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(Stroke. 2007;38:770.)
© 2007 American Heart Association, Inc.

Adaptive Immunity: Introduction

Stroke-Induced Immunodepression

Experimental Evidence and Clinical Relevance

Ulrich Dirnagl, MD; Juliane Klehmet, MD; Johann S. Braun, MD; Hendrik Harms, MD; Christian Meisel, MD; Tjalf Ziemssen, MD; Konstantin Prass, MD Andreas Meisel, MD

From Department of Neurology (U.D., J.K., J.S.B., H.H., K.P., A.M.), Department of Experimental Neurology, Center for Stroke Research and Department of Medical Immunology (C.M.), Charité Universitätsmedizin, Berlin, Germany; Department of Neurology (T.Z.), University of Dresden, Germany.

Correspondence to Prof Dr Ulrich Dirnagl, Department of Experimental Neurology, Charite Universitätsmedizin Berlin, Charitéplatz 1, 10098 Berlin, Germany. E-mail ulrich.dirnagl{at}charite.de

Abstract

Stroke affects the normally well-balanced interplay of the 2 supersystems: the nervous and the immune system. Recent research elucidated some of the involved signals and mechanisms and, importantly, was able to demonstrate that brain-immune interactions are highly relevant for functional outcome after stroke. Immunodepression after stroke increases the susceptibility to infection, the most relevant complication in stroke patients. However, immunodepression after stroke may also have beneficial effects, for example, by suppressing autoaggressive responses during lesion-induced exposure of central nervous system-specific antigens to the immune system. Thus, before immunomodulatory therapy can be applied to stroke patients, we need to understand better the interaction of brain and immune system after focal cerebral ischemia. Until then, anticipating an important consequence of stroke-induced immunodepression, bacterial infection, preventive antibiotic strategies have been proposed. In mouse experiments, preventive antibiotic treatment dramatically improves mortality and outcome. Results of clinical studies on this issue are contradictory at present, and larger trials are needed to settle the question whether (and which) stroke patients should be preventively treated. Nevertheless, clinical evidence is emerging demonstrating that stroke-induced immunodepression in humans not only exists, but has very similar features to those characterized in rodent experiments.

Key Words: brain infarction • brain ischemia • experimental • focal ischemia • immunology • infectious disease • inflammation • treatment

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