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  • Original Communication
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Antioxidant supplementation enhances antioxidant capacity and mitigates oxidative damage following acute ischaemic stroke

Abstract

Objective:

To test whether supplementary antioxidants immediately following acute ischaemic stroke will enhance antioxidant capacity and mitigate oxidative damage.

Design:

A randomised controlled trial.

Setting:

A university teaching hospital.

Subjects:

A total of 48 acute ischaemic stroke patients within 12 h of symptom onset.

Intervention:

Daily oral 800 IU (727 mg) of α-tocopherol and 500 mg of vitamin C (n=24), or no treatment (n=24) for 14 days. Treatment group and controls were matched for stroke subtype and age.

Main outcome measures:

α-Tocopherol, ascorbic acid, total antioxidant capacity (TAOC), plasma malondialdehyde (MDA) and C-reactive protein (CRP) before treatment, at day 7 and day 14 following recruitment.

Results:

In all, 14 days of vitamin supplementation significantly improved plasma α-tocopherol and ascorbic concentrations in the treatment group compared with the decrease seen in the control group (P<0.005 for difference in cumulative changes). TAOC increased significantly in the treatment group compared with controls (P<0.003). There was a significant reduction in plasma MDA concentration in the treatment group, in contrast to the increase seen in the control group (P<0.002).

Conclusion:

Supplementation with antioxidant vitamins within 12 h of onset of acute ischaemic stroke increased antioxidant capacity, reduced lipid peroxidation products and may have an anti-inflammatory effect.

Sponsorship:

Sheffield Teaching Hospital NHS Trust.

After adjusting for clinical complications CRP concentrations within 90 days postinfarct were significantly lower in the treatment group compared with controls.

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References

  • Bamford J, Sandercock P, Dennis M, Burn J & Warlow C (1991): Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 337, 1521–1526.

    Article  CAS  Google Scholar 

  • Cherubini A, Polidori MC, Bregnocchi M, Pezzuto S, Cecchetti R, Ingegni T, diIorio A, Senin U & Mecocci P (2000): Antioxidant profile and early outcome in stroke patients. Stroke 31, 2295–2300.

    Article  CAS  Google Scholar 

  • Cooper AJL, Pulsinelli WA & Duffy TE (1980): Glutathione and ascorbate during ischaemia and reperfusion in rat brain. J. Neurochem. 35, 1242–1245.

    Article  CAS  Google Scholar 

  • Devaraj S & Jialal I (2000): Alpha tocopherol supplementation decreases serum C-reactive protein and monocyte interleukin-6 levels in normal volunteers and type 2 diabetic patients. Free Radic. Biol Med. 29, 790–792.

    Article  CAS  Google Scholar 

  • Di Napoli M, Papa F & Bocola V (2001): Prognostic influence of increased C-reactive protein and fibrinogen levels in ischemic stroke. Stroke 32, 133–138.

    Article  CAS  Google Scholar 

  • Gariballa SE (2004): Nutrition and Stroke: Prevention and Treatment, pp 47–56, Oxford: Blackwell Publishing Ltd., RC388.5.G37.

    Google Scholar 

  • Gariballa SE, Hutchin TP & Sinclair AJ (2002): Antioxidant capacity after acute ischaemic stroke. Q J Med 95, 685–690.

    Article  CAS  Google Scholar 

  • Hamilton IM, Gilmore WS, Benzie IF, Mulholland CW & Strain JJ (2000): Interactions between vitamins C and E in human subjects. Br. J. Nutr. 84, 261–267.

    Article  CAS  Google Scholar 

  • Heart Protection Study Collaborative Group (2002): MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet 360, 23–33.

  • Langlois M, Duprez D, Delanghe J, De Buyzere M & Clement DL (2001): Serum vitamin C concentration is low in peripheral arterial disease and is associated with inflammation and severity of atherosclerosis. Circulation 103, 1863–1868.

    Article  CAS  Google Scholar 

  • Leinonen JS, Ahonen JP, Lonnrot K, Jehkonen M, Dastidar P, Molnar G & Alho H (2000): Low plasma antioxidant activity is associated with high lesion volume and neurological impairment in stroke. Stroke 31, 33–39.

    Article  CAS  Google Scholar 

  • Martin JMH & Elliot D (1998): OPCS Survey of Disability in Great Britain Report I: The Prevalence of Disability Among Adults. London: Office of Population Cencus and Survey.

    Google Scholar 

  • May JM, Qu ZC & Mendiratta S (1998): Protection and recycling of alpha-tocopherol in human erythrocytes by intracellular ascorbic acid. Arch Biochem. Biophys. 349, 281–289.

    Article  CAS  Google Scholar 

  • Miller NJ, Rice-Evans C, Davies MJ, Gopinathan V & Milner A (1993): A novel method for measuring antioxidant capacity and its application to monitoring the antioxidant status in premature neonates. Clin. Sci. (London) 84, 407–412.

    Article  CAS  Google Scholar 

  • Muir KW, Weir CJ, Alwan W, Squire IB & Lees KR (1999): C-reactive protein and outcome after ischemic stroke. Stroke 30, 981–985.

    Article  CAS  Google Scholar 

  • Nyyssonen K, Porkkala E, Salonen R, Korpela H & Salonen JT (1994): Increase in oxidation resistance of atherogenic serum lipoproteins following antioxidant supplementation: a randomized double-blind placebo-controlled clinical trial. Eur. J. Clin. Nutr. 48, 633–642.

    CAS  PubMed  Google Scholar 

  • Patt A, Harken AH, Burton LK, Rodell TC, Piermattei D, Schorr WJ, Parker NB, Berger EM, Horesh IR & Terada LS (1988): Xanthine oxidase-derived hydrogen peroxide contributes to ischemia reperfusion-induced edema in gerbil brains. J. Clin. Invest. 81, 1556–1562.

    Article  CAS  Google Scholar 

  • Pocock SJ (1988): Clinical Trials: A practical Approach. Chichester: John Wiley and Sons.

    Google Scholar 

  • Polidori MC, Frei B, Cherubini A, Nelles G, Rordorf G, Keaney Jr JF, Schwamm L, Mecocci P, Koroshetz WJ & Beal MF (1998): Increased plasma levels of lipid hydroperoxides in patients with ischemic stroke. Free Radic. Biol. Med. 25, 561–567.

    Article  CAS  Google Scholar 

  • Poungvarin N (1998): Stroke in the developing world. Lancet 352 (Suppl 3), SIII19–SIII22.

    Article  Google Scholar 

  • Standardised Assessment Scales for Older People (1992): A Report of Joint Workshop. London: The Royal College of Physicians of London and The British Geriatrics Society.

  • Thurnham DI, Smith E & Flora PS (1988): Concurrent liquid-chromatographic assay of retinol, alpha-tocopherol, beta-carotene, alpha-carotene, lycopene, and beta-cryptoxanthin in plasma, with tocopherol acetate as internal standard. Clin. Chem. 34, 377–381.

    CAS  Google Scholar 

  • Tornwall ME, Virtamo J, Korhonen PA, Virtanen MJ, Albanes D & Huttunen JK (2004): Postintervention effect of the alpha-tocopherol, β-carotene on different strokes. Stroke 35, 1908–1913.

    Article  Google Scholar 

  • Traystman RJ, Kirsch JR & Koehler RC (1991): Oxygen radical mechanisms of brain injury following ischemia and reperfusion. J. Appl. Physiol. 71, 1185–1195.

    Article  CAS  Google Scholar 

  • Vuilleumier JPKE (1989): Fluorometric assay of vitamin C in biological materials using a centrifugal analyser with fluorescence attachment. J. Micronutr. Anal. 5, 25–34.

    CAS  Google Scholar 

  • Warlow CP, Dennis MS, van Gijn J, Hankey GJ, Sandercock PAG, Bamford JM & Wardlaw J (eds) (1996): Reducing the burden of stroke and improving public health. In: Stroke a Practical Guide to Management, pp 632–649. Oxford: Blackwell Science Ltd.

    Google Scholar 

  • Winbeck K, Poppert H, Etgen T, Conrad B & Sander D (2002): Prognostic relevance of early serial C-reactive protein measurements after first ischemic stroke. Stroke 33, 2459–2464.

    Article  CAS  Google Scholar 

  • Wong SH, Knight JA, Hopfer SM, Zaharia O, Leach Jr CN & Sunderman Jr FW (1987): Lipoperoxides in plasma as measured by liquid-chromatographic separation of malondialdehyde-thiobarbituric acid adduct. Clin. Chem. 33 (Part 1), 214–220.

    CAS  Google Scholar 

  • Yoshida S, Busto R, Santiso M & Ginsberg MD (1984): Brain lipid peroxidation induced by postischemic reoxygenation in vitro: effect of vitamin E. J. Cereb. Blood Flow Metab. 4, 466–469.

    Article  CAS  Google Scholar 

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Acknowledgements

This work was supported by a Grant from Sheffield Teaching Hospital NHS Trust.

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Correspondence to S E Gariballa.

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Guarantor: SE Gariballa.

Contributors: SEG was the lead investigator and wrote the final draft of the paper and responded to the reviewers comments. Dr RU undertook subjects' recruitment and assessments and wrote the first draft of the paper. HJP was a co-investigator. All investigators were involved in the study design and analysis.

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Ullegaddi, R., Powers, H. & Gariballa, S. Antioxidant supplementation enhances antioxidant capacity and mitigates oxidative damage following acute ischaemic stroke. Eur J Clin Nutr 59, 1367–1373 (2005). https://doi.org/10.1038/sj.ejcn.1602248

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