The increase of serum Bcl‑2 concentration in moderate head injury outcome: The role of ACTH4‑10Pro8‑Gly9‑Pro10

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ORIGINAL ARTICLE

The increase of serum Bcl‑2 concentration in
moderate head injury outcome: The role of
ACTH4‑10Pro8‑Gly9‑Pro10
Rr Suzy Indharty
Department of Neurosurgery, University of Sumatera Utara, Medan, Indonesia

ABSTRACT
Background: Traumatic brain injury (TBI) is one of the major causes of death and disability. Apoptosis after TBI contributes
significantly to the final extent of tissue damage. The Bcl‑2 family proteins are important apoptosis modulators which
increased in injured neurons. Bcl‑2 has shown an antiapoptotic effect in rats and mice. ACTH4‑10Pro8‑Gly9‑Pro10 is a synthetic
short fragment of ACTH devoid of hormonal effects and has neuromodulatory properties. ACTH4‑10Pro8‑Gly9‑Pro10 has been
shown to increase levels of Bcl‑2 and BDNF in vitro as well as in vivo. It has been postulated that ACTH4‑10Pro8‑Gly9‑Pro10
will result in improved clinical outcome and reduce hospital length of stay. The goal of this study is to compare the effect
of standard therapy only with standard therapy and ACTH4‑10Pro8‑Gly9‑Pro10, the increase of Bcl‑2, and clinical outcome
with reduction of hospital stay.
Materials and Methods: Subjects of moderate head injury (MHI) with no indication of surgery were taken
consecutively (n = 40) and separated into two groups: standard treatment only and standard treatment combined with
ACTH4‑10Pro8‑Gly9‑Pro10. Blood samples were taken on day 1 and day 5 from each subject for measurements of Bcl‑2
concentration. Barthel Index and MMSE were measured, at discharge and hospital length of stay was noted.
Results: Forty subjects have been involved in this study, three subjects died in the standard therapy group, and one
subject in ACTH4‑10Pro8‑Gly9‑Pro10 group. Bcl‑2 serum level in standard therapy was 1.39 ± 0.75 ng/mL on day 1 and
1.48 ± 0.77 ng/mL on day 5. After treatment with ACTH4‑10Pro8‑Gly9‑Pro10, Bcl‑2 level was 1.39 ± 0.70 ng/mL on day 1
and 3.70 ± 1.02 ng/mL on day 5. The serum Bcl‑2 concentration was significantly increased with ACTH4‑10Pro8‑Gly9‑Pro10
therapy with shorter hospital length of stay (P