Spontaneous cervical artery dissection is associated with a distinct peripheral immune cell signature 2026 Beuker et al

[Andy]

Abstract​

Objectives​

Despite being a major cause of ischemic stroke in young adults, the biological underpinnings of cervical artery dissection (CeAD) remain poorly defined. Recent data implicate immune activation as a potential contributor. We aimed to determine whether patients with CeAD display a distinct peripheral immune signature, which may provide insights into pathogenic inflammatory processes.

Methods​

Peripheral blood mononuclear cells (PBMCs) from patients with spontaneous CeAD (n = 7 without and n = 11 with ischemic stroke) and ten age-matched healthy controls were analyzed via multi-color flow cytometry. Immune cell composition and activation markers were assessed, and sparse partial least squares discriminant analysis (sPLS-DA) was employed to identify CeAD-associated immune features. A secondary comparison with ischemic stroke controls was included to assess the specificity of identified immune alterations.

Results​

Compared to healthy controls, CeAD patients displayed increased frequencies of CD4 ⁺ T cells and decreased natural killer T (NKT) cells. sPLS-DA demonstrated clear separation of CeAD and control immune profiles, driven by increased CD28 expression on naïve CD8 ⁺ T cells, NKp46 on NK cells, and IL-2Rα (CD25) on myeloid dendritic cells (mDC2). Elevated granzyme K in naïve CD8 ⁺ T cells indicated enhanced cytotoxic potential, while regulatory T cells were diminished. These alterations were largely preserved when compared to ischemic stroke controls, suggesting CeAD-specific immune activation. No microbial pathogens were detected by untargeted metagenomic sequencing.

Discussion​

CeAD is associated with a distinct peripheral immune signature characterized by enhanced cytotoxic activity and reduced regulatory features. These alterations may reflect a post-infectious autoimmune mechanism triggering CeAD or a secondary immune-inflammatory response to vascular injury. Larger, longitudinal studies are needed to clarify causality and assess whether immune modulation could serve as a therapeutic target in CeAD.

Open access

 

[SNT Gatchaman]

Two principal, non-mutually exclusive mechanisms may explain our observations. On the one hand, immune activation could precede dissection as a pathogenic driver. Prior studies have linked recent, particularly viral, infections to CeAD onset, supporting the concept of a post-infectious or autoimmune-mediated trigger. In line with this, we observed increased CD28 expression on naïve CD8 ⁺ T-cells, elevated NKp46 expression on NK cells, and enhanced IL-2Rα on mDC2 cells, together pointing toward a proinflammatory and cytotoxic-prone immune state. The concomitant upregulation of granzyme K in naïve CD8 ⁺ T-cells further supports a cytokine-driven effector readiness.

Similar immune alterations have been described in systemic autoimmune diseases[…] Collectively, these parallels raise the possibility that CeAD shares immune signatures with systemic autoimmune and inflammatory disorders.

On the other hand, the immune alterations in CeAD may represent a secondary consequence of endothelial disruption. Arterial dissection exposes subendothelial structures that can elicit a coordinated immune response, as shown in aortic dissection where macrophage infiltration, T-cell activation, NK-cell cytotoxicity, and B-cell responses collectively create a proinflammatory milieu within the vessel wall. Such localized vascular inflammation may extend into the peripheral circulation, giving rise to the systemic immune profile observed here.