Ivermectin Increases Random-Pattern Skin Flap Survival in Rats: The Novel Role of GABAergic System

Ivermectin (IVM) was first used as an antiparasitic agent; however, the role of this drug evolved into a broad spectrum. Many mechanisms have been proposed, including interaction with the GABAergic system. Considering the presence of GABA receptor in the skin tissue and its role in ischemia-reperfusion I/R injury, we aimed to evaluate the effect of IVM through GABA receptors on random-pattern skin flap survival.

Sixty Wistar male rats were used. Multiple doses of IVM (0.01, 0.05, 0.2, and 0.5 mg/kg) were injected intraperitoneally before the surgery. Baclofen (selective GABA_B agonist) and bicuculline (selective GABA_A antagonist) were administered in combination with IVM to assess the role of the GABAergic system. Histopathological evaluations, immunohistochemical staining, quantitative assessment of IL-1β and TNFα, and the expression of GABA_A α1 subunit and GABA_B R1 receptors were evaluated in the skin tissue.

IVM 0.05 mg/kg could significantly increase flap survival compared with the control group (P < 0.001). Subeffective dose of baclofen (0.1 mg/kg) had synergistic effect with the subeffective dose of IVM (0.01 mg/kg) (P < 0.001), whereas bicuculline 1 mg/kg reversed the effect of IVM (0.05 mg/kg) (P < 0.001). IVM 0.05 mg/kg could also decrease the IL-1β and TNFα levels and increase the expression of GABA_A α1 subunit and GABA_B R1 receptors in the flap tissue compared with the control group.

IVM could improve skin flap survival, probably mediated by the GABAergic pathway. Both GABA_A and GABA_B receptors are involved in this process. This finding may repurpose the use of old drug, "Ivermectin."