Serum Intestinal Fatty Acid-binding Protein Levels Research Articles

Altered lactate/pyruvate ratio may be responsible for aging-associated intestinal barrier dysfunction in male rats

Some evidence points to a link between aging-related increased intestinal permeability and mitochondrial dysfunction in in-vivo models. Several studies have also demonstrated age-related accumulation of the of specific deletion 4834-bp of “common” mitochondrial DNA (mtDNA) in various rat tissues and suggest that this deletion may disrupt mitochondrial metabolism. The present study aimed to investigate possible associations among the mitochondrial DNA (mtDNA) common deletion, mitochondrial function, intestinal permeability, and aging in rats. The study was performed on the intestinal tissue from (24 months) and young (4 months) rats. mtDNA4834 deletion, mtDNA copy number, mitochondrial membrane potential, and ATP, lactate and pyruvate levels were analyzed in tissue samples. Zonulin and intestinal fatty acid-binding protein (I-FABP) levels were also evaluated in serum. Serum zonulin and I-FABP levels were significantly higher in 24-month-old rats than 4-month-old rats (p = 0.04, p = 0.026, respectively). There is not significant difference in mtDNA4834 copy levels was observed between the old and young intestinal tissues (p > 0.05). The intestinal mitochondrial DNA copy number was similar between the two age groups (p > 0.05). No significant difference was observed in ATP levels in the intestinal tissue lysates between old and young rats (p > 0.05). ATP levels in isolated mitochondria from both groups were also similar. Analysis of MMP using JC-10 in intestinal tissue mitochondria showed that mitochondrial membrane potentials (red/green ratios) were similar between the two age groups (p > 0.05). Pyruvate tended to be higher in the 24-month-old rat group and the L/P ratio was found to be approximately threefold lower in the intestinal tissue of the older rats compared to the younger rats (p < 0.002). The tissue lactate/pyruvate ratio (L/P) was three times lower in old rats than in young rats. Additionally, there were significant negative correlations between intestinal permeability parameters and L/P ratios. The intestinal tissues of aged rats are not prone to accumulate mtDNA common deletion, we suggest that this mutation does not explain the age-related increase in intestinal permeability. It seems to be more likely that altered glycolytic capacity could be a link to increased intestinal permeability with age. This observation strengthens assertions that the balance between glycolysis and mitochondrial metabolism may play a critical role in intestinal barrier functions.

Values of serum intestinal fatty acid-binding protein, fecal calprotectin, and fecal human β-defensin 2 for predicting necrotizing enterocolitis

BackgroundThis study aimed to assess the diagnostic potential of serum intestinal fatty acid-binding protein (I-FABP), fecal calprotectin (FC), and fecal human β-defensin 2 (hBD2) in predicting necrotizing enterocolitis (NEC) in preterm infants.MethodsA prospective cohort of neonates with a gestational age < 32 weeks, suspected of NEC, was enrolled between June 2021 and December 2022. Serum I-FABP, FC, and fecal hBD2 levels were measured upon NEC suspicion, and diagnosis was confirmed through radiological examination or surgical intervention. Diagnostic precision of serum I-FABP, FC, and fecal hBD2 was assessed using a logistic regression model with multiple variables.ResultsThe study included 70 neonates (45 males, 25 females), with 30 developing NEC (40% Stage III, n = 12; 60% Stage II, n = 18) and 40 in the control group. NEC patients exhibited significantly higher serum I-FABP and FC levels (4.76 ng/mL and 521.56 µg/g feces, respectively) than those with other diagnoses (1.38 ng/mL and 213.34 µg/g feces, respectively; p ˂ 0.05 for both biomarkers). Stage II NEC neonates showed elevated fecal hBD2 levels (376.44 ng/g feces) than Stage III NEC neonates and controls (336.87 ng/g and 339.86 ng/g feces, respectively; p ˂ 0.05). No such increase was observed in infants progressing to Stage III NEC. Using a serum I-FABP threshold of > 2.54 ng/mL yielded 76.7% sensitivity, 87.5% specificity, 82.1% positive predictive value (PPV), and 83.3% negative predictive value (NPV). For FC (cutoff > 428.99 µg/g feces), corresponding values were 76.7% sensitivity, 67.5% specificity, 63.9% PPV, and 79.4% NPV.ConclusionSerum I-FABP and FC levels are valuable for early NEC detection and provide insights into disease severity. Low fecal hBD2 levels suggest an inadequate response to luminal bacteria, potentially rendering these infants more susceptible to NEC development or exacerbation.

Impaired intestinal permeability in patients with multiple sclerosis.

A number of recent studies have shown that the intestinal microbiome, part of the brain-gut axis, is implicated in the pathophysiology of multiple sclerosis. An essential part of this axis, is the intestinal barrier and gastrointestinal disorders with intestinal barrier dysregulation appear to be linked to CNS demyelination, and hence involved in the etiopathogenesis of multiple sclerosis (MS). The aim of this study was to evaluate the integrity of the intestinal barrier in patients with clinically definite multiple sclerosis (CDMS) and clinically isolated syndrome (CIS) using two serum biomarkers, claudin-3 (CLDN3), a component of tight epithelial junctions, and intestinal fatty acid binding protein (I-FABP), a cytosolic protein in enterocytes. Serum levels of CLDN3 in 37 MS patients and 22 controls, and serum levels of I-FABP in 46 MS patients and 51 controls were measured using commercial ELISA kits. Complete laboratory tests excluded the presence of gluten-related disorders in all subjects. Thirty MS patients received either disease-modifying drugs (DMD), immunosuppression (IS) or corticosteroid treatment. CLDN3 levels were only significantly higher in the MS patients treated with DMD or IS compared to the control group (P=0.006). There were no differences in I-FABP serum levels between the groups. Serum CLDN3 levels did not correlate with serum I-FABP levels in CDMS, in CIS patients or controls. In multiple sclerosis patients, the intestinal epithelium may be impaired with increased permeability, but without significant enterocyte damage characterized by intracellular protein leakage. Based on our data, CLDN3 serum levels appear to assess intestinal dysfunction in MS patients but mainly in treated ones.

Evaluation of Some Intestinal Biomarkers in the Determination of Intestinal Damage in Calves with Coccidiosis

This study aimed to assess the usefulness of injury biomarkers specific to the intestines in identifying the presence and degree of intestinal epithelial damage in coccidiosis-infected calves. Forty calves of various breeds and sexes, aged 21 days to 60 days, were used in the study. Of these, 30 were in the experimental group, and 10 were healthy control. The McMaster Oocyte counting technique was used to diagnose Eimeria and confirm clinical coccidiosis. Cases with clinical signs and more than 5,000 oocysts in gram feces were included in the study. All calves had blood samples drawn at the 0 th hours and 72 nd hours. Blood gas measurements were performed with a blood gas analyzer. Hemogram was performed with an automated hematologic analyzer. Bovine-specific enzyme-linked immunosorbent analysis (ELISA) test kits were used to measure the intestinal fatty acid binding protein (I-FABP), trefoil factor-3 (TFF-3), intestinal alkaline phosphatase (IAP), claudin-3 (CLD-3), intestinal smooth muscle actin (ACTG2), and interleukin-8 (IL-8) biomarkers from serum samples. Calves with coccidiosis received a single dose of toltrazuril (15 mg/kg) and supportive care. Before treatment (0 th hours) in coccidiosis-infected calves, serum I-FABP and CLD-3 levels were greater than in healthy calves (p<0.05), and after treatment (72 nd hours), serum TFF-3 and ACTG2 levels were higher than in healthy calves. There was a significant decrease in serum IL-8 levels in coccidiosis-infected calves after treatment (72 nd hours) compared to pre-treatment (0 th hours) (p<0.05). I-FABP, TFF-3, CLD-3, ACTG2, and IL-8 are helpful and reliable biomarkers that can be utilized to assess the presence of intestinal epithelium injury in coccidiosis-infected calves.

Gastric ultrasound, citrulline, and intestinal fatty acid-binding protein as markers of gastrointestinal dysfunction in critically ill patients: A pilot prospective cohort study.

Gastrointestinal (GI) dysfunction is common in the intensive care unit (ICU), although there is no consensus on biomarkers of GI dysfunction. We aimed to evaluate ultrasound-based gastric antrum measurements and serum intestinal fatty acid-binding protein (IFABP) and citrulline levels in relation to GI dysfunction in critically ill patients. Adult critically ill patients receiving enteral nutrition and stayed for in the ICU for ≥48 h was included. GI dysfunction was described using Gastrointestinal Dysfunction Score (GIDS). Gastric antrum measurements, including craniocaudal (CC) diameter, anteroposterior diameter, and antral-cross sectional area (CSA), as well as serum levels for IFABP and citrulline, were prospectively recorded at baseline and on day 3 and day 5 of enteral nutrition. The receiver operating characteristic (ROC) analysis was performed to evaluate gastric ultrasound parameters, serum IFABP, and citrulline concentrations in predicting GI dysfunction. Thirty-nine participants with a median age of 60 years were recruited and 46.2% of participants had GI dysfunction. ROC analysis revealed that the cutoff value of CSA score to predict GI dysfunction was 4.48 cm2 , which provided 72.7% sensitivity and 77.2% specificity (area under the curve = 0.768, 95% CI: 0.555-0.980). At baseline, gastric residual volume was highly correlated with CC diameter and CSA (r = 0.764, P < 0.001 and r = 0.675, P < 0.001, respectively). Serum IFABP and citrulline levels had no correlation with GI dysfunction or gastric ultrasound parameters (P > 0.05). CSA was associated with GI dysfunction in critically ill patients. Serum IFABP and citrulline concentrations were poor in predicting GI dysfunction.

Intestinal fatty acid binding protein (I-FABP) and CXC3L1 evaluation as biomarkers for patients at high-risk for coeliac disease in Johannesburg, South Africa

Coeliac disease (CD) is an autoimmune disorder and one of the few gastroenteropathies with accurate serological testing. CD serology has decreased accuracy for patients on a gluten-free diet and for monitoring mucosal healing. New ancillary tests would, therefore, be useful. Intestinal Fatty Acid Binding Protein (I-FABP) and CX3CL1 (Fractalkine) are two promising biomarkers for CD but haven’t been examined in patients who are at a high-risk for CD such as patients with type one diabetes (TID). This study, therefore, aimed to investigate serum levels of I-FABP and CX3CL1 in a cohort of South African patients with TID at a high-risk of developing CD. The serum I-FABP levels were significantly higher in CD-positive patients compared to CD-negative individuals (p = 0.03). No significant differences in the serum CX3CL1 levels were detected although this may reflect the impact of the comorbid autoimmune diseases had on the serum CX3CL1 levels. In conclusion, this study is the first to assess the levels of these biomarkers in a multiethnic population with comorbid autoimmune disease and determined I-FABP to be the more promising biomarker in such clinical contexts. Future research should focus on a diverse biomarker panel and longitudinal follow-up of patients at a high-risk for CD.

Intestinal fatty acid-binding protein, a biomarker of intestinal barrier dysfunction, increases with the progression of type 2 diabetes.

ObjectiveTo investigate serum intestinal fatty acid-binding protein (I-FABP) in two groups of patients with different duration of hyperglycemia in a cross-sectional study.Materials and MethodsIn the present study, a total of 280 individuals (158 outpatients and 122 inpatients) suffering from hyperglycemia were recruited between May and September 2019. The clinical information of all participants was collected from the hospital information system, including the duration of hyperglycemia, age, gender, hemoglobin A1c (HbA1c), 75-g oral glucose tolerance test including fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG), fasting C-peptide (FC-pep), 2-hour C-peptide (2hC-pep), fasting insulin (FIns), and 2-hour insulin (2hIns). In addition, the morbidity of diabetic complications (retinopathy, neuropathy, and nephropathy) in the inpatient group was determined. Furthermore, the difference between 2hPG and FPG (ΔPG), the difference between 2hC-pep and FC-pep (ΔC-pep), and the difference between 2hIns and FIns (ΔIns) were calculated. The level of serum I-FABP, a biomarker of intestinal barrier (IB) dysfunction, was estimated by an enzyme-linked immunosorbent assay.ResultsFor the outpatient group, the median duration of hyperglycemia was less than a year; the serum I-FABP level was positively correlated with age (R = 0.299, P < 0.001). For the inpatient group, the median duration of hyperglycemia was ten years; correlation analysis showed that the serum I-FABP level was positively associated with age and ΔPG (R = 0.286, P = 0.001; R = 0.250, P = 0.006, respectively) while negatively associated with FC-pep and 2hC-pep (R = − 0.304, P = 0.001; R = − 0.241, P = 0.008, respectively); multiple linear regression analysis showed that the serum I-FABP level was positively associated with the duration of hyperglycemia (β = 0.362, P < 0.001); moreover, patients with retinopathy had a significantly higher I-FABP level than those without retinopathy (P = 0.001).ConclusionsIn the outpatients whose duration of hyperglycemia was less than a year, the serum I-FABP level was positively associated with age. In the inpatients with different courses of diabetes, the serum I-FABP level was positively associated with the duration of hyperglycemia and glycemic variability but negatively associated with islet beta-cell function; moreover, the serum I-FABP level was higher in patients with retinopathy than in those without retinopathy, suggesting that the IB dysfunction got worse with the progression of diabetes.

Potential role of serum intestinal fatty acid-binding protein as a marker for early prediction and diagnosis of necrotizing enterocolitis in preterm neonates

Introduction:Intestinal fatty acid-binding protein (I-FABP) is located in the apex of mature enterocytes and released into circulation; once the injury of enterocyte happens, its circulating levels are considered an early and sensitive marker of intestinal ischemia as in necrotizing enterocolitis (NEC); because of its small molecular weight, it can be detected in urine.Aims:The aim was to study the usefulness of both serum and urine I-FABP in early diagnosis of NEC and to correlate the serum and urinary levels.Settings and Design:This study was case–control design.Methods:Simultaneous serum and urine samples obtained at the onset of symptoms, in 40 preterms with suspected NEC, with gestational age ± 27.70 weeks and birth weight ± 1.11 kg, i.e., 20 preterms diagnosed at Stage I, 12 preterms at Stage II, and 8 preterms at Stage III, were compared with age- and weight-matched preterms with no NEC.Statistical Analysis:The collected data were tabulated, coded, and then analyzed using the computer program Statistical Package for the Social Science (SPSS version 22).Results:Serum levels of I-FABP in NEC cases were significantly higher than the control group, with a mean of 6005.77 ± 6384.77 and 1480.79 ± 1276.48 pg/ml, respectively (P < 0.001). Urine levels of I-FABP in NEC cases were significantly higher than the control group, with a mean of 5009.22 ± 3941.64 and 2677.62 ± 2257.29 pg/ml, respectively (P = 0.04). Both serum and urine I-FABP levels not only in Stage II are significantly higher than Stage I but also in Stage III are significantly higher than Stage I and II (P < 0.001, P = 0.03, respectively), which showed significant positive correlation with stages of NEC (r = 0.618; P < 0.001; r = 0.306; P = 0.049, respectively). Both serum and urine I-FABP levels had a highly significant positive correlation with each other (r = 0.406 P < 0.0001). Receiving operating characteristic curve showed an area under the curve of 0.92 and 0.81 for serum and urine I-FABP, respectively.Conclusions:Whether serum or urinary I-FABP is valuable in the diagnosis and prediction of NEC and strongly correlated with the disease severity and with each other.

Clinical study of D-lactate and intestinal fatty acid binding protein in evaluating disease severity and prognosis of ICU patients: secondary analysis of a prospective, multicenter clinical study

To analyze the relationship between D-lactate, intestinal fatty acid binding protein (I-FABP) and the severity as well as the prognosis of patients in intensive care unit (ICU). Using a retrospective approach, the data derived from a prospective, randomized, single-blind, multicenter clinical study published earlier by our group were further analyzed to evaluate the effect of fat-modified enteral nutrition (EN) suspension on the intestinal barrier in ICU patients. In this study, a total of 141 patients were recruited from 7 ICUs in South China, and 15 healthy volunteers were included as healthy control group. Clinical data of patients were collected, including gender, age, disease severity related indicators such as acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), C-reactive protein (CRP) and initial ICU diagnosis, as well as prognostic indicators such as length of stay in ICU, length of stay in hospital and prognosis of patients at 28 days. To compare the difference of serum D-lactate and I-FABP between ICU patients and healthy control group on day 0 (the day before EN reached 500 mL) and day 5 (EN ≥ 2 092 kJ/d for 5 days). According to the hemodynamic and/or mechanical ventilation status on day 5 (compared with day 0), 141 patients were divided into the improvement group (101 cases) and the non-improvement group (40 cases), and the changes of D-lactate and I-FABP in the two groups were observed. Spearman correlation analysis was used to analyze the correlation between serum D-lactate, I-FABP and the severity of the disease, as well as the predictive value of dynamic changes of D-lactate and I-FABP on the prognosis of 28 days. Compared with the healthy volunteers, the serum D-lactate and I-FABP levels of ICU patients on day 0 were significantly increased [D-lactate (mg/L): 10.82 (3.31, 25.48) vs. 6.63 (1.54, 17.70), I-FABP (ng/L): 519.60 (159.06, 1 362.14) vs. 84.40 (30.78, 108.57), both P < 0.01], and D-lactate and I-FABP on day 5 were both decreased compared with the levels on day 0, but still higher than the healthy volunteers. I-FABP in the improvement group was significantly lower than that in the non-improvement group on day 0, and there was no significant difference in D-lactate levels between the two groups, D-lactate and I-FABP in both groups were significantly lower on day 5 than those on day 0, and D-lactate and I-FABP in the improvement group on day 5 were significantly lower than those in the non-improvement group [D-lactate (mg/L): 7.61 (1.71, 27.22) vs. 9.38 (2.09, 20.56), I-FABP (ng/L): 378.65 (152.56, 864.62) vs. 521.21 (205.93, 1 413.11), all P < 0.05]. Correlation analysis showed that D-lactate was significantly positively correlated with APACHE II score and SOFA score on day 0 and day 5 (R12 = 0.367, P < 0.001; R22 = 0.240, P = 0.012); I-FABP was significantly positively correlated with APACHE II score on day 0 (R2 = 0.264, P = 0.004); D-lactate on day 5 and I-FABP on day 0 and day 5 were significantly negatively correlated with prognosis on day 28 (R12 = -0.203, P = 0.022; R22 = -0.208, P = 0.023; R32 = -0.211, P = 0.021). The area under curve (AUC) analysis showed that D-lactate on day 5 and I-FABP on day 0 and day 5 had independent predictive value for 28-day prognosis, with AUC of 0.634, 0.638 and 0.652, P values of 0.023, 0.024 and 0.017, 95% confidence intervals (95%CI) of 0.533-0.734, 0.523-0.754 and 0.525-0.778, respectively. When the cut-off values were 7.71 mg/L, 593.55 ng/L and 468.10 ng/L, the sensitivity were 51.5%, 68.5% and 75.3%, and the specificity were 91.0%, 60.0% and 60.0%, respectively. Serum D-lactate and I-FABP were increased significantly and decreased with the improvement of the condition, and these two molecular biomarkers have certain value in predicting the prognosis of ICU patients.

Effects of prebiotic consumption on serum intestinal fatty acid-binding protein levels in patients with diabetes: A case-control study.

BackgroundType 2 diabetes mellitus (T2DM) is a condition involving several molecular mechanisms related to the intestinal microbiota for its development. Intestinal fatty acid‐binding protein (I‐FABP) is a sensitive marker to study enterocyte damage. A prebiotic is a non‐digestible food ingredient that improves host health by selectively stimulating the growth and/or activities of bacteria in the colon. We aimed to clarify the currently described effects of prebiotics in the prevention and management of T2DM.MethodsIn this case‐control study, we chose 68 participants with T2DM and 52 healthy participants. Both groups were further divided based on consumption of prebiotics. Forty participants with T2DM consumed prebiotics, and 28 did not; 30 healthy volunteers consumed prebiotics, and 22 did not. We used the analysis of variance to compare the inflammation levels between the case and control groups. Multiple linear regression was performed for the significantly correlated groups to estimate the influence of prebiotics on inflammation level.ResultsAge was a significant factor for difference in I‐FABP levels (standardized coefficient: 0.06; P = .047). The analysis of eating habits showed that vegetarian diets produced lower I‐FABP levels than non‐vegetarian diets (standardized coefficient: −2.55; P = .022). Results showed that patients with T2DM who consumed prebiotics expressed lower I‐FABP levels, reflecting an improvement in inflammation level, than the healthy volunteers who did not consume prebiotics (standardized coefficient: −3.20; P = .019).ConclusionsFor patients with T2DM, prebiotics supplemented produced no significant impact on serum I‐FABP levels.

Association between Enterocyte Injury and Mortality in Patients on Hemodialysis Who Underwent Cardiac Surgery: An Exploratory Study

BackgroundIntestinal ischemia and enterocyte injury are significant causes of death after cardiac surgery. Hemodialysis is a well-known risk factor for intestinal ischemia. However, the relationship between enterocyte injury and mortality is unclear. This exploratory study assessed the association between intestinal fatty acid–binding protein (I-FABP), a specific marker of enterocyte injury, at intensive care unit (ICU) admission and in-hospital mortality in patients on hemodialysis who underwent cardiac surgery with cardiopulmonary bypass. Materials and methodsForty-seven consecutive patients on long-term hemodialysis who underwent elective cardiac surgery (median age, 70 y; men, 27 [57%]) were prospectively enrolled. The association between serum I-FABP levels at ICU admission and in-hospital mortality was compared with the associations between serum I-FABP levels and prognostic severity scores, vasoactive-inotropic scores, and lactate levels. ResultsOnly I-FABP levels at ICU admission were significantly related to in-hospital mortality (odds ratio, 5.54; 95% confidence interval [CI], 1.08-28.43) in the simple logistic regression analysis. Univariate and multiple linear regression analyses indicated prolonged cardiopulmonary bypass (ρ, 0.49; 95% CI, 0.15-0.83), higher mean norepinephrine dose (ρ, 0.07; 95% CI, 0.02-0.12), lower mean dopamine dose (ρ, −0.51; 95% CI, −0.94 to −0.08), and intra-aortic balloon pump use (ρ, 3.63; 95% CI, 1.68-5.59) were significant risk factors for high I-FABP levels. ConclusionsEnterocyte injury at ICU admission was associated with in-hospital mortality after cardiac surgery for patients on hemodialysis. Intraoperative hidden hypoperfusion of the intestine may impact prognoses. Enterocyte injury prevention, early diagnosis, and intervention for intestinal ischemia might be required to improve outcomes.

Intestinal fatty acid binding protein as a marker of damage intestinal barrier in children with burn injury

Introduction. Intestinal fatty acid binding protein (I-FABP) can serve as one of biomarkers of the damage to the intestinal mucosa in burned children occupying a special place among the complications and causes of their death. Materials and methods. There were examined 24 children with burns from 20% to 80% of the body surface. Blood serum I-FABP and lactate levels were determined during both the acute period of burn disease and septicotoxemia. Results. In the acute period wide variations in I-FABP values (from 22.67 to 385.18 pg/ml) were demonstrated. During the septicotoxemia I-FABP level increased by an average of 1.4 times, reflecting intestinal cell damage. Children with a burn area &gt;40% had a higher I-FABP level during all follow-up periods compared to children with a burn ≤ 40%. In the acute period there was a positive correlation between the lactate and I-FABP levels. During the septicotoxemia, despite the increase of lactatemia and I-FABP level, this relationship was absent. The maximum increase in I-FABP level was observed in patients with complications of burn disease on the part of the intestine (duodenitis, bulbitis, stress ulcers) and with the development of sepsis. Conclusion. It seems promising to further study this biomarker in order to timely diagnose increased intestinal permeability in children with thermal trauma and develop proper treatment tactics to prevent possible complications, such as intestinal erosive and ulcerative bleeding, the development of bacterial translocation, sepsis and multi-organ failure syndrome.

The importance of serum intestinal fatty acid-binding protein for the early diagnosis of acute mesenteric ischemia.

Acute mesenteric ischemia (AMI), although relatively rare, is an emergency condition with high mortality rates (60-80%) attributed to lack of early diagnosis. The aim of this experimental study was to observe the changes in serum intestinal fatty acid-binding protein (I-FABP) levels over time in the AMI model by ligating superior mesenteric artery (SMA) in rats and to compare with the serum I-FABP levels of the rats in the control group. Twenty rats were randomly allocated into two groups as control and ischemia group. The basal serum I-FABP levels were determined. SMA was isolated by laparotomy in all animals. In the ischemia group, SMA was ligated and intestinal ischemia was formed. Blood was taken from each rat in both groups at 30th, 60th, and 90th min to determine the serum I-FABP levels. The blood results were compared between two groups and were also compared by time in each group. In the ischemia group, serum I-FABP levels were significantly higher than the control group at post-operative 30th, 60th, and 90th min (p<0.01). In comparison with pre-operative serum I-FABP levels, remarkable increases were observed statistically at post-operative 30th, 60th, and 90th min in the ischemia group (p<0.01). In contrast, there was no statistically significant difference within the serum I-FABP levels over time in the control group. The increases of serum I-FABP levels in the ischemia group were directly correlated with the time of ischemia. Serum I-FABP levels have increased significantly in the intestinal ischemia and these values have risen progressively over time. Serum I-FABP may be a useful and promising biomarker for the early diagnosis of AMI.

The Prognostic Value of Endotoxemia and Intestinal Barrier Biomarker ZO-1 in Bacteremic Sepsis

BackgroundIntestinal barrier dysfunction exerts a pivotal pathophysiological role in the development of multiple organ dysfunction in sepsis. The present study was undertaken to investigate the potential role of serum intestinal fatty acid-binding protein (I-FABP) and zonula occludens-1 (ZO-1) levels as biomarkers of intestinal barrier dysfunction in bacteremic sepsis. MethodsSeventy-five patients with bacteremic sepsis of abdominal origin (n = 34) or nonabdominal origin (n = 41) and 12 healthy controls were retrospectively studied. Blood samples collected upon sepsis diagnosis were analyzed for serum ZO-1, I-FABP and endotoxin levels. Prognostic scores Sequential Organ Failure Assessment (SOFA), quickSOFA and Acute Physiology and Chronic Health Evaluation (APACHE-II) were determined over the first 24 hours after sepsis diagnosis and patients’ outcome in terms of 28-day mortality was recorded. ResultsSerum ZO-1 levels were significantly higher in bacteremic septic patients as compared to controls with no difference between patients with abdominal or extra-abdominal source of infection. Serum I-FABP levels were significantly lower in septic patients as compared to control and this reduction was more evident in patients with bacteremic abdominal sepsis. Serum ZO-1 and endotoxin concentrations were found significantly higher in patients who did not survive from sepsis. In receiver operating characteristic curve analysis, both endotoxin and ZO-1 predicted 28-day mortality. In addition, ZO-1 and endotoxin were correlated with the prognostic scores of qSOFA, SOFA and APACHE II. ConclusionsThe results of this study indicate that serum ZO-1 might be a reliable biomarker of gut barrier dysfunction in sepsis, not affected by the abdominal or extra-abdominal site of infection. ZO-1, measured early at sepsis diagnosis, might represent a valuable additional prognostic tool for patients’ outcome.

Clinical significance on serum intestinal fatty acid binding protein and D-lactic acid levels in early intestinal injury of patients with sepsis

To investigate the changes and clinical significances of intestinal fatty acid binding protein (I-FABP) and D-lactic acid levels in early intestinal injury of patients with sepsis and septic shock. A prospective observational study was conducted. Thirty septic patients (septic group) and 30 septic shock patients (septic shock group) were admitted to the intensive care unit (ICU) of General Hospital of Ningxia Medical University from August 2018 to December 2018, and 20 healthy adults were served as healthy control group. Serum samples were collected within 24 hours after ICU admission in septic shock and septic groups, and in healthy control group during physical examination. The serum I-FABP, D-lactic acid, endotoxin, hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and lactic acid (Lac) were determined. Gender and age of all subjects, and basic diseases, the main area of infection and acute physiology and chronic health evaluation II (APACHE II) scores within 24 hours after ICU admission of all patients were recorded. At the same time, the survival of the patients was followed up for 28 days. Spearman correlation analysis was used to analyze the correlation between serum I-FABP, D-lactic acid and other parameters. Risk factors of death in patients with sepsis and septic shock were screened by multivariate Logistic regression analysis of bicategorized variables. There was no significant difference in gender or age among the groups, as well as in the proportion of basic diseases, celiac infection or non-celiac infection between the sepsis group and the septic shock group, indicating that the general clinical baseline data among the groups were comparable. Serum levels of I-FABP and D-lactic acid in the sepsis group and the septic shock group were significantly higher than those in the healthy control group [I-FABP (μg/L): 27.46 (22.52, 34.39), 36.95 (29.82, 44.24) vs. 17.93 (14.65, 22.11), D-lactic acid (mg/L): 15.32 (9.84, 38.62), 27.95 (10.01, 47.69) vs. 9.38 (8.81, 14.48), all P < 0.01]. The serum level of I-FABP in the septic shock group was significantly higher than that in the sepsis group (P < 0.05), but the difference in serum D-lactic acid level between the two groups was not statistically significant (P > 0.05). Serum I-FABP level in the celiac infection group (n = 40) was significantly higher than that in the non-celiac infection group [n = 20; μg/L: 34.76 (27.46, 43.90) vs. 25.71 (20.55, 37.77), P < 0.01], but the difference in serum D-lactic acid level was not statistically significant [mg/L: 25.13 (9.83, 40.55) vs. 30.36 (10.17, 50.00), P > 0.05]. There was no significant difference in serum I-FABP or D-lactic acid levels between the survival group (n = 34) and the death group [n = 26; I-FABP (μg/L): 33.39 (25.20, 39.50) vs. 29.26 (22.50, 43.81), D-lactic acid (mg/L): 14.83 (9.71, 38.45) vs. 33.90 (11.93, 45.34), both P > 0.05]. Correlation analysis between serum I-FABP, D-lactic acid level and endotoxin, inflammatory factors, Lac and APACHE II score in septic and septic shock patients showed that only D-lactic acid was significantly positively correlated with TNF-α and Lac (r values were 0.455 and 0.406, respectively, both P < 0.01), while I-FABP was not correlated with endotoxin, inflammatory factors, Lac or APACHE II score. Multivariable Logistic regression analysis showed the APACHE II score was an independent risk factor to affect the prognosis (death for 28 days) of septic and septic shock patients [odds ratio (OR) = 1.248, 95% confidence interval (95%CI) = 1.091-1.427, P = 0.001], while I-FABP, D-lactic acid, endotoxin, hs-CRP, TNF-α, IL-6, and Lac had no impact on 28-day prognosis of patients. Serum I-FABP and D-lactic acid levels can evaluate early intestinal injury in patients with sepsis and septic shock, but neither of them is related to the prognosis of patients.

Preventive oral rehydration salts III could protect intestinal function in rats with exertional heatstroke

To observe the damage of various organs of rats with exertional heatstroke (EHS), and to investigate the protective effect of oral rehydration salts III (ORS III) on multi-organ function in rats with EHS. Fifty-one male Sprague-Dawley (SD) rats were randomly divided into four groups by random digit table: normal control group (n = 13), EHS group (n = 13), EHS+water group (n = 12), and EHS+ORS III group (n = 13). All rats in the EHS groups received adaptive training for 7 days before the experiment. On the 8th day, the rats of EHS+water and EHS+ORS III groups were orally given 20 mL/kg water or ORS III 30 minutes before the experiment. No pretreatment was performed in the EHS group. EHS model was reproduced by forcing rats to run under hot environment. The rats which refused to exercise and which core temperature > 40.5 centigrade were considered as the onset of EHS. The rats in the normal control group were exposed to room temperature (25±2) centigrade and humidity (50±5)% without any treatment. Six hours later, blood of inferior vena cava was collected, and the levels of serum MB isoenzyme of creatine kinase (CK-MB), lactate dehydrogenase (LDH), alanine transaminase (ALT), aspartate transaminase (AST), serum creatinine (SCr), blood urea nitrogen (BUN), serum potassium, serum sodium and serum chloride were determined by automatic chemical analyzer. Serum intestinal fatty acid-binding protein (I-FABP) was determined by enzyme linked immunosorbent assay (ELISA). The levels of LDH, ALT, AST, BUN, serum sodium and serum chloride in the EHS group were significantly higher than those in the normal control group [LDH (U/L): 1 220±427 vs. 837±485, ALT (U/L): 138 (97, 164) vs. 37 (33, 42), AST (U/L): 409 (380, 566) vs. 86 (78, 104), BUN (mmol/L): 11.7 (9.6, 13.2) vs. 5.9 (5.5, 6.1), serum sodium (mmol/L): 148.0 (143.5, 154.5) vs. 139.0 (138.0, 140.5), serum chloride (mmol/L): 100.9±2.3 vs. 97.3±1.4, all P < 0.05], but no significant difference in CK-MB, SCr or serum potassium could be found [CK-MB (U/L): 1 280±373 vs. 1 379±480, SCr (μmol/L): 38.2±7.5 vs. 35.5±6.3, serum potassium (mmol/L): 5.5 (4.4, 6.2) vs. 4.7 (4.4, 4.9), all P > 0.05]. In the EHS+ORS III group, only serum potassium level was significantly lower than that in the EHS group [mmol/L: 4.0 (3.7, 4.4) vs. 5.5 (4.4, 6.2), P < 0.01], while no significant difference in other parameters was found between the EHS+ORS III group and the EHS group as well as the EHS+water group. Serum I-FABP level in the EHS group was significantly higher than that in the normal control group [μg/L: 36.90 (29.10, 45.00) vs. 11.39 (0.31, 20.80), P < 0.01]. Serum I-FABP level in the EHS+water and EHS+ORS III groups were notably lower than that in the EHS group [μg/L: 24.19 (20.00, 28.36), 0.31 (0.31, 5.58) vs. 36.90 (29.10, 45.00), both P < 0.01], additionally, I-FABP level was much lower in the EHS+ORS III group (P < 0.01). EHS could lead to liver, intestinal barrier dysfunction and electrolyte disturbance. Pre-treatment of ORS III could alleviate the intestinal dysfunction and electrolyte disorder caused by EHS in rats. It can lower the serum potassium to some extent. However, ORS III failed to protect liver from EHS.

Changes and significance of serum intestinal fatty acid binding protein in children with traumatic brain injury complicated with gastrointestinal dysfunction

Objective To study the changes and significance of serum intestinal fatty acid binding protein (IFABP) in children with traumatic brain injury(TBI) complicaled with acute gastrointestinal injury(AGI). Methods A total of 95 children suffering from TBI hospitalized in the PICU of the First Affiliated Hospital of Zhengzhou University from January 2017 to March 2018 were enrolled in the study.According to the modified Glasgow coma score combined with clinical classification criteria for acute closed head injury, the cases were devided into mild(43 cases), moderate (23 cases), and severe(29 cases). Children were graded according to AGI (AGI Ⅰ42 cases, AGI Ⅱ 30 cases, AGI Ⅲ 13 cases, and AGI Ⅳ 10 cases). Thirty healthy children who underwent physical examination at outpatient service were enrolled as the control group.Blood samples were collected at the time of admission and on the 3rd day after admission.Serum IFABP was detected by ELISA, and the differences of serum IFABP concentrations were compared among groups.The correlations between IFABP with TBI classification and AGI grade were analyzed.The receiver operating characteristic (ROC) curve was drawn, and the predictive values of IFABP for the diagnosis of children with TBI complicated with AGI were evaluated. Results On the day of admission, the serum levels of IFABP in mild, moderate and severe brain injury group were significantly higher than that in control group (all P<0.01). And serum IFABP concentration gradually increased with the increase of brain injury (all P<0.01). Serum IFABP levels in children with AGI grade Ⅰto Ⅳ were significantly higher than those in control group (all P<0.01). The levels of serum IFABP also increased with the increase of AGI level (all P<0.01). The concentration of serum IFABP was positively correlated with the grade of TBI and AGI (rs=0.82, P<0.01; rs=0.70, P<0.01). In each group, the levels of serum IFABP on the 3rd day after admission were lower than those on admission (all P<0.01). The ROC curve analysis showed that serum IFABP was of high diagnostic value in children with TBI complicated with AGI, and the area under the ROC curve was 0.88.When the cutoff value of IFABP was 431.36 ng/L, the sensitivity and specificity were 71.61% and 90.00%, respectively. Conclusion Serum IFABP can be used as a sensitive indicator for the early diagnosis and disease assessment in children with TBI complicated with gastrointestinal dysfunction. Key words: Intestinal fatty acid binding protein; Traumatic brain injury; Gastrointestinal dysfunction; Children

Intestinal fatty acid-binding protein as a predictor of prognosis in postoperative cardiac surgery patients.

During the perioperative period of cardiac disease, as many risk factors exist, such as primary cardiac diseases, the use of vasopressors, ischemia-reperfusion injury during cardiopulmonary bypass (CPB), and surgical stress, the gut suffered from ischemia, anoxia and oxidative stress, which would lead to the enterocyte injury. The aim of this study was to explore whether serum intestinal fatty acid-binding protein (IFABP), which is excreted specifically from damaged intestinal enterocytes, as a predictor of prognosis in postoperative cardiac surgery patients.From January 2017 to December 2017, 40 postoperative cardiac surgery patients were enrolled in this observational study. Serum IFABP levels and prognostic biomarkers were recorded at intensive care unit (ICU) admission.The serum IFABP levels were significantly higher in postoperative cardiac surgery patients who complicated with multiple organ dysfunction syndrome (MODS) (median, 883.20 pg/mL vs 426.10 pg/mL; P < .001), infective complications (median, 917.70 pg/mL vs 409.40 pg/mL; P < .001), or who stayed in ICU beyond 4 days (median, 807.65 pg/mL vs 426.10 pg/mL; P < .001). Moreover, in patients who suffered from right ventricular dysfunction, the serum IFABP levels were significantly higher (median, 737.85 pg/mL vs 445.55 pg/mL; P = .016). The serum IFABP levels also showed great precision for the prediction of MODS (the area under curve, AUC 0.923), infective complications (AUC 0.961) and ICU stay beyond 4 days (AUC 0.853). And it correlated significantly with the acute physiology and chronic health evaluation (APACHE) II score (P < .05), sequential organ failure assessment (SOFA) score (P < .05), and acute gastrointestinal injury (AGI) grade (P < .001).The serum IFABP level at ICU admission is a valuable, convenient, and objective early predictor of prognosis in postoperative cardiac surgery patients.

Significance of dynamic evolution of TNF-α, IL-6 and intestinal fatty acid-binding protein levels in neonatal necrotizing enterocolitis.

To study the significance of dynamic evolution of serum tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6) and intestinal fatty acid-binding protein (I-FABP) levels in neonatal necrotizing enterocolitis (NEC). A total of 45 NEC child patients, 45 non-NEC child patients and 45 healthy newborns were enrolled. After the day age, weight, gestational week and delivery mode were matched, the serum TNF-α, IL-6 and I-FABP levels at 6, 24 and 72 h after admission were measured via ELISA method, and their correlations with prognosis were analyzed. The levels of serum TNF-α and IL-6 in NEC and non-NEC group reached the peak at 24 h and fell at 72 h; there were no differences in each time point between the two groups (P>0.05), but the levels of serum TNF-α and IL-6 were higher than those in the control group (P<0.05). The level of serum I-FABP in NEC and non-NEC group reached the peak at 6 h, and it fell at 72 h in NEC group and 24 h in non-NEC group; the level of I-FABP in each time point in NEC was significantly higher than that in non-NEC group, and the level was the lowest in healthy group; the differences were statistically significant (P<0.05). There were 40 cases of survival and 5 cases of death (11.1%) in NEC group, while there were 43 cases of survival and 2 cases of death (4.4%) in non-NEC group. There were no differences in serum TNF-α and IL-6 levels at different times between surviving child patients and dead child patients in NEC group (P>0.05), but the levels of serum I-FABP in surviving child patients at 6 h and 24 h were significantly lower than those in dead child patients (P<0.05), and there was no difference at 72 h (P>0.05). There were no differences in serum TNF-α, IL-6 and I-FABP levels at different times between surviving and dead child patients in non-NEC group (P>0.05). Serum I-FABP level and its dynamic evolution may be important indexes of early diagnosis and prognosis evaluation of NEC.

Diagnostic value of citrulline and intestinal fatty acid binding protein on acute gastrointestinal injury in critical patients: a prospective study of 530 patients

To observe the incidence of acute gastrointestinal injury (AGI) in intensive care unit (ICU) patients, and to approach the value of serum citrulline and intestinal fatty acid binding protein (IFABP) on diagnosis of AGI in critical patients. A prospective study was conducted. 576 critical patients admitted to ICU of Yantai Yuhuangding Hospital from February 2016 to February 2017 were enrolled. According to the AGI classification proposed by European Society of Intensive Care Medicine (ESICM) in 2012, the AGI and severity of the patients were observed. The general data, severity and prognosis of patients with different AGI grades were recorded. According to the random number table, 20 patients with normal kidney function from AGI I to IV were selected. The femoral artery blood was collected within 12 hours of ICU admission, and serum citrulline level was detected by high performance liquid chromatography (HPLC). Serum IFABP level was determined by enzyme-linked immunosorbent assay (ELISA). Twenty healthy subjects were selected as controls. The receiver operating characteristic curve (ROC) was drawn, and the predictive values of citrulline and IFABP for AGI diagnosis were evaluated. (1) 576 patients were enrolled in the analysis. Of which 530 patients (92.0%) had AGI, and 289 patients with grade I (54.5%), 154 with grade II (29.1%), 64 with grade III (12.1%), and 23 with grade IV (4.3%). With the increase in AGI classification, acute physiology and chronic health evaluation system II (APACHE II) score, sequential organ failure score (SOFA), the length of ICU stay and 28-day mortality were gradually increased. (2) Compared with health control group, the levels of serum citrulline in patients with different AGI grades were significantly decreased, and IFABP was significantly increased. With the increase in AGI classification, the citrulline level was gradually decreased, and IFABP level was gradually increased [citrulline levels (μmol/L) in AGI I,II,III,IV groups were 14.1±3.6, 12.7±3.1, 8.3±2.7, and 5.6±3.4, F = 3.287, P = 0.027, and IFABP levels (ng/L) were 526.7±204.9, 698.4±273.8, 894.7±455.9, and 1 062.8±532.2, F = 2.903, P = 0.043]. ROC curve analysis showed that citrulline had a higher predictive value for AGI diagnosis. The area under the ROC curve (AUC) was 0.927. When the cut-off value of citrulline was 9.7 μmol/L, the sensitivity and specificity were 87.5% and 87.5%, respectively. The AUC of IFABP was 0.043, which has no predictive value for the diagnosis of AGI. The AGI is extremely common in ICU. The higher the AGI grade is, the worse the prognosis is. Citrulline has high diagnostic value for AGI in critical patients, but IFABP has no predictive value on the diagnosis of AGI.