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Wang Q, Du J, Yu P, Bai B, Zhao Z, Wang S, Zhu J, Feng Q, Gao Y, Zhao Q, Liu C. Hepatic steatosis depresses alpha-1-antitrypsin levels in human and rat acute pancreatitis. Sci Rep 2015; 5:17833. [PMID: 26634430 PMCID: PMC4669469 DOI: 10.1038/srep17833] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/06/2015] [Indexed: 12/11/2022] Open
Abstract
Hepatic steatosis (HS) can exacerbate acute pancreatitis (AP). This study aimed to investigate the relation between α1-antitrypsin (AAT) and acute pancreatitis when patients have HS. Using proteomic profiling, we identified 18 differently expressed proteins pots in the serum of rats with or without HS after surgical establishment of AP. AAT was found to be one of the significantly down-regulated proteins. AAT levels were significantly lower in hepatic steatosis acute pancreatitis (HSAP) than in non-HSAP (NHSAP) (P < 0.001). To explore the clinical significance of these observations, we measured the levels of AAT in the serum of 240 patients with HSAP, NHSAP, fatty liver disease (FLD), or no disease. Compared with healthy controls, serum AAT levels in patients with NHSAP were significantly higher (P < 0.01), while in patients with HSAP serum AAT levels were significantly lower (P < 0.01). Further studies showed that acute physiology and chronic health evaluation (APACHE-II) scores were negatively correlated with serum AAT levels (r = −0.85, P < 0.01). In conclusion, low serum levels of AAT in patients with HSAP are correlated with disease severity and AAT may represent a potential target for therapies aiming to improve pancreatitis.
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Affiliation(s)
- Qian Wang
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, China
| | - Jianjun Du
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Pengfei Yu
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, China
| | - Bin Bai
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, China
| | - Zhanwei Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, China
| | - Shiqi Wang
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, China
| | - Junjie Zhu
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, China
| | - Quanxin Feng
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, China
| | - Yun Gao
- Department of Surgery, China PLA 323323 Hospital, Beijing, 100853, China
| | - Qingchuan Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, China
| | - Chaoxu Liu
- Department of General Surgery, Huashan Hospital North, Fudan University, Shanghai, 201907, China.,Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, 710032, China
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Feng C, Su X, Chen LI, Zhou X, Li B, Wang LL, Lv FQ, Li TS. Ulinastatin enhances the therapeutic effect of intraperitoneal lavage on severe acute pancreatitis in rats. Exp Ther Med 2015; 9:1651-1655. [PMID: 26136873 DOI: 10.3892/etm.2015.2334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 12/17/2014] [Indexed: 11/06/2022] Open
Abstract
The present study investigated the therapeutic effect of peritoneal lavage with ulinastatin on the outcome of rats with severe acute pancreatitis (SAP). A total of 110 male Wistar rats were randomly divided into the following groups: Control (C), SAP model (SAP), saline lavage (SL), intravenous ulinastatin (IU) and low-dose (LUL), medium-dose (MUL), high-dose (HUL) and ultrahigh-dose (UHUL) ulinastatin lavage. The treatments were performed immediately subsequent to the establishment of the SAP model. Intraperitoneal lavage with or without ulinastatin was performed for 3 h. Survival time was recorded for 12 h and the median survival time was calculated. Histopathological analyses, and measurements of plasma amylase and lipase levels were performed. Blood pH, lactic acid and base excess were also detected. The LUL, MUL, HUL, UHUL and IU groups showed an increase in the median survival time compared with the SAP group, with the maximal effect observed in the MUL group (P<0.01). The SL, MUL and IU groups showed a reduced activity of amylase and lipase compared with the SAP group. The SL (P<0.01) and the MUL groups (P<0.01) additionally showed a reduction in the lactic acid in arterial blood relative to the SAP group but the IU group did not. The MUL group showed greater improvements in pH (P<0.01) and base excess (P<0.01) versus the SAP group than the SL and IU groups. Furthermore the MUL group demonstrated a more marked reduction in the histological changes in necrosis, edema and inflammation compared with the SL and IU groups. Intraperitoneal lavage with ulinastatin significantly improves the prognosis of SAP in rats.
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Affiliation(s)
- Cong Feng
- Department of Emergency, General Hospital of the PLA, Beijing 100853, P.R. China ; The Li-Shi Road Out-Patient Department of General Hospital of the Second Artillery, Beijing 100045, P.R. China
| | - Xuan Su
- Department of Hepatology-Immunology, Beijing Youan Hospital of the Capital Medical University, Beijing 100069, P.R. China
| | - L I Chen
- Department of Emergency, General Hospital of the PLA, Beijing 100853, P.R. China
| | - Xuan Zhou
- Department of Emergency, General Hospital of the PLA, Beijing 100853, P.R. China
| | - Bei Li
- Department of Emergency, General Hospital of the PLA, Beijing 100853, P.R. China
| | - Li-Li Wang
- Department of Emergency, General Hospital of the PLA, Beijing 100853, P.R. China
| | - Fa-Qin Lv
- Department of Ultrasound, General Hospital of the PLA, Beijing 100853, P.R. China
| | - Tan-Shi Li
- Department of Emergency, General Hospital of the PLA, Beijing 100853, P.R. China
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Feng C, Su X, Zhou X, Wang LL, Li B, Chen LI, Lv FQ, Li TS. Early peritoneal lavage with ulinastatin improves outcome and enhances multi-organ protection in a model of severe acute pancreatitis. Exp Ther Med 2015; 9:1171-1177. [PMID: 25780405 PMCID: PMC4353754 DOI: 10.3892/etm.2015.2251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 01/20/2015] [Indexed: 01/15/2023] Open
Abstract
The aim of this study was to investigate the effect of early peritoneal lavage with ulinastatin on the outcome of a rat model of severe acute pancreatitis (SAP). A total of 80 male Wistar rats were randomly divided into the following groups: Sham-operated (C), SAP model (M), saline lavage (SL), intravenous ulinastatin (IU), early ulinastatin lavage (EUL) and late ulinastatin lavage (LUL). Intraperitoneal lavage or injection were performed immediately subsequent to the establishment of the SAP model in groups SL, IU and EUL and 3 h later in group LUL. Intraperitoneal lavage with or without ulinastatin was performed for 3 h. The survival time of the rats in groups C, M, EUL and LUL was recorded over a 12-h period and the median survival time was calculated. At 3 h after the induction of SAP, histopathological analyses were performed and the biochemical parameters of groups C, M, SL, IU and EUL were assessed. Groups EUL and LUL exhibited an increased median survival time compared with Group M, with the survival time of the rats in group EUL markedly longer than that in the group LUL rats. Group SL, IU and EUL rats were found to have reduced plasma activities of amylase, lipase, aspartate transaminase and alanine transaminase, with the biggest change observed in the group EUL rats. Furthermore, the intervention in groups SL and EUL was more effective at reducing creatinine and urea levels than that in group IU. Rats in group EUL exhibited a greater inhibition of the SAP-induced increase in troponin T levels than rats in groups SL and IU. The pathological severity scores of the pancreas, liver, kidney and lung in group EUL were significantly lower than those in groups M and better than those in groups SL and IU. In conclusion, early intraperitoneal lavage with ulinastatin significantly improves the median survival time and protects multi-organ function in an SAP model.
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Affiliation(s)
- Cong Feng
- Department of Emergency, General Hospital of the PLA, Beijing 100853, P.R. China ; The Li-Shi Road Outpatient Department of the General Hospital of the Second Artillery, Beijing 100045, P.R. China
| | - Xuan Su
- Department of Hepatology-Immunology, Beijing You An Hospital of the Capital Medical University, Beijing 100069, P.R. China
| | - Xuan Zhou
- Department of Emergency, General Hospital of the PLA, Beijing 100853, P.R. China
| | - Li-Li Wang
- Department of Emergency, General Hospital of the PLA, Beijing 100853, P.R. China
| | - Bei Li
- Department of Emergency, General Hospital of the PLA, Beijing 100853, P.R. China
| | - L I Chen
- Department of Emergency, General Hospital of the PLA, Beijing 100853, P.R. China
| | - Fa-Qin Lv
- Department of Ultrasound, General Hospital of the PLA, Beijing 100853, P.R. China
| | - Tan-Shi Li
- Department of Emergency, General Hospital of the PLA, Beijing 100853, P.R. China
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Baltatzis M, Pavlidis TE, Ouroumidis O, Koliakos G, Nikolaidou C, Venizelos I, Michopoulou A, Sakantamis A. Aprotinin reduces oxidative stress induced by pneumoperitoneum in rats. J Surg Res 2014; 189:238-48. [PMID: 24674839 DOI: 10.1016/j.jss.2014.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/17/2014] [Accepted: 02/20/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ischemia-reperfusion injury induced by pneumoperitoneum is a well-studied entity, which increases oxidative stress during laparoscopic operations. The reported anti-inflammatory action of aprotinin was measured in a pneumoperitoneum model in rats for the first time in this study. MATERIALS AND METHODS A total of 60 male Albino Wistar rats were used in our protocol. Prolonged pneumoperitoneum (4 h) was applied, causing splanchnic ischemia and a period of reperfusion with a duration of 60 or 180 min followed. Several cytokines and markers of oxidative stress were measured in liver, small intestine, and lungs to compare the aprotinin group with the control group. Tissue inflammation was also evaluated and compared between groups using a five-scaled histopathologic score. RESULTS In aprotinin group values of biochemical markers (tumor necrosis factor α, interleukin 6, endothelin 1, C reactive protein, pro-oxidant-antioxidant balance, and carbonyl proteins) were lower in all tissues studied. Statistical significance was greater in liver and lungs (P < 0.05). Histopathologic examination revealed significant difference between control and aprotinin groups in all tissues examined. Aprotinin groups showed mild to moderate lesions, while in control groups severe to very severe inflammation was present. Aprotinin subgroup with prolonged reperfusion period (180 min) showed milder lesions in all tissues than the rest of the groups. CONCLUSIONS Aprotinin reduced inflammatory response and oxidative stress induced by pneumoperitoneum in liver, small intestine, and lungs.
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Affiliation(s)
- Minas Baltatzis
- Second Propedeutical Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Theodoros E Pavlidis
- Second Propedeutical Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Odysseas Ouroumidis
- Second Propedeutical Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Koliakos
- Department of Biochemistry, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ioannis Venizelos
- Department of Pathology, Hippocration Hospital, Thessaloniki, Greece
| | - Anna Michopoulou
- Department of Biochemistry, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Sakantamis
- Second Propedeutical Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
Aprotinin, a Kunitz protease inhibitor, has a wide inhibitory action with particular activity against trypsin, chymotrypsin and kallikrein, making it theoretically attractive in ameliorating the effects of acute pancreatitis. Its use in acute pancreatitis has been studied for the last 50 years with disappointing results. In this paper, we review the previous studies and argue that all the studies have not been adequately powered, have inappropriate end-points, but most importantly have not attained adequate plasma and peritoneal levels of aprotinin to produce sufficient inhibitory activity. We hypothesise that a well-powered study with adequate aprotinin dosing may clarify its clinical benefit in severe acute pancreatitis.
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Affiliation(s)
- M Smith
- Barts & The London HPB Centre, The Royal London Hospital, London and Department of Haematology, Guy's & St Thomas' Trust, London, UK
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Elfar M, Gaber LW, Sabek O, Fischer CP, Gaber AO. The inflammatory cascade in acute pancreatitis: relevance to clinical disease. Surg Clin North Am 2008; 87:1325-40, vii. [PMID: 18053834 DOI: 10.1016/j.suc.2007.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Acute pancreatitis is an inflammatory condition that is initiated by the intra pancreatic activation of proteases. Pancreatic enzyme activation triggers a local and systemic inflammatory response that is associated with recruitment of inflammatory cells into the pancreas and a widespread up-regulation of inflammatory markers in distant tissues.
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Affiliation(s)
- Mohammed Elfar
- Weill Cornell Medical College, Department of Surgery, The Methodist Hospital, 6550 Fannin Street, Suite SM1661A, Houston, TX 77030, USA
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Logan JC, Callan MB, Drew K, Marryott K, Oakley DA, Jefferies L, Giger U. Clinical indications for use of fresh frozen plasma in dogs: 74 dogs (October through December 1999). J Am Vet Med Assoc 2001; 218:1449-55. [PMID: 11345309 DOI: 10.2460/javma.2001.218.1449] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To document reasons for use of fresh frozen plasma (FFP) in dogs and determine variables that apparently triggered the decision to use FFP. DESIGN Retrospective study. ANIMALS 74 dogs. PROCEDURE Medical records of dogs that received FFP at a veterinary teaching hospital during a 3-month period were reviewed. RESULTS The 74 dogs underwent 144 transfusion episodes (TE; a TE was defined as 1 day of transfusion therapy) and received 252 units (120 ml/unit) of FFP. Fresh frozen plasma was administered to provide coagulation factors (67 TE), albumin (91), alpha-macroglobulin (15), or immunoglobulins (19); for some TE, multiple clinical indications were identified. Variables that apparently triggered the decision to administer FFP included active hemorrhage with or without prolongation of coagulation times, low total plasma protein concentration, persistent vomiting associated with pancreatitis, and sepsis. Mean doses of FFP for each indication were between 8.5 and 9.4 ml/kg (3.9 and 4.3 ml/lb). Small dogs were generally given higher doses (mean dose, 13.9 ml/kg [6.3 ml/lb]) than large dogs (mean dose, 5.1 ml/kg [2.3 ml/lb]). Fifty (68%) dogs were alive at the time of discharge from the hospital. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that FFP plays an important role in the care of critically ill dogs. Because the supply of FFP is limited, guidelines for when administration of FFP may be clinically useful should be developed.
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Affiliation(s)
- J C Logan
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia 19104-6010, USA
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8
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Abstract
In the 1920s Moynihan described acute pancreatitis as "..the most terrible of all intra-abdominal calamities". He established a practice of immediate surgical intervention to remove the toxic products accumulating in the peritoneal cavity, and this treatment was endorsed by most centres, remaining the standard therapy for the next 20 years. In the 1940s, the mortality of patients treated surgically was shown to be far higher than those treated conservatively, and a more conservative line of management was recommended, comprising nasogastric stomach decompression, intravenous fluid therapy, opiate analgesia, and the administration of atropine. Despite half a century passing, a clinician would not be criticised for adopting such a regime today, which in part reflects the lack of understanding of this condition and the failure of seemingly appropriate therapy. Reduction in mortality is a consequence of advances in intensive care preventing the high early mortality of organ failure, but the area of specific therapy remains elusive. While this is so, the mortality rates for these patients will remain static, while the doctor continues to feel clinically impotent.
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Affiliation(s)
- P Skaife
- Department of Surgery, University of Liverpool, UK
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Kiriyama M, Izumi R, Miyazaki I. Protective effect of AA-861 (5-lipoxygenase inhibitor) on experimental acute necrotizing pancreatitis in rats. INTERNATIONAL JOURNAL OF PANCREATOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PANCREATOLOGY 1993; 13:201-8. [PMID: 7690378 DOI: 10.1007/bf02924441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The effect of the 5-lipoxygenase inhibitor AA-861 on acute necrotizing pancreatitis was studied in an experimental model. Pancreatitis was induced in rats by retrograde injection of 0.4 mL/kg body wt of 6% taurocholic acid into the pancreatic duct. The animals were divided into three groups: control group; administered AA-861 in a single dose of 30 mg/kg; and administered AA-861 in a single dose of 60 mg/kg. The following parameters were examined: serum amylase, lipase, trypsin, blood sugar, and survival rate. Histology of the pancreas was also studied. The serum amylase and lipase activities in groups 2 and 3 were lower than those in group 1 in the early phase after induction of pancreatitis. The elevation of serum trypsin was not suppressed by AA-861. Blood sugar was more efficiently controlled in groups 2 and 3 than in group 1. The survival rates in groups 2 and 3 were better than that in group 1, but there were no significant differences among the three groups. Histologically, massive tissue necrosis with hemorrhage, edema, and inflammatory cell infiltration was prominent in group 1, whereas such changes were obviously suppressed in groups 2 and 3. The results suggest that AA-861 may prove useful in the treatment of acute pancreatitis.
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Affiliation(s)
- M Kiriyama
- Second Department of Surgery, School of Medicine, Kanazawa University, Japan
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Fric P, Slabý J, Kasafírek E, Kocna P, Marek J. Effective peritoneal therapy of acute pancreatitis in the rat with glutaryl-trialanin-ethylamide: a novel inhibitor of pancreatic elastase. Gut 1992; 33:701-6. [PMID: 1377154 PMCID: PMC1379306 DOI: 10.1136/gut.33.5.701] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The six hour peritoneal lavage with glutaryl-trialanin-ethylamide, a low molecular competitive inhibitor of pancreatic elastase (IC50-8 mumol/l), effectively suppresses the evolution of taurocholate induced acute pancreatitis in the rat. The lavage alone is followed by a marked decrease of fat necrosis and amylase and lipase activity in serum. The area of pancreatic haemorrhage was significantly reduced only after the lavage solution was supplemented with Glt-Ala3-NHEt. The effect was not enhanced by a bolus injection of the inhibitor before starting the lavage. The combination of Glt-Ala3-NHEt with aprotinin or nafamstate mesilate produced only marginal greater benefit. The effect of Glt-Ala3-NHEt on pancreatic haemorrhage is time and dose related even with delayed onset of the lavage. Animals treated with peritoneal lavage without Get-Ala3-NHEt lived longer than controls (p less than 0.05), but by 60 hours the survival rate of both groups was almost the same (76 v 74%). All animals lavaged with Glt-Ala3-NHEt survived 120 hours and the difference in the survival rate between this and both remaining groups was significant (100% v 76% v 74% - p less than 0.05). The results were considered favourable and preliminary clinical trials of Glt-Ala3-NHEt in subjects with acute pancreatitis justified.
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Affiliation(s)
- P Fric
- Department of Medicine, Charles University, Prague, Czechoslovakia
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Donnelly PK, Booth H, White M, Shenton BK. Alpha 2-macroglobulin and generation of oxygen radicals by granulocytes: potential role in prevention and treatment of reperfusion injury. Clin Chim Acta 1991; 202:55-64. [PMID: 1725510 DOI: 10.1016/0009-8981(91)90255-b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- P K Donnelly
- Department of Surgery, University of Newcastle on Tyne, Medical School, UK
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Wilson C, Shenkin A, Imrie C. Role of the protease-antiprotease balance in peritoneal exudate during acute pancreatitis. Br J Surg 1991; 78:78-81. [PMID: 1705461 DOI: 10.1002/bjs.1800780124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The peritoneal exudate formed during experimental pancreatitis is toxic when administered intraperitoneally or intravenously to other animals. Overwhelming of the peritoneal antiprotease defences by proteolytic enzymes released from the pancreas may be a key factor responsible for this toxicity and is examined in the current study. Human pancreatitis exudates possessed tryptic amidase activity indicating trypsinogen activation. The trypsin inhibitory capacities of exudates were reduced indicating a degree of consumption of the peritoneal antiproteases. Of 21 exudates examined, three showed marked reduction of their trypsin inhibitory capacity indicating almost complete consumption of their antiproteases. All three patients were shocked at the time of sampling, two dying of fulminant pancreatitis within 24 h. Overwhelming of the peritoneal antiproteases was not confirmed, but may occur in a few instances where proteolytic enzyme release or zymogen activation continues. Intraperitoneal administration of exogenous antiproteases prolongs survival in rats with pancreatitis and has been suggested as a therapy in man. The current data suggests that few patients are likely to benefit from such an approach.
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Affiliation(s)
- C Wilson
- Department of Surgery, Royal Infirmary, Glasgow, UK
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