Absence of circulating aldosterone attenuates foreign body reaction around surgical sutures.
OBJECTIVE
Adrenal hormones influence inflammatory and fibrotic activity and thereby are involved in wound-healing process. Any excess as well as any shortage of glucocorticoids leads to a delayed wound healing. Mineralocorticoids like aldosterone have a pro-fibrotic and pro-inflammatory impact; thus, reduction of circulating aldosterone should result in an attenuated inflammatory response to implanted foreign bodies.


METHODS
Eighteen rats were bilaterally adrenalectomized and substituted with dexamethasone (12 microg/kg per day) and 1% salt in their drinking water; 22 rats were sham-operated. The surgical suture material was removed after 3 weeks and analyzed for size of granuloma, ratio of collagen type I/III, apoptotic cells (terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling), expression of matrix metalloproteinase (MMP)-2, cyclooxygenase 2, tumor necrosis factor receptor 2 (TNF-R2), cluster of differentiation 68 (CD68), Ki67, and cold shock protein Y box binding protein 1 (YB-1). Cell expression was scored according to Remmele.


RESULTS
All animals developed foreign body granulomas around the sutures. Absence of circulating aldosterone after adrenalectomy (ADX) was associated with smaller granuloma size and a reduced ratio of collagen type I/III. Ki67 and MMP-2 showed the strongest expression in cells of the infiltrate around suture. In adrenalectomized rats, we observed significantly less CD68-positive macrophages and less Ki67-positive cells but no significant differences in the expression of YB-1, TNF-R2, or MMP-2. Looking for correlations and co-expressions of proteins, the number of significant Spearman correlations was reduced in the ADX group compared to controls (one and four, respectively).


CONCLUSIONS
The absence of circulating aldosterone attenuates inflammatory intensity around suture material. Foreign body granuloma seems to be an appropriate model to study chronic inflammatory process.
Klinge
Uwe
U
Surgical Department, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany. Klinge@hia.rwth-aachen.de
Theuer
Stefanie
S
Krott
Ellen
E
Fiebeler
Anette
A
D000315:Adrenalectomy; D000450:Aldosterone / Q000378:metabolism*; D000818:Animals; D004195:Disease Models, Animal; D015745:Granuloma, Foreign-Body / Q000378:metabolism*; D007249:Inflammation / Q000378:metabolism*; D008297:Male; D051381:Rats; D017208:Rats, Wistar; D013537:Sutures / Q000009:adverse effects; D014945:Wound Healing / Q000502:physiology*
D000450:Aldosterone