[Cytokines and other immunological parameters as markers of distant organ involvement in acute pancreatitis]

Effects of dexamethasone and Salvia miltiorrhiza on multiple organs in rats with severe acute pancreatitis

OBJECTIVE

To investigate the protective effects and mechanisms of action of dexamethasone and Salvia miltiorrhiza on multiple organs in rats with severe acute pancreatitis (SAP).

METHODS

The rats were divided into sham-operated, model control, dexamethasone treated, and Salvia miltiorrhiza treated groups. At 3, 6, and 12 h after operation, the mortality rate of different groups, pathological changes, Bcl-2-associated X protein (Bax) and nuclear factor-κB (NF-κB) protein expression levels in multiple organs (the pancreas, liver, kidneys, and lungs), toll-like receptor 4 (TLR-4) protein levels (only in the liver), intercellular adhesion molecule 1 (ICAM-1) protein levels (only in the lung), and terminal deoxynucleotidy transferase mediated deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL) staining expression levels, as well as the serum contents of amylase, glutamate-pyruvate transaminase (GPT), glutamic-oxaloacetic transaminase (GOT), blood urea nitrogen (BUN), and creatinine (CREA) were observed.

RESULTS

The mortality rate of the dexamethasone treated group was significantly lower than that of the model control group (P<0.05). The pathological changes in multiple organs in the two treated groups were relieved to different degrees (P<0.05 and P<0.01, respectively), the expression levels of Bax and NF-κB proteins, and apoptotic indexes of multiple organs were reduced (P<0.05 and P<0.01, respectively). The contents of amylase, GPT, GOT, BUN, and CREA in the two treated groups were significantly lower than those in model control groups (P<0.05 and P<0.01, respectively). The expression level of ICAM-1 protein in the lungs (at 3 and 12 h) in the dexamethasone treated group was significantly lower than that in the Salvia miltiorrhiza treated group (P<0.05). The serum contents of CREA (at 12 h) and BUN (at 6 h) of the Salvia miltiorrhiza treated group were significantly lower than those in the dexamethasone treated group (P<0.05).

CONCLUSIONS

Both dexamethasone and Salvia miltiorrhiza can reduce the inflammatory reaction, regulate apoptosis, and thus protect multiple organs of rats with SAP.

Ghrelin attenuates acute pancreatitis-induced lung injury and inhibits substance P expression

OBJECTIVE

To investigate the effect of ghrelin administration on the severity of acute lung injury and on the production of proinflammatory cytokines and Substance P (SP) in rats with acute pancreatitis (AP).

METHODS

AP was induced in rats by sodium taurocholate injection through pancreaticobiliary duct. Ghrelin 20 nmol/kg was given before and after the treatment. Tumor necrosis factor-alpha, interleukin-1beta, and -6 levels in the serum were measured using the radioimmunoassay method. Morphological signs of lung injury, pulmonary water content, microvascular permeability, and myeloperoxidase activity were measured. Meanwhile, the determination of pulmonary SP mRNA level and its expression were performed by reverse transcriptase polymerase chain reaction and immunohistochemistry.

RESULTS

The serum proinflammatory cytokines, pulmonary water content, microvascular permeability, and myeloperoxidase activity were increased, and morphological damages were observed in the lung of AP rats. SP mRNA level and its expression were significantly higher in sham-operated rats (P < 0.05). Morphological damages were attenuated and serum cytokines and pulmonary parameters were reduced by pre- and posttreatment with ghrelin. Pulmonary SP expression was also significantly down-regulated by ghrelin (P < 0.05).

CONCLUSIONS

Ghrelin attenuates the severity of acute lung injury induced by AP. The reduction of neutrophil sequestration, limitation of proinflammatory cytokines release, and inhibition of pulmonary SP expression may be the mechanisms involved in the therapeutic effect of ghrelin.

Efficacy of celecoxib in the treatment of severe acute pancreatitis in rats

AIM: To investigate the efficacy of celecoxib in the treatment of severe acute pancreatitis (SAP) in rats and explore potential mechanisms involved.

METHODS: A total of 135 Sprague-Dawley rats were used in this study, of which 75 were randomly and equally divided into three groups (SAP model control group, low-dose and high-dose celecoxib treatment groups) to investigate the survival rate, and 60 were randomly and equally divided into four groups (sham operation group, SAP model control group and low-dose and high-dose celecoxib treatment groups) to detect pancreatic histopathological changes, serum tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6) levels, and pancreatic expression of cyclooxygenase-2 (COX-2). SAP was induced in rats by retrograde injection of sodium taurocholate into the biliopancreatic duct. The histopathological changes in the pancreas of rats were evaluated using a semi-quantitative scoring method. The changes in serum TNF-α, IL-1β and IL-6 levels at different time points were measured by enzyme-linked immunosorbent assay (ELISA). The expression of COX-2 mRNA in the pancreas was detected by reverse transcription-polymerase chain reaction (RT-PCR).

RESULTS: Celecoxib ameliorated pancreatic pathological damage in SAP rats. High-dose celecoxib could significantly mitigate edema at 24 hours (2.28 ± 0.30 vs 2.73 ± 0.22, P < 0.05), acinar necrosis at 12 and 24 hours (2.03 ± 0.15 vs 2.48 ± 0.24 and 2.09 ± 0.10 vs 2.65 ± 0.25, respectively; both P < 0.05), and inflammatory cell infiltration at 12 and 24 hours (1.80 ± 0.22 vs 2.51 ± 0.17 and 1.57 ± 0.26 vs 2.20 ± 0.22, respectively; both P < 0.05). The levels of serum TNF-α, IL-1β and IL-6 in SAP rats were significantly higher than those in normal control mice at all time points. After celecoxib treatment, the levels of serum TNF-α, IL-1β and IL-6 significantly decreased in SAP rats, especially prominent in the high-dose group (P < 0.05). Celecoxib treatment could also improve the survival rate of SAP rats (16% vs 52%, P < 0.05).

CONCLUSION: Celecoxib can ameliorate pathological damage in the pancreas of SAP rats possibly by inhibiting the production of serum TNF-α, IL-1β and IL-6 and the expression of COX-2 in the pancreas.

Pathogenesis and treatment of acute pancreatitis with liver injury

Acute pancreatitis is a frequent acute abdomen in clinic, causes damages not only to pancreas, but also to distant organs. Liver is one of the mainly involved organs. The development of liver injury may aggravate pancreatitis. The pathogenesis of acute pancreatitis with liver injury is mainly related to cytokines, pancreatic enzyme, oxidative stress, microcirculation disturbance, apoptosis and pancreatitis-associated ascitic fluid, etc. Its treatment is also to eradicate these factors. However, more methods are still under animal studies. Their clinical application requires further study.

Advances in research of severe acute pancreatitis complicated by lung injury

Lung injury is one of the most common complications of severe acute pancreatitis (SAP). At present, the pathogenesis of SAP complicated by lung injury still remains unclear. However, great attention has been paid to it at home and abroad. Many factors such as pancreatic enzyme, polymorphonuclear neutrophil, oxygen free radical, cytokine, microcirculatory disturbance, complement, kinin, NO and ET play an important role in the pathogenesis of SAP by interacting with each other. This paper reviews the advances in the pathogenesis of SAP complicated by lung injury and related studies in order to provide the theoretical basis for its effective prevention and treatment.