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Dowhan L, Moccia L, Fujiki M. Nutrition care for the adult post-intestinal transplant patient. Nutr Clin Pract 2024; 39:60-74. [PMID: 38069605 DOI: 10.1002/ncp.11100] [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: 09/19/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 01/13/2024] Open
Abstract
Intestinal transplantation has emerged as an accepted treatment choice for individuals experiencing irreversible intestinal failure. This treatment is particularly relevant for those who are not candidates or have poor response to autologous gut reconstruction or trophic hormone therapy, and who can no longer be sustained on parenteral nutrition. One of the main goals of transplant is to eliminate the need for parenteral support and its associated complications, while safely restoring complete nutrition autonomy. An intestinal transplant is a complex process that goes beyond merely replacing the intestines to provide nourishment and ceasing parenteral support. It requires an integrated management approach in the pretransplant and posttransplant setting, and high-quality nutrition treatment is one of the cornerstones leading to favorable outcomes and long-term management. Since the outset of intestinal transplant in the early 2000s, there is observed improvement of achieving nutrition autonomy sooner in the initial posttransplant phase; however, the development of nutrition complications in the chronic posttransplant period remains a long-term risk. This review delineates the decision-making process and clinical protocols used to nutritionally manage and monitor pre- and post-intestine transplant patients.
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Affiliation(s)
- Lindsay Dowhan
- Center for Gut Rehabilitation and Transplantation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lisa Moccia
- Center for Gut Rehabilitation and Transplantation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Masato Fujiki
- Center for Gut Rehabilitation and Transplantation, Cleveland Clinic, Cleveland, Ohio, USA
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2
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Raghu V, Abdelhadi R, Garcia MA, McDonnell E, Mezoff E, Namjoshi SS. Push and pull: The art of intestinal rehabilitation. JPEN J Parenter Enteral Nutr 2023; 47:960-962. [PMID: 37689981 PMCID: PMC10843054 DOI: 10.1002/jpen.2559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/07/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Vikram Raghu
- Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Ruba Abdelhadi
- Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, University of Missouri-Kansas City School of Medicine
| | - Mary Abigail Garcia
- Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, University of California-San Diego School of Medicine
| | - Erin McDonnell
- Department of Clinical Nutrition, Lucile Packard Children’s Hospital Stanford
| | - Ethan Mezoff
- Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Ohio State University School of Medicine
| | - Shweta S. Namjoshi
- Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Stanford University School of Medicine
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3
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Höllwarth ME, Solari V. Nutritional and pharmacological strategy in children with short bowel syndrome. Pediatr Surg Int 2021; 37:1-15. [PMID: 33392698 DOI: 10.1007/s00383-020-04781-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 12/11/2022]
Abstract
Short bowel syndrome in neonates is a severe and life-threatening disease after a major loss of small bowel with or without large bowel. Intestinal adaptation, by which the organism tries to restore digestive and absorptive capacities, is entirely dependent on stimulation of the active enterocytes by enteral nutrition. This review summarizes recent knowledge about the pathophysiologic consequences after the loss of different intestinal parts and outlines the options for enteral nutrition and pharmacological therapies to support the adaptation process.
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Affiliation(s)
- Michael E Höllwarth
- Univ. Clinic of Pediatric and Adolescent Surgery, Medical University, Graz, Austria.
| | - Valeria Solari
- Department of Pediatric Surgery, Klinik Donaustadt, 1220, Vienna, Austria
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4
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Jiang H, Li Y, Huang Z. Protein disulfide isomerase A3: A potential regulatory factor of colon epithelial cells. CANCER TRANSLATIONAL MEDICINE 2020. [DOI: 10.4103/ctm.ctm_33_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Pereira-Fantini PM, Byars SG, Pitt J, Lapthorne S, Fouhy F, Cotter PD, Bines JE. Unravelling the metabolic impact of SBS-associated microbial dysbiosis: Insights from the piglet short bowel syndrome model. Sci Rep 2017; 7:43326. [PMID: 28230078 PMCID: PMC5322370 DOI: 10.1038/srep43326] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/11/2017] [Indexed: 12/16/2022] Open
Abstract
Liver disease is a major source of morbidity and mortality in children with short bowel syndrome (SBS). SBS-associated microbial dysbiosis has recently been implicated in the development of SBS-associated liver disease (SBS-ALD), however the pathological implications of this association have not been explored. In this study high-throughput sequencing of colonic content from the well-validated piglet SBS-ALD model was examined to determine alterations in microbial communities, and concurrent metabolic alterations identified in urine samples via targeted mass spectrometry approaches (GC-MS, LC-MS, FIA-MS) further uncovered impacts of microbial disturbance on metabolic outcomes in SBS-ALD. Multi-variate analyses were performed to elucidate contributing SBS-ALD microbe and metabolite panels and to identify microbe-metabolite interactions. A unique SBS-ALD microbe panel was clearest at the genus level, with discriminating bacteria predominantly from the Firmicutes and Bacteroidetes phyla. The SBS-ALD metabolome included important alterations in the microbial metabolism of amino acids and the mitochondrial metabolism of branched chain amino acids. Correlation analysis defined microbe-metabolite clustering patterns unique to SBS-ALD and identified a metabolite panel that correlates with dysbiosis of the gut microbiome in SBS.
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Affiliation(s)
- Prue M Pereira-Fantini
- Intestinal Failure and Clinical Nutrition Group, Murdoch Childrens Research Institute, Parkville, Australia
| | - Sean G Byars
- Centre for Systems Genomics, School of Biosciences, The University of Melbourne, Parkville, Australia.,Department of Pathology, The University of Melbourne, Parkville, Australia
| | - James Pitt
- Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Susan Lapthorne
- Intestinal Failure and Clinical Nutrition Group, Murdoch Childrens Research Institute, Parkville, Australia
| | - Fiona Fouhy
- Teagasc Food Research Centre, Moorepark, Fermoy, Ireland
| | - Paul D Cotter
- Teagasc Food Research Centre, Moorepark, Fermoy, Ireland.,APC Microbiome Institute, Cork, Ireland
| | - Julie E Bines
- Intestinal Failure and Clinical Nutrition Group, Murdoch Childrens Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Australia
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6
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Pereira-Fantini PM, Bines JE, Lapthorne S, Fouhy F, Scurr M, Cotter PD, Gahan CG, Joyce SA. Short bowel syndrome (SBS)-associated alterations within the gut-liver axis evolve early and persist long-term in the piglet model of short bowel syndrome. J Gastroenterol Hepatol 2016; 31:1946-1955. [PMID: 27037739 DOI: 10.1111/jgh.13383] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/22/2016] [Accepted: 03/17/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Short bowel syndrome (SBS) is primarily characterized by malabsorption and malnutrition, resulting from loss of intestinal absorptive area following massive small bowel resection (SBR). Bile acids and the gut microbiota are functionally linked within the gut-liver axis; however, SBS-associated disturbances within the gut-liver axis remain largely unexplored. The aim of this study was to characterize the evolution of bile acid alterations within the gut-liver axis at both short-term and long-term time points and to relate these changes to alterations in colonic bacterial composition. METHODS Four-week-old piglets were assigned to 75% SBR, sham-operation or non-operation control groups. High throughput sequencing was employed to determine bacterial abundance in colonic content and ultra-performance liquid chromatography used to determine the bile acid concentration of gall bladder, portal serum, and fecal samples. RESULTS Bile acid complexity and relative abundance are altered in the SBS piglet model at two weeks post-SBR, and these changes persisted at six weeks post-SBR. Our examination of the microbial profile revealed an early and persistent loss in bacteria belonging to the Clostridiales order. CONCLUSIONS This study provides evidence of an early and persistent disturbance of the bile acid profile throughout the entero-hepatic circulation with an increase in the proportion of primary bile acids and a decrease in secondary bile acids following SBR. These changes were associated with a loss of bacteria belonging to the Clostridiales order consistent with a disturbance in the bile-microbial axis following SBR.
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Affiliation(s)
- Prue M Pereira-Fantini
- Intestinal Failure and Clinical Nutrition Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Julie E Bines
- Intestinal Failure and Clinical Nutrition Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Susan Lapthorne
- Intestinal Failure and Clinical Nutrition Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Fiona Fouhy
- School of Microbiology, University College Cork, Cork, Ireland.,Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, Ireland
| | - Michelle Scurr
- Intestinal Failure and Clinical Nutrition Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Paul D Cotter
- Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Cormac Gm Gahan
- School of Microbiology, University College Cork, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland.,School of Pharmacy, University College Cork, Cork, Ireland
| | - Susan A Joyce
- APC Microbiome Institute, University College Cork, Cork, Ireland
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Gillard L, Billiauws L, Stan-Iuga B, Ribeiro-Parenti L, Jarry AC, Cavin JB, Cluzeaud F, Mayeur C, Thomas M, Freund JN, Lacorte JM, Le Gall M, Bado A, Joly F, Le Beyec J. Enhanced Ghrelin Levels and Hypothalamic Orexigenic AgRP and NPY Neuropeptide Expression in Models of Jejuno-Colonic Short Bowel Syndrome. Sci Rep 2016; 6:28345. [PMID: 27323884 PMCID: PMC4914859 DOI: 10.1038/srep28345] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/01/2016] [Indexed: 12/20/2022] Open
Abstract
Short bowel syndrome (SBS) patients developing hyperphagia have a better outcome. Gastrointestinal endocrine adaptations help to improve intestinal functions and food behaviour. We investigated neuroendocrine adaptations in SBS patients and rat models with jejuno-ileal (IR-JI) or jejuno-colonic (IR-JC) anastomosis with and without parenteral nutrition. Circulating levels of ghrelin, PYY, GLP-1, and GLP-2 were determined in SBS rat models and patients. Levels of mRNA for proglucagon, PYY and for hypothalamic neuropeptides were quantified by qRT-PCR in SBS rat models. Histology and immunostaining for Ki67, GLP-1 and PYY were performed in SBS rats. IR-JC rats, but not IR-JI, exhibited significantly higher crypt depths and number of Ki67-positive cells than sham. Fasting and/or postprandial plasma ghrelin and PYY concentrations were higher, or tend to be higher, in IR-JC rats and SBS-JC patients than in controls. Proglucagon and Pyy mRNA levels were significantly enhanced in IR-JC rats. Levels of mRNA coding hypothalamic orexigenic NPY and AgRP peptides were significantly higher in IR-JC than in sham rats. We demonstrate an increase of plasma ghrelin concentrations, major changes in hypothalamic neuropeptides levels and greater induction of PYY in SBS-JC rats and patients suggesting that jejuno-colonic continuity creates a peculiar environment promoting further gut-brain adaptations.
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Affiliation(s)
- Laura Gillard
- Inserm UMR1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity, AP-HP, F-75890 Paris, France
| | - Lore Billiauws
- Inserm UMR1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity, AP-HP, F-75890 Paris, France
- AP-HP, Hôpital Beaujon, Service de Gastroentérologie et d’Assistance nutritive, Clichy, France
| | - Bogdan Stan-Iuga
- Inserm UMR1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity, AP-HP, F-75890 Paris, France
| | - Lara Ribeiro-Parenti
- Inserm UMR1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity, AP-HP, F-75890 Paris, France
- AP-HP, Hôpital Bichat - Claude Bernard, Service de Chirurgie Générale et Digestive, F-75018 Paris, France
| | - Anne-Charlotte Jarry
- Inserm UMR1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity, AP-HP, F-75890 Paris, France
| | - Jean-Baptiste Cavin
- Inserm UMR1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity, AP-HP, F-75890 Paris, France
| | - Françoise Cluzeaud
- Inserm UMR1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity, AP-HP, F-75890 Paris, France
| | - Camille Mayeur
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France
| | - Muriel Thomas
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France
| | - Jean-Noël Freund
- INSERM UMR_S1113, Université de Strasbourg, Faculté de Médecine, FMTS, 67081 Strasbourg, France
| | - Jean-Marc Lacorte
- INSERM, UMR_S 1166, Research Institute of Cardiovascular Disease, Metabolism and Nutrition, ICAN, Université Pierre et Marie Curie, Sorbonne Université, F-75013, Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Biochimie Endocrinienne et Oncologique, F-75651, Paris, Cedex
- Université Pierre et Marie Curie, Sorbonne Université, F-75005, Paris, France
| | - Maude Le Gall
- Inserm UMR1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity, AP-HP, F-75890 Paris, France
| | - André Bado
- Inserm UMR1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity, AP-HP, F-75890 Paris, France
| | - Francisca Joly
- Inserm UMR1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity, AP-HP, F-75890 Paris, France
- AP-HP, Hôpital Beaujon, Service de Gastroentérologie et d’Assistance nutritive, Clichy, France
| | - Johanne Le Beyec
- Inserm UMR1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity, AP-HP, F-75890 Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Biochimie Endocrinienne et Oncologique, F-75651, Paris, Cedex
- Université Pierre et Marie Curie, Sorbonne Université, F-75005, Paris, France
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Lapthorne S, Bines JE, Fouhy F, Dellios NL, Wilson G, Thomas SL, Scurr M, Stanton C, Cotter PD, Pereira-Fantini PM. Changes in the colon microbiota and intestinal cytokine gene expression following minimal intestinal surgery. World J Gastroenterol 2015; 21:4150-4158. [PMID: 25892864 PMCID: PMC4394075 DOI: 10.3748/wjg.v21.i14.4150] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/06/2014] [Accepted: 10/21/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the impact of minor abdominal surgery on the caecal microbial population and on markers of gut inflammation.
METHODS: Four week old piglets were randomly allocated to a no-surgery “control” group (n = 6) or a “transection surgery” group (n = 5). During the transection surgery procedure, a conventional midline incision of the lower abdominal wall was made and the small intestine was transected at a site 225 cm proximal to the ileocaecal valve, a 2 cm segment was removed and the intestine was re-anastomosed. Piglets received a polymeric infant formula diet throughout the study period and were sacrificed at two weeks post-surgery. Clinical outcomes including weight, stool consistency and presence of stool fat globules were monitored. High throughput DNA sequencing of colonic content was used to detect surgery-related disturbances in microbial composition at phylum, family and genus level. Diversity and richness estimates were calculated for the control and minor surgery groups. As disturbances in the gut microbial community are linked to inflammation we compared the gene expression of key inflammatory cytokines (TNF, IL1B, IL18, IL12, IL8, IL6 and IL10) in ileum, terminal ileum and colon mucosal extracts obtained from control and abdominal surgery groups at two weeks post-surgery.
RESULTS: Changes in the relative abundance of bacterial species at family and genus level were confined to bacterial members of the Proteobacteria and Bacteroidetes phyla. Family level compositional shifts included a reduction in the relative abundance of Enterobacteriaceae (22.95 ± 5.27 vs 2.07 ± 0.72, P < 0.01), Bacteroidaceae (2.54 ± 0.56 vs 0.86 ± 0.43, P < 0.05) and Rhodospirillaceae (0.40 ± 0.14 vs 0.00 ± 0.00, P < 0.05) following transection surgery. Similarly, at the genus level, changes associated with transection surgery were restricted to members of the Proteobacteria and Bacteroidetes phyla and included decreased relative abundance of Enterobacteriaceae (29.20 ± 6.74 vs 2.88 ± 1.08, P < 0.01), Alistipes (4.82 ± 1.73 vs 0.18 ± 0.13, P < 0.05) and Thalassospira (0.53 ± 0.19 vs 0.00 ± 0.00, P < 0.05). Surgery-associated microbial dysbiosis was accompanied by increased gene expression of markers of inflammation. Within the ileum IL6 expression was decreased (4.46 ± 1.60 vs 0.24 ± 0.06, P < 0.05) following transection surgery. In the terminal ileum, gene expression of TNF was decreased (1.51 ± 0.13 vs 0.80 ± 0.16, P < 0.01) and IL18 (1.21 ± 0.18 vs 2.13 ± 0.24, P < 0.01), IL12 (1.04 ± 0.16 vs 1.82 ± 0.32, P < 0.05) and IL10 (1.04 ± 0.06 vs 1.43 ± 0.09, P < 0.01) gene expression increased following transection surgery. Within the colon, IL12 (0.72 ± 0.13 vs 1.78 ± 0.28, P < 0.01) and IL10 (0.98 ± 0.02 vs 1.95 ± 0.14, P < 0.01) gene expression were increased following transection surgery.
CONCLUSION: This study suggests that minor abdominal surgery in infants, results in long-term alteration of the colonic microbial composition and persistent gastrointestinal inflammation.
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Sangild PT, Ney DM, Sigalet DL, Vegge A, Burrin D. Animal models of gastrointestinal and liver diseases. Animal models of infant short bowel syndrome: translational relevance and challenges. Am J Physiol Gastrointest Liver Physiol 2014; 307:G1147-68. [PMID: 25342047 PMCID: PMC4269678 DOI: 10.1152/ajpgi.00088.2014] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Intestinal failure (IF), due to short bowel syndrome (SBS), results from surgical resection of a major portion of the intestine, leading to reduced nutrient absorption and need for parenteral nutrition (PN). The incidence is highest in infants and relates to preterm birth, necrotizing enterocolitis, atresia, gastroschisis, volvulus, and aganglionosis. Patient outcomes have improved, but there is a need to develop new therapies for SBS and to understand intestinal adaptation after different diseases, resection types, and nutritional and pharmacological interventions. Animal studies are needed to carefully evaluate the cellular mechanisms, safety, and translational relevance of new procedures. Distal intestinal resection, without a functioning colon, results in the most severe complications and adaptation may depend on the age at resection (preterm, term, young, adult). Clinically relevant therapies have recently been suggested from studies in preterm and term PN-dependent SBS piglets, with or without a functional colon. Studies in rats and mice have specifically addressed the fundamental physiological processes underlying adaptation at the cellular level, such as regulation of mucosal proliferation, apoptosis, transport, and digestive enzyme expression, and easily allow exogenous or genetic manipulation of growth factors and their receptors (e.g., glucagon-like peptide 2, growth hormone, insulin-like growth factor 1, epidermal growth factor, keratinocyte growth factor). The greater size of rats, and especially young pigs, is an advantage for testing surgical procedures and nutritional interventions (e.g., PN, milk diets, long-/short-chain lipids, pre- and probiotics). Conversely, newborn pigs (preterm or term) and weanling rats provide better insights into the developmental aspects of treatment for SBS in infants owing to their immature intestines. The review shows that a balance among practical, economical, experimental, and ethical constraints will determine the choice of SBS model for each clinical or basic research question.
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Affiliation(s)
- Per T. Sangild
- 1Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark; ,2Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark;
| | - Denise M. Ney
- 3Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin;
| | | | - Andreas Vegge
- 1Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark; ,5Diabetes Pharmacology, Novo Nordisk, Måløv, Denmark; and
| | - Douglas Burrin
- 6USDA-ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
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10
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Pereira-Fantini PM, Lapthorne S, Joyce SA, Dellios NL, Wilson G, Fouhy F, Thomas SL, Scurr M, Hill C, Gahan CGM, Cotter PD, Fuller PJ, Hardikar W, Bines JE. Altered FXR signalling is associated with bile acid dysmetabolism in short bowel syndrome-associated liver disease. J Hepatol 2014; 61:1115-25. [PMID: 24999016 DOI: 10.1016/j.jhep.2014.06.025] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 05/27/2014] [Accepted: 06/22/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Despite the mortality associated with liver disease observed in patients with short bowel syndrome (SBS), mechanisms underlying the development of SBS-associated liver disease (SBS-ALD) are poorly understood. This study examines the impact of bacterially-mediated bile acid (BA) dysmetabolism on farnesoid X receptor (FXR) signalling pathways and clinical outcome in a piglet model of SBS-ALD. METHODS 4-week old piglets underwent 75% small bowel resection (SBR) or sham operation. Liver histology and hepatic inflammatory gene expression were examined. Abundance of BA biotransforming bacteria was determined and metabolomic studies detailed the alterations in BA composition of stool, portal serum and bile samples. Gene expression of intestinal and hepatic FXR target genes and small heterodimer partner (SHP) transrepression targets were assessed. RESULTS Histological evidence of SBS-ALD included liver bile duct proliferation, hepatocyte ballooning and fibrosis. Inflammatory gene expression was increased. Microbiota changes included a 10-fold decrease in Clostridium and a two-fold decrease in Bacteroides in SBS-ALD piglets. BA composition was altered and reflected a primary BA dominant composition. Intestinal and hepatic regulation of BA synthesis was characterised by a blunted intestinal FXR activation response and a failure of SHP to repress key hepatic targets. CONCLUSIONS We propose a pathological scenario in which microbial dysbiosis following SBR results in significant BA dysmetabolism and consequent outcomes including steatorrhoea, persistent diarrhoea and liver damage. Furthermore alterations in BA composition may have contributed to the observed disturbance in FXR-mediated signalling pathways. These findings provide an insight into the complex mechanisms mediating the development of liver disease in patients with SBS.
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Affiliation(s)
- Prue M Pereira-Fantini
- Intestinal Failure and Clinical Nutrition Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
| | - Susan Lapthorne
- Intestinal Failure and Clinical Nutrition Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | | | - Nicole L Dellios
- Intestinal Failure and Clinical Nutrition Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Guineva Wilson
- Intestinal Failure and Clinical Nutrition Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Surgery, Monash Medical Centre, Clayton, Victoria, Australia
| | - Fiona Fouhy
- School of Microbiology, University College Cork, Cork, Ireland; Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, Ireland
| | - Sarah L Thomas
- Intestinal Failure and Clinical Nutrition Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Michelle Scurr
- Intestinal Failure and Clinical Nutrition Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Colin Hill
- Alimentary Pharmabiotic Centre, Cork, Ireland
| | | | - Paul D Cotter
- Alimentary Pharmabiotic Centre, Cork, Ireland; Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, Ireland
| | - Peter J Fuller
- Prince Henry's Institute for Medical Research, Clayton, Victoria, Australia
| | - Winita Hardikar
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Gastro and Food Allergy Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Julie E Bines
- Intestinal Failure and Clinical Nutrition Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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11
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Lim DW, Turner JM, Wales PW. Emerging Piglet Models of Neonatal Short Bowel Syndrome. JPEN J Parenter Enteral Nutr 2014; 39:636-43. [PMID: 25293943 DOI: 10.1177/0148607114554621] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 09/15/2014] [Indexed: 12/19/2022]
Abstract
Short bowel syndrome (SBS) is a growing problem in the human neonatal population. In infants, SBS is the leading cause of intestinal failure, the state of being unable to absorb sufficient nutrients for growth and development. Neonates with SBS are dependent on long-term parenteral nutrition therapy, but many succumb to the complications of sepsis and liver disease. Research in neonatal SBS is challenged by the ethical limits of studying sick human neonates and the heterogeneous nature of the disease process. Outcomes in SBS vary depending on residual intestinal anatomy, intestinal length, patient age, and exposure to nutrition therapies. The neonatal piglet serves as an appropriate translational model of the human neonate because of similarities in gastrointestinal ontogeny, physiological maturity, and adaptive processes. Re-creating the disease process in a piglet model presents a unique opportunity for researchers to discover novel insights and therapies in SBS. Emerging piglet models of neonatal SBS now represent the entire spectrum of disease seen in human infants. This review aims to contextualize these emerging piglet models within the context of SBS as a heterogeneous disease. We first explore the factors that account for SBS heterogeneity and then explore the suitability of the neonatal piglet as an appropriate translational animal model. We then examine differences between the emerging piglet models of neonatal SBS and how these differences affect their translational potential to human neonates with SBS.
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Affiliation(s)
- David W Lim
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Justine M Turner
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Paul W Wales
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Department of Surgery, Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada
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12
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Harrison E, Lal S, McLaughlin JT. Enteroendocrine cells in gastrointestinal pathophysiology. Curr Opin Pharmacol 2013; 13:941-5. [PMID: 24206752 DOI: 10.1016/j.coph.2013.09.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/08/2013] [Accepted: 09/09/2013] [Indexed: 01/15/2023]
Abstract
Enteroendocrine cells in the gastrointestinal tract play an important role in the regulation of appetite and digestive responses through the secretion of peptides. Their involvement in gastrointestinal diseases has been acknowledged, but relatively few studies have sought to clearly define their role in the pathogenesis or as therapeutic targets. Recent, but still limited, work has identified new roles for EEC in GI diseases.
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Affiliation(s)
- Elizabeth Harrison
- Institute of Inflammation and Repair, Faculty of Medical and Human Sciences and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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13
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Choban P, Dickerson R, Malone A, Worthington P, Compher C. A.S.P.E.N. Clinical Guidelines. JPEN J Parenter Enteral Nutr 2013; 37:714-44. [DOI: 10.1177/0148607113499374] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Patricia Choban
- Mt Carmel Hospital, Central Ohio Surgical Associates, Columbus, OH, USA
| | | | - Ainsley Malone
- Department of Pharmacy, Mt Carmel West Hospital, Columbus, OH, USA
| | | | - Charlene Compher
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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14
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Kim SJ, Kim BR, Lee SM, Kong HJ, Shin CS. Nutritional support process for a patient with short bowel syndrome in conjunction with panperitonitis: a case report. Clin Nutr Res 2013; 2:149-53. [PMID: 23908982 PMCID: PMC3728465 DOI: 10.7762/cnr.2013.2.2.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 07/01/2013] [Accepted: 07/03/2013] [Indexed: 11/19/2022] Open
Abstract
Short Bowel Syndrome (SBS) is a condition that causes malabsorption and nutrient deficiency because a large section of the small intestine is missing or has been surgically removed. SBS may develop congenitally or from gastroenterectomy, which often change the motility, digestive, and/or absorptive functions of the small bowel. The surgical procedure for SBS and the condition itself have high mortality rates and often lead to a range of complications associated with long-term parenteral nutrition (PN). Therefore, careful management and appropriate nutrition intervention are needed to prevent complications and to help maintain the physiologic integrity of the remaining intestinal functions. Initial postoperative care should provide adequate hydration, electrolyte support and total parenteral nutrition (TPN) to prevent fatal dehydration. Simultaneously, enteral nutrition should be gradually introduced, with the final goal of using only enteral nutrition support and/or oral intake and eliminating TPN from the diet. A patient should be considered for discharge when macro and micronutrients can be adequately supplied through enteral nutrition support or oral diet. Currently, there is more research on pediatric patients with SBS than on adult patient population. A 35-year-old man with no notable medical history was hospitalized and underwent a surgery for acute appendicitis at a local hospital. He was re-operated on the 8th day after the initial surgery due to complications and was under observation when he suddenly complained of severe abdominal pain and high fever. He was immediately transferred to a tertiary hospital where the medical team discovered free air in the abdomen. He was subsequently diagnosed with panperitonitis and underwent an emergency reoperation to explore the abdomen. Although the patient was expected to be at a high risk of malnutrition due to short bowel syndrome resulting from multiple surgeries, through intensive care under close cooperation between the medical and nutrition support team, his nutritional status improved significantly through continuous central and peripheral parenteral nutrition, enteral nutrition, and oral intake. The purpose of this paper is to report the process of the patient's recovery.
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Affiliation(s)
- Sun Jung Kim
- Department of Nutrition Services, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 135-720, Korea
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15
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Lapthorne S, Pereira-Fantini PM, Fouhy F, Wilson G, Thomas SL, Dellios NL, Scurr M, O’Sullivan O, Ross RP, Stanton C, Fitzgerald GF, Cotter PD, Bines JE. Gut microbial diversity is reduced and is associated with colonic inflammation in a piglet model of short bowel syndrome. Gut Microbes 2013; 4:212-21. [PMID: 23549027 PMCID: PMC3669166 DOI: 10.4161/gmic.24372] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Following small bowel resection (SBR), the luminal environment is altered, which contributes to clinical manifestations of short bowel syndrome (SBS) including malabsorption, mucosal inflammation and bacterial overgrowth. However, the impact of SBR on the colon has not been well-defined. The aims of this study were to characterize the colonic microbiota following SBR and to assess the impact of SBR on mucosal inflammation in the colon. RESULTS Analysis of the colonic microbiota demonstrated that there was a significant level of dysbiosis both two and six weeks post-SBR, particularly in the phylum Firmicutes, coupled with a decrease in overall bacterial diversity in the colon. This decrease in diversity was associated with an increase in colonic inflammation six weeks post-surgery. METHODS Female (4-week old) piglets (5-6/group) received a 75% SBR, a transection (sham) or no surgery. Compositional analysis of the colonic microbiota was performed by high-throughput sequencing, two- and six-weeks post-surgery. The gene expression of the pro-inflammatory cytokines interleukin (IL)-1β, IL-6, IL-8, IL-18 and tumor necrosis factor (TNF)-α in the colonic mucosa was assessed by qRT-PCR and the number of macrophages and percentage inducible nitric oxide synthase (iNOS) staining in the colonic epithelium were quantified by immunohistochemistry. CONCLUSIONS SBR significantly decreased the diversity of the colonic microbiota and this was associated with an increase in colonic mucosal inflammation. This study supports the hypothesis that SBR has a significant impact on the colon and that this may play an important role in defining clinical outcome.
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Affiliation(s)
- Susan Lapthorne
- Intestinal Failure and Clinical Nutrition Group; Murdoch Childrens Research Institute; Parkville, Australia,Correspondence to: Susan Lapthorne,
| | - Prue M. Pereira-Fantini
- Intestinal Failure and Clinical Nutrition Group; Murdoch Childrens Research Institute; Parkville, Australia
| | - Fiona Fouhy
- Teagasc Food Research Centre; Moorepark; Fermoy, Ireland,Department of Microbiology; University College Cork; Cork, Ireland
| | - Guineva Wilson
- Intestinal Failure and Clinical Nutrition Group; Murdoch Childrens Research Institute; Parkville, Australia
| | - Sarah L. Thomas
- Intestinal Failure and Clinical Nutrition Group; Murdoch Childrens Research Institute; Parkville, Australia
| | - Nicole L. Dellios
- Intestinal Failure and Clinical Nutrition Group; Murdoch Childrens Research Institute; Parkville, Australia
| | - Michelle Scurr
- Intestinal Failure and Clinical Nutrition Group; Murdoch Childrens Research Institute; Parkville, Australia
| | | | - R. Paul Ross
- Teagasc Food Research Centre; Moorepark; Fermoy, Ireland,Alimentary Pharmabiotic Centre; University College Cork; Cork, Ireland
| | - Catherine Stanton
- Teagasc Food Research Centre; Moorepark; Fermoy, Ireland,Alimentary Pharmabiotic Centre; University College Cork; Cork, Ireland
| | - Gerald F. Fitzgerald
- Department of Microbiology; University College Cork; Cork, Ireland,Alimentary Pharmabiotic Centre; University College Cork; Cork, Ireland
| | - Paul D. Cotter
- Teagasc Food Research Centre; Moorepark; Fermoy, Ireland,Alimentary Pharmabiotic Centre; University College Cork; Cork, Ireland
| | - Julie E. Bines
- Intestinal Failure and Clinical Nutrition Group; Murdoch Childrens Research Institute; Parkville, Australia,Department of Paediatrics; University of Melbourne; Parkville, Australia,Department of Gastroenterology and Clinical Nutrition; Royal Children’s Hospital; Parkville, Australia
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16
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El-Salhy M, Mazzawi T, Gundersen D, Hatlebakk JG, Hausken T. The role of peptide YY in gastrointestinal diseases and disorders (review). Int J Mol Med 2013; 31:275-82. [PMID: 23292145 PMCID: PMC4042877 DOI: 10.3892/ijmm.2012.1222] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 11/09/2012] [Indexed: 12/13/2022] Open
Abstract
Peptide YY (PYY) is affected in several gastrointestinal diseases and disorders. Changes in PYY appear to be an adaptive response to alterations in pathophysiological conditions caused by the disease. This applies to gastrointestinal diseases/disorders such as irritable bowel syndrome, inflammatory bowel disease, celiac disease, systemic sclerosis, and post-intestinal resection. By contrast, the changes in PYY in chronic idiopathic slow transit constipation (CST) seem to be of a primary nature, and may be one etiological factor of the disease. Abnormalities in PYY seem to contribute to the development of symptoms present in irritable bowel syndrome, inflammatory bowel disease, gastroenteropathy in long-standing diabetes and CST. The changes in PYY could, however, be favorable in some gastrointestinal disorders such as celiac disease, systemic sclerosis and post-intestinal resection state. Investigating changes in PYY in gastrointestinal diseases/disorders could be beneficial in clinical practice, where a receptor agonist or an antagonist can be used as a drug, depending on the condition. Similar to other neuroendocrine peptides/amines of the gut, PYY has broad physiological/pharmacological effects: it can bind to and activate several receptors with independent actions. Thus, in order to use PYY as a drug, receptor-specific agonists or antagonists need to be developed.
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Affiliation(s)
- Magdy El-Salhy
- Section for Gastroenterology, Department of Medicine, Stord Helse-Fonna Hospital, Stord, Norway.
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17
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Matarese LE. Nutrition and Fluid Optimization for Patients With Short Bowel Syndrome. JPEN J Parenter Enteral Nutr 2012; 37:161-70. [DOI: 10.1177/0148607112469818] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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