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Khasanov R, Svoboda D, Tapia-Laliena MÁ, Kohl M, Maas-Omlor S, Hagl CI, Wessel LM, Schäfer KH. Muscle hypertrophy and neuroplasticity in the small bowel in short bowel syndrome. Histochem Cell Biol 2023; 160:391-405. [PMID: 37395792 PMCID: PMC10624713 DOI: 10.1007/s00418-023-02214-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 07/04/2023]
Abstract
Short bowel syndrome (SBS) is a severe, life-threatening condition and one of the leading causes of intestinal failure in children. Here we were interested in changes in muscle layers and especially in the myenteric plexus of the enteric nervous system (ENS) of the small bowel in the context of intestinal adaptation. Twelve rats underwent a massive resection of the small intestine to induce SBS. Sham laparotomy without small bowel transection was performed in 10 rats. Two weeks after surgery, the remaining jejunum and ileum were harvested and studied. Samples of human small bowel were obtained from patients who underwent resection of small bowel segments due to a medical indication. Morphological changes in the muscle layers and the expression of nestin, a marker for neuronal plasticity, were studied. Following SBS, muscle tissue increases significantly in both parts of the small bowel, i.e., jejunum and ileum. The leading pathophysiological mechanism of these changes is hypertrophy. Additionally, we observed an increased nestin expression in the myenteric plexus in the remaining bowel with SBS. Our human data also showed that in patients with SBS, the proportion of stem cells in the myenteric plexus had risen by more than twofold. Our findings suggest that the ENS is tightly connected to changes in intestinal muscle layers and is critically involved in the process of intestinal adaptation to SBS.
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Affiliation(s)
- Rasul Khasanov
- Department of Pediatric Surgery, University Hospital Mannheim, Medical Faculty Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Daniel Svoboda
- Department of Pediatric Surgery, University Hospital Mannheim, Medical Faculty Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - María Ángeles Tapia-Laliena
- Department of Pediatric Surgery, University Hospital Mannheim, Medical Faculty Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Martina Kohl
- Department of Pediatric and Adolescent Medicine, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Silke Maas-Omlor
- Enteric Nervous System Group, University of Applied Sciences Kaiserslautern, Amerikastrasse 1, 66482, Zweibrücken, Germany
| | - Cornelia Irene Hagl
- Carl Remigius Medical School, Charles de Gaulle Str. 2, 81737, Munich, Germany
| | - Lucas M Wessel
- Department of Pediatric Surgery, University Hospital Mannheim, Medical Faculty Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Karl-Herbert Schäfer
- Enteric Nervous System Group, University of Applied Sciences Kaiserslautern, Amerikastrasse 1, 66482, Zweibrücken, Germany
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2
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Kamalova AA, Podshivalin AA, Sageeva GI, Druzhkova EE. Regional experience in the treatment of children with short bowel syndrome. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2022. [DOI: 10.21508/1027-4065-2022-67-5-231-236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Short bowel syndrome is a rare, chronic, debilitating, and potentially life-threatening condition in which loss of intestinal absorption capacity deprives children of the ability to absorb sufficient nutrients from the food they consumed. The authors describe regional experience of treating children with short bowel syndrome, which includes conservative and surgical approach, with an analysis of the leading causes, prognostic factors, timing of achieving intestinal autonomy, complications and catamnesis.Purpose. The study aims at analyzing cases of short bowel syndrome in children in order to improve the provision of medical care for children in the Republic of Tatarstan and the nearest regions.Material and methods. Single-center, retrospective study was conducted of 22 cases of children with short bowel syndrome who received treatment in the surgical department for young children in the State Autonomous Healthcare Institution Children’s Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan for the period September 2014 till November 2021.Results. The most common cause of intestinal resection in the study group were: congenital malformations in 7 children (32%), necrotizing enterocolitis in 5 children (23%), small intestine malrotation (Ladd’s bands) in 4 children (18%), mesenteric thrombosis in 4 (18%), Hirschsprung’s disease in 2 children (9%). By the end of the first year after diagnosis, intestine self-regulation was achieved in 17 children. The mortality rate was 9%.
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Affiliation(s)
- A. A. Kamalova
- Kazan State Medical University;
Children’s Republican Clinical Hospital
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3
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Pérez-Robles R, Hermosilla J, Navas N, Clemente-Bautista S, Jiménez-Lozano I, Cabañas-Poy MJ, Ruiz-Travé J, Hernández-García MA, Cabeza J, Salmerón-García A. Tracking the physicochemical stability of teduglutide (Revestive®) clinical solutions over time in different storage containers. J Pharm Biomed Anal 2022; 221:115064. [PMID: 36152491 DOI: 10.1016/j.jpba.2022.115064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/20/2022]
Abstract
Teduglutide, the active ingredient of the medicine Revestive® (5 mg), is a recombinant therapeutic peptide that mimics the effects of the endogenous glucagon-like peptide 2 (GLP-2). It stimulates intestinal growth, adaptation and function in patients with Short Bowel Syndrome who are dependent on parenteral nutrition. The Summary of Product Characteristics recommends immediate use of the reconstituted solutions and the discarding of any subsequent surplus. This study aims to carry out a long-term stability study that reproduces hospital conditions of use which provide sound evidence regarding the use of teduglutide surplus beyond the Summary Product Characteristics recommendations. We conducted a stability study of teduglutide solutions prepared from a 5 mg vial of Revestive®. Some of the solutions were stored in their original vial after reconstitution, while others were repackaged in plastic syringes to evaluate their physicochemical stability over time. For this purpose, we applied a set of previously validated analytical methodologies to evaluate the main critical quality attributes of teduglutide, i.e., primary (including post-tralational modifications), secondary and tertiary structures, aggregates, particulate, concentration and pH. The results indicate that the solutions maintain high physicochemical stability over time, regardless of the storage temperature (4ºC or -20ºC) or the storage container (vials or syringes). This research provides new data on the stability of Revestive® that will be of great value to hospital pharmacists. This comprehensive assessment of the physicochemical long-term stability of TGT has demonstrated that under the storage conditions and over the period studied here, the medicine maintains its quality, efficacy and safety profiles.
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Affiliation(s)
- Raquel Pérez-Robles
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain; Department of Analytical Chemistry, Science Faculty, University of Granada, Granada, Spain; Fundación para la Investigación Biosanitaria de Andalucía Oriental-Alejandro Otero, Granada, Spain
| | - Jesús Hermosilla
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain; Department of Analytical Chemistry, Science Faculty, University of Granada, Granada, Spain
| | - Natalia Navas
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain; Department of Analytical Chemistry, Science Faculty, University of Granada, Granada, Spain.
| | | | - Inés Jiménez-Lozano
- Maternal and Child Pharmacy Service, Vall d'Hebron Hospital, Pharmacy, Barcelona, Spain
| | | | - Julio Ruiz-Travé
- Department of Analytical Chemistry, Science Faculty, University of Granada, Granada, Spain
| | | | - Jose Cabeza
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain; Department of Clinical Pharmacy, San Cecilio University Hospital, Granada, Spain
| | - Antonio Salmerón-García
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain; Department of Clinical Pharmacy, San Cecilio University Hospital, Granada, Spain
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4
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Modi BP, Galloway DP, Gura K, Nucci A, Plogsted S, Tucker A, Wales PW. ASPEN definitions in pediatric intestinal failure. JPEN J Parenter Enteral Nutr 2021; 46:42-59. [PMID: 34287974 DOI: 10.1002/jpen.2232] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 11/09/2022]
Abstract
Pediatric intestinal failure (PIF) is a relatively rare disease entity which requires focused interdisciplinary care and specialized nutrition management. There has long been a lack of consensus in the definition of key terms related to PIF due to its rarity and plethora of small studies rather than large trials. As such, the American Society for Parenteral and Enteral Nutrition (ASPEN) Pediatric Intestinal Failure Section, composed of clinicians from a variety of disciplines caring for children with intestinal failure, is uniquely poised to provide insight into this definition void. This document is the product of an effort by the Section to create evidence-based consensus definitions, with the goal of allowing for appropriate comparisons between clinical studies and measurement of longterm patient outcomes. This manuscript was approved by the ASPEN Board of Directors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Biren P Modi
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - David P Galloway
- Division of Gastroenterology, Hepatology and Nutrition, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kathleen Gura
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Anita Nucci
- Department of Nutrition, Georgia State University, Atlanta, Georgia, USA
| | | | - Alyssa Tucker
- Department of Clinical Nutrition, Children's National Medical Center, Washington, District of Columbia, USA
| | - Paul W Wales
- Group for Improvement of Intestinal Function and Treatment, Department of Surgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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5
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Hollanda Martins Da Rocha M, Lee ADW, Marin MLDM, Faintuch S, Mishaly A, Faintuch J. Treating short bowel syndrome with pharmacotherapy. Expert Opin Pharmacother 2020; 21:709-720. [DOI: 10.1080/14656566.2020.1724959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Mariana Hollanda Martins Da Rocha
- Clinical nutrition multidisciplinary team (MDT), Hospital das Clinicas, Sao Paulo, Brazil
- Head, Short bowel syndrome MDT, Hospital das Clinicas, Sao Paulo, Brazil
| | - André Dong Won Lee
- Clinical nutrition multidisciplinary team (MDT), Hospital das Clinicas, Sao Paulo, Brazil
- Liver and Digestive Organs Transplantation Service, Hospital das Clinicas, Department of Gastroenterology, Hospital das Clinicas, Sao Paulo, Brazil
| | - Marcia Lucia De Mario Marin
- Clinical nutrition multidisciplinary team (MDT), Hospital das Clinicas, Sao Paulo, Brazil
- Research Unit, Central Pharmacy, Hospital das Clinicas, Sao Paulo, Brazil
| | - Salomao Faintuch
- Clinical Director, Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Asher Mishaly
- Medical Student, Americas Faculty of Medicine, Sao Paulo, Brazil
| | - Joel Faintuch
- Department of Gastroenterology, Hospital das Clinicas and Sao Paulo University Medical School, Sao Paulo, Brazil
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Frongia G, Majlesara A, Saffari A, Abbasi DS, Gharabaghi N, Okun JG, Thiel C, Günther P, Vianna R, Mehrabi A. Simultaneous Serial Transverse Enteroplasty (STEP) in Size Mismatch Small Bowel Transplantations. J Gastrointest Surg 2019; 23:331-338. [PMID: 30091037 DOI: 10.1007/s11605-018-3893-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/20/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Small bowel transplantation (SBTX) in children receiving larger grafts from adults can be challenging because of size mismatch. The aim of the present study was to assess whether a simultaneous serial transverse enteroplasty (STEP) can address the problem of size mismatch. METHODS Three different size ratio groups between donors and recipients were compared in a porcine model with a 14-day follow-up. The groups were size matched, size mismatched (1:3.8 weight ratio), and size mismatched + STEP (each n = 8). RESULTS It was technically feasible to simultaneously perform a STEP and SBTX of a mismatched intestinal segment. The postoperative clinical course was uneventful. No signs of bleeding, leakage, stenosis, or ileus were observed and the intestinal segment was well perfused at relaparotomy. Body weight decreased in all groups, but the percentage decrease was lowest in the mismatched + STEP group. Vital enterocyte masses were similar in all the groups (citrulline levels) and the nutritional status was best in the STEP group (transferrin levels, p = 0.04). CONCLUSIONS We have demonstrated that a simultaneous STEP and SBTX procedure is technically feasible and clinically useful in overcoming the challenges associated with size mismatched SBTX. Our short-term findings justify further investigation in a larger series to elucidate the long-term outcomes of this procedure.
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Affiliation(s)
- Giovanni Frongia
- Division of Pediatric Surgery, Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ali Majlesara
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Arash Saffari
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Dezfouli Sepher Abbasi
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Negin Gharabaghi
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Jürgen Günther Okun
- Department of Pediatrics, Pediatric Metabolic Laboratory, University Hospital of Heidelberg, Heidelberg, Germany
| | - Christian Thiel
- Department of Pediatrics, Pediatric Metabolic Laboratory, University Hospital of Heidelberg, Heidelberg, Germany
| | - Patrick Günther
- Division of Pediatric Surgery, Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Rodrigo Vianna
- Division of Liver/Gastrointestinal Transplantation, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
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7
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Hopkins J, Cermak SA, Merritt RJ. Oral Feeding Difficulties in Children With Short Bowel Syndrome: A Narrative Review. Nutr Clin Pract 2017; 33:99-106. [DOI: 10.1177/0884533617707493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Judy Hopkins
- Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Sharon A. Cermak
- Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
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8
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Cullis PS, Gudlaugsdottir K, Andrews J. A systematic review of the quality of conduct and reporting of systematic reviews and meta-analyses in paediatric surgery. PLoS One 2017; 12:e0175213. [PMID: 28384296 PMCID: PMC5383307 DOI: 10.1371/journal.pone.0175213] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/22/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Our objective was to evaluate quality of conduct and reporting of published systematic reviews and meta-analyses in paediatric surgery. We also aimed to identify characteristics predictive of review quality. BACKGROUND Systematic reviews summarise evidence by combining sources, but are potentially prone to bias. To counter this, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was published to aid in reporting. Similarly, the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) measurement tool was designed to appraise methodology. The paediatric surgical literature has seen an increasing number of reviews over the past decade, but quality has not been evaluated. METHODS Adhering to PRISMA guidelines, we performed a systematic review with a priori design to identify systematic reviews and meta-analyses of interventions in paediatric surgery. From 01/2010 to 06/2016, we searched: MEDLINE, EMBASE, Cochrane, Centre for Reviews and Dissemination, Web of Science, Google Scholar, reference lists and journals. Two reviewers independently selected studies and extracted data. We assessed conduct and reporting using AMSTAR and PRISMA. Scores were calculated as the sum of reported items. We also extracted author, journal and article characteristics, and used them in exploratory analysis to determine which variables predict quality. RESULTS 112 articles fulfilled eligibility criteria (53 systematic reviews; 59 meta-analyses). Overall, 68% AMSTAR and 56.8% PRISMA items were reported adequately. Poorest scores were identified with regards a priori design, inclusion of structured summaries, including the grey literature, citing excluded articles and evaluating bias. 13 reviews were pre-registered and 6 in PRISMA-endorsing journals. The following predicted quality in univariate analysis:, word count, Cochrane review, journal h-index, impact factor, journal endorses PRISMA, PRISMA adherence suggested in author guidance, article mentions PRISMA, review includes comparison of interventions and review registration. The latter three variables were significant in multivariate regression. CONCLUSIONS There are gaps in the conduct and reporting of systematic reviews in paediatric surgery. More endorsement by journals of the PRISMA guideline may improve review quality, and the dissemination of reliable evidence to paediatric clinicians.
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Affiliation(s)
- Paul Stephen Cullis
- Department of Surgical Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Katrin Gudlaugsdottir
- Department of Surgical Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
| | - James Andrews
- Department of Surgical Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
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9
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Khasanov RR, Gumerov AA, Vessel LM. [The role of small intestine length in the development of short bowel syndrome]. Khirurgiia (Mosk) 2017:63-67. [PMID: 28209957 DOI: 10.17116/hirurgia2017163-67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM To define the the role of small bowel length in development of SBS. MATERIAL AND METHODS Seventeen patients with SBS after small bowel resection in neonatal period were included into the study. Total small bowel length ranged from 5 to 55 cm (11.8±5.59% from normal length for certain age). RESULTS Described small bowel length has high risk of SBS/IF development irrespective to other factors (specific segment of small bowel that was resected, preserved intestinal segment state, absence of colon and/or ileocecal valve). CONCLUSION It is required to perform further studies with greater amount of patients to discover exact small bowel length which is associated with SBS and other factors affecting small bowel state.
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Affiliation(s)
- R R Khasanov
- Department of Pediatric Surgery, Bashkir State Medical University, Ufa, Russia; Clinic of Pediatric Surgery, Mannheim University's Hospital, University of Heidelberg, Germany
| | - A A Gumerov
- Department of Pediatric Surgery, Bashkir State Medical University, Ufa, Russia
| | - L M Vessel
- Clinic of Pediatric Surgery, Mannheim University's Hospital, University of Heidelberg, Germany
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Frongia G, Nickkholgh A, Hafezi M MR, Arvin J, Saffari A, Golriz M, Aydin E, Weih S, Kessler M, Emami G, Garoussi C, Okun JG, Schmidt K, Thiel C, Brune M, Günther P, Holland-Cunz S, Mehrabi A. Significance of the Extent of Intestinal Resection on the Outcome of a Short-bowel Syndrome in a Porcine Model. J INVEST SURG 2015; 29:57-65. [PMID: 26375577 DOI: 10.3109/08941939.2015.1057304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIM OF THE STUDY Insufficient data are available to determine the most suitable extent of intestinal resection required to induce short-bowel syndrome (SBS) in pigs. This study aimed to compare the three main SBS-models published. METHODS A 75%, 90%, or 100% mid-intestinal resection was performed in groups of n = 5 pigs each. Clinical (body weight, stool consistency) and biochemical (serum eletrolytes, citrulline, albumin, prealbumin, and transferrin) parameters were determined daily, functional (D-xylose resorption) and histological (intestinal villus length) parameters were determined after 2 weeks. A t-test and ANOVA were used for statistical analysis. RESULTS Only in the 100% group, we observed a persistent weight loss (13.6 ± 3.8%) and diarrhea, as well as a decrease in prealbumin-levels (41%) and transferrin levels (33%). Serum electrolytes remained stable in all groups during the observation period. Citrulline stabilized at different levels (100% group 13.9 ± 1.0 μmol/L; 90% group 18.8 ± 1.0 μmol/L; 75% group 26.3 ± 1.4 μmol/L; all p < .05). D-xylose resorption was lowest in the 100%, followed by 90% and 75% group (100% group 32.8 ± 4.9 mg/L; 90% group 50.0 ± 19.6 mg/L; 75% group 57.8 ± 8.8 mg/L; p = .393). Intestinal villus length decreased in all groups (100% group 11.0%; 90% group 14.0%; 75% group 19.1%). CONCLUSIONS 75% intestinal resection is less suitable as an SBS model, as animals tend to recover remarkably. The 90% model is suitable for longer-term studies, as animals might survive longer due to partial compensation. Due to severe nutritional, biochemical, and physiological derangements, the 100% model can only be used for acute experiments and those immediately followed by small bowel transplantation.
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Affiliation(s)
- Giovanni Frongia
- a Division of Pediatric Surgery, University Hospital of Heidelberg , Heidelberg , Germany
| | - Arash Nickkholgh
- b Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg , Heidelberg , Germany
| | - Mohammad Reza Hafezi M
- b Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg , Heidelberg , Germany
| | - Jalal Arvin
- b Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg , Heidelberg , Germany
| | - Arash Saffari
- b Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg , Heidelberg , Germany
| | - Mohammad Golriz
- b Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg , Heidelberg , Germany
| | - Esvad Aydin
- b Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg , Heidelberg , Germany
| | - Sandra Weih
- a Division of Pediatric Surgery, University Hospital of Heidelberg , Heidelberg , Germany
| | - Markus Kessler
- a Division of Pediatric Surgery, University Hospital of Heidelberg , Heidelberg , Germany
| | - Golnaz Emami
- b Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg , Heidelberg , Germany
| | - Camelia Garoussi
- b Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg , Heidelberg , Germany
| | - Jürgen G Okun
- c Department of Pediatrics, University Hospital of Heidelberg , Heidelberg , Germany
| | - Kathrin Schmidt
- c Department of Pediatrics, University Hospital of Heidelberg , Heidelberg , Germany
| | - Christian Thiel
- c Department of Pediatrics, University Hospital of Heidelberg , Heidelberg , Germany
| | - Maik Brune
- d Department of Internal Medicine I and Clinical Chemistry, University Hospital of Heidelberg , Heidelberg , Germany
| | - Patrick Günther
- a Division of Pediatric Surgery, University Hospital of Heidelberg , Heidelberg , Germany
| | - Stefan Holland-Cunz
- a Division of Pediatric Surgery, University Hospital of Heidelberg , Heidelberg , Germany
| | - Arianeb Mehrabi
- b Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg , Heidelberg , Germany
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11
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Mehrabi V, Mehrabi A, Jamshidi SH, Pedram MS, Sabagh MS, Jaberansari N, Fonouni HR, Sharifi AH, Malekzadeh R, Frongia G. Modified Spiral Intestinal Lengthening and Tailoring for Short Bowel Syndrome. Surg Innov 2015. [DOI: 10.1177/1553350615596639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. The spiral intestinal lengthening and tailoring (SILT) procedure is a new surgical technique for autologous intestinal reconstruction in patients with short bowel syndrome. The aim of this work is to present a first description of a modified SILT technique by which the mucosal layer is left intact to possibly reduce the severe postoperative complications of intestinal leakage and abdominal abscess formation. Materials and Methods. The modified SILT technique was performed on a 10-cm-long intestinal segment in 2 pigs to determine the technical feasibility. Thereafter, the short-term clinical feasibility was monitored clinically in 2 dogs by gastrointestinal X-ray series at postoperative day 4 and by relaparotomy postoperative day 10. Results. It was technically feasible to lengthen the intestinal segment from 10 cm to 20 cm and tailoring it from 3 cm to 1.7 cm in diameter, while leaving the intestinal mucosal layer intact. The postoperative course was uneventful for both dogs. The gastrointestinal X-ray series showed an inconspicuous intestinal transit time without any signs of stricture, perforation, or leakage. In the relaparotomy, the initially achieved lengthening and tailoring extents were preserved and the operated intestinal segment was well perfused with no early signs of necrosis, stenosis, or leakage. Conclusions. Leaving the mucosal layer intact during SILT is technically and clinically feasible in the short term in a large animal model. Further studies are needed to fully assess the impact of this technical modification on the long-term outcome of larger series.
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Affiliation(s)
| | | | | | | | - M. S. Sabagh
- Tehran University of Medical Science, Shariati, Iran
| | | | | | - A. H. Sharifi
- Tehran University of Medical Science, Shariati, Iran
| | - R. Malekzadeh
- Tehran University of Medical Science, Shariati, Iran
| | - G. Frongia
- Heidelberg University, Heidelberg, Germany
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12
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Smooth muscle strips for intestinal tissue engineering. PLoS One 2014; 9:e114850. [PMID: 25486279 PMCID: PMC4259486 DOI: 10.1371/journal.pone.0114850] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 11/14/2014] [Indexed: 01/04/2023] Open
Abstract
Functionally contracting smooth muscle is an essential part of the engineered intestine that has not been replicated in vitro. The purpose of this study is to produce contracting smooth muscle in culture by maintaining the native smooth muscle organization. We employed intact smooth muscle strips and compared them to dissociated smooth muscle cells in culture for 14 days. Cells isolated by enzymatic digestion quickly lost maturity markers for smooth muscle cells and contained few enteric neural and glial cells. Cultured smooth muscle strips exhibited periodic contraction and maintained neural and glial markers. Smooth muscle strips cultured for 14 days also exhibited regular fluctuation of intracellular calcium, whereas cultured smooth muscle cells did not. After implantation in omentum for 14 days on polycaprolactone scaffolds, smooth muscle strip constructs expressed high levels of smooth muscle maturity markers as well as enteric neural and glial cells. Intact smooth muscle strips may be a useful component for engineered intestinal smooth muscle.
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13
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Kovalenko PL, Yuan L, Sun K, Kunovska L, Seregin S, Amalfitano A, Basson MD. Regulation of epithelial differentiation in rat intestine by intraluminal delivery of an adenoviral vector or silencing RNA coding for Schlafen 3. PLoS One 2013; 8:e79745. [PMID: 24244554 PMCID: PMC3823574 DOI: 10.1371/journal.pone.0079745] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/23/2013] [Indexed: 12/15/2022] Open
Abstract
Although we stimulate enterocytic proliferation to ameliorate short gut syndrome or mucosal atrophy, less effort has been directed at enterocytic differentiation. Schlafen 3 (Slfn3) is a poorly understood protein induced during IEC-6 enterocytic differentiation. We hypothesized that exogenous manipulation of Slfn3 would regulate enterocytic differentiation in vivo. Adenoviral vector coding for Slfn3 cDNA (Ad-GFP-Slfn3) or silencing RNA for Slfn3 (siSlfn3) was introduced intraluminally into rat intestine. We assessed Slfn3, villin, sucrase-isomaltase (SI), Dpp4, and Glut2 by qRT-PCR, Western blot, and immunohistochemistry. We also studied Slfn3 and these differentiation markers in atrophic defunctionalized jejunal mucosa and the crypt-villus axis of normal jejunum. Ad-GFP-Slfn3 but not Ad-GFP increased Slfn3, villin and Dpp4 expression in human Caco-2 intestinal epithelial cells. Injecting Ad-GFP-Slfn3 into rat jejunum in vivo increased mucosal Slfn3 mRNA three days later vs. intraluminal Ad-GFP. This Slfn3 overexpression was associated with increases in all four differentiation markers. Injecting siSlfn3 into rat jejunum in vivo substantially reduced Slfn3 and all four intestinal mucosal differentiation markers three days later, as well as Dpp4 specific activity. Endogenous Slfn3 was reduced in atrophic mucosa from a blind-end Roux-en-Y anastomosis in parallel with differentiation marker expression together with AKT and p38 signaling. Slfn3 was more highly expressed in the villi than the crypts, paralleling Glut2, SI and Dpp4. Slfn3 is a key intracellular regulator of rat enterocytic differentiation. Understanding how Slfn3 works may identify targets to promote enterocytic differentiation and maintain mucosal function in vivo, facilitating enteral nutrition and improving survival in patients with mucosal atrophy or short gut syndrome.
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Affiliation(s)
- Pavlo L. Kovalenko
- Department of Surgery, Michigan State University, East Lansing, Michigan, United States of America
| | - Lisi Yuan
- Department of Surgery, Michigan State University, East Lansing, Michigan, United States of America
- Research Service, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan, United States of America
| | - Kelian Sun
- Department of Surgery, Michigan State University, East Lansing, Michigan, United States of America
| | - Lyudmyla Kunovska
- Department of Surgery, Michigan State University, East Lansing, Michigan, United States of America
| | - Sergey Seregin
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, United States of America
| | - Andrea Amalfitano
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, United States of America
| | - Marc D. Basson
- Department of Surgery, Michigan State University, East Lansing, Michigan, United States of America
- Research Service, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan, United States of America
- * E-mail:
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14
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Frongia G, Kessler M, Weih S, Nickkholgh A, Mehrabi A, Holland-Cunz S. Comparison of LILT and STEP procedures in children with short bowel syndrome -- a systematic review of the literature. J Pediatr Surg 2013; 48:1794-805. [PMID: 23932625 DOI: 10.1016/j.jpedsurg.2013.05.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/02/2013] [Accepted: 05/21/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare LILT and STEP, the two principal procedures to lengthen the native bowel in children with a short bowel syndrome (SBS), by discussing the indications and presenting the outcome from published data. METHODS A review of literature was performed. N=39 publications were reviewed. RESULTS For LILT and STEP, failure to achieve intestinal autonomy by conservative therapy represents the main indication, and end-stage liver disease the main contraindication. A sufficiently dilated intestinal segment is a common anatomical precondition for both procedures. STEP can be performed on shorter intestinal segments and on intricate segments such as the duodenum, which is technically not feasible for LILT. Both procedures have a similar extent of intestinal lengthening (approximately 70%) and result in improvement of enteral nutrition and reversal of complications of parenteral nutrition. STEP seems to have a lower mortality and overall progression to transplantation. CONCLUSIONS STEP and LILT are both accepted procedures for non-transplant surgical management of SBS in children. The outcome after STEP seems to be more favourable, but larger series are needed to further assess accurate selection of eligible patients and to estimate effectiveness of procedures. A considerably higher number of cases for evaluation might be accomplished through the widespread use of a centralised registry.
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Affiliation(s)
- Giovanni Frongia
- Department of Pediatric Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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