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Invited Critique
July 1, 2006

Decreased Inflammation and Improved Survival With Recombinant Human Activated Protein C Treatment in Experimental Acute Pancreatitis—Invited Critique

Arch Surg. 2006;141(7):676. doi:10.1001/archsurg.141.7.676

The study by Alsfasser and his colleagues1 suggests that drotrecogin (or activated protein C) decreases the 24-hour mortality in a modified cerulein-injection model of acute pancreatitis from 5 of 8 control rats to 1 of 8 treated rats. Interestingly, the data show that this survival advantage occurred despite the same degree of tissue injury in the pancreas of treated and untreated animals. No histologic evaluation of lung tissue was performed, but the tissue myeloperoxidase level, which is said to be “a quantitative indicator of leukocyte infiltration,” was reduced in the pancreas and lungs of treated animals, and the authors conclude that “treatment reduces inflammation in the pancreas and lungs.” Unfortunately, no assays of mediators of inflammation such as proinflammatory or anti-inflammatory cytokines were performed, no other autopsy findings were described, and hematologic and coagulation measures such as white blood cell count, hematocrit, platelet count, prothrombin time, and partial thromboplastin time were also not affected, so the mechanism of this survival benefit remains unclear from this study.

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