Update on Inflammatory Biomarkers and Treatments in Ischemic Stroke

Abstract

After an acute ischemic stroke (AIS), inflammatory processes are able to concomitantly induce both beneficial and detrimental effects. In this narrative review, we updated evidence on the inflammatory pathways and mediators that are investigated as promising therapeutic targets. We searched for papers on PubMed and MEDLINE up to August 2016. The terms searched alone or in combination were: ischemic stroke, inflammation, oxidative stress, ischemia reperfusion, innate immunity, adaptive immunity, autoimmunity. Inflammation in AIS is characterized by a storm of cytokines, chemokines, and Damage-Associated Molecular Patterns (DAMPs) released by several cells contributing to exacerbate the tissue injury both in the acute and reparative phases. Interestingly, many biomarkers have been studied, but none of these reflected the complexity of systemic immune response. Reperfusion therapies showed a good efficacy in the recovery after an AIS. New therapies appear promising both in pre-clinical and clinical studies, but still need more detailed studies to be translated in the ordinary clinical practice. In spite of clinical progresses, no beneficial long-term interventions targeting inflammation are currently available. Our knowledge about cells, biomarkers, and inflammatory markers is growing and is hoped to better evaluate the impact of new treatments, such as monoclonal antibodies and cell-based therapies.

Monocyte count at onset predicts poststroke outcomes during a 90-day follow-up

“…Other indirect effects of smoke derivatives were demonstrated to upregulate cytokines [16], matrix metalloproteinases [38] and adhesion molecules [39] which favour leucocyte-mediated inflammation [40]. neuron-specific enolase, matrix metalloproteinase 9 and malondialdehyde) [46], blood monocyte count is a routine and cheap test that is universally available. monocytes and neutrophils) as well as adhesion molecules when compared to nonsmokers.…”

“…Contrarily to other known inflammatory-related biomarker potentially predicting AIS outcome (e.g. neuron-specific enolase, matrix metalloproteinase 9 and malondialdehyde) [46], blood monocyte count is a routine and cheap test that is universally available. Thanks to these features, circulating monocytes might guide the physicians' therapeutic choices even at the emergency department.…”

Evaluation of lipoprotein‐associated phospholipase A2, serum amyloid A, and fibrinogen as diagnostic biomarkers for patients with acute cerebral infarction

“…Atherosclerotic plaques will gradually develop into vascular stenosis and even completely block the cerebral blood flow, leading to an ischemic stroke . Recent researches have confirmed that inflammatory response and various inflammatory factors play an important role in the development of ACI and it has become a research hot spot …”

“…5,6 Recent researches have confirmed that inflammatory response and various inflammatory factors play an important role in the development of ACI and it has become a research hot spot. 7,8 Lipoprotein-associated phospholipase A2 (Lp-PLA2), also known as platelet-activating factor acetylhydrolase, is mainly released from atherosclerotic plaque by macrophages and neutrophils. 9 Multiple studies confirm that Lp-PLA2 plays an important role in the process of atherosclerosis and participates in the development of plaque.…”

CCL23 is a promising biomarker of injury in patients with ischaemic stroke

“…Little is known about chemokines, small inflammatory molecules classically described to attract circulating inflammatory cells at inflammatory sites . To date, main chemokines for which a pathophysiological role is supposed in IS are as follows: C‐X‐C motif chemokine (CXCL)12, CX3CL1 and C‐C motif chemokine ligand (CCL)2 .…”