Albumin Administration in Acute Pancreatitis Increases Lung and Pancreatic Damage Reversed by Nitric Oxide Synthase Inhibitor
Emilio E. Abdo1, ANA Maria M. Coelho1, Sandra N. Sampietre1, Nilza a. Molan1, Rosely a. Patzina2, José Eduardo M. Cunha1, Luiz Augusto C. D'Albuquerque1, Marcel C. Machado*1
1Gastroenterology, University of Sao Paulo, Sao Paulo, Brazil; 2Pathology, University of São Paulo School of Medicine, Clinical Hospital, Sao Paulo, Brazil
Backgroun/Aim: Colloid resuscitation in acute pancreatitis (AP) is a matter of controversy due to the possible deleterious effect on lung function. Previous study demonstrated that albumin administration increases lung damage in burns and that this effect can be reversed by inhibition of nitric oxide synthase (iNOS) .We hypothesized that albumin administration in AP may be deleterious not only to the lungs but also to the pancreas and that those effects can be reversed by inhibition of iNOS. The aim of this study was to evaluate whether inhibition of iNOS reverses the effect of albumin on lung and pancreatic damage in AP.Methods: AP was induced in male Wistar rats by intraductal 5% taurocholate injection. To evaluate the effect of albumin on lung damage in AP, animals received IV saline (Group I) or human albumin (Group II) immediately after AP. To evaluate the effect of iNOS inhibition on lung damage in AP, iNOS specific inhibitor S-methylisothiourea (SMT) was given to animals immediately after AP. The animals were divided into groups: Group III: saline was given after AP and SMT, and Group IV: albumin was given after AP and SMT. After 12 hours serum amylase levels, lung myeloperoxidase (MPO) activity, pulmonary vascular permeability, and histological analysis in pulmonary and pancreatic tissue were determined.Results: Serum amylase levels, lung MPO activities, vascular permeability and inflammatory infiltration, and pancreatic edema were significantly increased after AP. Albumin administrated after AP increased lung permeability and inflammatory infiltration, pancreatic edema, and serum levels of amylase compared to saline administration (p<0.05). However, albumin administration with SMT reduced lung permeability and inflammatory infiltration, and pancreatic edema compared to albumin administration without SMT (p<0.05). There were no significant differences in lung MPO activities among groups.Conclusion: Restoration of extracellular fluid in AP with albumin increased the lung and pancreatic damage. Inhibition of iNOS before albumin administration reduced albumin induced damaging effects in AP.
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