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Neuroimmune mechanisms and therapies mediating post-ischaemic brain injury and repair

Nature Reviews Neuroscience volume 24, pages 299–312 (2023)Cite this article

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Abstract

The nervous and immune systems control whole-body homeostasis and respond to various types of tissue injury, including stroke, in a coordinated manner. Cerebral ischaemia and subsequent neuronal cell death activate resident or infiltrating immune cells, which trigger neuroinflammation that affects functional prognosis after stroke. Inflammatory immune cells exacerbate ischaemic neuronal injury after the onset of brain ischaemia; however, some of the immune cells thereafter change their function to neural repair. The recovery processes after ischaemic brain injury require additional and close interactions between the nervous and immune systems through various mechanisms. Thus, the brain controls its own inflammation and repair processes after injury via the immune system, which provides a promising therapeutic opportunity for stroke recovery.

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Fig. 1: Timeline of events in neuro-immune interaction after ischaemic stroke.
Fig. 2: Time-dependent functional changes of immune cells in ischaemic stroke.
Fig. 3: Immune mechanisms in acute harmful inflammation.
Fig. 4: Long-term neuro-immune interactions for stroke recovery.
Fig. 5: New brain homeostasis after long-term neuro-immune interaction.

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Authors and Affiliations

  1. Stroke Renaissance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan

    Takashi Shichita

  2. Department of Neuroinflammation and Repair, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan

    Takashi Shichita

  3. Core Research for Evolutionary Medical Science and Technology (CREST), Japan Agency for Medical Research and Development (AMED), Tokyo, Japan

    Takashi Shichita

  4. Section of Internal Medicine, Department of Medicine, Fukuoka Dental College, Fukuoka, Japan

    Hiroaki Ooboshi

  5. Department of Microbiology and Immunology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan

    Akihiko Yoshimura

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All authors made substantial contributions to the discussion of content, writing, reviewing and editing of the manuscript before submission. In addition, T.S. and A.Y. researched data for the article.

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Glossary

Endovascular therapy

Recanalization therapy using microcatheters that remove a blood clot or deliver thrombolytic drugs.

Ischaemic core

The centre of the infarct region in which cerebral blood flow is most decreased.

Reperfusion therapy

Treatment to restore cerebral blood flow, including intravenous administration of tissue plasminogen activator and endovascular therapy.

Stenosis

Narrowing of a vascular lumen (for example, of the cerebral arteries) due to atherosclerosis or vasospasm.

Transcytosis

A vesicular transport system that transfers the molecules from one side of a cell to the other.

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Shichita, T., Ooboshi, H. & Yoshimura, A. Neuroimmune mechanisms and therapies mediating post-ischaemic brain injury and repair. Nat Rev Neurosci 24, 299–312 (2023). https://doi.org/10.1038/s41583-023-00690-0

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