Abstract
Various studies have shown a role for citrulline as a gut mass biomarker in patients with short bowel syndrome. Our hypothesis is that plasma citrulline is both a gastrointestinal (GI) function and a gut mass marker. Our objective was to validate previous observations, by prospectively analyzing plasma citrulline concentrations in patients with GI disease with or without bowel resection, compared to patients without GI disease. Plasma from blood samples of parenteral nutrition fed neonates and infants was obtained. Samples were analyzed by ion-exchange chromatography. Data collected included age, diagnoses and surgical documentation of bowel resection. Patients were classified into 3 main groups: those without GI disease nor resection (Group 1), those with GI disease but no resection (Group 2), and those with GI disease and resection (Group 3). Group medians were compared using Kruskal-Wallis ANOVA. Seventeen samples were evaluated. Patients in Group 3 were older compared to patients in Groups 1 and 2; median age (in days) 156 vs. 12 vs. 57 respectively. Median (range) plasma citrulline concentrations were 20.9 (14.9 - 29.0) μmol/L, 8.7 (0.5 - 20.0) μmol/L and 9.6 (5.9 - 13.2) μmol/L for Groups 1, 2 and 3 respectively. There were significant differences among medians and sample distributions between Groups 1 and 2 and between 1 and 3 (p < 0.05). No differences were observed between Groups 2 and 3. Patients without GI disease and no resection had significantly higher plasma citrulline concentrations than patients with GI disease with or without resection at the time of assessment.
Highlights
Citrulline is a non-essential amino acid synthesized predominantly in the enterocytes [1]
Stultz et al conducted a retrospective analysis of plasma citrulline levels from infants requiring parenteral nutrition (PN), with or without bowel loss
Our study included neonates and infants up to 6 months of age, inpatients at Le Bonheur Children’s Hospital (LBCH) in Memphis, TN, who were enrolled in the PN service during their hospital stay and had received intravenous nutrition
Summary
Citrulline is a non-essential amino acid synthesized predominantly in the enterocytes [1]. In the early 2000’s, the first reports were published of potential clinical uses of citrulline as a marker of gastrointestinal (GI) absorptive function in adults with short bowel syndrome [3]. Preterm neonates, given their immaturity, are at risk of developing necrotizing enterocolitis (NEC) [4] [5]. Given their immaturity, are at risk of developing necrotizing enterocolitis (NEC) [4] [5] These infants often require prolonged parenteral nutrition (PN) supplementation due to development of enteral feeding intolerance [6]. The aim of this study was to validate previous results from our institution, by analyzing differences in plasma citrulline concentrations in a cohort of patients with GI disease and variable degrees of bowel resection, compared to patients without GI disease as well as add to the growing body of literature showing plasma citrulline utility as a marker in GI disease
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