Plasminogen activator/plasminogen activator inhibitor-1 and cytokine modulation by the PROACT System.
OBJECTIVE
To examine the effects of the PROACT treatment on the fibrinolytic system and inflammatory cytokines in human peritoneum.


METHODS
Controlled clinical study.


METHODS
University hospital.


METHODS
Nine subjects undergoing laparotomy had peritoneal samples taken at the incision.


METHODS
The PROACT applicator was inserted through the peritoneal incision, and treatment of peritoneum was performed twice. A peritoneal sample was taken from one treated area. At closure, the second treated sample and an additional control sample were taken. All four samples were snap frozen in liquid nitrogen. Samples were homogenized and protein content extracted.


METHODS
Concentrations of total and active transforming growth factor-beta 1 (TGF-beta1), tumor necrosis factor-alpha (TNF-alpha), tissue-type plasminogen activator (t-PA), urokinase plasminogen activator (uPA), and plasminogen activator inhibitor 1 (PAI-1) were obtained.


RESULTS
Total TGF-beta1 at opening was 30% less in treated samples. At closure, active TGF-beta1 increased significantly (163%) in control samples and not in treated samples. Tumor necrosis factor alpha was detectable only in control samples at closure. During surgery, tPA levels showed a marked decrease in control samples vs. a small increase in treated samples. Levels of uPA increased significantly only in the control samples. In control samples, tPA/PAI-1 ratio was two thirds of treated sample ratio.


CONCLUSIONS
Heating of the peritoneum with the PROACT System modulates the biologic tissue response to induce effects that would be consistent with inhibition of postoperative adhesion development.
Department of Surgery, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden.
Marie-Louise
ML
Ivarsson
Michael P
MP
Diamond
Peter
P
Falk
Lena
L
Holmdahl
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007813:Laparotomy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010532:Peritoneal Diseases / Q000378:metabolism / Q000517:prevention & control*; D017395:Plasminogen Activator Inhibitor 1 / Q000378:metabolism*; D000267:Tissue Adhesions / Q000378:metabolism / Q000517:prevention & control; D010959:Tissue Plasminogen Activator / Q000378:metabolism*; D016212:Transforming Growth Factor beta / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014568:Urokinase-Type Plasminogen Activator / Q000378:metabolism*
D017395:Plasminogen Activator Inhibitor 1; D016212:Transforming Growth Factor beta; D014409:Tumor Necrosis Factor-alpha; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator