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Review
. 2024 Jul 5;10(14):e34121.
doi: 10.1016/j.heliyon.2024.e34121. eCollection 2024 Jul 30.

A comprehensive review on the neuroprotective potential of resveratrol in ischemic stroke

Affiliations
Review

A comprehensive review on the neuroprotective potential of resveratrol in ischemic stroke

Maryam Owjfard et al. Heliyon. .

Abstract

Stroke is the second leading cause of death and the third leading cause of disability worldwide. Globally, 68 % of all strokes are ischemic, with 32 % being hemorrhagic. Ischemic stroke (IS) poses significant challenges globally, necessitating the development of effective therapeutic strategies. IS is among the deadliest illnesses. Major functions are played by neuroimmunity, inflammation, and oxidative stress in the multiple intricate pathways of IS. Secondary brain damage is specifically caused by the early pro-inflammatory activity that follows cerebral ischemia, which is brought on by excessive activation of local microglia and the infiltration of circulating monocytes and macrophages. Resveratrol, a natural polyphenol found in grapes and berries, has shown promise as a neuroprotective agent in IS. This review offers a comprehensive overview of resveratrol's neuroprotective role in IS, focusing on its mechanisms of action and therapeutic potential. Resveratrol exerts neuroprotective effects by activating nuclear factor erythroid 2-related factor 2 (NRF2) and sirtuin 1 (SIRT1) pathways. SIRT1 activation by resveratrol triggers the deacetylation and activation of downstream targets like peroxisome proliferator-activated receptor-gamma coactivator 1 alpha (PGC-1α) and forkhead box protein O (FOXO), regulating mitochondrial biogenesis, antioxidant defense, and cellular stress response. Consequently, resveratrol promotes cellular survival and inhibits apoptosis in IS. Moreover, resveratrol activates the NRF2 pathway, a key mediator of the cellular antioxidant response. Activation of NRF2 through resveratrol enhances the expression of antioxidant enzymes, like heme oxygenase-1 (HO-1) and NAD(P)H quinone oxidoreductase 1 (NQO1), which neutralize reactive oxygen species and mitigate oxidative stress in the ischemic brain. Combined, the activation of SIRT1 and NRF2 pathways contributes to resveratrol's neuroprotective effects by reducing oxidative stress, inflammation, and apoptosis in IS. Preclinical studies demonstrate that resveratrol improves functional outcomes, reduces infarct size, regulates cerebral blood flow and preserves neuronal integrity. Gaining a comprehensive understanding of these mechanisms holds promise for the development of targeted therapeutic interventions aimed at promoting neuronal survival and facilitating functional recovery in IS patients and to aid future studies in this matter.

Keywords: Ischemic stroke; Neuroprotective; Nrf2; Resveratrol; SIRT1.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Neuroprotective role of resveratrol in IS. Following cerebral ischemia, the secondary damage continues to affect the brain and injure neurons due to immune cell infiltration, oxidative stress and BBB disruption. Resveratrol holds the potential to inhibit inflammatory cytokine release and preserve the BBB integrity through the activation of the SIRT1 and Nrf2 pathway. Resveratrol upregulates the expression of anti-oxidant genes including Superoxide dismutase (SOD)2 and NAD(P)H quinone oxidoreductase 1 (NQO-1). Resveratrol also stimulates the expression of the Bcl-2 anti-apoptotic gene while suppressing the expression of apoptotic genes like Bax, caspase and Hypoxia-inducible factor 1-alpha (HIF-1a). Resveratrol is capable of reducing cerebral edema by preserving the BBB integrity and reducing the expression of aquaporin (AQP)-4. The SIRT1 pathway leads to increased nitric oxide (NO) production. Increased NO along with the reduction in angiotensin II and endothelin 1 contribute to resveratrol effects on regulating blood pressure and cerebral blood flow.

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