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Chu D, Li X, Qu X, Diwan D, Warner DS, Zipfel GJ, Sheng H. SIRT1 Activation Promotes Long-Term Functional Recovery After Subarachnoid Hemorrhage in Rats. Neurocrit Care 2023; 38:622-632. [PMID: 36224490 DOI: 10.1007/s12028-022-01614-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/19/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND An increase in sirtuin 1 (SIRT1) reportedly attenuates early brain injury, delayed cerebral ischemia, and short-term neurologic deficits in rodent models of subarachnoid hemorrhage (SAH). This study investigates the effect of resveratrol, a SIRT1 activator, on long-term functional recovery in a clinically relevant rat model of SAH. METHODS Thirty male Wistar rats were subjected to fresh arterial blood injection into the prechiasmatic space and randomized to receive 7 days of intraperitoneal resveratrol (20 mg/kg) or vehicle injections. Body weight and rotarod performance were measured on days 0, 3, 7, and 34 post SAH. The neurologic score was assessed 7 and 34 days post SAH. Morris water maze performance was evaluated 29-33 days post SAH. Brain SIRT1 activity and CA1 neuronal survival were also assessed. RESULTS Blood pressure rapidly increased in all SAH rats, and no between-group differences in blood pressure, blood gases, or glucose were detected. SAH induced weight loss during the first 7 days, which gradually recovered in both groups. Neurologic score and rotarod performance were significantly improved after resveratrol treatment at 34 days post SAH (p = 0.01 and 0.04, respectively). Latency to find the Morris water maze hidden platform was shortened (p = 0.02). In the resveratrol group, more CA1 neurons survived following SAH (p = 0.1). An increase in brain SIRT1 activity was confirmed in the resveratrol group (p < 0.05). CONCLUSIONS Treatment with resveratrol for 1 week significantly improved the neurologic score, rotarod performance, and latency to find the Morris water maze hidden platform 34 days post SAH. These findings indicate that SIRT1 activation warrants further investigation as a mechanistic target for SAH therapy.
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Affiliation(s)
- Dongmei Chu
- Multidisciplinary Neuroprotection Laboratories, Center for Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA
- Department of Pediatrics, The Fifth Central Hospital of Tianjin, Tanggu District, Tianjin, China
| | - Xuan Li
- Multidisciplinary Neuroprotection Laboratories, Center for Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Xingguang Qu
- Multidisciplinary Neuroprotection Laboratories, Center for Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA
- Intensive Care Unit, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei, China
| | - Deepti Diwan
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - David S Warner
- Multidisciplinary Neuroprotection Laboratories, Center for Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Department of Neurobiology, Duke University Medical Center, Durham, NC, USA
| | - Gregory J Zipfel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Huaxin Sheng
- Multidisciplinary Neuroprotection Laboratories, Center for Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA.
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Dhandapani S, Singh A, Singla N, Praneeth K, Aggarwal A, Sodhi HB, Pal SS, Goudihalli S, Salunke P, Mohindra S, Kumar A, Gupta V, Chhabra R, Mukherjee KK, Tewari MK, Khandelwal N, Mathuriya SN, Khosla VK, Gupta SK. Has Outcome of Subarachnoid Hemorrhage Changed With Improvements in Neurosurgical Services? Stroke 2019; 49:2890-2895. [PMID: 30571395 DOI: 10.1161/strokeaha.118.022865] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background and Purpose- Though reports suggest decreasing fatality rates of subarachnoid hemorrhage with time, trends in outcome are not reported much especially from developing countries. This study was to analyze changes in outcome across 2 decades and elucidate probable factors. Methods- Prospective databases during 1996 to 2015 were reviewed for neurological outcome at 3 months in relation to demographics, Hunt and Hess grade, Fisher grade, and definitive treatment; and compared between 2 decades, contrasted by establishment of intensive care unit with continuous monitoring and other advancements. Univariate and multivariate analyses were performed. Results- Of the total 2039 patients, 1035 were managed in the former and 1004 in the recent decades. Compared with the former decade, there is delayed age at presentation (46 versus 49 years, P<0.001), poorer Fisher grades (81% versus 87%, P<0.001), and more patients with Hunt and Hess grade 2 (24% versus 39%, P<0.001) in the recent decade. While all patients in databases of the former decade had undergone clipping, 6% in the recent decade underwent coiling. 11% in the recent decade could not undergo definitive treatment. Despite this, there was significantly higher overall favorable outcome (50% versus 60%; odds ratio, 1.5; P<0.001) in recent decade. Favorable outcome of surgical clipping per se improved significantly from 50% to 67% (odds ratio 2.0; P<0.001). Though the improvement was across subgroups, it was more marked among Hunt and Hess grade 3 and Fisher grades 3 and 4. In multivariate analyses, both overall outcome (adjusted odds ratio, 1.7; 95% CI, 1.4-2.1; P<0.001) and surgical outcome (adjusted odds ratio, 1.8; 95% CI, 1.5-2.2; P<0.001) were significantly better in recent decade, independent of known prognostic factors. Conclusions- This is probably the first report to show independent improvement in outcome of subarachnoid hemorrhage with betterment in neurosurgical services from developing country. Dedicated intensive care unit care and focused management protocols could be the likely causes for improvement. Resource-constrained institutions may target patients in Hunt and Hess grade 3 and Fisher grades 3 and 4 for optimal intensive care unit utilization.
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Affiliation(s)
- Sivashanmugam Dhandapani
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Apinderpreet Singh
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Navneet Singla
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kokkula Praneeth
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ashish Aggarwal
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Harsimrat B Sodhi
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sudhir S Pal
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sachin Goudihalli
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Pravin Salunke
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sandeep Mohindra
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ajay Kumar
- Department of Neuroradiology (N.K., A.K., V.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Vivek Gupta
- Department of Neuroradiology (N.K., A.K., V.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Rajesh Chhabra
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kanchan K Mukherjee
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Manoj K Tewari
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Niranjan Khandelwal
- Department of Neuroradiology (N.K., A.K., V.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Suresh N Mathuriya
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Virender K Khosla
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sunil K Gupta
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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