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Phospholipase-resistant phosphatidylcholine reduces intra-abdominal adhesions induced by bacterial peritonitis
1Department of Surgery, Lund University, Sweden.
Insights
This study shows that L-phosphatidylcholine and DL-alpha-phosphatidylcholine can reduce intra-abdominal adhesions after bacterial peritonitis in rats. However, L-phosphatidylcholine increased mortality, while DL-alpha-phosphatidylcholine did not significantly alter it.
Area of Science:
- Gastroenterology
- Surgical Research
- Inflammation Research
Background:
- Intra-abdominal adhesions frequently develop postoperatively or after peritonitis.
- Previous research indicated L-phosphatidylcholine reduces postoperative peritoneal adhesions in rats.
Purpose of the Study:
- To investigate the efficacy of L-phosphatidylcholine and DL-alpha-phosphatidylcholine in reducing adhesion formation following bacterial peritonitis.
- To assess the impact of these phosphatidylcholines on mortality rates associated with peritonitis.
Main Methods:
- Bacterial peritonitis was induced in rats via caecal ligation and double puncture.
- Cecotomy was performed at 12, 15, or 18 hours post-induction.
- Adhesion scores were evaluated 7 days post-cecotomy; L-phosphatidylcholine or DL-alpha-phosphatidylcholine were administered intraperitoneally for 3 days.
Main Results:
- Performing cecotomy 15 hours after peritonitis induction resulted in a significant adhesion score (4.3 +/- 0.9), which was reduced by both phosphatidylcholine treatments.
- L-phosphatidylcholine administration significantly increased mortality (P < 0.01).
- DL-alpha-phosphatidylcholine did not significantly alter the mortality rate (30%) while reducing adhesions.
Conclusions:
- Both L-phosphatidylcholine and DL-alpha-phosphatidylcholine demonstrate efficacy in decreasing adhesion formation after bacterial peritonitis.
- DL-alpha-phosphatidylcholine presents a potentially safer option due to a lack of increased mortality compared to L-phosphatidylcholine.
Abstract:
The majority of intra-abdominal adhesions develop postoperatively or following peritonitis. We have previously shown that L-phosphatidylcholine reduces postoperative peritoneal adhesions in rats. In the present study, we examined whether adhesion formation after bacterial peritonitis is also reduced by L-phosphatidylcholine or by DL-alpha-phosphatidylcholine, which is degraded only 50% by phospholipase A2. Peritonitis was induced in the rat by caecal ligation and double puncture; cecotomy was performed 12, 15, or 18 h later. Adhesions were assessed blindly by a scoring system 7 days after cecotomy. When cecotomy was scheduled for 18 h after caecal ligation and puncture, the 7-day mortality was 90% (n = 20). When cecotomy was performed at 12 h, no mortality was seen; however, the adhesion score was low (2.3 +/- 0.7). When cecotomy was performed 15 h after caecal ligation and puncture, the mortality was 25% and the adhesion score was 4.3 +/- 0.9. This figure was reduced significantly by intraperitoneal instillation of L-phosphatidylcholine or DL-alpha-phosphatidylcholine for 3 subsequent days. However, the mortality increased by L-phosphatidylcholine (P < 0.01), whereas mortality after DL-alpha-phosphatidylcholine remained at 30%. We conclude that administration of both L-phosphatidylcholine and DL-alpha-phosphatidylcholine decrease adhesion formation after bacterial peritonitis.