13C-acetic acid is more sensitive than 13C-octanoic acid for evaluating gastric emptying of liquid enteral nutrient formula by breath test in conscious rats

High temporal resolution gastric emptying breath tests in mice

BACKGROUND

Gastric emptying is a complex physiological process regulating the division of a meal into smaller partitions for the small intestine. Disrupted gastric emptying contributes to digestive disease, yet current measures may not reflect different mechanisms by which the process can be altered.

METHODS

We have developed high temporal resolution solid and liquid gastric emptying breath tests in mice using [13 C]-octanoic acid and off axis- integrated cavity output spectroscopy (OA-ICOS). Stretched gamma variate and 2-component stretched gamma variate models fit measured breath excretion data.

KEY RESULTS

These assays detect acceleration and delay using pharmacological (7.5 mg/kg atropine) or physiological (nutrients, cold exposure stress, diabetes) manipulations and remain stable over time. High temporal resolution resolved complex excretion curves with 2 components, which was more prevalent in mice with delayed gastric emptying following streptozotocin-induced diabetes. There were differences in the gastric emptying of Balb/c vs C57Bl6 mice, with slower gastric emptying and a greater occurrence of two-phase gastric emptying curves in the latter strain. Gastric emptying of C57Bl6 could be accelerated by halving the meal size, but with no effect on the occurrence of two-phase gastric emptying curves. A greater proportion of two-phase gastric emptying was induced in Balb/c mice with the administration of PYY (8-80 nmol) 60 min following meal ingestion.

CONCLUSIONS AND INFERENCES

Collectively, these results demonstrate the utility of high temporal resolution gastric emptying assays. Two-phase gastric emptying is more prevalent than previously reported, likely involves intestinal feedback, but contributes little to the overall rate of gastric emptying.

Update on diagnostic value of breath test in gastrointestinal and liver diseases

In the field of gastroenterology, breath tests (BTs) are used intermittently as diagnostic tools that allow indirect, non-invasive and relatively less cumbersome evaluation of several disorders by simply quantifying the appearance in exhaled breath of a metabolite of a specific substrate administered. The aim of this review is to have an insight into the principles, methods of analysis and performance parameters of various hydrogen, methane and carbon BTs which are available for diagnosing gastrointestinal disorders such as Helicobacter pylori infection, small intestinal bacterial overgrowth, and carbohydrate malabsorption. Evaluation of gastric emptying is routinely performed by scintigraphy which is however, difficult to perform and not suitable for children and pregnant women, this review has abridged the 13C-octanoic acid test in comparison to scintigraphy and has emphasized on its working protocol and challenges. A new development such as electronic nose test is also highlighted. Moreover we have also explored the limitations and constraints restraining the wide use of these BT. We conclude that breath testing has an enormous potential to be used as a diagnostic modality. In addition it offers distinct advantages over the traditional invasive methods commonly employed.

A novel suspension formulation enhances intestinal absorption of macromolecules via transient and reversible transport mechanisms

PURPOSE

Medium chain fatty acid salts promote absorption by increasing paracellular permeability of the intestinal epithelium. Novel oily suspension (OS) formulation disperses a powder containing sodium caprylate and macromolecules such as octreotide or fluorescent dextran (FD). Formulation safety, macromolecule absorption and pharmacokinetic (PK)/pharmacodynamic (PD) were evaluated.

METHODS

Octreotide/OS toxicity was evaluated in monkeys following 9 months of daily oral enteric-coated capsule administration. The OS permeation effect was also assessed in rats, using FD/OS and octreotide/OS preparations. Octreotide/OS effects on circulating growth hormone (GH) levels were also measured.

RESULTS

Safety assessment of octreotide/OS in monkeys after 9 months showed minor drug-related findings, comparable to the injectable octreotide. Octreotide exposure levels were similar across the treatment periods. In rats, OS facilitated FD permeation up to 70 kDa in a reversible, spatial and dose-dependent manner, independent of the intestinal dosing site. Following OS administration, the staining pattern of the tight-junction protein, ZO-1, changed transiently, and a paracellular penetration marker, LC-biotin, permeated between adjacent epithelial cells. Enteral octreotide/OS absorption was dose-dependent and suppressed rat GH levels.

CONCLUSIONS

Oral octreotide/OS dosing was shown to be safe in monkeys. OS enhances intestinal absorption of active octreotide, likely by transient alteration of the tight junction protein complex.

Simultaneous measurement of gastric emptying and gastrocecal transit times in conscious rats using a breath test after ingestion of [1-13C] acetic acid and lactose-[13C] ureide

This study reports a method for the evaluation of both gastric emptying and gastrocecal transit times in rats simultaneously by using the same breath testing system measuring equipment. Male rats were used after fasting. Gastric emptying and gastrocecal transit time were evaluated by using [1-13C] acetic acid (8 mg/kg) and lactose-[13C] ureide (60 mg/kg), respectively. A mixture of both 13C-labelled compounds dissolved in Racol (liquid nutrient formula) was administered orally. The level of 13CO2 in the expired air was measured using an infrared spectrometer at appropriate intervals for a period of 420 min. The level of 13CO2 in the expired air from [1-13C] acetic acid increased with time and peaked at about 30 min before decreasing, while that from lactose-[13C] ureide increased after about 180 min. The time taken to reach the maximum value of gastric emptying (Tmax) was 27.5±0.9 min. Gastrocecal transit time was 180±11.5 min, which was calculated as the time before the 13CO2 value increased again. These results accorded with the results of gastric emptying and gastrocecal transit time evaluated by using each 13C-labelled compound separately. These results demonstrate that this method is useful for the simultaneous evaluation of gastric emptying and gastrocecal transit times in rats.

A new gastric-emptying mouse model based on in vivo non-invasive bioluminescence imaging

BACKGROUND

Different techniques were used to assess gastric emptying (GE) in small animals; most of them require sophisticated equipment, animal sacrifice and are expensive. In the present investigation a simple, non-invasive method based on bioluminescence imaging (BLI) is reported to study GE, using light-emitting Escherichia coli cells as a marker of the gastric content.

METHODS

A new thermostable red-emitting luciferase was chosen as reporter gene to transform E. coli cells. Bioluminescent (BL) bacteria were administered to fasting mice, after a solid meal, and in response to different doses of metoclopramide (MET) and hyoscine butylbromide (HY). Bioluminescence imaging allowed to evaluate the real time 2D spatial and temporal distribution of bacteria along the gastrointestinal tract in animals and to calculate GE rate in basal conditions and following pharmacological stimulation.

KEY RESULTS

  The administered BL bacteria were easily imaged and localized in the stomach and subsequently followed in the duodenum and upper intestine allowing to accurately calculate GE. Gastric emptying after the test meal was significantly slower (T(1/2) 16 ± 3 min) than that obtained in fasting conditions (T(1/2) 2 ± 1 min); administration of HY (1 mg kg(-1) b.w.) significantly (P < 0.05) increased T(1/2) that was delayed up to 25 ± 4 min; MET (1 mg kg(-1) b.w.) significantly (P < 0.05) accelerated T(1/2), that was achieved within 8 ± 2 min.

CONCLUSION & INFERENCES

The reported model is simple, inexpensive, reliable, sensitive and accurate; it can detect both acceleration and slowdown of GE. The model is useful in the investigation of new drug-induced alterations of gastric motility allowing to reduce the number of experimental animals.

Gastric emptying of enterally administered liquid meal in conscious rats and during sustained anaesthesia

BACKGROUND

Gastric motility studies are frequently conducted with anaesthetized animal models. Some studies on the same animal species have reported differences in vagal control of the stomach that could not be explained solely by slightly different experimental conditions. A possible limitation in the comparison between similar studies relates to the use of different anaesthetic agents. Furthermore, anaesthetic effects may also limit generalizations between mechanistic studies of gastric function and the gastric function of conscious animals. In the present study, we used the [(13)C]-breath test following a liquid mixed-nutrient test meal (Ensure), 1 ml) with the aim to investigate the rate of gastric emptying in animals that were either conscious or anaesthetized with either Inactin or urethane.

METHODS

One week after determining the maximum (13)CO(2) concentration, time to peak [(13)C] recovery and gastric half emptying time in control, conscious rats, we repeated the experiment in the same rats anaesthetized with Inactin or urethane.

KEY RESULTS

Our data show that Inactin anaesthesia prolonged the time to peak [(13)C] recovery but did not significantly reduce the maximum (13)CO(2) concentration nor delay gastric half emptying time. Conversely, urethane anaesthesia resulted in a significant slowing of all parameters of gastric emptying as measured by the maximum (13)CO(2) concentration, time to peak [(13)C] recovery and half emptying time.

CONCLUSIONS & INFERENCES

Our data indicate that Inactin(R) anaesthesia does not significantly affect gastric emptying while urethane anaesthesia profoundly impairs gastric emptying. We suggest that Inactin(R), not urethane, is the more suitable anaesthetic for gastrointestinal research.

Effect of atropine sulfate on gastric emptying and gastrocecal transit time evaluated by using the [1-(13)C]acetic acid and lactose-[(13)C]ureide breath test in conscious rats

Breath tests have been used to investigate many physiological functions. Recently, we have developed a breath test system by using a non-invasive technique in conscious rats. In this study, we investigated the effect of atropine sulfate on the gastric emptying and gastrocecal transit time using [1-(13)C]acetic acid and lactose-[(13)C]ureide, respectively. Gastric emptying was significantly delayed by atropine sulfate in a dose-dependent manner (0.03-0.3 mg kg(-1)), but the effects of 0.1 and 0.3 mg kg(-1) were almost equal. C(max) and T(max) values were also significantly and dose-dependently decreased and delayed, respectively. However, AUC(120 min) values were not significantly different for the three doses of atropine sulfate. This suggests that although atropine sulfate slows the emptying of the gastric content, it is excreted eventually to the same content as the control. The gastrocecal transit time was significantly delayed by atropine sulfate at a dose of 1 mg kg(-1), but not at a dose of 0.1 mg kg(-1). These findings demonstrate that the breath tests can evaluate the effect of atropine sulfate on the gastric emptying and gastrocecal transit time. The effective dose of atropine sulfate may be different for gastric emptying and gastrocecal transit time.

Methods and functions: Breath tests

Breath tests provide a valuable non-invasive diagnostic strategy to in vivo assess a variety of enzyme activities, organ functions or transport processes. Both the hydrogen breath tests and the (13)C-breath tests using the stable isotope (13)C as tracer are non-radioactive and safe, also in children and pregnancy. Hydrogen breath tests are widely used in clinical practice to explore gastrointestinal disorders. They are applied for diagnosing carbohydrate malassimilation, small intestinal bacterial overgrowth and for measuring the orocecal transit time. (13)C-breath tests non-invasively monitor the metabolisation of a (13)C-labelled substrate. Depending on the choice of the substrate they enable the assessment of gastric bacterial Helicobacter pylori infection, gastric emptying, liver and pancreatic function as well as measurements of many other enzyme activities. The knowledge of potential pitfalls and influencing factors are important for correct interpretation of breath test results before drawing clinical conclusions.

The utility of noninvasive (13)C-acetate breath test using a new solid test meal to measure gastric emptying in mice

In clinical and experimental settings, the (13)C breath test is performed to measure gastric emptying and has advantages of noninvasiveness and repeatability. We intended to apply the (13)C breath test method to mice with an easy-to-handle solid test meal that is more physiological than liquid meals. Male ddY mice were trained to eat (13)C-acetate-containing pellets as the solid test meal. Thirty minutes after administration of metoclopramide (0.3-3 mg/kg, p.o.) or atropine sulfate (0.3-3 mg/kg, i.p.), mice received the test meal and were placed in chambers. The (13)CO(2) levels in the expired air were measured and the maximum concentration (C(max); per thousand) and the time to reach the maximum concentration (T(max); min) were determined. Metoclopramide significantly and dose-dependently increased C(max) and decreased T(max). On the other hand, atropine sulfate significantly and dose-dependently decreased C(max) and increased T(max). The (13)C-acetate breath test using a solid test meal is sensitive enough to detect both enhanced and delayed gastric emptying of the reference drugs.

Monosodium L-glutamate added to a high-energy, high-protein liquid diet promotes gastric emptying

BACKGROUND

Free glutamate activates taste receptors on nerves in the oral cavity to elicit a unique taste known as umami. Recently, umami taste receptors were also found in the gastric mucosa. Although reports suggest that mucosal receptors may respond to free glutamate to modulate gastric function, no evidence of any effect on gastric emptying has been documented.

OBJECTIVE

We hypothesized that glutamate may act as a modulator of gastric function. We studied the effects of L-glutamate enrichment of a protein-rich liquid meal, and similar enrichment of an equicaloric carbohydrate meal or noncaloric water, on gastric emptying.

DESIGN

Ten healthy men were enrolled. Nine of the 10 subjects included in the study ingested all test meals with and without monosodium L-glutamate (MSG), and the remaining subject ingested only the protein-rich meals with and without MSG. All experimental and control liquid meals included [1-(13)C]sodium acetate as a tracer. After a test meal or water was ingested, (13)C breath tests were performed to estimate gastric emptying.

RESULTS

MSG enrichment not only resulted in a significant decrease in the mathematically simulated half-excretion (emptying) time of a protein-rich meal, but also increased the area under the curve (%dose/h) significantly. In contrast, MSG had no significant effect on the gastric emptying of a carbohydrate meal or a noncaloric water meal.

CONCLUSIONS

Enrichment with MSG facilitated gastric emptying of a protein-rich meal exclusively, which suggests that free glutamate is important for protein digestion and may be helpful in the management of delayed gastric emptying.

Retention, fixation, and loss of the [13C] label: a review for the understanding of gastric emptying breath tests

A [13C]-breath test is a promising method for measuring gastric emptying. The methodological relevance is based on a close correspondence between gastric emptying of [13C]-acetate/octanoate (input) and pulmonary excretion of [13CO2] (output). Despite the close input-output correspondence, the pulmonary output is quite remote from the gastric input: the pulmonary output is delayed compared to the gastric input, and the total recovery of [13CO2] in the breath is incomplete. This review focuses on the kinetics of [13C]-acetate/octanoate in the body and suggests that (1) the delayed pulmonary output results from temporal retention of [13CO2] in the well-perfused tissues (heart, brain, etc.), (2) the incomplete recovery results from incorporation of the label into metabolic products (ketone bodies, amino acids, etc.) or from fixation of [13CO2] in the low-perfused tissues (bone, skeletal muscle, etc.), and (3) knowledge on the retention is the key to appropriate interpretations of breath test results. Recognition of these kinetic aspects is essential for appropriate interpretations of these breath test results.