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You SH, Cho MY, Sohn JH, Lee CG. Pancreatic radiation effect in apoptosis-related rectal radiation toxicity. JOURNAL OF RADIATION RESEARCH 2018; 59:529-540. [PMID: 29901726 PMCID: PMC6151648 DOI: 10.1093/jrr/rry043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/19/2018] [Indexed: 06/08/2023]
Abstract
Pancreatic radiation effect (PRE) can be a component of gastrointestinal tract (GIT) radiotoxicity. This inter-organ correlation between the GIT and the pancreas was assessed through a rat model. Separate local irradiation to the abdomen and the pelvis was applied concurrently for 8-week-old male Sprague Dawley rats. Abdominal irradiation was categorized into pancreatic shield (PS) and non-pancreatic shield (NPS) irradiation. After 5 Gy and 15 Gy irradiation, the rectal mucosa was analyzed at the first week (early phase, Ep) and the 14th week (late phase, Lp). A slow gain in body weight was observed initially, particularly in the NPS group receiving a 15 Gy dose (P < 0.001). The large number of apoptotic bodies after 15 Gy at Ep decreased at Lp. At Ep for the 5-Gy group, the NPS group revealed more fibrotic change than the PS group (P = 0.002). Cleaved caspase-3 (CCP3) expression was greater at Lp, and the Ep-Lp increase was prominent in the NPS-15-Gy group (P = 0.010). At Lp, for 15 Gy irradiation, CCP3 was expressed more in the NPS group than in the PS group (P = 0.032). Despite no direct toxicity difference between the PS and NPS groups, small changes in parameters such as fibrosis or CCP3 expression suggest that pancreatic shielding does have an effect on the radiation response in the rectal mucosa, which suggests a need for a multi-organ effect-based approach in GIT radiotoxicity assessment.
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Affiliation(s)
- Sei Hwan You
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
- Department of Radiation Oncology, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Republic of Korea
| | - Mee Yon Cho
- Department of Pathology, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Republic of Korea
| | - Joon Hyung Sohn
- Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Republic of Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
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Commentary for JCF review “Drug induced complications; can we do more?” J Cyst Fibros 2013 Dec;12(6):547–58. J Cyst Fibros 2014; 13:485. [DOI: 10.1016/j.jcf.2014.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 02/02/2014] [Indexed: 11/19/2022]
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Infante Pina D, Redecillas Ferreiro S, Torrent Vernetta A, Segarra Cantón O, Maldonado Smith M, Gartner Tizziano L, Hidalgo Albert E. Optimización de la función intestinal en pacientes con fibrosis quística mediante la administración de probióticos. An Pediatr (Barc) 2008; 69:501-5. [DOI: 10.1016/s1695-4033(08)75231-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Qin X. Inactivation of digestive proteases: Another aspect of gut bacteria that should be taken into more consideration. World J Gastroenterol 2007; 13:2390-1. [PMID: 17511046 PMCID: PMC4147156 DOI: 10.3748/wjg.v13.i16.2390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Abstract
Fibrosing colonopathy is a serious bowel disorder which was first seen in 1991 in patients with cystic fibrosis treated with high doses of pancreatic enzyme supplements. Epidemiological evidence from two case-control studies, temporal data and direct experimental evidence support the conclusion that there is a causal relationship between the disease and intake of high doses of the excipient, methacrylic acid copolymer, which is used to coat certain brands of pancreatic enzyme. A high intake of lipase, the active ingredient in pancreatic enzymes, is not a risk factor for fibrosing colonopathy in the absence of methacrylic acid copolymer. Excipients may be toxic if used in new patient populations such as children and in doses exceeding the safe levels predicted by animal toxicology.
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Affiliation(s)
- P Prescott
- Faculty of Mathematical Studies, The University of Southampton, Southampton SO17 1BJ, UK.
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Serban DE, Florescu P, Miu N. Fibrosing colonopathy revealing cystic fibrosis in a neonate before any pancreatic enzyme supplementation. J Pediatr Gastroenterol Nutr 2002; 35:356-9. [PMID: 12352527 DOI: 10.1097/00005176-200209000-00022] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although its pathogenesis remains still unknown, fibrosing colonopathy (FCP) is considered to be the result of prolonged treatment by high doses of pancreatic enzyme preparations, in a small proportion of patients who present with cystic fibrosis (CF). We present the case of a newborn with meconium ileus (treated by conservative measures), in which, at the age of 3 weeks, the features of intestinal obstruction made necessary the removal of 15 cm of the proximal large intestine. Macroscopical and especially microscopical appearances typical for FCP were found, despite the absence of any enzymatic treatment. These findings raised the suspicion of CF, which was confirmed 4 weeks later at necropsy by the presence of characteristic pancreatic lesions. This case and another similar report in the literature suggest that the mechanism of FCP must be linked with the disease itself, at least in some patients. Thus, for us, FCP is not a "closed subject" and we sustain the importance of continuing studies, which will shed light on its etiopathogenesis.
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Hendriks HJ, van Kreel B, Forget PP. Effects of therapy with lansoprazole on intestinal permeability and inflammation in young cystic fibrosis patients. J Pediatr Gastroenterol Nutr 2001; 33:260-5. [PMID: 11593119 DOI: 10.1097/00005176-200109000-00006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Defective pancreatic bicarbonate secretion with low intestinal pH or intestinal inflammation of any origin increase intestinal permeability in cystic fibrosis (CF). METHODS In this open study, the authors evaluated the effect of a proton-pump inhibitor on intestinal permeability and inflammation in 14 young, pancreatic-insufficient CF patients. Permeability was measured by a three-sugar permeability test before and after 1 year of lansoprazole use, and urinary nitric oxide (NO) oxidation products were assessed before and during that year as a marker of inflammation. RESULTS After 1 year of lansoprazole use, median urinary recovery percentages changed from 2.5% to 1.7% (P = 0.064), from 24.9% to 24.5% (no significance), and from 10.5% to 11.1% (no significance) for lactulose, mannitol, and L-rhamnose, respectively. Despite the fact that the median urinary excretion ratios decreased from 0.108 to 0.083 (P = 0.03) and from 0.246 to 0.176 (P = 0.016) for lactulose and mannitol and for lactulose and rhamnose, respectively, they both remained increased. Median urinary NO products-to-creatinine ratios were 0.287 for CF patients before lansoprazole and 0.130 for healthy control participants (P = 0.002). Although there was a tendency toward a decrease in the NO products-to-creatinine ratio during treatment, this was not significant at the end point. CONCLUSIONS Intestinal permeability is considerably increased in CF patients and is partly corrected after the use of a proton-pump inhibitor for 1 year, which may point to a harmful effect of the acid luminal contents on the tight junctional related paracellular permeability pathway. The start and end values for the NO products-to-creatinine ratio in CF patients were not significantly different, but were considerably increased when compared with control participants (P = 0.002).
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Affiliation(s)
- H J Hendriks
- Department of Paediatrics, University Hospital of Maastricht, Maastricht, The Netherlands.
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Lloyd-Still JD, Beno DW, Uhing MR, Jiyamapa-Serna VA, Kimura RE. Ursodeoxycholic acid ameliorates ibuprofen-induced enteropathy in the rat. J Pediatr Gastroenterol Nutr 2001; 32:270-3. [PMID: 11345174 DOI: 10.1097/00005176-200103000-00007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The objective of the study was to determine whether ursodeoxycholic acid (Ursodiol) is protective against ibuprofen (IBU)-induced enteropathy. METHODS Using the chronically catheterized rat model, IBU (60 mg/kg body weight per day) was infused via the gastric catheter twice daily. Pancreatic enzyme (PE; 10,000 U lipase/kg body weight per day) and Ursodiol (10 mg/kg body weight per day) in two doses were infused via the duodenal catheter. Rats were assigned to one of six treatment groups and were administered treatment for 20 days: control, IBU, PE, IBU + PE, IBU + Ursodiol, and IBU + PE + Ursodiol. The entire jejunum, ileum, cecum, and colon were available for histologic analysis using previously described techniques. RESULTS Addition of Ursodiol to high-dose IBU and normal doses of PE showed a significant reduction in the percentage of rats with ulcers (P < 0.05), total number of serositis events (P < 0.01), total number of severe ulcers (P < 0.001), and an absence of ulcers in the large intestine. CONCLUSIONS Ursodiol, the drug of choice for the treatment of cystic fibrosis liver disease, may offer a safe method of using high-dose IBU in these patients by ameliorating the enteropathy.
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Affiliation(s)
- J D Lloyd-Still
- Department of Pediatrics, Rush Medical College, Chicago, Illinois, USA
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Wang J, Zheng H, Sung CC, Hauer-Jensen M. The synthetic somatostatin analogue, octreotide, ameliorates acute and delayed intestinal radiation injury. Int J Radiat Oncol Biol Phys 1999; 45:1289-96. [PMID: 10613325 DOI: 10.1016/s0360-3016(99)00293-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Reducing intraluminal proteolytic activity attenuates intestinal radiation toxicity. This study assessed whether pharmacological inhibition of exocrine pancreatic secretion protects against early and delayed radiation enteropathy in a preclinical rat model. METHODS AND MATERIALS Rat ileum was sham-irradiated or exposed to 16 once-daily 4.2 Gy fractions of X-radiation. Vehicle or somatostatin analogue (octreotide, 2 microg/kg/hr) were administered from 2 days prior to 10 days after the end of irradiation. Mucosal injury was monitored noninvasively by assessment of granulocyte transmigration. Radiation injury was assessed at 2 weeks (early phase) and 26 weeks (chronic phase) using quantitative histopathology, immunohistochemistry, and morphometry. RESULTS Octreotide decreased granulocyte transmigration (p<0.0006), reduced accumulation of myeloperoxidase-positive cells at 2 weeks (p = 0.0002), attenuated structural injury at 2 weeks (p = 0.04) and 26 weeks (p = 0.02), preserved mucosal surface area at 2 weeks (p = 0.0008) and 26 weeks p = 0.0008), and reduced intestinal wall thickening at 26 weeks (p = 0.002). Octreotide did not affect granulocyte transmigration, histology, or mucosal surface area in sham-irradiated controls. CONCLUSION These results demonstrate the importance of consequential mechanisms in the pathogenesis of chronic radiation enteropathy. Short-term octreotide administration ameliorates acute radiation-induced mucosal injury, as well as chronic structural changes, and should be subject to further preclinical and clinical testing.
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Affiliation(s)
- J Wang
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
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Kimura RE, Dy SA, Uhing MR, Beno DW, Jiyamapa VA, Lloyd-Still JD. The effects of high-dose ibuprofen and pancreatic enzymes on the intestine of the rat. J Pediatr Gastroenterol Nutr 1999; 29:178-83. [PMID: 10435655 DOI: 10.1097/00005176-199908000-00014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND High-dose ibuprofen therapy limits the progression of lung disease in patients with cystic fibrosis. However, ibuprofen increases intestinal permeability, which potentiates intestinal damage caused by high-dose pancreatic enzyme treatment, as was shown in a previous study by this group. In the present study, the combined effects of ibuprofen and pancreatic enzyme treatment on the intestine and liver were examined. METHODS Using a chronically catheterized rat model, high-dose ibuprofen (60 mg/kg x day in two doses), with or without pancreatic enzyme treatment was infused into gastric and duodenal catheters, respectively, for 20 days. Six groups were studied: control group; ibuprofen treatment alone; pancreatic enzyme treatment alone (two groups: normal dose, 10,000 U lipase/kg x day and high dose, 40,000 U lipase/kg x day); and ibuprofen combined with pancreatic enzyme (two groups: ibuprofen with high-dose pancreatic enzyme and ibuprofen and low-dose pancreatic enzyme). After treatment, rats were autopsied, and complete histologic analyses of the entire intestine and liver were performed. RESULTS Ibuprofen caused mild ulceration of the small intestine in 50% of rats. Pancreatic enzyme treatment alone did not induce ulceration of the intestine. The combination of pancreatic enzyme and ibuprofen treatment increased the severity of the ulcers in the small intestine but not the number of ulcers or the percentage of rats affected. Ibuprofen treatment alone did not cause ulcers in the large intestine, but with the addition of pancreatic enzymes, ulceration and fibrosis were present. CONCLUSIONS Ibuprofen at doses used to limit progression of cystic fibrosis lung disease caused enteropathy in 50% of rats. There was synergism between ibuprofen and pancreatic enzyme treatment in the production of severe ulcers. Ulcers in the cecum and colon were increased with combined ibuprofen and pancreatic enzyme treatment compared with incidence in control animals.
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Affiliation(s)
- R E Kimura
- Department of Pediatrics, Rush Medical College, Chicago, Illinois, USA
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Abstract
An epidemic of fibrosing colonopathy, a new disease caused by the prolonged administration of excessive doses of pancreatic enzymes, was first reported in 1994. More than 60 cases were known to occur worldwide before dosage guidelines were enforced. Predisposing factors were young age, previous intestinal surgery, meconium ileus equivalent, and use of H2 blockers, corticosteroids, and DNase. Abnormal features included foreshortened colon, strictures, marked submucosal fibrosis, ascites, and nodular hyperplasia of the liver. Histologic examination showed eosinophilia, mild cryptitis, epithelial regeneration, and widespread interruption of the muscularis mucosa. These findings are distinct from, but share many of the features of, those of Crohn's's disease and ischemic bowel disease. The pathogenic mechanisms remain unknown.
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Affiliation(s)
- J D Lloyd-Still
- Rush Medical College, Department of Gastroenterology and Nutrition, Rush Presbyterian-St. Lukes Medical Center, 1725 Harrison Street, Chicago, IL 60612, USA
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Lewis TC, Casey SC, Kapur RP. Clinical pathologic correlation: A 3-year-old boy with cystic fibrosis and intestinal obstruction. J Pediatr 1999; 134:514-9. [PMID: 10190932 DOI: 10.1016/s0022-3476(99)70215-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- T C Lewis
- Department of Pediatrics, Division of Pulmonary Medicine, University of Washington School of Medicine, Seattle, USA
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