European Journal of Cardio-Thoracic Surgery, Vol 12, 913-918, Copyright © 1997 by European Association for Cardio-thoracic Surgery
Aprotinin reduces injury of the spinal cord in transient ischemia
BH Sirin, L Yilik, R Ortac, E Coskun, H Sirin and N Celebisoy
Department of Cardiovascular Surgery, Pamukkale University Hospital, Denizli, Turkey.
OBJECTIVE: The protective effect of aprotinin, which is a protease
inhibitor, was assessed in a rabbit spinal cord ischemia model. DESIGN:
Randomized, controlled, prospective study. SETTING: University research
laboratory. SUBJECTS: New Zealand white rabbits (36) of both sexes.
METHODS: In 24 animals, ischemia was induced with midline laparotomy and
clamping the aorta just distal to left renal artery and proximal to aortic
bifurcation for 20 min. Aprotinin was given 30000 KIU as a short
intravenous injection after anesthesia, and was followed by 10000 KIU/h by
continuous infusion in group 1 (n = 12). Similar volume of saline solution
was used in control group of animals (group 2, n = 12). Group 3 of animals
(sham group, n = 12) were anesthetized and subjected to laparotomy without
aortic occlusion. Physiological parameters and somatosensory
evoked-potentials (SEP) were monitored in animals before ischemia, during
ischemia and in the first 60 min of reperfusion. Their neurological outcome
was clinically evaluated up to 48 h postischemia. Their motor function was
scored, and the intergroup differences were compared. The animals were
sacrificed after two days of postischemia. Their spinal cord, abdominal
aorta, and its branches were processed for histopathological examination.
RESULTS: In group 3, SEP amplitudes did not change during the procedures,
and all animals recovered without neurologic deficits. At the end of
ischemic period, the average amplitude was reduced to 53+/-7% of the
baseline in all ischemic animals. This was followed by a gradual return to
89+/-8 and 81+/-13% of the initial amplitude after 60 min of reperfusion in
group 1 and group 2 correspondingly (P > 0.05). The average motor
function score was significantly higher in group 1 than group 2 at 24 and
48 h after the ischemic insult (P < 0.05). Histological observations
were clearly correlated with the neurological findings. CONCLUSION: The
results suggest that aprotinin reduces spinal cord injury and preserves
neurologic function in transient spinal cord ischemia in rabbits.
