Abstract
Aim
The aim of this experimental study is to investigate the effects of tacrolimus on colonic anastomotic healing after subcutaneous administration.
Materials and methods
Forty Albino–Wistar male rats were divided into two groups, with two equal subgroups each. They all underwent colonic resection followed by a single-layer, inverted colon anastomosis and were injected subcutaneously with either 1 ml of 0.9% NaCl solution or tacrolimus (0.1 mg/kg body weight) depending on their group. Half of the rats were sacrificed on the fourth postoperative day, while the remaining half were sacrificed on the eighth postoperative day. Macroscopical and histological assessment was performed, while anastomotic bursting pressures and the tissue concentrations in hydroxyproline and collagenase I were evaluated.
Results
On the fourth postoperative day, the bursting pressures (217.00 ± 11.12, p < 0.001), the fibroblast activity (2.80 ± 0.42, p = 0.022), the neoangiogenesis (2.10 ± 0.32, p = 0.007) and the tissue hydroxyproline concentration (254.23 ± 67.10, p = 0.001) were significantly higher in the tacrolimus-treated animals. Furthermore, tacrolimus significantly decreased the inflammatory cell infiltration (1.50 ± 0.53, p < 0.001) and the tissue collagenase I concentration (4.16 ± 0.76, p = 0.002).
On the eighth day, the bursting pressure (264.00 ± 32.61, p < 0.001) and the hydroxyproline tissue concentration (331.04 ± 55.56, p = 0.002) were significantly higher in the tacrolimus subgroups. The inflammatory cell infiltration (1.20 ± 0.42, p < 0.001) and the collagenase I concentration (1.61 ± 0.83, p < 0.001) were significantly lower. In addition, the adhesion formation score was significantly lower (1.20 ± 0.92, p = 0.065).
Conclusion
Tacrolimus, when injected subcutaneously, promotes healing of colonic anastomoses in rats. It impairs not only inflammatory response but also collagen degradation, resulting to increased anastomotic strength on the fourth as well as on the eighth postoperative day.
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References
Kanellos I, Blouhos K, Demetriades H, Pramateftakis MG, Mantzoros I, Zacharakis E, Betsis D (2004) The failed intraperitoneal colon anastomosis after colon resection. Tech Coloproctol 8:53–55
Kanellos I (2004) Progress in the treatment of colorectal cancer. Tech Coloproctol 8:1–2
Pramateftakis MG, Vrakas G, Hatzigianni P, Tsachalis T, Matzoros I, Christoforidis E, Raptis D, Roidos G, Lazaridis C (2010) The handsewn anastomosis after colon resection due to colonic cancer. Tech Coloproctol 14:57–59
Ho YH, Ashour MA (2010) Techniques for colorectal anastomosis. World J Gastroenterol 16:1610–1621
Schrock TR, Deveney CV, Dunphy JE (1973) Factor contributing to leakage of colonic anastomoses. Ann Surg 177:513–518
Kanellos I, Angelopoulos S, Tsachalis T, Pramateftakis MG, Mantzoros I, Betsis D (2004) Anastomotic leakage following anterior resection for rectal cancer. Tech Coloproctol 8:79–81
Hämäläinen M, Lahti A, Moilanen E (2002) Calcineurin inhibitors, cyclosporin A and tacrolimus inhibit expression of inducible nitric oxide synthase in colon epithelial and macrophage cell lines. Eur J Pharmacol 448:239–244
Thomson AW, Bonham CA, Zeevi A (1995) Mode of action of tacrolimus (FK506): molecular and cellular mechanisms. Ther Drug Monit 17:584–591
Miyagi M, Muramatsu M, Ishikawa Y, Ishii T, Sakai K, Arai K, Aikawa A, Ohara T, Mizuiri M, Hirayama N, Hasegawa A (2002) Comparison of the therapeutic effects between CsA and FK506 on chronic renal allograft injury and TGF-beta expression. Transplant Proc 34:1589–1590
Kiyama T, Tajiri T, Tokunaga A, Yoshiyuki T, Barbul A (2002) Tacrolimus enhances colon anastomotic healing in rats. Wound Repair Regen 10:308–313
Van der Ham AC, Kort WJ, Weijma IM, van den Ingh HF, Jeekel H (1992) Effect of antibiotics in fibrin sealant on healing colonic anastomoses in the rat. Br J Surg 79:525–528
Ozel SK, Kazez A, Akpolat N (2006) Does a fibrin–collagen patch support early anastomotic healing in the colon? An experimental study. Tech Coloproctol 10:233–236
Phillips JD, Kim CS, Fonkalsrud EW, Zeng H, Dindar H (1992) Effects of chronic corticosteroids and vitamin A on the healing of intestinal anastomoses. Am J Surg 163:71–77
Reddy GK, Enweneka CS (1996) A simplified method for the analysis of hydroxyproline in biological tissues. Clin Biochem 29:225–229
Cohen J (1988) Statistical power analysis for the behavioral sciences. Erlbaum, New Jersey
Faul F, Erdfelder E (1992) GPOWER: a priori, post-hoc and compromise power analyses for MS-DOS [computer program]. Bonn University, Dep. of Psychology, Bonn
Toothaker L (1993) Multiple comparison procedures. Sage, Newbury Park
Mehta C, Patel R (1996) SPSS Exact Tests 7.0 for Windows. SPSS Inc., Chicago
Kanellos D, Pramateftakis MG, Vrakas G, Hatzigianni P, Agelopoulos S, Tsachalis T, Koukouritaki Z, Raptis D, Kanellos I (2010) Laparoscopic right hemicolectomy due to colon cancer. Tech Coloproctol 14:71–72
Merkel S, Hohenberger W, Hermanek P (2010) Intra-operative local tumor cell dissemination in rectal carcinoma surgery: effect of operation principles and neoadjuvant therapy. Chirurg 81:719–727
Kanellos D, Pramateftakis MG, Demetriades H, Zacharakis E, Angelopoulos S, Mantzoros I, Kanellos I, Despoudi K, Zaraboukas T, Koliakos G, Galovatsea K, Lazaridis H (2008) Healing of colonic anastomoses after immediate postoperative intraperitoneal administration of oxaliplatin. Int J Colorectal Dis 23:1185–1191
Pramateftakis MG, Kanellos D, Demetriades H, Kanellos I, Mantzoros I, Zacharakis E, Despoudi K, Angelopoulos S, Koliakos G, Zaraboukas T, Betsis D (2007) The effects of irinotecan on the healing of colonic anastomoses in rats. The Open Surgery Journal 1:1–6
Mantzoros I, Kanellos I, Angelopoulos S, Koliakos G, Pramateftakis MG, Kanellos D, Zacharakis E, Zaraboukas T, Betsis D (2006) The effect of insulin-like growth factor I on healing of colonic anastomoses in cortisone-treated rats. Dis Colon Rectum 49:1431–1438
Ng SC, Arebi N, Kamm MA (2007) Medium-term results of oral tacrolimus treatment in refractory inflammatory bowel disease. Inflamm Bowel Dis 13:129–134
Pronio A, Di Filippo A, Narilli P, Mancini B, Caporilli D, Piroli S, Vestri A, Montesani C (2007) Anastomotic dehiscence in colorectal surgery. Analysis of 1290 patients. Chir Ital 59:599–609
Demling RH (2009) Nutrition, anabolism, and the wound healing process: an overview. Eplasty 9:9
Alamo JM, Galindo A, Morales S, Daza G, Socas M, Suárez-Artacho G, Suárez-Grau JM, García-Moreno J, Pareja F, Gómez MA (2007) Role of malnutrition in intestinal anastomosis collagenization: an analysis of procollagen (PINP) and carboxyterminal telopeptide (ICTP) by radioimmunoassay. Rev Esp Enferm Dig 99:76–83
Ghosh S, Panaccione R (2010) Anti-adhesion molecule therapy for inflammatory bowel disease. Therap Adv Gastroenterol 3:239–258
Sadek K, Macklon N, Bruce K, Cagampang F, Cheong Y (2011) Hypothesis: role for the circadian clock system and sleep in the pathogenesis of adhesions and chronic pelvic pain? Med Hypotheses 76:453–456
Wasserberg N, Nunoo-Mensah JW, Ruiz P, Tzakis AG (2007) The effect of immunosuppression on peritoneal adhesions formation after small bowel transplantation in rats. J Surg Res 141:294–298
Brunner G (2003) Theme issue: wound healing mechanisms. Thromb Haemost 90:976–977
Otrock ZK, Mahfouz RA, Makarem JA, Shamseddine AI (2007) Understanding the biology of angiogenesis: review of the most important molecular mechanisms. Blood Cells Mol Dis 39:212–220
Wang XJ, Dong Z, Zhong XH, Shi RZ, Huang SH, Lou Y, Li QP (2008) Transforming growth factor-beta1 enhanced vascular endothelial growth factor synthesis in mesenchymal stem cells. Biochem Biophys Res Commun 365:548–554
Tuxhorn JA, McAlhany SJ, Yang F (2002) Inhibition of transforming growth factor-beta activity decreases angiogenesis in a human prostate cancer-reactive stroma xenograft model. Cancer Res 62:6021–6025
Jung H, Kim HH, Lee DH, Hwang YS, Yang HC, Park JC (2011) Transforming growth factor-beta 1 in adipose derived stem cells conditioned medium is a dominant paracrine mediator determines hyaluronic acid and collagen expression profile. Cytotechnology 63:57–66
Kiyama T, Onda M, Tokunaga A, Efron DT, Barbul A (2001) Effect of matrix metalloproteinase inhibition on colonic anastomotic healing in rats. J Gastrointest Surg 5:303–311
Witte MB, Thornton FJ, Kiyama T, Efron DT, Schulz GS, Moldawer LL, Barbul A (1998) Metalloproteinase inhibitors and wound healing: a novel enhancer of wound strength. Surgery 124:464–470
Nishi K, Ishii T, Wada M, Amae S, Sano N, Nio M, Hayashi Y (2004) The colon displays an absorptive capacity of tacrolimus. Transplant Proc 36:364–366
Acknowledgements
The authors wish to acknowledge the contribution of Dr. G. Menexes, lecturer of Biometry in Aristotle University of Thessaloniki, to the statistical analysis of this study. Mrs. Vasiliki Kanellou, BA in English Language and Linguistics, MA in Applied Linguistics, is also acknowledged for proof reading and revising the paper.
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Raptis, D., Mantzoros, I., Pramateftakis, M.G. et al. The effects of tacrolimus on colonic anastomotic healing in rats. Int J Colorectal Dis 27, 299–308 (2012). https://doi.org/10.1007/s00384-011-1337-y
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DOI: https://doi.org/10.1007/s00384-011-1337-y