Correlation Between GPx and Nrf2 Antioxidant Levels and Clinical Improvement in Ischemic Stroke Patients Receiving Glutathione Supplementation

Abstract

Background and Objective: Acute ischemic stroke induces metabolic and biomolecular changes, resulting in brain functional disorders and morphological damage as well as increased production of free radicals and reactive oxygen species (ROS). The antioxidant defense system in stroke includes glutathione peroxidase (GPx) and nuclear erythroid-related factor 2 (Nrf2), with glutathione playing a vital role in reducing ROS levels. This study aimed to assess the correlation between serum GPx and Nrf2 levels and clinical improvement in acute ischemic stroke patients receiving glutathione supplementation. Materials and Methods: A randomized controlled trial was conducted at Dr. Kariadi Hospital, Semarang, from September 2021 to January 2022, with acute ischemic stroke patients diagnosed through head CT as the study population. Serum GPx and Nrf2 levels were collected within <72 hrs of stroke onset and clinical outcomes were evaluated using National Institutes of Health Stroke Scale (NIHSS). Data normality was examined using Kolmogorov-Smirnov test. Correlation and association were tested using Spearman correlation and Mann-Whitney U test, respectively. Statistical significance was set at p<0.05. Results: From a total of 40 subjects, serum GPx and Nrf2 levels were significantly elevated in the treatment group compared to controls (p = 0.000 and p = 0.030, respectively). A significant positive correlation was observed between elevated serum GPx levels and clinical improvement (r = 0.464, p = 0.039), while no significant correlation was found between Nrf2 levels and clinical improvement (r = -0.033, p = 0.889). Conclusion: In conclusion, there was a positive correlation between elevated serum GPx levels and clinical improvement in acute ischemic stroke patients receiving glutathione supplementation. The same could not be said regarding Nrf2 levels. These findings emphasize the potential of GPx as a therapeutic target in stroke management.