Evolution of cerebral tumor necrosis factor-alpha production during human ischemic stroke

Background and Purpose-Tumor necrosis factor-alpha (TNF-alpha) is detected in ischemic brain cells in experimental animal models and is believed to pl ay an important role in apoptosis. However, the natural expression of TNF-a lpha during human stroke is not known. Methods-We examined TNF-alpha immunohistochemistry and terminal deoxynucleo tidyl transferase-mediated dUTP nick-end labeling (TUNEL) in brain samples of stroke victims (n = 16) after variable survival (15 hours to 18 days). S ystemic TNF-alpha content from a separate cohort including severe or lethal stroke cases (n=26) was also assayed. Results-Neuronal TNF-alpha was demonstrated from 0.6 to 5.4 days after the onset of stroke symptoms, peaking bilaterally during days 2 and 3. Bilatera l glial TNF-alpha immunoreactivity was detected during the acute phase, wit h the astrocytic TNF-alpha expression dominating in later phases and persis ting contralaterally to the infarct in more matured phases (17 to 18 days). Invading inflammatory cells were TNF-alpha immunopositive beginning on the third day. Besides, vascular wall structures showed immunoreactivity spora dically. TNF-alpha levels were mostly nondetectable in peripheral blood. TU NEL labeling and TNF-alpha staining overlapped, although not completely, du ring the first days. Conclusions-The data support the hypothesis that TNF-alpha may be involved both in the acute propagation of inflammatory processes and cell death and possibly in the more delayed reconstitutive processes of human ischemic str oke.