Gut Atrophy Research Articles

Insulinlike growth factor 1 (IGF-1) reduces gut atrophy and bacterial translocation after severe burn injury.

Bacterial translocation after severe burns is associated with gut mucosal atrophy and increased mucosal permeability. Insulinlike growth factor 1 (IGF-1) levels are low after trauma and do not respond to growth hormone treatment. Since IGF-1 receptors have been demonstrated in gut mucosa, we proposed that treatment with IGF-1 would reduce mucosal atrophy and bacterial translocation. Rats received 50% total body surface area full-thickness burn or sham burn. They were treated with a continuous, subcutaneous infusion of either IGF-1 (approximately 3 mg/kg per day) or placebo (0.01 mol of acetate) for up to 5 days after receiving the burn. The mesenteric lymph node and liver were cultured for gram-negative bacteria. The small intestinal mucosa was scraped, weighed, and analyzed for DNA and protein content. Treatment with IGF-1 improved body weight, spleen weight, and gut mucosal weight. It stimulated mucosal DNA and protein content and reduced the incidence of bacterial translocation to the mesenteric lymph node from 89% to 30%. Insulinlike growth factor may reduce gut barrier failure by decreasing mucosal atrophy and subsequent barrier failure. In addition to its general anabolic effects, recombinant human IGF-1 may improve gut mucosal function and reduce infectious morbidity in severely traumatized or septic patients by reducing gut atrophy and reducing bacterial translocation.

Amino Acid Metabolism, Muscular Fatigue and Muscle Wasting

Recent investigations from our and other laboratories indicate that glycogen is a carbon-chain precursor in muscle for the synthesis of TCA cycle intermediates and glutamine. During intense exercise and in conditions of a relative lack of energy (hypoxia, trauma, sepsis) the metabolism of branched-chain amino acids (BCAA) is accelerated in muscle. In the primary BCAA aminotransferase reaction 2-oxoglutarate is used as amino-group acceptor (putting a carbon-drain on the TCA cycle) under formation of glutamate. Glutamate will subsequently react with ammonia, generated in the AMP deaminase reaction or by deamination of amino acids, under formation of glutamine in a reaction catalysed by glutamine synthetase (glutamate + ammonia + ATP--> glutamine + ADP). Muscle glycogen stores may be smaller or less available at high altitude. It is hypothesized that this will lead to premature fatigue (due to both a lack of fuel and of TCA cycle carbon-precursor) and to a reduction in the synthesis rate of glutamine. A chronic reduction in the synthesis rate of glutamine during a long term stay at high altitude on its turn may lead to gut atrophy, bacterial translocation, endotoxemia, muscle protein catabolism and a weakened immune status.

Serum and Intestinal Diamine Oxidase Activity During Intestinal Adaptation

Diamine oxidase (DAO) is a cytoplasmic enzyme found primarily in the villus epithelial cells of the small intestine. Serum DAO levels have been evaluated as a potential marker of intestinal disease in a variety of disorders, including gut atrophy, ischemia, and inflammation. In this study serum and tissue DAO levels were evaluated during intestinal adaptation. Twenty dogs were divided into 4 groups: sham laparotomy (n = 5), and 25% (n = 5), 50% (n = 5), and 75% (n = 5) distal enterectomy. Serum DAO activity (basal or postheparin) was measured prior to and 2 days, 4 weeks, 8 weeks, and 12 weeks after operation. Tissue DAO and changes in intestinal length, mucosal protein content, and villus height were measured at sacrifice 12 weeks later. Intestinal remnant length and protein content increased significantly with 50 and 75% resection. Tissue DAO activity was significantly decreased with any enterectomy. Serum postheparin DAO activity was significantly greater than basal at all time points but there was no significant change in either basal or postheparin DAO levels at any time following resection. It is concluded that serum DAO levels are not changed during the early adaptive period following intestinal resection and thus would not be useful as a marker of this process. Tissue DAO levels were diminished during adaptation, suggesting that tissue DAO activity is influenced not only by mucosal mass but by cellular metabolism and the proliferative status of the mucosa.

Influence of glutamine and branched chain amino acids on the jejunal atrophy associated with parenteral nutrition

Infusions of conventional parenteral nutrients (CPN) are associated with gut atrophy. This may be due to the absence of glutamine in such solutions. Although glutamine is a preferred gut nutrient, it is excluded from CPN because it is unstable at room temperature. This problem may be circumvented either directly by the infusion of fresh solutions of glutamine, or indirectly by the infusion of branched chain amino acids (BCAA). We evaluated the effect of infusing either glutamine, BCAA, or glutamine plus BCAA-enriched CPN on the rat jejunum. Sixty male Wistar rats were randomized to receive 6 days of either conventional parenteral nutrition (CPN), CPN plus 1.5% glutamine (GLN), CPN plus 2% BCAA (BCAA), CPN plus 0.8% BCAA and 1.0% glutamine (GLN/BCAA), or a normal oral diet (Chow). Standardized segments of jejunum were then removed for assessment. Compared with the CPN group, both the GLN/BCAA and the BCAA groups had greater mucosal weights (P less than 0.05) and mucosal protein concentrations (P less than 0.05), the GLN/BCAA group had greater jejunal weights (P less than 0.05), and the GLN group had an increased jejunal weight (P less than 0.05) and a higher crypt cell production rate (P less than 0.05). We conclude that the infusion of glutamine or BCAA-enriched parenteral nutrition improves jejunal morphology compared with conventional parenteral nutrition.

Use of l-glutamine in total parenteral nutrition

Gut atrophy develops during prolonged total parenteral nutrition (TPN). TPN solutions do not contain glutamine, an energy substrate of the intestinal tract. This study evaluated the effect of addition of l-glutamine to TPN on gut nitrogen content, histology, and disaccharidase enzyme activity. Five groups of six Fisher 344 rats received rat chow, D5W, TPN (23% calories as lipid), or TPN with 1 or 2% l-glutamine. Animals given TPN received 30 kcal and 0.22 g nitrogen/100 g/day. Metabolic cages allowed nitrogen balance for each group. After 6 days infusion, stomach, small bowel, and colon were assayed for total nitrogen and sucrase, lactase, and maltase activity. Mucosal height and fatty infiltration of the liver were determined from histologic sections. Adding either 1 or 2% l-glutamine resulted in no toxic clinical effects. Glutamine preserved intestinal nitrogen content of the stomach and colon compared to standard TPN and increased nitrogen content of small bowel to greater than that in chow-fed animals. Glutamine maintained mucosal height of the stomach and colon, but was no better than TPN alone in maintenance of small bowel mucosal height. One percent glutamine increased and standard TPN depressed maltase activity compared to chow. Standard TPN and 1% glutamine both stimulated sucrase and lactase activity compared to chow. Addition of 1 or 2% glutamine protected the liver from fatty infiltration seen with standard TPN. These studies would suggest the addition of glutamine might be beneficial during provision of standard total parenteral nutrition.

Effects of semistarvation on large intestinal calcium transport: in vivo studies in the rat

In the semistarved rat, body, and gut growth are impaired, metabolism of vitamin D is thought to be abnormal and in vitro duodenal calcium transport is depressed. Since large intestinal calcium transport may have a role in calcium homeostasis, we studied calcium transport by cecum and colon in young semistarved rats. Animals were fed ad libitum (control group) or restricted to 50% of ad libitum food intake (semistarved group). After 11 to 14 days, calcium transport was studied in situ by intraluminal perfusion of cecum and colon with 1.2 mm calcium in saline with tracer 45Ca to determine net calcium movements and lumen-to-plasma flux. Calcium transport by the entire segment (total transport) and per gram dry weight of segment (specific transport) was measured. Specific net absorption and lumen-to-plasma flux of calcium by cecum was nearly twice as great in semistarved animals as in controls, but there was no difference between groups in colon. Cecal and colonic gut mass was decreased in semistarved animals as compared with controls. Despite gut atrophy, total transport per segment did not change with semistarvation in cecum, because of increased specific transport. In colon, semistarvation decreased total lumen-to-plasma flux, but there was no significant effect on total net movements, presumably due to depressed plasma-to-lumen flux. These findings suggest that, in the rat, the large intestine may contribute to maintaining calcium homeostasis in semistarvation.