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Open Access Research article

Relevance of novel inflammatory markers in stroke-induced immunosuppression

András Folyovich1, Enikő Biró2, Csaba Orbán2, Anna Bajnok2, Viktória Varga1, Anna K Béres-Molnár1, Barna Vásárhelyi3 and Gergely Toldi2*

Author Affiliations

1 Department of Neurology, Szent János Hospital, Budapest, Diós árok 1–3 H-1125, Hungary

2 First Department of Pediatrics, Semmelweis University, Budapest, Bókay u. 53–54 H-1083, Hungary

3 Department of Laboratory Medicine, Semmelweis University, Budapest, Nagyvárad tér 4 H-1089, Hungary

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BMC Neurology 2014, 14:41  doi:10.1186/1471-2377-14-41

Published: 6 March 2014

Abstract

Background

Acute 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.

Methods

We 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.

Results

CRP, 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).

Conclusions

Our 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.

Keywords:
CD4+ lymphocyte; CD64+ neutrophil; CRP; Stroke; suPAR; Treg