Celery seed-derived drug beneficial in ischaemic stroke patients

Butylphthalide, a novel medication that contains a compound found in celery, appears to help with functional recovery in patients with ischaemic stroke, as shown in a study presented at ISC 2023.

“Patients who received butylphthalide had less severe neurological symptoms and a better living status at 90-days poststroke compared to those who received the placebo,” reported the study’s co-author Dr Baixue Jia, an attending physician in interventional neuroradiology in the Beijing Tiantan Hospital of Capital Medical University and a faculty member at the China National Clinical Research Center for Neurological Diseases, both in Beijing, China.

In a cohort of patients with acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator (rt-PA) and/or endovascular treatment (EVT), butylphthalide was associated with a 1.7-fold greater odds of having a favourable outcome 90 days after the index event as compared with placebo (56.7 percent vs 44.0 percent; odds ratio [OR], 1.70, 95 percent confidence interval [CI], 1.35–2.14; p<0.001). [ISC 2023, abstract 90]

Favourable outcome was defined as a modified Rankin Scale (mRS) score of 0 in patients with a baseline National Institutes of Health Stroke Scale (NIHSS) score of 4–7, an mRS score of 0–1 in those with a baseline NIHSS score of 8–14, and an mRS score of 0–2 in patients with a baseline NIHSS score of 15–25.

Meanwhile, secondary events such as recurrent stroke and intracranial haemorrhage did not significantly differ in the butylphthalide and placebo arms.

“If the results are confirmed in other trials, this may lead to more options to treat strokes caused by clots,” said Jia.

Butylphthalide is a cerebro-protective drug that was originally extracted from seeds of Apium graveolens, which is known as celery. Already, the drug has shown therapeutic potential in animal models of ischaemia-reperfusion in preclinical experiments. [Neural Regenerat Res 2011;6:2773-2778; Neurochem Int 2012; 60:134-144; Acta Pharmacol Sin 2003;24:796-804]

“This is the first trial to show the benefit of using a medication that protects the brain from damage caused by a lack of oxygen to brain tissue,” Jia said.

The double-blinded trial included 1,216 adult patients (average age 66 years, 68 percent men) who were initially treated with rt-PA or EVT. These patients were also randomly assigned to receive either butylphthalide (n=607) or a look-alike placebo (n=609), administered as intravenous injection daily for the first 14 days, then as oral capsules for the next 76 days.

Dr Daniel Lackland, director of the Division of Translational Neurosciences and Population Studies at the Medical University of South Carolina in Charleston, South Carolina, US, who was not involved in the trial, commented on the study: “While these are interesting results, this is only one relatively small study on a fairly select population in China.

“Butylphthalide is not ready for use in standard stroke treatment,” Lackland asserted, adding however that the results of the trial warrant further consideration.

“The medication used in this study is not the same as celery seed or celery seed extract supplements. Stroke survivors should always consult with their neurologist or healthcare professional regarding diet after a stroke,” Lackland said.