Mesna Preserves Hepatocyte Regenerating Capacity Following Liver Radiofrequency Ablation Under Pringle Maneuver

Background The objectives of the present study were to test the hypothesis that hepatocyte regenerating activity induced by radiofrequency ablation (RFA) of the liver is attenuated when performed under Pringle maneuver, and to investigate the potentially protective effect of mesna prophylactic administration. Materials and Methods Wistar rats were subjected to liver RFA (group RFA), RFA plus Pringle maneuver for 30min (group RFA + P), RFA plus Pringle plus mesna (400mg/kg, per os, 3h prior to operation) (group RFA + P+M), Pringle only (group P), or sham operation (group S) after midline laparotomy. At 1h, liver oxidative state (glutathione to glutathione disulfide ratio–GSH/GSSG) and nuclear factor κB (NF-κB) activity were assessed in liver specimens. At 1, 3, and 6h, the levels of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) were measured in blood serum. At 24h, 48h, 1wk, and 3 wk, the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured in blood serum and the histopathologic profile and hepatocyte mitotic activity were assessed in liver specimens. Results Mitotic activity was low but sustained in groups RFA and RFA + P+M, more intense in group P, while suppressed in group RFA + P. Histopathologic profile was deteriorated with lesions being more intense in group RFA + P but significantly less severe in group RFA + P+M. Oxidative stress was equally induced in all experimental groups. NF-κB was activated in groups RFA, RFA + P, and P, but not in group RFA + P+M. IL-6 and TNF-α serum levels were increased; the levels were significantly higher in group RFA + P, while lower in group RFA + P+M. Serum transaminases levels were increased during the first 48h. Conclusions Hepatocyte regenerating activity is suppressed following liver RFA under Pringle maneuver. Prophylactic administration of mesna preserves hepatocyte regenerating capacity by attenuating acute inflammatory response and minimizing hepatic tissue injury in the non-ablated liver parenchyma.