The effect of activated protein C on experimental acute necrotizing pancreatitis

Introduction

Bacterial contamination has been estimated to occur in 30–40% of patients with necrotizing pancreatitis. Development of pancreatic necrosis mainly depends on the degree of inflammation and microvascular circulation of the pancreatic tissue. Translocation of bacteria from the gut is one of the most important factors in the development of septic complications and mortality in acute pancreatitis. We aimed to investigate the effect of activated protein C (APC) on histopathology and bacterial translocation in experimental acute necrotizing pancreatitis.

Materials and methods

Forty-five male Sprague–Dawley rats were studied. Rats were randomly allocated into three groups. Acute pancreatitis was induced in Group II (positive control, n = 15), and Group III (treatment, n = 15) by retrograde injection of taurocholate into the common biliopancreatic duct. Group I rats (Sham, n = 15) received normal saline injection into the common biliopancreatic duct for mimicking the pressure effect. Group III rats were treated with intravenous activated protein C 6 hours after induction of pancreatitis. Pancreatic tissue samples were obtained from all animals for histopathological examination when they were sacrificed. Bacterial translocations to the pancreas, and mesenteric lymph nodes were examined.

Results

Acute pancreatitis developed in all groups, but not in Group I (Sham), as indicated by microscopic parenchymal necrosis, fat necrosis and abundant turbid peritoneal fluid. The pathologic score of the pancreatitis in the APC group (10.31 ± 0.47) was lower when compared with the positive control group (14.00 ± 0.52) (P < 0.001). Bacterial translocations to mesenteric lymph nodes and to the pancreas in the group treated with APC were significantly lower when compared with the control group (P < 0.02, and P < 0.007, respectively).

Conclusion

We suggest that beneficial effect of APC on histopathology and bacterial translocation may be the results of improving pancreatic microcirculation and anti-inflammatory effect of APC.