Temporal and Age-Dependent Regulation of Phagocytosis-Related Signatures After Ischemic Stroke: Cross-Species Transcriptomic Evidence

Background: Efferocytosis, the phagocytic clearance of apoptotic and damaged cells, promotes inflammation resolution and tissue repair following ischemic stroke. This study investigated temporal changes in efferocytosis and phagocytosis-related transcriptional programs during acute experimental stroke, examined the effects of aging on these responses, and assessed whether similar immune signatures are present in human ischemic stroke. Methods: Publicly available transcriptomic datasets from murine transient middle cerebral artery occlusion (tMCAO; GSE104036 and GSE112348), permanent middle cerebral artery occlusion (pMCAO; GSE137482), and human peripheral blood after ischemic stroke (GSE16561) were analyzed using OmicSoft/Ingenuity-style pathway analysis. Functional validation included in vivo assessment of efferocytosis after tMCAO and in vitro phagocytosis assays using bone marrow-derived macrophages from young and aged mice. Results: Both acute tMCAO models exhibited robust inflammatory activation together with sustained activation of phagocyte-related pathways during the first 24 hours after stroke. Human peripheral blood demonstrated similar inflammatory and phagocytic signatures, supporting translational relevance. Increased efferocytosis at 24 hours after tMCAO was associated with neuroprotection. Although both young and aged mice activated phagocytosis-related pathways after pMCAO, aged mice showed reduced phagosome formation. Consistent with these findings, macrophages from aged mice exhibited enhanced inflammatory responses and impaired uptake of apoptotic cells. Conclusions: A conserved post-stroke immune response characterized by inflammatory activation and phagocyte-mediated clearance was identified across murine and human datasets. Efficient efferocytosis was associated with neuroprotection, whereas aging impaired apoptotic cell clearance and promoted a pro-inflammatory macrophage phenotype, highlighting efferocytosis as a potential therapeutic target for ischemic stroke.