Infliximab: A new therapeutic agent in acute pancreatitis?

Purpose: Tumor necrosis factor alpha (TNF-alpha) has a central role in the pathogenesis of acute pancreatitis and related systemic complications. The aim of this study is to investigate the therapeutic effectiveness of monoclonal TNF antibody (infliximab) in acute edematous and severe necrotizing pancreatitis models in rats. Methods: One hundred rats were randomly divided into 10 groups. Acute edematous pancreatitis (AEP) was induced by injection of cerulein 20 mug/kg 4 times subcutaneously at hourly intervals. Severe necrotizing pancreatitis (SNP) was induced by retrograde injection of 3% taurocholate into the common biliopancreatic duct. Infliximab 8 mg/kg was given via intravenous infusion. Serum amylase activity, pancreatic histopathology, myeloperoxidase enzyme activity (MPO), and pulmonary changes were assessed. Results: Infliximab treatment significantly decreased serum amylase activity (11939+/-1914 U/L versus 3458+/-915 U/L, P<0.001) and histopathologic score (4.1 +/- 0.5 versus 1.5 +/- 0.3, P<0.001) in AEP. It also suppressed neutrophil infiltration and MPO activity of the pancreatic tissue. In SNP, infliximab treatment was found to decrease pathologic score (9.4+/-1.2 versus 3.6+/-0.8, P<0.001) and serum amylase activity (20442 +/- 2375 versus 8990 +/- 1730, P<0.01). It ameliorated both parenchymal and fatty tissue necrosis of the pancreas. Infliximab also alleviated alveolar edema and acute respiratory distress syndrome like pulmonary complications, but the difference was not significant. Conclusions: Chimeric TNF antibody, infliximab, should be evaluated for treatment of acute pancreatitis.