Classical and intermediate monocytes and their ratios in the natural immune course of ischemic stroke
8 affiliations
- 1PhD Program in Neuroscience, Universidad Autónoma de Madrid-Cajal Institute , ,
- 2Stroke Unit, Department of Neurology, Hospital Universitario Fundación Jiménez Díaz , ,
- 3Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM) , ,
- 4Department of Cell Biology and Histology, Faculty of Medicine, Complutense University , ,
- 5Instituto de Investigación Hospital 12 Octubre (imas12) , ,
- 6Department of Psychology, School of Health Sciences, Rey Juan Carlos University , ,
- 7Stroke Unit, Department of Neurology, Hospital Universitario 12 de Octubre , ,
- 8Neurovascular Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC) , ,
Abstract
Introduction: Monocytes contribute to the immune response to ischemic stroke (IS), participating in both acute inflammation and post-ischemic repair. However, classical (cMo), intermediate (intMo), and non-classical (ncMo) monocytes differ in function, and composite indices such as the lymphocyte-to-monocyte ratio (LMR) do not distinguish between them. We characterized the dynamics of monocyte subpopulations and of two subset-derived ratios, the lymphocyte-to-classical monocyte ratio (LMRclas) and the lymphocyte-to-intermediate monocyte ratio (LMRint), in patients with acute IS who did not undergo reperfusion therapy, allowing assessment of the natural immune response.
Methods: We prospectively studied 31 patients and 16 controls, obtaining complete blood counts and/or flow cytometry in patients at admission, 24 h, and 48 h, and relating these findings to the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS) through 90 days, and the development of stroke-associated infection (SAI). Correlations were assessed using Spearman’s rank correlation coefficient, with Benjamini-Hochberg correction applied within four prespecified families.
Results: Compared with controls, patients showed reduced lymphocyte counts at admission, 24 h, and 48 h, whereas total monocyte counts did not differ at any time point. Within the monocyte compartment, intMo counts increased at 24 h and 48 h, and LMRint decreased at 48 h, while cMo and ncMo counts remained unchanged. A lower LMR at 48 h was associated with greater stroke severity and with poorer functional outcome; higher cMo counts at 48 h and a lower LMRclas at 24 h were associated with poorer outcome at 90 days; and a lower LMRclas at admission was associated with the development of SAI. None of these associations retained significance after correction for multiple comparisons, and neither ratio remained independently associated with 90-day outcome after adjustment for age, sex, and baseline NIHSS.
Discussion: Taken together, these exploratory findings suggest a reorganization of the monocyte compartment after ischemic stroke despite an unchanged total monocyte count, a shift that composite indices cannot capture but that LMRclas and LMRint might reflect. The estimates reported here may serve as a basis for evaluating these ratios in larger, adequately powered cohorts.
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BibTeX
@article{oses2026classical,
title = {{Classical and intermediate monocytes and their ratios in the natural immune course of ischemic stroke}},
author = {Marta Oses and María Araceli García-Torres and Cristina Serrano del Castillo and Ana Moraga and Inmaculada Navas and Marta Guillán and Ivana Zamarbide and Víctor Mora and Carolina Peña-Martínez and Fernando Ostos and Patricia Calleja and María Ángeles Moro and Alicia García-Culebras and Ignacio Lizasoain},
journal = {Frontiers in neuroscience},
year = {2026},
month = sep,
doi = {10.3389/fnins.2026.1889912},
url = {https://europepmc.org/article/PMC/PMC13661920},
note = {CC BY},
}
RIS
TY - JOUR
TI - Classical and intermediate monocytes and their ratios in the natural immune course of ischemic stroke
AU - Marta Oses
AU - María Araceli García-Torres
AU - Cristina Serrano del Castillo
AU - Ana Moraga
AU - Inmaculada Navas
AU - Marta Guillán
AU - Ivana Zamarbide
AU - Víctor Mora
AU - Carolina Peña-Martínez
AU - Fernando Ostos
AU - Patricia Calleja
AU - María Ángeles Moro
AU - Alicia García-Culebras
AU - Ignacio Lizasoain
PY - 2026
DA - 2026/09/30
JO - Frontiers in neuroscience
DO - 10.3389/fnins.2026.1889912
UR - https://europepmc.org/article/PMC/PMC13661920
AB - Introduction: Monocytes contribute to the immune response to ischemic stroke (IS), participating in both acute inflammation and post-ischemic repair. However, classical (cMo), intermediate (intMo), and non-classical (ncMo) monocytes differ in function, and composite indices such as the lymphocyte-to-monocyte ratio (LMR) do not distinguish between them. We characterized the dynamics of monocyte subpopulations and of two subset-derived ratios, the lymphocyte-to-classical monocyte ratio (LMRclas) and the lymphocyte-to-intermediate monocyte ratio (LMRint), in patients with acute IS who did not undergo reperfusion therapy, allowing assessment of the natural immune response. Methods: We prospectively studied 31 patients and 16 controls, obtaining complete blood counts and/or flow cytometry in patients at admission, 24 h, and 48 h, and relating these findings to the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS) through 90 days, and the development of stroke-associated infection (SAI). Correlations were assessed using Spearman’s rank correlation coefficient, with Benjamini-Hochberg correction applied within four prespecified families. Results: Compared with controls, patients showed reduced lymphocyte counts at admission, 24 h, and 48 h, whereas total monocyte counts did not differ at any time point. Within the monocyte compartment, intMo counts increased at 24 h and 48 h, and LMRint decreased at 48 h, while cMo and ncMo counts remained unchanged. A lower LMR at 48 h was associated with greater stroke severity and with poorer functional outcome; higher cMo counts at 48 h and a lower LMRclas at 24 h were associated with poorer outcome at 90 days; and a lower LMRclas at admission was associated with the development of SAI. None of these associations retained significance after correction for multiple comparisons, and neither ratio remained independently associated with 90-day outcome after adjustment for age, sex, and baseline NIHSS. Discussion: Taken together, these exploratory findings suggest a reorganization of the monocyte compartment after ischemic stroke despite an unchanged total monocyte count, a shift that composite indices cannot capture but that LMRclas and LMRint might reflect. The estimates reported here may serve as a basis for evaluating these ratios in larger, adequately powered cohorts.
SN - 1662-4548
SN - 1662-453X
ER -