Evaluation of the efficacy of several sclerosing agents for pleurodesis in rats

Abstract

Objective: This study aims to evaluate the efficiencies and effects of different sclerosing agents. Materials and Methods: Thirty-five female Wistar-albino rats were included in this study and divided into five groups randomly. Isotonic saline (group 1), iodopovidone (group 2), rifamycin (group 3), autologous blood (group 4), talc (group 5) were given into intrapleural space. On postoperative 28th day, ipsilateral and contralateral pleural and parenchymal fibrosis and inflammation were evaluated. Results: There were statistically differences between control and other groups on macroscopically pleural fibrosis examination (p=0.004, p=0.001, p=0.001, p=0.000, respectively). Microscopically pleural fibrosis were determined in all groups when compared to control group (p=0.023, p=0.023, p=0.035, p=0.001, respectively). There were no significant differences between sclerosing agent groups (p>0.05). Significant differences were observed according to microscopic pleural inflammation evaluation between talc group and other groups. There was superiority in talc group according to intraparenchymal inflammation grade compared to other groups (p=0.010, p=0.042, p=0.030, respectively). Macroscopically, fibrosis and microscopically, inflammation were significantly observed between talc and other groups in the contralateral pleura (p = 0.037and p=0.009, respectively). Conclusion: Iodopovidone, autologous blood, talc, and rifamycin can be used as effective pleurodesis agents. However, we found that rifamycin and autologous blood are safer as effective pleurodesis agents. We think that these two agents can be used in patients with secondary lung diseases due to their less intraparenchymal inflammation rates. It may be advantageous to prefer other sclerosing agents which has lower costs and less side effects comparing to talc.

Keywords

• Pleurodesis
• Pleural effusions
• Pleural inflammation
• Animal experiments

References

1. Light RW, Vargas FS. Pleural sclerosis for the treatment of pneumothorax and pleural effusion. Lung 1997;175:213-23.
2. Ozpolat B, Gazyagci S, Gözübüyük A, Ayva S, Atinkaya C. Autologous blood pleurodesis in rats to elucidate the amounts of blood required for reliable and reproducible results. J Surg Res 2010:15;161:228-32. doi: 10.1016/j.jss.2009.01.027.
3. Teixeira LR, Vargas FS, Acencio MM, Bumlai RU, Antonangelo L, Marchi E. Experimental pleurodesis induced by antibiotics (macrolides or quinolones). Clinics 2006;61:559-64.
4. Ahn HY, Cho JS, Kim YD, et al. Efficacy of mistletoe for chemical pleurodesis in rats without malignancy. Open Med (Wars) 2015:4;10:346-51. doi: 10.1515/med-2015-0051.
5. Light RW, Wang NS, Sassoon CS, Gruer SE, Vargas FS. Talc slurry is an effective pleural sclerosant in rabbits. Chest 1995;107:1702-6.
6. Arifin WN, Zahiruddin WM. Sample size calculation in animal studies using resource equation approach. Malays J Med Sci 2017; 24: 101-5. doi: 10.21315/mjms2017.24.5.11.
7. Mitchem RE, Herndon BL, Fiorella RM, Molteni A, Battie CN, Reisz GR. Pleurodesis by autologous blood, doxycycline, and talc in a rabbit model. Ann Thorac Surg 1999;67:917-21.
8. Robinson CLN. Autologous blood for pleurodesis in recurrent and chronic spontaneous pneumothorax. Can J Surg 1987;30:428-9.

9. Lang-Lazdunski L, Coonar AS. A prospective study of autologous ‘blood patch’ pleurodesis for persistent air leak after pulmonary resection. Eur J Cardiothorac Surg 2004;26:897-900.
10. Droghetti A, Schiavini A, Muriana P, et al. Autologous blood patch in persistent air leaks after pulmonary resection. J Thorac Cardiovasc Surg 2006;132:556-9.
11. Bethune N. Pleural poudrage: new technique for deliberate production of pleural adhesions as preliminary to lobectomy. J Thorac Surg 1935; 4:251-61.
12. Rehse DH, Aye RW, Florence MG. Respiratory failure following talc pleurodesis. Am J Surg 1999;177:4:437-40.
13. Yildirim H, Metintas M, Ucgun I, Erginel S, Alatas F, Kurt E. Talc Plörodezise bağlı gelişen yan etkiler. Osman Gazi Tıp Dergisi 2005;27:51-6.
14. Werebe EC, Pazetti R, Milanez de Campos JR, et al. Systemic distribution of talc after intrapleural administration in rats. Chest 1999;115:190-3.
15. Yalçınkaya S, Yalçınkaya U. Non-steroid anti-inflammatory drugs reduce the efficacy of autologous blood pleurodesis. Turk Gogus Kalp Dama 2019;27:343-9. doi: 10.5606/tgkdc. dergisi.2019.17544
16. Yazicioglu A, Uysal S, Sahinoglu T, Subasi M, Demirag F, Yekeler E. Does sericin, as a novel pleurodesis agent, have higher effectiveness compared to talcum powder, doxycycline, and silver nitrate pleurodesis? Arch Bronconeumol 2019;55:357-67. doi: 10.1016/j.arbres.2018.10.003.
17. Gözübüyük A, Ozpolat B, Ciçek AF, et al. Comparison of side effects of oxytetracycline and talc pleurodesis: an experimental study. J Cardiothorac Surg 2010:13;5:128. doi: 10.1186/1749- 8090-5-128.
18. Dongel İ, Sunam GS, Külahçı Ö, Ceran S. A comparison of the efficacies of heterologous blood, rifamycin, and talc as pleural sclerosants in rabbits: An experimental study. Turk Gogus Kalp Dama 2012;20:590-95.
19. Echavarría A, Pinzón V, Barés JP, Fernández E. Intracavitary treatment of malignant pleural effusion with iodine-povidone. Rev Med Panama 1991;16:69-74.
20. Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Efficacy and safety of iodopovidone in chemical pleurodesis: A metaanalysis of observational studies. Respir Med 2006;100:2043- 7, doi:http://dx.doi.org/10.1016/j.rmed.2006.02.009.
21. Bagheri R, Noori M, Rajayi M, et al. The effect of iodopovidone versus bleomycin in chemical pleurodesis. Asian Cardiovasc Thorac Ann 2018;26:382-386. doi: 10.1177/021.849.2318778485.
22. Ibrahim IM, Dokhan AL, El-Sessy AA and Eltaweel MF. Povidone-iodine pleurodesis versus talc pleurodesis in preventing recurrence of malignant pleural effusion. J Cardiothorac Surg 2015;1;10:64. doi: 10.1186/s13019.015.0270-5.
23. Bryant WP, Zimmerman D. Iodine-induced hyperthyroidism in a newborn. Pediatrics. 1995;95:434-6. Erratum in: Pediatrics 1995;96:779.
24. Yeginsu A, Karamustafaoglu A, Ozugurlu F. Etikan I. Iodopovidone pleurodesis does not effect thyroid function in normal adults. Interact Cardiovasc Thorac Surg 2007;6: 563-4.