Direct peritoneal resuscitation improves survival and decreases inflammation after intestinal ischemia and reperfusion injury

Trevor D. Crafts, Erin B.ailey Hunsberger, Amanda R. Jensen, Frederick Rescorla, Mervin Yoder, Troy A. Markel

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND: Direct peritoneal resuscitation (DPR) has previously been shown to alter blood flow in the small bowel mesenteric vessels in models of intestinal ischemia. However, a survival advantage or its effects on local tissue inflammation have not been previously demonstrated. We hypothesized that DPR would increase survival and decrease intestinal tissue inflammation after intestinal ischemia and reperfusion (I/R) injury.

METHODS: Eight-week-old male C57Bl6J mice were anesthetized and underwent midline laparotomy. I/R and DPR groups were exposed to superior mesenteric artery occlusion for 60 min with a nontraumatic clamp. Immediately after removal of the clamp, 1 mL of phosphate-buffered saline, 1 mL of minimal essential media, or 1 mL of minimal essential media supplemented with fetal bovine serum, penicillin and/or streptomycin, and glutamine were placed into the abdominal cavity of DPR groups. Animals were then closed in two layers and allowed to reperfuse for 6 h (cytokine analysis, n = 6 per group) or 7 d (survival analysis, n = 10 per group). After 6 h of reperfusion, animals were euthanized. Intestines were harvested and homogenized. Extracts were quantified for total protein content (Bradford assay), myeloperoxidase activity, tissue inflammatory cytokine, and growth factor production. P < 0.05 was significant.

RESULTS: I/R caused marked intestinal ischemia, significant mortality, and a significant increase in tissue cytokine and growth factor levels (P < 0.05). Seven-day survival was 30% for I/R without treatment and rose to 60% with DPR therapy using phosphate-buffered saline as the dialysate. DPR using plain MEM or MEM with supplements after ischemia increased 7-d survival to 90% (P < 0.05). DPR also significantly decreased intestinal tissue levels of myeloperoxidase, as well as intestinal tissue levels of multiple growth factors and inflammatory cytokines.

CONCLUSIONS: DPR increases survival and decreases intestinal inflammation after intestinal I/R injury. Translational applications are readily achievable and should be considered for patients with intestinal ischemic pathology.

Original languageEnglish (US)
Pages (from-to)428-434
Number of pages7
JournalThe Journal of surgical research
Volume199
Issue number2
DOIs
StatePublished - Dec 1 2015

Fingerprint

Reperfusion Injury
Resuscitation
Inflammation
Ischemia
Reperfusion
Cytokines
Intercellular Signaling Peptides and Proteins
Peroxidase
Survival
Phosphates
Superior Mesenteric Artery
Abdominal Cavity
Dialysis Solutions
Thromboplastin
Streptomycin
Survival Analysis
Glutamine
Penicillins
Laparotomy
Intestines

Keywords

  • Intestinal ischemia
  • Mesenteric ischemia
  • Necrotizing enterocolitis
  • Peritoneal resuscitation
  • Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Direct peritoneal resuscitation improves survival and decreases inflammation after intestinal ischemia and reperfusion injury. / Crafts, Trevor D.; Hunsberger, Erin B.ailey; Jensen, Amanda R.; Rescorla, Frederick; Yoder, Mervin; Markel, Troy A.

In: The Journal of surgical research, Vol. 199, No. 2, 01.12.2015, p. 428-434.

Research output: Contribution to journalArticle

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AU - Crafts, Trevor D.

AU - Hunsberger, Erin B.ailey

AU - Jensen, Amanda R.

AU - Rescorla, Frederick

AU - Yoder, Mervin

AU - Markel, Troy A.

PY - 2015/12/1

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N2 - BACKGROUND: Direct peritoneal resuscitation (DPR) has previously been shown to alter blood flow in the small bowel mesenteric vessels in models of intestinal ischemia. However, a survival advantage or its effects on local tissue inflammation have not been previously demonstrated. We hypothesized that DPR would increase survival and decrease intestinal tissue inflammation after intestinal ischemia and reperfusion (I/R) injury.METHODS: Eight-week-old male C57Bl6J mice were anesthetized and underwent midline laparotomy. I/R and DPR groups were exposed to superior mesenteric artery occlusion for 60 min with a nontraumatic clamp. Immediately after removal of the clamp, 1 mL of phosphate-buffered saline, 1 mL of minimal essential media, or 1 mL of minimal essential media supplemented with fetal bovine serum, penicillin and/or streptomycin, and glutamine were placed into the abdominal cavity of DPR groups. Animals were then closed in two layers and allowed to reperfuse for 6 h (cytokine analysis, n = 6 per group) or 7 d (survival analysis, n = 10 per group). After 6 h of reperfusion, animals were euthanized. Intestines were harvested and homogenized. Extracts were quantified for total protein content (Bradford assay), myeloperoxidase activity, tissue inflammatory cytokine, and growth factor production. P < 0.05 was significant.RESULTS: I/R caused marked intestinal ischemia, significant mortality, and a significant increase in tissue cytokine and growth factor levels (P < 0.05). Seven-day survival was 30% for I/R without treatment and rose to 60% with DPR therapy using phosphate-buffered saline as the dialysate. DPR using plain MEM or MEM with supplements after ischemia increased 7-d survival to 90% (P < 0.05). DPR also significantly decreased intestinal tissue levels of myeloperoxidase, as well as intestinal tissue levels of multiple growth factors and inflammatory cytokines.CONCLUSIONS: DPR increases survival and decreases intestinal inflammation after intestinal I/R injury. Translational applications are readily achievable and should be considered for patients with intestinal ischemic pathology.

AB - BACKGROUND: Direct peritoneal resuscitation (DPR) has previously been shown to alter blood flow in the small bowel mesenteric vessels in models of intestinal ischemia. However, a survival advantage or its effects on local tissue inflammation have not been previously demonstrated. We hypothesized that DPR would increase survival and decrease intestinal tissue inflammation after intestinal ischemia and reperfusion (I/R) injury.METHODS: Eight-week-old male C57Bl6J mice were anesthetized and underwent midline laparotomy. I/R and DPR groups were exposed to superior mesenteric artery occlusion for 60 min with a nontraumatic clamp. Immediately after removal of the clamp, 1 mL of phosphate-buffered saline, 1 mL of minimal essential media, or 1 mL of minimal essential media supplemented with fetal bovine serum, penicillin and/or streptomycin, and glutamine were placed into the abdominal cavity of DPR groups. Animals were then closed in two layers and allowed to reperfuse for 6 h (cytokine analysis, n = 6 per group) or 7 d (survival analysis, n = 10 per group). After 6 h of reperfusion, animals were euthanized. Intestines were harvested and homogenized. Extracts were quantified for total protein content (Bradford assay), myeloperoxidase activity, tissue inflammatory cytokine, and growth factor production. P < 0.05 was significant.RESULTS: I/R caused marked intestinal ischemia, significant mortality, and a significant increase in tissue cytokine and growth factor levels (P < 0.05). Seven-day survival was 30% for I/R without treatment and rose to 60% with DPR therapy using phosphate-buffered saline as the dialysate. DPR using plain MEM or MEM with supplements after ischemia increased 7-d survival to 90% (P < 0.05). DPR also significantly decreased intestinal tissue levels of myeloperoxidase, as well as intestinal tissue levels of multiple growth factors and inflammatory cytokines.CONCLUSIONS: DPR increases survival and decreases intestinal inflammation after intestinal I/R injury. Translational applications are readily achievable and should be considered for patients with intestinal ischemic pathology.

KW - Intestinal ischemia

KW - Mesenteric ischemia

KW - Necrotizing enterocolitis

KW - Peritoneal resuscitation

KW - Survival

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