Plasma glutathione and cystine as risk markers for severity and disability in acute hemorrhagic stroke

Abstract Background The metabolism of aminothiols such as glutathione (GSH) and cysteine (Cys) plays an important role in the pathophysiology of stroke. We evaluate the association of cysteine and glutathione forms in blood plasma with the severity and disability of acute hemorrhagic stroke (HS). Methods The levels of reduced glutathione (rGSH), reduced cysteine (rCys) and cystine (CysS) in blood plasma were determined in patients with acute HS (n = 64; 39–59 years old), and the patients’ condition upon admission and on days 7–10 of illness was assessed using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), respectively. Results The median levels of plasma cystine (CysS) and reduced glutathione (rGSH) were 51.1 and 1.04 µM, respectively. Patients with high levels (≥ 50 µM) of CysS had a significantly higher frequency of mild or moderate neurological impairment (NIHSS ≤ 10) than patients with levels of CysS < 50 µM (OR = 7.73, CI95% 2.19–27.28). Patients with high levels (≥ 1.9 µM) of rGSH also had a significantly higher frequency of mild disability (mRS ≤ 2) compared to patients with rGSH < 1.9 µM (OR = 12.35, CI95% 3.43–44.5). Conclusion Thus CysS and rGSH levels are associated with reduced risk of severe neurological deficit and disability, respectively, in the acute period of hemorrhagic stroke. These indicators could be used to evaluate the severity of neurological impairment in stroke patients. Further research is needed to determine potential of circulating free thiols as biomarkers and to evaluate the usefulness of GSH-targeting therapy in acute hemorrhagic stroke.