The Potential Effect of Omega3 Supplement in Fish Oil on Infarced Areas in the Brain and Improvement of Neurological Functions fo Ischemic Stroke Patients

Introduction and Background According to the Center of Disease Control and Prevention, stroke is the 5th leading cause of mortality in the US, and a leading cause of significant long-term disability where almost 50% of stroke survivors, age 65 and above, suffer from disabling decrease in mobility. In its simplest form, an ischemic stroke is a decrease in the blood flow to a certain area in the brain, due to a clot, stenosis or other cause, which lasts long enough to cause permanent cellular injury and death and by extension, disability [1]. However, much more goes into that process.

The decreased blood flow to the tissue leads to the primary insult caused by ischemia which leads to direct and immediate cell death. Meanwhile, the tissue surrounding this ischemic area gets affected by the inflammation in the ischemic area, but maintains its viability and is called the penumbra. Later on, this penumbra gets affected by the immune response and toxic inflammatory mediators released in the ischemic area. Which ultimately results in axonal structural changes and subsequent neuronal damage (secondary insult.) The main attention of this paper is looking into the prevention of secondary insult and preserving the penumbra which carries a neurorestorative capacity that is diminished by the inflammatory response and the possibility of restoring the damaged area by neurogenesis as will be explained later. As a result, improving the disability caused by the ischemic event [2].

Currently, the only FDA approved treatments of stroke are Tissue Plasminogen Activator (tPA) and Trevo which is a clot removal device, introduced in 2012. However, the group harvesting the benefits of those treatments are fairly limited. For example, tPA has many contraindications in addition to a narrow window of application of 4.5 hours from the start of symptoms. Trevo can only be used within 6 hours as well (extended to 24h in certain cases) [3]. Furthermore, a major downside that plagues these interventions is the ischemia/reperfusion injury. I/R injury is characterized by reduced vascular relaxation and perfusion, increased macromolecular permeability and an intense inflammatory response derived by reactive oxygen species (ROS) from the ischemic area [2].

Other interventions are being currently studied in the preclinical setting which is aimed at enhancing and supporting the activity of neurons and neural progenitor cells and promoting long-term functional recovery. Rather than concentrating on restoring blood flow, these interventions are aimed towards inducing neuroprotection and saving brain function in the long term. One such example, is omega-3 essential polyunsaturated fatty acids (PUFA n3) specifically docosahexaenoic acid (DHA, 22:6, n-3) and eicosapentaenoic acid (EPA, 20:5, n-3), to a lesser extent. They have been shown to have a profound effect on decreasing the neuroinflammation in the brain tissue of animal models after an acute stroke in addition to its positive effects on cognitive function and neurodevelopment [4,5]. Furthermore, studies conducted on mice such as the one conducted by José Pedro De La Cruz et al has shown great neuroprotective qualities and a significant reduction in post-stroke neuroinflammation using olive oil and acetylsalicylic acid [6].

Considering all that which have been mentioned in our introduction, the investigators have set several objectives for this paper. First of all, studying the effects of using * omega-3* as a safe and effective measures to prevent neuroinflammation after an ischemic event and how can this affect the process of neurogenesis and subsequently and effect on patient disability by using olive oil as one of the resources of omega-3.