Enhanced anastomotic healing by Daikenchuto (TJ-100) in rats

Abstract

Daikenchuto (DKT), a traditional Japanese medicine, is widely used to treat various gastrointestinal disorders. This study aimed to investigate whether DKT could promote the anastomotic healing in a rat model. Pedicled colonic segments were made in left colon by ligation of the feeding arteries, and then intestinal continuity was restored. Colonic blood flow was analyzed by using ICG fluorescence imaging: Fmax, Tmax, T1/2, and Slope were calculated. Anastomotic leakage (AL) was found in 6 of 19 rats (31.6%) in the control group, whereas in 1 of 16 rats (6.2%) in the DKT group. The Fmax and Slope of DKT group were significantly higher than those of control group. DKT could promote the anastomotic healing, with the higher bursting pressure on postoperative day (POD) 2 and 5, the larger granulation thickness on POD 5, and neoangiogenesis on POD 5. Histological examination showed DKT exhibited a decreased inflammatory cell infiltration, enhanced fibroblast infiltration, and enhanced collagen density on POD 5. In the DKT group, the levels of TGFβ1 on POD 2 and VEGFα on POD5 were significantly higher, whereas the level of TNFα on POD 2 was significantly lower. Therefore, DKT could be effective for the prevention of AL following colorectal surgery.

Therapeutic effect and mechanism of Daikenchuto in a model of methotrexate-induced acute small intestinal mucositis

“…The mRNA level of TGF-β1 in the DKT-MTX group was higher than that in the control group on day 15, but it was lower in the jejunum and ileum than in the MTX group. This method of mucosal repair was also veri ed in another experiment of DKT in the treatment of intestinal injury repair in rats 20 .…”

“…In addition to these effects, Wada et al also demonstrated that DKT enhanced anastomotic healing via an anti-in ammatory effect and increased blood ow after intestinal surgery in rats 20 . DKT has been widely used clinically in patients with gastrointestinal symptoms, such as postoperative intestinal obstruction, in ammatory bowel disease, abdominal pain, and pain accompanied by abdominal atulence 19,21−23 .…”

An imaging approach for determining the mechanism of enhancement of intestinal absorption of an L-theanine supplement

“…Behrendt et al observed the intestinal transit using ICG though no time-profiles after intestinal treatment was shown [ 35 ]. Wada et al also reported that colonic blood flow was analyzed using ICG and some parameters were calculated [ 36 ]. There were some differences of parameters in their report.…”

Quantitative Analysis of Colonic Perfusion Using ICG Fluorescence Angiography and Its Consequences for Anastomotic Healing in a Rat Model

“…Despite advances in postoperative care and surgical techniques, the AL rate after rectal surgery remains at approximately 10% worldwide [ 1 , 2 ]. Although multifactorial factors are associated with the formation of AL, a general consensus in experimental and clinical studies indicates that a sufficient blood supply can promote anastomotic healing [ 3 , 4 , 5 ]. Therefore, an accurate evaluation of the intestinal blood perfusion is critical to avoid AL.…”

“…However, in most of these clinical reports, colonic blood flow at the anastomosed site was subjectively evaluated with the surgeon’s naked eyes. A few animal experiments [ 3 , 4 , 13 , 14 ] and clinical studies [ 15 , 16 , 17 , 18 ] quantify ICG fluorescence intensity using luminance analysis software, such as ROIs, VR-RENDER, and Tracker4.97. Luminance analysis software can provide a quantitative and reproducible fluorescence value and a time-dependent change in the luminance value.…”