The correlation of Nrf2 levels with improvement of NIHSS scores in acute ischemic stroke patients with glutathione antioxidant supplementation

Background: Acute ischemic stroke triggers complex cellular cascades and increases the production of oxidative stress. Nrf2 (nuclear erythroid-related factor 2) is a transcription factor that regulates a series of neuroprotective antioxidant genes that can improve the clinical outcome of stroke. Glutathione is an antioxidant that can protect cells against oxidative stress and can increase Nrf2 levels. This study aimed to determine the effect of glutathione supplementation on Nrf2 levels and its impact on clinical stroke outcomes. Methods: The research design was a randomized controlled trial, single-blind, and pre-posttest group. About 41 acute ischemic stroke subjects who met the inclusion and exclusion criteria were divided into 2 groups, namely the treatment and control groups. Serum Nrf2 levels were examined using the ELISA method from venous blood and clinical outcomes were assessed using the NIHSS score between days 1 and 14. The treatment group received 500 mg capsule glutathione supplements per 12 hours orally for 14 days. Analysis was carried out using Statistical Product and Service Solutions (SPSS) edition 29. Results: There was a significant difference in the increase in serum Nrf2 levels between the treatment and control groups (p = 0.005). There was an increase in serum Nrf2 levels in the treatment group compared to the control group. There was no significant correlation between increasing Nrf2 levels and improving NIHSS scores (p = 0.331). Conclusion: There was no correlation between increasing Nrf2 levels and improving NIHSS scores in acute ischemic stroke patients who received glutathione antioxidant supplements.