Changes in the cellular immune system and circulating inflammatory markers of stroke patients

// Chao Jiang 1,2,* , Weixia Kong 3,* , Yuejuan Wang 1 , Wendy Ziai 2,4 , Qingwu Yang 5 , Fangfang Zuo 1 , Fangfang Li 1 , Yali Wang 1 , Hongwei Xu 6 , Qian Li 2 , Jie Yang 2 , Hong Lu 7 , Jiewen Zhang 8 and Jian Wang 1,2 1 Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China 2 Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA 3 Department of Ultrasonography, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China 4 Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA 5 Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China 6 Department of Radiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China 7 Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China 8 Department of Neurology, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China * These authors have contributed equally to this work Correspondence to: Chao Jiang, email: // Jian Wang, email: // Keywords : ischemic stroke, lymphocyte subpopulations, circulating inflammatory markers, infection, immunosuppression Received : June 07, 2016 Accepted : September 16, 2016 Published : September 22, 2016 Abstract This study was designed to investigate dynamic changes in the cellular immune system and circulating inflammatory markers after ischemic stroke. Blood was collected from 96 patients and 99 age-matched control subjects for detection of lymphocyte subpopulations and inflammatory markers. We observed decreases in B cells, Th cells, cytotoxic T cells, and NK cells and an increase in regulatory T (Treg) cells in stroke patients on days 1, 3, and 7. Serum levels of TNF-α, C-reactive protein (CRP), IL-4, IL-6, IL-10, IL-17, IL-23, and TGF-β increased, whereas serum level of IFN-γ decreased at all time points after stroke. Stroke patients with infection exhibited a similar tendency toward changes in some lymphocyte subpopulations and inflammatory markers as stroke patients without infection. After controlling for NIH Stroke Scale (NIHSS), we observed no differences in lymphocyte subpopulations between patients with anterior circulation stroke and those with posterior circulation stroke at any time point. The splenic volume correlated positively with the percentages of B cells, Th cells, and cytotoxic T cells, but negatively with Treg cells on day 3 after stroke. Infections were associated with splenic volume, leukocyte counts, percentage of Treg cells, and serum levels of CRP, IL-10, and IFN-γ on day 3. Lesion volume correlated positively with CRP, IL-6, and IL-23, but negatively with IFN-γ on day 3. The NIHSS showed a positive relation with IL-6 and IL-10 on day 3. Ischemic stroke has a profound effect on the systemic immune system that might explain the increased susceptibility of stroke patients to infection.