The vascular-immune-neural network: a new pathophysiological paradigm and the dawn of cytoprotection in stroke

At present, no drugs related to brain protection have received strong recommendations from the guidelines in the treatment of stroke. Given the increasing understanding of the interactions between the immune system and the central nervous system and the promising efficacy of our latest immune therapy, it is necessary to reconsider the critical role of immunity in the pathophysiology of stroke. In this review, we propose a new pathophysiological paradigm, namely, the vascular-immune-neural network (VIN), emphasizing the dynamic and continuous interactions between the immune system and the vascular neural network. We update current pathways of brain-immune communication during AIS and dissect the panorama of the immune response to stroke, both in the global brain and the whole body, highlighting the importance and features of the VIN paradigm in stroke. Additionally, we summarize recent advances in immune-related therapies to shed light on the use of cytoprotective treatments throughout the stroke process.