title: Trans-Serosal Leakage of Proinflammatory Mediators during Abdominal Aortic Aneurysm Repair: Role of Phospholipase A2 in Activating Leukocytes.
abstract: Gut barrier failure and the resultant translocation of luminal bacteria and bacterial products into the systemic circulation have been proposed as pathogenic mechanisms of multiorgan dysfunction syndrome (MODS) in open repair of abdominal aortic aneurysm (AAA). Our study aimed to demonstrate the direct release of gut-derived inflammatory mediators via the trans-serosal route in humans. Fifteen patients who underwent elective infrarenal open repair of AAA were randomized into two groups. In Group I patients (n = 10), the small intestine was exteriorized into a bowel bag. In Group II patients (n = 5), the small intestine was packed within the peritoneal cavity using large gauzes. We collected the bowel bag fluid in Group I and the ascites fluid, squeezed out from the gauzes at the end of surgery, in Group II. Leukocytes were collected from patients' blood samples. Incubation with the bowel bag fluid and ascites fluid caused a significant increase in both granulocyte pseudopod formation and CD11b expression compared to that with control fluid (p < 0.01). The addition of phospholipase A2 (PLA2) inhibitor quinacrine abolished leukocyte activation by the bowel bag fluid. Based on these results, we consider that trasns-serosal leakage of gut-derived mediators occurred during the open repair of AAA; further, sPLA2 may be the most potent mediator in the activation of leukocytes among such gut-derived mediators in AAA surgery.
authors.affiliation: Division of Vascular Surgery, Hamamatsu University School of Medicine ; Second Department of Surgery, Hamamatsu University School of Medicine.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sagara
authors.forename: Naoki
authors.initials: N
authors.lastname: Unno
authors.forename: Naoto
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Minoru
authors.initials: M
authors.lastname: Suzuki
authors.forename: Motohiro
authors.initials: M
authors.lastname: Nishiyama
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Konno
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mitsuoka
keywords: abdominal aortic aneurysm; gut barrier function; peritoneum; permeability; phospholipase A2
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