LIVER REGENERATION AND CHEMOTHERAPY, IS IT FEASIBLE?

Introduction

Despite the known cytotoxic and hepatotoxic effects of the most common chemotherapy drugs, their use in the context of liver regeneration as part of antitumor treatment is controversial.

Methods

Thirty-six WAG/RijHsd rats were induced to selective portal ligation of 50% of the hepatic parenchyma, and divided into 3 experimental groups. 72 hours before, two of the groups were treated with 5-Fluorouracil (50mg/kg) (5FU) or with 5-FU (50mg/kg) + Oxaliplatin (10mg/kg) (5-FU+OX); the third was the untreated control. The weight of the animals and the liver remnant were quantified and the biochemical profile was determined after 24 hours (half of the animals) or 7 days (the other half).

Results

The treated animals did not show differences in the percentage of liver remnant after 24h or 7 days (control: 67±3.5; 5-FU: 66±2.9; 5-FU+OX: 65±1.1%). After 24 hours, an increase in AST and ALT was detected in the treated groups (5-FU and 5-FU+OX) compared to the control (1783±110 vs. 2306±516 vs. 1400±273 IU/L; and 1251 ±121 vs. 1822±386 vs. 949±145 IU/l, respectively, p<0.05). After 7 days, slight differences remained, but were not statistically significant. Albumin was significantly altered throughout the experimental process, without normalizing after 7 days.

Conclusion

The combined 5FU+OX treatment does not affect the regenerated liver volume, although it triggers an initial cytolytic reaction, which normalizes over time, with the nutritional deficit persisting.

ANTIOXIDANT TREATMENTS IN THE PROPHYLAXIS OF INTESTINAL REPERFUSION DAMAGE

Introduction

Intestinal ischemia-reperfusion is still a relevant clinical problem, especially in newborns and in the elderly. In this piece of work, we check the utility of curcumin and dexmedetomidine to overcome the damage induced by reperfusion, both locally and in distant organs, using α-tocopherol as a comparison.

Methods

In female Wag/RijHsd rats, the superior mesenteric artery was clamped for 1 h; then, animals were allowed 4 h of reperfusion. Curcumin (200 mg/kg, oral) was given 24 h and 2 h before clamping; α-tocopherol (20 mg/kg, i.p.) was administered 2 h before ischemia, and dexmedetomidine (10 or 40 mg/kg, s.c.; dex-10 and dex-40, respectively) was given 15 minutes before ischemia. Blood samples and terminal ileum were collected. Additionally, a D-xylose absorption test was performed to evaluate intestinal absorption; 1h after D-xylose administration, D-xylose plasma levels were quantified (mg/ml).

Results

All of the treatments reduced histological damage assessed with Chiu's scale (non-treated, 2.6 ± 0.75; curcumin, 1.54 ± 0.8; dex-10, 1.47 ± 0.7; dex-40 1.43 ± 0.9; α-tocopherol, 1.01 ± 0.8) and improved absorption of D-xylose (healthy rats 2.06 ± 0.07; non-treated, 1.18 ± 0.07; curcumin 1.76 ± 0.30; dex-10, 2.29 ± 0.20; dex-40, 2.25 ± 0.26; α-tocopherol 1.66 ± 0.21). Dexmedetomidine improved renal function (it reduced both creatinine and urea in serum). The elevation of liver enzymes in serum was not improved by any of the drugs.

Conclusions

The three drugs proved to be useful, though α-tocopherol was more efficient regarding histological damage, and only dexmedetomidine restored D-xylose absorption to normal values.

ANTI-TUMORAL EFFECT OF 5-FLUOROURACIL AND OXALIPLATIN IN A LIVER REGENERATION MODEL

Introduction

Colorectal cancer liver metastases (CRCLM) continue to be a therapeutic challenge, since their resectability is usually limited by the functionality of the liver remnant. In this context, it is necessary to study the regenerative response of the liver in a selective portal vein ligation (PVL) model, after the administration of 5-fluorouracil and oxaliplatin, and to assess the effect of compensatory hypertrophy on tumor progression.

Methods

Twenty-eight WAG/RijHsd rats carrying CRCLM were divided into four groups: control, PVL, 5FU (50mg/kg) and 5FU+Oxaliplatin (50mg/kg+10mg/kg). After 18 days of tumor development, a dose of the corresponding treatment was administered, performing a PVL of 50% 72h later. Seven days later, tumor size was quantified and a biochemical profile was performed.

Results

The 5FU+Oxaliplatin and 5FU alone treatment decreased tumor growth by 6 and 3 times compared to the PVL and control groups, respectively (p<0.001). At a biochemical level, the combination of drugs resulted in a decrease in albumin levels (3.3 ± 0.39 mg/dl; p<0.02) and a significant weight loss of 10%; however, glucose (152±6.6 mg/dl), AST (161±27.1 IU/L), and ALT (46.7±9.4 IU/L) were not significantly altered. Seven days after PVL, the liver remnant did not change in either group (5FU+Oxaliplatin: 8±1; 5FU: 9.7±1.2; control 9.4±1.9 g; p>0.05).

Conclusion

In our model, the combined therapy of 5-Fluorouracil and oxaliplatin, prior to PVL, does not affect the necessary hepatic regeneration; while the volume of tumor implants decreases, no significant alteration of the biochemical parameters is detected.

ENHANCERS OF LIVER REGENERATION IN ONCOLOGICAL SURGERY

INTRODUCTION

Chemotherapy hinders liver function and probably its regenerating capacity, forcing to delay it after surgery. Our objective has been to verify this effect in an experimental model and to see if a hepatotrophic agent can prevent it.

MATERIAL AND METHODS

Four groups of 6 WAG/RijHsd rats (males, 3-4 months) were submitted to ligation of the portal branch to the left lateral and left paramedian lobes. They were sacrificed 36 h later to quantify the percentage of liver corresponding to the ligated lobes (weight), the number of hepatocyte’s nuclei (nº/100 µm2) and their mean size (µm2). One group received no treatment (control); another folic acid (2.5 mg/kg ip, during surgery); other 5-Fluorouracil (5-FU 50 mg/kg ip 48 h before); and the fourth received folic&5-FU.

RESULTS

The animals treated with folic acid showed a greater number of hepatocyte’s nuclei (24.4 ± 2.77 vs 15.2 ± 1.51) and their mean size was also greater (121 ± 2.34 vs 111 ± 1.8). However, the reduction in weight of the ligated parenchyma was less than in control group (33.4 ± 1.08 vs 29.5 ± 1.08). 5-FU did not modify the number of nuclei (15.6 ± 18.4), although they were smaller in size (104 ± 1.7). The addition of folic acid to 5-FU increased the number of nuclei (21.7 ± 2.8) and normalized their size (111 ± 3.2).

CONCLUSIONS

5-FU exerts a depressant effect on livers regeneration, and folic acid overcomes it. Thus, folic acid could allow early application of chemotherapy without affecting liver regeneration.

[Costal chondrosarcoma. Apropos of 4 cases]

Four cases of costal chondrosarcoma were observed in the Thoracic Surgery Department of Nostra Señora de Aránzazu Hospital in San Sebastián. This tumour rarely occurs in the ribs and no papers concerning more than one personal case, over such a brief interval, have been reported. The diagnosis was established on the basis of clinical and radiological data in three cases and after biopsy in the fourth case. Large surgical resection allowed complete histological examination, which confirmed the diagnosis of chondrosarcoma. The tumours were classified into grade I and II according to the degree of differentiation of the tumour cells. All 4 patients were treated exclusively by surgical resection. Marlex mesh was necessary to repair the chest wall defect in 3 cases. The functional result was satisfactory. One of these patients was lost to follow-up and no signs of recurrence have been observed in the other 3 patients, although the follow-up remains relatively short (9, 8 and 7 months, respectively).