Published online May 27, 2020. doi: 10.4254/wjh.v12.i5.184
Peer-review started: October 23, 2019
First decision: November 22, 2019
Revised: March 25, 2020
Accepted: March 30, 2020
Article in press: March 30, 2020
Published online: May 27, 2020
The Pringle maneuver [portal triad obstruction(PTO)] provides huge disturbances during ischemia and even more thereafter in reperfusion. Contrarily, a possible solution may be stable gastric pentadecapeptide BPC 157, with already documented beneficial effects in ischemia/reperfusion conditions. Recently, BPC 157, as a cytoprotective agent, successfully resolved vessel occlusions in rats (ischemic colitis; deep vein thrombosis, superior anterior pancreaticoduodenal vein; bile duct cirrhosis) through rapid collateral vessel recruitment to circumvent vessel occlusion. Thereby, medication BPC 157 regimens were administered as a single challenge before and during ischemia or, alternatively, at various time points during reperfusion.
To introduce BPC 157 therapy against pringle maneuver-damage.
In deeply anesthetised rats, the portal triad was clamped up for 30 min. Rats then underwent reperfusion for either 15 min or 24 h. Medication [(10 µg, 10 ng/kg) regimens, administered as a single challenge] picked (a) ischemia, PTO period [at 5 min before (ip) or at 5 or 30 min of ligation time (as a bath to PTO)] or (b) reperfusion, post-PTO period [at 1 or 15 min (bath during surgery) or 24 h (ip) reperfusion-time]. We provided gross, microscopy, malondialdehyde, serum enzymes, electrocardiogram, portal, caval, and aortal pressure, thrombosis and venography assessments.
BPC 157 counteracts electrocardiogram disturbances (increased P wave amplitude, S1Q3T3 QRS pattern and tachycardia). Rapidly presented vascular pathway (portal vein-superior mesenteric vein-inferior mesenteric vein-rectal veins-left ileal vein-inferior caval vein) as the adequate shunting immediately affected disturbed haemodynamics. Portal hypertension and severe aortal hypotension during PTO, as well as portal and caval hypertension and mild aortal hypotension in reperfusion and refractory ascites formation were markedly attenuated (during PTO) or completely abrogated (reperfusion); thrombosis in portal vein tributaries and inferior caval vein or hepatic artery was counteracted during portal triad obstruction PTO. Also, counteraction included the whole vicious injurious circle [i.e., lung pathology (severe capillary congestion), liver (dilated central veins and terminal portal venules), intestine (substantial capillary congestion, submucosal oedema, loss of villous architecture), splenomegaly, right heart (picked P wave values)] regularly perpetuated in ischemia and progressed by reperfusion in Pringle rats.
BPC 157 resolves pringle maneuver-damage in rats, both for ischemia and reperfusion.
Core tip: Recently, cytoprotective agent BPC 157 successfully resolved vessel occlusions in rats (ischemic colitis; deep vein thrombosis, superior anterior pancreaticoduodenal vein) through rapid collateral vessel recruitment to circumvent vessel occlusion. Medication BPC 157 [(10 µg, 10 ng/kg) regimens, administered as a single challenge] picked (1) ischemia, portal triad obstruction (PTO) period [at 5 min before (ip) or at 5 or 30 min of ligation time (as a bath to PTO)] or (2) reperfusion, post-PTO period [at 1 or 15 min (bath during surgery) or 24 h (ip) reperfusion time]. Gross, microscopy, malondialdehyde, serum enzymes, electrocardiogram, portal, caval and aortal pressure, thrombosis and venography assessments demonstrated that BPC 157 successfully attenuates ischemia-reperfusion injury of the liver and other organs. In particular, BPC 157 rapidly activates portocaval shunt, normalises arterial and disturbed blood pressure (portal and caval hypertension and aortal hypotension), counteracts formation of blood clots and cardiac rhythm changes and counteracts gastrointestinal mucosal lesions, as complications that follow the Pringle maneuver.