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Cirak Z, Tanoglu A, Yeniceri M, Tanoglu EG, Kaplan M, Sade AG. Certolizumab Has Favorable Efficacy on Preventing Pancreas and Target Organs Damage in Acute Pancreatitis. Pancreas 2024; 53:e588-e594. [PMID: 38986079 DOI: 10.1097/mpa.0000000000002343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
OBJECTIVE It was targeted to assess the efficacy of certolizumab on pancreas and target organs via biochemical parameters and histopathologic scores in experimental acute pancreatitis (AP). MATERIALS AND METHODS Forty male Sprague Dawley rats were divided into the following 5 equal groups: group 1 (sham group), group 2 (AP group), group 3 (AP + low-dose certolizumab group), group 4 (AP + high-dose certolizumab group), and group 5 (placebo group). Rats in all groups were sacrificed 24 hours after the last injection and amylase, tumor necrosis factor α, transforming growth factor β, interleukin 1β, malondialdehyde, superoxide dismutase, and glutathione peroxidase levels were studied in blood samples. Histopathological investigation of both the pancreas and target organs (lungs, liver, heart, kidneys) was performed by a pathologist blind to the groups. In silico analysis were also accomplished. RESULTS The biochemical results in the certolizumab treatment groups were identified to be significantly favorable compared to the AP group (P < 0.001). The difference between the high-dose group (group 4) and low-dose treatment group (group 3) was found to be significant in terms of biochemical parameters and histopathological scores (P < 0.001). In terms of the effect of certolizumab treatment on the target organs (especially on lung tissue), the differences between the low-dose treatment group (group 3) and high-dose treatment group (group 4) with the AP group (group 2) were significant. CONCLUSIONS Certolizumab has favorable protective effects on pancreas and target organs in AP. It may be a beneficial agent for AP treatment and may prevent target organ damage.
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Affiliation(s)
- Zafer Cirak
- From the Department of Internal Medicine, Honaz State Hospital
| | - Alpaslan Tanoglu
- Department of Internal Medicine, Division of Gastroenterology, Bahçeşehir University, Faculty of Medicine
| | - Murat Yeniceri
- University of Health Sciences, Institution of Hamidiye Health Sciences, Department of Molecular Biology and Genetics
| | - Esra Guzel Tanoglu
- Department of Internal Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Hospital
| | - Mustafa Kaplan
- Department of Internal Medicine, University of Health Sciences, Sultan Abdülhamid Han Hospital
| | - Ayşe Gökcen Sade
- Department of Pathology, University of Health Sciences, Sultan Abdülhamid Han Hospital, Istanbul, Turkey
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Abstract
Acute pancreatitis is a serious inflammatory condition. Research has shown an increase in the number of pancreatitis-associated hospitalizations, with a marked decline in the mortality rates down to 0.79% in patients with acute pancreatitis and 0.26% in patients with exacerbation of chronic pancreatitis. Up to one-third of patients develop pancreatic tissue necrosis, with a mortality rate of 30%. One of the mechanisms is the disturbances in pancreatic microcirculation due to the release of endothelin, a long-acting vasoconstrictor. The development of pancreatitis causes the release of other inflammatory mediators, which reduce blood flow in the microcirculation. The activation of intracellular trypsinogen initiates a cascade of mechanisms in pancreatitis. There is no specific treatment for acute pancreatitis. Protease inhibitors are not effective in treating severe acute pancreatitis. There is an important role of low-molecular-weight heparin in attenuating necrosis and restoring perfusion of the pancreas. Other drugs used are endothelin receptor antagonists, antagonist of interleukin-1 and interleukin-6 receptors, α-tocopherol, tumor necrosis factor-α and platelet-activating factor inhibitors, acetylsalicylic acid, and local intra-arterial injection of lidocaine. The prophylactic use of antibiotics is not recommended. The treatment outcome of acute pancreatitis is still unsatisfactory.
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Montenegro ML, Corral JE, Lukens FJ, Ji B, Kröner PT, Farraye FA, Bi Y. Pancreatic Disorders in Patients with Inflammatory Bowel Disease. Dig Dis Sci 2022; 67:423-436. [PMID: 33625614 DOI: 10.1007/s10620-021-06899-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) can involve multiple organ systems, and pancreatic manifestations of IBD are not uncommon. The incidence of several pancreatic diseases is more frequent in patients with Crohn's disease and ulcerative colitis than in the general population. Pancreatic manifestations in IBD include a heterogeneous group of disorders and abnormalities ranging from mild, self-limited disorders to severe diseases. Asymptomatic elevation of amylase and/or lipase is common. The risk of acute pancreatitis in patients with IBD is increased due to the higher incidence of cholelithiasis and drug-induced pancreatitis in this population. Patients with IBD commonly have altered pancreatic histology and chronic pancreatic exocrine dysfunction. Diagnosing acute pancreatitis in patients with IBD is challenging. In this review, we discuss the manifestations and possible causes of pancreatic abnormalities in patients with IBD.
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Affiliation(s)
- Marilia L Montenegro
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Juan E Corral
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Frank J Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Baoan Ji
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Paul T Kröner
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Yan Bi
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Charalabopoulos A, Davakis S, Lambropoulou M, Papalois A, Simopoulos C, Tsaroucha A. Apigenin Exerts Anti-inflammatory Effects in an Experimental Model of Acute Pancreatitis by Down-regulating TNF-α. In Vivo 2019; 33:1133-1141. [PMID: 31280202 DOI: 10.21873/invivo.11583] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIM This study investigated the anti-inflammatory effect of apigenin in an experimental model of acute pancreatitis. Inflammatory response was reflected by tissue expression of the cytokine TNF-α coupled with histological examination. MATERIALS AND METHODS Wistar rats were divided into three groups: Sham-group animals underwent laparotomy only, without any other interventions. Control-group animals underwent laparotomy and bilio-pancreatic duct ligation to induce pancreatitis without apigenin administration. Apigenin group animals were further treated with apigenin. Euthanasia was performed at 6, 12, 24, 48 and 72 h post-operatively. RESULTS Over-expression of TNF-α in relation to postoperative time was observed in the control group (p<0.001). In the apigenin group, under-expression of TNF-α in relation to postoperative time was observed (p<0.013). At 72 h, apigenin reduced pancreatic TNF-α expression and prevented pancreatic necrosis. CONCLUSION Apigenin slows progression and reduces severity of acute pancreatitis. Apigenin may serve as an adjunct to a more successful therapeutic strategy in acute pancreatitis.
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Affiliation(s)
- Alexandros Charalabopoulos
- Department of Upper Gastrointestinal and General Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Essex, U.K.,Experimental-Research Center, ELPEN Pharmaceuticals, Athens, Greece
| | - Spyridon Davakis
- Department of Upper Gastrointestinal and General Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Essex, U.K. .,First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Lambropoulou
- Department of Histopathology, Faculty of Medicine, Democritus University of Thrace, Alexandroupoli, Greece
| | | | - Constantinos Simopoulos
- Laboratory of Experimental Surgery and Surgical Research, Faculty of Medicine, Democritus University of Thrace, Alexandroupoli, Greece
| | - Alexandra Tsaroucha
- Laboratory of Experimental Surgery and Surgical Research, Faculty of Medicine, Democritus University of Thrace, Alexandroupoli, Greece
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Vege SS, Atwal T, Bi Y, Chari ST, Clemens MA, Enders FT. Pentoxifylline Treatment in Severe Acute Pancreatitis: A Pilot, Double-Blind, Placebo-Controlled, Randomized Trial. Gastroenterology 2015; 149:318-20.e3. [PMID: 26112745 DOI: 10.1053/j.gastro.2015.04.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/07/2015] [Accepted: 04/23/2015] [Indexed: 12/19/2022]
Abstract
In acute pancreatitis (AP) tumor necrosis factor-α mediates multi-organ failure; in animal models its blockade with pentoxifylline ameliorates AP. The efficacy of pentoxifylline in predicted severe AP (pSAP) was tested in a double-blinded, randomized, control trial. Twenty-eight patients with pSAP were randomized within 72 hours of diagnosis to pentoxifylline or placebo. Baseline characteristics were similar in both groups. The pentoxifylline group had fewer intensive care unit admissions and shorter intensive care unit and hospital stays of longer than 4 days (all P < .05). Patients receiving pentoxifylline had no adverse effects. Pentoxifylline within 72 hours of pSAP is safe; a larger study of pentoxifylline in AP is needed to confirm efficacy. ClinicalTrials.gov number: NCT01292005.
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Affiliation(s)
- Santhi Swaroop Vege
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Tegpal Atwal
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yan Bi
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Suresh T Chari
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Magdalen A Clemens
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Felicity T Enders
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Kambhampati S, Park W, Habtezion A. Pharmacologic therapy for acute pancreatitis. World J Gastroenterol 2014; 20:16868-16880. [PMID: 25493000 PMCID: PMC4258556 DOI: 10.3748/wjg.v20.i45.16868] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/23/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
While conservative management such as fluid, bowel rest, and antibiotics is the mainstay of current acute pancreatitis management, there is a lot of promise in pharmacologic therapies that target various aspects of the pathogenesis of pancreatitis. Extensive review of preclinical studies, which include assessment of therapies such as anti-secretory agents, protease inhibitors, anti-inflammatory agents, and anti-oxidants are discussed. Many of these studies have shown therapeutic benefit and improved survival in experimental models. Based on available preclinical studies, we discuss potential novel targeted pharmacologic approaches that may offer promise in the treatment of acute pancreatitis. To date a variety of clinical studies have assessed the translational potential of animal model effective experimental therapies and have shown either failure or mixed results in human studies. Despite these discouraging clinical studies, there is a great clinical need and there exist several preclinical effective therapies that await investigation in patients. Better understanding of acute pancreatitis pathophysiology and lessons learned from past clinical studies are likely to offer a great foundation upon which to expand future therapies in acute pancreatitis.
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Garcia FAO, Pinto SF, Cavalcante AF, Lucetti LT, Menezes SM, Felipe CFB, Alves APN, Brito GAC, Cerqueira GS, Viana GS. Pentoxifylline decreases glycemia levels and TNF-alpha, iNOS and COX-2 expressions in diabetic rat pancreas. SPRINGERPLUS 2014; 3:283. [PMID: 24991532 PMCID: PMC4070224 DOI: 10.1186/2193-1801-3-283] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/29/2014] [Indexed: 01/01/2023]
Abstract
Pentoxifylline (PTX), a methyl xanthine derivative, is a phosphodiesterase inhibitor with anti-inflammatory and renoprotective effects in diabetic patients, among other properties. We studied PTX actions and mechanisms in reducing blood biochemical parameters, in diabetic rats. For diabetes induction, alloxan was intravenously administered to male Wistar rats. One group was left untreated and the other ones treated with PTX (25, 50 and 100 mg/kg), glibenclamide or metformin, as references. Forty-eight hours later and after 1-week to 3-month treatments, blood was collected for determination of glycemia, triglycerides, cholesterol, transaminases, fructosamine and glycated hemoglobin. Afterwards, the animals were euthanized and pancreas, liver and kidney processed for histological analyses and immunohistochemistry assays for TNF-alpha, iNOS and COX-2. The results showed that PTX decreased glycemia and also triglyceride levels, starting 1 week after treatments, as compared to the same group before treatments. Glycemia values were brought towards normality, after 1-month treatment. PTX hypoglycemic effects were potentiated by glibenclamide but not by metformin. It also decreased fructosamine and glycated hemoglobin. Some histological and immunohistochemical alterations for TNF-alpha, iNOS and COX-2 in the diabetic pancreas were also reversed by PTX. We conclude that PTX acts similarly to glibenclamide, and its hypoglycemic actions are, partly, a consequence of ATP-sensitive K(+) channels inhibition. In addition, by its anti-inflammatory and antioxidant properties, PTX may be a therapeutic alternative for the treatment of diabetes and its complications.
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Affiliation(s)
| | - Sofia F Pinto
- Faculty of Medicine Estácio of Juazeiro do Norte, Juazeiro do Norte, Brazil
| | | | - Lívia T Lucetti
- Faculty of Medicine Estácio of Juazeiro do Norte, Juazeiro do Norte, Brazil
| | - Silvana Ms Menezes
- Faculty of Medicine of the Federal University of Ceará, Fortaleza, Brazil
| | | | - Ana Paula Nn Alves
- Faculty of Medicine of the Federal University of Ceará, Fortaleza, Brazil
| | - Gerly Anne C Brito
- Faculty of Medicine of the Federal University of Ceará, Fortaleza, Brazil
| | | | - Glauce Sb Viana
- Faculty of Medicine of the Federal University of Ceará, Fortaleza, Brazil ; Faculty of Medicine Estácio of Juazeiro do Norte, Juazeiro do Norte, Brazil
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Le Campion ER, Jukemura J, Coelho AM, Patzina R, Carneiro D'Albuquerque LA. Effects of intravenous administration of pentoxifylline in pancreatic ischaemia-reperfusion injury. HPB (Oxford) 2013; 15:588-94. [PMID: 23458290 PMCID: PMC3731579 DOI: 10.1111/hpb.12013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 10/17/2012] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Edmond Raymond Le Campion
- Division of Digestive Tract Transplantation (LIM/37), Department of Gastroenterology, University of São Paulo, São Paulo, Brazil.
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