Perioperative anti-endotoxin strategies

Altered hepatic gene expression profiles associated with improved fatty liver, insulin resistance, and intestinal permeability after hydroxypropyl methylcellulose (HPMC) supplementation in diet-induced obese mice

The effect of hydroxypropyl methylcellulose (HPMC) on hepatic gene expression was analyzed by exon microarray and real-time PCR from livers of diet-induced obese (DIO) mice fed a high-fat (HF) diet supplemented with either 6% HPMC or 6% microcrystalline cellulose (MCC). HPMC-fed mice exhibited significantly reduced body weight gain (55% lower compared to MCC), liver weight (13%), plasma LDL-cholesterol concentration (45%), and HF diet-increased intestinal permeability (48%). HPMC significantly reduced areas under the curve for 2 h insulin and glucose responses, indicating enhanced insulin sensitivity and glucose metabolism. HPMC up-regulated hepatic genes related to fatty acid oxidation, cholesterol and bile acid synthesis, and cellular activation of glucocorticoid (bile acid recycling) and down-regulated genes related to oxidative stress, triglyceride synthesis, and polyunsaturated fatty acid elongation. In conclusion, HPMC consumption ameliorates the effects of a HF diet on intestinal permeability, insulin resistance, hepatic lipid accumulation, glucocorticoid-related bile acid recycling, oxidative stress, and weight gain in DIO mice.

Relationship between intestinal endotoxemia and liver regeneration after partial hepatectomy in rats

AIM: To investigate the dynamic changes and the relationship between intestinal endotoxemia (IETM) and liver regeneration after partial hepatectomy (PH) in rats.

METHODS: Wistar rats were randomly divided into three groups: normal control (NC) group, sham operation (SO) group and PH group. Levels of endotoxin (ET) in blood were measured in rats of each group 6, 12, 24, 36, 48, 72, 120 and 168 h after PH, respectively. Liver regeneration was evaluated by different methods.

RESULTS: Plasma endotoxin level was increased in PH group during 6-72 h after PH, and the levels appeared at 12 and 48 h were significantly higher than those at the corresponding time point in NC and SO groups (12 h: P = 0.002 < 0.01 vs NC, SO; 48 h: P = 0.002 < 0.01 vs NC, P = 0.000 < 0.01 vs SO). However, ET returned to normal level after 72 h. After PH, the weight of remnant liver, the rate of liver regeneration, the percent of S phase liver cells and the index of PCNA in liver were increased significantly, but there was no relationship between these data and plasma ET. In NC and SO groups, liver regeneration showed no significant difference between the different time points.

CONCLUSION: There is no relationship between IETM and liver regeneration after PH, suggesting that IETM has no direct effects on liver regeneration.

Endotoxemia predicts outcome in acute pancreatitis

The incidence of complications of acute pancreatitis is high in patients with endotoxemia, and so we determined the endotoxin levels in the blood and peritoneal fluid of patients with acute severe pancreatitis to correlate the levels with any sequelae. Fourteen patients with acute severe pancreatitis were examined with regard to clinical features, biochemical tests, and laparotomy (n = 9). In all coagulation profiles, blood gas analysis, chest and abdominal x-rays, ultrasound, and abdominal computed tomography scan (n = 10) were performed. Qualitative estimation of endotoxin levels was done in peripheral blood and peritoneal and peripancreatic fluid. Ten (71.42%) of 14 patients had endotoxin in the blood, and 9 (64.28%) had it in the peritoneal fluid. Twelve (85.7%) had pulmonary involvement, with hypoxia being the most common (85.7%); among them endotoxin was found in the blood of 10 (83.32%) and in the peritoneal fluid of 8 (66.66%) patients. Renal dysfunction was found in 4 (28.57%) patients; endotoxin was present in the blood of all 4 patients and in the peritoneal fluid of 3 (75%) patients. Cardiovascular abnormality was detected in 8 (57.14%) patients, and endotoxin was present in the blood and peritoneal fluid of all patients. Metabolic abnormality was present in 8 (57.14%) patients; endotoxin was present in the blood of all 8 patients and in the peritoneal fluid of 7 (87.6%) patients. Eight (88.88%) of the 9 patients who required surgery had endotoxemia. Three (30%) patients with endotoxemia survived, whereas all 4 patients without endotoxemia survived. Mean hospital stay was 61.2 days and 46.7 days for endotoxin-positive and endotoxin-negative patients, respectively. We conclude that the presence of endotoxin in blood and peritoneal fluid correlates with the severity, systemic complications, and mortality rates of acute pancreatitis. Endotoxin estimation can identify patients at risk in the early stages of acute pancreatitis.