Arterial infusion using gabexate mesilate: Is it effective therapy for severe acute pan...( Severe acute pancreatitis (SAP) rema...),Health

Severe acute pancreatitis (SAP) remains a lethal disease. It is defined as an inflammatory process of the pancreas with possible peripancreatic tissue and multi-organ involvement inducing multi-organ dysfunction syndrome (MODS) with an increased mortality rate. Protease inhibitors are widely applied to treat acute pancreatitis in Japan, but the protease inhibitors used to treat acute necrotizing pancreatitis cannot easily reach the pancreas when administered intravenously, and, because of ischemia or impaired microcirculation, they hardly penetrate into pancreatic tissue. Recently, continuous regional arterial infusion (CRAI) with protease inhibitor of nafamostat mesilate and antibiotics has proven effective as an initial therapy in Japan. However, evidence supporting the value of CRAI in treating acute pancreatitis is insufficient. Actually, CRAI of protease inhibitors and antibiotics may possibly reduce the mortality rate and incidence of infectious complications in necrotizing pancreatitis. Furthermore, until now, most cases have been used with nafamostat mesilate as protease inhibitor. Therefore, a prospective study was performed to treat SAP with CRAI using gabexate mesilate and investigated the clinical benefits and sequential changes in serum inflammation-related parameters such as cytokines and chemokines.

A research article to be published on November 7, 2008 in the World Journal of Gastroenterology addresses this question. The research team led by Dr. ITO from Pancreatic Diseases Branch of Kyushu University in Japan conducted a prospective study to confirm the efficacy of arterial infusions of gabexate mesilate and antibiotics for SAP. This strategy suppresses early inflammation and infection in pancreatic tissue, which controls subsequent systemic inflammation. The level of protease inhibitor in pancreatic tissues after CRAI using nafamostat was 5-fold higher than that delivered by intravenous injection, and trypsin activities in pancr
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