Octreotide attenuates impaired microcirculation in postischemic pancreatitis when administered before induction of ischemia. Transplantation. 2008;86:961-967. [PMID: 18852663 DOI: 10.1097/tp.0b013e318186b783]

Octreotide (somatostatin analog) attenuates cardiac ischemia/reperfusion injury via activating nuclear factor (erythroid-derived 2)-like 2 (Nrf2) signaling pathway in rat model of hyperthyroidism

Background

Hyperthyroidism is known to increase the risk of ischemic heart diseases. Octreotide has been reported to attenuate ischemia/reperfusion (I/R) injury. Whether it is useful when ischemic heart disease is accompanied with co-morbidities like hyperthyroidism needs more clarifying. So, this study aimed to explore the effect of octreotide on cardiac I/R injury in hyperthyroid rats and to clarify if Nrf2 activation is involved in this effect. Forty adult female Wistar rats were subdivided into control (euthyroid) (n = 10) and hyperthyroid (n = 30) groups. Rats in hyperthyroid group received l-thyroxine (12 mg/L) in drinking water for 35 days, then were randomly divided into three equal subgroups (n = 10): hyperthyroid control positive group, hyperthyroid octreotide treated group, and hyperthyroid octreotide + Nrf2 inhibitor (brusatol) treated group. Isolated hearts were submitted to I/R and evaluated for cardiac hemodynamics and infarct size. Serum T3 and T4, coronary efflux lactate dehydrogenase (LDH) and creatine kinase-myoglobin binding (CK-MB) and cardiac tissue malondialdehyde (MDA) were estimated. Nrf2- regulated gene expressions of HO-1, SOD, GPx, and catalase were assessed.

Results

Octreotide administration to hyperthyroid rats improved baseline and post-ischemic recovery of cardiac hemodynamics, decreased the high coronary efflux LDH and CK-MB and tissue MDA, reduced infarction size, and upregulated the decreased antioxidative enzymes HO-1, SOD, GPx, and catalase mRNA expressions in the hyperthyroid I/R rat hearts. The Nrf2 inhibitor brusatol reversed the cardioprotective effect of octreotide in hyperthyroid I/R rat hearts.

Conclusion

Octreotide can reduce oxidative stress to effectively alleviate I/R injury in the hyperthyroid rat hearts through upregulation of Nrf2-dependent antioxidative signaling pathways.

Study on acute recent stage pancreatitis

Acute pancreatitis (AP) is an inflammatory disease of the pancreas which involves the pancreas and surrounding tissue, and systemic inflammation with a characteristic systemic increase of vascular permeability and increased risk of multiple organ dysfunction. Currently, the pathogenesis of AP is fuzzy, and the diagnosis and treatment need to be standardized. Nevertheless, increased knowledge of AP may achieve more thorough understanding of the pathogenesis. The use of further advanced diagnostic tools and superior treatment, potentially will help clinicians to manage AP at an appropriate stage. However, in view of the multi factorial disease and the complex clinical manifestations, the management of patients with AP is also remaining areas for improvement.

The effects of profound hypothermia on pancreas ischemic injury: a new experimental model

OBJECTIVE

Pancreatic ischemia-reperfusion (IR) has a key role in pancreas surgery and transplantation. Most experimental models evaluate the normothermic phase of the IR. We proposed a hypothermic model of pancreas IR to evaluate the benefic effects of the cold ischemic phase.

METHODS

We performed a reproducible model of hypothermic pancreatic IR. The ischemia was induced in the pancreatic tail portion (1-hour ischemia, 4-hour reperfusion) in 36 Wistar rats. They are divided in 3 groups as follows: group 1 (control), sham; group 2, normothermic IR; and group 3, hypothermic IR. In group 3, the temperature was maintained as close to 4.5°C. After reperfusion, serum amylase and lipase levels, inflammatory mediators (tumor necrosis factor α, interleukin 6), and pancreas histology were evaluated.

RESULTS

In pancreatic IR groups, amylase, cytokines, and histological damage were significantly increased when compared with group 1. In the group 3, we observed a significant decrease in tumor necrosis factor α (P = 0.004) and interleukin 6 (P = 0.001) when compared with group 2. We did not observe significant difference in amylase (P = 0.867), lipase (P = 0.993), and histology (P = 0.201).

CONCLUSIONS

In our experimental model, we reproduced the cold phase of pancreas IR, and the pancreas hypothermia reduced the inflammatory mediators after reperfusion.

Effects of intravenous administration of pentoxifylline in pancreatic ischaemia-reperfusion injury

BACKGROUND

Therapeutic strategies to reduce the occurrence of pancreatic ischaemia-reperfusion (I-R) injury might improve outcomes in human pancreas and kidney transplantation. In addition to its haemorrheologic effects, pentoxifylline has an anti-inflammatory effect by inhibiting NF-κB activation. This group has previously demonstrated that pentoxifylline induces an anti-inflammatory response in acute pancreatitis and liver I-R models. This led to the hypothesis that pentoxifylline might reduce pancreatic and renal lesions and the systemic inflammatory response in pancreatic I-R injury. The aim of this experimental study was to evaluate the effect of pentoxifylline administration in a rat model of pancreatic I-R injury.

METHODS

Pancreatic I-R was performed in Wistar rats over 1 h by clamping the splenic vessels. The animals submitted to I-R were divided into two groups: Group 1 (n = 20, control) rats received saline solution administered i.v. at 45 min after ischaemia, and Group 2 (n = 20) rats received pentoxifylline (25 mg/kg) administered i.v. at 45 min after ischaemia. Blood samples were collected to enable the determination of amylase, creatinine, tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-10. Pancreatic malondialdehyde (MDA) content, pancreas histology and pulmonary myeloperoxidase (MPO) were also assessed.

RESULTS

Significant reductions in serum TNF-α, IL-6 and IL-10 were observed in Group 2 compared with Group 1 (P < 0.05). No differences in pancreatic MDA content or serum amylase levels were observed between the two groups. The histologic score was significantly lower in pentoxifylline-treated animals, denoting less severe pancreatic histologic damage.

CONCLUSIONS

Pentoxifylline administration reduced the systemic inflammatory response, the pancreatic histological lesion and renal dysfunction in pancreatic I-R injury and may be a useful tool in pancreas and kidney transplantation.

High-dose versus low-dose octreotide in the treatment of acute pancreatitis: a randomized controlled trial

To evaluate the therapeutic efficacy of high-dose octreotide in patients with predicted severe acute pancreatitis (SAP) or SAP, two hundred and thirty-six patients with predicted SAP and 136 patients with SAP were randomized into control, high-dose octreotide (High-O) and low-dose octreotide (Low-O) groups. In addition to the conventional managements administrated in control group, High-O group received an intravenous infusion of octreotide at 50 μg/h × 3d + 25 μg/h × 4d, and Low-O group received octreotide at 25 μg/h × 7d. The major primary outcomes included the numbers of predicted SAP patients which developed SAP after intervention and the number of patients with SAP amelioration. Secondary outcomes included APACHE II, SIRS scores, plasma levels of somatostatin (SST), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6). There were no significant differences between the control and Low-O groups in terms of prevention and treatment for SAP. The incidence of SAP in patients with predicted SAP who received High-O was significantly lower than the Low-O group: 37.5% vs. 59.8%, p=0.005. Compared with Low-O group, the number of SAP patients in the SAP arm in the High-O group was reduced by 29.8%. Plasma levels of SST in both predicted SAP and the SAP patients were efficiently recovered (from 132.71±31.40 pg/ml to 180.00±23.50 pg/ml, p<0.05) after high-dose octreotide supplementation, which concomitantly reduced TNF-α and IL-6 levels. High-dose octreotide administration within 48h after AP onset may efficiently reduce the risk of SAP developing and partly attenuate SAP through raising plasma SST to a normal level and decreasing IL-6 and TNF-α.

Continuous regional arterial infusion with fluorouracil and octreotide attenuates severe acute pancreatitis in a canine model

Aim

To investigate the therapeutic effects of fluorouracil (5-Fu) and octreotide (Oct) continuous regional arterial infusion (CRAI,) alone or in combination, was administered in a canine model of severe acute pancreatitis (SAP).

Materials and Methods

The animals were divided into five groups; group A (Sham), group B (SAP), group C (SAP and 5-Fu), group D (SAP and Oct), and group E (SAP and 5-Fu + Oct). Levels of amylase, α-tumor necrosis factor (TNF-α), blood urea nitrogen (BUN), creatinine, thromboxane B2 and 6-keto- prostaglandin F1α were measured both before and after the induction of SAP. Pathologic examination of the pancreas and kidneys was performed after termination of the study.

Results

Pathologic changes noted in the pancreas in SAP significantly improved following CRAI with either single or combined administration of 5-Fu and Oct, where combination therapy demonstrated the lowest injury score. All treatment groups had significantly lower levels of serum TNF-α and amylase activity (P<0.05), though only groups D and E had a lower BUN level as compared to group B. The plasma thromboxane B₂ level increased in SAP, but the ratio of thromboxane B₂/6-keto- prostaglandin F_1α decreased in the treatment groups, with the combination therapy (group E) demonstrating the lowest ratio as compared to the other 3 experimental groups (P<0.05).

Conclusions

The findings in the present study demonstrate an attenuation of SAP in a canine model following CRAI administration with 5-Fu or Oct, alone or in combination.

Pretreatment of cisplatin in recipients attenuates post-transplantation pancreatitis in murine model

Pancreas transplantation is the definite treatment for type 1 diabetes that enables the achievement of long-term normoglycemia and insulin independence. However Post-Transplantation Pancreatitis (PTP) due to ischemia reperfusion (IR) injury and preservation is a major complication in pancreas transplantation. Owning the potential anti-inflammatory effect of Cisplatin (Cis) in liver IR injury, we have examined if Cis could attenuate PTP using a murine model. We found that Cis is able to prevent inflammatory response in PTP. Pretreatment of Cis in recipient mice reduce the impairments of the grafts and hyperamylasimea in the recipients. We documented that the protective mechanism of Cis in PTP involves improvement of microcirculation, reduction of the mononuclear cellular infiltration and apoptosis, suppression of inflammatory cytokine-cascade and inhibition of translocation of high-motility group box protein-1 (HMGB-1) from nucleus to cytoplasm. In short, our study demonstrated that pretreatment of Cis in recipients may reduce the onset of PTP in pancreas transplantation.

Preconditioning of pancreatic graft with isoproterenol reduces posttransplant ischemia/reperfusion injury in rats

AIM: To determine the protective effects of isoproterenol preconditioning (IPC) against ischemia/reperfusion injury in rats after pancreas transplantation and to explore mechanisms involved.

METHODS: The expression of heat shock protein 70 (HSP70) in the pancreas of rats undergoing IPC was detected at different time points after IPC. A rat model of posttransplant pancreatic ischemia/reperfusion injury was established. The donor rats that showed high expression of HSP70 in the pancreas were used as experiment group, while donor rats that did not undergo IPC were used as control group. The blood and pancreatic samples were taken 6 h after pancreas transplantation. The expression of HSP70 in the pancreas was detected by Western blot and immunohistochemistry. The expression of TNF-α in the pancreas was detected by immunohistochemistry. Serum amylase was determined by iodine colorimetry. The apoptosis rate of pancreatic cells was determined by flow cytometry.

RESULTS: The expression level of HSP70 in the pancreas of donor rats reached the peak at 24 h after IPC, which was significantly higher than those at other time points (0.92 ± 0.25 vs 0.24 ± 0.04, 0.34 ± 0.06, 0.58 ± 0.07, 0.62 ± 0.11 and 0.25 ± 0.09, respectively; all P < 0.05). The expression levels of HSP70 in the experimental group at 6, 12, 24 and 36 h after IPC were significantly higher than those in the control group at corresponding time points (0.34 ± 0.06 vs 0.28 ± 0.07, 0.58 ± 0.07vs 0.25 ± 0.04, 0.92 ± 0.25 vs 0.27 ± 0.05 and 0.62 ± 0.11 vs 0.25 ± 0.06, respectively; all P < 0.05) but returned to normal level at 48 h. No significant differences were noted in the expression levels of HSP70 among each time point in the control group. HSP70 was mainly expressed in pancreatic acinar cells and the vessel wall. The expression level of TNF-α, apoptosis rate, neutrophil count and serum amylase significantly increased in the control group when compared with those in sham-operated group (all P < 0.01). However, the levels of these parameters significantly decreased in the experiment group when compared with those in the control group (11 929 ± 1 220 vs 46 111 ± 3 127, 26.7% ± 4.5% vs 37.4% ± 4.7%, 3 308 ± 531 vs6 668 ± 1 506 and 1 057 IU/L± 148 IU/L vs 1 408 IU/L± 195 IU/L, respectively; all P < 0.05).

CONCLUSION: Isoproterenol preconditioning reduces ischemia/reperfusion injury in rats after pancreas transplantation perhaps by inducing the production of HSP70.

Ischemia-reperfusion injury and acute pancreatitis

Though the pathogenesis of acute pancreatitis is still not entirely clear, animal experiments and clinical studies suggest that ischemia-reperfusion injury plays an important role in the development of acute pancreatitis. The combined action of microcirculatory disturbance, increased free radical production, intracellular calcium overload, inflammatory mediators, leukocyte-platelet interaction, intestinal endotoxemia and other factors leads to pancreatic ischemia-reperfusion injury. Thus, ischemia-reperfusion injury is fundamental to the pathogenesis of acute pancreatitis. In this article, we will review the mechanisms behind the development of pancreatic ischemia-reperfusion injury in acute pancreatitis.