Stroke-associated pneumonia (SAP) is the major cause of mortality in patients who have suffered from acute ischemic stroke. Multi-center clinical studies suggested that prophylactic antibiotic treatments do not reduce the incidence of mortality or SAP. Moreover, the emergence of antibiotic resistant bacteria renders the ?gold standard? antibiotic treatments ineffective. Therefore, novel therapeutic strategies are needed to improve clinical outcomes. Studies utilizing animal models of focal brain ischemia demonstrated that stroke-induced immune suppression is one of the causes of SAP. The overall goal of this proposal is to understand the cause of stroke-induced immune suppression and identify novel therapeutic targets for SAP. Innate immune cells including neutrophils, monocytes, macrophages, and dendritic cells (DCs) are the first line of lung immune defense, which is followed by subsequent recruitment and activation of the antigen-specific T and B cells. In phase one of the Stroke CoBRE, we used transient middle cerebral artery occlusion (tMCAO), a mouse model of focal brain ischemia, to analyze immune cell niches in the brain and the lungs, as well as determined the expression of inflammatory cytokines and chemokines in the lungs after ischemic stroke induction. Our preliminarily data demonstrate that 1) ischemic stroke increases the number of alveolar macrophages, CD11b+ DCs, and neutrophils in the lungs, but monocyte number remains unchanged despite an increased expression of monocyte chemoattractant CCL2; 2) monocyte number is significantly increased in the brain after ischemic stroke induction; 3) ischemic stroke decreases the number of T cells, B cells, and NK cells in the lungs, correlating with the reduction of chemokines CCL5 and CCL22. These observations suggest that ischemic stroke events alter the immune cell niches in the lungs and potentially impair their functions. Using tMCAO coupled with P. aeruginosa infection, we propose to further test our hypothesis that SAP is caused by the impairment of the lung-specific, anti-bacterial innate immunity. Our hypothesis will be tested in three aims.
In Aim 1, we will determine the phagocytic and bactericidal activities of innate immune cells in the lungs following tMCAO and P. aeruginosa infection.
In Aim 2, we will test our hypothesis that monocyte infiltration to the brain after ischemic stroke impedes their infiltrating to the lungs, and thereby contributes to SAP. We will test this hypothesis by adoptive transfer of purified monocytes from B6 CD45.2 mice to the B6 CD45.1 congenic strain recipient mice, followed by tMCAO and P. aeruginosa infection.
In Aim 3, we will investigate the protective role of CCL5 and CCL22 in SAP by determining if intratracheal administration of these chemokines restores lymphocyte availability and reduces severity of SAP. We are hopeful that this research will identify key immune cell types, molecular pathways, and downstream mediators that are critical for the host defense against lung infections following ischemic stroke, and ultimately improve clinical outcomes.
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