title: Neutrophil elastase inhibitor (sivelestat) preserves antitumor immunity and reduces the inflammatory mediators associated with major surgery.
abstract: OBJECTIVE
  To examine the effects of the administration of perioperative sivelestat, a selective neutrophil elastase inhibitor, on tumor immunity and inflammatory mediators in patients who undergo major surgery.
  
  
  METHODS
  Thirteen patients admitted to the hospital for elective surgery were equally randomized into one of two groups: the Sivelestat group (n = 6) and the control group (n = 7). Thereafter, the immunosuppressive acidic protein (IAP), serum interleukin-6 (IL-6), and type 1/type 2 T-helper cell balance were all assessed at several time points before and after surgical intervention.
  
  
  RESULTS
  The serum IL-6 values at 1 and 12 h after surgery and on postoperative days 1 and 3 were all significantly lower in the sivelestat group than in the control group. The IAP values at postoperative days 7 and 28 in the sivelestat group were also significantly lower than those in the control group. There was a significant correlation between the IL-6 level at 1 h after surgery and the IAP level at postoperative days 7 and 28.
  
  
  CONCLUSIONS
  In this preliminary study, the perioperative administration of sivelestat was thus suggested to reduce surgical stress by decreasing the cytokine release and preserving the antitumor immunity.
authors.affiliation: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kita, Kagawa 761-0793, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Akamoto
authors.forename: Keiichi
authors.initials: K
authors.lastname: Okano
authors.forename: Takanori
authors.initials: T
authors.lastname: Sano
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yachida
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Izuishi
authors.forename: Hisashi
authors.initials: H
authors.lastname: Usuki
authors.forename: Hisao
authors.initials: H
authors.lastname: Wakabayashi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000276:immunology / Q000601:surgery; D004067:Digestive System Neoplasms / Q000276:immunology* / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D004938:Esophageal Neoplasms / Q000276:immunology / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005998:Glycine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D019272:Leukocyte Elastase / Q000037:antagonists & inhibitors*; D008113:Liver Neoplasms / Q000276:immunology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011184:Postoperative Period; D011446:Prospective Studies; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use; D016037:Single-Blind Method; D013312:Stress, Physiological / Q000276:immunology*; D013449:Sulfonamides / Q000627:therapeutic use*; D018417:Th1 Cells / Q000378:metabolism; D018418:Th2 Cells / Q000378:metabolism
chemical_list: D015850:Interleukin-6; D015842:Serine Proteinase Inhibitors; D013449:Sulfonamides; C069195:sivelestat; D019272:Leukocyte Elastase; D005998:Glycine