Ulinastatin reduces elevation of cytokines and soluble adhesion molecules during cardiac surgery

Kawamura, Takae; Inada, Katsuya; Akasaka, Noriko; Wakusawa, Reiji

doi:10.1007/bf03018106

Cited by 30 publications

(23 citation statements)

References 11 publications

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“…[20,24] Some of the tumor cells may also use VCAM-1 to adhere to the vascular wall and to migrate. [25][26][27] CAMs are affected by surgery and, in turn, may influence outcome after oncologic surgery. [26][27][28] There are only a few studies on the effect of laparoscopic surgery on the level of CAMs.…”

Section: Discussionmentioning

confidence: 99%

The Effects of a Small Dose of Dexamethasone on Cell Adhesion Molecules during Laparoscopic Cholecystectomy

et al. 2011

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Background and Objective: There are only a few publications on the effects of dexamethasone on the plasma levels of cell adhesion molecules (CAMs). The goal of this study was to investigate the effects of dexamethasone 4 mg on the perioperative plasma levels of CAMs (soluble intercellular adhesion molecules [sICAM-1] and soluble vascular cell adhesion molecules [sVCAM-1]) during laparoscopic cholecystectomy. Methods: Forty-two patients undergoing laparoscopic cholecystectomy under total intravenous anesthesia were enrolled and randomly divided into two groups: the first group received dexamethasone 4 mg (DEX group, n = 21) and the second group were controls (C group, n = 21). Plasma levels of sICAM-1 and sVCAM-1 were assessed before anesthesia, after induction (before surgery), and at 2 and 24 hours after surgery, respectively. Comparisons were performed for area under the plasma concentration-time curve (AUC) and within-group values. Results: AUC comparison for sICAM-1 showed significantly increased levels in the C group (p = 0.036), while there was no significant difference for sVCAM-1 (p = 0.052). Within-group analysis showed increased levels for both sICAM-1 and sVCAM-1 in the C group at 24 hours postoperatively (p = 0.35 and p = 0.025, respectively). Conclusions: In our study, dexamethasone 4 mg given before laparoscopic cholecystectomy determined a significant decrease in plasma levels of sICAM-1.

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Section: Discussionmentioning

confidence: 99%

The Effects of a Small Dose of Dexamethasone on Cell Adhesion Molecules during Laparoscopic Cholecystectomy

et al. 2011

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“…Production of TNF-α, interleukin-1α, and interleukin-1β is inhibited by ulinastatin in a dose-dependent manner [23]. Ulinastatin also has a protective effect against free-radical-induced membrane lipid peroxidation [24], and it may suppress the increase in interleukin-8 production and the expression of ICAM-1 during cardiac surgery [25]. Finally, ulinastatin has a protective effect against cisplatin nephrotoxicity and prevents an increase in lysosomal fragility [14].…”

Section: Discussionmentioning

confidence: 99%

Intravenous Ulinastatin Therapy for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Pediatric Patients

Inamo¹,

Okubo

Wada

et al. 2002

Int Arch Allergy Immunol

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Background: More effective therapy is needed for the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The clinical efficacy of intravenous ulinastatin therapy was investigated in 3 Japanese pediatric patients with SJS or TEN. Methods: Ulinastatin was given to 1 pediatric SJS patient and 2 pediatric TEN patients within 7 days (patient 1; SJS), 6 days (patient 2; TEN), or 4 days (patient 3; TEN) after the onset of the skin rash. Ulinastatin was administered intravenously at a dose of 7,500 U/kg/day (maximum dose: 300,000 U/day). No corticosteroids were given. After the skin lesions resolved, the ulinastatin dose was reduced to between 2,500 and 5,000 U/kg/day as maintenance therapy and then the drug was withdrawn. Results: Erythema, fatigue, and fever improved within 12–36 h of starting the ulinastatin infusion, and the skin lesions resolved completely after 4–7 days of ulinastatin therapy. None of the patients had cutaneous or ocular sequelae. No patient developed secondary infection or relapse and ulinastatin therapy caused no side effects. Conclusion: Ulinastatin dramatically reduced the febrile period with no adverse effects and was very safe in this study. Ulinastatin appears to be a useful and effective therapy for controlling SJS and TEN without sequelae.

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“…Glucocorticoids and protease inhibitors have been tested in both clinical and experimental studies [8, 9, 10, 11, 12, 29, 30]. The use of protease inhibitors has been shown to be a useful strategy for inhibiting the production of TNF-α and IL-1β [29, 30].…”

Section: Discussionmentioning

confidence: 99%

“…These 20 patients had hepatocellular carcinoma [9]and hepatic metastases from colorectal cancer [11]. We had no special criteria for performing this randomized controlled study; however, we excluded patients with bile duct and gallbladder cancers, because they had obstructive jaundice or needed bilioenteric reconstruction.…”

Section: Methodsmentioning

confidence: 99%

“…Modulation of excessive inflammatory cytokine production may therefore improve surgical morbidity, and may be easy to manage in postoperative patients after major surgery. Recently, glucocorticoids and protease inhibitors have been reported to reduce cytokine release from monocytes in patients undergoing several different kinds of major surgery [8, 9, 10, 11, 12]. Ulinastatin, or urinary trypsin inhibitor (UTI), which is a human protease inhibitor purified from fresh human urine [13], has been used clinically for the treatment of circulatory shock and acute pancreatitis as a polyvalent inhibitor of various enzymes including trypsin, chymotrypsin, and polymorphonuclear granulocyte elastase (PMNE) [14, 15, 16, 17].…”

Section: Introductionmentioning

confidence: 99%

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Effects of Perioperative Protease Inhibitor on Inflammatory Cytokines and Acute-Phase Proteins in Patients with Hepatic Resection

Ambiru

Miyazaki²,

Sasada³

et al. 2000

Dig Surg

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Aim: The objective of this study was to examine the effects of perioperative administration of ulinastatin, or urinary trypsin inhibitor (UTI), on inflammatory cytokines and acute-phase proteins induced by inflammatory cytokines in patients who had undergone hepatic resection. Method: Twenty patients admitted to the hospital for hepatic resection were equally randomized to one of two groups: the UTI group, those who were administered perioperative UTI, and the control group. Results: The UTI group had no adverse effects from using UTI. Production of serum interleukin-6 (IL-6) tended to be attenuated in the UTI group when compared with the control group. Moreover, the UTI group had significantly decreased positive acute-phase C-reactive protein (p < 0.05) and significantly increased negative acute-phase protein prealbumin and retinol-binding protein (p < 0.05). Serum IL-6 levels significantly correlated with serum C-reactive protein levels on postoperative day 1 (r = 0.70, p < 0.01). Conclusion: These results suggest that perioperative administration of UTI might deserve further assessment for use in modulating acute-phase responses without adverse effects in patients who have undergone hepatic resection.

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Ulinastatin reduces elevation of cytokines and soluble adhesion molecules during cardiac surgery

Cited by 30 publications

References 11 publications

The Effects of a Small Dose of Dexamethasone on Cell Adhesion Molecules during Laparoscopic Cholecystectomy

The Effects of a Small Dose of Dexamethasone on Cell Adhesion Molecules during Laparoscopic Cholecystectomy

Intravenous Ulinastatin Therapy for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Pediatric Patients

Effects of Perioperative Protease Inhibitor on Inflammatory Cytokines and Acute-Phase Proteins in Patients with Hepatic Resection

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