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REVIEW

Inflammation in ischemic stroke patients with type 2 diabetes – Part I: Atherosclerosis formation, acute ischemia, post-stroke infection, and long-term sequelae

Liqun Zhang1* ,  Ying Chen2,3 ,  Jingxian Xu2,3 ,  Christopher P. Corpe4 ,  Anan Shtaya5 ,  Philip Benjamin6 ,  Yun Xu2,3,7,8,9
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1 Department of Neurology, St George’s University Hospital, London, United Kingdom
2 Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
3 Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing, Jiangsu, China
4 Department of Nutritional Sciences, School of Life Courses and Population Sciences, King’s College London, London, United Kingdom
5 Head of Neuroscience at Arab Hospitals Group, Ramallah, Palestine
6 Department of Neuroradiology, St George’s University Hospital, London, United Kingdom
7 Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, Jiangsu, China
8 Jiangsu Provincial Key Discipline of Neurology, Nanjing, Jingasu, China
9 Nanjing Neurology Medical Center, Nanjing, Jinagsu, China
Advanced Neurology, 1683 https://doi.org/10.36922/an.1683
Submitted: 26 August 2023 | Accepted: 27 February 2024 | Published: 4 June 2024
(This article belongs to the Special Issue Advances in stroke research and therapy)
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Stroke is the leading cause of disability and the second leading cause of death worldwide. Diabetes mellitus is a critical independent cardiovascular risk factor in patients, irrespective of age, smoking, and hypertension. Approximately one-third of first-time ischemic stroke patients have diabetes. Inflammation is among the most important pathological mechanisms in atheroma formation, the damage cascades of the acute phase, as well as during the subacute and chronic phases after stroke. Diabetes, as a common risk factor for stroke, is often present for a long time before a stroke occurs, causing low-grade inflammation, and disrupting the proper functioning of the neurovascular units. These proinflammatory processes and maladaptive immune mechanisms are further accelerated after cerebral ischemia and worsen the stroke outcome in diabetic patients. Clinical treatments for ischemic stroke are currently focused on restoring cerebral blood flow (reperfusion) in the acute phase, including thrombolysis and mechanical thrombectomy, which are not applicable to patients that fall outside of the treatment window and/or without large-vessel occlusion. There are few approved treatments targeting cellular injury caused by inflammation. There are even fewer data on effective treatment for diabetic stroke targeting inflammation. This paper presents the first part of a review focusing on the temporospatial aspects of inflammation in ischemic stroke pathophysiology in stroke patients with type 2 diabetes.

Keywords
Stroke
Diabetes
Inflammation
Immune
Pathophysiology
Therapeutics
Funding
None.
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Conflict of interest
The authors declare that they have no conflicts of interest.
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