Evaluation of the sclerotherapeutic efficacy of ethanol, polidocanol, and OK-432 using an in vitro model.
BACKGROUND
Sclerosants are used to treat vascular malformations. Owing to variations in the flow, the injected concentrations and the duration of exposure of these sclerosants are altered. Therefore, the clinical effectiveness of sclerotherapy is variable.


OBJECTIVE
The objective was to evaluate the differences in clinical response, usually observed among ethanol, polidocanol, and OK-432, using an in vitro sclerotherapy model.


METHODS
Endothelial cells were cultured and exposed to different concentrations of the sclerosants for 5 seconds and the remaining viable cells were counted using a MTT assay kit. Dyes were used to visualize the morphologic changes. Precipitant formation in blood was also evaluated. Finally, the degree of ICAM-1 expression, after exposure to lower concentrations of these sclerosants, was studied using immunocytochemistry.


RESULTS
Only ethanol causes precipitant formation and kills almost all cells from 30% concentration. Polidocanol begins to disrupt the cell membrane from 0.0125% onward. Only OK-432 induces ICAM-1 expression.


CONCLUSIONS
Ethanol's strong precipitant-forming effect may induce thromboembolism, thus enhancing sclerosis. Polidocanol's endothelial cell-lysing effect was clearly documented. OK-432 may mediate its effect by inducing inflammatory response of the endothelium via ICAM-1 expression. This in vitro model may be useful in evaluating other sclerosants as well.
Mol
William
W
Department of Plastic and Reconstructive Surgery, University of Hokkaido at Sapporo, Graduate School of Medicine, Sapporo, Japan.
Furukawa
Hiroshi
H
Sasaki
Satoru
S
Tomaru
Utano
U
Hayashi
Toshihiko
T
Saito
Akira
A
Nagao
Munetomo
M
Saito
Noriko
N
Hata
Shinya
S
Yamamoto
Yuhei
Y
D002470:Cell Survival / Q000187:drug effects; D002478:Cells, Cultured; D042783:Endothelial Cells / Q000187:drug effects* / Q000378:metabolism; D000431:Ethanol / Q000494:pharmacology*; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000096:biosynthesis; D008954:Models, Biological; D010844:Picibanil / Q000494:pharmacology*; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000494:pharmacology*; D012597:Sclerosing Solutions / Q000494:pharmacology*; D016896:Treatment Outcome
D012597:Sclerosing Solutions; D000077423:Polidocanol; D018799:Intercellular Adhesion Molecule-1; D010844:Picibanil; D000431:Ethanol; D011092:Polyethylene Glycols