Monocyte subsets, T cell activation profiles, and stroke in men and women: The Multi-Ethnic Study of Atherosclerosis and Cardiovascular Health Study. (June 2022)

• Record Type: Journal Article
• Authors: Feinstein, Matthew J.; Buzkova, Petra; Olson, Nels C.; Doyle, Margaret F.; Sitlani, Colleen M.; Fohner, Alison E.; Huber, Sally A.; Floyd, James; Sinha, Arjun; Thorp, Edward B.; Landay, Alan; Freiberg, Matthew S.; Longstreth, William T.; Tracy, Russell P.; Psaty, Bruce M.; Delaney, Joseph AC.
• Is Part Of: Atherosclerosis. Volume 351(2022)
• Page Start: 18
• Page End: 25
• Publication Date: 2022-06
• Subjects: Inflammation -- Immune cells -- Stroke -- Epidemiology -- Biomarkers; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2022.05.007
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: Despite mechanistic data implicating unresolving inflammation in stroke pathogenesis, data regarding circulating immune cell phenotypes – key determinants of inflammation propagation versus resolution – and incident stroke are lacking. Therefore, we aimed to comprehensively define associations of circulating immune phenotypes and activation profiles with incident stroke. Methods: We investigated circulating leukocyte phenotypes and activation profiles with incident adjudicated stroke in 2104 diverse adults from the Multi-Ethnic Study of Atherosclerosis (MESA) followed over a median of 16.6 years. Cryopreserved cells from the MESA baseline examination were thawed and myeloid and lymphoid lineage cell subsets were measured using polychromatic flow cytometry and intracellular cytokine activation staining. We analyzed multivariable-adjusted associations of cell phenotypes, as a proportion of parent cell subsets, with incident stroke (overall) and ischemic stroke using Cox regression models. Results: We observed associations of intermediate monocytes, early-activated CD4 + T cells, and both CD4 + and CD8 + T cells producing interleukin-4 after cytokine stimulation (Th2 and Tc2, respectively) with higher risk for incident stroke; effect sizes ranged from 35% to 62% relative increases in risk for stroke. Meanwhile, differentiated and memory T cell phenotypes were associated with lower risk for incident stroke. In sex-stratified analyses, positive and negative associations were especially strong among men but null among women. Conclusions: Circulating IL-4 producing T cells and intermediate monocytes were significantly associated with incident stroke over nearly two decades of follow-up. These associations were stronger among men and not among women. Further translational studies are warranted to define more precise targets for prognosis and intervention. Graphical abstract: Image 1 Highlights: Human data link persistent inflammation with stroke, but lack insights into immune cell subsets underlying this relationship. We investigated circulating leukocyte phenotypes and activation profiles with incident stroke over 18.5 years. Intermediate monocytes and interleukin-4-producing T cells were associated with higher risk for incident stroke. Associations were especially strong among men but null among women. These findings have implications for future investigation of cellular triggers of inflammation and stroke.