DOI: http://dx.doi.org/10.18203/2349-3933.ijam20201128

A review of role of uric acid in acute ischemic stroke: changing trends

Soorya Narayanan Balasubramani, Jeyapalan Kuppuswamy

Abstract


Uric acid, a powerful and potent antioxidant. Effect of uric acid in acute stroke was a controversy. Chronic hyperuricemia is atherogenic. But in recent days various articles were published about the antioxidant and the beneficial effects of uric acid due to cerebral antioxidant effect. In this article, we had reviewed various articles which discuss the major beneficial and deleterious effect of uric acid in neurological diseases to conclude the effect of uric acid in the scenario of acute ischemic stroke. This review was conducted through an Internet search on a public access website like PubMed, Google Scholar, Cochrane library, ProQuest and Medline databases until 2019. Keywords utilized included uric acid (UA), Acute ischemic stroke, neuroprotection, stroke therapy, and vasculoprotection. Total of 10 article from literature was reviewed, the major exclusion criteria were the studies that included patients which coronary artery disease, chronic kidney disease, Metabolic syndrome and patients who are taking drugs that influencing the uric acid levels. Chronic hyperuricemia is atherogenic and it had a negative impact on outcome in stroke, but in acute setting resent days various papers had been published about the beneficial effect of uric acid due to its antioxidants property. This was further supported by the co administration of Intravenous uric acid along with thrombolysis for acute ischemic stroke. Hence, we had concluded that, uric acid had a beneficial effect in a setting of acute ischemic stroke.


Keywords


Acute ischemic stroke, Antioxidant, Cerebrovascular accident, Hyperuricemia, Neuro-protective, Uric acid

Full Text:

PDF

References


French BR, Boddepalli RS, Govindarajan R. Acute Ischemic Stroke: Current Status and Future Directions. Mo Med. 2016;113(6):480-6.

Ragoschke-Schumm A, Walter S. DAWN and DEFUSE-3 trials: is time still important?. Der Radiologe. 2018 Nov 1;58(1):20-3.

Proctor Peter H. Uric Acid and Neuroprotection. Stroke. 2008 Aug 1;39(8):e126.

Balaji B, Srinivas B. Hyperuricemia as a Prognostic Marker in Acute Ischemic Stroke. Inter J Sci Study. 2018;6(7):6.

Warlow CP. Epidemiology of stroke. Lancet. 1998 Oct 1;352:S1-4.

Pandian JD, Sudhan P. Stroke Epidemiology and Stroke Care Services in India. J Stroke. 2013 Sep;15(3):128-34.

Khaw KT. Epidemiology of stroke. J Neurol Neurosurg Psychiatr. 1996 Oct;61(4):333-8.

Yesilot N, Putaala J, Bahar SZ, Tatlısumak T. Ethnic and Geographical Differences in Ischaemic Stroke Among Young Adults. Curr Vasc Pharmacol. 2017;15(5):416-29.

O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112-23.

Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983-8.

Antón FM, García Puig J, Ramos T, González P, Ordás J. Sex differences in uric acid metabolism in adults: evidence for a lack of influence of estradiol-17 beta (E2) on the renal handling of urate. Metab Clin Exp. 1986 Apr;35(4):343-8.

Pak CY, Moe OW, Sakhaee K, Peterson RD, Poindexter JR. Physicochemical metabolic characteristics for calcium oxalate stone formation in patients with gouty diathesis. J Urol. 2005 May 1;173(5):1606-9.

Johnson RJ, Kivlighn SD, Kim YG, Suga S, Fogo AB. Reappraisal of the pathogenesis and consequences of hyperuricemia in hypertension, cardiovascular disease, and renal disease. Am J Kidney Dis. 1999 Feb 1;33(2):225-34.

Johnson RJ, Feig DI, Nakagawa T, Sanchez-Lozada LG, Rodriguez-Iturbe B. Pathogenesis of essential hypertension: historical paradigms and modern insights. J Hypertens. 2008 Mar;26(3):381-91.

Forman JP, Choi H, Curhan GC. Plasma Uric Acid Level and Risk for Incident Hypertension Among Men. JASN. 2007 Jan 1;18(1):287-92.

Mazzali M, Kanbay M, Segal MS, Shafiu M, Jalal D, Feig DI, et al. Uric Acid and Hypertension: Cause or Effect? Curr Rheumatol Rep. 2010 Apr 1;12(2):108-17.

Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA. Hyperuricemia and coronary heart disease: a systematic review and meta-analysis. Arthr Care Res (Hoboken). 2010 Feb;62(2):170-80.

Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA. Hyperuricemia and risk of stroke: A systematic review and meta-analysis. Arthr Care Res. 2009;61(7):885-92.

Álvarez-Lario B, MacArrón-Vicente J. Is there anything good in uric acid? QJM. 2011 Dec 1;104(12):1015-24.

Li H, Horke S, Förstermann U. Vascular oxidative stress, nitric oxide and atherosclerosis. Atheroscler. 2014 Nov;237(1):208-19.

Fabian RH, DeWitt DS, Kent TA. In vivo detection of superoxide anion production by the brain using a cytochrome c electrode. J Cereb Blood Flow Metab. 1995 Mar;15(2):242-7.

Ames BN, Cathcart R, Schwiers E, Hochstein P. Uric acid provides an antioxidant defense in humans against oxidant- and radical-caused aging and cancer: a hypothesis. Proc Natl Acad Sci USA. 1981 Nov;78(11):6858-62.

Proctor PH. Uric acid: neuroprotective or neurotoxic?. Stroke. 2008 May 1;39(5):e88.

Davies KJ, Sevanian A, Muakkassah-Kelly SF, Hochstein P. Uric acid-iron ion complexes. A new aspect of the antioxidant functions of uric acid. Biochem J. 1986 May 1;235(3):747-54.

Chamorro Á, Obach V, Cervera Á, Revilla M, Deulofeu R, Aponte JH. Prognostic Significance of Uric Acid Serum Concentration in Patients With Acute Ischemic Stroke. Stroke. 2002 Apr;33(4):1048-52.

Amaro S, Jiménez-Altayó F, Chamorro Á. Uric acid therapy for vasculoprotection in acute ischemic stroke. Brain Circulat. 2019 Apr 1;5(2):55.

Llull L, Laredo C, Renú A, Pérez B, Vila E, Obach V, et al. Uric acid therapy improves clinical outcome in women with acute ischemic stroke. Stroke. 2015 Aug;46(8):2162-7.

Amaro S, Laredo C, Renú A, Llull L, Rudilosso S, Obach V, et al. Uric acid therapy prevents early ischemic stroke progression: a tertiary analysis of the URICO-ICTUS trial (efficacy study of combined treatment with uric acid and r-tPA in acute ischemic stroke). Stroke. 2016 Nov;47(11):2874-6.

Haberman F, Tang SC, Arumugam TV, Hyun DH, Yu QS, Cutler RG, et al. Soluble neuroprotective antioxidant uric acid analogs ameliorate ischemic brain injury in mice. Neuromolecular Med. 2007;9(4):315-23.

Chamorro A, Amaro S, Castellanos M, Segura T, Arenillas J, Martí-Fábregas J, et al. Safety and efficacy of uric acid in patients with acute stroke (URICO-ICTUS): a randomised, double-blind phase 2b/3 trial. Lancet Neurol. 2014 May;13(5):453-60.

Mapoure YN, Ayeah CM, Doualla MS, Ba H, Ngahane HBM, Mbahe S, et al. Serum Uric Acid Is Associated with Poor Outcome in Black Africans in the Acute Phase of Stroke. Stroke Res Treatm. 2017;2017:1-9.