Review: Systemic inflammation after stroke. Therapy and perspective

Abstract

Systemic inflammation following ischemic stroke is driven by a complex interplay among pro-inflammatory cytokines, immune cell activation, and neurovascular dysfunction. Both aging and obesity significantly amplify this inflammatory response, exacerbating stroke severity and impeding recovery. Aging induces a chronic low-grade inflammatory state—referred to as inflammaging —that heightens vulnerability to stroke-induced brain injury. Similarly, obesity promotes a persistent pro-inflammatory milieu that disrupts metabolic and immune homeostasis, further worsening neurological outcomes. The combined effects of aging and obesity pose a substantial barrier to effective stroke rehabilitation and long-term recovery. To improve post-stroke care, future research should focus on three key areas. First, there is a pressing need for targeted therapies that modulate systemic inflammation with minimal side effects. Anti-inflammatory agents such as minocycline have shown promise in preclinical models, but clinical validation is needed. Second, elucidating the molecular mechanisms linking aging, obesity, and systemic inflammation—such as the roles of adipokines and immune cell phenotypes—may reveal novel therapeutic targets. Finally, personalized treatment strategies that consider individual risk factors like age and obesity are essential to optimize stroke management and rehabilitation. Given the limited efficacy of current stroke treatments, prioritizing prevention by identifying high-risk individuals is critical. Recognizing non-modifiable risk factors can support more intensive intervention on modifiable ones and guide vigilance toward vulnerable populations. Overall, advancing our understanding of systemic inflammation and its modifiers will be key to developing innovative, patient-specific therapies aimed at improving outcomes and quality of life for stroke survivors.

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