Acute, acalculous cholecystitis is a serious, often fatal disease that is seen among patients suffering with bacterial sepsis, burns, or trauma, including surgical trauma, and cancer (1). In 1921, F. C. Mann (2) of the Mayo Clinic induced acute inflammation and hemorrhage in the gall bladder of dogs by intravenous injection of solutions of sodium hypochloride. Mann's experiments (2) indicated that the gall bladder could be injured by intravenous injection of a known chemical substance and/or a chain of events set in motion by such an injection.Factor XII (Hageman factor) can be activated by bacterial endotoxin and by exposure of plasma to collagen (3, 4). It is possible in the clinical settings mentioned above that induction of acute cholecystitis results from the activation of the intrinsic pathway of coagulation leading to generation of mediators of inflammation.To test this hypothesis we injected dogs and monkeys intravenously with chemically defined polyphenol activators of factor XII, with Escherichia coli endotoxin, or with buffered saline and observed the effects of systemic activation of factor XII-dependent pathways on the gall bladder and other tissues. The results of these experiments are described below.
Materials and MethodsExperimental Protocol. 12 mongrel male dogs that weighed between 8 and 15 kg, and 3 male African Green Monkeys (Cercopithecus aethiops) that weighed between 4 and 6 kg, were used. The animals were anesthetized by intravenous injection of pentobarbital, and under surgical conditions the abdomen was opened and the gall bladder visualized. Besides the gall bladder, the stomach, duodenum, small bowel, colon, mesentery, liver, and spleen were clearly visible in the operative field.Animals were injected in the femoral vein with 10 -4 M solutions of ellagic acid (K and K Laboratories, Inc., Plainview, N. Y.), rutin (Sigma Chemical Co., St. Louis, Mo.), or with lipopolysaccharide W E. coli O128:B12 (Difco Laboratories, Detroit, Mich.), all dissolved in phosphate-buffered physiologic saline (PBS), 1 or with PBS in comparable volume as control according to the plan in Table I.Blood samples were obtained before injection of solutions of ellagic acid, rutin, E. coli endotoxin, or PBS, at intervals thereafter either by venopuncture with plastic syringes or through a polyethylene catheter implanted in the femoral vein, and anticoagulated with Na citrate in chilled plastic tubes for studies described below.The gall bladder and other viscera were observed for 1 h after injection of activator substance or control PBS, and photographs taken at different intervals during this period. At the end of