Botulinum toxin as a treatment for short bowel syndrome in rats.

Isabela Cristina De Souza Marques,Juliana Ribeiro,Lourenço Sbragia Neto,Mariane Quaglio Marques,Sérgio Britto Garcia,Stefânia Bovo Minto,Paola Castro Moraes

doi:10.1590/s0102-865020190070000005

Abstract

Purpose:The denervation of the intestine with benzalkonium chloride (BAC) reduces mortality and improves weight gain in rats with short bowel syndrome (SBS). Nevertheless, translating these promising findings from bench to bedside is not feasible because BAC promotes peritonitis and irreversible denervation which may be followed by an uncontrolled dilatation of the viscera. The use of botulinum toxin (BT) instead of BAC to achieve the denervation of the remaining small intestine in SBS could be an interesting option because it leads to a mild and transient denervation of the intestine.Methods:Here we evaluated the effects of the ileal denervation with BT in rats with SBS by verifying the body weight variation and intestinal morphological parameters. Four groups with 6 animals each were submitted to enterectomy with an ileal injection of saline (group E) or BT (group EBT). Control groups were submitted to simulated surgery with an ileal injection of BT (group BT) or saline (group C - control).Results:We observed that the treatment of the remaining ileum with BT completely reversed the weight loss associated to extensive small bowel resection.Conclusion:This may provide a new promising approach to the surgical treatment of SBS.

Highlights

Short bowel syndrome (SBS) is an intestinal failure resulting from an insufficient absorption surface of the intestine, usually due to surgical removal of more than 50% of the intestine length
Both the surgical procedures and the botulinum toxin (BT) injections were well tolerated, and no side effects were seen in the animals
The intestinal remnants did not change in length among the experimental groups but the animals from the Groups BT and EBT showed a noticeable increase in the ileum diameter in the segment submitted to the BT application

Summary

Introduction

Short bowel syndrome (SBS) is an intestinal failure resulting from an insufficient absorption surface of the intestine, usually due to surgical removal of more than 50% of the intestine length. It would be reckless to perform such experiments in humans because BAC promotes peritonitis with further risk of pseudo-obstruction, as well as irreversible denervation followed by uncontrolled dilatation of the viscera[6]. In this aspect the use of botulinum toxin (BT) instead of BAC as a way of achieving the denervation of the remaining small intestine in SBS could be an interesting option because it leads to a mild and transient denervation of the intestine[7]. We evaluated the effects of the ileal denervation with BT in rats with SBS by verifying the body weight variation and intestinal morphological parameters

Methods

Results

Conclusion