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Therapy for Unhealed Gastrocutaneous Fistulas in Rats as a Model for Analogous Healing of Persistent Skin Wounds and Persistent Gastric Ulcers: Stable Gastric Pentadecapeptide BPC 157, Atropine, Ranitidine, and Omeprazole

Abstract

Objective This study focused on unhealed gastrocutaneous fistulas to resolve whether standard drugs that promote healing of gastric ulcers may simultaneously have the same effect on cutaneous wounds, and corticosteroid aggravation, and to demonstrate why peptides such as BPC 157 exhibit a greater healing effect. Therefore, with the fistulas therapy, we challenge the wound/growth factors theory of the analogous nonhealing of wounds and persistent gastric ulcers. Methods The healing rate of gastrocutaneous fistula in rat (2-mm-diameter stomach defect, 3-mm-diameter skin defect) validates macro/microscopically and biomechanically a direct skin wound/stomach ulcer relation, and identifies a potential therapy consisting of: (i) stable gastric pentadecapeptide BPC 157 [in drinking water (10 μg/kg) (12 ml/rat/day) or intraperitoneally (10 μg/kg, 10 ng/kg, 10 pg/kg)], (ii) atropine (10 mg/kg), ranitidine (50 mg/kg), and omeprazole (50 mg/kg), (iii) 6-alpha-methylprednisolone (1 mg/kg) [intraperitoneally, once daily, first application at 30 min following surgery; last 24 h before sacrifice (at postoperative days 1, 2, 3, 7, 14, and 21)]. Results Greater anti-ulcer potential and efficiency in wound healing compared with standard agents favor BPC 157, efficient in inflammatory bowel disease (PL-14736, Pliva), given in drinking water or intraperitoneally. Even after 6-alpha-methylprednisolone aggravation, BPC 157 promptly improves both skin and stomach mucosa healing, and closure of fistulas, with no leakage after up to 20 ml water intragastrically. Standard anti-ulcer agents, after a delay, improve firstly skin healing and then stomach mucosal healing, but not fistula leaking and bursting strength (except for atropine). Conclusion We conclude that BPC 157 may resolve analogous nonhealing of wounds and persistent gastric ulcers better than standard agents.

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References

  1. Papavramidis ST, Eleftheriadis EE, Papavramidis TS, Kotzampassi KE, Gamvros OG (2004) Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant. Gastrointest Endosc 59:296–300

    Article  PubMed  Google Scholar 

  2. Deruyter L, Van Blerk M, Cadière GB, De Graef J, Willems G (1991) Treatment of high-output gastric fistulas with omeprazole. Hepatogastroenterology 38(Suppl 1):83–86

    PubMed  Google Scholar 

  3. Paran H, Neufeld D, Kaplan O, Klausner J, Freund U (1995) Octreotide for treatment of postoperative alimentary tract fistulas. World J Surg 19:430–433

    Article  PubMed  CAS  Google Scholar 

  4. di Costanzo J, Cano N, Martin J, Richieri JP, Mercier R, Lafille C, Lepeuch D (1987) Treatment of external gastrointestinal fistulas by a combination of total parenteral nutrition and somatostatin. J Parenter Enteral Nutr 11:465–470

    Article  Google Scholar 

  5. Misiewicz JJ (1985) Future trends in the management of peptic ulcer disease. Scand J Gastroenterol Suppl 146:175–184

    Google Scholar 

  6. Szabo S, Vincze A (2000) Growth factors in ulcer healing: lessons from recent studies. J Physiol (Paris) 94:77–81

    Article  CAS  Google Scholar 

  7. Christensen S, Riis A, Nørgaard M, Thomsen RW, Tønnesen EM, Larsson A, Sørensen HT (2006) Perforated peptic ulcer: use of pre-admission oral glucocorticoids and 30-day mortality. Aliment Pharmacol Ther 23:45–52

    Article  PubMed  CAS  Google Scholar 

  8. Sikiric P, Petek M, Rucman R, Seiwerth S, Grabarevic Z, Rotkvic I et al (1993) A new gastric peptide BPC. An overview of stomach-organoprotection hypothesis and beneficial effect of BPC. J Physiol (Paris) 87:313–327

    Article  CAS  Google Scholar 

  9. Sikiric P, Seiwerth S, Brcic L, Blagaic AB, Zoricic I, Sever M, Klicek R, Radic B, Keller N, Sipos K, Jakir A, Udovicic M, Tonkic A, Kokic N, Turkovic B, Mise S, Anic T (2006) Stable gastric pentadecapeptide BPC 157 in trials for inflammatory bowel disease (PL-10, PLD-116, PL 14736, Pliva, Croatia). Full and distended stomach, and vascular response. Inflammopharmacology 14:214–221

    Article  PubMed  CAS  Google Scholar 

  10. Wood JD (2004) The first Nobel prize for integrated systems physiology: Ivan Petrovich Pavlov, 1904. Physiology 19:326–330

    Article  PubMed  Google Scholar 

  11. Sikiric P, Seiwerth S, Grabarevic Z, Petek M, Rucman R, Turkovic B et al (1994) The beneficial effect of BPC 157, a 15 amino acid peptide BPC fragment, on gastric and duodenal lesion induced by restraint stress, cysteamine and 96% ethanol in rats. A comparative study with H2 receptor antagonists, dopamine promoters and gut peptides. Life Sci 54:PL63–PL68

    Google Scholar 

  12. Sikiric P, Seiwerth S, Grabarevic Z, Rucman R, Petek M, Jagic V et al (1996) Beneficial effect of novel pentadecapeptide BPC 157 on gastric lesions induced by restraint stress, ethanol, indomethacin, and capsaicin neurotoxicity. Dig Dis Sci 41:1604–1614

    Article  PubMed  CAS  Google Scholar 

  13. Sikiric P, Seiwerth S, Grabarevic Z, Rucman R, Petek M, Jagic V et al (1997) The influence of a novel pentadecapeptide BPC 157 on NG-nitro-L-arginine methylester and L-arginine effect on stomach mucosal integrity and blood pressure. Eur J Pharmacol 332:23–33

    Article  PubMed  Google Scholar 

  14. Sikiric P, Mikus D, Seiwerth S, Grabarevic Z, Rucman R, Petek M et al (1997) Pentadecapeptide BPC 157, cimetidine, ranitidine, bromocriptine, and atropine effect in cysteamine lesions in totally gastrectromized rats: a model for cytoprotective studies. Dig Dis Sci 42:1029–1037

    Article  PubMed  CAS  Google Scholar 

  15. Bedekovic V, Mise S, Anic T, Staresinic M, Gjurasin M, Kopljar M et al (2003) Different effect of antiulcer agents on rat cysteamine-induced duodenal ulcer after sialoadenectomy, but not gastrectomy. Eur J Pharmacol 477:73–80

    Article  PubMed  CAS  Google Scholar 

  16. Xue XC, Wu YJ, Gao MT, Li WG, Zhao N, Wang ZL, Bao CJ, Yan Z, Zhang YO (2004) Protective effects of pentadecapeptide BPC 157 on gastric ulcer in rats. World J Gastroenterol 10:1032–1036

    PubMed  CAS  Google Scholar 

  17. Sandor Z, Deng XM, Khomenko T, Tarnawski AS, Szabo S (2006) Altered angiogenic balance in ulcerative colitis: a key to impaired healing? Biochem Biophys Res Commun 350:147–150

    Article  PubMed  CAS  Google Scholar 

  18. Veljaca M, Chan K, Guglietta A (1995) Digestion of h-EGF, h-TGF alpha and BPC-15 in human gastric juice. Gastroenterology 108:761

    Article  Google Scholar 

  19. Ruenzi M, Stolte M, Veljaca M, Oreskovic K, Peterson J, Ulcerative Colitis Study Group (2005) A multicenter, randomized, double blind, placebo-controlled phase II study of PL 14736 enema in the treatment of mild-to-moderate ulcerative colitis. Gastroenterology 128:A584

    Google Scholar 

  20. Veljaca M, Krnic Z, Brajsa K, Mildner B, Pavic-Saladojev D, Seveljevic-Jaran D et al (2002) The development of PL 14736 for treatment of inflammatory bowel disease. IUPHAR-GI section symposium, Honolulu, Hawaii, 2002, 13–15 July, O–32.

  21. Veljaca M, Pavic Sladoljev D, Mildner B, Brajsa K, Bubenik M, Stipanicic S et al (2003) Safety, tolerability and pharmacokinetics of PL 14736, a novel agent for treatment of ulcerative colitis, in healthy male volunteers. Gut 51(Suppl III):A309

    Google Scholar 

  22. Mikus D, Sikiric P, Seiwerth S, Petricevic A, Aralica G, Druzijanic N et al (2001) Pentadecapeptide BPC 157 cream improves burn-wound healing and attenuates burn-gastric lesions in mice. Burns 127:817–827

    Article  Google Scholar 

  23. Sikiric P, Seiwerth S, Mise S, Staresinic M, Bedekovic V, Zarkovic N et al (2003) Corticosteroids-impairment healing and gastric pentadecapeptide BPC 157 creams in burned mice. Burns 29:323–334

    PubMed  CAS  Google Scholar 

  24. Seiwerth S, Sikiric P, Grabarevic Z, Zoricic I, Hanzevacki M, Ljubanovic D et al (1997) BPC 157’s effect on healing. J Physiol (Paris) 91:173–178

    Article  CAS  Google Scholar 

  25. Seveljevic Jaran D, Cuzic S, Dominis Kramaric M, Glojnaric I, Ivetic V, Radosevic S et al (2006) Accelerated healing of excisional skin wound by PL 14736 in alloxan-hyperglycemic rats. Skin Pharmacol Physiol 19:266–274

    Article  PubMed  CAS  Google Scholar 

  26. Xue XC, Wu YJ, Gao MT (2004) Study of the protective effects of pentadecapeptide BPC 157 on wounds in small type pigs. Chin New Drugs J 12:602–604

    Google Scholar 

  27. Ivetic Tkalcevic I, Cuzic S, Brajsa K, Mildner B, Bokulic A, Situm K et al (2007) Enhancement by PL 14736 of granulation and collagen organization in healing wounds and the potential role of egr-1 expression. Eur J Pharmacol 570:212–221

    Article  CAS  Google Scholar 

  28. Sebecic B, Nikolic V, Sikiric P, Seiwerth S, Sosa T, Patrlj L et al (1999) Osteogenic effect of a gastric pentadecapeptide, BPC-157, on the healing of segmental bone defect in rabbits: a comparison with bone marrow and autologous cortical bone implantation. Bone 24:195–202

    Article  PubMed  CAS  Google Scholar 

  29. Rao KS, Patil PA, Malur PR (2007) Promotion of cutaneous wound healing by famotidine in Wistar rats. Indian J Med Res 125:149–154

    PubMed  CAS  Google Scholar 

  30. Räntfors J, Cassuto J (2003) Role of histamine receptors in the regulation of edema and circulation postburn. Burns 29:769–777

    Article  PubMed  Google Scholar 

  31. Numata Y, Terui T, Okuyama R, Hirasawa N, Sugiura Y, Miyoshi I et al (2006) The accelerating effect of histamine on the cutaneous wound-healing process through the action of basic fibroblast growth factor. J Invest Dermatol 126:1403–1409

    Article  PubMed  CAS  Google Scholar 

  32. Yang YX, Lewis JD, Epstein S, Metz DC (2006) Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 296:2947–2953

    Article  PubMed  CAS  Google Scholar 

  33. Frank S, Madlener M, Pfeilschifter J, Werner S (1998) Induction of inducible nitric oxide synthase and its corresponding tetrahydrobiopterin-cofactor-synthesizing enzyme GTP-cyclohydrolase I during cutaneous wound repair. J Invest Dermatol 111:1058–1064

    Article  PubMed  CAS  Google Scholar 

  34. Eubanks TR, Greenberg JJ, Dobrin PB, Harford FJ, Gamelli RL (1997) The effects of different corticosteroids on the healing colon anastomosis and cecum in a rat model. Am Surg 63:266–269

    PubMed  CAS  Google Scholar 

  35. Golan J, Mitelman S, Baruchin A, Ben-Hur N (1980) Vitamin A and corticosteroid interaction in wound healing in rats. Isr J Med Sci 16:572–575

    PubMed  CAS  Google Scholar 

  36. Filaretova L, Podvigina T, Bagaeva T, Bobryshev P, Takeuchi K (2007) Gastroprotective role of glucocorticoid hormones. J Pharmacol Sci 104:195–201

    Article  PubMed  CAS  Google Scholar 

  37. Sikiric P, Separovic J, Anic T, Buljat G, Mikus D, Seiwerth S et al (1999) The effect of pentadecapeptide BPC 157, H2 blockers and sucralfate on new vessels and new granulation tissue formation. J Physiol (Paris) 93:479–485

    Article  CAS  Google Scholar 

  38. Szabo S (1986) Experimental basis for a role for sulfhydryls and dopamine in ulcerogenesis: a primer for cytoprotection–organoprotection. Klin Wochenschr 64:116–122

    PubMed  CAS  Google Scholar 

  39. Torres-García AJ, Argüello JM, Balibrea JL (1994) Gastrointestinal fistulas: pathology and prognosis. Scand J Gastroenterol 207(Suppl):39–41

    Article  Google Scholar 

  40. Krivic A, Anic T, Seiwerth S, Huljev D, Sikiric P (2006) Achilles detachment in rat and stable gastric pentadecapeptide BPC 157: promoted tendon to bone healing and opposed corticosteroid aggravation. J Orthopaed Res 24:982–989

    Article  CAS  Google Scholar 

  41. Staresinic M, Sebecic B, Jadrijevic S, Suknaic S, Perovic D, Aralica G et al (2003) Gastric pentadecapeptide BPC 157 accelerates healing of transected rat Achilles tendon and in vitro stimulates tendocytes growth. J Orthopaed Res 21:976–983

    Article  CAS  Google Scholar 

  42. Gjurasin M, Miklic P, Buljat G, Perovic D, Jukic I, Sikiric P et al (2003) Selective healing effect of the gastric pentadecapeptide BPC 157 on injured part of the nerve in subtotal sciatic nerve transection. Dig Dis Sci 48:1878

    Google Scholar 

  43. Staresinic M, Petrovic I, Novinscak T, Jukic I, Pevec D, Suknaic S et al (2006) Effective therapy of transected quadriceps muscle in rat: gastric pentadecapeptide BPC 157. J Orthopaed Res 24:1109–1117

    Article  CAS  Google Scholar 

  44. Lazic R, Gabric N, Dekaris I, Bosnar D, Boban-Blagaic A, Sikiric P (2005) Gastric pentadecapeptide BPC 157 promotes corneal epithelial defects healing in rats. Coll Antropol 29:321–325

    PubMed  Google Scholar 

  45. Kalogjera L, Ries M, Baudoin T, Ferencic Z, Trotic R, Pegan B (1997) Dose-dependent protective effect of BPC 157 on capsaicin-induced rhinitis in rats. Eur Arch Otorhinolaryngol 254(Suppl 1):S9–S11

    Article  PubMed  Google Scholar 

  46. Grabarevic Z, Tisljar M, Artukovic B, Bratulic M, Dzaja P, Seiwerth S et al (1997) The influence of BPC 157 on nitric oxide agonist and antagonist induced lesions in broiler chicks. J Physiol (Paris) 91:139–149

    Article  CAS  Google Scholar 

  47. Turkovic B, Sikiric P, Seiwerth S, Mise S, Anic T, Petek M et al (2004) Stable gastric pentadecapeptide BPC 157 studied for inflammatory bowel disease (PLD-116, PL14736, Pliva) induces nitric oxide synthesis. Gastroenterology 126:287

    Google Scholar 

  48. Lovric-Bencic M, Sikiric P, Separovic J, Seiwerth S, Rogic D, Kusec V et al (2004) Doxorubicine congestive heart failure-increased big-endothelin 1 plasma concentration. Reversal by amlodipine, losartan and gastric pentadecapeptide BPC 157 in rat and mouse. J Pharmacol Sci 95:19–26

    Article  PubMed  CAS  Google Scholar 

  49. Petrovic I, Dobric I, Drvis P, Shejbal D, Brcic L, Boban Blagaic A et al (2006) An experimental model of prolonged esophagitis with sphincter failure in rat and therapeutic potential of gastric pentadecapeptide BPC 157. J Pharmacol Sci 102:269–277

    Article  PubMed  CAS  Google Scholar 

  50. Dobric I, Drvis P, Petrovic I, Shejbal D, Brcic L, Boban Blagaic A et al (2007) Prolonged esophagitis after primary dysfunction of the pyloric sphincter in the rat and therapeutic potential of the gastric pentadecapeptide BPC 157. J Pharm Sci 104:7–18

    Article  CAS  Google Scholar 

  51. Pawlik WW, Sikiric P, Brzozowski T, Seiwerth S, Drozdowicz D, Pajdo R, Pawlik M, Konturek SJ (2004) Acceleration of ulcer healing by pentadecapeptide BPC 157 in rats. Involvement of endogenous prostaglandins and gastric secretion. Gastroenterology 126:541

    Article  CAS  Google Scholar 

  52. Robert A (1979) Cytoprotection by prostaglandins. Gastroenterology 77:761–767

    PubMed  CAS  Google Scholar 

  53. Okabe S, Amagase K (2005) An overview of acetic acid ulcer models–the history and state of the art of peptic ulcer research. Biol Pharm Bull 28:1321–1341

    Article  PubMed  CAS  Google Scholar 

  54. Selye H, Szabo S (1973) Experimental model for production of perforating duodenal ulcers by cysteamine in the rat. Nature 244:458–459

    Article  PubMed  CAS  Google Scholar 

  55. Suzuki T, Tsukamoto Y, Goto H, Hase S, Arisawa T, Asai J (1992) Effects of histamine H2-receptor antagonists and a proton pump inhibitor on the mucosal hydroxyproline content of ethanol-HCl-induced gastric lesions in rats. Digestion 51:161–167

    PubMed  CAS  Google Scholar 

  56. Houck JC (1964) Connective tissue. X. Dermal chemical response to atropine. Proc Soc Exp Biol Med 115:725–728

    PubMed  CAS  Google Scholar 

  57. Arisawa T, Harata M, Kamiya Y, Shibata T, Nagasaka M, Nakamura M, Fujita H, Hasegawa S, Nakamura M, Mizuno T, Tahara T, Ohta Y, Nakano H (2006) Is omeprazole or misoprostol superior for improving indomethacin-induced delayed maturation of granulation tissue in rat gastric ulcers? Digestion 73:32–39

    Article  PubMed  CAS  Google Scholar 

  58. Park PO, Alumets J, Arvidsson S, Grimelius L, Haglund U (1990) The influence of a histamine2-receptor antagonist on the healing of an experimentally induced gastric mucosal lesion. APMIS 98:305–312

    Article  PubMed  CAS  Google Scholar 

  59. Bairy KL, Rao CM, Ramesh KV, Kulkarni DR (1991) Effects of antihistamines on wound healing. Indian J Exp Biol 29:398–399

    PubMed  CAS  Google Scholar 

  60. Karádi O, Nagy Z, Bódis B, Mózsik G (2001) Atropine-induced gastrointestinal cytoprotection dependences to the intact of vagal nerve against indomethacin-induced gastrointestinal mucosal and microvascular damage in rats. J Physiol (Paris) 95:29–33

    Article  Google Scholar 

  61. Clissold SP, Campoli-Richards DM (1986) Omeprazole. An updated review. Drugs 32:15–47

    Article  PubMed  CAS  Google Scholar 

  62. Veljaca M, Lesch CA, Sanchez B, Low J, Guglietta A (1995) Protection of BPC-15 on TNBS-induced colitis in rats: possible mechanisms of action. Gastroenterology 108:936

    Google Scholar 

  63. Veljaca M, Lesch CA, Pllana R, Sanchez B, Chan K, Guglietta A (1994) BPC-15 reduces trinitrobenzene sulfonic acid-induced colonic damage in rats. J Pharmacol Exp Ther 272:417–422

    Google Scholar 

  64. Gelbmann CM, Rogler G, Gross V, Gierend M, Bregenzer N, Andus T et al (2002) Prior bowel resections, perianal disease, and a high initial Crohn’s disease activity index are associated with corticosteroid resistance in active Crohn’s disease. Am J Gastroenterol 97:1438–1444

    Article  PubMed  Google Scholar 

  65. Lamarque D, Whittle BJ (2001) Increase in gastric intramucosal hydrogen ion concentration following endotoxin challenge in the rat and the actions of nitric oxide synthase inhibitors. Clin Exp Pharmacol Physiol 28:164–168

    Article  PubMed  CAS  Google Scholar 

  66. Bayir Y, Odabasoglu F, Cakir A, Aslan A, Suleyman H, Halici M et al (2006) The inhibition of gastric mucosal lesion, oxidative stress and neutrophil-infiltration in rats by the lichen constituent diffractaic acid. Phytomedicine 13:584–590

    Article  PubMed  CAS  Google Scholar 

  67. Murakami I, Satoh H, Asano S, Maeda R (1996) Role of capsaicin-sensitive sensory neurons and nitric oxide in the protective effect of lansoprazole, a proton pump inhibitor, on the gastric mucosa in rats. Jpn J Pharmacol 72:137–147

    Article  PubMed  CAS  Google Scholar 

  68. Whittle BJR, Boughton-Smith NK, Moncada S (1992) Biosynthesis and role of the endothelium-derived vasodilator, nitric oxide in gastric mucosa. Ann NY Acad Sci 664:126–139

    Article  PubMed  CAS  Google Scholar 

  69. Tabrizi MN, Chams-Davatchi C, Esmaeeli N, Noormohammadpoor P, Safar F, Etemadzadeh H et al (2007) Accelerating effects of epidermal growth factor on skin lesions of pemphigus vulgaris: a double-blind, randomized, controlled trial. J Eur Acad Dermatol Venereol 21:79–84

    Article  PubMed  CAS  Google Scholar 

  70. Obara K, Ishihara M, Fujita M, Kanatani Y, Hattori H, Matsui T et al (2005) Acceleration of wound healing in healing-impaired db/db mice with a photocrosslinkable chitosan hydrogel containing fibroblast growth factor-2. Wound Repair Regen 13:390–397

    Article  PubMed  Google Scholar 

  71. Cheng B, Liu HW, Fu XB, Sun TZ, Sheng ZY (2007) Recombinant human platelet-derived growth factor enhanced dermal wound healing by a pathway involving ERK and c-fos in diabetic rats. J Dermatol Sci 45:193–201

    Article  PubMed  CAS  Google Scholar 

  72. Urist MR (1996) The first three decades of bone morphogenetic protein. Osteologie 4:207–233

    Google Scholar 

  73. Mustoe TA, Pierce GF, Thomason A, Gramates P, Sporn MB, Duel TF (1987) Accelarated healing of incisional wounds in rats induced by transforming growth factor-β. Science 237:1333–1336

    Article  PubMed  CAS  Google Scholar 

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Skorjanec, S., Dolovski, Z., Kocman, I. et al. Therapy for Unhealed Gastrocutaneous Fistulas in Rats as a Model for Analogous Healing of Persistent Skin Wounds and Persistent Gastric Ulcers: Stable Gastric Pentadecapeptide BPC 157, Atropine, Ranitidine, and Omeprazole. Dig Dis Sci 54, 46–56 (2009). https://doi.org/10.1007/s10620-008-0332-9

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Keywords

  • Unhealed gastrocutaneous fistulas
  • Stable gastric pentadecapeptide BPC 157
  • Atropine
  • Ranitidine
  • Omeprazole
  • Analogous healing
  • Persistent skin ulcer
  • Persistent gastric ulcer
  • Rat