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World J Gastroenterol. Sep 21, 2008; 14(35): 5436-5441
Published online Sep 21, 2008. doi: 10.3748/wjg.14.5436
Direct hemoperfusion with a polymyxin B-immobilized cartridge in intestinal warm ischemia reperfusion
Hiroaki Sato, Kiyohiro Oshima, Kazuhisa Arakawa, Katsumi Kobayashi, Hodaka Yamazaki, Yujin Suto, Izumi Takeyoshi
Hiroaki Sato, Kazuhisa Arakawa, Katsumi Kobayashi, Hodaka Yamazaki, Yujin Suto, Izumi Takeyoshi, Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan
Kiyohiro Oshima, Intensive Care Unit, Gunma University Hospital, Maebashi, Gunma 371-8511, Japan
Author contributions: Sato H, Oshima K and Takeyoshi I contributed equally to this work; Sato H and Takeyoshi I designed research; Sato H, Arakawa K, Kobayashi K, Yamazaki H, and Suto Y performed research; Sato H and Oshima K analyzed data; and Sato H and Oshima K wrote the paper.
Correspondence to: Izumi Takeyoshi, MD, Professor, Chairman, Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan. takeyosi@showa.gunma-u.ac.jp
Telephone: +81-27-2208245 Fax: +81-27-2208255
Received: June 30, 2008
Revised: July 28, 2008
Accepted: August 4, 2008
Published online: September 21, 2008
Abstract

AIM: To investigate the effectiveness of direct hemoperfusion with polymyxin B-immobilized fibers (DHP-PMX therapy) on warm ischemia-reperfusion (I/R) injury of the small intestine.

METHODS: The proximal jejunum and distal ileum of mongrel dogs were resected. Warm ischemia was performed by clamping the superior mesenteric artery (SMA) and vein (SMV) for 2 h. Blood flow to the proximal small intestine was restored 1 h after reperfusion, and the distal small intestine was used as a stoma. The experiment was discontinued 6 h after reperfusion. The dogs were divided into two groups: the DHP-PMX group (n = 6, DHP-PMX was performed for 180 min; from 10 min prior to reperfusion to 170 min after reperfusion) and the control group (n = 5). The rate pressure product (RPP), SMA blood flow, mucosal tissue blood flow, and intramucosal pH (pHi) were compared between the two groups. The serum interleukin (IL)-10 levels measured 170 min after reperfusion were also compared.

RESULTS: The RPP at 6 h after reperfusion was significantly higher in the PMX group than in the control group (12 174 ± 1832 mmHg/min vs 8929 ± 1797 mmHg/min, P < 0.05). The recovery rates of the SMA blood flow at 1 and 6 h after reperfusion were significantly better in the PMX group than in the control group (61% ± 7% vs 44% ± 4%, P < 0.05, and 59% ± 5% vs 35% ± 5%, P < 0.05, respectively). The recovery rate of the mucosal tissue blood flow and the pHi levels at 6 h after reperfusion were significantly higher in the PMX group (61% ± 8% vs 31% ± 3%, P < 0.05 and 7.91 ± 0.06 vs 7.69 ± 0.08, P < 0.05, respectively). In addition, the serum IL-10 levels just before DHP-PMX removal were significantly higher in the PMX group than in the control group (1 569 ± 253 pg/mL vs 211 ± 40 pg/mL, P < 0.05).

CONCLUSION: DHP-PMX therapy reduced warm I/R injury of the small intestine. IL-10 may play a role in inhibiting I/R injury during DHP-PMX therapy.

Keywords: Ischemia-reperfusion injury, Interleukin-10, Polymyxin B-immobilized hemoperfusion cartridge, PMX