• World J. Gastroenterol. · Sep 2008

    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, and Izumi Takeyoshi.
    • Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, Japan.
    • World J. Gastroenterol. 2008 Sep 21; 14 (35): 5436-41.

    AimTo 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.MethodsThe 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.ResultsThe 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).ConclusionDHP-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.

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