1
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Heuvelings DJI, Wintjens AGWE, Jongen ACHM, Gielen MJCAM, Lenaerts K, Fransen PPKH, Gijbels MJ, van Almen GC, Dankers PYW, de Hingh IHJT, Bouvy ND. Evaluation of the Effect of an Intraperitoneal Cytostatic-Loaded Supramolecular Hydrogel on Intestinal Anastomotic Healing in an Animal Model. Life (Basel) 2023; 13:2076. [PMID: 37895458 PMCID: PMC10608244 DOI: 10.3390/life13102076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
The prognosis of colorectal cancer patients with peritoneal metastases is very poor. Intraperitoneal drug delivery systems, like supramolecular hydrogels, are being developed to improve local delivery and intraperitoneal residence time of a cytostatic such as mitomycin C (MMC). In this study, we evaluate the effect of intraperitoneal hydrogel administration on anastomotic healing. Forty-two healthy Wistar rats received a colonic end-to-end anastomosis, after which 6 animals received an intraperitoneal injection with saline, 18 with unloaded hydrogel and 18 with MMC-loaded hydrogel. After 7 days, animals were euthanized, and the anastomotic adhesion and leakage score were measured as primary outcome. Secondary outcomes were bursting pressure, histological anastomosis evaluation and body weight changes. Twenty-two rats completed the follow-up period (saline: n = 6, unloaded hydrogel: n = 10, MMC-loaded hydrogel: n = 6) and were included in the analysis. A trend towards significance was found for anastomotic leakage score between the rats receiving saline and unloaded hydrogel after multiple-comparison correction (p = 0.020, α = 0.0167). No significant differences were found for all other outcomes. The main reason for drop-out in this study was intestinal blood loss. Although the preliminary results suggest that MMC-loaded or unloaded hydrogel does not influence anastomotic healing, the intestinal blood loss observed in a considerable number of animals receiving unloaded and MMC-loaded hydrogel implies that the injection of the hydrogel under the studied conditions is not safe in the current rodent model and warrants further optimalisation of the hydrogel.
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Affiliation(s)
- Danique J. I. Heuvelings
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of General Surgery, Maastricht University Medical Center (MUMC+), 6202 AZ Maastricht, The Netherlands
| | - Anne G. W. E. Wintjens
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of General Surgery, Maastricht University Medical Center (MUMC+), 6202 AZ Maastricht, The Netherlands
| | | | - Maurits J. C. A. M. Gielen
- Department of General Surgery, Maastricht University Medical Center (MUMC+), 6202 AZ Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Kaatje Lenaerts
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of General Surgery, Maastricht University Medical Center (MUMC+), 6202 AZ Maastricht, The Netherlands
| | | | - Marion J. Gijbels
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Pathology, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Infection and Immunity, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | | | - Patricia Y. W. Dankers
- Institute for Complex Molecular Systems, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
- Department of Biomedical Engineering, Laboratory of Chemical Biology, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
- Department of Chemical Engineering & Chemistry, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Ignace H. J. T. de Hingh
- Department of General Surgery, Catharina Ziekenhuis, 5623 EJ Eindhoven, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Nicole D. Bouvy
- Department of General Surgery, Maastricht University Medical Center (MUMC+), 6202 AZ Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, 6229 ER Maastricht, The Netherlands
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van Helsdingen CPM, Wildeboer ACL, Zafeiropoulou K, Jongen ACHM, Bosmans JWAM, Gallé C, Hakvoort TBM, Gijbels MJJ, de Jonge WJ, Bouvy ND, Li Yim AYF, Derikx JPM. Histology and transcriptome insights into the early processes of intestinal anastomotic healing: a rat model. BJS Open 2023; 7:zrad099. [PMID: 37855751 PMCID: PMC10586197 DOI: 10.1093/bjsopen/zrad099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/24/2023] [Accepted: 08/22/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Understanding the early processes underlying intestinal anastomotic healing is crucial to comprehend the pathophysiology of anastomotic leakage. The aim of this study was to assess normal intestinal anastomotic healing and disturbed healing in rats to investigate morphological, cellular and intrinsic molecular changes in the anastomotic tissue. METHOD Anastomoses were created in two groups of Wistar rats, using four sutures or 12 sutures to mimic anastomotic leakage and anastomotic healing respectively. At 6, 12, 24 hours and 2, 3, 5 and 7 days, anastomotic tissue was assessed macroscopically using the anastomotic complication score and histologically using the modified Ehrlich-Hunt score. Transcriptome analysis was performed to assess differences between anastomotic leakage and anastomotic healing at the first three time points to find affected genes and biological processes. RESULTS Ninety-eight rats were operated on (49 animals in the anastomotic leakage and 49 in the anastomotic healing group) and seven rats analysed at each time point. None of the animals with 12 sutures developed anastomotic leakage macroscopically, whereas 35 of the 49 animals with four sutures developed anastomotic leakage. Histological analysis showed increasing influx of inflammatory cells up to 3 days in anastomotic healing and up to 7 days in anastomotic leakage, and this increase was significantly higher in anastomotic leakage at 5 (P = 0.041) and 7 days (P = 0.003). Transcriptome analyses revealed large differences between anastomotic leakage and anastomotic healing at 6 and 24 hours, mainly driven by an overall downregulation of genes in anastomotic leakage. CONCLUSION Transcriptomic analyses revealed large differences between normal and disturbed healing at 6 hours after surgery, which might eventually serve as early-onset biomarkers for anastomotic leakage.
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Affiliation(s)
- Claire P M van Helsdingen
- Emma Children’s Hospital, Amsterdam UMC, location University of Amsterdam, Paediatric Surgery, Amsterdam, The Netherlands
- Amsterdan UMC, location University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Aurelia C L Wildeboer
- Emma Children’s Hospital, Amsterdam UMC, location University of Amsterdam, Paediatric Surgery, Amsterdam, The Netherlands
- GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Konstantina Zafeiropoulou
- Emma Children’s Hospital, Amsterdam UMC, location University of Amsterdam, Paediatric Surgery, Amsterdam, The Netherlands
- Amsterdan UMC, location University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Audrey C H M Jongen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joanna W A M Bosmans
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Camille Gallé
- Department of General Surgery, Maastricht University, Maastricht, The Netherlands
| | - Theodorus B M Hakvoort
- Amsterdan UMC, location University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Marion J J Gijbels
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Biochemistry, Amsterdam UMC, location University of Amsterdam, Experimental Vascular Biology, Amsterdam, The Netherlands
- Amsterdam Infection and Immunity, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Wouter J de Jonge
- Amsterdan UMC, location University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Department of Surgery, University of Bonn, Bonn, Germany
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andrew Y F Li Yim
- Emma Children’s Hospital, Amsterdam UMC, location University of Amsterdam, Paediatric Surgery, Amsterdam, The Netherlands
- Amsterdan UMC, location University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Department of Human Genetics, Amsterdam UMC, location University of Amsterdam, Genome Diagnostics Laboratory, Amsterdam, The Netherlands
| | - Joep P M Derikx
- Emma Children’s Hospital, Amsterdam UMC, location University of Amsterdam, Paediatric Surgery, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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van den Bos J, Jongen ACHM, Melenhorst J, Breukink SO, Lenaerts K, Schols RM, Bouvy ND, Stassen LPS. Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study. Surg Endosc 2019; 33:3766-3774. [PMID: 30710314 PMCID: PMC6795629 DOI: 10.1007/s00464-019-06673-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/17/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) might help reduce anastomotic leakage (AL) after colorectal surgery. This pilot study aims to analyze whether a relation exists between measured fluorescence intensity (FI) and postoperative inflammatory markers of AL, C-reactive protein (CRP), Intestinal fatty-acid binding protein (I-FABP), and calprotectin, to AL, in order to evaluate the potential of FI to objectively predict AL. METHODS Patients scheduled for anastomotic colorectal cancer surgery were eligible for inclusion in this prospective pilot study. During surgery, at three time points (after bowel devascularization; before actual transection; after completion of anastomosis) a bolus of 0.2 mg/kg ICG was administered intravenously for assessment of bowel perfusion. FI was scored in scale from 1 to 5 based on the operating surgeon's judgment (1 = no fluorescence visible, 5 = maximum fluorescent signal). The complete surgical procedure was digitally recorded. These recordings were used to measure FI postoperatively using OsiriX imaging software. Serum CRP, I-FABP, and calprotectin values were determined before surgery and on day 1, 3, and 5 postoperative; furthermore, the occurrence of AL was recorded. RESULTS Thirty patients (n = 19 males; mean age 67 years; mean BMI 27.2) undergoing either laparoscopic or robotic anastomotic colorectal surgery were included. Indication for surgery was rectal-(n = 10), rectosigmoid-(n = 2), sigmoid-(n = 10), or more proximal colon carcinomas (n = 8). Five patients (16.7%) developed AL (n = 2 (6.6%) grade C according to the definition of the International Study group of Rectal Cancer). In patients with AL, the maximum fluorescence score was given less often (P = 0.02) and a lower FI compared to background FI was measured at 1st assessment (P = 0.039). However, no relation between FI and postoperative inflammatory parameters could be found. CONCLUSION Both subjective and measured FI seem to be related to AL. In this study, no relation between FI and inflammatory serum markers could yet be found.
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Affiliation(s)
- Jacqueline van den Bos
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. .,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Audrey C H M Jongen
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Stéphanie O Breukink
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Kaatje Lenaerts
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Rutger M Schols
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
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Schuermans VNE, Li Z, Jongen ACHM, Wu Z, Shi J, Ji J, Bouvy ND. Pilot Study: Detection of Gastric Cancer From Exhaled Air Analyzed With an Electronic Nose in Chinese Patients. Surg Innov 2018; 25:429-434. [PMID: 29909757 PMCID: PMC6166235 DOI: 10.1177/1553350618781267] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of this pilot study is to investigate the ability of an electronic nose (e-nose) to distinguish malignant gastric histology from healthy controls in exhaled breath. In a period of 3 weeks, all preoperative gastric carcinoma (GC) patients (n = 16) in the Beijing Oncology Hospital were asked to participate in the study. The control group (n = 28) consisted of family members screened by endoscopy and healthy volunteers. The e-nose consists of 3 sensors with which volatile organic compounds in the exhaled air react. Real-time analysis takes place within the e-nose, and binary data are exported and interpreted by an artificial neuronal network. This is a self-learning computational system. The inclusion rate of the study was 100%. Baseline characteristics differed significantly only for age: the average age of the patient group was 57 years and that of the healthy control group 37 years (P value = .000). Weight loss was the only significant different symptom (P value = .040). A total of 16 patients and 28 controls were included; 13 proved to be true positive and 20 proved to be true negative. The receiver operating characteristic curve showed a sensitivity of 81% and a specificity of 71%, with an accuracy of 75%. These results give a positive predictive value of 62% and a negative predictive value of 87%. This pilot study shows that the e-nose has the capability of diagnosing GC based on exhaled air, with promising predictive values for a screening purpose.
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Affiliation(s)
| | - Ziyu Li
- 2 Beijing University Cancer Hospital & Institute, Beijing, China
| | - Audrey C H M Jongen
- 1 Maastricht University Medical Centre, Maastricht, Netherlands.,3 NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, Netherlands
| | - Zhouqiao Wu
- 2 Beijing University Cancer Hospital & Institute, Beijing, China
| | - Jinyao Shi
- 2 Beijing University Cancer Hospital & Institute, Beijing, China
| | - Jiafu Ji
- 2 Beijing University Cancer Hospital & Institute, Beijing, China
| | - Nicole D Bouvy
- 1 Maastricht University Medical Centre, Maastricht, Netherlands.,3 NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, Netherlands
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Bosmans JWAM, Jongen ACHM, Birchenough GMH, Nyström EEL, Gijbels MJJ, Derikx JPM, Bouvy ND, Hansson GC. Functional mucous layer and healing of proximal colonic anastomoses in an experimental model. Br J Surg 2017; 104:619-630. [PMID: 28195642 DOI: 10.1002/bjs.10456] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/14/2016] [Accepted: 11/09/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Anastomotic leakage (AL) is the most dreaded complication after colorectal surgery, causing high morbidity and mortality. Mucus is a first line of defence against external factors in the gastrointestinal tract. In this study, the structural mucus protein Muc2 was depleted in genetically engineered mice and the effect on healing of colonic anastomoses studied in an experimental model. METHODS Mice of different Muc2 genotypes were used in a proximal colonic AL model. Tissues were scored histologically for inflammation, bacterial translocation was determined by quantitative PCR of bacterial 16S ribosomal DNA, and epithelial cell damage was determined by assessing serum levels of intestinal fatty acid-binding protein. RESULTS Of 22 Muc2-deficient (Muc2-/- ) mice, 20 developed AL, compared with seven of 22 control animals (P < 0·001). Control mice showed normal healing, whereas Muc2-/- mice had more inflammation with less collagen deposition and neoangiogenesis. A tendency towards higher bacterial translocation was seen in mesenteric lymph nodes and spleen in Muc2-/- mice. Intestinal fatty acid-binding protein levels were significantly higher in Muc2-/- mice compared with controls (P = 0·011). CONCLUSION A functional mucous layer facilitates the healing of colonic anastomoses. Clinical relevance Colorectal anastomotic leakage remains the most dreaded complication after colorectal surgery. It is known that the aetiology of anastomotic leakage is multifactorial, and a role is suggested for the interaction between intraluminal content and mucosa. In this murine model of proximal colonic anastomotic leakage, the authors investigated the mucous layer at the intestinal mucosa, as the first line of defence, and found that a normal, functioning mucous layer is essential in the healing process of colonic anastomoses. Further research on anastomotic healing should focus on positively influencing the mucous layer to promote better postoperative recovery.
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Affiliation(s)
- J W A M Bosmans
- Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - A C H M Jongen
- Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - G M H Birchenough
- Department of Medical Biochemistry, University of Gothenburg, Gothenburg, Sweden
| | - E E L Nyström
- Department of Medical Biochemistry, University of Gothenburg, Gothenburg, Sweden
| | - M J J Gijbels
- Departments of Pathology and Molecular Genetics, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.,Experimental Vascular Biology, Department of Medical Biochemistry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J P M Derikx
- Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,Paediatric Surgical Centre Amsterdam, Emma Children's Hospital/VU University Medical Centre, Amsterdam, The Netherlands
| | - N D Bouvy
- Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - G C Hansson
- Department of Medical Biochemistry, University of Gothenburg, Gothenburg, Sweden
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Bosmans JWAM, Jongen ACHM, Boonen BTC, van Rijn S, Scognamiglio F, Stucchi L, Gijbels MJJ, Marsich E, Bouvy ND. Comparison of three different application routes of butyrate to improve colonic anastomotic strength in rats. Int J Colorectal Dis 2017; 32:305-313. [PMID: 27942836 PMCID: PMC5316396 DOI: 10.1007/s00384-016-2718-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Despite extensive research, anastomotic leakage (AL) remains one of the most dreaded complications after colorectal surgery. Since butyrate enemas are known to enhance anastomotic healing, several administration routes have been explored in this study. METHODS Three intraluminal approaches involving butyrate were investigated: (1) butyrin-elucidating patch, (2) a single injection of hyaluronan-butyrate (HA-But) prior to construction of the proximal anastomosis and (3) rectal hyaluronan-butyrate (HA-But) enemas designed for distal anastomoses. The main outcome was AL and secondary outcomes were bursting pressure, histological analysis of the anastomosis, zymography to detect MMP activity and qPCR for gene expression of MMP2, MMP9, MUC2 and TFF3. RESULTS Neither the patches nor the injections led to a reduction of AL in experiments 1 and 2. In experiment 3, a significant reduction of AL was accomplished with the (HA-But) enema compared to the control group together with a higher bursting pressure. Histological analysis detected only an increased inflammation in experiment 2 in the hyaluronan injection group compared to the control group. No other differences were found regarding wound healing. Zymography identified a decreased proenzyme of MMP9 when HA-But was administered as a rectal enema. qPCR did not show any significant differences between groups in any experiment. CONCLUSION Butyrate enemas are effective in the enhancement of colonic anastomosis. Enhanced butyrate-based approaches designed to reduce AL in animal models for both proximal and distal anastomoses were not more effective than were butyrate enemas alone. Further research should focus on how exogenous butyrate can improve anastomotic healing after gastrointestinal surgery.
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Affiliation(s)
- J W A M Bosmans
- Department of General Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands.
- NUTRIM School for Nutrition and Translation Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
| | - A C H M Jongen
- Department of General Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translation Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - B T C Boonen
- Department of General Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - S van Rijn
- Department of General Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translation Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - F Scognamiglio
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - L Stucchi
- SIGEA Srl, AREA Science Park, Trieste, Italy
| | - M J J Gijbels
- Departments of Pathology and Molecular Genetics, CARIM, Maastricht University, Maastricht, The Netherlands
- Department of Medical Biochemistry, Academic Medical Center, Maastricht, the Netherlands
| | - E Marsich
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - N D Bouvy
- Department of General Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translation Research in Metabolism, Maastricht University, Maastricht, the Netherlands
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Bosmans JWAM, Jongen ACHM, Bouvy ND, Derikx JPM. Colorectal anastomotic healing: why the biological processes that lead to anastomotic leakage should be revealed prior to conducting intervention studies. BMC Gastroenterol 2015; 15:180. [PMID: 26691961 PMCID: PMC4687306 DOI: 10.1186/s12876-015-0410-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/10/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Anastomotic leakage (AL) remains the most dreaded complication after colorectal surgery and causes high morbidity and mortality. The pathophysiology of AL remains unclear, despite numerous studies that have been conducted on animals and humans, probably due to the undetermined healing process of colorectal anastomoses. Increasing basic knowledge on this healing process may shed more light on causal factors of AL, and additionally reduce the quantity and accelerate the quality of experimental studies. In this debate article, our aim was to provide different perspectives on what is known about the colorectal healing process in relation to wound healing and AL. DISCUSSION Since knowledge on anastomotic healing is lacking, it remains difficult to conclude which factors are essential in preventing AL. This is essential information in the framework of humane animal research, where the focus should lie on Replacement, Reduction and Refinement (3Rs). While many researchers compare anastomotic healing with wound healing in the skin, there are substantial recognized differences, e.g. other collagen subtypes and different components involved. Based on our findings in literature as well as discussions with experts, we advocate stop considering anastomotic healing in the gastrointestinal tract and cutaneous healing as a similar process. Furthermore, intervention studies should at least address the anastomotic healing process in terms of histology and certain surrogate markers. Finally, the anastomotic healing process ought to be further elucidated - with modern techniques to achieve 3Rs in animal research--to provide starting points for potential interventions that can prevent AL.
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Affiliation(s)
- Joanna W A M Bosmans
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. .,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Audrey C H M Jongen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. .,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. .,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Joep P M Derikx
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands. .,Pediatric Surgical Center Amsterdam, Emma Children's Hospital AMC/VUMC, P.O.Box 22660, 1100 DD, Amsterdam, The Netherlands.
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