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Do Different Doses of Talc Influence the Acute Systemic Inflammatory Response in Experimental Pleurodesis?

FMUSP, Sao Paulo, Brazil

PURPOSE: Talc used for pleurodesis may elicit systemic effects due to the migration of small talc particles into the systemic circulation or the absorption of inflammatory mediators from the pleural space. The aim of this study was to compare the acute systemic inflammatory response produced by talc in doses considered effective (400 mg/kg) and ineffective (100 mg/kg) in producing pleurodesis in rabbits.

METHODS: Groups of six rabbits were injected intrapleurally with talc 100 or 400 mg/kg and after 6, 24 and 48 hours samples of blood were assayed for leukocytes (WBC), neutrophil percent (%N), lactic dehydrogenase (LDH) and the inflammatory cytokines interleukin-8 (IL-8) and vascular endothelial growth factor (VEGF). Pre-injection blood samples were used as controls. Statistics: ANOVA.

RESULTS:

6 hours 24 hours 48 hours Control TL100 TL400 TL100 TL400 TL100 TL400 WBC 5.1 ± 1.6* 7.6 ± 2.1 9.7 ± 3.6 4.7 ± 1.3 6.8 ± 3.1 7.8 ± 2.9 9.0 ± 3.4 %N 53 ± 7* 74 ± 9 77 ± 6 61 ± 5 44 ± 1# 54 ± 6 30 ± 9# LDH 217 ± 84 499 ± 170 677 ± 569 336 ± 160 359 ± 228 227 ± 135 206 ± 100 IL-8 90 ± 31* 890 ± 390 620 ± 380 1461 ± 610 880 ± 540 1410 ± 870 1600 ± 440 VEGF < 15* 65 ± 35 43 ± 10 66 ± 42 95 ± 92 121 ± 56 164 ± 142

WBC: *p< 0.05 TL400 6 and 48 hours vs control.

%N: *p< 0.001 TL100 and TL400 6h vs control; #p< 0.05 TL100 24 and 48 hours vs TL400.

LDH: NS.

IL-8 and VEGF: *p< 0.05 TL100 and TL400 at all times vs control.

CONCLUSIONS: Intrapleural talc elicited an acute systemic inflammatory response of a comparable degree with doses considered either ineffective or effective in producing pleurodesis. The WBC tended to increase more in the TL400 groups while the %N tended to increase more in the TL100 group. In both treatment groups, there were significant increases in the %N, LDH, IL-8 and VEGF at most time points.

CLINICAL IMPLICATIONS: Side-effects reported with talc pleurodesis may be related to a systemic inflammatory response that is not dependent on the dose of talc instilled into the pleural cavity.

SUPPORTED BY: FAPESP, CNPq.

DISCLOSURE: E. Marchi, None.