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Decreased Inflammation and Improved Survival With Recombinant Human Activated Protein C Treatment in Experimental Acute Pancreatitis
Guido Alsfasser, MD;
Andrew L. Warshaw, MD;
Sarah P. Thayer, MD, PhD;
Bozena Antoniu, MS;
Michael Laposata, MD, PhD;
Kent B. Lewandrowski, MD;
Carlos Fernández-del Castillo, MD
Arch Surg. 2006;141:670-676.
Hypothesis Drotrecogin alfa (activated), the pharmacologic form of activated protein C and the first Food and Drug Administration–approved drug for treatment of severe sepsis, is beneficial in experimental acute pancreatitis (AP).
Design Animal study.
Setting Laboratory.
Subjects Male Sprague-Dawley rats.
Interventions Mild (intravenous cerulein) or severe (intravenous cerulein plus intraductal glycodeoxycholic acid) AP was induced in 72 rats, and coagulation evaluated. Rats with severe AP were randomized to treatment with drotrecogin alfa (activated), 100 µg/kg per hour, or isotonic sodium chloride.
Main Outcome Measures Histologic scoring of pancreatic necrosis, inflammation of the pancreas and lung (measured by myeloperoxidase concentration), coagulation measures, and 24-hour survival.
Results Severe consumptive coagulopathy, hemoconcentration, and leukocytosis were observed 6 hours after induction of severe AP, but not in mild AP. Treatment of AP with drotrecogin did not worsen coagulation measures. Although the degree of pancreatic necrosis was comparable in treated and untreated animals with severe AP, drotrecogin significantly reduced myeloperoxidase levels in the pancreas (P = .009) and lungs (P = .03). The 24-hour survival in severe AP was markedly improved in animals treated with drotrecogin (86% vs 38%; P = .05).
Conclusions Animals with severe AP have severe consumptive coagulopathy, but administration of drotrecogin alfa (activated), 100 µg/kg per hour, does not worsen coagulation abnormalities. Drotrecogin treatment reduces inflammation in the pancreas and lungs and significantly improves survival. These results encourage clinical investigation of drotrecogin in the treatment of severe AP.
Author Affiliations: Departments of Surgery (Drs Alsfasser, Warshaw, Thayer, and Fernández-del Castillo and Ms Antoniu) and Pathology (Drs Laposata and Lewandrowski), Massachusetts General Hospital, Harvard Medical School, Boston.
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Arch Surg. 2006;141(7):676.
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Decreased Inflammation and Improved Survival With Recombinant Human Activated Protein C Treatment in Experimental Acute Pancreatitis—Invited Response
Guido Alsfasser, Andrew L. Warshaw, and Carlos Fernández-del Castillo
Arch Surg. 2006;141(7):677.
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Decreased Inflammation and Improved Survival With Recombinant Human Activated Protein C Treatment in Experimental Acute Pancreatitis--Invited Critique
Andersen
Arch Surg 2006;141:676-676.
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