Relevance of novel inflammatory markers in stroke-induced immunosuppression

Abstract

BackgroundAcute ischemic stroke (AIS) has a biphasic effect on the peripheral immune system. The initial inflammatory response is followed by systemic immunosuppression, referred to as stroke-induced immunosuppression (SIIS), leading to severe complications in stroke patients. We aimed to identify an inflammatory marker that best represents this biphasic immunological response after AIS.MethodsWe investigated the alteration of CRP, WBC, neutrophil count, suPAR levels, CD4+ CD25high Tregs, CD64+ and CD177+ neutrophils and monocytes in 12 acute ischemic stroke patients free of infection within 6 hours and one week after the insult. As controls, 14 age-matched healthy individuals were included.ResultsCRP, WBC and neutrophil count values were comparable in stroke patients within 6 hours and controls, however, they were elevated in stroke one week after the insult. suPAR levels were higher in both stroke groups compared to controls. The prevalence of CD64+ neutrophils was higher in stroke patients within 6 hours than in controls and it decreased in stroke one week after the insult below the level in controls (5.95 [5.41-8.75] % vs. 32.38 [9.21-43.93] % vs. 4.06 [1.73-6.77] %, p < 0.05).ConclusionsOur pilot study identified that the prevalence of CD64+ neutrophils may reflect a biphasic alteration of the immune response following AIS. Since its level decreases below baseline after one week of the CNS insult in stroke patients without infection, it might serve as a reliable candidate to identify the developing inflammatory response due to infection after stroke in the future.

Traumatic Brain Injury and Peripheral Immune Suppression: Primer and Prospectus

“…These include: (1) reduced monocytic HLA-DR expression and low CD4 + T-cell counts ( 153 , 154 ), (2) reduced ex vivo TNF-α release by monocytes ( 155 ), and (3) elevated plasma IL-10 levels ( 156 ). In addition, it has recently been postulated that a rise in the frequency of circulating CD64 + neutrophils 1 week after stroke may serve as a marker by which to identify an inflammatory response developing as a consequence of infection ( 157 ). In the context of TBI-induced immune suppression, no study to our knowledge has examined whether alterations in neutrophil surface phenotype can predict the development of infection, a reflection of the paucity of data in this area of research.…”

Risk factors for intracranial infection after craniotomy: A case–control study

“…White blood cell count or neutrophil count is still indicators of infection and clinical judgment; however, their specificity might not be high (Folyovich et al., 2014; Westendorp, Nederkoorn, Vermeij, Dijkgraaf, & van de Beek, 2011). Surgical drainage and antibiotics are also the effective therapy to treat intracranial infection (Dashti et al., 2008; Kural et al., 2019).…”

Diagnostic and prognostic value of procalcitonin for early intracranial infection after craniotomy

“…However, their specificity might not be high. Studies have shown that blood leukocyte and neutrophil counts after acute stroke are similar in patients with and without infection ( 8 , 9 ).…”