Pharmacologic Resuscitation: Cell Protective Mechanisms of Histone Deacetylase Inhibition in Lethal Hemorrhagic Shock1

Muhammad U. Butt, Elizabeth A. Sailhamer, Yongqing Li, Baoling Liu, Fahad Shuja, George C. Velmahos, Marc deMoya, David R. King, Hasan B. Alam*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Background: We have demonstrated that valproic acid (VPA), a histone deacetylase inhibitor (HDACI), can improve animal survival after hemorrhagic shock, and protect neurons from hypoxia-induced apoptosis. This study investigated whether VPA treatment works through the c-Jun N-terminal kinase (JNK)/Caspase-3 survival pathways. Methods: Wistar-Kyoto rats underwent hemorrhagic shock (60% blood loss over 60 min) followed by post-shock treatment with VPA (300 mg/kg), without any additional resuscitation fluids. The experimental groups were: (1) Sham (no hemorrhage, no resuscitation), (2) no resuscitation (hemorrhage, no resuscitation), and (3) VPA treatment. The animals were sacrificed at 1, 6, or 24 h (n = 3/timepoint), and liver tissue was harvested. Cytosolic and nuclear proteins were isolated and analyzed for acetylated histone-H3 at lysine-9 (Ac-H3K9), total and phosphorylated JNK, and activated caspase-3 by Western blot. Results: Hemorrhaged animals were in severe shock, with mean arterial pressures of 25-30 mmHg and lactic acid 7-9 mg/dL. As expected, only the VPA treated animals survived to the 6- and 24-h timepoints; none of the non-resuscitated animals survived to these time points. Treatment of hemorrhaged animals with VPA induced acetylation of histone H3K9, which peaked at 1 h and returned back to normal by 24 h. Hemorrhage induced phosphorylation of JNK (active form) and increased activated caspase-3 levels, representing a commitment to subsequent cell death. Treatment with VPA decreased the phospho-JNK (P = 0.06) expression at 24 h, without changing the total levels of JNK (P = 0.89), and this correlated with attenuation of activated caspase-3 at 24 h (P = 0.04), compared with the non-resuscitated animals. Conclusion: Treatment with HDACI, induces acetylation of histone H3K9, and reduces JNK phosphorylation and subsequent caspase-3 activation. This discovery establishes for the first time that HDACI may protect cells after severe hemorrhage through modulation of the JNK/caspase-3 apoptotic pathway.

Original languageEnglish (US)
Pages (from-to)290-296
Number of pages7
JournalJournal of Surgical Research
Issue number2
StatePublished - Oct 2009
Externally publishedYes


  • acetylation
  • hemorrhage
  • liver
  • resuscitation
  • shock
  • valproic acid

ASJC Scopus subject areas

  • Surgery


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