Therapeutic potential of nitric oxide and its donors in hemorrhagic and ischemic stroke: a systematic review.

In 30 seconds

This systematic review examined nitric oxide (NO) and NO donors in hemorrhagic and ischemic stroke, drawing on experimental and clinical research. It describes NO as potentially neuroprotective through vasodilation and antithrombotic effects, but also potentially neurotoxic through oxidative stress and glutamate excitotoxicity. These effects vary with concentration, source, stroke subtype, and timing. Experimental studies suggest possible benefit, but clinical translation remains limited; the review emphasizes that intervention timing may affect outcomes and that evidence is particularly scarce for intracerebral hemorrhage.

Key findings

• NO may protect or harm neural tissue, with effects depending on its concentration, timing, and source.
• The potential efficacy of NO-based interventions varies by stroke subtype and when treatment is administered.
• Clinical evidence is limited, particularly for NO donors in intracerebral hemorrhage, and larger trials are needed to assess efficacy and safety.

Why it matters

The review highlights why NO-based approaches cannot be considered uniformly beneficial across stroke: vascular effects may be offset by neurotoxicity, and the balance may change over time and between stroke types. This distinction is relevant when interpreting experimental findings and considering translation to patient care, where evidence remains insufficient to establish optimal timing, dosing, or long-term effects.

What to keep in mind

The review reports limited clinical studies, especially in intracerebral hemorrhage; translation from animal studies and long-term neurological effects remain uncertain.