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P330. The impact of peri-operative administration of infliximab on the healing process of intestinal anastomosis: A rat experimental study

I. Papaconstantinou1, C. Zeglinas2, M. Gazouli3, C. Nastos1, A. Yiallourou1, A. Papalois4, C. Tzathas2, 1Areteion Hospital, Medical School, University of Athens, 2nd Department of Surgery, Athens, Greece, 2Tzaneio General Hospital, Department of Gastroenterology, Piraeus, Greece, 3School of Medicine, University of Athens, Laboratory of Histology and Embryology, Athens, Greece, 4ELPEN-Pharmaceuticals Co. Inc, Experimental-Research Unit, Pikermi Attikis, Greece

Background

Peri-operative administration of Infliximab is a common scenario for patients with complicated or refractory to medication Crohn's Disease who require surgical treatment. Whether the peri-operative administration of Infliximab compromises the intestinal healing ability leading thus to weaker anastomoses and increased risk of post-operative complications rate remains controversial.

The aim of this experimental study was to investigate the effect of peri-operative Infliximab infusion on the healing process of intestinal anastomosis in rats.

Methods

Fifty-six adult Wistar rats were allocated to 4 groups: (a) 20 subjected to excision of part of the terminal ileum followed by anastomosis after which animals were sacrificed (b) 20 received Infliximab and thereafter a same strategy to group (a) was followed (c) 8 rats received Infliximab and served as relative control group and (d) 8 rats with no intervention served as absolute control group.

Rats of (b) and (c) groups received subcutaneous injections of 5 mg/kg infliximab on days 0, 3, 6, 9, 12 and group (b) underwent surgery 3 days after the completion of administration.

On the 3rd or the 7th post-operative day anastomoses of the rats of the groups (a) and (b) were excised and submitted to immunohistochemistry for TNF-a, TGFb1, MMP1, MMP2 and Collagen V. The results were confirmed by Western blot analysis.

Results

Immunohistochemical analysis revealed no significant difference of TNF-a in the anastomosis of all specimens. Protein expression of TGFb1, MMP2 and collagen V was significantly higher in the Infliximab-treated anastomosis compared to the non-Infliximab treated group (p < 0.01, p < 0.05, and p < 0.05 respectively).

MMP1 expression was low in all cases and was not changed significantly by IFX treatment.

The immunohistochemical results between non-Infliximab treated and Infliximab treated groups were confirmed by Western blot analysis.

Conclusion

Infliximab influenced the intestinal healing with the formation of anastomosis with higher tissue remodeling activity.