Nature medicine - volume 17 issue 7, july 2011

THE IMMUNOLOGY OF STROKE: FROM MECHANISMS TO TRANSLATION Immunity and inflammation are key elements of the pathobiology of stroke, a devastating illness second only to cardiac ischemia as a

cause of death worldwide. The immune system participates in the brain damage produced by ischemia, and the damaged brain, in turn, exerts an immunosuppressive effect that promotes fatal

infections that threaten the survival of people after stroke. Inflammatory signaling is involved in all stages of the ischemic cascade, from the early damaging events triggered by arterial

occlusion to the late regenerative processes underlying post-ischemic tissue repair. Recent developments have revealed that stroke engages both innate and adaptive immunity. But adaptive

immunity triggered by newly exposed brain antigens does not have an impact on the acute phase of the damage. Nevertheless, modulation of adaptive immunity exerts a remarkable protective

effect on the ischemic brain and offers the prospect of new stroke therapies. As immunomodulation is not devoid of deleterious side effects, a better understanding of the reciprocal

interaction between the immune system and the ischemic brain is essential to harness the full therapeutic potential of the immunology of stroke. * Costantino Iadecola * Josef Anrather