Efficacy of polyarginine peptides in the treatment of stroke: A systematic review and meta‐analysis

• Published in: Brain and behavior Vol. 13; no. 1; pp. e2858 - n/a
• Main Authors: Tahmasbi, Fateme, Madani Neishaboori, Arian, Mardani, Mahta, Toloui, Amirmohammad, Komlakh, Khalil, Azizi, Yaser, Yousefifard, Mahmoud
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.01.2023; John Wiley and Sons Inc; Wiley
• Subjects: Animals; Bias; brain edema; Edema; functional status; Humans; Infarction; Ischemia; Meta-analysis; Peptides; polyarginine; Review; Reviews; Stroke; Stroke - drug therapy; Stroke Rehabilitation; Systematic review; Australia; infarction; brain edema; Stroke; functional status; polyarginine
• ISSN: 2162-3279; 2162-3279
• DOI: 10.1002/brb3.2858

Background Disparities exist regarding an efficient treatment for stroke. Polyarginines have shown promising neuroprotective properties based on available published studies. Thus, the present study aims to systemically review and analyze existing evidence regarding polyarginine's administration efficacy in animal stroke models. Method Medline, Scopus, Embase, and Web of Science were systematically searched, in addition to manual search. Inclusion criteria were administrating polyarginine peptides in stroke animal models. Exclusion criteria were previous polyarginine administration, lacking a control group, review articles, and case reports. Data were collected and analyzed using STATA 17.0; a pooled standardized mean difference (SMD) with a 95% confidence interval (CI), meta‐regression, and subgroup analyses were presented. Risk of bias, publication bias, and level of evidence were assessed using SYRCLE's tool, Egger's analysis, and Grading of Recommendations Assessment, Development and Evaluation framework, respectively. Results From the 468 searched articles, 11 articles were included. Analyses showed that R18 significantly decreases infarct size (SMD = –0.65; 95% CI: –1.01, –0.29) and brain edema (SMD = –1.90; 95% CI: –3.28, –0.51) and improves neurological outcome (SMD = 0.67; 95% CI: 0.44, 0.91) and functional status (SMD = 0.55; 95% CI: 0.26, 0.85) in stroke animal models. Moreover, R18D significantly decreases infarct size (SMD = –0.75; 95% CI: –1.17, –0.33) and improves neurological outcome (SMD = 0.46; 95% CI: 0.06, 0.86) and functional status (SMD = 0.35; 95% CI: 0.16, 0.54) in stroke models. Conclusion Moderate level of evidence demonstrated that both R18 and R18D administration can significantly improve stroke outcomes in animal stroke models. However, considering the limitations, further pre‐clinical and clinical studies are warranted to substantiate the neuroprotective efficacy of polyarginines for stroke. The findings are summarized in the above figure. Both R18 and R18D showed promising effects on decreasing the infarct size, enhancing functional status, and improving neurological outcome in animal models of stroke. In addition, R18 administration was effective in decreasing brain edema as well.