%0 Journal Article
%T Role of Talc Modulation on Cytokine Activation in Cancer Patients Undergoing Pleurodesis
%A Yehuda Schwarz
%A Alex Star
%J Pulmonary Medicine
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/806183
%X We investigate the mechanism of talc pleurodesis (TP) in 20 patients with recurrent malignant pleural effusion and 10 patients with nonmalignant pleural effusions. We measured IL-8 levels before and 6£¿h after TP and find a significant threefold increase (2.26£¿ng/mL ¡À 0.7 to 6.5£¿ng/mL 0.1), which explains the recruitment of inflammatory cells in these patients. We hypothesize that TP is enable by stimulating the mesothelial cells (MS) to secrete FGF. A significant tenfold increase in FGF-b (0.05£¿ng/mL ¡À 0.02 to 0.44£¿ng/mL 0.6) was seen 24£¿h after talc instillation ( ). In order to examine whether FGF-b is secreted by MS cells, MS recovered from CHF patients with recurrent pleural effusions were cultured for 48£¿h in the presence or absence of increasing concentrations of talc (from 100£¿ng/mL to 1£¿mg/mL). They produced significant levels of FGF-b in a dose dependent manner ( ). We hypothesized that a successful pleurodesis involves an early enhanced recruitment of inflammatory cells through a rise of IL-8 followed by enrollment of fibroblasts from the submesothelial space through increased mesothelial FGF-b production. 1. Introduction Recurrent pleural effusion in cancer patients is a common problem that significantly affects their quality of lives. Several palliative treatment options are available for malignant recurrent pleural effusion in cancer patients who are not responding to chemotherapy, repeated thoracocentesis, or chemical pleurodesis. The most widely used pleurodesis technique is based on the instillation of sclerosing agents into the pleural space. The therapeutic goal in the management of symptomatic patients with malignant pleural effusions is to achieve effective pleural sclerosis. The aim of the sclerosant agent is to irritate both pleurae and to induce mesothelial cell sloughing and subsequent formation of adhesions between the parietal and visceral surfaces. Although the agent must have irritant attributes, it needs to limit and even obviate adverse effects to the patient. Several sclerosing agents are used in clinical practice, among them doxycycline, minocycline, tetracycline, bleomycin, cisplatin, etoposide, fluorouracil, interferon-¦Â, and corynebacterium parvum. Talc has minimal long-term adverse side effects and it was shown to be the most effective agent for preventing recurrences [1]. The mechanisms of pleurodesis have not yet been entirely understood. Diffuse pleural inflammation and fibrin deposition have been considered influential in the success of pleural symphysis [2]. In animal studies, histologic analysis of talc-treated
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