Stroke is a major cause of morbidity and mortality worldwide. Despite the intensive search for new therapies, hundreds of agents targeting various pathophysiological mechanisms have failed clinical trials, and the thrombolytic agent tissue plasminogen activator is currently the only FDA-approved medication for the treatment of acute ischemic stroke. The immune system is involved in all stages of stroke, from the pathogenesis of risk factors to neurotoxicity, to tissue remodeling and repair. There is a bidirectional interaction between the brain and the immune system, with stroke-induced immunosuppression and subsequent infection a principal source of patient mortality. Newer work also points to a role for the gut microbiota in the immune response to stroke, while clinical sequelae such as dementia might now also be explained in immune terms. However, the exact roles of innate and adaptive components have not been fully elucidated, with studies reporting both detrimental and beneficial functions. Time is a key determinant in defining whether immunity and inflammation are neuroprotective or neurotoxic. The local inflammatory milieu also has a clear influence on many proposed treatments. This review examines the individual components of the immune response to stroke, highlighting the most promising future stroke immunotherapies.

中文翻译：

---

免疫系统和中风：从目前的目标到未来的治疗。

中风是全世界发病率和死亡率的主要原因。尽管正在寻找新的疗法，但针对各种病理生理机制的数百种药物仍未通过临床试验，并且溶栓剂组织纤溶酶原激活剂目前是唯一获得FDA批准的用于治疗急性缺血性中风的药物。免疫系统涉及中风的所有阶段，从危险因素的发病机理到神经毒性，再到组织重塑和修复。大脑与免疫系统之间存在双向相互作用，中风诱发的免疫抑制和随后的感染是患者死亡的主要来源。较新的工作也指出了肠道菌群在中风免疫反应中的作用，而诸如痴呆之类的临床后遗症现在也可以用免疫学来解释。然而，尚未充分阐明先天和适应性成分的确切作用，研究报告了有害和有益的功能。时间是决定免疫力和炎症是神经保护还是神经毒性的关键决定因素。局部炎症环境对许多建议的治疗方法也有明显的影响。这项审查审查了对中风的免疫反应的各个组成部分，突出了最有前途的未来中风免疫疗法。