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Shulman RJ, Devaraj S, Heitkemper M. Activation of the Innate Immune System in Children With Irritable Bowel Syndrome Evidenced by Increased Fecal Human β-Defensin-2. Clin Gastroenterol Hepatol 2021; 19:2121-2127. [PMID: 32961343 PMCID: PMC8041153 DOI: 10.1016/j.cgh.2020.09.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The role of the innate immune system in functional gastrointestinal pain disorders is unclear. We investigated the role of β-defensin-2 and gut permeability in childhood irritable bowel syndrome (IBS) and functional abdominal pain (FAP) symptom generation. METHODS Fecal β-defensin-2 (and in a subset, gut permeability) was measured in children with IBS (n = 116), FAP (n = 33), and healthy control (HC) children (n = 72). IBS and FAP patients were recruited from tertiary and primary care, and HCs were recruited from primary care. RESULTS β-defensin-2 concentration was greater in children with IBS (P = .003) and FAP (P = .03) than in HCs. β-defensin-2 was greater in girls with IBS than female HCs (P = .007) and in girls with IBS vs boys with IBS (P = .036). There was no difference by sex in the FAP and HC groups. For the entire cohort, β-defensin-2 correlated with multiple pain symptoms. In the IBS group, β-defensin-2 correlated with pain interference (P = .014). No correlation with pain was found in the FAP or HC group. Gut permeability was greater in the IBS vs the FAP and HC groups (P = .038). For the entire cohort, permeability correlated with the number of pain episodes (P = .041) and interfering pain episodes (P = .049). For the entire cohort there was a correlation between β-defensin-2 and permeability (P = .003), with borderline correlation in the IBS group (P = .086). For the cohort and IBS and HC groups, the number of bowel movements was modestly inversely related to fecal β-defensin-2 concentrations. CONCLUSIONS Increased fecal β-defensin-2 concentration in children with IBS suggests activation of the innate immune system in some, which, along with increased gut permeability, appears related to abdominal pain symptoms. Sex is an important variable in interpreting β-defensin-2 concentration in children with IBS.
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Affiliation(s)
- Robert J Shulman
- Department of Pediatrics; Children's Nutrition Research Center; Texas Children's Hospital; Baylor College of Medicine, Houston, Texas.
| | - Sridevi Devaraj
- Texas Children's Hospital; Baylor College of Medicine, Houston, Texas; Department of Pathology and Immunology
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Shulman RJ, Devaraj S, Heitkemper M. Gut permeability is affected by sex and increased in children with irritable bowel syndrome but not in functional abdominal pain. Neurogastroenterol Motil 2020; 32:e13765. [PMID: 31820520 PMCID: PMC7050934 DOI: 10.1111/nmo.13765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Gut permeability is increased in some children and adults with irritable bowel syndrome (IBS). We investigated whether this also is true for children with functional abdominal pain (FAP). We also determined whether sex affected permeability results. METHODS Sucrose, lactulose, mannitol, and sucralose were ingested after an overnight fast in well-phenotyped children with IBS (n = 95), FAP (n = 25), and healthy controls (HC) (n = 60). Urine was collected for 24 hours. Percent sucrose recovery was calculated based on the 0- to 3-hour collection; lactulose/mannitol ratio both on the 0- to 3-hour and 0- to 24-hour collections; and percent sucralose recovery on the 0- to 24-hours collection. KEY RESULTS Age was similar among the groups (P = .26). The lactulose/mannitol ratio was increased in IBS compared with HC at 0-3 and 0-24 hours (P = .023, P = .05, respectively). Percent sucralose recovery was greater in FAP than in HC (P = .045). No differences were noted among the groups in percent sucrose recovery. Taking sex into account, percent sucrose recovery was greater in girls with IBS vs HC girls (P = .008). The lactulose/mannitol ratio was greater in boys with IBS compared with HC boys at both time points (both P = .02). Percent sucralose recovery was greater in boys with IBS than in FAP or HC (both P < .001). CONCLUSIONS AND INFERENCES Sex is a critically important factor when measuring gut permeability. Boys with IBS have increased lactulose/mannitol ratios and percent sucralose recovery. Girls with IBS have increased percent recovery of sucrose. Children with FAP do not demonstrate abnormal gut 0permeability even taking sex into account.
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Affiliation(s)
- Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX,Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Sridevi Devaraj
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX,Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX
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Winkler A, Messinger H, Bär A. Subchronic (91-day) oral toxicity study of cellobiose in rats. Regul Toxicol Pharmacol 2019; 110:104518. [PMID: 31704258 DOI: 10.1016/j.yrtph.2019.104518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/22/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Andreas Winkler
- LPT Laboratory of Pharmacology and Toxicology GmbH & Co. KG, 21147, Hamburg, Germany
| | | | - Albert Bär
- Bioresco Ltd., 4054, Basel, Switzerland.
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Mani V, Rubach JK, Sanders DJ, Pham T, Koltes DA, Gabler NK, Poss MJ. Evaluation of the protective effects of zinc butyrate in IPEC-J2 cells and grower pigs under heat stress. Transl Anim Sci 2019; 3:842-854. [PMID: 32704850 PMCID: PMC7200505 DOI: 10.1093/tas/txz023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/22/2019] [Indexed: 11/20/2022] Open
Abstract
Heat stress (HS) is a major environmental stressor primarily affecting swine performance through negative effects on intestinal health. Zinc and butyric acid supplementation help maintain intestinal integrity and barrier function, and has been shown to be beneficial to swine during stress conditions. We tested a novel formulation of zinc butyrate (ZnB) to study whether it has protective effects toward swine using pig intestinal epithelial cells (IPEC-J2) and in a grower swine HS trial. IPEC-J2 cells were grown either under an inflammatory challenge (Escherichia coli lipopolysaccharide) or HS (41.5 °C for 48 h) using Transwell plates. The tight junction integrity of the cells under various treatments, including ZnB, zinc sulfate, and calcium butyrate, was followed over a period of 36 to 48 h by measuring transepithelial electrical resistance (TER). During inflammatory challenge, ZnB-treated cells had the greatest TER (P < 0.05) at 36 h. When the cells were exposed to HS at 41.5 °C, ZnB-treated cells had similar TER to the cells incubated at 37.0 °C, indicating significant protection against HS. In the swine trial (two dietary treatments, control and an encapsulated form of 40% zinc butyrate [E-ZnB] in hydrogenated palm oil pearls, 12 pigs per treatment), grower gilts (35 ± 1 kg) were supplemented with E-ZnB for 24 d before being subjected to biphasic HS for 7 d, 30 to 32 °C for 8 h and 28 °C for 16 h, for a total duration of 56 h of HS. At the end of the HS phase, half the pigs were euthanized from each treatment (n = 6 per treatment), and growth performance was calculated. During the HS phase, average daily gain (ADG; 0.53 vs. 0.79 kg) and gain-to-feed ratio (G:F; 0.33 vs. 0.43) were greater in the E-ZnB group (P < 0.05). Although in vivo intestinal permeability increased during the HS phase (P < 0.05), no differences were observed in the present study for the intestinal health parameters measured including TER, villus height:crypt depth ratio, and in vivo and ex vivo intestinal permeability between the two treatment groups. In conclusion, results presented here demonstrate that E-ZnB supplementation during HS improves ADG and G:F in grower pigs. Although we could not measure any differences, the mode of action of butyric acid and zinc suggests that the performance improvements are related to improved intestinal health.
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Affiliation(s)
| | | | | | | | - Dawn A Koltes
- Department of Animal Science, Iowa State University, Ames, IA
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Castan L, Villemin C, Claude M, Aubert P, Durand T, Neunlist M, Brossard C, Magnan A, Bodinier M, Bouchaud G. Acid-Hydrolyzed Gliadins Worsen Food Allergies through Early Sensitization. Mol Nutr Food Res 2018; 62:e1800159. [DOI: 10.1002/mnfr.201800159] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/12/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Laure Castan
- INRA, UR1268 BIA, rue de la géraudière; BP 71627 F-44316 Nantes France
- INSERM, UMR1087, l'institut du thorax; F-44000 Nantes France
- CNRS, UMR6291; F-44000 Nantes France
- Université de Nantes; F-44000 Nantes France
| | - Clélia Villemin
- INRA, UR1268 BIA, rue de la géraudière; BP 71627 F-44316 Nantes France
| | - Mathilde Claude
- INRA, UR1268 BIA, rue de la géraudière; BP 71627 F-44316 Nantes France
| | - Philippe Aubert
- Université de Nantes; F-44000 Nantes France
- INSERM UMR1235, Institut des Maladies de l'Appareil Digestif (IMAD), Faculté de Médecine; F-44000 Nantes France
| | - Tony Durand
- Université de Nantes; F-44000 Nantes France
- INSERM UMR1235, Institut des Maladies de l'Appareil Digestif (IMAD), Faculté de Médecine; F-44000 Nantes France
| | - Michel Neunlist
- Université de Nantes; F-44000 Nantes France
- INSERM UMR1235, Institut des Maladies de l'Appareil Digestif (IMAD), Faculté de Médecine; F-44000 Nantes France
| | - Chantal Brossard
- INRA, UR1268 BIA, rue de la géraudière; BP 71627 F-44316 Nantes France
| | - Antoine Magnan
- INSERM, UMR1087, l'institut du thorax; F-44000 Nantes France
- CNRS, UMR6291; F-44000 Nantes France
- Université de Nantes; F-44000 Nantes France
| | - Marie Bodinier
- INRA, UR1268 BIA, rue de la géraudière; BP 71627 F-44316 Nantes France
| | - Grégory Bouchaud
- INRA, UR1268 BIA, rue de la géraudière; BP 71627 F-44316 Nantes France
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Heitkemper MM, Cain KC, Shulman RJ, Burr RL, Ko C, Hollister EB, Callen N, Zia J, Han CJ, Jarrett ME. Stool and urine trefoil factor 3 levels: associations with symptoms, intestinal permeability, and microbial diversity in irritable bowel syndrome. Benef Microbes 2018; 9:345-355. [PMID: 29633639 DOI: 10.3920/bm2017.0059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Previously we showed that urine trefoil factor 3 (TFF3) levels were higher in females with irritable bowel syndrome (IBS) compared to non-IBS females. To assess if TFF3 is associated with symptoms and/or reflect alterations in gastrointestinal permeability and gut microbiota in an IBS population, we correlated stool and urine TFF3 levels with IBS symptoms, intestinal permeability, stool microbial diversity and relative abundance of predominant bacterial families and genera. We also tested the relationship of stool TFF3 to urine TFF3, and compared results based on hormone contraception use. Samples were obtained from 93 females meeting Rome III IBS criteria and completing 4-week symptom diaries. TFF3 levels were measured by ELISA. Permeability was assessed with the urine lactulose/mannitol (L/M) ratio. Stool microbiota was assessed using 16S rRNA. Stool TFF3, but not urine TFF3, was associated positively with diarrhoea and loose stool consistency. Higher stool TFF3 was also associated with lower L/M ratio and microbial diversity. Of the 20 most abundant bacterial families Mogibacteriaceae and Christensenellaceae were inversely related to stool TFF3, with only Christensenellaceae remaining significant after multiple comparison adjustment. There were no significant relationships between stool or urine TFF3 levels and other symptoms, nor between stool and urine levels. In premenopausal females, urine TFF3 levels were higher in those reporting hormone contraception. Collectively these results suggest that higher stool TFF3 levels are associated with IBS symptoms (loose/diarrhoeal stools), lower gut permeability, and altered stool bacteria composition (decreased diversity and decreased Christensenellaceae), which further suggests that TFF3 may be an important marker of host-bacteria interaction.
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Affiliation(s)
- M M Heitkemper
- 1 Department of Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-7266, USA
| | - K C Cain
- 2 Department of Biostatistics and Office of Nursing Research, University of Washington, 1959 NE Pacific Street, Seattle, WA, USA
| | - R J Shulman
- 3 Children's Nutrition Research Center, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA
| | - R L Burr
- 1 Department of Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-7266, USA
| | - C Ko
- 4 University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - E B Hollister
- 5 Department of Pathology and Immunology, Baylor College of Medicine, Texas Children's Microbiome Center, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA
| | - N Callen
- 6 Department of Family and Child Nursing, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - J Zia
- 4 University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - C J Han
- 1 Department of Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-7266, USA
| | - M E Jarrett
- 1 Department of Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-7266, USA
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Associations among gut permeability, inflammatory markers, and symptoms in patients with irritable bowel syndrome. J Gastroenterol 2014; 49:1467-76. [PMID: 24435814 PMCID: PMC4102674 DOI: 10.1007/s00535-013-0919-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/21/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Alterations in gastrointestinal (GI) permeability and immune measures are present in some patients with irritable bowel syndrome (IBS) but the relationship to symptoms is poorly defined. In adults with IBS, we compared permeability, unstimulated peripheral blood monocyte (PBMC) interleukin-10 (IL-10) levels, IBS life interference, and GI and psychological distress symptoms. METHODS In 88 women and 18 men with IBS, GI permeability was quantitated as percent recovery of urinary sucrose and the lactulose/mannitol (L/M) ratio. IL-10 was measured in supernatants from 72-h incubated, unstimulated PBMCs. Participants completed a 4-week daily diary recording IBS life interference on daily activities and work, IBS symptoms, and psychological distress symptoms. They also completed the Brief Symptom Inventory. RESULTS The L/M ratio but not percent sucrose recovery was significantly correlated with IBS interference with activities and work and retrospectively measured anxiety and depression. Unstimulated PBMC production of IL-10 correlated significantly with IBS interference with daily work, IBS symptom score, and abdominal pain. We identified a subgroup of IBS subjects with higher IL-10 and/or higher L/M ratio who had substantially higher IBS interference and IBS symptom scores. CONCLUSIONS Our findings suggest a distinct subgroup of IBS patients with alterations in gut barrier function. This subgroup is characterized by increased GI permeability and/or increased PBMC production of IL-10. These physiologic alterations reflect more severe IBS as measured by interference of IBS with daily activities and daily IBS symptoms.
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The dietary intake of wheat and other cereal grains and their role in inflammation. Nutrients 2013; 5:771-87. [PMID: 23482055 PMCID: PMC3705319 DOI: 10.3390/nu5030771] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/08/2013] [Accepted: 02/21/2013] [Indexed: 12/18/2022] Open
Abstract
Wheat is one of the most consumed cereal grains worldwide and makes up a substantial part of the human diet. Although government-supported dietary guidelines in Europe and the U.S.A advise individuals to eat adequate amounts of (whole) grain products per day, cereal grains contain “anti-nutrients,” such as wheat gluten and wheat lectin, that in humans can elicit dysfunction and disease. In this review we discuss evidence from in vitro, in vivo and human intervention studies that describe how the consumption of wheat, but also other cereal grains, can contribute to the manifestation of chronic inflammation and autoimmune diseases by increasing intestinal permeability and initiating a pro-inflammatory immune response.
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Effects of timing, sex, and age on site-specific gastrointestinal permeability testing in children and adults. J Pediatr Gastroenterol Nutr 2010; 50:269-75. [PMID: 20081547 PMCID: PMC2830368 DOI: 10.1097/mpg.0b013e3181aa3aa9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Measurement of gastrointestinal (GI) permeability is commonly used in research and often used clinically. Despite its utility, little is known about sugar excretion timeframes or the potential effects of age and sex on GI permeability testing. We seek to determine the timeframes of sugar excretion and the potential effects of age and sex on urinary recovery of the sugars. SUBJECTS AND METHODS Healthy adults (n = 17) and children (n = 15) fasted 4 hours after the evening meal and then ingested a solution of sucrose, lactulose, mannitol, and sucralose. Urine was collected at 30, 60, and 90 minutes after ingestion and then each time the subjects voided during the next 24 hours. Each urine void was collected separately. RESULTS Median age for the adults was 47.5 years (range 21-57 years) and for children 10 years (range 5-17 years). There were no differences between children and adults in mean percent dose of sugar recovered. The time of peak urinary recovery of the sugars was generally similar between children and adults. Sucrose urinary recovery declined with age (P = 0.008; r2 = 0.19) unrelated to sex. Lactulose and sucralose urinary recovery declined with age in females (P = 0.05, r2 = 0.24 and P = 0.011, r2 = 0.41; respectively) but not in males. CONCLUSIONS Overall, sugar urinary recovery is comparable in children and adults. Specific sugar urinary recovery may change as a function of age and/or sex. These results need to be taken into account when planning and interpreting gastrointestinal permeability studies.
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Human-derived probiotic Lactobacillus reuteri demonstrate antimicrobial activities targeting diverse enteric bacterial pathogens. Anaerobe 2008; 14:166-71. [PMID: 18396068 DOI: 10.1016/j.anaerobe.2008.02.001] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 01/29/2008] [Accepted: 02/07/2008] [Indexed: 12/27/2022]
Abstract
Lactobacillus reuteri is a commensal-derived anaerobic probiotic that resides in the human gastrointestinal tract. L. reuteri converts glycerol into a potent broad-spectrum antimicrobial compound, reuterin, which inhibits the growth of gram-positive and gram-negative bacteria. In this study, we compared four human-derived L. reuteri isolates (ATCC 55730, ATCC PTA 6475, ATCC PTA 4659 and ATCC PTA 5289) in their ability to produce reuterin and to inhibit the growth of different enteric pathogens in vitro. Reuterin was produced by each of the four L. reuteri strains and assessed for biological activity. The minimum inhibitory concentration (MIC) of reuterin derived from each strain was determined for the following enteric pathogens: enterohemorrhagic Escherichia coli, enterotoxigenic E. coli, Salmonella enterica, Shigella sonnei and Vibrio cholerae. We also analyzed the relative abilities of L. reuteri to inhibit enteric pathogens in a pathogen overlay assay. The magnitude of reuterin production did not directly correlate with the relative ability of L. reuteri to suppress the proliferation of enteric pathogens. Additional antimicrobial factors may be produced by L. reuteri, and multiple factors may act synergistically with reuterin to inhibit enteric pathogens.
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Intestinal permeability and effects of Lactobacillus rhamnosus therapy in children with short bowel syndrome. J Pediatr Gastroenterol Nutr 2008; 46:41-7. [PMID: 18162832 DOI: 10.1097/01.mpg.0000304452.92175.f5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The present study was conducted to investigate the effects of Lactobacillus rhamnosus (also known as LGG) on intestinal permeability (IP) in children with short bowel syndrome (SBS). PATIENTS AND METHODS In a double-blind, placebo-controlled crossover clinical trial, baseline IP (ie, lactulose-to-mannitol ratio) was measured in subjects with SBS and healthy control subjects. Subjects with SBS received LGG or placebo for 4 weeks, followed by a 3-week washout before therapy was crossed over for another 4 weeks. IP, quantitative fecal cultures for Lactobacillus species (in colony-forming units [cfu] per gram of stool) and hydrogen breath test (HBT) were performed during LGG and placebo phases of therapy. RESULTS Twenty-one children (SBS, n = 9; control, n = 12) with a median age of 4.5 years (range 1.6-16.4 years) enrolled. Baseline IP measurements were similar in patients with SBS and control subjects: 0.08 +/- 0.06 (mean +/- SD) versus 0.07 +/- 0.05 (P = 1.0). IP was correlated with age in control subjects (r = -0.83, P = 0.001) but not among patients with SBS (r = -0.55, P = 0.16). Fecal colonization with Lactobacillus species did not differ during LGG versus placebo therapy (median 1.4 x 10(9) cfu/g [range 4.0 x 10(5) to 4.0 x 10(9) cfu/g] vs 6.0 x 10(9) cfu/g [1.0 x 10(3) to 1.0 x 10(10) cfu/g], respectively; P = 0.83). LGG therapy had no consistent effects on IP (P = 0.58) or its relationship with age (r = -0.40, P = 0.29), and was associated with conversion to positive HBT results in 1 subject. CONCLUSIONS In this sample of children with SBS, the IP was within normal limits but did not correlate with age. LGG therapy had no consistent effects on IP. These findings do not support empiric LGG therapy to enhance IP in children with SBS.
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Colomé G, Sierra C, Blasco J, García MV, Valverde E, Sánchez E. Intestinal permeability in different feedings in infancy. Acta Paediatr 2007; 96:69-72. [PMID: 17187607 DOI: 10.1111/j.1651-2227.2007.00030.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To determine the intestinal permeability (IP) as a marker of intestinal epithelial integrity in formula-fed infants compared with healthy breast-fed infants. METHODS IP was measured in 57 healthy infants less than 4 months old. A dual sugar test with lactulose and mannitol was performed. Three urinary ratios were established: lactulose/mannitol (L/M), lactulose/creatinine (L/C) and mannitol/creatinine (M/C). Five groups were studied: breast-fed (n = 11), prebiotic supplemented formula (n 17), nucleotides supplemented formula (n = 9), LC-PUFA supplemented formula (n = 9) and LC-PUFA and nucleotides supplemented formula (n = 11). RESULTS We have not found any difference in IP between breast-fed and formula-fed infants nor when the different formulas are compared with each other. The indirect information of the paracellular pathway by the ratio L/C and the transcellular route by the ratio M/C reflects some difference when the ingredients added are fructooligosaccharides and galactooligosaccharides, expressing a higher degree of lactulose permeation with respect to mannitol. When LC-PUFA supplementation was evaluated a lesser ratio of L/C was found, expressing intestinal barrier related to a process of epithelial tight. CONCLUSIONS The most important factor in the maintenance of the integrity of epithelial barrier function is probably the delivery of nutrients in the gastrointestinal tract. The role of the different ingredients added should be clarified.
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Affiliation(s)
- Gemma Colomé
- Unidad de Gastroenterología y Nutrición Infantil, Hospital Materno-Infantil, Málaga, Spain
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Farhadi A, Keshavarzian A, Fields JZ, Sheikh M, Banan A. Resolution of common dietary sugars from probe sugars for test of intestinal permeability using capillary column gas chromatography. J Chromatogr B Analyt Technol Biomed Life Sci 2006; 836:63-8. [PMID: 16621740 DOI: 10.1016/j.jchromb.2006.03.046] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 03/15/2006] [Indexed: 12/13/2022]
Abstract
BACKGROUND The most widely accepted method for the evaluation of intestinal barrier integrity is the measurement of the permeation of sugar probes following an oral test dose of sugars. The most-widely used sugar probes are sucrose, lactulose, mannitol and sucralose. Measuring these sugars using a sensitive gas chromatographic (GC) method, we noticed interference on the area of the lactulose and mannitol peaks. METHODS We tested different sugars to detect the possible makeup of these interferences and finally detected that the lactose interferes with lactulose peak and fructose interferes with mannitol peak. On further developing of our method, we were able to reasonably separate these peaks using different columns and condition for our assay. Sample preparation was rapid and simple and included adding internal standard sugars, derivitization and silylation. We used two chromatographic methods. In the first method we used Megabore column and had a run time of 34 min. This resulted in partial separation of the peaks. In the second method we used thin capillary column and was able to reasonably separate the lactose and lactulose peaks and the mannitol and fructose peaks with run time of 22 min. RESULTS The sugar probes including mannitol, sucrose, lactulose, sucralose, fructose and lactose were detected precisely, without interference. The assay was linear between lactulose concentrations of 0.5 and 40 g/L (r(2)=1.000, P<0.0001) and mannitol concentrations of 0.01 and 40 g/L (r(2)=1.000). The sensitivity of this method remained high using new column and assay condition. The minimum detectable concentration calculated for both methods was 0.5 mg/L for lactulose and 1 mg/L for mannitol. CONCLUSION This is the first report of interference of commonly used sugars with test of intestinal permeability. These sugars are found in most of fruits and dairy products and could easily interfere with the result of permeability tests. Our new GC assay of urine sugar probes permits the simultaneous quantitation of sucralose, sucrose, mannitol and lactulose, without interference with lactose and fructose. This assay is a rapid, simple, sensitive and reproducible method to accurately measure intestinal permeability.
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Affiliation(s)
- Ashkan Farhadi
- Department of Internal Medicine, Section of Gastroenterology and Nutrition, Rush University Medical Center, Chicago, IL 60612, USA.
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Drago S, El Asmar R, Di Pierro M, Grazia Clemente M, Tripathi A, Sapone A, Thakar M, Iacono G, Carroccio A, D'Agate C, Not T, Zampini L, Catassi C, Fasano A. Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Scand J Gastroenterol 2006; 41:408-19. [PMID: 16635908 DOI: 10.1080/00365520500235334] [Citation(s) in RCA: 317] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Little is known about the interaction of gliadin with intestinal epithelial cells and the mechanism(s) through which gliadin crosses the intestinal epithelial barrier. We investigated whether gliadin has any immediate effect on zonulin release and signaling. MATERIAL AND METHODS Both ex vivo human small intestines and intestinal cell monolayers were exposed to gliadin, and zonulin release and changes in paracellular permeability were monitored in the presence and absence of zonulin antagonism. Zonulin binding, cytoskeletal rearrangement, and zonula occludens-1 (ZO-1) redistribution were evaluated by immunofluorescence microscopy. Tight junction occludin and ZO-1 gene expression was evaluated by real-time polymerase chain reaction (PCR). RESULTS When exposed to gliadin, zonulin receptor-positive IEC6 and Caco2 cells released zonulin in the cell medium with subsequent zonulin binding to the cell surface, rearrangement of the cell cytoskeleton, loss of occludin-ZO1 protein-protein interaction, and increased monolayer permeability. Pretreatment with the zonulin antagonist FZI/0 blocked these changes without affecting zonulin release. When exposed to luminal gliadin, intestinal biopsies from celiac patients in remission expressed a sustained luminal zonulin release and increase in intestinal permeability that was blocked by FZI/0 pretreatment. Conversely, biopsies from non-celiac patients demonstrated a limited, transient zonulin release which was paralleled by an increase in intestinal permeability that never reached the level of permeability seen in celiac disease (CD) tissues. Chronic gliadin exposure caused down-regulation of both ZO-1 and occludin gene expression. CONCLUSIONS Based on our results, we concluded that gliadin activates zonulin signaling irrespective of the genetic expression of autoimmunity, leading to increased intestinal permeability to macromolecules.
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Affiliation(s)
- Sandro Drago
- Mucosal Biology Research Center, Center for Celiac Research and Division of Pediatric Gastroenterology and Nutrition, University of Maryland, School of Medicine, Baltimore, MD 21201, USA
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15
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Galpin L, Manary MJ, Fleming K, Ou CN, Ashorn P, Shulman RJ. Effect of Lactobacillus GG on intestinal integrity in Malawian children at risk of tropical enteropathy. Am J Clin Nutr 2005; 82:1040-5. [PMID: 16280436 DOI: 10.1093/ajcn/82.5.1040] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Tropical enteropathy is an asymptomatic villous atrophy of the small bowel that is prevalent in the developing world and is associated with altered intestinal function and integrity. The histology of tropical enteropathy resembles that seen in small-bowel bacterial overgrowth. OBJECTIVE This study tested the hypothesis that treatment of 3-5-y-old Malawian children with the probiotic Lactobacillus GG would improve their intestinal function and integrity. DESIGN Clinically healthy children (n = 164) were enrolled in a placebo-controlled, randomized, double-blind trial. Intestinal function and integrity were measured by using the site-specific sugar-absorption test before and after 30 d of treatment with Lactobacillus GG or placebo. The primary outcomes were the ratios of urinary lactulose to mannitol (L:M) and of urinary sucrose to lactulose (S:L) excretion. RESULTS Of the 161 children who completed the study, 119 (73%) had tropical enteropathy on enrollment (L:M > 0.10). Children receiving Lactobacillus GG did not differ significantly from the placebo group in the excretion (in % of dose administered) of mannitol (mean +/- SD: 8.9 +/- 4.4 and 8.9 +/- 3.9, respectively), lactulose (0.31 +/- 0.20 and 0.33 +/- 0.23, respectively), or sucrose (0.078 +/- 0.058 and 0.082 +/- 0.075, respectively). L:M and S:L also did not differ significantly between the Lactobacillus and placebo groups (0.19 +/- 0.13 and 0.20 +/- 0.12, respectively, for L:M; 0.58 +/- 0.46 and 0.65 +/- 0.57, respectively, for S:L). CONCLUSION Administration of Lactobacillus GG for 30 d had no effect on the intestinal integrity of 3-5-y-old Malawian children.
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Affiliation(s)
- Lauren Galpin
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
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16
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Abazia C, Ferrara R, Corsaro MM, Barone G, Coccoli P, Parrilli G. Simultaneous gas-chromatographic measurement of rhamnose, lactulose and sucrose and their application in the testing gastrointestinal permeability. Clin Chim Acta 2003; 338:25-32. [PMID: 14637262 DOI: 10.1016/j.cccn.2003.07.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As it is important to test gastric and intestinal permeability simultaneously in gastrointestinal disorders such as Celiac disease, we developed a gas-chromatographic (GC) method to estimate rhamnose (L-rh), lactulose (Lacl) and sucrose (Suc) in urine. METHODS The method is based on the use of alditol acetate derivatives giving a lower number of GC peaks than reducing sugars do. Acetate derivatives are more stable and less expensive than GC silylates and keep the flame-detector cleaner. We checked the chemical stability of alditol acetates by verifying the reproducibility of the standard curve of a sugar derivative sample which had been stored for 2 months at -20 degrees C. RESULTS The calibration proved linear over the range 0.1-1 microg of sugar injected. Analytical sugar recovery was 88%+/-19.4% (mean+/-S.D.) for rhamnose, 105%+/-7.4% for sucrose and 102%+/-2.4% for lactulose. Mean within-day precision (CV) was 7.7% for rhamnose, 5.7% for sucrose and 1.9% for lactulose, and between-day (CV) was 6.7% for rhamnose, 3.9% for sucrose and 1.6% for lactulose. The rhamnose, lactulose and sucrose as the lactulose/rhamnose ratio clearly differentiated 25 healthy controls from 36 patients with active gluten-sensitive enteropathy. CONCLUSIONS A fast, reliable and cheap gas-chromatographic method is presented here to evaluate gastric and intestinal permeability.
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Affiliation(s)
- Cristiana Abazia
- Dipartimento di Medicina Clinica e Sperimentale, Università Federico II,Via S. Pansini, 5 80131 Naples, Italy
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17
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Kansagra K, Stoll B, Rognerud C, Niinikoski H, Ou CN, Harvey R, Burrin D. Total parenteral nutrition adversely affects gut barrier function in neonatal piglets. Am J Physiol Gastrointest Liver Physiol 2003; 285:G1162-70. [PMID: 12969831 DOI: 10.1152/ajpgi.00243.2003] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Sepsis is the most common morbidity in preterm infants, who often receive total parenteral nutrition (TPN). We hypothesized that gut barrier function is compromised in TPN-fed compared with enterally fed newborn piglets (ENT pigs). Colostrum-deprived newborn pigs were implanted with jugular venous and bladder catheters under general anesthesia. Pigs were either administered TPN (n = 15) or fed formula (ENT pigs, n = 15). After 6 days, pigs were gavaged a solution of mannitol, lactulose, and polyethylene glycol 4000 (PEG 4000) and urine was collected for 24 h. At 7 days, small bowel samples were assayed for myeloperoxidase activity, morphometry, and tight junction protein abundance. Intestinal contents and peripheral organ sites were cultured for bacteria. Urinary recovery (%dose) of mannitol (53 vs. 68) was lower, whereas that of lactulose (2.93 vs. 0.18) and PEG 4000 (12.78 vs. 0.96) were higher in TPN vs. ENT pigs, respectively (P < 0.05). Incidence of translocation was similar in TPN and ENT pigs. Myeloperoxidase activity was increased in TPN vs. ENT pigs in the jejunum (P < 0.001) and was weakly correlated with lactulose (R2 = 0.32) and PEG 4000 (R2 = 0.38) recovery. Goblet cell counts did not change, but intraepithelial lymphocyte numbers decreased with TPN. Only claudin-1 protein abundance was increased in the TPN group. We conclude that TPN is associated with impairment of neonatal gut barrier function as measured by permeability but not translocation.
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Affiliation(s)
- Ketan Kansagra
- Department of Pediatrics, Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, USA
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18
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Farhadi A, Keshavarzian A, Holmes EW, Fields J, Zhang L, Banan A. Gas chromatographic method for detection of urinary sucralose: application to the assessment of intestinal permeability. J Chromatogr B Analyt Technol Biomed Life Sci 2003; 784:145-54. [PMID: 12504193 DOI: 10.1016/s1570-0232(02)00787-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We developed a capillary column gas chromatography (CCGC) method for the measurement of urinary sucralose (S) and three other sugar probes including, sucrose, lactulose (L) and mannitol (M) for use in in vivo studies of intestinal permeability. We compared the capillary method with a packed column gas chromatography (PCGC) method. We also investigated a possible role for sucralose as a probe for the measurement of whole gut permeability. Sample preparation was rapid and simple. The above four sugars were detected precisely, without interference. We measured intestinal permeability using 5- and 24-h urine collections in 14 healthy volunteers. The metabolism of sugars was evaluated by incubating the intestinal bacteria with an iso-osmolar mixture of mannitol, lactulose and sucralose at 37 degrees C for 19 h. Sugar concentrations and the pH of the mixture were monitored. The use of the CCGC method improved the detection of sucralose as compared to PCGC. The average coefficient of variation decreased from 15% to 4%. It also increased the sensitivity of detection by 200-2000-fold. The GC assay was linear between sucralose concentrations of 0.2 and 40 g/l (r=1.000). Intestinal bacteria metabolized lactulose and acidified the media but did not metabolize sucralose or mannitol. The new method for the measurement of urinary sucralose permits the simultaneous quantitation of sucrose, mannitol and lactulose, and is rapid, simple, sensitive, accurate and reproducible. Because neither S nor M is metabolized by intestinal bacteria, and because only a tiny fraction of either sugar is absorbed, this pair of sugar probes appears to be available for absorption throughout the GI tract. Thus, the 24-h urinary concentrations of S and M, or the urinary S/M ratio following an oral dose of a sugar mixture, might be good markers for whole gut permeability.
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Affiliation(s)
- Ashkan Farhadi
- Department of Internal Medicine, Division of Digestive Diseases, Rush University Medical Center, 60612, Chicago, IL, USA.
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19
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Generoso M, De Rosa M, De Rosa R, De Magistris L, Secondulfo M, Fiandra R, Carratù R, Cartenì M. Cellobiose and lactulose coupled with mannitol and determined using ion-exchange chromatography with pulsed amperometric detection, are reliable probes for investigation of intestinal permeability. J Chromatogr B Analyt Technol Biomed Life Sci 2003; 783:349-57. [PMID: 12482477 DOI: 10.1016/s1570-0232(02)00766-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Lactulose/mannitol and cellobiose/mannitol tests are currently used in the investigation of intestinal permeability (IP) in many gastrointestinal diseases. The aim of this study was to produce a good technique for the determination and comparison of the above-mentioned sugar probes to overcome the problem caused by the presence of significant glycosuria in patients affected by particular metabolic disorders such as diabetes mellitus. Tests were performed in 25 healthy volunteers, using either cellobiose (Ce) (5 g) and mannitol (Ma) (2 g), or lactulose (La) (5 g) and mannitol (2 g), given as oral isosmolar loads. Sugars were recovered in urine collected for 5 h. Analysis was carried out by using anion-exchange chromatography (AEC) with pulsed amperometric detection (PAD). Baseline separation of the above carbohydrates was achieved within 13 min by using a Carbopac PA-100 column and linear gradient elution. Carbohydrate quantification was performed by an internal standard method. The calibration curve for each sugar is linear to 40 mM. The limit of sugar detection is 0.01 mM. Recovery of sugar probes is between 98.2 and 100%. The %La, %Ce, %Ma in urine were evaluated and their ratios (Ce/Ma and La/Ma) were calculated. No significant difference in IP parameters were shown (La/Ma to Ce/Ma 0.018+/-0.014 vs. 0.012+/-0.007; the attendant probability of the null hypothesis being P=0.0714). Ce/Ma and/or La/Ma tests result similarly reliable in the clinical investigation of IP and the described new method is also helpful in urine even with high glucose concentration, without any interference.
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Affiliation(s)
- Maddalena Generoso
- Department of Experimental Medicine, School of Medicine, Second University of Naples, Via De Crecchio 8, 80138, Naples, Italy.
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20
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Goodgame RW, Kimball K, Akram S, Ike E, Ou CN, Sutton F, Graham D. Randomized controlled trial of clarithromycin and ethambutol in the treatment of Crohn's disease. Aliment Pharmacol Ther 2001; 15:1861-6. [PMID: 11736715 DOI: 10.1046/j.1365-2036.2001.01099.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND A mycobacterial infection may be the cause of Crohn's disease in some patients. Measurement of intestinal permeability may identify Crohn's disease patients with a high likelihood of relapse and may quantify the severity of intestinal injury. AIM To assess the effect of 3 months of clarithromycin and ethambutol on the disease activity and intestinal permeability in patients with Crohn's disease at high risk of relapse. METHODS Patients with Crohn's disease, with a lactulose-mannitol permeability test above 0.03, were randomly assigned to receive either clarithromycin, 500 mg twice daily, and ethambutol, 15 mg/kg daily, or identically appearing placebo for 3 months in addition to their regular therapy. The Harvey-Bradshaw index and the lactulose-mannitol test were assessed in a blind fashion every 3 months for 12 months. RESULTS Thirty-one patients were randomized to receive either drugs (n=15) or placebo (n=16). The groups were similar in age, sex, duration of disease, location of disease, past complications and disease severity. Specifically, there was no difference between the drug or placebo groups in the mean Harvey-Bradshaw index (4.8 vs. 4.4), number with active disease (33% vs. 44%) and mean lactulose-mannitol test (0.06 vs. 0.10). During the 12-month follow-up period, there were no consistent, statistically significant differences in the mean Harvey-Bradshaw index or lactulose-mannitol test between treatment and placebo groups. Individual patients showed either improvement or worsening of these indices, but these were not related to study medication. Specifically, no 'cures' were noted with anti-mycobacterial treatment. CONCLUSIONS Three months of treatment with clarithromycin and ethambutol does not benefit Crohn's disease patients who are receiving standard medical therapy.
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Affiliation(s)
- R W Goodgame
- Department of Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA.
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21
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Uil JJ, van Elburg RM, Janssens PM, Mulder CJ, Heymans HS. Sensitivity of a hyperosmolar or "low"-osmolar test solution for sugar absorption in recognizing small intestinal mucosal damage in coeliac disease. Dig Liver Dis 2000; 32:195-200. [PMID: 10975768 DOI: 10.1016/s1590-8658(00)80820-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Reliability of differential sugar absorption tests is hampered by a lack of standardization of the content and osmolarity of the test solutions. We evaluated the effect of osmolarity of the test solution of the sugar absorption test on the 5 hour urine excretion of orally administered lactulose and mannitol. A group of 28 controls and 14 coeliacs, with villous atrophy grade II to IV, ingested a hyperosmolar sugar absorption test solution and a "low"-osmolar solution, respectively. After an overnight fast, each subject ingested hyperosmolar sugar absorption test solution (2 g mannitol, 5 g lactulose and 40 g sucrose/100 ml (around 1,560 mmol/l)). After two days, this procedure was repeated with low-osmolar solution (2 g mannitol and 5 g lactulose/100 ml (around 375 mmol/l). The influence of the sequence of the tests on the results had previously been excluded. All urine from the 5 h-period following ingestion of the test solution was collected. To calculate the low-osmolar solution ratio, samples were analysed for lactulose and mannitol concentrations by gas chromatography The sensitivity of hyperosmolar SAT solution and low-osmolar solution for the detection of mucosal abnormalities in coeliacs was 64% and 43%, respectively. In conclusion, a hyperosmolar solution discriminates better between normal and damaged mucosa of the small bowel such as villous atrophy due to a relative increase in permeability for lactulose.
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Affiliation(s)
- J J Uil
- Department of Gastroenterology, University Hospital, Utrecht, The Netherlands
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22
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Marsilio R, D’Antiga L, Zancan L, Dussini N, Zacchello F. Simultaneous HPLC determination with light-scattering detection of lactulose and mannitol in studies of intestinal permeability in pediatrics. Clin Chem 1998. [DOI: 10.1093/clinchem/44.8.1685] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract
We describe a new HPLC method for the simultaneous determination of lactulose and mannitol in urine, in which cation-exchange chromatography and evaporative light-scattering detection are used. The two sugars are orally administered for the estimation of intestinal permeability in children. Samples were purified by solid phase extraction on a C18 cartridge and subsequent addition of anion-exchange resin. Cellobiose may be used as an internal standard. The chromatographic separation was carried out in 16 min at a flow rate of 0.5 mL/min, using deionized water as the mobile phase. Within-run precision (CV) measured at three concentrations was 1.6–2.3% for lactulose and 1.0–1.9% for mannitol. Between-run CVs were 2.1–4.1% and 1.3–2.7% for lactulose and mannitol, respectively. Analytical recovery of both sugar probes was 97–101%. The detection limits (signal-to-noise ratio = 3) were 0.82 mg/L for lactulose and 0.65 mg/L for mannitol. The lactulose/mannitol ratio in control subjects was 0.024 ± 0.006; in patients with Crohn’s and coeliac diseases in active phase, the ratios were 0.200 ± 0.082 and 0.072 ± 0.025, respectively. The method is rapid, simple, and sensitive, and suitable for determination of intestinal permeability in children.
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Affiliation(s)
| | | | | | | | - Franco Zacchello
- Department of Pediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
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23
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Catassi C, Fabiani E, Rätsch IM, Coppa GV, Giorgi PL. Celiac disease in the general population: should we treat asymptomatic cases? J Pediatr Gastroenterol Nutr 1997; 24:S10-2; discussion S12-3. [PMID: 9161968 DOI: 10.1097/00005176-199700001-00004] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- C Catassi
- Department of Paediatrics, University of Ancona, Italy
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24
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25
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Abstract
STUDY OBJECTIVE To determine the digestion and absorption of lactose, a combination of lactose and glucose polymers, and glucose polymers alone in infants born at 28 to 42 weeks of gestation. DESIGN Each infant received the three carbohydrate solutions (85 gm/L concentration) in random order. SETTING Tertiary care urban children's hospital. INTERVENTIONS A double-lumen perfusion catheter was placed in the duodenum-jejunum. Absorption was defined as the disappearance of the carbohydrate and all its components (e.g., for lactose: galactose, glucose). MEASUREMENTS AND MAIN RESULTS Absorption of lactose was less than that of the lactose-glucose polymer combination and the glucose polymers alone. There was no relationship between lactose absorption and postnatal age, whereas absorption of the lactose-glucose polymer combination and the glucose polymers alone correlated with age. Lactose absorption was not related to the number of days that the infants received full-strength feedings or the total number of days of feeding before the study, whereas absorption of both the lactose-glucose polymer combination and the glucose polymers alone was related to both. Absorption of the three solutions was not related to gestational age or to the number of days before the initial feeding. Lactose absorption was greater in infants who received formula alone than in infants fed formula together with human milk. CONCLUSIONS Premature infants do not digest and absorb lactose as well as glucose polymers. However, lactose does not impair the absorption of glucose polymers. Lactose assimilation is not affected by maturation, but the type of diet may affect lactose digestion and absorption. In contrast, digestion and absorption of glucose polymers are related to both postnatal age and diet.
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Affiliation(s)
- R J Shulman
- U.S. Department of Agriculture/Agricultural Research Service (USDA/ARS) Children's Nutrition Research Center, Houston, TX, USA
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26
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Martínez-Augustin O, Boza JJ, Romera JM, Gil A. A rapid gas-liquid chromatography method for the determination of lactulose and mannitol in urine: clinical application in studies of intestinal permeability. Clin Biochem 1995; 28:401-5. [PMID: 8521594 DOI: 10.1016/0009-9120(95)00015-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The purpose of this study was to develop a gas-liquid chromatography method for the determination of the urinary excretion of two nonmetabolizable sugars (lactulose and mannitol) to estimate the intestinal permeability. METHODS Two internal standards (alpha-methyl-D-glucopyranosyde and sucrose) were added to the urine samples prior to derivatization with the aid of a solution of pyridine, [N, O-bis (trimethylsilyl)]-acetamide and chlorotrimethylsilan. Sample preparation was simpler and faster than in other previous methods and the four sugars were resolved within 27 min. RESULTS The inclusion of internal standards reduced the coefficient of variation from 9.44% to 4.78%. The method provided better sensitivity, range of analysis, and linearity than a previously published HPLC method reducing variances in the recovery of lactulose and mannitol added to urine. The clinical application of this method was tested in preterm infants fed human milk or cow's milk based formula and in breast fed term infants. CONCLUSION The method described here for the determination of urinary lactulose and mannitol is more rapid, simpler, and more accurate than other previously published methods.
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Affiliation(s)
- O Martínez-Augustin
- Department of Biochemistry and Molecular Biology, University of Granada, Spain
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27
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Goodgame RW, Kimball K, Ou CN, White AC, Genta RM, Lifschitz CH, Chappell CL. Intestinal function and injury in acquired immunodeficiency syndrome-related cryptosporidiosis. Gastroenterology 1995; 108:1075-82. [PMID: 7698574 DOI: 10.1016/0016-5085(95)90205-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIMS The pathogenesis of the diarrhea in acquired immunodeficiency syndrome (AIDS)-related cryptosporidiosis is not known. The hypothesis of this study was that the intestinal dysfunction and injury are related to the number of organisms infecting the intestinal mucosa. The aim of this study was to study the influence of intensity of infection on intestinal function and injury in AIDS-related cryptosporidiosis. METHODS In 16 patients with AIDS with intestinal Cryptosporidium infection, the intensity of infection was quantified by counting the total number of fecal oocysts excreted in 24 hours and by determining the percent of duodenal epithelium covered by organisms. Intestinal function was assessed by vitamin B12 absorption and serum D-xylose test. Intestinal injury was assessed by morphology of duodenal mucosa, differential urinary excretion of lactulose and mannitol, and fecal alpha 1-antitrypsin clearance. Measurements were repeated after treatment with paromomycin. RESULTS Vitamin B12 and D-xylose absorption negatively correlated with intensity of infection. Villus atrophy occurred only in patients with oocyst excretion of > 10(8) oocyst/24 hours. Lactulose/mannitol urinary excretion ratio showed a positive correlation with intensity of infection. Intestinal function and injury improved in patients whose oocyst counts were reduced by treatment with paromomycin. CONCLUSIONS Cryptosporidium infection in patients with AIDS causes malabsorption and intestinal injury in proportion to the number of organisms infecting the intestine.
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Affiliation(s)
- R W Goodgame
- Department of Medicine, Baylor College of Medicine, Houston, Texas
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Sørensen SH, Proud FJ, Adam A, Rutgers HC, Batt RM. A novel HPLC method for the simultaneous quantification of monosaccharides and disaccharides used in tests of intestinal function and permeability. Clin Chim Acta 1993; 221:115-25. [PMID: 8149629 DOI: 10.1016/0009-8981(93)90026-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The quantification of monosaccharides and disaccharides used as probes in intestinal function and permeability tests can be technically demanding, detracting from the value of this approach to the indirect assessment of intestinal damage. In this study, a procedure is described for the simultaneous quantification of rhamnose, lactulose, 3-O-methyl-D-glucose and xylose in urine by HPLC using an anion exchange column with pulsed amperometric detection. This method is relatively fast and simple to perform, requiring no pre-treatment of urine samples or post-column derivatization. Accuracy and precision of determinations are illustrated by analytical recoveries (mean percentage +/- S.D., CV., n = 30) for multiple batch analyses of a diluted urine sample containing 20 mg/l of rhamnose (100 +/- 6.8, 6.2%), lactulose (100 +/- 6.1, 5.5%), 3-O-methyl-D-glucose (98 +/- 5.9, 5.5%) and xylose (104 +/- 7.1, 6.5%). Linearity of standard curves indicated that the lower limit for accurate quantification was 0.1 mg/l for all four sugars. Urinary recoveries following oral administration of these sugars to control dogs were determined as a baseline for the investigation of intestinal damage in this species and comparison of chromatograms illustrated enhanced permeability in dogs with gluten-sensitive enteropathy.
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Affiliation(s)
- S H Sørensen
- Department of Small Animal Medicine and Surgery, Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
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Sanghi S, Kok W, Koomen G, Hoek F. Determination of inert sugars in urine by liquid chromatography with pulsed amperometric detection. Anal Chim Acta 1993. [DOI: 10.1016/0003-2670(93)80189-r] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Catassi C, Natalini G, Rätsch IM, Gabrielli O, Coppa GV, Giorgi PL. Documented latent coeliac disease in a child with insulin-dependent diabetes mellitus. Eur J Pediatr 1991; 150:832-4. [PMID: 1743213 DOI: 10.1007/bf01955001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The histological development of coeliac disease has been documented in a child with insulin-dependent diabetes mellitus (IDDM). Serum antigliadin IgG was temporarily present at the onset of IDDM. It is assumed that IDDM may exert a trigger effect on the development of coeliac disease.
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Affiliation(s)
- C Catassi
- Department of Paediatrics, University of Ancona, Italy
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