The effect of ACTH4-10Pro8Gly9Pro10 and HMG-CoA reductase inhibitor in moderate head injury: clinical outcome and serum Bcl-2 concentration

Background: an important component of brain tissue damage is apoptotic neuronal death. bcl-2 is an anti-apoptotic protein, which inhibits the intrinsic pathway of apoptosis. acth4-10pro8gly9pro10 and hmg-coa reductase inhibitor are known for their neuroprotective effects. this study aimed to compare the effect of standard therapy, acth4-10pro8gly9pro10, and hmgcoa reductase inhibitor (simvastatin 40 mg/day) on serum bcl-2 levels, clinical outcome, and reduction of hospital stay. methods: sixty subjects with moderate head injury without any indication for surgery were taken consecutively and separated into three groups: standard treatment only (control group), standard treatment combined with acth4-10pro8gly9pro10, and standard treatment combined with inhibitor of hmg-coa reductase. blood samples were taken on day-1 and day-5 from each subject for measurement of bcl-2 concentration. barthel index and mmse were measured at discharge and hospital length of stay was noted. difference in mean was analyzed with one way anova and correlation between bcl-2 and clinical outcome was measured with pearson correlation test. results: bcl-2 serum levels on day-1 and day-5 were tespectively as follows: in control group were 1.39 ± 0.75 and 1.48 ± 0.77 ng/ml; in acth4-10pro8gly9pro10 group 1.39 ± 0.70 and 3.70 ± 1.01 ng/ml which was significantly higher compared to other groups and associated with the shortest length of stay. in simvastatin group, 1.53 ± 0.55 and 2.17 ± 0.56 ng/ml. we found the length of stay in the acth4-10pro8gly9pro10 group to be significantly shorter (p < 0.001). the correlation of clinical outcome (barthel index and mmse) with serum bcl-2 levels was not significant.conclusion: acth4-10pro8gly9pro10 significantly increased serum bcl-2 concentration in head injury and associated with shorter length of stay. an increase of serum bcl-2 concentration was also found in simvastatin group, but it was not significant.