Biphasic effects of ankaferd blood stopper on renal tubular apoptosis in the rat partial nephrectomy model representing distinct levels of hemorrhage.

OBJECTIVE To investigate the effect of Ankaferd Blood Stopper (ABS), on renal tubular apoptosis and on expressions of endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS), and apoptosis protease-activating factor-1 (Apaf-1) in the ipsilateral kidney after an experimentally formed partial nephrectomy in a rat model. METHODS The study was performed in 2009 at the Ankara Training and Research Hospital, Animal Laboratory Center, Ankara, Turkey. We divided 24 Wistar rats into the following 4 groups. Group I (GI) - partial nephrectomy (PN) with hilar control as the conventional technique, Group II (GII)-the conventional technique with ABS, Group III (GIII) - received ABS application to the renal parenchyma and collecting duct with hilar control (non-sutured group). Group IV (GIV) - PN and ABS were performed without hilar control. The ABS solution (1 cc) was applied during the surgery to stop bleeding from resected renal tissue. At first month, all rats were sacrificed. Renal tubular apoptosis was investigated. RESULTS The mean percentage of apoptotic cell counts in GI were 20% iNOS, 20% eNOS, and 10% Apaf-1. In GII they were 10% iNOS, 20% eNOS, 5% Apaf-1, in GIII they were 40% iNOS, 50% eNOS, 30% Apaf-1, and in GIV they were 5% iNOS, 5% eNOS, and 3% Apaf-1. There was no significant decrease in apoptotic cells in GII, GIII, and GIV, to which we applied ABS. The highest percentage of apoptosis was shown in GIII accompanied by significant inflammation. The lowest percentage was determined in GIV, the non-warm ischemia group. The ABS has a dual biphasic de novo effects on apoptosis. CONCLUSION The challenge of severe hemorrhage in the renal tubular cellular micro-environment causes ABS-induced down-regulations in the expressions of apoptotic molecules, indicating that ABS may act as a topical biological response modifier.