title: Autoimmune responses to the brain after stroke are associated with worse outcome.
abstract: OBJECTIVE
  Immune responses to brain antigens occur after stroke, and experimental studies show that the likelihood of developing a detrimental autoimmune response to these antigens is increased by systemic inflammation at the time of stroke. The aim of this study was to determine if patients who developed infection in the poststroke period would be similarly predisposed to develop autoimmune responses to central nervous system antigens.
  
  
  METHODS
  We enrolled 114 patients within 72 hours of ischemic stroke. Clinical and demographic data were obtained, and cellular immune responses to a panel of central nervous system antigens were assessed during the initial week and again at Day 90. Outcome was assessed using the modified Rankin Scale.
  
  
  RESULTS
  Patients who developed an infection, especially pneumonia, in the 15 days after stroke were more likely to evidence a Th1(+) response to myelin basic protein and glial fibrillary acidic protein (P=0.019 and P=0.039, respectively) at 90 days after stroke. Further, more robust Th1 responses to myelin basic protein at 90 days were associated with a decreased likelihood of good outcome, even after adjusting for baseline stroke severity and patient age (OR, 0.477; 95% CI, 0.244 to 0.935; P=0.031).
  
  
  CONCLUSIONS
  This study demonstrates that immune responses to brain antigens occur after stroke. Although these responses are likely to be an epiphenomenon of ischemic brain injury, the response to myelin basic protein appears to have clinical consequences. The potential role of postischemic autoimmune-mediated brain injury deserves further investigation.
authors.affiliation: Department of Neurology, University of Washington School of Medicine, Box 359775, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104-2499, USA. kjb@u.washington.edu
authors.forename: Kyra J
authors.initials: KJ
authors.lastname: Becker
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Kalil
authors.forename: Pat
authors.initials: P
authors.lastname: Tanzi
authors.forename: Dannielle K
authors.initials: DK
authors.lastname: Zierath
authors.forename: Anna V
authors.initials: AV
authors.lastname: Savos
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gee
authors.forename: Jessica
authors.initials: J
authors.lastname: Hadwin
authors.forename: Kelly T
authors.initials: KT
authors.lastname: Carter
authors.forename: Dean
authors.initials: D
authors.lastname: Shibata
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Cain
mesh_terms: D000328:Adult; D000368:Aged; D015551:Autoimmunity / Q000276:immunology*; D001921:Brain / Q000276:immunology*; D002545:Brain Ischemia / Q000175:diagnosis / Q000276:immunology*; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000276:immunology*