Recent Advances in the Impact of Infection and Inflammation on Stroke Risk and Outcomes

Abstract

Purpose of the Review Inflammation is a key component in the pathogenesis of cerebrovascular diseases. In the past few years, the role of systemic infection and gut dysbiosis in modulating inflammation and stroke risk has been increasingly acknowledged. In this review, we synthesize contemporary literature on the effects of infection and inflammation on stroke risk and outcomes, with a focus on periodontal disease, COVID-19 infection, and gut dysbiosis. Recent Findings Chronic and acute infections such as periodontitis and COVID-19 induce systemic inflammation that cause atherogenesis and increase cardiac injury and arrhythmias. These infections also directly injure the endothelium leading to worsened secondary inflammation after stroke. Gut dysbiosis engenders a pro-inflammatory state by modulating intestinal lymphocyte populations that can traffic directly to the brain. Additionally, post-stroke immune dysregulation creates a compounding feedback loop of further infections and gut dysbiosis that worsen outcomes. Summary Recent advances in understanding the pathophysiology of how infection and dysbiosis affect the progression of stroke, as well as long-term recovery, have revealed tantalizing glimpses at potential therapeutic targets. We discuss the multidirectional relationship between stroke, infection, and gut dysbiosis, and identify areas for future research to further explore therapeutic opportunities. Supplementary Information The online version contains supplementary material available at 10.1007/s11910-022-01179-6.

The Role of Inflammation in Cardiovascular Disease

“…In turn, this promotes a vascular low-grade inflammatory response, leading to the progression of atherosclerosis [ 25 ]. Hence, inflammation is a common mechanism linking traditional and emerging CV risk factors to the development of atherosclerosis, leading to CAD, large artery thrombotic stroke, and cerebral aneurysms [ 1 , 26 , 27 , 28 , 29 ]. All phases of atherosclerosis, from retention of atherogenic lipoproteins within the arterial wall, to plaque development and rupture, involve a complex network, including innate and adaptive immune systems, bone marrow, and spleen, which modulate the pro-inflammatory and anti-inflammatory activities of protein mediators, such as cytokines, and immune cells such as leukocytes, macrophages, and lymphocytes [ 30 ].…”

“…This review summarizes the current knowledge about the role of inflammation and the immune system in the development of atherosclerosis, the progression to stable and vulnerable plaque, the relationship between the central nervous system and arterial inflammatory response, the role of ageing in promoting atherosclerosis beyond a prolonged exposure to the traditional risk factors, and new therapeutic opportunities targeting inflammation to reduce the CVD burden. Although most studies refer to CAD, the relationship between inflammation and atherosclerosis in coronary and cerebral arteries is based on the same mechanisms [ 1 , 27 , 42 ].…”

Acute Ischemic Stroke in Tubercular Meningitis Patients Without Conventional Vascular Risk Factors: A Retrospective Case Control Study

“…19 In addition to conventional vascular risk factors, such as hypertension, diabetes, long-term smoking and drinking and hyperlipidaemia, recent studies have found that inflammation is closely connected to cerebral infarction. [20][21][22] In clinical terms, tuberculosis is a common chronic inflammatory disease. Although tuberculosis meningitis comprises 1% of the incident cases of tuberculosis, it remains the most serious form of extrapulmonary tuberculosis.…”

Advances in the study of the effects of chronic periodontitis on cardiac arrhythmias

“…In addition, periodontal treatment can reduce serum total cholesterol, low-density lipoprotein, oxidized low-density lipoprotein, and other lipid levels. The role of these mechanisms in preventing the occurrence and progression of atrial fibrillation remains unclear [30][31][32] .…”