Inhibition of growth of a transplanted rat pancreatic acinar carcinoma with CCK-8

Gastrointestinal hormones and neuropeptides are known to regulate growth of various normal gastrointestinal tissues and many cancers. Since cholecystokinin (CCK) is considered the most potent trophic factor for the exocrine pancreas, we studied its effect on growth of an acinar cell tumor, initially induced by azaserine and transplanted to the rat, in comparison with the normal pancreas. When tumors became palpable, rats were treated three times daily for 12 or 14 days with CCK-8 or NaCl 0.9% (controls) alone or in combination with the CCK receptor antagonist CR1409 (10 mg/kg) administered subcutaneously twice daily. Then tumors and pancreata were analyzed for their size, composition, and CCK receptors. Tumor volume, weight, and protein content, RNA, DNA, and enzymes decreased after CCK-8 treatment in a dose-dependent manner, the maximal effect being observed with 4-micrograms/kg treatment. This inhibitory effect was partially suppressed by CR1409, which by itself also reduced tumor growth, but to a lesser degree. CCK-8 exerted a stimulating effect on growth of the normal pancreas with low doses (1 and 2 micrograms/kg) and an inhibitory effect or no effect with a higher dose (4 micrograms/kg). CR1409 prevented this latter effect, but did not affect by itself the normal pancreas. These findings suggest that CCK-8 inhibits growth of an acinar cell tumor grafted to the rat; this effect is mediated by the occupation of specific CCK receptors present in high density on these cells. In contrast, CCK-8 exerts a biphasic effect on the normal pancreas as a function of its dose.

Intra-abdominal photodynamic therapy: from theory to feasibility

Photodynamic therapy is a new anticancer technique, directed at the selective destruction of neoplastic tissue, which has been used in the treatment of superficial or intraluminal lesions. The technique has now reached the stage where it can be considered in the peroperative management of gastrointestinal tumours, for example in an attempt to eradicate micrometastases in the tissue around the primary tumour or in residual lymph nodes after curative resection. Many practical problems remain to be solved, such as the pharmacokinetics of photosensitizers, the dosimetry of illumination and the sensitivity of intra-abdominal organs. An experimental and clinical evaluation is in progress to assess the feasibility of photodynamic therapy in surgical practice.

In vitro resistance of artificial connective tissues to human bile and pancreatic juice

The resistance of connective tissue generated from elastin, placenta extracts and human collagen was tested by in vitro incubation with bile and pancreatic juice to investigate the potential use in human digestive surgery. The resistance, determined by macroscopical and microscopical examinations, has been directly compared to those of bovine collagen matrices (Spongel, Pangen, Helistat, Translagen). Only the compact and cross-linked human collagen patch resisted both bile and pancreatic juice. All other biomaterials tested dissolved either in bile or in pancreatic juice. The in vivo behaviour of this new human collagen matrix and its involvement in gastrointestinal wound healing must now be investigated.

Diffusion properties of an artificial membrane used for Langerhans islets encapsulation: an in vitro test

Glucose and insulin permeability of an artificial membrane (AN69, HOSPAL, Sweden) used for Langerhans islets encapsulation were investigated. In vivo, a 1 and 7 d intraperitoneal implantation of the AN69 membrane in rats induced a loss of permeability towards glucose and insulin probably due to a protein-coating performed after implantation. In vitro, a protein-coating of the AN69 membrane with fetal calf serum solution reproduced similar results. Thus this in vitro test which mimicks in vivo conditions should be proposed to evaluate rapidly the physicochemical properties of a membrane suitable for pancreatic islets encapsulation.

[Photodynamic therapy in oncological digestive tract surgery]

Photodynamic therapy is a useful new antitumoral treatment, since it is relatively selective and noniatrogenic. The photosensitizers become preferentially localized in the tumoral tissue, where their excitation by light causes the production of free cytotoxic radicals. If haematoporphyrin derivatives are the most widely used photosensitizers, numerous molecules are being tested. Now used as a palliative photodynamic therapy could logically be used as adjuvant treatment in curative surgical excision. The practical utility of peroperative photodynamic therapy in gastroenterological surgery is being evaluated experimentally and clinically.

Inhibition of the growth of transplanted rat pancreatic acinar carcinoma with octreotide

The effects of octreotide on transplanted azaserine-induced pancreatic acinar tumours were investigated in the rat. When tumours became palpable, rats were treated either with octreotide (40 micrograms/kg per day, by infusion) or NaCl 0.9% (controls) for 14 days. Tumours were then analysed for their size, composition and somatostatin receptors. Octreotide induced a 80% reduction in tumour growth rate during the first 2 days of treatment. This rate was less marked from day 4 to day 15. The tumour weight, protein, DNA, RNA and enzyme content were reduced in parallel by 50 to 60%. A homogeneous distribution density and a high affinity of somatostatin receptors were found by receptor autoradiography and in vitro binding assays in tumours of both groups. These findings indicate that octreotide reduces the growth rate of the transplanted pancreatic acinar tumour and may exert its inhibitory effect directly via specific somatostatin receptors on tumour cells.

In vitro and in vivo studies of the properties of an artificial membrane for pancreatic islet encapsulation

Encapsulation of pancreatic islets with an artificial membrane has been proposed as a means of immunoprotection after transplantation. Such a membrane should be biocompatible, nondegradable, and should allow the passage of insulin and glucose while preventing that of antibodies and lymphocytes. Thus, we have studied in vitro and in vivo, the characteristics of an acrylonitrile membrane (AN69, HOSPAL, Sweden) for islet encapsulation. The AN69 membrane composed of a fiber network with a porous structure, allowed a satisfactory passage of glucose (75% of the initial amount within one hour) but not of insulin (only 7%). The morphological state of rat islets cultured on membranes under both conditions for 2 weeks was similar to that of islets cultured on dishes; in addition rat fibroblasts retracted after a 3-day culture. Finally, the membrane was unaltered after a 12 month implantation in the peritoneal cavity of rats. When the surface properties of the AN69 membrane were changed by adsorption of a hydrophilic copolymer or by protein coating, the permeability of the membrane was modified. Glucose and insulin diffusion were significantly decreased after protein-coating, whereas glucose diffusion was preserved and that of insulin doubled after adsorption of a copolymer onto the membrane. In addition, after a 12-month implantation in the rat, the membrane surface treated by the copolymer was altered leading to the adhesion of macrophages. In conclusion, the AN69 acrylonitrile membrane may be useful for pancreatic islet encapsulation; its insulin permeability should be increased by a surface treatment aimed at increasing its hydrophilic properties. However the stability of this treatment seems to be an important factor in preserving the biocompatibility of the membrane.

Prevention of anastomosis leakage: an artificial connective tissue

Anastomosis leakage still causes considerable morbidity and mortality after digestive tract surgery. We report here our experience of the use of reconstituted connective tissue created from elastin, fibronectin and collagen in preventing anastomosis leakage and closing intestinal fistulas. In animal studies (56 rats), this connective tissue was used as a patch applied with fibrin sealant to the edges of a 1 cm diameter colonic defect. In a clinical evaluation, eight patients had an intestinal fistula closed by a simple sewn suture reinforced by a sealed patch and seven patients had a high risk anastomosis reinforced by a sealed patch, in most cases as an alternative to staged surgery. In animal studies, complete reconstitution of the three colonic layers was obtained without retraction and without inflammatory reaction within 40 days, while the patch was slowly resorbed. In clinical trials all 15 defects and anastomoses healed without complication. Three patients died from other causes and, at autopsy, the patch was found to have remained in place covering the suture line. If these results are confirmed by a prospective clinical trial, such biomaterial offers the possibility of reducing the occurrence of anastomosis leakage, especially in high risk circumstances.

Effect of prolonged administration of long-acting somatostatin on caerulein, CCK-8 and GRP induced pancreatic growth in the rat

This work investigates the effects of the long-acting somatostatin analogue, octreotide also named SMS 201-995 or Sandostatin, on pancreatic growth in function of the dose and duration of treatment. Octreotide was administered s.c. twice daily, while pancreatico-trophic peptides, caerulein and CCK-8 (1.8 nmol/kg b.wt.) or GRP (3.6 nmol/kg b.wt.) were administered s.c. three times daily. Octreotide (1,10,20 micrograms/kg b.wt.) administered for 4 days reduced pancreatic growth induced by caerulein in a dose-dependent manner. This effect, significant from 10 micrograms/kg, was more obvious with 20 micrograms/kg. At this latter dose, octreotide inhibited significantly the increase in pancreatic weight and protein, RNA, DNA and enzyme content induced by a 4- or 10-day treatment with GRP. A similar effect was observed after a 4-day treatment with CCK-8, but after a 10-day treatment only protein and enzyme contents were reduced. Octreotide by itself did not affect pancreatic size and composition after a 10-day treatment, but decreased enzyme content after a 4-day treatment. It is concluded that octreotide exerts an antitrophic effect on the rat exocrine pancreas which depends on the dose and duration of treatment and can be modulated by the trophic factor applied for a long-term.

The effect of site of administration in the gastrointestinal tract on the absorption of insulin from nanocapsules in diabetic rats

Isobutylcyanoacrylate nanocapsules have been used as drug carriers for the enteral absorption of insulin. Their absorption has been studied by measuring fasted glycaemia in streptozotocin-induced diabetic rats after a single administration of encapsulated insulin (100 units kg-1) at various sites along the gastrointestinal tract. Glycaemia decreased from the second day, the intensity and duration depending on the site of administration (65% ileum, 59% stomach, 52% duodenum and jejunum, 34% colon). This hypoglycaemic effect lasted up to the 18th day after administration for ileum and jejunum, the 15th day for stomach and duodenum, and the 13th day for colon. In-vitro, nanocapsules protect insulin against proteolysis from pepsin, chymotrypsin and trypsin. These results suggest (i) that insulin is protected by nanocapsules in the gastrointestinal tract, (ii) that it is absorbed in an active form, and (iii) that ileum is the most potent site of absorption.

Malnutrition and body weight loss after biliopancreatic bypass in the rat

In this study designed to investigate the nutritional state induced by biliopancreatic bypass in the rat, the pancreatico-biliary secretions were diverted via the duodenum and jejunum into the distal ileum, the remaining intestine being directly anastomosed to the stomach after antrectomy. Bypassed animals lost weight: it was only 56 percent of that of controls after 36 days and death by cachexia resulted within two months of the procedure. The reduced food intake (16 percent less than control) at the 36th postoperative day cannot by itself explain the weight loss, since pair-fed rat weights did not differ statistically from controls at 36 days. Protein-energy malabsorption occurred: drops in serum protein concentration (25 percent less than control), triglycerides (40 percent less) and total cholesterol (28 percent less) were recorded from the 12th postoperative day on. Biliopancreatic bypass may be an adequate procedure of treatment for morbid obesity simultaneously aggravated by metabolic disorders.

Repair of experimental arteriotomy in rabbit aorta using a new resorbable elastin-fibrin biomaterial

A new artificial connective matrix which results from two reactions of fibrinogen and fibronectin on elastin was used to obturate a slit made in the abdominal aorta of rabbit. The so-called Elastin-Fibrin biomaterial behaved as a scaffold through which all the different structures were restored to their former condition. At 3 months, the material had disappeared and no thrombus, no inflammation or reject had been detected.

Some factors affecting properties of elastin-fibrin biomaterial

The elasticity, mechanical strength and permeability of a new biomaterial made of elastin and fibrin were investigated. It was shown that gamma-irradiation to sterilize the product, and sulphur derivatives (Merceptyl, thiourea, cystein) working as reticulating agents modified these properties. Depending on whether or not the biomaterial needs to be stiff, strong or elastic both physical processes could intervene separately or together. The good permeability of this material allows it to be used in several surgical fields as a true artificial connective matrix.

Pancreatic lithiasis: a rare cause of gastrointestinal hemorrhage

The rare instance of a gastrointestinal hemorrhage caused by a lithiasis of the duct of Wirsung is described. The world literature records only 13 other cases. Pancreatic calculi cause hemorrhage by either migrating through the pancreatic parenchyma to perforate the duodenum, ulcerating the vessels of the periductal parenchyma, or rupturing the pancreas. The usual sign of this complication of chronic calcifying pancreatitis, difficult to diagnose, is repeated gastrointestinal hemorrhages and sometimes pain, as in epigastric colitis. The immediate therapy is control of the hemorrhage. With transcatheter occlusive techniques, radical surgery can be postponed until it is more tolerable.

Evidence for a direct trophic effect of bombesin on the mouse pancreas: in vivo and cell culture studies

The present work studied the effect of chronic bombesin on the mouse pancreas and analyzed whether or not this effect was direct. Bombesin administered s.c. 3 times daily for 4 days at various concentrations (0.1, 1, 10, 20 micrograms/kg b. wt.) induced pancreatic growth in a dose-dependent manner. This growth was characterized by an increase in pancreatic weight, its protein and RNA contents suggesting cellular hypertrophy. Pancreatic enzyme content was also increased, especially for amylase (14-fold) and at a lesser degree for chymotrypsin and lipase (2.5-fold). The DNA content of the gland increased significantly after a 1 microgram/kg bombesin treatment suggesting hyperplasia. [3H]thymidine incorporation into DNA increased slightly from 24 h after the first bombesin injection and more obviously at 72 and 96 h indicating DNA synthesis. To determine the direct effect of bombesin on pancreatic acinar cell growth cells were cultured as monolayers on collagen gels in media lacking added hormones and containing 2.5% FBS with or without bombesin (1 microM-1 nM) or caerulein (10 nM). [3H]thymidine incorporation into DNA was increased by caerulein (10 nM) and bombesin (100 nM and 1 microM). Therefore, it is concluded that bombesin is a pancreaticotrophic peptide in mice. Moreover, it is suggested that this effect occurs directly on pancreatic cells.

Effect of a new CCK-receptor antagonist, CR 1409, on pancreatic growth induced by caerulein, CCK-8, bombesin and gastrin-releasing peptide in the rat

The effect of a peripheral cholecystokinin (CCK)-receptor antagonist, CR 1409, on pancreatic growth has been studied in the rat. 1.8 nmol/kg CCK-8 or caerulein and 3.6 nmol/kg bombesin or gastrin-releasing peptide (GRP) administered subcutaneously 3 times daily for 4 successive days increased pancreatic weight and its content in protein, enzymes and RNA but not in DNA, suggesting cellular hypertrophy. CR 1409 (10 mg/kg) administered intragastrically 30 min prior to peptides prevented pancreatic growth due to CCK-8 or caerulein but not that induced by bombesin and GRP. It is concluded that bombesin and GRP act on the exocrine pancreas directly rather than through the release of CCK.

Comparative effect of chronic bombesin, gastrin-releasing peptide and caerulein on the rat pancreas

This study was designed to compare, on a molar basis, the effect of chronic bombesin, gastrin-releasing peptide (GRP) and caerulein on pancreatic growth in the rat. These 3 peptides were administered s.c. 3 times daily for 4 days at the following concentrations: 0.036, 0.36, 3.6 and 7.2 nmol/kg of body weight. Bombesin and GRP induced pancreatic growth in a dose-dependent manner from 3.6 nmol/kg. This growth was characterized by an increase in pancreatic weight, its protein and RNA contents but not in DNA content suggesting cellular hypertrophy. Caerulein exerted a biphasic effect on pancreatic growth, inducing cellular hypertrophy at low doses since 0.36 nmol/kg and atrophy with the highest dose (7.2 nmol/kg). Bombesin and caerulein (until 3.6 nmol/kg) increased the pancreatic content in chymotrypsin more than in amylase. The 7.2 nmol/kg caerulein treatment depressed all enzyme activities while the same dose of GRP increased pancreatic lipase content. It is concluded that (1) bombesin and GRP are equipotent trophic factors for the pancreas; (2) caerulein is the most potent factor and exerts a biphasic effect on pancreatic growth; (3) pancreatic growth and synthesis and/or secretion of enzymes are not regulated through the same mechanism.

New approach for oral administration of insulin with polyalkylcyanoacrylate nanocapsules as drug carrier

Polyalkylcyanoacrylate nanocapsules (mean size 220 nm), composed of spheric polymeric structures, have been used as a drug carrier for insulin. The rate of encapsulation of insulin is 54.9%, and we studied the therapeutic efficiency of the nanocapsules in diabetic and normal rats. When administered subcutaneously, insulin-loaded nanocapsules prolonged the hypoglycemic effect of insulin; the duration of this effect increased with the doses. When administered orally by force-feeding to diabetic rats, insulin nanocapsules (12.5, 25, and 50 U/kg) decreased fasted glycemia 50-60% by day 2. This effect was maintained for 6 or 20 days with 12.5 or 50 U/kg, respectively. Only the dose of 100 U/kg decreased fed glycemia by 25% in diabetic rats. In normal rats, hyperglycemia induced by an oral glucose load was reduced by 50% with the same dose of oral insulin nanocapsules. We concluded that polyalkylcyanoacrylate nanocapsules preserve the therapeutic effect of insulin when administered orally and prolong this effect when administered subcutaneously and orally.

Influence of repeated administration of bombesin on rat pancreatic secretion

To study the effects of chronic bombesin on pancreatic growth and secretion, rats were injected subcutaneously, 3 times daily for 4 days with either saline or bombesin (10 micrograms/kg). Bombesin significantly increased the pancreatic weight and content in protein and RNA but not in DNA. The ratios of the three former parameters to DNA increased, suggesting cellular hypertrophy. The pancreatic content in enzymes was also elevated, especially for chymotrypsin and to a lesser degree for amylase. However, the volume of pancreatic secretion and the output of enzymes in response to CCK under a continuous infusion of secretin remained unchanged. The in vitro secretory response to caerulein and bombesin was reduced for amylase and lipase. It is concluded that chronic bombesin exerts a trophic action on the rat pancreas but decreases the sensitivity of each cell to hormonal stimulation.

A new reconstituted connective tissue matrix: preparation, biochemical, structural and mechanical studies

A fibrinogen derivative generated by thrombin was reacted with elastin to yield a new addition product or adduct between the two proteins. Addition of fibronectin, and then of collagen, did not interfere with the basic elastin-fibrinogen reaction and conferred the qualities of an artificial connective tissue to the product. Biochemical, structural and biomechanical aspects of the new matrix were studied. Aprotinin, heparin, thiomersal, and thiourea did not inhibit the main reaction; indeed, some of these ingredients improved the matrix cohesion. Scanning electron microscopy showed the genesis of a true network whose meshes were more reticulated by the addition of thiourea. Biomechanical studies, i.e., strength and elasticity showed the thiourea matrix to be the strongest. These intrinsic properties suggest the product could have biological and clinical applications.

Small bowel bypass prevents the trophic action of cholecystokinin on the rat pancreas

The effect of a chronic administration of cholecystokinin (CCK) on the rat pancreas has been studied in rats subjected to a 90% jejunoileal bypass or an intestinal transection (controls). Jejunoileal bypass, when compared to transection, did not modify the size of the pancreas but decreased its enzyme content, especially for amylase, and reduced the number of zymogen granules. These structural and biochemical changes were maintained when bypassed animals were treated three times daily and for six days with cholecystokinin (20 Ivy Dog Units (IDU)/kg). In contrast, CCK treatment in transected animals induced growth of the pancreas due to cellular hypertrophy and hyperplasia; pancreatic enzyme content, especially for chymotrypsin, and the population of zymogen granules in acinar cells were also enhanced. It is concluded that jejunoileal bypass prevents the trophic action of chronic CCK on the pancreas.

A slow wave frequency complex of the canine small intestine during the fasting state

The electrical activity of the duodenum and proximal jejunum was studied in conscious healthy dogs implanted with unipolar silver electrodes. A computerized method was used for the calculation of the mean frequency of the slow wave for each consecutive minute of the electromyographic signal. A "slow wave frequency complex" was identified in the fasted animals. It was characterized by an increase of the mean frequency of the slow wave which ranged, from one dog to another, between 1 and 3 cycles/min. The complex lasted about 30 min. It consisted of two distinct phases: a phase of increasing frequency of the slow wave which lasted about one-third of the total duration of the complex and a phase of progressive return of the frequency to its precomplex value. Each phase III of the migrating myoelectric complex occurring in both the duodenum and the jejunum was associated with one slow wave frequency complex. The phase III began a few minutes before the start of the slow wave frequency complex and ended a few minutes before the slow wave frequency reached its maximum. Ectopic phase IIIs which occurred in the jejunum but not in the duodenum were not associated with slow wave frequency complexes. The slow wave frequency complex was never seen in the fed dogs.