skip to main content

The effect of addition protein, phosphatidylcholine, phosphatidylserine, and inulin on GFAP levels of acute ischemic stroke patients at Dr. Kariadi Hospital, Semarang

1Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Indonesia

2Department of Neurology, Faculty of Medicine, Diponegoro University, Indonesia

3Public Health Nutrition Section, Faculty of Public Health, Diponegoro University, Indonesia

Received: 28 Aug 2020; Published: 30 Jun 2021.

Citation Format:
Abstract

Background: The occurrence of ischemia causes a loss of energy to switch to anaerobic processes resulting in acidosis due to reduced Adenosina Triphosphate (ATP). This condition makes neuron cells apoptotic. Apoptotic of several biochemical substrates in the brain, such as Glial Fibrillary Acidic Protein (GFAP) exit into the circulatory system which is associated with dysbiosis through immunological pathways.

Objectives: To determine the effect of giving enteral formula containing protein, phosphatidylcholine, phosphatidylserine, and inulin on GFAP levels in patients with acute ischemic stroke Dr. Kariadi Hospital.

Materials and Methods: This study was done in a single-blind RCT. Eighteen ischemic stroke patients were randomly divided into intervention (9 subjects) and control groups (9 subjects). The intervention group received 69 g of the powdered enteral formula three times a day for seven days. The formula contained protein (15 g), phosphatidylcholine (128 mg),  phosphatidylserine (32 mg), and inulin (3 g). The subject who had diabetes mellitus received for 14 days at a dose of 34.5 g per day (7.5 g protein with additions 64mg phosphatidylcholine, 16mg phosphatidylserine, 1.5 g inulin). The control group received the standard enteral formula from the hospital, which contains (11.8 g protein without additions protein, phosphatidylcholine, phosphatidylserine, and inulin). GFAP levels by ELISA method (Enzyme-linked immunosorbent Assay) at pre and post-intervention.

Results: There was a trend of decreasing GFAP levels before and after in the intervention group towards a better direction from 8.37±4.25 to 8.30±4.9 compared with the control group which experienced an increasing trend from 5.4±1.8 to 7.5±4. There was no significant difference in GFAP levels after intervention between groups (p = 0.7).

Conclusions: The addition of protein, phosphatidylcholine, phosphatidylserine, and inulin had no significant effect on GFAP levels.

Fulltext View|Download
Keywords: GFAP; Protein; Phosphatidylcholine; Phosphatidylserine; Inulin

Article Metrics:

  1. Liu G, Geng J. Glial fibrillary acidic protein as a prognostic marker of acute ischemic stroke. Hum Exp Toxicol. 2018;37(10):1048–53
  2. Surjawan Y, As’ad S, Ranakusuma TAS, Wijaya A. The different patterns of blood S100b protein and GFAP concentrations in ischemic stroke. Med J Indones. 2013;22(4):215–20
  3. Petzold A. Glial fibrillary acidic protein is a body fluid biomarker for glial pathology in human disease. Brain Res [Internet]. 2015;1600:17–31. Available from: http://dx.doi.org/10.1016/j.brainres.2014.12.027
  4. Middeldorp J, Hol EM. GFAP in health and disease. Prog Neurobiol [Internet]. 2011;93(3):421–43. Available from: http://dx.doi.org/10.1016/j.pneurobio.2011.01.005
  5. Žurek J, Fedora M. The usefulness of S100B, NSE, GFAP, NF-H, secretagogin and Hsp70 as a predictive biomarker of outcome in children with traumatic brain injury. Acta Neurochir (Wien). 2012;154(1):93–103
  6. Dvorak F, Haberer I, Sitzer M, Foerch C. Characterisation of the diagnostic window of serum glial fibrillary acidic protein for the differentiation of intracerebral hemorrhage and ischaemic stroke. Cerebrovasc Dis. 2009;27(1):37–41
  7. Puspitasari V, Gunawan PY, Wiradarma HD, Hartoyo V. Glial fibrillary acidic protein serum level as a predictor of clinical outcome in ischemic stroke. Open Access Maced J Med Sci. 2019;7(9):1471–4
  8. Raisa N, Sujuti H, Purnomo H, Rahayu M, Dalhar M. the Influence of Sampling Time To Serum Glial Fibrillary Acidic Protein (Gfap) Levels in Acute Stroke. MNJ (Malang Neurol Journal). 2019;5(1):30–3
  9. Presley B. Penatalaksanaan Farmakologi Stroke Iskemik Akut. Bul Rasional [Internet]. 2013;12(1):6–8. Available from: http://repository.ubaya.ac.id/21378/1/Rasional Vol 12 No 1.pdf
  10. Glade MJ, Smith K. Phosphatidylserine and the human brain. 2015;31(6):781–6. Available from: http://dx.doi.org/10.1016/j.nut.2014.10.014
  11. Overgaard K. The effects of citicoline on acute ischemic stroke: A review. J Stroke Cerebrovasc Dis [Internet]. 2014;23(7):1764–9. Available from: http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2014.01.020
  12. Sahota P, Savitz SI. Investigational Therapies for Ischemic Stroke: Neuroprotection and Neuro recovery. Neurotherapeutics. 2011;8(3):434–51
  13. Kato-Kataoka A, Sakai M, Ebina R, Nonaka C, Asano T, Miyamori T. Soybean-derived phosphatidylserine improves memory function of the elderly Japanese subjects with memory complaints. J Clin Biochem Nutr. 2010;47(3):246–55
  14. Anderson H, Luhovyy B, Akhavan T, Panahi S. Enteral formula proteins in the regulation of body weight, satiety, food intake, and glycemia. Nestle Nutr Work Ser Pediatr Progr. 2011;67:147–59
  15. Lien DTK, Nhung BT, Khan NC, Hop LT, Nga NTQ, Hung NT, et al. Impact of enteral formula consumption on performance and health of primary school children in rural Vietnam. Asia Pac J Clin Nutr. 2009;18(3):326–34
  16. Patel S. Functional food relevance of whey protein: A review of recent findings and scopes ahead. J Funct Foods. 2015;19:308–19
  17. Mitchell CJ, McGregor RA, D’Souza RF, Thorstensen EB, Markworth JF, Fanning AC, et al. Consumption of enteral formula protein or whey protein results in a similar increase in muscle protein synthesis in middle-aged men. Nutrients. 2015;7(10):8685–99
  18. Colonic T, Homeostasis C, Smith PM, Howitt MR, Panikov N, Michaud M, et al. Reports 1000. 2013;(August):569–74
  19. Liu TW, Cephas KD, Holscher HD, Kerr KR, Mangian HF, Tappenden KA, et al. Nondigestible fructans alter gastrointestinal barrier function, gene expression, histomorphology, and the microbiota profiles of diet-induced obese C57BL/6J Mice. J Nutr. 2016;146(5):949–56
  20. Chunchai T, Keawtep P, Arinno A, Saiyasit N, Prus D, Apaijai N, et al. N-acetyl cysteine, inulin and the two as a combined therapy ameliorate cognitive decline in testosterone-deprived rats. Aging (Albany NY). 2019;11(11):3445–62
  21. Bansal V, Costantini T, Ryu SY, Peterson C, Loomis W, Putnam J, et al. Stimulating the central nervous system to prevent intestinal dysfunction after traumatic brain injury. J Trauma - Inj Infect Crit Care. 2010;68(5):1059–63
  22. BPOM RI. Peraturan Kepala Badan Pengawas Obat dan Makanan Republik Indonesia Nomor 9 Tahun 2016 tentang Acuan Label Gizi. Badan Pengawas Obat dan Makanan Republik Indones. 2016;1–28
  23. Wahyudi R, Hasmono D, Fitrina R, Armal K. Injected Citicoline Improves Impairment and Disability During Acute Phase Treatment in Ischemic Stroke Patients. Folia Medica Indones. 2016;51(4):245
  24. Dávalos A, Castillo J, Álvarez-Sabín J, Secades JJ, Mercadal J, López S, et al. Oral citicoline in acute ischemic stroke: An individual patient data pooling analysis of clinical trials. Stroke. 2002;33(12):2850–7
  25. Wirth R, Smoliner C, Jäger M, Warnecke T, Leischker AH, Dziewas R, et al. Guideline clinical nutrition in patients with stroke. Exp Transl Stroke Med. 2013;5(1):1–11
  26. A. K-K, M. S, R. E, C. N, T. A, T. M. Soybean-derived phosphatidylserine improves memory function of the elderly Japanese subjects with memory complaints. J Clin Biochem Nutr [Internet]. 2010;47(3):246–55. Available from: http://linker.worldcat.org/?rft.institution_id=129635&spage=246&pkgName=UKPMC&issn=0912-0009&linkclass=to_article&jKey=897&issue=3&provider=NLM&date=2010-11&aulast=Kato-Kataoka+A.%3B+Sakai+M.%3B+Ebina+R.%3B+Nonaka+C.%3B+Asano+T.%3B+Miyamori+T.&atitle=Soyb
  27. Setiarto RHB, Widhyastuti N, Saskiawan I, Safitri RM. Pengaruh Variasi Konsentrasi Inulin Pada Proses Fermentasi Oleh Lactobacillus acidophilus, Lactobacillus bulgaricus Dan Streptococcus thermophilus. Biopropal Ind. 2016;8(June):1–17
  28. Zang J, Liu AX, Qi L. The cytological mechanism and effects of hypertensive cerebral hemorrhage treatment by citicoline on serum GFAP and copeptin level. Eur J Inflamm. 2019;17
  29. Andriani A, Prijanti AR, Mudjihartini N, Jusman SWA. Dampak Hipoksia Sistemik terhadap Malondialdehida, Glial Fibrillary Acidic Protein dan Aktivitas Asetilkolin Esterase Otak Tikus. eJournal Kedokt Indones. 2016;4(2)
  30. Ren C, Kobeissy F, Alawieh A, Li N, Li N, Zibara K, et al. Assessment of serum UCH-L1 and GFAP in acute stroke patients. Sci Rep. 2016;14(6):1–9
  31. Lotosh NG, Savel’Eva EK, Selishcheva AA, Savel’Ev S V. Autoantibodies to neuron-specific proteins S100, GFAP, MBP, and NGF in the serum of rats with streptozotocin-induced diabetes. Bull Exp Biol Med. 2013;155(1):48–51
  32. Ji M, Li S, Dong Q, Hu W. Impact of an early high-protein diet on neurofunctional recovery in rats with ischemic stroke. Med Sci Monit. 2018;24:2235–43
  33. Aquilani R, Scocchi M, Iadarola P, Franciscone P, Verri M, Boschi F, et al. Protein supplementation may enhance the spontaneous recovery of neurological alterations in patients with ischaemic stroke. Clin Rehabil. 2008;22(12):1042–50
  34. Tykhomyrov AA, Kushnir YS, Nedzvetsky VS, Grinenko T V., Kuryata O V. Citicoline affects serum angiostatin and neuro specific protein levels in patients with atrial fibrillation and ischemic stroke. Ukr Biochem J. 2019;91(5):34–45
  35. Hoffman JD, Yanckello LM, Chlipala G, Hammond TC, McCulloch SD, Parikh I, et al. Dietary inulin alters the gut microbiome, enhances systemic metabolism, and reduces neuroinflammation in an APOE4 mouse model. PLoS One. 2019;14(8):1–22
  36. Baydas G, Reiter RJ, Yasar A, Tuzcu M, Akdemir I, Nedzvetskii VS. Melatonin reduces glial reactivity in the hippocampus, cortex, and cerebellum of streptozotocin-induced diabetic rats. Free Radic Biol Med. 2003;35(7):797–804
  37. Silva YP, Bernardi A, Frozza RL. The Role of Short-Chain Fatty Acids From Gut Microbiota in Gut-Brain Communication. Front Endocrinol (Lausanne). 2020;11(January):1–14
  38. Dennis M. Routine oral nutritional supplementation for stroke patients in hospital (FOOD): A multicentre randomized controlled trial. Lancet. 2005;365(9461):755–63
  39. Alvarez-Sabín J, Ortega G, Jacas C, Santamarina E, Maisterra O, Ribo M, et al. Long-term treatment with citicoline may improve poststroke vascular cognitive impairment. Cerebrovasc Dis. 2013;35(2):146–54
  40. Clark WM, Wechsler LR, Sabounjian LA, Schwiderski UE. A phase III randomized efficacy trial of 2000 mg citicoline in acute ischemic stroke patients. Neurology. 2001;57(9):1595–602
  41. Manor I, Magen A, Keidar D, Rosen S, Tasker H, Cohen T, et al. Safety of phosphatidylserine containing omega3 fatty acids in ADHD children: A double-blind placebo-controlled trial followed by an open-label extension. Eur Psychiatry. 2013;28(6):386–91
  42. Tuncay P, Arpaci F, Doganay M, Erdem D, Sahna A, Ergun H, et al. Use of standard enteral formula versus enteric formula with prebiotic content in nutrition therapy: A randomized controlled study among neuro-critical care patients. Clin Nutr ESPEN [Internet]. 2018;25:26–36. Available from: https://doi.org/10.1016/j.clnesp.2018.03.123

Last update:

No citation recorded.

Last update: 2024-11-20 22:35:53

No citation recorded.