Endogenous Antioxidants in Stroke

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To the Editor:

The study by Perlstein et al¹ has demonstrated that higher bilirubin levels correlate with a lower prevalence and better outcome in stroke. This study adds to the growing evidence of the neuroprotective role of endogenous antioxidant and anti-inflammatory molecules in stroke. It has been shown that plasma antioxidant levels are important for neuroprotection in patients of stroke.² Also, the levels of plasma antioxidants seem to fall immediately after stroke.³ What remains to be proven is if supplementation of antioxidants—exogenous or endogenous—can improve outcomes in the patients of stroke. It would be pertinent to point out that past studies have demonstrated the correlation of higher serum albumin levels with better outcome in ischemic stroke.⁴ The possible mechanism of benefit is possibly due to the anti-inflammatory and antioxidant properties of albumin. The use of human albumin has shown evidence of neuroprotective benefit in experimental animals as well as in early human trials.⁵

Despite all the limitations of the current study, the findings are significant and a basis for further evaluation of the role of serum bilirubin levels in stroke, especially acute stroke, so that evidence for actual correlation of serum bilirubin values at the onset of stroke with outcome can be obtained. One can only hope that the endogenous antioxidants and anti-inflammatory molecules open a new window of opportunity as far as therapy for acute stroke is concerned.

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References 

1. Perlstein TS, Pande RL, Creager MA, et al. Serum total bilirubin level, prevalent stroke, and stroke outcomes: NHANES 1999-2004. Am J Med. 2008;121:781–788
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2. Leinonen JS, Ahonen JP, Lönnrot K, et al. Low plasma antioxidant activity is associated with high lesion volume and neurological impairment in stroke. Stroke. 2000;31:33–39
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