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Talc mediates angiostasis in malignant pleural effusions via endostatin induction

¹ Division of Pulmonary and Critical Care Medicine, Dept of Medicine, College of Medicine, and ² Dept of Materials Science and Engineering, College of Engineering, and Particle Engineering Research Center, University of Florida, Gainesville, FL, USA. ³ Lungenklinik Heckeshorn, Berlin, Germany.

CORRESPONDENCE: V. B. Antony, Division of Pulmonary and Critical Care Medicine, Dept of Medicine, University of Florida, P.O. Box 100225, Gainesville, FL, USA, Fax: 1 3522714559. E-mail: antonvb{at}medicine.ufl.edu

Keywords: Angiogenesis, malignant pleural effusions, pleura, pleurodesis

Received: May 8, 2006
Accepted December 26, 2006

Talc remains the most effective sclerosing agent for pleurodesis. However, its mechanism of action in resolving pleural malignant disease remains unclear.

The present study evaluated the angiogenic balance in the pleural space in patients with malignant pleural effusions (MPE) following talc insufflation.

Patient pleural fluid samples were collected both before and after talc insufflation. The ability of pleural mesothelial cells (PMC) and malignant mesothelioma cells (MMC) to produce endostatin in vitro was compared. The biological effects of pleural fluids and conditioned media from talc-activated PMC on endothelial cells were evaluated by performing proliferation, invasion, tube formation and apoptosis assays.

Pleural fluids from patients with MPE who received thoracoscopic talc insufflation contained significantly higher levels of endostatin (median 16.75 ng·mL^–1) compared with pre-talc instillation (1.06 ng·mL^–1). Talc-activated PMC released significantly greater amounts of endostatin (mean±SEM 1052.39±38.66 pg·mL^–1) when compared with a MMC line (134.73±8.72 pg·mL^–1).

In conlusion, talc alters the angiogenic balance in the pleural space from a biologically active and angiogenic environment to an angiostatic milieu. Functional improvement following talc poudrage in patients with malignant pleural effusions may, in part, reflect these alterations in the pleural space.