Research for Intrinsic Regulation against Cerebral Vasospasm and Ischemia after Aneurysmal Subarachnoid Hemorrhage

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We clarified the potential role of an inducible heme-metabolizing enzyme, heme oxygenase(HO)-1, and an inducible iron-detoxifying protein, ferritin, in cerebral vasospasm after aneurysmal subarachnoid hemorrhage(SAH). The authors measured the levels of bilirubin and iron, which are by-products of HO-1, and the ferritin levels in the cerebrospinal fluid after SAH, and determined the relation between these by-products of HO-1 or ferritin and vasospasm. The levels of ferritin, bilirubin and iron were all significantly elevated after SAH. The levels of ferritin and bilirubin were significantly higher in the group with no vasospasm than in the group with, asymptomatic and symptomatic vasospasm on Days 5 through 7 (P<0.05,respectively) and on Days 11 through 14 (P<0.025 in bilirubin) post-SAH. However, no significant difference was observed in the iron levels between these groups. In summary, this study showed that higher levels of bilirubin and ferritin in the cerebrospinal fluid after SAH were associated with no vasospasm. These findings support the concept that the induction of HO-1 and ferritin may be an intrinsic regulatory mechanism that acts against cerebral vasospasm.