Brain Trauma Stroke
treatments may be ineffective in removing viable pathogens from circulating monocytes, for example.86
Conclusion
Promising research investigating the role of acute and chronic infectious exposure suggests that there may be a causal role of pathogens in atherosclerotic progression and plaque destabilisation to negatively affect vascular risk; however, the evidence is preliminary. Further studies are required to identify molecular targets for pharmaceutical intervention along pathways by which IB may elicit atherosclerotic effects, to evaluate the role of IB on small-vessel disease and stroke, to ensure that socioeconomic measures are adequately considered, to assess probable interactions with host genetic and risk-factor profiles and to further define a standard measure for composite IB. Infectious agents provide tempting targets for interventions, but the role of pathogens in atherogenesis (if it exists) is likely complex and occurs over the life-course. Short-term antibiotic regimes are indicated to clinically treat acute phases of infection, but there is insufficient evidence to support any antibiotic benefits of long-term treatment or treatment earlier in the life-course. Vaccination strategies and development for likely viral contributors of vascular burden may be another viable option. n
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Jorge M Luna is a Graduate Research Assistant in the Department of Neurology at Columbia University College of Physicians and Surgeons, a doctoral candidate in epidemiology in the Department of Epidemiology at the Joseph Mailman School of Public Health at Columbia University and a Global Health Fellow Intern in the Office of HIV Surveillance at United States Agency for International Development (USAID). His primary clinical and research interests include inflammation and acute infectious precipitants of stroke.
Mitchell SV Elkind is an Associate Professor of Neurology and Associate Chairman of Neurology at Columbia University College of Physicians and Surgeons and an Associate Professor of Epidemiology at the Joseph Mailman School of Public Health at Columbia University. His research is focused on inflammatory and infectious biomarkers in stroke-risk prediction and acute stroke therapy. He is the principal investigator of three independent investigator awards
from the National Institutes of Health/National Institute of Neurological Disorders and Stroke (NIH/NINDS). He is a former Neurology Residency Program Director at Columbia, and now edits the Resident and Fellow Section of Neurology. Professor Elkind graduated from Harvard Medical School and completed a neurology residency at Massachusetts General Hospital. He holds a master’s degree in epidemiology from Columbia University.
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