Acute Ischemic Stroke: Uric Acid May Improve Outcomes Interview with:
Dr. Ángel Chamorro

Director, Comprehensive Stroke Center
Hospital Clinic
Barcelona, Spain

Medical Research: What is the background for this study? What are the main findings?

Chamorro: There is a great need of new therapies in patients with acute stroke and our study is based on the clinical observation that patients with acute stroke recover better if at the time of the stroke the levels of uric acid are increased in their blood. That first observation led to a long way of research and administrative challenges but we finally came out with a solution of uric acid (a potent antioxidant) manufactured according to the strict rules which apply to drugs aimed for human use. Thus, we performed a pilot study that showed that uric acid could be safely administered to these patients. We then performed a larger clinical trial in 421 patients which provided very encouraging results overall. Now we are reporting in the Stroke journal appearing on July 9, that women obtained a much greater benefit than men because they had lower levels of uric acid than men because estrogens (female hormones) are efficient excretors of uric acid. In consequence, women were in greater need of uric acid replenishment following the stroke than men.

Medical Research: What should clinicians and patients take away from your report?

Dr. Chamorro: Clinicians should take the message of the importance of oxidative stress in acute stroke. There were a lot of experimental research data in the field but we provide the very first clinical evidence in support of the clinical relevance of diminishing oxidative stress to improve the outcome of these patients. Other drugs that targeted oxidative stress in these patients failed in previous attempts most likely because the drugs that were selected were much weaker in their antioxidant capacity than uric acid, and because unlike uric acid these drugs were not endogenous (that is, produced by own body). What we have accomplished in this exciting trial is to boost a endogenous mechanism – the production of uric acid- which is chiseled in our genes. Indeed, we humans have significant higher levels of uric acid than any other mammal on earth because of our genes make this to happen. We may ask why but the answer is rather simple: it is advantageous for us !!! Certainly, although having too high levels of uric acid may derive in diseases, such as gouty attacks and renal failure, the same product is beneficial when the brain lacks blood and this is the precise condition that we are discussing. This could have major and global consequences worldwide because strokes are responsible for the first cause of permanent disability in adults in most countries.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Chamorro: We need to convince our colleagues that a confirmatory trial is required if we want to have this simple, cheap, and beneficial compound available to our patients. However, as the saying goes: if no money, no party, and nowadays is very challenging to collect money to perform a large clinical trial lacking the support of a big pharmaceutical company. Hopefully, we will succeed. Patients, particularly women, would deserve this trial. Indeed, women have a much worse prognosis after acute stroke than men and we give some new clues to explain this. As previously mentioned, the reason could stand on their low levels of uric acid.


Uric Acid Therapy Improves Clinical Outcome in Women With Acute Ischemic Stroke

Laura Llull, Carlos Laredo, Arturo Renú, Belén Pérez, Elisabet Vila, Víctor Obach, Xabier Urra, Anna Planas, Sergio Amaro, and Ángel Chamorro

Stroke. 2015;STROKEAHA.115.009960published online before print July 9 2015, doi:10.1161/STROKEAHA.115.009960

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Dr. Ángel Chamorro (2015). Acute Ischemic Stroke: Uric Acid May Improve Stroke Outcomes