respectively obtained from the utilization of 60% barium sulfate suspension and Iohexol as contrast agents for videofluoroscopic swallowing studies and the relationship between the clinical application of the two kinds of contrast agents and the incidence of pneumonia.METHODS:Sixty cases of stroke patients with dysphagia were selected in rehabilitation department of our hospital, and the gender, age, position of the disease, and stroke nature between groups had no significant difference. Among which, 30 patients who were administered 350 mgI/ml Iohexol, and the other 30 patients with 60% barium sulfate suspension as contrast agent. We performed videofluoroscopic swallowing studies with barium 60% versus Iohexol within 1 week after admission and 2 weeks after admission.RESULTS:After 2 weeks in hospital, the aspiration pneumonia incidence of two groups was statistically significant (p<0.05), the pneumonia incidence of Iohexol group was lower than barium sulfate group which might have a impossble relevance with barium aspiration.CONCLUSIONS:During the videofluoroscopic swallowing study of dysphagia after stroke, barium sulfate can enhance the pneumonia incidence, and Iohexol can be widely applied in videofluoroscopic swallowing study.

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“…Acute ischemic stroke is followed by profound immunoreactions, including an inflammatory response and subsequent immunodepression [ 1 , 2 ]. In addition, an immunodepressive reaction is called stroke-induced immunodeficiency syndrome (SIDS) and is reflected in monocyte dysfunction and lymphocytopenia [ 3 – 5 ]. As SIDS contributes to brain repair mechanisms and infection complications, the underlying inflammatory mechanisms are under intensive investigation [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

β-arrestin2 functions as a key regulator in the sympathetic-triggered immunodepression after stroke

Wang

Deng

Peng

et al. 2018

J Neuroinflammation

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BackgroundStroke-induced immunodeficiency syndrome (SIDS) is regarded as a protective mechanism for secondary inflammatory injury as well as a contributor to infection complications. Although stroke-induced hyperactivation of the sympathetic system is proved to facilitate SIDS, the involved endogenous factors and pathways are largely elusive. In this study, we aim to investigate the function of beta-arrestin-2 (ARRB2) in the sympathetic-mediated SIDS.MethodsSplenic ARRB2 expression and the sympathetic system activity were detected after establishing transient models of middle cerebral artery occlusion (MCAO). In addition, a correlation between ARRB2 expression and the sympathetic system activity was analyzed using a linear correlation analysis. Any SIDS reflected in monocyte dysfunction was investigated by measuring inflammatory cytokine secretion and neurological deficit scores and infarct volume were tested to assess neurological outcome. Further, ARRB2 expression in the monocytes was knocked down in vitro by siRNAs. Following the stimulation of noradrenaline and lipopolysaccharide, cytokine secretion and the nuclear factor-κB (NF-κB) pathway were evaluated to gain insight into the mechanisms related to the contribution of ARRB2 to adrenergic-induced monocyte dysfunction.ResultsSplenic ARRB2 expression was significantly increased after stroke and also showed a significant positive correlation with the sympathetic system activity. Stroke-induced monocyte dysfunction resulted in an increase of the interleukin-10 (IL-10) level as well as a decrease of the interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) levels. Also, blockade of adrenergic-activity significantly reversed these cytokine levels, and blockade of adrenergic-activity improved stroke-induced neurological results. However, the improved neurological results had no significant correlation with ARRB2 expression. Furthermore, the in vitro results showed that the deficiency of ARRB2 dramatically repealed adrenergic-induced monocyte dysfunction and the inhibition of NF-κB signaling phosphorylation activity.ConclusionsARRB2 is implicated in the sympathetic-triggered SIDS, in particular, monocyte dysfunction after stroke. Accordingly, ARRB2 may be a promising therapeutic target for the immunological management of stroke in a clinic.

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Neuroanatomical correlates of stroke-associated infection and stroke-induced immunodepression

Cited by 48 publications

References 48 publications

Prognostic Significance of Infarct Size and Location: The Case of Insular Stroke

Prognostic Significance of Infarct Size and Location: The Case of Insular Stroke

Study on the Correlation between Barium Radiography and Pulmonary Infection rate in the Evaluation of Swallowing Function

β-arrestin2 functions as a key regulator in the sympathetic-triggered immunodepression after stroke

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