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Biodegradable Biliary Stents Have Potentially a Beneficial Effect Over Covered Metal Stents on Protein Expression Associated With Tissue Healing in Benign Biliary Strictures
Antti Siiki*1, Ralf Jesenofsky2, J. Matthias LöHR3, Isto Nordback1, Juhani Sand1, Johanna Laukkarinen1
1Dept. of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; 2Dept. of Medicine II, University of Heidelberg, Mannheim, Germany; 3Gastrocentrum, Karolinska University Hospital, Huddinge, Sweden
Background: Endoscopy is the first therapeutic option in benign biliary strictures (BBS) secondary to e.g. chronic pancreatitis or previous surgery. In BBS, the use of covered self-expandable metal stents (CSEMS) is increasingly common. Biodegradable biliary stents (BDBS) have shown promising results in animal models and in percutaneous use in humans. Tissue response in BBS to different types of stents is largely unknown.
Aim: To evaluate the expression pattern of proteins related to tissue healing in BBS compared to the intact bile duct (BD), and assess the protein expression after therapy with CSEMS or BDBS.
Materials and methods: Swine with experimental ischemic model of BBS were endoscopically treated either with poly-lactide BDBS or CSEMS. Tissue samples were harvested from swine with intact BD (n=5), untreated BBS (n=5) and after six months of therapy with BDBS (n=4) or CSEMS (n=5). Two-dimensional electrophoresis with protein identification was performed to evaluate protein expression. The animal study protocol was reviewed and approved by the Provincial Government of Eastern Finland and the Animal Ethics Committee of the University of Kuopio, Finland.
Results: Compared to the intact BD, in BBS the expression of Galectin-2 and Annexin-A4 decreased. BDBS treatment normalized Galectin-2 level, but with CSEMS therapy it remained low. Annexin-A4 expression remained low after both treatments. Transgelin expression, which was low in intact BD and in the BBS, remained low after BDBS treatment but increased after CSEMS therapy.
Conclusion: The protein expression of BBS changes from what is seen in intact BD. The expression of proteins related to tissue healing in BBS is different after treatment with BDBS and CSEMS. Treatment with BDBS may bring the protein expression towards what is seen in the intact BD. These findings warrant further studies for the future therapeutic implications.
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