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Hendriks S, Stokmans SC, Plas M, Buurman WA, Spoorenberg SLW, Wynia K, Heineman E, van Leeuwen BL, de Haan JJ. Compromised intestinal integrity in older adults during daily activities: a pilot study. BMC Geriatr 2021; 21:628. [PMID: 34736396 PMCID: PMC8567646 DOI: 10.1186/s12877-021-02573-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 10/22/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Malnutrition is a common and significant problem in older adults. Insight into factors underlying malnutrition is needed to develop strategies that can improve the nutritional status. Compromised intestinal integrity caused by gut wall hypoperfusion due to atherosclerosis of the mesenteric arteries in the aging gastrointestinal tract may adversely affect nutrient uptake. The presence of compromised intestinal integrity in older adults is not known. The aim of this study is to provide a proof-of-concept that intestinal integrity is compromised in older adults during daily activities. METHODS Adults aged ≥75 years living independently without previous gastrointestinal disease or abdominal surgery were asked to complete a standardized walking test and to consume a standardized meal directly afterwards to challenge the mesenteric blood flow. Intestinal fatty acid-binding protein (I-FABP) was measured as a plasma marker of intestinal integrity, in blood samples collected before (baseline) and after the walking test, directly after the meal, and every 15 min thereafter to 75 min postprandially. RESULTS Thirty-four participants (median age 81 years; 56% female) were included. Of the participants, 18% were malnourished (PG-SGA score ≥ 4), and 32% were at risk of malnutrition (PG-SGA score, 2 or 3). An I-FABP increase of ≥50% from baseline was considered a meaningful loss of intestinal integrity and was observed in 12 participants (35%; 8 females; median age 80 years). No significant differences were observed in either baseline characteristics, walking test scores, or calorie/macronutrient intake between the groups with and without a ≥ 50% I-FABP peak. CONCLUSION This study is first to indicate that intestinal integrity is compromised during daily activities in a considerable part of older adults living independently.
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Affiliation(s)
- Sharon Hendriks
- Department of Surgery, University Medical Center Groningen, 9713, GZ, Groningen, The Netherlands.
| | - Suzanne C Stokmans
- Department of Surgery, University Medical Center Groningen, 9713, GZ, Groningen, The Netherlands
| | - Matthijs Plas
- Department of Surgery, University Medical Center Groningen, 9713, GZ, Groningen, The Netherlands
| | - Wim A Buurman
- MHeNs School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sophie L W Spoorenberg
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaske Wynia
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik Heineman
- Department of Surgery, University Medical Center Groningen, 9713, GZ, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University Medical Center Groningen, 9713, GZ, Groningen, The Netherlands
| | - Jacco J de Haan
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
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2
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Hundscheid IHR, Schellekens DHSM, Grootjans J, Den Dulk M, Van Dam RM, Beets GL, Buurman WA, Lenaerts K, Derikx JPM, Dejong CHC. Evaluating the safety of two human experimental intestinal ischemia reperfusion models: A retrospective observational study. PLoS One 2021; 16:e0253506. [PMID: 34143845 PMCID: PMC8213171 DOI: 10.1371/journal.pone.0253506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background We developed a jejunal and colonic experimental human ischemia-reperfusion (IR) model to study pathophysiological intestinal IR mechanisms and potential new intestinal ischemia biomarkers. Our objective was to evaluate the safety of these IR models by comparing patients undergoing surgery with and without in vivo intestinal IR. Methods A retrospective study was performed comparing complication rates and severity, based on the Clavien-Dindo classification system, in patients undergoing pancreatoduodenectomy with (n = 10) and without (n = 20 matched controls) jejunal IR or colorectal surgery with (n = 10) and without (n = 20 matched controls) colon IR. Secondary outcome parameters were operative time, blood loss, 90-day mortality and length of hospital stay. Results Following pancreatic surgery, 63% of the patients experienced one or more postoperative complications. There was no significant difference in incidence or severity of complications between patients undergoing pancreatic surgery with (70%) or without (60%, P = 0.7) jejunal IR. Following colorectal surgery, 60% of the patients experienced one or more postoperative complication. Complication rate and severity were similar in patients with (50%) and without (65%, P = 0.46) colonic IR. Operative time, amount of blood loss, postoperative C-reactive protein, length of hospital stay or mortality were equal in both intervention and control groups for jejunal and colon IR. Conclusion This study showed that human experimental intestinal IR models are safe in patients undergoing pancreatic or colorectal surgery.
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Affiliation(s)
- Inca H. R. Hundscheid
- Department of Pathology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- * E-mail:
| | - Dirk H. S. M. Schellekens
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Joep Grootjans
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel Den Dulk
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Ronald M. Van Dam
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Geerard L. Beets
- Department of Surgery, The Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Wim A. Buurman
- MHeNs School for Mental Healthy and Neuroscience, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kaatje Lenaerts
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Joep P. M. Derikx
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Centre, University of Amsterdam, Free University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis H. C. Dejong
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Surgery, RWTH University Hospital Aachen, Aachen, Germany
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3
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Fraszczyk E, Luijten M, Spijkerman AMW, Snieder H, Wackers PFK, Bloks VW, Nicoletti CF, Nonino CB, Crujeiras AB, Buurman WA, Greve JW, Rensen SS, Wolffenbuttel BHR, van Vliet-Ostaptchouk JV. The effects of bariatric surgery on clinical profile, DNA methylation, and ageing in severely obese patients. Clin Epigenetics 2020; 12:14. [PMID: 31959221 PMCID: PMC6972025 DOI: 10.1186/s13148-019-0790-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Received: 10/01/2019] [Accepted: 11/27/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Severe obesity is a growing, worldwide burden and conventional therapies including radical change of diet and/or increased physical activity have limited results. Bariatric surgery has been proposed as an alternative therapy showing promising results. It leads to substantial weight loss and improvement of comorbidities such as type 2 diabetes. Increased adiposity is associated with changes in epigenetic profile, including DNA methylation. We investigated the effect of bariatric surgery on clinical profile, DNA methylation, and biological age estimated using Horvath's epigenetic clock. RESULTS To determine the impact of bariatric surgery and subsequent weight loss on clinical traits, a cohort of 40 severely obese individuals (BMI = 30-73 kg/m2) was examined at the time of surgery and at three follow-up visits, i.e., 3, 6, and 12 months after surgery. The majority of the individuals were women (65%) and the mean age at surgery was 45.1 ± 8.1 years. We observed a significant decrease over time in BMI, fasting glucose, HbA1c, HOMA-IR, insulin, total cholesterol, triglycerides, LDL and free fatty acids levels, and a significant small increase in HDL levels (all p values < 0.05). Epigenome-wide association analysis revealed 4857 differentially methylated CpG sites 12 months after surgery (at Bonferroni-corrected p value < 1.09 × 10-7). Including BMI change in the model decreased the number of significantly differentially methylated CpG sites by 51%. Gene set enrichment analysis identified overrepresentation of multiple processes including regulation of transcription, RNA metabolic, and biosynthetic processes in the cell. Bariatric surgery in severely obese patients resulted in a decrease in both biological age and epigenetic age acceleration (EAA) (mean = - 0.92, p value = 0.039). CONCLUSIONS Our study shows that bariatric surgery leads to substantial BMI decrease and improvement of clinical outcomes observed 12 months after surgery. These changes explained part of the association between bariatric surgery and DNA methylation. We also observed a small, but significant improvement of biological age. These epigenetic changes may be modifiable by environmental lifestyle factors and could be used as potential biomarkers for obesity and in the future for obesity related comorbidities.
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Affiliation(s)
- Eliza Fraszczyk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mirjam Luijten
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Annemieke M W Spijkerman
- Centre for Nutrition, Prevention and Health services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul F K Wackers
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Vincent W Bloks
- Department of Pediatrics, section of Molecular Metabolism and Nutrition, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolina F Nicoletti
- Laboratory of Nutrigenomics Studies, Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Carla B Nonino
- Laboratory of Nutrigenomics Studies, Department of Health Sciences, Ribeirão Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Ana B Crujeiras
- Epigenomics in Endocrinology and Nutrition, Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago (CHUS/SERGAS) and Santiago de Compostela University (USC), Santiago de Compostela, Spain.,CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain
| | - Wim A Buurman
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jan Willem Greve
- Department of Surgery, Zuyderland Medical Center Heerlen, Dutch Obesity Clinic South, Heerlen, The Netherlands.,Department of Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Sander S Rensen
- Department of Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jana V van Vliet-Ostaptchouk
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,Genomics Coordination Center, Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.
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4
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Abstract
Tumor Necrosis Factor (TNF) is a multifunctional cytokine. It plays an important role in the pathophysiology of several diseases. Recently, it has been discovered that TNF is circulating in two different forms, a bioactive form and an immunologically detectable form. These two forms of TNF show different clearance kinetics. The immunological form is supposed to be an inactivated TNF protein. For this inactivation, proteolytic degradation or TNF binding by inactivating proteins is necessary. In this review we have focused on TNF inactivation by TNF binding proteins. Recent data show that there are soluble TNF receptors circulating which can bind and inactivate TNF. These receptors are membrane-bound TNF receptors which have been proteolytically cleaved from the cell membrane. Two TNF receptors are circulating, the soluble TNF receptor of 55 kDa (P55) and the receptor of 75 kDa (P75). The receptors are held responsible not only for inactivation of the TNF, but also for the clearance of TNF. Recent data show that the kidney is the most important organ for TNF clearance, followed by the liver. All other organs are of less importance. In this review, function, release, and clearance of TNF are discussed.
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Affiliation(s)
- M H A Bemelmans
- Department of Surgery, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - L J H van Tits
- Department of Surgery, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - W A Buurman
- Department of Surgery, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
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5
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Leenarts CA, Grootjans J, Hundscheid IH, Schellekens DH, Lenaerts K, Buurman WA, Dejong CH, Derikx JP. Histopathology of human small intestinal and colonic ischemia-reperfusion: Experiences from human IR-models. Histol Histopathol 2018; 34:711-722. [PMID: 30543383 DOI: 10.14670/hh-18-074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Intestinal ischemia-reperfusion (IR) injury is a frequent, but potentially life-threatening condition. Although much has been learned about its pathophysiology from animal IR models, the translation to the human setting is imperative for better understanding of its etiology. This could provide us with new insight into development of early detection and potential new therapeutic strategies. Over the past decade, we have studied the pathophysiology of human small intestinal and colonic ischemia-reperfusion (IR) in newly developed human in vivo IR models. In this review, we give an overview of new insights on the sequelae of human intestinal IR, with particular attention for the differences in histopathology between small intestinal and colonic IR.
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Affiliation(s)
- Claire Aji Leenarts
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Joep Grootjans
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Inca H Hundscheid
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Dirk Hsm Schellekens
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kaatje Lenaerts
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Wim A Buurman
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Cornelis Hc Dejong
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Joep Pm Derikx
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands.,Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU Medical Center, Amsterdam, the Netherlands
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6
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Bahrami S, Redl H, Buurman WA, Schlag G. Influence of the Xanthine Derivate HWA 138 on Endotoxin-Related Coagulation Disturbances: Effects in Non-Sensitized vs D-Galactosamine Sensitized Rats. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe have evaluated the effects of the xanthine derivate HWA 138 in rat endotoxemia in order to 1) prevent coagulation disturbances and other endotoxin-induced physiological abnormalities and 2) to reduce mortality. We performed two studies using two different models (sensitized vs non-sensitized rats) with a similar mortality but different severity of coagulation disturbances: a) LPS (15 mg/kg) alone or with HWA 138 (80 mg/kg) as a treatment modality 30 min pre LPS, b) galactosamine (500 mg/ kg) simultaneously with LPS (100 µg/kg) with or without HWA 138 (80 mg/kg) pretreatment. Experiments c) and d) employed D-galactosamine and/or LPS similar to experiments a) and b), while HWA 138 was applied simultaneously. We found significant 1) amelioration of life-threatening coagulation disturbances in non-sensitized rats, 2) prevention of liver dysfunction in sensitized rats, 3) reduction of TNF formation in both models, and 4) improvement of survival in all groups receiving HWA 138. Our data indicate protective effects of HWA 138 against clotting disturbances either directly via reduced LPS-induced formation of procoagulant activity or indirectly via reduced TNF formation.
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Affiliation(s)
- Soheyl Bahrami
- The Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - H Redl
- The Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - W A Buurman
- The Department of Surgery, University of Limburg, Maastricht, The Netherlands
| | - G Schlag
- The Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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7
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Schellekens DHSM, Hundscheid IHR, Leenarts CAJI, Grootjans J, Lenaerts K, Buurman WA, Dejong CHC, Derikx JPM. Human small intestine is capable of restoring barrier function after short ischemic periods. World J Gastroenterol 2017; 23:8452-8464. [PMID: 29358855 PMCID: PMC5752707 DOI: 10.3748/wjg.v23.i48.8452] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/08/2017] [Accepted: 08/15/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess intestinal barrier function during human intestinal ischemia and reperfusion (IR).
METHODS In a human experimental model, 6 cm of jejunum was selectively exposed to 30 min of ischemia (I) followed by 30 and 120 min of reperfusion (R). A sham procedure was also performed. Blood and tissue was sampled at all-time points. Functional barrier function was assessed using dual-sugar absorption tests with lactulose (L) and rhamnose (R). Plasma concentrations of citrulline, an amino acid described as marker for enterocyte function were measured as marker of metabolic enterocytes restoration. Damage to the epithelial lining was assessed by immunohistochemistry for tight junctions (TJs), by plasma marker for enterocytes damage (I-FABP) and analyzed by electron microscopy (EM) using lanthanum nitrate as an electrondense marker.
RESULTS Plasma L/R ratio’s were significantly increased after 30 min of ischemia (30I) followed by 30 min of reperfusion (30R) compared to control (0.75 ± 0.10 vs 0.20 ± 0.09, P < 0.05). At 120 min of reperfusion (120R), ratio’s normalized (0.17 ± 0.06) and were not significantly different from control. Plasma levels of I-FABP correlated with plasma L/R ratios measured at the same time points (correlation: 0.467, P < 0.01). TJs staining shows distortion of staining at 30I. An intact lining of TJs was again observed at 30I120R. Electron microscopy analysis revealed disrupted TJs after 30I with paracellular leakage of lanthanum nitrate, which restored after 30I120R. Furthermore, citrulline concentrations closely paralleled the histological perturbations during intestinal IR.
CONCLUSION This study directly correlates histological data with intestinal permeability tests, revealing that the human gut has the ability of to withstand short episodes of ischemia, with morphological and functional recovery of the intestinal barrier within 120 min of reperfusion.
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Affiliation(s)
- Dirk HSM Schellekens
- Department of Surgery, Maastricht University Medical Center, Maastricht 6200 MD, the Netherlands
- NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6200 MD, the Netherlands
| | - Inca HR Hundscheid
- Department of Surgery, Maastricht University Medical Center, Maastricht 6200 MD, the Netherlands
- NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6200 MD, the Netherlands
| | - Claire AJI Leenarts
- Department of Surgery, Maastricht University Medical Center, Maastricht 6200 MD, the Netherlands
- NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6200 MD, the Netherlands
| | - Joep Grootjans
- NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6200 MD, the Netherlands
- Department of Gastroenterology, Academic Medical Center, Amsterdam 1105 AZ, the Netherlands
| | - Kaatje Lenaerts
- Department of Surgery, Maastricht University Medical Center, Maastricht 6200 MD, the Netherlands
- NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6200 MD, the Netherlands
| | - Wim A Buurman
- NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6200 MD, the Netherlands
- MHeNs School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht 6200 MD, the Netherlands
| | - Cornelis HC Dejong
- Department of Surgery, Maastricht University Medical Center, Maastricht 6200 MD, the Netherlands
- NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6200 MD, the Netherlands
| | - Joep PM Derikx
- Department of Surgery, Maastricht University Medical Center, Maastricht 6200 MD, the Netherlands
- NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6200 MD, the Netherlands
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital Academic Medical Center and VU University Medical Center, Amsterdam 1100 DE, the Netherlands
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8
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Reisinger KW, Willigers HM, Jansen J, Buurman WA, Von Meyenfeldt MF, Beets GL, Poeze M. Doppler-guided goal-directed fluid therapy does not affect intestinal cell damage but increases global gastrointestinal perfusion in colorectal surgery: a randomized controlled trial. Colorectal Dis 2017; 19:1081-1091. [PMID: 29028286 DOI: 10.1111/codi.13923] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/17/2017] [Indexed: 01/13/2023]
Abstract
AIM Individualized, goal-directed fluid therapy (GDFT), based on Doppler measurements of stroke volume, has been proposed as a treatment strategy in terms of reducing complications, mortality and length of hospital stay in major bowel surgery. We studied the effect of Doppler-guided GDFT on intestinal damage as compared with standard postoperative fluid replacement. METHOD Patients undergoing elective colorectal resection for malignancy were randomized either to standard intra- and postoperative fluid therapy or to standard fluid therapy with additional Doppler-guided GDFT. The primary outcome was intestinal epithelial cell damage measured by plasma levels of intestinal fatty acid-binding protein (I-FABP). Global gastrointestinal perfusion was measured by gastric tonometry, expressed as regional (gastric) minus arterial CO2 -gap (Pr-a CO2 -gap). RESULTS I-FABP levels were not significantly different between the intervention group and the control group (respectively, 440.8 (251.6) pg/ml and 522.4 (759.9) pg/ml, P = 0.67). Mean areas under the curve (AUCs) of intra-operative Pr-a CO2 -gaps were significantly lower in the intervention group than in the control group (P = 0.01), indicating better global gastrointestinal perfusion in the intervention group. Moreover, the mean intra-operative Pr-a CO2 -gap peak in the intervention group was 0.5 (1.0) kPa, which was significantly lower than the mean peak in the control group, of 1.4 (1.4) kPa (P = 0.03). CONCLUSION Doppler-guided GDFT during and in the first hours after elective colorectal surgery for malignancy increases global gastrointestinal perfusion, as measured by Pr-a CO2 -gap.
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Affiliation(s)
- K W Reisinger
- Department of Surgery, Maastricht University Medical Center & Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - H M Willigers
- Department of Anaesthesiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J Jansen
- Department of Anaesthesiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - W A Buurman
- School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - M F Von Meyenfeldt
- Department of Surgery, Maastricht University Medical Center & Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - G L Beets
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M Poeze
- Department of Surgery, Maastricht University Medical Center & Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
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9
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Meesters A, den Bosch-Meevissen YMCI, Weijzen CAH, Buurman WA, Losen M, Schepers J, Thissen MRTM, Alberts HJEM, Schalkwijk CG, Peters ML. The effect of Mindfulness-Based Stress Reduction on wound healing: a preliminary study. J Behav Med 2017; 41:385-397. [PMID: 29159589 DOI: 10.1007/s10865-017-9901-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/06/2017] [Indexed: 01/24/2023]
Abstract
Psychological factors have been shown to influence the process of wound healing. This study examined the effect of Mindfulness-Based Stress Reduction (MBSR) on the speed of wound healing. The local production of pro-inflammatory cytokines and growth factors was studied as potential underlying mechanism. Forty-nine adults were randomly allocated to a waiting-list control group (n = 26) or an 8-week MBSR group (n = 23). Pre- and post-intervention/waiting period assessment for both groups consisted of questionnaires. Standardized skin wounds were induced on the forearm using a suction blister method. Primary outcomes were skin permeability and reduction in wound size monitored once a day at day 3, 4, 5, 6, 7, and 10 after injury. Secondary outcomes were cytokines and growth factors and were measured in wound exudates obtained at 3, 6, and 22 h after wounding. Although there was no overall condition effect on skin permeability or wound size, post hoc analyses indicated that larger increases in mindfulness were related to greater reductions in skin permeability 3 and 4 days after wound induction. In addition, MBSR was associated with lower levels of interleukin (IL)-8 and placental growth factor in the wound fluid 22 h after wound induction. These outcomes suggest that increasing mindfulness by MBSR might have beneficial effects on early stages of wound healing. Trial Registration NTR3652, http://www.trialregister.nl.
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Affiliation(s)
- Astrid Meesters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Yvo M C In den Bosch-Meevissen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Chantal A H Weijzen
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Wim A Buurman
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Mario Losen
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Jan Schepers
- Department of Methodology and Statistics, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Monique R T M Thissen
- Department of Dermatology, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Universiteitssingel 40, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Hugo J E M Alberts
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Madelon L Peters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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10
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Nies VJM, Struik D, Wolfs MGM, Rensen SS, Szalowska E, Unmehopa UA, Fluiter K, van der Meer TP, Hajmousa G, Buurman WA, Greve JW, Rezaee F, Shiri-Sverdlov R, Vonk RJ, Swaab DF, Wolffenbuttel BHR, Jonker JW, van Vliet-Ostaptchouk JV. TUB gene expression in hypothalamus and adipose tissue and its association with obesity in humans. Int J Obes (Lond) 2017; 42:376-383. [PMID: 28852204 DOI: 10.1038/ijo.2017.214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/21/2017] [Accepted: 07/30/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES Mutations in the Tubby gene (TUB) cause late-onset obesity and insulin resistance in mice and syndromic obesity in humans. Although TUB gene function has not yet been fully elucidated, studies in rodents indicate that TUB is involved in the hypothalamic pathways regulating food intake and adiposity. Aside from the function in central nervous system, TUB has also been implicated in energy metabolism in adipose tissue in rodents. We aimed to determine the expression and distribution patterns of TUB in man as well as its potential association with obesity. SUBJECTS/METHODS In situ hybridization was used to localize the hypothalamic regions and cells expressing TUB mRNA. Using RT-PCR, we determined the mRNA expression level of the two TUB gene alternative splicing isoforms, the short and the long transcript variants, in the hypothalami of 12 obese and 12 normal-weight subjects, and in biopsies from visceral (VAT) and subcutaneous (SAT) adipose tissues from 53 severely obese and 24 non-obese control subjects, and correlated TUB expression with parameters of obesity and metabolic health. RESULTS Expression of both TUB transcripts was detected in the hypothalamus, whereas only the short TUB isoform was found in both VAT and SAT. TUB mRNA was detected in several hypothalamic regions involved in body weight regulation, including the nucleus basalis of Meynert and the paraventricular, supraoptic and tuberomammillary nuclei. We found no difference in the hypothalamic TUB expression between obese and control groups, whereas the level of TUB mRNA was significantly lower in adipose tissue of obese subjects as compared to controls. Also, TUB expression was negatively correlated with indices of body weight and obesity in a fat-depot-specific manner. CONCLUSIONS Our results indicate high expression of TUB in the hypothalamus, especially in areas involved in body weight regulation, and the correlation between TUB expression in adipose tissue and obesity. These findings suggest a role for TUB in human obesity.
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Affiliation(s)
- V J M Nies
- Section of Molecular Metabolism and Nutrition, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D Struik
- Section of Molecular Metabolism and Nutrition, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M G M Wolfs
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S S Rensen
- Department of General Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - E Szalowska
- Centre for Medical Biomics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - U A Unmehopa
- Department of Endocrinology & Metabolism, Academic Medical Center, Amsterdam, The Netherlands
| | - K Fluiter
- Department of Genome Analysis, Academic Medical Center, Amsterdam, The Netherlands
| | - T P van der Meer
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G Hajmousa
- Cardiovascular Regenerative Medicine, Department Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W A Buurman
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - J W Greve
- Department of Surgery, Zuyderland Medical Center Heerlen; Dutch Obesity Clinic South, Heerlen, The Netherlands
| | - F Rezaee
- Centre for Medical Biomics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Shiri-Sverdlov
- Departments of Molecular Genetics, School of Nutrition & Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - R J Vonk
- Centre for Medical Biomics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D F Swaab
- Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - B H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J W Jonker
- Section of Molecular Metabolism and Nutrition, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J V van Vliet-Ostaptchouk
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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11
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Peters EG, Dekkers M, van Leeuwen-Hilbers FW, Daams F, Hulsewé KWE, de Jonge WJ, Buurman WA, Luyer MDP. Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial. Colorectal Dis 2017; 19:667-674. [PMID: 27943617 DOI: 10.1111/codi.13582] [Citation(s) in RCA: 25] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/27/2016] [Indexed: 02/08/2023]
Abstract
AIM Anastomotic leakage (AL) following abdominal surgery is a critical determinant of postoperative recovery, of which the aetiology is largely unknown. Interestingly, interventions aimed at reducing the inflammatory response and postoperative ileus (POI) have an unexpected effect on AL. The aim of this study was to investigate the relation of POI with inflammation and AL after colorectal resection. METHOD A post hoc analysis of a prospective randomized controlled trial in which patients underwent a colorectal resection was performed. Patients undergoing a colorectal resection were stratified into having or not having POI. The incidence of AL and other clinical parameters was registered prospectively. Intestinal fatty acid binding protein (I-FABP, a marker for tissue damage) and the inflammatory response in plasma and colon tissue were determined. RESULTS AL was present in nine of 43 patients in the POI group, and in one of 65 in the group without POI (P < 0.001). There was a significant association between POI and AL (OR 12.57, 95% CI: 2.73-120.65; P = 0.0005). Patients with POI had significantly higher plasma levels of soluble tumour necrosis factor receptor 1 (TNFRSF1A) at 4 h postoperatively (0.89 ng/l, interquartile range 0.56) than patients without POI (0.80 ng/l, interquartile range 0.37; P = 0.04) and higher plasma levels of C-reactive protein on the second day postoperatively (234 ± 77 vs 163 ± 86 mg/l; P = 0.001). Patients who developed AL had significantly higher plasma levels of I-FABP compared with patients without AL at 24 h after onset of surgery. CONCLUSION POI is associated with a higher prevalence of AL and an increased inflammatory response.
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Affiliation(s)
- E G Peters
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.,Tytgat Institute for Liver and Intestinal Research, Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - M Dekkers
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - F W van Leeuwen-Hilbers
- Tytgat Institute for Liver and Intestinal Research, Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - F Daams
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - K W E Hulsewé
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - W J de Jonge
- Tytgat Institute for Liver and Intestinal Research, Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - W A Buurman
- Institute MHeNS, Maastricht University, Maastricht, The Netherlands
| | - M D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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12
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Fransen EJ, Ganushchak YM, Vijay V, de Jong DS, Buurman WA, Maessen JG. Evaluation of a new condensed extra-corporeal circuit for cardiac surgery: a prospective randomized clinical pilot study. Perfusion 2017; 20:91-9. [PMID: 15918446 DOI: 10.1191/0267659105pf795oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This prospective randomized clinical pilot study was conducted to evaluate a recently introduced reduced volume CPB system that is coated with the biopassive Xcoating™. Twenty-two patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB), either with a fully heparin-coated CPB circuit (control, n=11) or with an Xcoating™ coated condensed extra-corporeal circuit (CondECC, n=11), were included. We examined activation of the complement system (C3bc and C4bc), activation of neutrophils (BPI), the acute phase response (interleukin (IL)-6, and acute phase proteins (LBP, AGP, and CRP)), myocardial tissue injury (troponin T), hemolysis (free hemoglobin (FHb)), and clinical outcome parameters. Preoperative risk profiles were identical for both patient groups. All patients went through the procedure without major complications and were discharged from the hospital. FHb and BPI levels at the end of pump support ( p <0.01) and at 15 min after the administration of protamine ( p <0.05) were significantly higher in the control group. In addition, FHb levels were still significantly elevated upon arrival on the cardiothoracic intensive care unit (CICU) in the control group ( p <0.05). C3bc and C4bc, acute phase proteins, IL-6, and troponin T concentrations, and clinical outcome variables were identical in both patient groups. In conclusion, the evaluated condensed extracorporeal circuit is a flexible and multifunctional CPB sytem that offers safe procedures. Furthermore, the results indicate improved biocompatibility of this option for extracorporeal circulation.
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Affiliation(s)
- Erik J Fransen
- Department of Cardiothoracic Surgery, University Hospital Maastricht, CARIM, Maastricht, The Netherlands.
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13
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Walenbergh SMA, Houben T, Rensen SS, Bieghs V, Hendrikx T, van Gorp PJ, Oligschlaeger Y, Jeurissen MLJ, Gijbels MJJ, Buurman WA, Vreugdenhil ACE, Greve JWM, Plat J, Hofker MH, Kalhan S, Pihlajamäki J, Lindsey P, Koek GH, Shiri-Sverdlov R. Plasma cathepsin D correlates with histological classifications of fatty liver disease in adults and responds to intervention. Sci Rep 2016; 6:38278. [PMID: 27922112 PMCID: PMC5138820 DOI: 10.1038/srep38278] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 10/25/2016] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic steatohepatitis (NASH) is characterized by liver lipid accumulation and inflammation. The mechanisms that trigger hepatic inflammation are poorly understood and subsequently, no specific non-invasive markers exist. We previously demonstrated a reduction in the plasma lysosomal enzyme, cathepsin D (CatD), in children with NASH compared to children without NASH. Recent studies have raised the concept that non-alcoholic fatty liver disease (NAFLD) in adults is distinct from children due to a different histological pattern in the liver. Yet, the link between plasma CatD to adult NASH was not examined. In the current manuscript, we investigated whether plasma CatD in adults correlates with NASH development and regression. Biopsies were histologically evaluated for inflammation and NAFLD in three complementary cohorts of adults (total n = 248). CatD and alanine aminotransferase (ALT) were measured in plasma. Opposite to our previous observations with childhood NASH, we observed increased levels of plasma CatD in patients with NASH compared to adults without hepatic inflammation. Furthermore, after surgical intervention, we found a reduction of plasma CatD compared to baseline. Our observations highlight a distinct pathophysiology between NASH in children and adults. The observation that plasma CatD correlated with NASH development and regression is promising for NASH diagnosis.
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Affiliation(s)
- Sofie M A Walenbergh
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Tom Houben
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Sander S Rensen
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Veerle Bieghs
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Tim Hendrikx
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Patrick J van Gorp
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Yvonne Oligschlaeger
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Mike L J Jeurissen
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Marion J J Gijbels
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Wim A Buurman
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Anita C E Vreugdenhil
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Jan Willem M Greve
- Surgery, Atrium Medical Center Parkstad, 6419PC, Heerlen, The Netherlands
| | - Jogchum Plat
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Marten H Hofker
- Pathology and Medical Biology, Molecular Genetics, Medical Biology Section, University Medical Center Groningen, 9713GZ, Groningen, The Netherlands
| | - Satish Kalhan
- Pathobiology, Lerner Research Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, USA
| | - Jussi Pihlajamäki
- Clinical Nutrition, University of Eastern Finland, FI-70211 Kuopio, Finland.,Clinical Nutrition and Obesity Center, Kuopio University Hospital, FI-70211 Kuopio, Finland
| | - Patrick Lindsey
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Ger H Koek
- Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Ronit Shiri-Sverdlov
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
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14
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Neis EPJG, Bloemen JG, Rensen SS, van der Vorst JR, van den Broek MA, Venema K, Buurman WA, Dejong CHC. Effects of Liver Resection on Hepatic Short-Chain Fatty Acid Metabolism in Humans. PLoS One 2016; 11:e0166161. [PMID: 27835668 PMCID: PMC5105994 DOI: 10.1371/journal.pone.0166161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/24/2016] [Indexed: 01/14/2023] Open
Abstract
AIM To determine whether acute loss of liver tissue affects hepatic short-chain fatty acid (SCFA) clearance. METHODS Blood was sampled from the radial artery, portal vein, and hepatic vein before and after hepatic resection in 30 patients undergoing partial liver resection. Plasma SCFA levels were measured by liquid chromatography-mass spectrometry. SCFA exchange across gut and liver was calculated from arteriovenous differences and plasma flow. Liver volume was estimated by CT liver volumetry. RESULTS The gut produced significant amounts of acetate, propionate, and butyrate (39.4±13.5, 6.2±1.3, and 9.5±2.6 μmol·kgbw-1·h-1), which did not change after partial hepatectomy (p = 0.67, p = 0.59 and p = 0.24). Hepatic propionate uptake did not differ significantly before and after resection (-6.4±1.4 vs. -8.4±1.5 μmol·kgbw-1·h-1, p = 0.49). Hepatic acetate and butyrate uptake increased significantly upon partial liver resection (acetate: -35.1±13.0 vs. -39.6±9.4 μmol·kgbw-1·h-1, p = 0.0011; butyrate: -9.9±2.7 vs. -11.5±2.4 μmol·kgbw-1·h-1, p = 0.0006). Arterial SCFA concentrations were not different before and after partial liver resection (acetate: 176.9±17.3 vs. 142.3±12.5 μmol/L, p = 0.18; propionate: 7.2±1.4 vs. 5.6±0.6 μmol/L, p = 0.38; butyrate: 4.3±0.7 vs. 3.6±0.6 μmol/L, p = 0.73). CONCLUSION The liver maintains its capacity to clear acetate, propionate, and butyrate from the portal blood upon acute loss of liver tissue.
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Affiliation(s)
- Evelien P. J. G. Neis
- TI Food and Nutrition, 6709 PA Wageningen, The Netherlands
- Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- * E-mail:
| | - Johanne G. Bloemen
- TI Food and Nutrition, 6709 PA Wageningen, The Netherlands
- Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Sander S. Rensen
- Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Joost R. van der Vorst
- Department of Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Maartje A. van den Broek
- Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- Department of Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Koen Venema
- TI Food and Nutrition, 6709 PA Wageningen, The Netherlands
- Beneficial Microbes Consultancy, Wageningen University, 6708 PB Wageningen, The Netherlands
| | - Wim A. Buurman
- Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
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15
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Grootjans J, Lenaerts K, Buurman WA, Dejong CHC, Derikx JPM. Life and death at the mucosal-luminal interface: New perspectives on human intestinal ischemia-reperfusion. World J Gastroenterol 2016; 22:2760-2770. [PMID: 26973414 PMCID: PMC4777998 DOI: 10.3748/wjg.v22.i9.2760] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/24/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
Intestinal ischemia is a frequently observed phenomenon. Morbidity and mortality rates are extraordinarily high and did not improve over the past decades. This is in part attributable to limited knowledge on the pathophysiology of intestinal ischemia-reperfusion (IR) in man, the paucity in preventive and/or therapeutic options and the lack of early diagnostic markers for intestinal ischemia. To improve our knowledge and solve clinically important questions regarding intestinal IR, we developed a human experimental intestinal IR model. With this model, we were able to gain insight into the mechanisms that allow the human gut to withstand short periods of IR without the development of severe inflammatory responses. The purpose of this review is to overview the most relevant recent advances in our understanding of the pathophysiology of human intestinal IR, as well as the (potential) future clinical implications.
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16
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Wang Y, van der Tuin S, Tjeerdema N, van Dam AD, Rensen SS, Hendrikx T, Berbée JFP, Atanasovska B, Fu J, Hoekstra M, Bekkering S, Riksen NP, Buurman WA, Greve JW, Hofker MH, Shiri-Sverdlov R, Meijer OC, Smit JWA, Havekes LM, van Dijk KW, Rensen PCN. Plasma cholesteryl ester transfer protein is predominantly derived from Kupffer cells. Hepatology 2015; 62:1710-22. [PMID: 26174697 DOI: 10.1002/hep.27985] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/10/2015] [Indexed: 02/06/2023]
Abstract
UNLABELLED The role of Kupffer cells (KCs) in the pathophysiology of the liver has been firmly established. Nevertheless, KCs have been underexplored as a target for diagnosis and treatment of liver diseases owing to the lack of noninvasive diagnostic tests. We addressed the hypothesis that cholesteryl ester transfer protein (CETP) is mainly derived from KCs and may predict KC content. Microarray analysis of liver and adipose tissue biopsies, obtained from 93 obese subjects who underwent elective bariatric surgery, showed that expression of CETP is markedly higher in liver than adipose tissue. Hepatic expression of CETP correlated strongly with that of KC markers, and CETP messenger RNA and protein colocalized specifically with KCs in human liver sections. Hepatic KC content as well as hepatic CETP expression correlated strongly with plasma CETP concentration. Mechanistic and intervention studies on the role of KCs in determining the plasma CETP concentration were performed in a transgenic (Tg) mouse model expressing human CETP. Selective elimination of KCs from the liver in CETP Tg mice virtually abolished hepatic CETP expression and largely reduced plasma CETP concentration, consequently improving the lipoprotein profile. Conversely, augmentation of KCs after Bacille-Calemette-Guérin vaccination largely increased hepatic CETP expression and plasma CETP. Also, lipid-lowering drugs fenofibrate and niacin reduced liver KC content, accompanied by reduced plasma CETP concentration. CONCLUSIONS Plasma CETP is predominantly derived from KCs, and plasma CETP level predicts hepatic KC content in humans.
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Affiliation(s)
- Yanan Wang
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Sam van der Tuin
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nathanja Tjeerdema
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrea D van Dam
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Sander S Rensen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tim Hendrikx
- Department of Molecular Genetics, Maastricht University, Maastricht, The Netherlands
| | - Jimmy F P Berbée
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Biljana Atanasovska
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jingyuan Fu
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Menno Hoekstra
- Department of Biopharmaceutics, Leiden Academic Center for Drug Research, Leiden, The Netherlands
| | - Siroon Bekkering
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The, Netherlands
| | - Niels P Riksen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The, Netherlands
| | - Wim A Buurman
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Willem Greve
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marten H Hofker
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ronit Shiri-Sverdlov
- Department of Molecular Genetics, Maastricht University, Maastricht, The Netherlands
| | - Onno C Meijer
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Johannes W A Smit
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The, Netherlands
| | - Louis M Havekes
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ko Willems van Dijk
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Patrick C N Rensen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Adriaanse MPM, van der Sande LJTM, van den Neucker AM, Menheere PPCA, Dompeling E, Buurman WA, Vreugdenhil ACE. Evidence for a Cystic Fibrosis Enteropathy. PLoS One 2015; 10:e0138062. [PMID: 26484665 PMCID: PMC4617711 DOI: 10.1371/journal.pone.0138062] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 08/25/2015] [Indexed: 01/13/2023] Open
Abstract
Background Previous studies have suggested the existence of enteropathy in cystic fibrosis (CF), which may contribute to intestinal function impairment, a poor nutritional status and decline in lung function. This study evaluated enterocyte damage and intestinal inflammation in CF and studied its associations with nutritional status, CF-related morbidities such as impaired lung function and diabetes, and medication use. Methods Sixty-eight CF patients and 107 controls were studied. Levels of serum intestinal-fatty acid binding protein (I-FABP), a specific marker for enterocyte damage, were retrospectively determined. The faecal intestinal inflammation marker calprotectin was prospectively studied. Nutritional status, lung function (FEV1), exocrine pancreatic insufficiency (EPI), CF-related diabetes (CFRD) and use of proton pump inhibitors (PPI) were obtained from the medical charts. Results Serum I-FABP levels were elevated in CF patients as compared with controls (p<0.001), and correlated negatively with FEV1 predicted value in children (r-.734, p<0.05). Faecal calprotectin level was elevated in 93% of CF patients, and correlated negatively with FEV1 predicted value in adults (r-.484, p<0.05). No correlation was found between calprotectin levels in faeces and sputum. Faecal calprotectin level was significantly associated with the presence of CFRD, EPI, and PPI use. Conclusion This study demonstrated enterocyte damage and intestinal inflammation in CF patients, and provides evidence for an inverse correlation between enteropathy and lung function. The presented associations of enteropathy with important CF-related morbidities further emphasize the clinical relevance.
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Affiliation(s)
- Marlou P. M. Adriaanse
- Department of Paediatric Gastroenterology & Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Linda J. T. M. van der Sande
- Department of Paediatric Gastroenterology & Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Anita M. van den Neucker
- Department of Paediatric Gastroenterology & Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Paul P. C. A. Menheere
- Department of Immunodiagnostics, Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Edward Dompeling
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Wim A. Buurman
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Anita C. E. Vreugdenhil
- Department of Paediatric Gastroenterology & Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
- * E-mail:
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de Jonge C, Rensen SS, Verdam FJ, Vincent RP, Bloom SR, Buurman WA, le Roux CW, Bouvy ND, Greve JWM. Impact of Duodenal-Jejunal Exclusion on Satiety Hormones. Obes Surg 2015; 26:672-8. [DOI: 10.1007/s11695-015-1889-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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van Wijck K, Wijnands KAP, Meesters DM, Boonen B, van Loon LJC, Buurman WA, Dejong CHC, Lenaerts K, Poeze M. L-citrulline improves splanchnic perfusion and reduces gut injury during exercise. Med Sci Sports Exerc 2015; 46:2039-46. [PMID: 24621960 DOI: 10.1249/mss.0000000000000332] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Splanchnic hypoperfusion is a physiological phenomenon during strenuous exercise. It has been associated with gastrointestinal symptoms and intestinal injury and may hamper athletic performance. We hypothesized that L-citrulline supplementation improves splanchnic perfusion and decreases intestinal injury by enhancing arginine availability. The aim of this study was to determine the effect of L-citrulline intake on splanchnic perfusion, intestinal injury, and barrier function during exercise. METHODS In this randomized, double-blind crossover study, 10 men cycled for 60 min at 70% of their maximum workload after L-citrulline (10 g) or placebo (L-alanine) intake. Splanchnic perfusion was assessed using gastric air tonometry. Sublingual microcirculation was evaluated by sidestream dark field imaging. Plasma amino acid levels and intestinal fatty acid binding protein concentrations, reflecting enterocyte damage, were assessed every 10 min. Urinary excretion of sugar probes was measured to evaluate intestinal permeability changes. RESULTS Oral L-citrulline supplementation enhanced plasma citrulline (1840.3 ± 142.3 µM) and arginine levels (238.5 ± 9.1 µM) compared with that in placebo (45.7 ± 4.8 µM and 101.5 ± 6.1 µM, respectively, P < 0.0001), resulting in increased arginine availability. Splanchnic hypoperfusion was prevented during exercise after L-citrulline ingestion (reflected by unaltered gapg-apCO2 levels), whereas gapg-apCO2 increased with placebo treatment (P < 0.01). Accordingly, L-citrulline intake resulted in an increased number of perfused small sublingual vessels compared with that in placebo (7.8 ± 6.0 vs -2.0 ± 2.4, P = 0.06). Furthermore, plasma intestinal fatty acid binding protein levels were attenuated during exercise after L-citrulline supplementation compared with that in placebo (AUC0-60 min, -185% ± 506% vs 1318% ± 553%, P < 0.01). No significant differences were observed for intestinal permeability. CONCLUSIONS Pre-exercise L-citrulline intake preserves splanchnic perfusion and attenuates intestinal injury during exercise in athletes compared with placebo, probably by enhancing arginine availability. These results suggest that oral L-citrulline supplementation is a promising intervention to combat splanchnic hypoperfusion-induced intestinal compromise.
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Affiliation(s)
- Kim van Wijck
- 1Top Institute Food and Nutrition, Wageningen, The NETHERLANDS; 2Department of General Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, Maastricht, The NETHERLANDS; and 3Department of Human Movement Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, Maastricht, The NETHERLANDS
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20
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Kolmeder CA, Ritari J, Verdam FJ, Muth T, Keskitalo S, Varjosalo M, Fuentes S, Greve JW, Buurman WA, Reichl U, Rapp E, Martens L, Palva A, Salonen A, Rensen SS, de Vos WM. Colonic metaproteomic signatures of active bacteria and the host in obesity. Proteomics 2015; 15:3544-52. [DOI: 10.1002/pmic.201500049] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 07/03/2015] [Accepted: 07/24/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Carolin A. Kolmeder
- Department of Veterinary Biosciences; University of Helsinki; Helsinki Finland
| | - Jarmo Ritari
- Department of Veterinary Biosciences; University of Helsinki; Helsinki Finland
| | - Froukje J. Verdam
- Department of General Surgery; NUTRIM School of Nutrition and Translational Research in Metabolism; Maastricht University Medical Center; Maastricht The Netherlands
| | - Thilo Muth
- Max Planck Institute for Dynamics of Complex Technical Systems; Bioprocess Engineering; Magdeburg Germany
| | - Salla Keskitalo
- Institute of Biotechnology; University of Helsinki; Helsinki Finland
| | - Markku Varjosalo
- Institute of Biotechnology; University of Helsinki; Helsinki Finland
| | - Susana Fuentes
- Laboratory of Microbiology; Wageningen University; Wageningen The Netherlands
| | - Jan Willem Greve
- Department of General Surgery; NUTRIM School of Nutrition and Translational Research in Metabolism; Maastricht University Medical Center; Maastricht The Netherlands
| | - Wim A. Buurman
- Department of General Surgery; NUTRIM School of Nutrition and Translational Research in Metabolism; Maastricht University Medical Center; Maastricht The Netherlands
| | - Udo Reichl
- Max Planck Institute for Dynamics of Complex Technical Systems; Bioprocess Engineering; Magdeburg Germany
- Chair of Bioprocess Engineering; Otto-von-Guericke University; Magdeburg Germany
| | - Erdmann Rapp
- Max Planck Institute for Dynamics of Complex Technical Systems; Bioprocess Engineering; Magdeburg Germany
| | - Lennart Martens
- Department of Biochemistry; Ghent University; Ghent Belgium
- VIB Medical Biotechnology Center; Department of Medical Protein Research; Ghent Belgium
| | - Airi Palva
- Department of Veterinary Biosciences; University of Helsinki; Helsinki Finland
| | - Anne Salonen
- Department of Bacteriology and Immunology; Immunobiology Research Program; University of Helsinki; Helsinki Finland
| | - Sander S. Rensen
- Department of General Surgery; NUTRIM School of Nutrition and Translational Research in Metabolism; Maastricht University Medical Center; Maastricht The Netherlands
| | - Willem M. de Vos
- Department of Veterinary Biosciences; University of Helsinki; Helsinki Finland
- Laboratory of Microbiology; Wageningen University; Wageningen The Netherlands
- Department of Bacteriology and Immunology; Immunobiology Research Program; University of Helsinki; Helsinki Finland
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21
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Rijks JM, Plat J, Mensink RP, Dorenbos E, Buurman WA, Vreugdenhil ACE. Children With Morbid Obesity Benefit Equally as Children With Overweight and Obesity From an Ongoing Care Program. J Clin Endocrinol Metab 2015; 100:3572-80. [PMID: 26186296 DOI: 10.1210/jc.2015-1444] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Despite stabilization of childhood overweight and obesity prevalence, there is a shift toward more severe degrees of obesity, which results in an increasing prevalence of children with morbid obesity. Prior studies demonstrated that lifestyle modification without ongoing treatment has only a modest and not sustainable effect in children with morbid obesity. This suggests that a chronic care model is necessary for long-term effects on weight management and health. OBJECTIVE This study aimed to evaluate the effect of an ongoing lifestyle intervention in children with morbid obesity in comparison with children with overweight and obesity. DESIGN AND SETTING This was a nonrandomized prospective intervention study with 12- and 24-month followup at the Centre for Overweight Adolescent and Children's Healthcare. PATIENTS AND INTERVENTION Children and adolescents (n = 100 females and 72 males) with overweight, obesity, or morbid obesity were given long-term, outpatient, tailored lifestyle intervention. MAIN OUTCOME MEASURE Body mass index (BMI) z score was measured. RESULTS In children with morbid obesity, 12- and 24-month interventions resulted in a decrease of BMI z score of -0.13 ± 0.25 (P = .001) and -0.23 ± 0.32 (P = .01) respectively, whereas weight status category improved to obese in 21% and 25% of the children. Cardiovascular risk parameters including serum total cholesterol, low-density lipoprotein cholesterol, glycosylated hemoglobin (HbA1c), and diastolic blood pressure significantly improved after 1-year intervention in the complete group. Most important, BMI z score as well as cardiovascular risk parameters improved to a similar degree in children with overweight, obesity, and morbid obesity. CONCLUSIONS Children with overweight, obesity, and morbid obesity benefit equally from an ongoing, outpatient, tailored lifestyle intervention, and demonstrate significant weight loss and improvement of cardiovascular risk parameters.
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Affiliation(s)
- J M Rijks
- Centre for Overweight Adolescent and Children's Healthcare, Department of Paediatrics (J.M.R., E.D.M., A.C.E.V.), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; Department of Human Biology (J.P., R.P.M.), School of Nutrition and Translational Research in Metabolism (J.M.R., J.P., R.P.M., E.D., A.C.E.V.), Maastricht University, Universiteitssingel 6229 HR, Maastricht, The Netherlands; and Department of Neuropsychology & School for Mental Health and Neuroscience (W.A.B.), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - J Plat
- Centre for Overweight Adolescent and Children's Healthcare, Department of Paediatrics (J.M.R., E.D.M., A.C.E.V.), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; Department of Human Biology (J.P., R.P.M.), School of Nutrition and Translational Research in Metabolism (J.M.R., J.P., R.P.M., E.D., A.C.E.V.), Maastricht University, Universiteitssingel 6229 HR, Maastricht, The Netherlands; and Department of Neuropsychology & School for Mental Health and Neuroscience (W.A.B.), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - R P Mensink
- Centre for Overweight Adolescent and Children's Healthcare, Department of Paediatrics (J.M.R., E.D.M., A.C.E.V.), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; Department of Human Biology (J.P., R.P.M.), School of Nutrition and Translational Research in Metabolism (J.M.R., J.P., R.P.M., E.D., A.C.E.V.), Maastricht University, Universiteitssingel 6229 HR, Maastricht, The Netherlands; and Department of Neuropsychology & School for Mental Health and Neuroscience (W.A.B.), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - E Dorenbos
- Centre for Overweight Adolescent and Children's Healthcare, Department of Paediatrics (J.M.R., E.D.M., A.C.E.V.), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; Department of Human Biology (J.P., R.P.M.), School of Nutrition and Translational Research in Metabolism (J.M.R., J.P., R.P.M., E.D., A.C.E.V.), Maastricht University, Universiteitssingel 6229 HR, Maastricht, The Netherlands; and Department of Neuropsychology & School for Mental Health and Neuroscience (W.A.B.), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - W A Buurman
- Centre for Overweight Adolescent and Children's Healthcare, Department of Paediatrics (J.M.R., E.D.M., A.C.E.V.), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; Department of Human Biology (J.P., R.P.M.), School of Nutrition and Translational Research in Metabolism (J.M.R., J.P., R.P.M., E.D., A.C.E.V.), Maastricht University, Universiteitssingel 6229 HR, Maastricht, The Netherlands; and Department of Neuropsychology & School for Mental Health and Neuroscience (W.A.B.), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - A C E Vreugdenhil
- Centre for Overweight Adolescent and Children's Healthcare, Department of Paediatrics (J.M.R., E.D.M., A.C.E.V.), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; Department of Human Biology (J.P., R.P.M.), School of Nutrition and Translational Research in Metabolism (J.M.R., J.P., R.P.M., E.D., A.C.E.V.), Maastricht University, Universiteitssingel 6229 HR, Maastricht, The Netherlands; and Department of Neuropsychology & School for Mental Health and Neuroscience (W.A.B.), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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van der Beek CM, Bloemen JG, van den Broek MA, Lenaerts K, Venema K, Buurman WA, Dejong CH. Hepatic Uptake of Rectally Administered Butyrate Prevents an Increase in Systemic Butyrate Concentrations in Humans. J Nutr 2015; 145:2019-24. [PMID: 26156796 DOI: 10.3945/jn.115.211193] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/15/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Short-chain fatty acids (SCFAs), fermentation products of undigested fibers, are considered beneficial for colonic health. High plasma concentrations are potentially harmful; therefore, information about systemic SCFA clearance is needed before therapeutic use of prebiotics or colonic SCFA administration. OBJECTIVE The aim of this study was to investigate the effect of rectal butyrate administration on SCFA interorgan exchange. METHODS Twelve patients (7 men; age: 66.4 ± 2.0 y; BMI 24.5 ± 1.4 kg/m(2)) undergoing upper abdominal surgery participated in this randomized placebo-controlled trial. During surgery, 1 group received a butyrate enema (100 mmol sodium butyrate/L; 60 mL; n = 7), and the other group a placebo (140 mmol 0.9% NaCl/L; 60 mL; n = 5). Before and 5, 15, and 30 min after administration, blood samples were taken from the radial artery, hepatic vein, and portal vein. Plasma SCFA concentrations were analyzed, and fluxes from portal-drained viscera, liver, and splanchnic area were calculated and used for the calculation of the incremental area under the curve (iAUC) over a 30-min period. RESULTS Rectal butyrate administration led to higher portal butyrate concentrations at 5 min compared with placebo (92.2 ± 27.0 μmol/L vs. 14.3 ± 3.4 μmol/L, respectively; P < 0.01). In the butyrate-treated group, iAUCs of gut release (282.8 ± 133.8 μmol/kg BW · 0.5 h) and liver uptake (-293.7 ± 136.0 μmol/kg BW · 0.5 h) of butyrate were greater than in the placebo group [-16.6 ± 13.4 μmol/kg BW · 0.5 h (gut release) and 16.0 ± 13.8 μmol/kg BW · 0.5 h (liver uptake); P = 0.01 and P < 0.05, respectively]. As a result, splanchnic butyrate release did not differ between groups. CONCLUSION After colonic butyrate administration, splanchnic butyrate release was prevented in patients undergoing upper abdominal surgery. These observations imply that therapeutic colonic SCFA administration at this dose is safe. The trial was registered at clinicaltrials.gov as NCT02271802.
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Affiliation(s)
- Christina M van der Beek
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands; Top Institute Food & Nutrition, Wageningen, Netherlands; and
| | - Johanne G Bloemen
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands; Top Institute Food & Nutrition, Wageningen, Netherlands; and
| | - Maartje A van den Broek
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Kaatje Lenaerts
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands; Top Institute Food & Nutrition, Wageningen, Netherlands; and
| | - Koen Venema
- Top Institute Food & Nutrition, Wageningen, Netherlands; and Beneficial Microbes Consultancy, Wageningen, Netherlands
| | - Wim A Buurman
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Cornelis H Dejong
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands; Top Institute Food & Nutrition, Wageningen, Netherlands; and
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23
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Keszthelyi D, Troost FJ, Jonkers DM, van Eijk HM, Dekker J, Buurman WA, Masclee AAM. Visceral hypersensitivity in irritable bowel syndrome: evidence for involvement of serotonin metabolism--a preliminary study. Neurogastroenterol Motil 2015; 27:1127-37. [PMID: 26031193 DOI: 10.1111/nmo.12600] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/22/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Altered serotonergic (5-HT) metabolism and visceral perception have been associated with the pathogenesis of irritable bowel syndrome (IBS). Aim of this preliminary study was to assess the effect of the direct precursor of 5-HT, 5-hydroxytryptophan (5-HTP), on systemic 5-HT metabolites and visceral perception and to assess potential differential responses between IBS and controls. METHODS 15 IBS patients and 15 healthy volunteers participated in this randomized double-blind placebo controlled study. Visceroperception was measured by rectal barostat. The 100 mg 5-HTP or placebo was ingested orally. Serotonergic metabolites were assessed in platelet poor plasma. KEY RESULTS 5-HTP induces rectal allodynia in a significant number of healthy controls; IBS patients exhibit lowered pain thresholds in both placebo and 5-HTP conditions. 5-HTP induces rectal hyperalgesia in hypersensitive but not in non-hypersensitive IBS patients. Administration of 5-HTP significantly increased plasma 5-HTP levels (p < 0.001), did not affect 5-HT levels (p > 0.05), while levels of the main metabolite of 5-HT, 5-hydroxyindoleacetic acid, increased significantly (p < 0.05) in both groups. The magnitude of these changes observed in 5-HT metabolites was significantly greater in IBS patients. CONCLUSIONS & INFERENCES Oral administration of 5-HTP induced significant alterations in systemic 5-HT metabolites that were accompanied by increased visceroperception of pain in controls and hypersensitive IBS patients. Changes in 5-HT metabolism appear to be important factors involved in visceral hypersensitivity as the 5-HTP-induced pro-nociceptive response was observed in all hypersensitive IBS patients and to a lesser magnitude in a significant number of healthy controls but in none of the non-hypersensitive IBS patients.
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Affiliation(s)
- D Keszthelyi
- Top Institute Food and Nutrition, Wageningen, The Netherlands.,Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - F J Troost
- Top Institute Food and Nutrition, Wageningen, The Netherlands.,Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - D M Jonkers
- Top Institute Food and Nutrition, Wageningen, The Netherlands.,Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - H M van Eijk
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J Dekker
- Top Institute Food and Nutrition, Wageningen, The Netherlands
| | - W A Buurman
- School for Mental Health and Neuroscience, Division Neuroscience, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - A A M Masclee
- Top Institute Food and Nutrition, Wageningen, The Netherlands.,Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
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Adriaanse MPM, Buurman WA, Vreugdenhil ACE. Letter: serum I-FABP as marker for enterocyte damage in first-degree relatives of patients with coeliac disease - authors' reply. Aliment Pharmacol Ther 2015; 42:122. [PMID: 26040523 DOI: 10.1111/apt.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- M P M Adriaanse
- Department of Pediatrics & Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - W A Buurman
- Department of Neuroscience, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - A C E Vreugdenhil
- Department of Pediatrics & Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands
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Abstract
Studies in neuroscience and immunology have clarified much of the anatomical and cellular basis for bidirectional interactions between the nervous and immune systems. As with other organs, intestinal immune responses and the development of immunity seems to be modulated by neural reflexes. Sympathetic immune modulation and reflexes are well described, and in the past decade the parasympathetic efferent vagus nerve has been added to this immune-regulation network. This system, designated 'the inflammatory reflex', comprises an afferent arm that senses inflammation and an efferent arm that inhibits innate immune responses. Intervention in this system as an innovative principle is currently being tested in pioneering trials of vagus nerve stimulation using implantable devices to treat IBD. Patients benefit from this treatment, but some of the working mechanisms remain to be established, for instance, treatment is effective despite the vagus nerve not always directly innervating the inflamed tissue. In this Review, we will focus on the direct neuronal regulatory mechanisms of immunity in the intestine, taking into account current advances regarding the innervation of the spleen and lymphoid organs, with a focus on the potential for treatment in IBD and other gastrointestinal pathologies.
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Affiliation(s)
- Rose A Willemze
- Department of Gastroenterology, Tytgat Institute for Liver and Intestinal Research, Academic Medical Centre, Meibergdreef 69, 1105BK Amsterdam, Netherlands
| | - Misha D Luyer
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, Netherlands
| | - Wim A Buurman
- School for Mental Health and Neuroscience, Health and Nutrition, 6200 MD, Maastricht University, Netherlands
| | - Wouter J de Jonge
- Department of Gastroenterology, Tytgat Institute for Liver and Intestinal Research, Academic Medical Centre, Meibergdreef 69, 1105BK Amsterdam, Netherlands
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26
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Wolfs MGM, Gruben N, Rensen SS, Verdam FJ, Greve JW, Driessen A, Wijmenga C, Buurman WA, Franke L, Scheja L, Koonen DPY, Shiri-Sverdlov R, van Haeften TW, Hofker MH, Fu J. Determining the association between adipokine expression in multiple tissues and phenotypic features of non-alcoholic fatty liver disease in obesity. Nutr Diabetes 2015; 5:e146. [PMID: 25664838 PMCID: PMC4338415 DOI: 10.1038/nutd.2014.43] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/28/2014] [Accepted: 11/15/2014] [Indexed: 12/20/2022] Open
Abstract
Objectives: Non-alcoholic fatty liver disease (NAFLD) is an obesity-associated disease, and in obesity adipokines are believed to be involved in the development of NAFLD. However, it is still not clear whether adipokines in the liver and/or adipose tissues can be related to the development of specific characteristics of NAFLD, such as steatosis and inflammation. We aimed to address this question by simultaneously examining the adipokine expression in three tissue types in obese individuals. Methods: We enrolled 93 severely obese individuals with NAFLD, varying from simple steatosis to severe non-alcoholic steatohepatitis. Their expression of 48 adipokines in the liver, visceral and subcutaneous adipose tissue (SAT) was correlated to their phenotypic features of NAFLD. We further determined whether the correlations were tissue specific and/or independent of covariates, including age, sex, obesity, insulin resistance and type 2 diabetes (T2D). Results: The expression of adipokines showed a liver- and adipose tissue-specific pattern. We identified that the expression of leptin, angiopoietin 2 (ANGPT2) and chemerin in visceral adipose tissue (VAT) was associated with different NAFLD features, including steatosis, ballooning, portal and lobular inflammation. In addition, the expression of tumor necrosis factor (TNF), plasminogen activator inhibitor type 1 (PAI-1), insulin-like growth factor 1 (somatomedin C) (IGF1) and chemokine (C-X-C motif) ligand 10 (CXCL10) in the liver tissue and the expression of interleukin 1 receptor antagonist (IL1RN) in both the liver and SAT were associated with NAFLD features. The correlations between ANGPT2 and CXCL10, and NAFLD features were dependent on insulin resistance and T2D, but for the other genes the correlation with at least one NAFLD feature remained significant after correcting for the covariates. Conclusions: Our results suggest that in obese individuals, VAT-derived leptin and chemerin, and hepatic expression of TNF, IGF1, IL1RN and PAI-1 are involved in the development of NAFLD features. Further, functional studies are warranted to establish a causal relationship.
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Affiliation(s)
- M G M Wolfs
- Molecular Genetics Section, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - N Gruben
- Molecular Genetics Section, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S S Rensen
- Department of General Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht, The Netherlands
| | - F J Verdam
- Department of General Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht, The Netherlands
| | - J W Greve
- Department of General Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht, The Netherlands
| | - A Driessen
- 1] Department of Pathology, Maastricht University Medical Centre, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht, The Netherlands [2] Department of Pathology, University Hospital Antwerp, Edegem, Belgium
| | - C Wijmenga
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W A Buurman
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - L Franke
- 1] Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands [2] Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, London, UK
| | - L Scheja
- Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D P Y Koonen
- Molecular Genetics Section, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Shiri-Sverdlov
- Department of Molecular Genetics, Maastricht University, Maastricht, The Netherlands
| | - T W van Haeften
- 1] Molecular Genetics Section, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands [2] Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M H Hofker
- Molecular Genetics Section, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Fu
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Peters EG, Smeets BJJ, Dekkers M, Buise MD, de Jonge WJ, Slooter GD, Reilingh TSDV, Wegdam JA, Nieuwenhuijzen GAP, Rutten HJT, de Hingh IHJT, Hiligsmann M, Buurman WA, Luyer MDP. The effects of stimulation of the autonomic nervous system via perioperative nutrition on postoperative ileus and anastomotic leakage following colorectal surgery (SANICS II trial): a study protocol for a double-blind randomized controlled trial. Trials 2015; 16:20. [PMID: 25623276 PMCID: PMC4318130 DOI: 10.1186/s13063-014-0532-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/19/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Postoperative ileus and anastomotic leakage are important complications following colorectal surgery associated with short-term morbidity and mortality. Previous experimental and preclinical studies have shown that a short intervention with enriched enteral nutrition dampens inflammation via stimulation of the autonomic nervous system and thereby reduces postoperative ileus. Furthermore, early administration of enteral nutrition reduced anastomotic leakage. This study will investigate the effect of nutritional stimulation of the autonomic nervous system just before, during and early after colorectal surgery on inflammation, postoperative ileus and anastomotic leakage. METHODS/DESIGN This multicenter, prospective, double-blind, randomized controlled trial will include 280 patients undergoing colorectal surgery. All patients will receive a selfmigrating nasojejunal tube that will be connected to a specially designed blinded tubing system. Patients will be allocated either to the intervention group, receiving perioperative nutrition, or to the control group, receiving no nutrition. The primary endpoint is postoperative ileus. Secondary endpoints include anastomotic leakage, local and systemic inflammation, (aspiration) pneumonia, surgical complications classified according to Clavien-Dindo, quality of life, gut barrier integrity and time until functional recovery. Furthermore, a cost-effectiveness analysis will be performed. DISCUSSION Activation of the autonomic nervous system via perioperative enteral feeding is expected to dampen the local and systemic inflammatory response. Consequently, postoperative ileus will be reduced as well as anastomotic leakage. The present study is the first to investigate the effects of enriched nutrition given shortly before, during and after surgery in a clinical setting. TRIAL REGISTRATION ClinicalTrials.gov: NCT02175979 - date of registration: 25 June 2014. Dutch Trial Registry: NTR4670 - date of registration: 1 August 2014.
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Affiliation(s)
- Emmeline G Peters
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands. .,Academic Medical Center, Tytgat Institute for Intestinal and Liver Research, Department of Gastroenterology, Meibergdreef 69-71, 1105 BK, Amsterdam, The Netherlands.
| | - Boudewijn J J Smeets
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Marloes Dekkers
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Marc D Buise
- Department of Anesthesiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Wouter J de Jonge
- Academic Medical Center, Tytgat Institute for Intestinal and Liver Research, Department of Gastroenterology, Meibergdreef 69-71, 1105 BK, Amsterdam, The Netherlands.
| | - Gerrit D Slooter
- Department of Surgery, Maxima Medical Center, De Run 4600, 5504 DB, Veldhoven, The Netherlands.
| | | | - Johannes A Wegdam
- Department of Surgery, Elkerliek Hospital, Wesselmanlaan 25, 5707 HA, Helmond, The Netherlands.
| | - Grard A P Nieuwenhuijzen
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Ignace H J T de Hingh
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Mickael Hiligsmann
- Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands.
| | - Wim A Buurman
- Institute MHeNS, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Misha D P Luyer
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
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van den Heijkant TC, Costes LMM, van der Lee DGC, Aerts B, Osinga-de Jong M, Rutten HRM, Hulsewé KWE, de Jonge WJ, Buurman WA, Luyer MDP. Randomized clinical trial of the effect of gum chewing on postoperative ileus and inflammation in colorectal surgery. Br J Surg 2014; 102:202-11. [PMID: 25524125 DOI: 10.1002/bjs.9691] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/01/2014] [Accepted: 09/30/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Postoperative ileus (POI) is a common complication following colorectal surgery that delays recovery and increases length of hospital stay. Gum chewing may reduce POI and therefore enhance recovery after surgery. The aim of the study was to evaluate the effect of gum chewing on POI, length of hospital stay and inflammatory parameters. METHODS Patients undergoing elective colorectal surgery in one of two centres were randomized to either chewing gum or a dermal patch (control). Chewing gum was started before surgery and stopped when oral intake was resumed. Primary endpoints were POI and length of stay. Secondary endpoints were systemic and local inflammation, and surgical complications. Gastric emptying was measured by ultrasonography. Soluble tumour necrosis factor receptor 1 (TNFRSF1A) and interleukin (IL) 8 levels were measured by enzyme-linked immunosorbent assay. RESULTS Between May 2009 and September 2012, 120 patients were randomized to chewing gum (58) or dermal patch (control group; 62). Mean(s.d.) length of hospital stay was shorter in the chewing gum group than in controls, but this difference was not significant: 9·5(4·9) versus 14·0(14·5) days respectively. Some 14 (27 per cent) of 52 analysed patients allocated to chewing gum developed POI compared with 29 (48 per cent) of 60 patients in the control group (P = 0·020). More patients in the chewing gum group first defaecated within 4 days of surgery (85 versus 57 per cent; P = 0·006) and passed first flatus within 48 h (65 versus 50 per cent; P = 0·044). The decrease in antral area measured by ultrasonography following a standard meal was significantly greater among patients who chewed gum: median 25 (range -36 to 54) per cent compared with 10 (range -152 to 54) per cent in controls (P = 0·004). Levels of IL-8 (133 versus 288 pg/ml; P = 0·045) and TNFRSF1A (0·74 versus 0·92 ng/ml; P = 0·043) were lower among patients in the chewing gum group. Fewer patients in this group developed a grade IIIb complication (2 of 58 versus 10 of 62; P = 0·031). CONCLUSION Gum chewing is a safe and simple treatment to reduce POI, and is associated with a reduction in systemic inflammatory markers and complications. REGISTRATION NUMBER NTR2867 (http://www.trialregister.nl).
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Plat J, Hendrikx T, Bieghs V, Jeurissen MLJ, Walenbergh SMA, van Gorp PJ, De Smet E, Konings M, Vreugdenhil ACE, Guichot YD, Rensen SS, Buurman WA, Greve JWM, Lütjohann D, Mensink RP, Shiri-Sverdlov R. Protective role of plant sterol and stanol esters in liver inflammation: insights from mice and humans. PLoS One 2014; 9:e110758. [PMID: 25356831 PMCID: PMC4214692 DOI: 10.1371/journal.pone.0110758] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/23/2014] [Indexed: 01/22/2023] Open
Abstract
The inflammatory component of non-alcoholic steatohepatitis (NASH) can lead to irreversible liver damage. Therefore there is an urgent need to identify novel interventions to combat hepatic inflammation. In mice, omitting cholesterol from the diet reduced hepatic inflammation. Considering the effects of plant sterol/stanol esters on cholesterol metabolism, we hypothesized that plant sterol/stanol esters reduces hepatic inflammation. Indeed, adding plant sterol/stanol esters to a high-fat-diet reduced hepatic inflammation as indicated by immunohistochemical stainings and gene expression for inflammatory markers. Finally, adding sterol/stanol esters lowered hepatic concentrations of cholesterol precursors lathosterol and desmosterol in mice, which were highly elevated in the HFD group similarly as observed in severely obese patients with NASH. In vitro, in isolated LPS stimulated bone marrow derived macrophages desmosterol activated cholesterol efflux whereas sitostanol reduced inflammation. This highly interesting observation that plant sterol/stanol ester consumption leads to complete inhibition of HFD-induced liver inflammation opens new venues in the treatment and prevention of hepatic inflammation.
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Affiliation(s)
- Jogchum Plat
- Department of Human Biology, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
- * E-mail: (JP); (RSS)
| | - Tim Hendrikx
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Veerle Bieghs
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Mike L. J. Jeurissen
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Sofie M. A. Walenbergh
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Patrick J. van Gorp
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Els De Smet
- Department of Human Biology, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Maurice Konings
- Department of Human Biology, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Anita C. E. Vreugdenhil
- Department of Pediatrics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Yasmin Dias Guichot
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Sander S. Rensen
- Department of General Surgery, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Wim A. Buurman
- Department of General Surgery, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Jan Willem M. Greve
- Department of General Surgery, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
- Atrium Medical Center Parkstad, Heerlen, the Netherlands
| | - Dieter Lütjohann
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Ronald P. Mensink
- Department of Human Biology, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Ronit Shiri-Sverdlov
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
- * E-mail: (JP); (RSS)
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Segers FM, Verdam FJ, de Jonge C, Boonen B, Driessen A, Shiri-Sverdlov R, Bouvy ND, Greve JWM, Buurman WA, Rensen SS. Complement alternative pathway activation in human nonalcoholic steatohepatitis. PLoS One 2014; 9:e110053. [PMID: 25299043 PMCID: PMC4192551 DOI: 10.1371/journal.pone.0110053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/08/2014] [Indexed: 01/07/2023] Open
Abstract
The innate immune system plays a major role in the pathogenesis of nonalcoholic steatohepatitis (NASH). Recently we reported complement activation in human NASH. However, it remained unclear whether the alternative pathway of complement, which amplifies C3 activation and which is frequently associated with pathological complement activation leading to disease, was involved. Here, alternative pathway components were investigated in liver biopsies of obese subjects with healthy livers (n = 10) or with NASH (n = 12) using quantitative PCR, Western blotting, and immunofluorescence staining. Properdin accumulated in areas where neutrophils surrounded steatotic hepatocytes, and colocalized with the C3 activation product C3c. C3 activation status as expressed by the C3c/native C3 ratio was 2.6-fold higher (p<0.01) in subjects with NASH despite reduced native C3 concentrations (0.94±0.12 vs. 0.57±0.09; p<0.01). Hepatic properdin levels positively correlated with levels of C3c (rs = 0.69; p<0.05) and C3c/C3 activation ratio (rs = 0.59; p<0.05). C3c, C3 activation status (C3c/C3 ratio) and properdin levels increased with higher lobular inflammation scores as determined according to the Kleiner classification (C3c: p<0.01, C3c/C3 ratio: p<0.05, properdin: p<0.05). Hepatic mRNA expression of factor B and factor D did not differ between subjects with healthy livers and subjects with NASH (factor B: 1.00±0.19 vs. 0.71±0.07, p = 0.26; factor D: 1.00±0.21 vs. 0.66±0.14, p = 0.29;). Hepatic mRNA and protein levels of Decay Accelerating Factor tended to be increased in subjects with NASH (mRNA: 1.00±0.14 vs. 2.37±0.72; p = 0.22; protein: 0.51±0.11 vs. 1.97±0.67; p = 0.28). In contrast, factor H mRNA was downregulated in patients with NASH (1.00±0.09 vs. 0.71±0.06; p<0.05) and a similar trend was observed with hepatic protein levels (1.12±0.16 vs. 0.78±0.07; p = 0.08). Collectively, these data suggest a role for alternative pathway activation in driving hepatic inflammation in NASH. Therefore, alternative pathway factors may be considered attractive targets for treating NASH by inhibiting complement activation.
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Affiliation(s)
- Filip M. Segers
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Froukje J. Verdam
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Charlotte de Jonge
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Department of Surgery, Atrium Medical Centre Parkstad, Heerlen, the Netherlands
| | - Bas Boonen
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Ann Driessen
- Department of Pathology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Ronit Shiri-Sverdlov
- Department of Genetics and Cell Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Nicole D. Bouvy
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Jan Willem M. Greve
- Department of Surgery, Atrium Medical Centre Parkstad, Heerlen, the Netherlands
| | - Wim A. Buurman
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Sander S. Rensen
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- * E-mail:
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Bonder MJ, Kasela S, Kals M, Tamm R, Lokk K, Barragan I, Buurman WA, Deelen P, Greve JW, Ivanov M, Rensen SS, van Vliet-Ostaptchouk JV, Wolfs MG, Fu J, Hofker MH, Wijmenga C, Zhernakova A, Ingelman-Sundberg M, Franke L, Milani L. Genetic and epigenetic regulation of gene expression in fetal and adult human livers. BMC Genomics 2014; 15:860. [PMID: 25282492 PMCID: PMC4287518 DOI: 10.1186/1471-2164-15-860] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/24/2014] [Indexed: 01/07/2023] Open
Abstract
Background The liver plays a central role in the maintenance of homeostasis and health in general. However, there is substantial inter-individual variation in hepatic gene expression, and although numerous genetic factors have been identified, less is known about the epigenetic factors. Results By analyzing the methylomes and transcriptomes of 14 fetal and 181 adult livers, we identified 657 differentially methylated genes with adult-specific expression, these genes were enriched for transcription factor binding sites of HNF1A and HNF4A. We also identified 1,000 genes specific to fetal liver, which were enriched for GATA1, STAT5A, STAT5B and YY1 binding sites. We saw strong liver-specific effects of single nucleotide polymorphisms on both methylation levels (28,447 unique CpG sites (meQTL)) and gene expression levels (526 unique genes (eQTL)), at a false discovery rate (FDR) < 0.05. Of the 526 unique eQTL associated genes, 293 correlated significantly not only with genetic variation but also with methylation levels. The tissue-specificities of these associations were analyzed in muscle, subcutaneous adipose tissue and visceral adipose tissue. We observed that meQTL were more stable between tissues than eQTL and a very strong tissue-specificity for the identified associations between CpG methylation and gene expression. Conclusions Our analyses generated a comprehensive resource of factors involved in the regulation of hepatic gene expression, and allowed us to estimate the proportion of variation in gene expression that could be attributed to genetic and epigenetic variation, both crucial to understanding differences in drug response and the etiology of liver diseases. Electronic supplementary material The online version of this article (doi:10.1186/1471-2164-15-860) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lude Franke
- University of Groningen, University Medical Center Groningen, Department of Genetics, Hanzeplein 1, 9700 RB Groningen, the Netherlands.
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Hoffmann C, Nogales-gadea G, Stevens J, Losen M, Szoke A, Leboyer M, De Hert M, Van Beveren NJ, Molenaar P, Buurman WA, De Baets MH, Rutten BB, Van Os J, Martinez-Martinez P. Analysis of pathogenic autoantibodies against the N-methyl-d-aspartate glutamate receptor in schizophrenia. J Neuroimmunol 2014. [DOI: 10.1016/j.jneuroim.2014.08.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vermeulen Windsant IC, de Wit NCJ, Sertorio JTC, van Bijnen AA, Ganushchak YM, Heijmans JH, Tanus-Santos JE, Jacobs MJ, Maessen JG, Buurman WA. Hemolysis during cardiac surgery is associated with increased intravascular nitric oxide consumption and perioperative kidney and intestinal tissue damage. Front Physiol 2014; 5:340. [PMID: 25249983 PMCID: PMC4157603 DOI: 10.3389/fphys.2014.00340] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/20/2014] [Indexed: 12/13/2022] Open
Abstract
Introduction: Acute kidney injury (AKI) and intestinal injury negatively impact patient outcome after cardiac surgery. Enhanced nitric oxide (NO) consumption due to intraoperative intravascular hemolysis, may play an important role in this setting. This study investigated the impact of hemolysis on plasma NO consumption, AKI, and intestinal tissue damage, after cardiac surgery. Methods: Hemolysis (by plasma extracellular (free) hemoglobin; fHb), plasma NO-consumption, plasma fHb-binding capacity by haptoglobin (Hp), renal tubular injury (using urinary N-Acetyl-β-D-glucosaminidase; NAG), intestinal mucosal injury (through plasma intestinal fatty acid binding protein; IFABP), and AKI were studied in patients undergoing off-pump cardiac surgery (OPCAB, N = 7), on-pump coronary artery bypass grafting (CABG, N = 30), or combined CABG and valve surgery (CABG+Valve, N = 30). Results: FHb plasma levels and NO-consumption significantly increased, while plasma Hp concentrations significantly decreased in CABG and CABG+Valve patients (p < 0.0001) during surgery. The extent of hemolysis and NO-consumption correlated significantly (r2 = 0.75, p < 0.0001). Also, NAG and IFABP increased in both groups (p < 0.0001, and p < 0.001, respectively), and both were significantly associated with hemolysis (Rs = 0.70, p < 0.0001, and Rs = 0.26, p = 0.04, respectively) and NO-consumption (Rs = 0.55, p = 0.002, and Rs = 0.41, p = 0.03, respectively), also after multivariable logistic regression analysis. OPCAB patients did not show increased fHb, NO-consumption, NAG, or IFABP levels. Patients suffering from AKI (N = 9, 13.4%) displayed significantly higher fHb and NAG levels already during surgery compared to non-AKI patients. Conclusions: Hemolysis appears to be an important contributor to postoperative kidney injury and intestinal mucosal damage, potentially by limiting NO-bioavailability. This observation offers a novel diagnostic and therapeutic target to improve patient outcome after cardiothoracic surgery.
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Affiliation(s)
- Iris C Vermeulen Windsant
- Department of Surgery, Maastricht University Medical Center Maastricht, Netherlands ; NUTRIM School for Nutrition, Toxicology & Metabolism, Maastricht University Medical Center Maastricht, Netherlands
| | - Norbert C J de Wit
- Central Diagnostic Laboratory, Maastricht University Medical Center Maastricht, Netherlands
| | - Jonas T C Sertorio
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paolo Ribeirao Preto, Brazil
| | - Annemarie A van Bijnen
- Department of Surgery, Maastricht University Medical Center Maastricht, Netherlands ; NUTRIM School for Nutrition, Toxicology & Metabolism, Maastricht University Medical Center Maastricht, Netherlands
| | - Yuri M Ganushchak
- Department of Extracorporeal Circulation, Maastricht University Medical Center Maastricht, Netherlands
| | - John H Heijmans
- Department of Anesthesiology, Maastricht University Medical Center Maastricht, Netherlands
| | - Jose E Tanus-Santos
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paolo Ribeirao Preto, Brazil
| | - Michael J Jacobs
- Department of Surgery, Maastricht University Medical Center Maastricht, Netherlands ; Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht, Netherlands ; Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, University Hospital Aachen Aachen, Germany
| | - Jos G Maessen
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht, Netherlands ; Department of Cardiothoracic Surgery, Maastricht University Medical Center Maastricht, Netherlands
| | - Wim A Buurman
- Department of Surgery, Maastricht University Medical Center Maastricht, Netherlands ; Central Diagnostic Laboratory, Maastricht University Medical Center Maastricht, Netherlands
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Keszthelyi D, Troost FJ, Jonkers DM, van Eijk HM, Lindsey PJ, Dekker J, Buurman WA, Masclee AAM. Serotonergic reinforcement of intestinal barrier function is impaired in irritable bowel syndrome. Aliment Pharmacol Ther 2014; 40:392-402. [PMID: 24943480 DOI: 10.1111/apt.12842] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/09/2014] [Accepted: 05/28/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alterations in serotonergic (5-HT) metabolism and/or intestinal integrity have been associated with irritable bowel syndrome (IBS). AIMS To assess the effects of the precursor of 5-HT, 5-hydroxytryptophan (5-HTP), on mucosal 5-HT availability and intestinal integrity, and to assess potential differences between healthy controls and IBS patients. METHODS Fifteen IBS patients and 15 healthy volunteers participated in this randomised double-blind placebo-controlled study. Intestinal integrity was assessed by dual-sugar test and by determining the mucosal expression of tight junction proteins after ingestion of an oral bolus of 100 mg 5-HTP or placebo. Mucosal serotonergic metabolism was assessed in duodenal biopsy samples. RESULTS 5-HTP administration significantly increased mucosal levels of 5-HIAA, the main metabolite of 5-HT, in both healthy controls (7.1 ± 1.7 vs. 2.5 ± 0.7 pmol/mg, 5-HTP vs. placebo, P = 0.02) and IBS patients (20.0 ± 4.8 vs. 8.1 ± 1.3 pmol/mg, 5-HTP vs. placebo, P = 0.02), with the latter group showing a significantly larger increase. Lactulose/L-rhamnose ratios were significantly lower after administration of 5-HTP (P < 0.05) in healthy controls and were accompanied by redistribution of zonula occludens-1 (ZO-1), pointing to reinforcement of the barrier. In IBS, expression of the tight junction proteins was significantly lower compared to healthy controls, and 5-HTP resulted in a further decrease in occludin expression. CONCLUSIONS Oral 5-HTP induced alterations in mucosal 5-HT metabolism. In healthy controls, a reinforcement of the intestinal barrier was seen whereas such reaction was absent in IBS patients. This could indicate the presence of a serotonin-mediated mechanism aimed to reinforce intestinal barrier function, which seems to dysfunction in IBS patients.
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Affiliation(s)
- D Keszthelyi
- Top Institute Food and Nutrition, Wageningen, The Netherlands; Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Gomez AM, Willcox N, Vrolix K, Hummel J, Nogales-Gadea G, Saxena A, Duimel H, Verheyen F, Molenaar PC, Buurman WA, De Baets MH, Martinez-Martinez P, Losen M. Proteasome inhibition with bortezomib depletes plasma cells and specific autoantibody production in primary thymic cell cultures from early-onset myasthenia gravis patients. J Immunol 2014; 193:1055-1063. [PMID: 24973445 DOI: 10.4049/jimmunol.1301555] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bortezomib is a potent inhibitor of proteasomes currently used to eliminate malignant plasma cells in multiple myeloma patients. It is also effective in depleting both alloreactive plasma cells in acute Ab-mediated transplant rejection and their autoreactive counterparts in animal models of lupus and myasthenia gravis (MG). In this study, we demonstrate that bortezomib at 10 nM or higher concentrations killed long-lived plasma cells in cultured thymus cells from nine early-onset MG patients and consistently halted their spontaneous production not only of autoantibodies against the acetylcholine receptor but also of total IgG. Surprisingly, lenalidomide and dexamethasone had little effect on plasma cells. After bortezomib treatment, they showed ultrastructural changes characteristic of endoplasmic reticulum stress after 8 h and were no longer detectable at 24 h. Bortezomib therefore appears promising for treating MG and possibly other Ab-mediated autoimmune or allergic disorders, especially when given in short courses at modest doses before the standard immunosuppressive drugs have taken effect.
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Affiliation(s)
- Alejandro M Gomez
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Nick Willcox
- Department of Clinical Neurology, University of Oxford, UK
| | - Kathleen Vrolix
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Jonas Hummel
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Gisela Nogales-Gadea
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Neuromuscular Diseases Unit, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Abhishek Saxena
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Hans Duimel
- ELMI Unit-CRISP, Department of Molecular Cell Biology, Maastricht University, Maastricht, the Netherlands
| | - Fons Verheyen
- ELMI Unit-CRISP, Department of Molecular Cell Biology, Maastricht University, Maastricht, the Netherlands
| | - Peter C Molenaar
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Wim A Buurman
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Marc H De Baets
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Pilar Martinez-Martinez
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Mario Losen
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Rutten EPA, Lenaerts K, Buurman WA, Wouters EFM. Disturbed intestinal integrity in patients with COPD: effects of activities of daily living. Chest 2014; 145:245-252. [PMID: 23928850 DOI: 10.1378/chest.13-0584] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND COPD is accepted to be a multicomponent disease with various comorbidities. To our knowledge, the contribution of the GI tract to the systemic manifestation of COPD has never been investigated. This metabolically active organ may experience recurring local oxygen deficits during daily life, leading to disturbed intestinal integrity in patients with COPD. METHODS Eighteen patients with moderate COPD (mean FEV₁, 55 ± 3% predicted) and 14 matched healthy control subjects were tested on two occasions: a baseline measurement at rest and, on another day, during the performance of activities of daily living (ADLs). To assess enterocyte damage, plasma intestinal fatty acid binding protein (IFABP) levels were determined, whereas urinary excretion of orally ingested sugar probes was measured using liquid chromatography and mass spectrometry to assess GI permeability. RESULTS Plasma IFABP concentrations were not different between patients with COPD and healthy control subjects at rest. In contrast, 0- to 3-h urinary lactulose to rhamnose and sucralose to erythritol ratios and 5- to 24-h urinary sucralose to erythritol ratios were significantly higher in patients with COPD compared with control subjects, indicating increased permeability of the small intestine and colon. Furthermore, the performance of ADLs led to significantly increased plasma IFABP concentrations in patients with COPD but not in control subjects. Similarly, the intestinal permeability difference between patients and control subjects was intensified. CONCLUSIONS Besides an altered intestinal permeability in patients with COPD when at rest, performing ADLs led to enterocyte damage in addition to intestinal hyperpermeability in patients with COPD but not in control subjects, indicating functional alteration in the GI tract. Hence, intestinal compromise should be considered as a new component of the multisystem disorder COPD. TRIAL REGISTRY ISRCTN Register; No.: ISRCTN33686980; URL: www.controlled-trials.com.
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Affiliation(s)
- Erica P A Rutten
- Centre of expertise for chronic organ failure (Ciro), Horn, The Netherlands
| | - Kaatje Lenaerts
- Centre of expertise for chronic organ failure (Ciro), Horn, The Netherlands; Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wim A Buurman
- Centre of expertise for chronic organ failure (Ciro), Horn, The Netherlands; Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Emiel F M Wouters
- Centre of expertise for chronic organ failure (Ciro), Horn, The Netherlands; Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Gaens KHJ, Goossens GH, Niessen PM, van Greevenbroek MM, van der Kallen CJH, Niessen HW, Rensen SS, Buurman WA, Greve JWM, Blaak EE, van Zandvoort MA, Bierhaus A, Stehouwer CDA, Schalkwijk CG. Nε-(carboxymethyl)lysine-receptor for advanced glycation end product axis is a key modulator of obesity-induced dysregulation of adipokine expression and insulin resistance. Arterioscler Thromb Vasc Biol 2014; 34:1199-208. [PMID: 24723555 DOI: 10.1161/atvbaha.113.302281] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Dysregulation of inflammatory adipokines by the adipose tissue plays an important role in obesity-associated insulin resistance. Pathways leading to this dysregulation remain largely unknown. We hypothesized that the receptor for advanced glycation end products (RAGE) and the ligand N(ε)-(carboxymethyl)lysine (CML) are increased in adipose tissue and, moreover, that activation of the CML-RAGE axis plays an important role in obesity-associated inflammation and insulin resistance. APPROACH AND RESULTS In this study, we observed a strong CML accumulation and increased expression of RAGE in adipose tissue in obesity. We confirmed in cultured human preadipocytes that adipogenesis is associated with increased levels of CML and RAGE. Moreover, CML induced a dysregulation of inflammatory adipokines in adipocytes via a RAGE-dependent pathway. To test the role of RAGE in obesity-associated inflammation further, we constructed an obese mouse model that is deficient for RAGE (ie, RAGE(-/-)/Leptr(Db-/-) mice). RAGE(-/-)/Leptr(Db-/-) mice displayed an improved inflammatory profile and glucose homeostasis when compared with RAGE(+/+)/Leptr(Db-/-) mice. In addition, CML was trapped in adipose tissue in RAGE(+/+)/Leptr(Db-/-) mice but not in RAGE(-/-)/Leptr(Db-/-). RAGE-mediated trapping in adipose tissue provides a mechanism underlying CML accumulation in adipose tissue and explaining decreased CML plasma levels in obese subjects. Decreased CML plasma levels in obese individuals were strongly associated with insulin resistance. CONCLUSIONS RAGE-mediated CML accumulation in adipose tissue and the activation of the CML-RAGE axis are important mechanisms involved in the dysregulation of adipokines in obesity, thereby contributing to the development of obesity-associated insulin resistance.
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Affiliation(s)
- Katrien H J Gaens
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Gijs H Goossens
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Petra M Niessen
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Marleen M van Greevenbroek
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Carla J H van der Kallen
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Hans W Niessen
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Sander S Rensen
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Wim A Buurman
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Jan Willem M Greve
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Ellen E Blaak
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Marc A van Zandvoort
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Angelika Bierhaus
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Coen D A Stehouwer
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Casper G Schalkwijk
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.).
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Schueth A, van Zandvoort MAMJ, Buurman WA, van Koeveringe GA. Murine bladder imaging by 2-photon microscopy: an experimental study of morphology. J Urol 2014; 192:973-80. [PMID: 24704014 DOI: 10.1016/j.juro.2014.03.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE We developed 2-photon laser scanning microscopy analysis of the native murine bladder. MATERIALS AND METHODS Bladder tissue from wild-type mice was imaged by 2-photon laser scanning microscopy autofluorescence and second harmonic generation microscopy. Bladder wall layers and structures were analyzed using differences in color, size, shape and morphology. RESULTS Autofluorescence of the urothelium, nerve structures and muscles was visible in the green spectral channel due to autofluorochromes such as NAD(P)H and elastin. Second harmonic generation of collagen was seen in the blue spectral channel. Imaging from the mucosal side revealed umbrella cells at 0 and 30 μm, of which the high cellular NAD(P)H content allows autofluorescence detection. Below that a network-like connective tissue layer was visualized up to 50 μm that contained vessels with a diameter of 10 to 40 μm and nerves with a diameter of 1 to 6 μm. Imaging from the adventitial side revealed a radiant collagen layer covered with nerves and macrophages at 0 to 20 μm. Below at 20 to 25 μm we visualized a thick muscle layer containing elastic fibers and macrophages. Findings were also represented in 3-dimensional reconstructions, providing information on structure localization, orientation and interconnection. CONCLUSIONS Two-photon laser scanning microscopy imaging using autofluorescence of the murine bladder is a promising technique to provide new insight into structures and morphology. It opens avenues to identify structural changes in bladder pathology.
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Affiliation(s)
- Anna Schueth
- Department of Urology, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Marc A M J van Zandvoort
- Department of Genetics and Cell Biology-Molecular Cell Biology, School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands; Institute for Molecular Cardiovascular Research, Rheinisch-Westfälische Technische Hochschule Aachen University of Aachen, Aachen, Germany
| | - Wim A Buurman
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Gommert A van Koeveringe
- Department of Urology, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Reisinger KW, Kramer BW, Van der Zee DC, Brouwers HAA, Buurman WA, van Heurn E, Derikx JPM. Non-invasive serum amyloid A (SAA) measurement and plasma platelets for accurate prediction of surgical intervention in severe necrotizing enterocolitis (NEC). PLoS One 2014; 9:e90834. [PMID: 24603723 PMCID: PMC3946234 DOI: 10.1371/journal.pone.0090834] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/05/2014] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the value of biomarkers to detect severe NEC. Summary Background Data The time point of surgery in necrotizing enterocolitis (NEC) is critical. Therefore, there is a need for markers that detect severe NEC, because clinical signs of severe NEC often develop late. This study evaluated the value of biomarkers reflecting intestinal cell damage and inflammation to detect severe NEC. Methods 29 neonates with NEC were included. Two definitions of moderate versus severe NEC were analyzed: medical NEC (n = 12) versus surgical or fatal NEC (n = 17); and Bell stage II NEC (n = 13) versus stage III NEC (n = 16). Urinary intestinal fatty acid binding protein (I-FABP), serum amyloid A (SAA), C3a and C5a, and fecal calprotectin were measured. C-reactive protein (CRP), white blood cell count (WBC) and platelet count data were measured in blood. Results In both definitions of moderate versus severe NEC, urinary SAA levels were significantly higher in severe NEC. A cut-off value of 34.4 ng/ml was found in surgical NEC versus medical NEC (sensitivity, 83%; specificity, 83%; LR+, 4.88 (95% CI, 1.37–17.0); LR−, 0.20 (95% CI, 0.07–0.60)) at diagnosis of NEC and at one day prior to surgery in neonates who were operated later on. Combination of urinary SAA and platelet count increased the accuracy, with a sensitivity, 94%; specificity, 83%; LR+, 5.53 (95% CI, 1.57–20.0); and LR−, 0.07 (95% CI, 0.01–0.48). Conclusion Urinary SAA is an accurate marker in differentiating severe NEC from moderate NEC; particularly if combined with serum platelet count.
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Affiliation(s)
- Kostan W. Reisinger
- Department of Surgery, Maastricht University Medical Centre, and Nutrition and Toxicology Research Institute (NUTRIM), Maastricht, the Netherlands
- * E-mail:
| | - Boris W. Kramer
- Department of Pediatrics, Maastricht University Medical Centre, and School for Oncology and Developmental Biology (GROW), School of Mental Health and Neurosciences, Maastricht, the Netherlands
| | - David C. Van der Zee
- Department of Surgery, Wilhelmina Children’s Hospital, University Medical Centre, Utrecht, the Netherlands
| | - Hens A. A. Brouwers
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Centre, Utrecht, the Netherlands
| | - Wim A. Buurman
- Formerly Department of Surgery, currently Maastricht University Medical Centre, NUTRIM Institute, Maastricht, the Netherlands
| | - Ernest van Heurn
- Department of Surgery, Maastricht University Medical Centre, and Nutrition and Toxicology Research Institute (NUTRIM), Maastricht, the Netherlands
| | - Joep P. M. Derikx
- Department of Surgery, Maastricht University Medical Centre, and Nutrition and Toxicology Research Institute (NUTRIM), Maastricht, the Netherlands
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41
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Wijnands KAP, Hoeksema MA, Meesters DM, van den Akker NMS, Molin DGM, Briedé JJ, Ghosh M, Köhler SE, van Zandvoort MAMJ, de Winther MPJ, Buurman WA, Lamers WH, Poeze M. Arginase-1 deficiency regulates arginine concentrations and NOS2-mediated NO production during endotoxemia. PLoS One 2014; 9:e86135. [PMID: 24465919 PMCID: PMC3897658 DOI: 10.1371/journal.pone.0086135] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 12/04/2013] [Indexed: 12/15/2022] Open
Abstract
Rationale and objective Arginase-1 is an important component of the intricate mechanism regulating arginine availability during immune responses and nitric oxide synthase (NOS) activity. In this study Arg1fl/fl/Tie2-Cretg/− mice were developed to investigate the effect of arginase-1 related arginine depletion on NOS2- and NOS3-dependent NO production and jejunal microcirculation under resting and endotoxemic conditions, in mice lacking arginase-1 in endothelial and hematopoietic cells. Methods and Results Arginase-1-deficient mice as compared with control mice exhibited higher plasma arginine concentration concomitant with enhanced NO production in endothelial cells and jejunal tissue during endotoxemia. In parallel, impaired jejunal microcirculation was observed in endotoxemic conditions. Cultured bone-marrow-derived macrophages of arginase-1 deficient animals also presented a higher inflammatory response to endotoxin than control littermates. Since NOS2 competes with arginase for their common substrate arginine during endotoxemia, Nos2 deficient mice were also studied under endotoxemic conditions. As Nos2−/− macrophages showed an impaired inflammatory response to endotoxin compared to wild-type macrophages, NOS2 is potentially involved. A strongly reduced NO production in Arg1fl/fl/Tie2-Cretg/− mice following infusion of the NOS2 inhibitor 1400W further implicated NOS2 in the enhanced capacity to produce NO production Arg1fl/fl/Tie2-Cretg/− mice. Conclusions Reduced arginase-1 activity in Arg1fl/fl/Tie2-Cretg/− mice resulted in increased inflammatory response and NO production by NOS2, accompanied by a depressed microcirculatory flow during endotoxemia. Thus, arginase-1 deficiency facilitates a NOS2-mediated pro-inflammatory activity at the expense of NOS3-mediated endothelial relaxation.
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Affiliation(s)
- Karolina A. P. Wijnands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands
- * E-mail:
| | - Marten A. Hoeksema
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Dennis M. Meesters
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nynke M. S. van den Akker
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM Cardiovascular Research Institute of Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Physiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Daniel G. M. Molin
- CARIM Cardiovascular Research Institute of Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Physiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jacob J. Briedé
- Department of Toxicogenomics, Maastricht University Medical Centre, Maastricht, the Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Mitrajit Ghosh
- CARIM Cardiovascular Research Institute of Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Genetics & cell Biology, Section Molecular Cell Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - S. Eleonore Köhler
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Anatomy & Embryology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marc A. M. J. van Zandvoort
- CARIM Cardiovascular Research Institute of Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Genetics & cell Biology, Section Molecular Cell Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Menno P. J. de Winther
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Wim A. Buurman
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Wouter H. Lamers
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Anatomy & Embryology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Martijn Poeze
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands
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42
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Vrolix K, Fraussen J, Losen M, Stevens J, Lazaridis K, Molenaar PC, Somers V, Bracho MA, Le Panse R, Stinissen P, Berrih-Aknin S, Maessen JG, Van Garsse L, Buurman WA, Tzartos SJ, De Baets MH, Martinez-Martinez P. Clonal heterogeneity of thymic B cells from early-onset myasthenia gravis patients with antibodies against the acetylcholine receptor. J Autoimmun 2014; 52:101-12. [PMID: 24439114 DOI: 10.1016/j.jaut.2013.12.008] [Citation(s) in RCA: 36] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
Abstract
Myasthenia gravis (MG) with antibodies against the acetylcholine receptor (AChR-MG) is considered as a prototypic autoimmune disease. The thymus is important in the pathophysiology of the disease since thymus hyperplasia is a characteristic of early-onset AChR-MG and patients often improve after thymectomy. We hypothesized that thymic B cell and antibody repertoires of AChR-MG patients differ intrinsically from those of control individuals. Using immortalization with Epstein-Barr Virus and Toll-like receptor 9 activation, we isolated and characterized monoclonal B cell lines from 5 MG patients and 8 controls. Only 2 of 570 immortalized B cell clones from MG patients produced antibodies against the AChR (both clones were from the same patient), suggesting that AChR-specific B cells are not enriched in the thymus. Surprisingly, many B cell lines from both AChR-MG and control thymus samples displayed reactivity against striated muscle proteins. Striational antibodies were produced by 15% of B cell clones from AChR-MG versus 6% in control thymus. The IgVH gene sequence analysis showed remarkable similarities, concerning VH family gene distribution, mutation frequency and CDR3 composition, between B cells of AChR-MG patients and controls. MG patients showed clear evidence of clonal B cell expansion in contrast to controls. In this latter aspect, MG resembles multiple sclerosis and clinically isolated syndrome, but differs from systemic lupus erythematosus. Our results support an antigen driven immune response in the MG thymus, but the paucity of AChR-specific B cells, in combination with the observed polyclonal expansions suggest a more diverse immune response than expected.
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Affiliation(s)
- Kathleen Vrolix
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Judith Fraussen
- Neuroimmunology group, Biomedical Research Institute and Transnationale Universiteit Limburg, School of Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Mario Losen
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jo Stevens
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | | | - Peter C Molenaar
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Veerle Somers
- Neuroimmunology group, Biomedical Research Institute and Transnationale Universiteit Limburg, School of Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Maria Alma Bracho
- Centre Superior d'Investigació en Salut Pública (CSISP), Àrea de Genòmica i Salut, Conselleria de Sanitat, Generalitat Valenciana, València, Spain; Institut "Cavanilles" de Biodiversitat i Biologia Evolutiva (ICBiBE), Universitat de València, València, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Ministerio de Ciencia e Innovación, Spain
| | - Rozen Le Panse
- UPMC UM 76/INSERM U974/CNRS UMR7215/Institute of Myology, 105 Bd de l'hôpital, Paris, France
| | - Piet Stinissen
- Neuroimmunology group, Biomedical Research Institute and Transnationale Universiteit Limburg, School of Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Sonia Berrih-Aknin
- UPMC UM 76/INSERM U974/CNRS UMR7215/Institute of Myology, 105 Bd de l'hôpital, Paris, France
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, University Hospital, Maastricht, The Netherlands
| | - Leen Van Garsse
- Department of Cardiothoracic Surgery, University Hospital, Maastricht, The Netherlands
| | - Wim A Buurman
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Socrates J Tzartos
- Department of Biochemistry, Hellenic Pasteur Institute, GR 11521 Athens, Greece
| | - Marc H De Baets
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Neuroimmunology group, Biomedical Research Institute and Transnationale Universiteit Limburg, School of Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Pilar Martinez-Martinez
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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43
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Bode GH, Losen M, Buurman WA, Veerhuis R, Molenaar PC, Steinbusch HWM, De Baets MH, Daha MR, Martinez-Martinez P. Complement activation by ceramide transporter proteins. J Immunol 2014; 192:1154-61. [PMID: 24395916 DOI: 10.4049/jimmunol.1301673] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
C1q is the initiator of the classical complement pathway and, as such, is essential for efficient opsonization and clearance of pathogens, altered self-structures, and apoptotic cells. The ceramide transporter protein (CERT) and its longer splicing isoform CERTL are known to interact with extracellular matrix components, such as type IV collagen, and with the innate immune protein serum amyloid P. In this article, we report a novel function of CERT in the innate immune response. Both CERT isoforms, when immobilized, were found to bind the globular head region of C1q and to initiate the classical complement pathway, leading to activation of C4 and C3, as well as generation of the membrane attack complex C5b-9. In addition, C1q was shown to bind to endogenous CERTL on the surface of apoptotic cells. These results demonstrate the role of CERTs in innate immunity, especially in the clearance of apoptotic cells.
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Affiliation(s)
- Gerard H Bode
- Division of Neuroscience, School for Mental Health and Neuroscience, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
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44
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de Jonge C, Rensen SS, D’Agnolo HMA, Bouvy ND, Buurman WA, Greve JWM. Six Months of Treatment with the Endoscopic Duodenal-Jejunal Bypass Liner Does Not Lead to Decreased Systemic Inflammation in Obese Patients with Type 2 Diabetes. Obes Surg 2013; 24:337-41. [DOI: 10.1007/s11695-013-1154-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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45
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Verdam FJ, Fuentes S, de Jonge C, Zoetendal EG, Erbil R, Greve JW, Buurman WA, de Vos WM, Rensen SS. Human intestinal microbiota composition is associated with local and systemic inflammation in obesity. Obesity (Silver Spring) 2013; 21:E607-15. [PMID: 23526699 DOI: 10.1002/oby.20466] [Citation(s) in RCA: 382] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 03/13/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Intestinal microbiota have been suggested to contribute to the development of obesity, but the mechanism remains elusive. The relationship between microbiota composition, intestinal permeability, and inflammation in nonobese and obese subjects was investigated. DESIGN AND METHODS Fecal microbiota composition of 28 subjects (BMI 18.6-60.3 kg m(-2) ) was analyzed by a phylogenetic profiling microarray. Fecal calprotectin and plasma C-reactive protein levels were determined to evaluate intestinal and systemic inflammation. Furthermore, HbA1c , and plasma levels of transaminases and lipids were analyzed. Gastroduodenal, small intestinal, and colonic permeability were assessed by a multisaccharide test. RESULTS Based on microbiota composition, the study population segregated into two clusters with predominantly obese (15/19) or exclusively nonobese (9/9) subjects. Whereas intestinal permeability did not differ between clusters, the obese cluster showed reduced bacterial diversity, a decreased Bacteroidetes/Firmicutes ratio, and an increased abundance of potential proinflammatory Proteobacteria. Interestingly, fecal calprotectin was only detectable in subjects within the obese microbiota cluster (n = 8/19, P = 0.02). Plasma C-reactive protein was also increased in these subjects (P = 0.0005), and correlated with the Bacteroidetes/Firmicutes ratio (rs = -0.41, P = 0.03). CONCLUSIONS Intestinal microbiota alterations in obese subjects are associated with local and systemic inflammation, suggesting that the obesity-related microbiota composition has a proinflammatory effect.
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Affiliation(s)
- Froukje J Verdam
- Department of General Surgery, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands; Department of General Surgery, Atrium Medical Center Parkstad, Heerlen, The Netherlands
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46
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de Jonge C, Rensen SS, Koek GH, Joosten MF, Buurman WA, Bouvy ND, Greve JWM. Endoscopic duodenal-jejunal bypass liner rapidly improves plasma parameters of nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2013; 11:1517-20. [PMID: 23920034 DOI: 10.1016/j.cgh.2013.07.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/16/2013] [Accepted: 07/15/2013] [Indexed: 02/07/2023]
Abstract
Bariatric surgery reduces nonalcoholic fatty liver disease (NAFLD). We investigated the effects of duodenal-jejunal bypass liner (DJBL), nonsurgical bariatric device, on plasma parameters of NAFLD. Seventeen obese subjects with type 2 diabetes received the DJBL for 24 weeks. Before, during, and after DJBL implantation, we determined plasma levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyltransferase (γ-GT), albumin, caspase-cleaved cytokeratin-18 (CK-18), and liver fatty acid-binding protein (L-FABP). At baseline, subjects had increased levels of AST (35 ± 4 IU/L), ALT (54 ± 5 IU/L), and γ-GT (66 ± 14 IU/L), compared with healthy individuals; subjects' mean concentrations of caspase-cleaved CK-18 and L-FABP were 214.4 ± 35.6 U/L and 29.3 ± 2.6 ng/mL, respectively. Three months after implantation of DJBL, all NAFLD-related parameters had decreased from baseline (AST, 28 ± 3 IU/L; ALT, 32 ± 2 IU/L; γ-GT, 44 ±7 IU/L; caspase-cleaved CK-18, 140.6 ± 16.3U/L; and L-FABP, 18.2 ± 1.5 ng/mL; all P < .05). After 6 months, levels of ALT and γ-GT had further decreased (ALT, 28 ± 2 IU/L and γ-GT, 35 ± 5 IU/L), whereas levels of AST, caspase-cleaved CK-18, and L-FABP had stabilized (P = not significant). Six months after DJBLs were removed, levels of ALT (37 ± 3 IU/L), γ-GT (42 ± 5 IU/L), and caspase-cleaved CK-18 (124.5 ± 12.5U/L) were still reduced (P < .05), whereas AST and L-FABP had returned to near baseline levels (P = not significant). Therefore, in obese subjects, DJBL reduces plasma parameters of NAFLD. ClinicalTrials.gov, Number: NCT00985114.
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Affiliation(s)
- Charlotte de Jonge
- Department of General Surgery and NUTRIM School for Nutrition, Toxicology and Metabolism Research, Maastricht University Medical Center, Maastricht, the Netherlands; Department of General Surgery, Atrium Medical Center Parkstad, Heerlen, the Netherlands
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47
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de Haan JJ, Hadfoune M, Lubbers T, Hodin C, Lenaerts K, Ito A, Verbaeys I, Skynner MJ, Cailotto C, van der Vliet J, de Jonge WJ, Greve JWM, Buurman WA. Lipid-rich enteral nutrition regulates mucosal mast cell activation via the vagal anti-inflammatory reflex. Am J Physiol Gastrointest Liver Physiol 2013; 305:G383-91. [PMID: 23812038 DOI: 10.1152/ajpgi.00333.2012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Nutritional stimulation of the cholecystokinin-1 receptor (CCK-1R) and nicotinic acetylcholine receptor (nAChR)-mediated vagal reflex was shown to reduce inflammation and preserve intestinal integrity. Mast cells are important early effectors of the innate immune response; therefore modulation of mucosal mast cells is a potential therapeutic target to control the acute inflammatory response in the intestine. The present study investigates intestinal mast cell responsiveness upon nutritional activation of the vagal anti-inflammatory reflex during acute inflammation. Mucosal mast cell degranulation was induced in C57/Bl6 mice by administration of Salmonella enterica LPS. Lipid-rich enteral feeding prior to LPS significantly decreased circulatory levels of mouse mast cell protease at 30 min post-LPS compared with isocaloric low-lipid nutrition or fasting. CCK-1R blockage reversed the inhibitory effects of lipid-rich feeding, whereas stimulation of the peripheral CCK-1R mimicked nutritional mast cell inhibition. The effects of lipid-rich nutrition were negated by nAChR blockers chlorisondamine and α-bungarotoxin and vagal intestinal denervation. Accordingly, release of β-hexosaminidase by MC/9 mast cells following LPS or IgE-ovalbumin complexes was dose dependently inhibited by acetylcholine and nicotine. Application of GSK1345038A, a specific agonist of the nAChR α7, in bone marrow-derived mast cells from nAChR β2-/- and wild types indicated that cholinergic inhibition of mast cells is mediated by the nAChR α7 and is independent of the nAChR β2. Together, the present study reveals mucosal mast cells as a previously unknown target of the nutritional anti-inflammatory vagal reflex.
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Affiliation(s)
- Jacco J de Haan
- Dept. of Surgery at Maastricht Univ. Medical Centre+, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
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van der Meer Y, Gerrits WJJ, van den Bosch M, Holst JJ, Moreto M, Buurman WA, Kulik W, van Kempen TATG. Chenodeoxycholic acid reduces intestinal permeability in newly weaned piglets. J Anim Sci 2013; 90 Suppl 4:302-4. [PMID: 23365361 DOI: 10.2527/jas.50998] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Piglets are highly susceptible to gut health-related problems. Intravenously administered chenodeoxycholic acid (CDCA) affects gut health mediated through glucagon-like peptide 2 (GLP-2). To test whether CDCA is a suitable feed additive for improving gut health, a trial was performed with newly weaned (21 d) piglets offered a diet with or without 60 mg CDCA/kg feed (n = 24/treatment). Upon weaning, piglets were fasted for 16 h and then intragastrically dosed with 20 g test feed in 40 g water. Subsequently, a jugular blood sample was taken on 45, 90, 135, or 180 min for analysis of GLP-2, peptide YY (PYY), and glucose. Afterwards, piglets were offered the experimental diets ad libitum. On days 3.5, 7.5, and 10.5 after weaning, serum responses to an intragastric dose of lactulose and Co-EDTA were tested at 2 h after dosing in 8 piglets per treatment. Immediately thereafter, piglets were euthanized, intestines were harvested, and permeability was measured ex vivo using the everted gut sac technique with 4 kDa fluorescein isothiocyanato (FITC)-dextran as marker at 25, 50, and 75% of the length of the small intestine. Dietary CDCA did not affect (P > 0.05) ADFI, ADG, G:F, blood glucose, and plasma GLP-2 and PYY. Serum cobalt and lactulose at day 10.5 tended to be lower in CDCA pigs compared with control pigs. Serum cobalt and lactulose concentrations were positively correlated (r = 0.67; P < 0.01). In conclusion, CDCA tended to reduce intestinal permeability at 10.5 d after weaning when fed to newly weaned piglets, implying that CDCA deserves further study as a means for improving intestinal health. The positive correlation found between Co-EDTA and lactulose indicates that both marker molecules measure similar change in permeability.
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Affiliation(s)
- Y van der Meer
- Animal Nutrition Group, Wageningen University, Wageningen, The Netherlands.
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49
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Schellekens DHSM, Hulsewé KWE, van Acker BAC, van Bijnen AA, de Jaegere TMH, Sastrowijoto SH, Buurman WA, Derikx JPM. Evaluation of the diagnostic accuracy of plasma markers for early diagnosis in patients suspected for acute appendicitis. Acad Emerg Med 2013; 20:703-10. [PMID: 23859584 DOI: 10.1111/acem.12160] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 02/13/2013] [Accepted: 02/21/2013] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The main objective of this study was to evaluate the diagnostic accuracy of two novel biomarkers, calprotectin (CP) and serum amyloid A (SAA), along with the more traditional inflammatory markers C-reactive protein (CRP) and white blood cell count (WBC), in patients suspected of having acute appendicitis (AA). The secondary objective was to compare diagnostic accuracy of these biomarkers with a clinical scoring system and radiologic imaging. METHODS A total of 233 patients with suspected AA, presenting to the emergency department (ED) between January 2010 and September 2010, and 52 healthy individuals serving as controls, were included in the study. Blood was drawn and CP and SAA-1 concentrations were measured using enzyme-linked immunosorbent assay (ELISA). CRP and WBC concentrations were routinely measured and retrospectively abstracted from the electronic health record, together with physical examination findings and radiologic reports. The Alvarado score was calculated as a clinical scoring system for AA. Final diagnosis of AA was based on histopathologic examination. The Mann-Whitney U-test was used for between-group comparisons. Receiver operating characteristic (ROC) curves were used to measure the diagnostic accuracy for the tests and to determine the best cutoff points. RESULTS Seventy-seven of 233 patients (33%) had proven AA. Median plasma levels for CP and SAA-1 were significantly higher in patients with AA than in those with another final diagnosis (CP, 320.9 ng/mL vs. 212.9 ng/mL; SAA-1, 30 mg/mL vs. 0.6 mg/mL; p < 0.001). CRP and WBC were significantly higher in patients with AA as well. The Alvarado score was helpful at the extremes (<3 or >7). Ultrasound (US) had a sensitivity of 84% and a specificity of 94%. Computed tomography (CT) had a sensitivity of 100% and a specificity of 91%. The area under the ROC (95% confidence interval [CI]) was 0.67 (95% CI = 0.60 to 0.74) for CP, 0.76 (95% CI = 0.70 to 0.82) for SAA, 0.71 (95% CI = 0.64 to 0.78) for CRP, and 0.79 (95% CI = 0.73 to 0.85) for WBC. No cutoff points had high enough sensitivity and specificity to accurately diagnose AA. However, a high sensitivity of 97% was shown at 7.5 × 10(9) /L for WBC and 0.375 mg/mL for SAA. CONCLUSIONS CP, SAA-1, CRP, and WBC were significantly elevated in patients with AA. None had cutoff points that could accurately discriminate between AA and other pathology in patients with suspected AA. A WBC < 7.5 × 10(9) /L, with a low level of clinical suspicion for AA, can identify a subgroup of patients who may be sent home without further evaluation, but who should have available next-day follow-up.
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Affiliation(s)
| | | | | | - Annemarie A. van Bijnen
- Department of Surgery; Maastricht University Medical Center and Nutrition and Toxicology Research Institute Maastricht; Maastricht; the Netherlands
| | | | | | - Wim A. Buurman
- Department of Surgery; Maastricht University Medical Center and Nutrition and Toxicology Research Institute Maastricht; Maastricht; the Netherlands
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50
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Eissing L, Scherer T, Tödter K, Knippschild U, Greve JW, Buurman WA, Pinnschmidt HO, Rensen SS, Wolf AM, Bartelt A, Heeren J, Buettner C, Scheja L. De novo lipogenesis in human fat and liver is linked to ChREBP-β and metabolic health. Nat Commun 2013; 4:1528. [PMID: 23443556 DOI: 10.1038/ncomms2537] [Citation(s) in RCA: 225] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 01/23/2013] [Indexed: 02/07/2023] Open
Abstract
Clinical interest in de novo lipogenesis has been sparked by recent studies in rodents demonstrating that de novo lipogenesis specifically in white adipose tissue produces the insulin-sensitizing fatty acid palmitoleate. By contrast, hepatic lipogenesis is thought to contribute to metabolic disease. How de novo lipogenesis in white adipose tissue versus liver is altered in human obesity and insulin resistance is poorly understood. Here we show that lipogenic enzymes and the glucose transporter-4 are markedly decreased in white adipose tissue of insulin-resistant obese individuals compared with non-obese controls. By contrast, lipogenic enzymes are substantially upregulated in the liver of obese subjects. Bariatric weight loss restored de novo lipogenesis and glucose transporter-4 gene expression in white adipose tissue. Notably, lipogenic gene expression in both white adipose tissue and liver was strongly linked to the expression of carbohydrate-responsive element-binding protein-β and to metabolic risk markers. Thus, de novo lipogenesis predicts metabolic health in humans in a tissue-specific manner and is likely regulated by glucose-dependent carbohydrate-responsive element-binding protein activation.
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Affiliation(s)
- Leah Eissing
- Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
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