lactoferrin and Postoperative-Complications

Recurrence of Crohn's disease following surgical resection is common, but the optimal strategy to assess, prevent, and treat postoperative recurrence remains unclear. Recent developments in the prevention and management of postoperative recurrence have provided additional information.. Predictors of Crohn's disease recurrence after surgery include cigarette smoking, disease behavior, number of prior resections, family history, anastomotic type, and time to first surgery. Only penetrating disease behavior and continued cigarette smoking after surgery remain clear predictors of postoperative Crohn's disease recurrence. Ileocolonoscopy is the only modality to detect mucosal recurrence after surgery; however, surrogate markers of inflammation, specifically stool lactoferrin and calprotectin as well as small intestine contrast ultrasound, are promising. Due to the high rate of surgery for the treatment of complications of Crohn's disease, prevention of postoperative disease has received considerable attention. Recent studies of azathioprine/6-mercaptopurine, nitroimidazole antibiotics, and infliximab have broadened the spectrum of medication options postoperatively.. Smoking cessation and ileocolonoscopy for early detection of Crohn's disease recurrence should be part of any postoperative management strategy. The selection of medication and optimal time to initiate treatment after surgery is less certain. Postoperative immunomodulators and antitumor necrosis factor agents may prevent Crohn's disease in those at high risk for recurrence. Treatment of patients by predictors of recurrence and personalization of management based on genotypes/phenotypes will be the focus of future study.

Topics: Anti-Inflammatory Agents; Colonoscopy; Crohn Disease; Endosonography; Feces; Gastrointestinal Agents; Humans; Lactoferrin; Leukocyte L1 Antigen Complex; Postoperative Complications; Recurrence; Risk Factors; Smoking; Time Factors

Human lactoferrin is a natural defense protein belonging to the innate immune system present in several body fluids and secretions, as well as in the secondary granules of polymorphonuclear neutrophils. Lactoferrin and its derivatives have pleiotropic functions including broad-spectrum anti-microbial activity, anti-tumor activity, regulation of cell growth and differentiation, and modulation of inflammatory as well as humoral and cellular immune responses. This is the reason why much research has addressed the potential therapeutic activity of these molecules in different clinical settings, especially regarding infectious diseases and uncontrolled inflammatory conditions. In patients with hematological malignancies treated with a hematopoietic stem cell transplantation (HSCT), morbidity and mortality due to infections and uncontrolled inflammation remains high, despite many advances in supportive care. These life-threatening complications are a result of the damage caused by the conditioning regimens to the mucosal barrier, and the innate and adaptive, humoral, and cellular immune defenses. These complications necessitate the continued exploration of new treatment modalities. Systemic and probably local levels of lactoferrin are decreased following HSCT. Therefore, the use of lactoferrin, or short peptide derivatives that retain the cationic N-terminal moiety that is essential for the anti-microbial and anti-inflammatory activity, may prove to be a promising versatile class of agents for managing the complications that arise from HSCT.

Topics: Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Infections; Inflammation; Lactoferrin; Postoperative Complications; Transplantation Immunology

Topics: Bacteriolysis; Ceruloplasmin; Cilia; Complement System Proteins; Cross Infection; Humans; Immunoglobulins; Intensive Care Units; Lactoferrin; Lymphocytes; Macrophages; Mucus; Neutrophils; Opsonin Proteins; Phagocytosis; Postoperative Complications; Respiratory System; Respiratory Tract Infections; Risk

Tooth extraction is a very common procedure in oral surgery. Despite this, very little information is available in the literature as to the antibiotic management of the patient. The aim of this study is to evaluate whether the antibiotic prophylaxis could be beneficial in preventing postextraction local complications and whether the use of a probiotic could help reduce the antibiotic gastro-intestinal side effects.. One hundred eleven patients meeting the inclusion criteria were initially included in this randomized clinical trial and randomly allocated to one of the three experimental groups according to a computer-generated randomization list. Patients allocated to the group 1 were given amoxicillin+clavulanic acid (2 g/day for 6 days), patients allocated to the group 2 received antibiotic + probiotic (Bifidobacterium longum+lactoferrin) and patients allocated to the group 3 received no antibiotic therapy after the extraction. To evaluate post-extractive complications, controls were performed at days 7, 14 and 21 after the extraction.. At T1 pain at the surgical site was present in the 48%, 30% and 71.4% of the patients belonging respectively to the antibiotic alone group, to the antibiotic+probiotic group and to the control group. The mean Numeric Rating Score (NRS) score was 1.56±1.91, 1.08±1.93, 2.02±2.27 respectively (P=0.0498). Two patients belonging to the control group experienced dry socket. In addition, 9 patients (33.3%) in the antibiotic-alone group and 1 patient (2.7%) in the antibiotic+probiotic group reported intestinal distension (P=0.0012), 7 days after surgery. Finally, diarrhea was recorded in 5 patients of the antibiotic alone group (18.5%), on the other hand, no patients of the antibiotic+probiotic group and the control group reported diarrhea.. Postextractive complications observed in each group have been mild and fast to resolve. The antibiotic administration showed a decrease in pain suffered by patients but a higher incidence of gastrointestinal side effects, such as abdominal distension and diarrhea, which seemed to be relieved by the concomitant use of the probiotic.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antibiotic Prophylaxis; Bifidobacterium longum; Diarrhea; Dry Socket; Female; Humans; Ibuprofen; Lactoferrin; Male; Middle Aged; Pain, Postoperative; Postoperative Complications; Probiotics; Surgical Wound Infection; Tooth Extraction; Treatment Outcome

The article analyzes the results of effect of combined and local cytokine- and ozone therapy on the indices of lipid peroxidation, endogenous intoxication and ferroproteins in 111 patients with diffuse peritonitis. It was shown, that combined sequential local and systemic cytokine and ozone therapy allows correcting the expression of endogenous intoxication and lipid peroxidation in diffuse peritonitis. This method suppresses an inflammation in the abdominal cavity. At the same time, it accelerates the elimination of intestine atony and thereby potentiates the possibilities of traditional methods of treatment.

Topics: Adjuvants, Immunologic; Cytokines; Drainage; Drug Administration Routes; Drug Monitoring; Drug Therapy, Combination; Endotoxemia; Ferritins; Humans; Lactoferrin; Laparotomy; Lipid Peroxidation; Oxidants, Photochemical; Ozone; Peristalsis; Peritoneal Lavage; Peritonitis; Postoperative Complications; Severity of Illness Index; Treatment Outcome

The effect of oral administration of lactoferrin (LF) was studied to determine if it could modify post-surgical immune response. The action of LF was evaluated in 18 LF-treated patients vs 28 placebo counterparts. Patients (women and men, mean age 50 years) were given daily oral doses (20 mg each) of LF for 5 consecutive days prior to thyroid surgery. The following immune response parameters were determined in blood samples taken from the patients day before, day after, and 5-7 days following surgery: cell morphology, the proliferative response of peripheral blood mononuclear cells to phytohemagglutinin, and the spontaneous and lipopolysaccharide (LPS)-induced production of tumor necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6). As a consequence of the thyroid surgery, the total leukocyte count increased on the post-operative day by about 50% in all patients and the percentage of lymphocytes fell by 26 and 35% in the control vs LF-treated group. The content of neutrophils, on the other hand, elevated on day 1 post-operation by 51 and 68%, respectively. The percent of neutrophil precursors was markedly higher in LF-treated patients, particularly on the day before and the day after surgery (4.1 and 4.8 vs 2.5 and 3.7%, respectively). The post-surgical values were, however, comparable in both groups for neutrophils. The proliferative response of lymphocytes showed a slight decrease in the control group and an increase in the LF-treated patients on day 5 post-operation (20% over control group). LPS-induced TNF-alpha production was higher in LF-treated patients both one day before and one day following surgery (28 and 24%, respectively). LPS-induced IL-6 production was comparable in both placebo and LF-treated patients before surgery, however, on day 1 and 5 following surgery, the production of IL-6 was higher in LF-treated patients by 65 and 27%, respectively. Taken together, the data presented in this study revealed an increased immune responsiveness in all patients treated with LF and subjected to thyroid surgery. This suggests that treatment with LF could constitute an effective protective measure against post-surgical complications.

Topics: Adjuvants, Immunologic; Administration, Oral; Blood Cell Count; Blood Cells; Double-Blind Method; Female; Humans; In Vitro Techniques; Interleukin-6; Lactoferrin; Lymphocyte Activation; Male; Middle Aged; Phytohemagglutinins; Postoperative Complications; Thyroid Diseases; Tumor Necrosis Factor-alpha

Heparin coating of the cardiopulmonary bypass circuit attenuates inflammatory response and confer clinical benefits in cardiac operations. The positive effects may be amplified with reduced systemic heparin dosage. We studied markers of inflammation and coagulation in thoracic aortic operations with heparin-coated circuits and standard vs reduced systemic heparinization.. Thirty patients were randomized to standard (group S; 300 IU/kg initially; activated clotting times [ACT] > 480 seconds; 5,000 IU in prime; n = 16) or reduced (group R; 100 IU/kg initially; ACT > 250 seconds; 2,500 IU in prime; n = 14) dose systemic heparin. The following markers were analyzed perioperatively: (a) inflammatory response; acute phase cytokine interleukin-6, and granulocytic proteins myeloperoxidase and lactoferrin; (b) complement activation; factor C3a and the C5a-9 terminal complement complex [TCC]; and (c) coagulation; thrombin-antithrombin III complex.. The clinical outcome did not differ between groups. Four (29%) patients in group R had a perioperative thromboembolic event. All studied markers were significantly elevated during and throughout cardiopulmonary bypass in both groups. Maximal values were higher in group R for all variables except for TCC. There were no statistically significant intergroup differences regarding markers of inflammation, complement activation, or coagulation activation.. The blood trauma in thoracic aortic operation is extensive, as reflected by the elevation of the studied biochemical markers, even when heparin-coated cardiopulmonary bypass circuits are used. In this study, we did not detect any benefits, either biochemical or clinical, of reducing the dose of systemic heparin.

Topics: Aged; Anticoagulants; Antithrombin III; Aorta, Thoracic; Cardiopulmonary Bypass; Complement C3a; Complement Membrane Attack Complex; Female; Heparin; Humans; Interleukin-6; Lactoferrin; Male; Middle Aged; Peptide Hydrolases; Peroxidase; Postoperative Complications

During cardiopulmonary bypass (CPB) oxygen free radicals (OFR) are formed, which can mediate reactions damaging tissue components. Blood contact with artificial surfaces during CPB leads to an activation of leukocytes, which are one of the sources of the OFR. Heparin coating of the CPB circuit reduces granulocyte activation. In the present study, the heparin-coated circuits with noncoated cardiotomy reservoirs (Group HC) were compared with noncoated, otherwise similar CPB sets (Group C). In each group, 8 patients were operated on for coronary revascularization. The release of granulocyte granule proteins myeloperoxidase (MPO) and lactoferrin (LF) was evaluated. Production of OFR in the whole blood and in the granulocyte suspension were measured by chemiluminescence (CL). In both groups the whole blood CL declined during CPB. The whole blood CL induced by serum-opsonized zymosan, when enhanced by luminol, was significantly lower in Group HC at 45 min after CPB start (68 +/- 6% of initial values in Group HC vs. 87 +/- 6% in Group C, mean +/- SEM) and 30 min after protaminization (54 +/- 6% of initial values in Group HC vs. 72 +/- 6% in Group C, mean +/- SEM), and CL was significantly higher in Group HC at CPB end (83 +/- 5% of initial values in Group HC vs. 67 +/- 5% in Group C, mean +/- SEM) when enhanced by lucigenin. CL of isolated granulocytes showed no significant differences between the groups. Release of MPO at CPB end and of LF 45 min after start of CPB and at CPB end were significantly lower in the heparin-coated CPB circuits.

Topics: Adult; Analysis of Variance; Cardiopulmonary Bypass; Coronary Artery Bypass; Female; Free Radicals; Granulocytes; Heparin; Humans; Intraoperative Complications; Lactoferrin; Leukocyte Count; Luminescent Measurements; Lymphocyte Activation; Lymphocyte Count; Male; Middle Aged; Neutrophils; Peroxidase; Postoperative Care; Postoperative Complications; Reactive Oxygen Species

Degranulation of polymorphonuclear (PMN) granulocytes, complement activation, and the endocrine metabolic response to hysterectomy were compared in two groups of patients receiving either general anaesthesia (GA group) or combined epidural analgesia and general anaesthesia (GAE group). The B-leucocyte and the cortisol responses were attenuated in the GAE group. There was no sign of complement activation. The post-operative rise in elastase-alpha-1-proteinase levels 4 h post-operatively on the first, second and third post-operative days was similar in the two groups. Plasma lactoferrin values were significantly elevated 4 h post-operatively and reached pre-operative values on Day 1 in both groups. Attenuation of the surgical stress response during uncomplicated hysterectomy did not influence the post-operative increase in proteinase activity. Mediators generated at the site of surgical trauma may account for the PMN degranulation observed after major surgery.

Topics: Adult; alpha 1-Antitrypsin; Analgesia, Epidural; Anesthesia, General; B-Lymphocytes; Bupivacaine; Cell Degranulation; Complement C3d; Endopeptidases; Female; Fentanyl; Humans; Hydrocortisone; Hysterectomy; Intraoperative Complications; Lactoferrin; Leukocyte Count; Midazolam; Middle Aged; Neutrophils; Pancreatic Elastase; Postoperative Complications; Stress, Physiological; Vecuronium Bromide

After liver transplantation (LT), biliary complications are associated with reduced graft survival. We tested inflammation markers for their association with biliary damage and graft loss in bile.. The study design was a retrospective case-control study. Calprotectin, lactoferrin and pyruvate kinase were measured in endoscopically retrieved bile with ELISA.. Calprotectin and lactoferrin were significantly higher in bile of ischemic-type biliary lesions and donor duct non-anastomotic strictures than in control, bile leakage, Cytomegalovirus infection, anastomotic stricture or acute cellular rejection patients (p<0.001) independent of serum liver values at endoscopy. Calprotectin (p=0.02) was independently associated with retransplantation free survival in multivariate analysis, as was γGT (p=0.03) but not ERC radiographic classification of the bile duct or cold ischemia time.. Calprotectin and lactoferrin are bile markers for biliary damage and are associated with re-transplantation free survival. They can differentiate progressive biliary damage from non-biliary liver value alterations after LT.

Topics: Adult; Aged; Bile; Bile Duct Diseases; Biomarkers; Case-Control Studies; Female; Graft Survival; Humans; Lactoferrin; Leukocyte L1 Antigen Complex; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Pyruvate Kinase; Retrospective Studies; Young Adult

Injuries to flexor tendons can lead to loss of finger function after healing due to adhesion formation. The aim of this study was to assess the efficacy and safety of the new peptide, PXL01, in the prevention of peritendinous adhesions. The effect of a single intraoperative administration of PXL01 in sodium hyaluronate on mobility of the affected digit after surgery was assessed in a rabbit model by measuring total active motion, metatarsophalangeal-claw distance and resistance to bending the digits. Load-to-failure testing was done in the same specimens to assess tendon healing. The results demonstrated that a single application of PXL01 in sodium hyaluronate significantly improved mobility of the treated digits compared with the digits in which the same surgery was carried out but no treatment was provided. No negative effects on tendon healing were observed in connection with the treatment.

Topics: Animals; Biomechanical Phenomena; Carrier Proteins; Disease Models, Animal; Female; Hindlimb; Hyaluronic Acid; Hydrogels; Lactoferrin; Postoperative Complications; Rabbits; Range of Motion, Articular; Stress, Mechanical; Tendon Injuries; Tissue Adhesions

The objective of the study was to evaluate whether a peptide derived from human lactoferrin, PXL01 could act safely to reduce the formation of peritoneal adhesions in the rat model and to map the molecular mechanisms of its action.. Adhesion formation is a significant problem within every surgical discipline causing suffering for the patients and major cost for the society. For many decades, attempts have been made to reduce postsurgical adhesions by reducing surgical trauma. It is now believed that major improvements in adhesion prevention will only be reached by developing dedicated antiscarring products, which are administrated in connection to the surgical intervention.. Anti-inflammatory as well as fibrinolytic activities of PXL01 were studied in relevant human cell lines. Using the sidewall defect-cecum abrasion model in the rat, the adhesion prevention properties of PXL01 formulated in sodium hyaluronate were evaluated. Large bowel anastomosis healing model in the rat was applied to study if PXL01 would have any negative effects on intestine healing.. PXL01 exhibits an inhibitory effect on the most important hallmarks of scar formation by reducing infections, prohibiting inflammation, and promoting fibrinolysis. PXL01 formulated in sodium hyaluronate markedly reduced formation of peritoneal adhesions in rat without any adverse effects on wound healing.. A new class of synthetically derived water soluble low molecular weight peptide compound, PXL01 showed marked reduction of peritoneal adhesion formation in an animal model without any negative effects on healing. On the basis of these data, a comprehensive adhesion prevention regimen in clinical situation is expected.

Topics: Adjuvants, Immunologic; Animals; Carrier Proteins; Cells, Cultured; Disease Models, Animal; Drug Compounding; Female; Humans; Hyaluronic Acid; Lactoferrin; Peritoneal Diseases; Postoperative Complications; Rats; Rats, Sprague-Dawley; Tissue Adhesions; Treatment Outcome

Mice subjected to thymectomy or splenectomy in general anesthesia release interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) into circulation reaching high concentrations after 4 h following operation. In the case of thymectomy IL-6 can be detected only on the day of operation and TNF-alpha attains a maximal value on day 3 postoperation. Splenectomy, which is a more extensive surgical operation, results in a higher, and more prolonged existence of IL-6 in circulation accompanied by higher levels of TNF-alpha. Bovine lactoferrin (BLF; 10 mg/mouse), given intravenously (i.v.) 24 h before thymectomy, reduced, on average, the level of serum IL-6 by 70% as measured 4 h after operation. The inhibiting effect of BLF on TNF-alpha production was smaller with a mean 30% reduction. The effects of BLF (i.v.) administration on the cytokine levels following splenectomy were less inhibitory. BLF caused an approximate 35% fall in IL-6 levels and even weaker effects (20% inhibition) on TNF-alpha release. Application of much lower (1-0.2 mg) per os doses of BLF was even more effective in lowering IL-6 levels after thymectomy (up to 90%) after 5 BLF doses, and by 55% of TNF-alpha. The data suggest that lactoferrin may find therapeutical application for diminishing manifestations of shock caused by clinical insults.

Topics: Administration, Oral; Anesthesia, General; Animals; Cattle; Injections, Intravenous; Interleukin-6; Lactoferrin; Male; Mice; Mice, Inbred CBA; Postoperative Complications; Shock; Splenectomy; Thymectomy; Tumor Necrosis Factor-alpha

Oxygen free radical generation by xanthine oxidase (XO) is a possible mechanism in the injury following reperfusion of transplanted organs. This study was undertaken to investigate XO in human lung, and to investigate whether XO is released into the blood stream during the immediate postoperative period after lung transplantation. XO activity was measured in healthy human lung tissue, and XO protein and the adenine nucleotide catabolic products hypoxanthine, xanthine and uric acid were analysed in the plasma samples collected during human heart-lung transplantation (n=4), double lung transplantation (n=2), and single lung transplantation (n=1). Neutrophil degranulation was assessed by plasma lactoferrin measurements. The results indicated that XO activity (detection limit 5 pmol x min(-1) x mg(-1) protein) and protein (detection limit 5 ng x mg-1 protein) were undetectable in the lungs of five healthy individuals. Similarly, no XO protein could be found in the plasma samples from the right ventricle or left atrium during and after the transplantation in any of the cases. Plasma xanthine and hypoxanthine concentrations were elevated 2-10 fold immediately after the reperfusion of the transplant, indicating washout of high-energy phosphate degradation products from the ischaemic lung. Plasma uric acid decreased rather than increased immediately after the surgery and during the following 24 h. Lactoferrin was elevated during the surgery. In conclusion, these results show that XO activity in human lung is low, it is not released into the blood stream during human heart-lung transplantation, and it is unlikely to contribute to postoperative complications in these patients.

Topics: Chromatography, High Pressure Liquid; Enzyme-Linked Immunosorbent Assay; Free Radicals; Heart-Lung Transplantation; Humans; Hypoxanthine; Lactoferrin; Lung; Lung Transplantation; Middle Aged; Postoperative Complications; Reperfusion Injury; Uric Acid; Xanthine; Xanthine Oxidase; Xanthines

Tear lactoferrin concentration was measured by ELISA technique and followed in 30 patients undergoing cataract surgery. On the first day following surgery, there was a significant decrease in tear lactoferrin concentration followed by a gradual return to the initial values during the postoperative observation period of 7 days. There was an inverse linear relationship between tear lactoferrin concentration and the tear secretion rate measured by a modified Schirmer I test (1 min) suggesting a constant lactoferrin secretion by the tear glands. Since lactoferrin has known antibacterial and anti-inflammatory effects, the results may contribute to further understanding of the microbial vulnerability or resistance of the eye following surgical procedures.

Topics: Aged; Aged, 80 and over; Cataract Extraction; Endophthalmitis; Enzyme-Linked Immunosorbent Assay; Female; Follow-Up Studies; Humans; Lacrimal Apparatus; Lactoferrin; Male; Middle Aged; Postoperative Complications; Postoperative Period; Tears

Topics: Graft Rejection; Graft Survival; Humans; Interferon-gamma; Kidney Transplantation; Lactoferrin; Macrophage-1 Antigen; Muromonab-CD3; Neutrophils; Postoperative Complications; Tumor Necrosis Factor-alpha

Tear concentration of lactoferrin (LF) was measured by an ELISA technique and followed in 25 patients undergoing cataract surgery. The pre-operative concentration of LF in tears was 773 +/- 60 micrograms/ml (+/- SE) (range: 407-1514 micrograms/ml). On the first day following surgery, there was a significant decrease in tear LF concentration to 377 +/- 45 micrograms/ml followed by a gradual return to the initial value during a post-operative observation period of twelve days. There was an inverse linear relationship between the LF concentration and the tear secretion rate measured by a modified Schirmer I test (1 min) suggesting a constant LF secretion rate by the tear glands. The contribution of LF from neutrophils to the tear fluid seems to be of minor importance. Since LF has known antibacterial and anti-inflammatory effects, our results may contribute to a further understanding of the microbial vulnerability or resistance of the eye following surgical procedures.

Topics: Adult; Aged; Cataract Extraction; Endophthalmitis; Enzyme-Linked Immunosorbent Assay; Female; Humans; Lactoferrin; Lactoglobulins; Male; Middle Aged; Postoperative Complications; Tears; Time Factors