Final published version
Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
}
TY - JOUR
T1 - Interleukin-1 receptor antagonist reverses stroke-associated peripheral immune suppression
AU - Smith, Craig J.
AU - Emsley, Hedley C.
AU - Udeh, Chinedu T.
AU - Vail, Andy
AU - Hoadley, Margaret E.
AU - Rothwell, Nancy J.
AU - Tyrrell, Pippa J.
AU - Hopkins, Stephen J.
PY - 2012/6
Y1 - 2012/6
N2 - Introduction: Infections are common following stroke and adversely affect outcome. Cellular immune suppression associated with acute stroke may increase susceptibility to infection. Cytokines are important contributors to both stroke pathology and the response to infection. Since interleukin (IL)-1 blockade is a candidate treatment for cerebral ischemia, we examined whether administration of interleukin-1 receptor antagonist (IL-1Ra) to patients with acute stroke affected innate cellular immune responses in a phase II placebo-controlled trial. Methods: Venous blood samples were taken prior to treatment initiation, at 24. h and 5 to 7d. Blood was also drawn from stroke-free controls. Lipopolysaccharide (LPS) stimulation of whole-blood cultures assessed the potential of leukocytes to produce cytokines. Results: Induction of tumor necrosis factor (TNF)-α, IL-1β, IL-6, IL-8 and IL-10 by LPS was significantly reduced in patients at admission, compared to controls. At 24. h, cytokine induction remained suppressed in the placebo group. In contrast, for patients treated with IL-1Ra, induction of TNF-α, IL-6 and IL-10 was similar to controls and IL-1β induction was significantly greater than in the placebo group. At 5 to 7d, TNF-α and IL-1β induction remained suppressed only in the placebo group (p<0.05). Plasma cortisol concentrations, elevated at admission in patients compared to controls, were substantially reduced at 24. h in the patients receiving IL-1Ra (p<0.05) and inversely correlated (p<0.001) with either TNF-α (r=. -0.71) or IL-1β induction (r=. -0.67) at admission. Conclusion: Treatment with IL-1Ra reverses peripheral innate immune suppression in the acute phase of stroke, which is associated with attenuated cortisol production. The mechanisms underlying these observations, including the potential impact of IL-1Ra on stroke severity and the clinical significance of immune suppression, require further evaluation in larger studies.
AB - Introduction: Infections are common following stroke and adversely affect outcome. Cellular immune suppression associated with acute stroke may increase susceptibility to infection. Cytokines are important contributors to both stroke pathology and the response to infection. Since interleukin (IL)-1 blockade is a candidate treatment for cerebral ischemia, we examined whether administration of interleukin-1 receptor antagonist (IL-1Ra) to patients with acute stroke affected innate cellular immune responses in a phase II placebo-controlled trial. Methods: Venous blood samples were taken prior to treatment initiation, at 24. h and 5 to 7d. Blood was also drawn from stroke-free controls. Lipopolysaccharide (LPS) stimulation of whole-blood cultures assessed the potential of leukocytes to produce cytokines. Results: Induction of tumor necrosis factor (TNF)-α, IL-1β, IL-6, IL-8 and IL-10 by LPS was significantly reduced in patients at admission, compared to controls. At 24. h, cytokine induction remained suppressed in the placebo group. In contrast, for patients treated with IL-1Ra, induction of TNF-α, IL-6 and IL-10 was similar to controls and IL-1β induction was significantly greater than in the placebo group. At 5 to 7d, TNF-α and IL-1β induction remained suppressed only in the placebo group (p<0.05). Plasma cortisol concentrations, elevated at admission in patients compared to controls, were substantially reduced at 24. h in the patients receiving IL-1Ra (p<0.05) and inversely correlated (p<0.001) with either TNF-α (r=. -0.71) or IL-1β induction (r=. -0.67) at admission. Conclusion: Treatment with IL-1Ra reverses peripheral innate immune suppression in the acute phase of stroke, which is associated with attenuated cortisol production. The mechanisms underlying these observations, including the potential impact of IL-1Ra on stroke severity and the clinical significance of immune suppression, require further evaluation in larger studies.
KW - Acute stroke
KW - Immune suppression
KW - Infection
KW - Inflammation
KW - Interleukin-1 receptor antagonist
U2 - 10.1016/j.cyto.2012.02.016
DO - 10.1016/j.cyto.2012.02.016
M3 - Journal article
C2 - 22445501
AN - SCOPUS:84862806229
VL - 58
SP - 384
EP - 389
JO - Cytokine
JF - Cytokine
SN - 1043-4666
IS - 3
ER -