Original Article
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2014; 20(40): 14841-14854
Published online Oct 28, 2014. doi: 10.3748/wjg.v20.i40.14841
Gut-liver axis improves with meloxicam treatment after cirrhotic liver resection
Astrit R Hamza, Avdyl S Krasniqi, Pramod Kadaba Srinivasan, Mamdouh Afify, Christian Bleilevens, Uwe Klinge, René H Tolba
Astrit R Hamza, Pramod Kadaba Srinivasan, Mamdouh Afify, René H Tolba, Institute for Laboratory Animal Science and Experimental Surgery, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, 52074 Aachen, Germany
Astrit R Hamza, Avdyl Krasniqi, Department of Abdominal Surgery, University Clinical Center of Kosova, Prishtina 10000, Kosovo
Christian Bleilevens, Department of Anesthesiology, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, 52074 Aachen, Germany
Uwe Klinge, Department of Surgery, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, 52074 Aachen, Germany
Author contributions: Hamza AR designed the study, performed experiments, collected and analyzed data, and wrote the article; Krasniqi AS designed the study and wrote the article; Srinivasan PK collected and analyzed data; Afify M analyzed histologic data; Bleilevens C performed polymerase chain reaction experiments and analysis; Klinge U performed collagen quantification; Tolba RH designed the study, analyzed data, revised the article and approved final version for publication.
Correspondence to: René H Tolba, MD, PhD, Professor, Director, Institute for Laboratory Animal Science and Experimental Surgery, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Pauwelsstraße 30, 52074 Aachen, Germany. rtolba@ukaachen.de
Telephone: +49-241-8080472 Fax: +49-241-8082462
Received: February 22, 2014
Revised: June 7, 2014
Accepted: June 25, 2014
Published online: October 28, 2014
Abstract

AIM: To investigate the effect of meloxicam on the gut-liver axis after cirrhotic liver resection.

METHODS: Forty-four male Wistar rats were assigned to three groups: (1) control group (CG); (2) bile duct ligation with meloxicam treatment (BDL + M); and (3) bile duct ligation without meloxicam treatment (BDL). Secondary biliary liver cirrhosis was induced via ligature of the bile duct in the BDL + M and BDL groups. After 2 wk, the animals underwent a 50% hepatectomy. In the BDL + M group 15 min prior to the hepatectomy, one single dose of meloxicam was administered. Parameters measured included: microcirculation of the liver and small bowel; portal venous flow (PVF); gastrointestinal (GI) transit; alanine aminotransferase (ALT); malondialdehyde; interleukin 6 (IL-6), transforming growth factor beta 1 (TGF-β1) and hypoxia-inducible factor 1 alpha (HIF-1α) levels; mRNA expression of cyclooxigenase-2 (COX-2), IL-6 and TGF-β1; liver and small bowel histology; immunohistochemical evaluation of hepatocyte and enterocyte proliferation with Ki-67 and COX-2 liver expression.

RESULTS: Proliferative activity of hepatocytes after liver resection, liver flow and PVF were significantly higher in CG vs BDL + M and CG vs BDL group (P < 0.05), whereas one single dose of meloxicam ameliorated liver flow and proliferative activity of hepatocytes in BDL + M vs BDL group. COX-2 liver expression at 24 h observation time (OT), IL-6 concentration and mRNA IL-6 expression in the liver especially at 3 h OT, were significantly higher in BDL group when compared with the BDL + M and CG groups (P < 0.01, P < 0.001, P < 0.01, respectively). Liver and small bowel histology, according to a semi quantitative scoring system, showed better integrity in BDL + M and CG as compared to BDL group. ALT release and HIF-1α levels at 1 h OT were significantly higher in BDL + M compared to CG and BDL group (P < 0.001 and P < 0.01, respectively). Moreover, ALT release levels at 3 and 24 h OT were significantly higher in BDL group compared to CG, P < 0.01. GI transit, enterocyte proliferative activity and number of goblet cells were in favor of meloxicam treatment vs BDL group (P < 0.05, P < 0.001, P < 0.01, respectively). Additionally, villus length were higher in BDL + M as compared to BDL group.

CONCLUSION: One single dose of meloxicam administered after cirrhotic liver resection was able to cause better function and integrity of the remaining liver and small bowel.

Keywords: Liver cirrhosis, Liver resection, Gut-liver axis, Meloxicam, Cyclooxigenase-2, Microcirculation

Core tip: Cyclooxygenase-2 (COX-2) inhibitors have been used in liver cirrhosis (LC), suppressing inflammation and liver fibrosis. However, the effects of COX-2 inhibition on the gut-liver axis after cirrhotic liver resection was not investigated previously. For the first time it can be concluded that one single dose of meloxicam administered 15 min prior to a 50% hepatectomy in LC, alleviates impairment of many functions of the gut-liver axis such as microcirculation, hepatocyte and enterocyte regeneration rate, and gastrointestinal transit, enabling better function and integrity of the remaining liver and the small bowel.