BACKGROUND S-Nitrosoglutathione (GSNO) is a nitric oxide donor that has been investigated for neuroprotective and neuro-recovery effect. We aimed to conduct a systematic review on the published literatures using GSNO in both pre-clinical and clinical stroke studies. METHODS We searched PubMed up to June 30, 2019, using the following keywords: S-Nitrosoglutathione, GSNO, stroke, cerebrovascular, carotid arteries, middle cerebral artery, and middle cerebral artery occlusion. Only studies published in the English language providing efficacy results of GSNO on ischemic stroke were included. Stroke Therapy Academic Industry Roundtable (STAIR) score was used to assess the quality of pre-clinical studies and PEDro score for clinical trials. A meta-analysis was conducted to compare the effect size. RESULTS Of 39 articles identified, 10 (6 for pre-clinical and 4 for clinical studies) met the eligibility criteria and were included. The median STAIR score across the pre-clinical studies was 5.5 (range: 4-7), and the median PEDro score for the 4 clinical trials was 10 (ranged: 6 to 10). Among the 6 pre-clinical studies, GSNO reduced infarct size in 6 studies and improved neurological behavior scales in 5 studies compared to placebo. Inverse-variance weighted linear meta-analysis of standardized mean difference (Hedge's g) on 4 human studies revealed a big effect size (Hedge's g = -0.82, 95% CI: [-1.26, -0.38], P = .0003) favoring the GSNO group in term of reducing embolic signals. I2 value was 0 across the included clinical studies in the meta-analysis. CONCLUSIONS Pre-clinical studies showed positive benefit of GSNO in animal stroke models. The meta-analysis of clinical studies demonstrated that GSNO is effective in reducing embolic signals in patients with symptomatic internal carotid artery stenosis undergoing carotid endarterectomy or stenting. Further investigation of this molecule is warranted.

中文翻译：

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脑卒中中S-亚硝基谷胱甘肽的研究：临床前和临床研究文献的系统评价和荟萃分析。

背景技术S-亚硝基谷胱甘肽（GSNO）是一氧化氮供体，已经对其神经保护和神经恢复作用进行了研究。我们旨在对临床前和临床卒中研究中使用GSNO的文献进行系统的综述。方法我们使用以下关键字搜索截至2019年6月30日的PubMed：S-硝基谷胱甘肽，GSNO，中风，脑血管，颈动脉，大脑中动脉和大脑中动脉闭塞。仅包括以英语发表的提供GSNO对缺血性中风功效结果的研究。中风疗法学术行业圆桌会议（STAIR）得分用于评估临床前研究的质量和临床试验的PEDro得分。进行荟萃分析以比较效应大小。结果在确定的39篇文章中，10名（临床前6名，临床研究4名）符合资格标准并被纳入研究。临床前研究的STAIR评分中位数为5.5（范围：4-7），而4项临床试验的PEDro评分中位数为10（范围：6至10）。与安慰剂相比，在6项临床前研究中，GSNO在6项研究中减少了梗塞面积，在5项研究中改善了神经行为量表。对4项人体研究的标准化均值差（Hedge's g）进行的方差加权线性荟萃分析显示，效应大小较大（Hedge's g = -0.82，95％CI：[-1.26，-0.38]，P = .0003） GSNO组在减少栓塞信号方面。在荟萃分析中纳入的所有临床研究中，I2值为0。结论临床前研究表明，GSNO在动物卒中模型中具有积极的益处。临床研究的荟萃分析表明，对于有症状的颈内动脉狭窄或接受颈动脉内膜切除术或支架置入术的患者，GSNO可有效减少栓塞信号。有必要对该分子进行进一步研究。