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  • Review Article
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The immunology of acute stroke

Nature Reviews Neurology volume 8, pages 401–410 (2012)Cite this article

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Abstract

Recent clinical and experimental studies have highlighted a complex role for the immune system in the pathophysiological changes that occur after acute stroke. Sensors of the innate immune system such as Toll-like receptors, or effectors such as the lectin pathway of complement activation and innate immune cells, are activated by brain ischaemia and tissue damage, leading to amplification of the inflammatory cascade. Activation of the adaptive arm of the immune system, mediated by lymphocyte populations including T and B cells, regulatory T cells, and γδT cells, in response to stroke can lead to deleterious antigen-specific autoreactive responses but can also have cytoprotective effects. Increased incidence of infections is observed after acute stroke, and might result from activation of long-distance feedback loops between the CNS and peripheral immune organs, which are thought to play a part in stroke-induced immunodepression. Ongoing clinical trials are investigating whether the preventive use of antibiotics improves functional outcome after stroke. This Review discusses the multifaceted role of the immune system in the pathophysiology of acute stroke.

Key Points

  • Acute stroke is followed by a complex interaction between the brain and the immune system

  • Damage-associated molecular patterns are released after neuronal damage, and activate the innate and adaptive arms of the immune system

  • Different populations of lymphocytes can exert beneficial or detrimental functions after acute stroke, although the underlying mechanisms are not fully elucidated

  • Stroke can lead to immunodepression, increasing the risk of infections such as pneumonia

  • Ongoing studies are addressing the prophylactic use of antibiotics after stroke

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Figure 1: Innate and adaptive immune responses after acute stroke.
Figure 2: The anti-inflammatory reflex and poststroke infection.

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Acknowledgements

This Review is dedicated to the memory of Dr Jesús Chamorro (1922–2012), who died during the preparation of the manuscript. This work was supported in part by a grant awarded to Ángel Chamorro from the Melchor Collet Foundation.

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Authors and Affiliations

  1. Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, 170 Villarroel, Barcelona, 08036, Spain

    Ángel Chamorro & Xabier Urra

  2. NeuroCure Clinical Research Center, Charité-University Medicine, Charitéplatz 1, Berlin, 10117, Germany

    Andreas Meisel

  3. Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Institut d'Investigacions Biomediques August Pi i Sunyer, Rossello 161, Barcelona, 08036, Spain

    Anna M. Planas

  4. Department of Neurology, Centre of Infection and Immunity Amsterdam, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105, AZ, The Netherlands

    Diederik van de Beek

  5. Department of Neurology, University of Heidelberg, INF 400, Heidelberg, 69120, Germany

    Roland Veltkamp

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  1. Ángel Chamorro
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  2. Andreas Meisel
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  3. Anna M. Planas
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  4. Xabier Urra
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All authors contributed to researching data for the article, discussion of the content, writing the article, and to review and/or editing of the manuscript before submission.

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Correspondence to Ángel Chamorro.

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Chamorro, Á., Meisel, A., Planas, A. et al. The immunology of acute stroke. Nat Rev Neurol 8, 401–410 (2012). https://doi.org/10.1038/nrneurol.2012.98

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