The cause of shingles can cause stroke is exosomes

According to a new study from the University of Colorado Anschutz School of Medicine, scientists are investigating why shingles patients are at higher risk of stroke, and now believe the answer lies in lipid vesicles called exosomes, which can pass proteins and genetic information
between cells.

The study, published today in The Journal of Infectious Diseases, details the mechanism
behind the link between shingles and stroke.

Dr Andrew Bubak, lead author of the study and assistant research professor in the Department of Neurology at the University of Colorado School of Medicine, said: "Most people know that shingles produces a painful rash, but they may not know that the risk of stroke is increased
one year after infection.
Importantly, the rash usually heals completely and patients feel normal, but despite this, they are at significantly higher
risk of stroke when they walk.
”

Herpes zoster (HZ) or shingles is caused
by the varicella zoster virus.
The virus stays in ganglion neurons and can reactivate, causing severe pain
.
But researchers have found that shingles also increases the risk of stroke, especially for those under 40, and the shingles vaccine
is generally not recommended.
People who have a rash on their face are most at risk, probably because they are so close to
the brain.
To better understand how it works, Bubak and his team began to study exosomes
more closely.

"Exosomes carry pathogenic substances that can cause thrombosis and inflammation far from the actual site of infection," Bubak said
.
"This can eventually lead to a stroke
in patients.
"

The researchers collected plasma samples
from 13 patients with shingles and 10 people with non-shingles.
Samples were taken at the time of infection and at 3-month follow-up, and exosomes
were extracted from the plasma.
The researchers found that prethrombotic exosomes may cause thrombosis in
infected patients.
At 3 months of follow-up, they also found pro-inflammatory exosomes, which also pose a risk of
stroke.

Bubak said the findings suggest that in a subset of shingles patients, the virus may not return to its incubation period, or circulating exosomes that induce a prolonged thrombotic state may persist, even after
treatment is completed and the rash is gone.
Long-term use of antivirals plus antiplatelet and anti-inflammatory drugs may help
, he said.

"There are also initiatives to increase HZ vaccine uptake to reduce stroke risk, especially in
individuals known to have pre-existing stroke risk factors," Bubak said.
If these findings are confirmed in larger longitudinal studies, this could change clinical practice
.
”

Most doctors don't know the link between shingles and stroke, and there is an effective vaccine
for shingles.

"But it's really important, and it's easy to mitigate," Bubak said
.
"Let them go home
with antiplatelet drugs.
"

Zoster-associated prothrombotic plasma exosomes and increased stroke risk