In vitro effects of proteases in human pancreatic juice on stability of liquid and carrier-bound fibrin sealantsAdelmeijer, J., Porte, R. J. & Lisman, T., Oct-2013, In : British Journal of Surgery. 100, 11, p. 1498-1504 7 p.
Research output: Contribution to journal › Article › Academic › peer-review
Background: Fibrin sealants are used in pancreatic surgery to prevent leakage of pancreatic fluid and reduce associated complications. The efficacy of this approach is unclear.
Methods: Fibrin clots were generated in vitro from two commercially available liquid fibrin sealants (Tissucol Duo (R) and Evicel (R)) and the carrier-bound fibrin sealant Tachosil (R), and exposed to normal saline or human pancreatic fluid. Stability of the sealants was assessed by release of the fibrin and collagen degradation products, D-dimer and hydroxyproline. The effect of protease inhibitors on sealant breakdown was assessed.
Results: Clots generated from liquid fibrin sealants degraded rapidly in pancreatic fluid, but not in normal saline. D-dimer release from fibrin clots by pancreatic fluid was approximately 1700 mu g/ml after 24 h and less than 20 mu g/ml by saline. Pancreatic fluid, but not normal saline, degraded both the fibrin and collagen component of Tachosil (R). After 6 h, mean(s.e.m.) D-dimer levels in pancreatic fluid exposed to Tachosil (R) were 850(183) ng/ml, compared with 60(6) ng/ml in normal saline. The mean(s.e.m.) hydroxyproline concentration in pancreatic fluid was 497(17) mu g/ml after a 24-h exposure to Tachosil (R), compared with 26(12) mu g/ml in normal saline. Protease inhibitors significantly inhibited breakdown of liquid sealants (D-dimer levels less than 50 mu g/ml after 24 h) and Tachosil (R) (D-dimer release 179(12) ng/ml at 6 h; hydroxyproline release 181(29) mu g/ml at 24 h).
Conclusion: Proteases in pancreatic juice effectively degrade both liquid and carrier-bound fibrin sealants in vitro. The use of these products in pancreatic surgery with the aim of preventing leakage of pancreatic fluid is not supported by this experimental study.
|Number of pages||7|
|Journal||British Journal of Surgery|
|Publication status||Published - Oct-2013|
- PROSPECTIVE RANDOMIZED-TRIAL, HUMAN ALPHA-1-PROTEINASE INHIBITOR, DISTAL PANCREATECTOMY, GLUE SEALANT, TRYPSIN-INHIBITOR, PREVENTION, RESECTION, FISTULA, THROMBIN, SURGERY