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O.31 Dietary fibre protects intestinal barrier function
0 . 3 0 Arginine-enriched total enteral nutrition increase liver albumin gene expression and does not increase iNOS expression J. Ren, S. Wang, Y. Zhao, J. Li and A. Li Research Institute of General Surgery, Jingling Hospital, Nanjing University, Nanjing, China. Aim: To examine the effects of arginine enriched total enteral nutrition (TEN) on liver albumin, TNF, IL-lcq IL-6R and inducible nitric oxide synthase (iNOS) gene expression. Methods: A 30% burn was applied in 40 rats after 7 days of gastrostomy. The rats received a continuous intragastric infusion of two different diets 2 hours after burn: low arginine (AL, arginine 0.01 g/kg/day) and arginine enriched (AE, arginine 0.264 g/kg/day). The two formulas were isocaloric (1 75 Kcal/kg/day) and isonitrogenous (1.25 gN/kg/day). The animals were sacrificed on day 1 post burn (PBD1) and PBD9. The mRNA of albumin, TNF, IL-l(z, IL-6R and iNOS of the liver were reverse transcribed (RT) into cDNA and the cDNA were amplifed by polymerase chain reaction (PCR). The RT-PCR products of albumin, TNF, IL-lc~, IL-6R and iNOS were determined by capillary electrophoresis (CE) and semi-quantified by the specific peak area of the CE chromatogram. Results: RT-PCR products of albumin, TNF, IL-6R and iNOS (absorbance unit).
Albumin
TNF
IL-6R
iNOS
AL(PBD1) 869_*:52 1031 _+23 4320_+108 965-+41 AE(PBD1) 813_+34 984+_27 3810+_217 984_+39 AL(PBD9) 1417 -+43~ 743 _+29* 2570 -+90* 547 _+23* AE(PBDg) 1812_+41"** 603_+32** 972-+87**~: 522_+48* Means -+SD, t-test: * P < 0.05 vs AL(PBD9), ** P < 0.01 vs AL(PBD9), 1:P < 0.01 vs PBDI.
Conclusion: TEN can improve albumin biosynthesis and reduce the gene expression of TNF, IL-1, IL-6R and iNOS. Arginine enriched TEN can further increase the gene expression of albumin possibly by reducing the expression of TNF and IL-6R and does not increase the expression of iNOS.
O.31
Dietary fibre protects intestinal barrier function
G. Y. Deng, Z. M. Jiang, Y. W. Liu, et al
Department of Surge~ Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. of China. Introduction: Many factors including chemotherapy might damage intestinal barrier function, which might lead to intestinal bacterial translocation. Little was known about the effect of dietary fibre on the intestinal barrier function. Aim: To evaluate the effect of dietary fibre on intestinal barrier function of 5-fluoruracil (5-Fu) challenged rat. Method: Thirty adult male Wistar rats underwent placement of gastrostomic catheters were assigned randomly to one of three groups (10 of each group). Chow; enteral nutrition (EN), or EN + Fiber 2g/100ml. Both EN and EN + Fiber group were isonitrogenic (2.5 g/kg/day) and isocaloric (250 kcal/kg/day). The rats kept their diet respectively for 8 days. 5-Fu (75 mg/kg) was injected intraperitoneally on day 4. Urinary recovery ratios of lactulose and mannitol (L%/M%) were measured respectively on day 3 and day 7. The mesenteric lymph nodes (MLN) were harvested for bacterial culture; small intestine and colon were taken for structure parameters (wet weight, mucosal thickness of both small and large intestine and villus height of small intestine) on day 8. Results: The incidence of bacterial translocation to MLN of EN + Fiber group (20%) was lower than those of EN group (70%) (P < 0.05), and similar to Chow group (20%) (P> 0.05). The L%/M% of both EN + Fiber (from 0.0265 _+0.0073 to 0.0274 + 0.0068) and Chow group (from 0.0268 + 0.0039 to 0.0281 _+ 0.0044) were unchanged (P > 0.05 for both), whereas those of EN group significantly increased (from 0.0289 _+0.0070 to 0.0331 _+0.0084) (P < 0.01 ). The body weight loss of EN + Fiber group (-3.1 + 3.4g) was less than EN group (-6.6 _+5.2g) (P< 0.05), whereas Chow group gained body weight (4.9 _+4.3 g) (P < 0.01 when compared with EN and EN + Fiber group). The parameters of intestinal structures of EN + Fiber group were superior to EN group and similar to Chow group. Conclusion: Dietary fibre could protect the intestinal barrier function of 5-Fu challenged rats.
0.32 atitis
Benefits of early enteral nutrition in acute pancre-
S. Kanwar, A. C. J. Windsor, P. Murchan, A. Li, J. I. Spark,
E Welsh, J. A. Guthrie, P. J. Guillou and J. V. Reynolds Professorial Surgical Unit, St James's University Hospital, Leeds, UK. Enteral nutrition (EN) significantly improves septic morbidity in patients with major trauma and burns when compared with total parenteral nutrition (TPN). Poor outcome in acute pancreatitis is associated with a high incidence of the systemic inflammatory response syndrome (SIRS) and sepsis, thus, EN may have a therapeutic rationale in acute pancreatitis. Glasgow score, Apache II, CT scan score, C-reactive protein (CRP), serum IgM anti-endotoxin (EndoCAb) antibodies and total antioxidant capacity (TAC) were determined on admission in 34 patients with acute pancreatitis. Patients were stratified according to disease severity and randomized to receive either TPN or EN for 7 days and then re-evaluated. Clinical outcome parameters (incidence of SIRs, sepsis, multiple organ failure, operative interention and mortality) were measured at follow-up. Clinical outcome, such as SIRS, sepsis, organ failure and ITU stay, were globally improved in the enterally fed patients. The acute phase response and disease severity scores were significantly improved following EN: CRP (156 (117-222) to 84 (50-141) P < 0.005) and APACHE II scores (8 (6-10) to 6 (4-8) P < 0.0001) without change in the CT scan scores. In the parenterally fed patients these parameters did not change but there was an increase in EndoCAb antibody levels (74 (+19) %) and a fall in TAC (30 (_+ 9) %). Enterally fed patients showed no change in the level of EndoCAb antibodies and an increase in TAC (20 (_+ 14) %). These data indicate that EN moderates the acute phase response, improves disease severity, and clinical outcome despite unchanged pancreatic injury on CT scan. In addition, these data provide evidence of reduced systemic exposure to endotoxin and reduced oxidant stress. Thus gut mucosal feeding modulates the inflammatory and sepsis response in acute pancreatitis and is clinically beneficial.
0.33 Human chyle inhibits endotoxin induced tumor necrosis factor-alpha (TNF-c0 production in vitro L. C. J. M. Lemaire 1'2, j. j. B. van Lanschot1, S. J. H. van Deventet2, T. van der PolF, J. H. M. Levels2 and D. J. Gouma 1 1Dept of Surgery and 2Experimental Internal Medicine, Academic Medical Center, Amsterdam. Lipoproteins can inhibit the toxic effects of endotoxin (LPS) in vitro and in vivo. LPS can pass the intestinal mucosa when this barrier is impaired. It has been shown that enteral feeding has a beneficial impact on gut barrier function. It is hypothesized that enteral feeding also protects the body against translocating LPS at the level of the thoracic duct, which transports chylomicrons and other lipoproteins from the intestines to the systemic circulation. Aim: To investigate LPS-neutralizing properties of human chyle by measuring LPS induced cytokine production in vitro, and to assess the chylecomponents which could affect this production. Methods: Triglyceride (TG)-poor (n = 8 patients) and TG-rich chyle (n = 16 patients) was collected from patients who underwent a transthoracic esophageal cancer resection. Patients with TG-rich chyle had drunk 250 mL cream 12 hrs prior to the operation. Apolipoprotein (Apo)A-1, Apo B and triglyceride concentrations were measured. TG-rich lymph was pooled, as was TG-poor lymph and subsequently preincubated with and without E. coil LPS for 24hrs at 37°C. Thereafter, peripheral blood mononuclear cells of 6 male volunteers were incubated with the different chyle/endotoxin suspensions for 4 hrs at 37 °C. TNF-c~ concentrations were measured. ApoA-1 concentrations and ApoB concentrations were comparable in TG-rich and TG-poor chyle. However, triglyceride concentrations differed significantly between the two groups (P < 0.01 ). 10% and 100% TG-rich chyle and TG-poor chyle, incubated with 1 ng/ml LPS decreased TNF-o~ production significantly as compared to incubation with 1 ng/mL LPS only.
Chyle
Mean(-+standarderrorof themean)TNF-c~production
10%TG-rich 591 ± 197pg/mL (P
There was no significant difference in the inhibition of TNF-(z production between the two different (TG-rich and TG-poor) chyle groups. Conclusion: HDL and LDL appear to be more important for endotoxin neutralization in human chyle than triglycerides.
Albumin
TNF
IL-6R
iNOS
AL(PBD1) 869_*:52 1031 _+23 4320_+108 965-+41 AE(PBD1) 813_+34 984+_27 3810+_217 984_+39 AL(PBD9) 1417 -+43~ 743 _+29* 2570 -+90* 547 _+23* AE(PBDg) 1812_+41"** 603_+32** 972-+87**~: 522_+48* Means -+SD, t-test: * P < 0.05 vs AL(PBD9), ** P < 0.01 vs AL(PBD9), 1:P < 0.01 vs PBDI.
Conclusion: TEN can improve albumin biosynthesis and reduce the gene expression of TNF, IL-1, IL-6R and iNOS. Arginine enriched TEN can further increase the gene expression of albumin possibly by reducing the expression of TNF and IL-6R and does not increase the expression of iNOS.
O.31
Dietary fibre protects intestinal barrier function
G. Y. Deng, Z. M. Jiang, Y. W. Liu, et al
Department of Surge~ Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. of China. Introduction: Many factors including chemotherapy might damage intestinal barrier function, which might lead to intestinal bacterial translocation. Little was known about the effect of dietary fibre on the intestinal barrier function. Aim: To evaluate the effect of dietary fibre on intestinal barrier function of 5-fluoruracil (5-Fu) challenged rat. Method: Thirty adult male Wistar rats underwent placement of gastrostomic catheters were assigned randomly to one of three groups (10 of each group). Chow; enteral nutrition (EN), or EN + Fiber 2g/100ml. Both EN and EN + Fiber group were isonitrogenic (2.5 g/kg/day) and isocaloric (250 kcal/kg/day). The rats kept their diet respectively for 8 days. 5-Fu (75 mg/kg) was injected intraperitoneally on day 4. Urinary recovery ratios of lactulose and mannitol (L%/M%) were measured respectively on day 3 and day 7. The mesenteric lymph nodes (MLN) were harvested for bacterial culture; small intestine and colon were taken for structure parameters (wet weight, mucosal thickness of both small and large intestine and villus height of small intestine) on day 8. Results: The incidence of bacterial translocation to MLN of EN + Fiber group (20%) was lower than those of EN group (70%) (P < 0.05), and similar to Chow group (20%) (P> 0.05). The L%/M% of both EN + Fiber (from 0.0265 _+0.0073 to 0.0274 + 0.0068) and Chow group (from 0.0268 + 0.0039 to 0.0281 _+ 0.0044) were unchanged (P > 0.05 for both), whereas those of EN group significantly increased (from 0.0289 _+0.0070 to 0.0331 _+0.0084) (P < 0.01 ). The body weight loss of EN + Fiber group (-3.1 + 3.4g) was less than EN group (-6.6 _+5.2g) (P< 0.05), whereas Chow group gained body weight (4.9 _+4.3 g) (P < 0.01 when compared with EN and EN + Fiber group). The parameters of intestinal structures of EN + Fiber group were superior to EN group and similar to Chow group. Conclusion: Dietary fibre could protect the intestinal barrier function of 5-Fu challenged rats.
0.32 atitis
Benefits of early enteral nutrition in acute pancre-
S. Kanwar, A. C. J. Windsor, P. Murchan, A. Li, J. I. Spark,
E Welsh, J. A. Guthrie, P. J. Guillou and J. V. Reynolds Professorial Surgical Unit, St James's University Hospital, Leeds, UK. Enteral nutrition (EN) significantly improves septic morbidity in patients with major trauma and burns when compared with total parenteral nutrition (TPN). Poor outcome in acute pancreatitis is associated with a high incidence of the systemic inflammatory response syndrome (SIRS) and sepsis, thus, EN may have a therapeutic rationale in acute pancreatitis. Glasgow score, Apache II, CT scan score, C-reactive protein (CRP), serum IgM anti-endotoxin (EndoCAb) antibodies and total antioxidant capacity (TAC) were determined on admission in 34 patients with acute pancreatitis. Patients were stratified according to disease severity and randomized to receive either TPN or EN for 7 days and then re-evaluated. Clinical outcome parameters (incidence of SIRs, sepsis, multiple organ failure, operative interention and mortality) were measured at follow-up. Clinical outcome, such as SIRS, sepsis, organ failure and ITU stay, were globally improved in the enterally fed patients. The acute phase response and disease severity scores were significantly improved following EN: CRP (156 (117-222) to 84 (50-141) P < 0.005) and APACHE II scores (8 (6-10) to 6 (4-8) P < 0.0001) without change in the CT scan scores. In the parenterally fed patients these parameters did not change but there was an increase in EndoCAb antibody levels (74 (+19) %) and a fall in TAC (30 (_+ 9) %). Enterally fed patients showed no change in the level of EndoCAb antibodies and an increase in TAC (20 (_+ 14) %). These data indicate that EN moderates the acute phase response, improves disease severity, and clinical outcome despite unchanged pancreatic injury on CT scan. In addition, these data provide evidence of reduced systemic exposure to endotoxin and reduced oxidant stress. Thus gut mucosal feeding modulates the inflammatory and sepsis response in acute pancreatitis and is clinically beneficial.
0.33 Human chyle inhibits endotoxin induced tumor necrosis factor-alpha (TNF-c0 production in vitro L. C. J. M. Lemaire 1'2, j. j. B. van Lanschot1, S. J. H. van Deventet2, T. van der PolF, J. H. M. Levels2 and D. J. Gouma 1 1Dept of Surgery and 2Experimental Internal Medicine, Academic Medical Center, Amsterdam. Lipoproteins can inhibit the toxic effects of endotoxin (LPS) in vitro and in vivo. LPS can pass the intestinal mucosa when this barrier is impaired. It has been shown that enteral feeding has a beneficial impact on gut barrier function. It is hypothesized that enteral feeding also protects the body against translocating LPS at the level of the thoracic duct, which transports chylomicrons and other lipoproteins from the intestines to the systemic circulation. Aim: To investigate LPS-neutralizing properties of human chyle by measuring LPS induced cytokine production in vitro, and to assess the chylecomponents which could affect this production. Methods: Triglyceride (TG)-poor (n = 8 patients) and TG-rich chyle (n = 16 patients) was collected from patients who underwent a transthoracic esophageal cancer resection. Patients with TG-rich chyle had drunk 250 mL cream 12 hrs prior to the operation. Apolipoprotein (Apo)A-1, Apo B and triglyceride concentrations were measured. TG-rich lymph was pooled, as was TG-poor lymph and subsequently preincubated with and without E. coil LPS for 24hrs at 37°C. Thereafter, peripheral blood mononuclear cells of 6 male volunteers were incubated with the different chyle/endotoxin suspensions for 4 hrs at 37 °C. TNF-c~ concentrations were measured. ApoA-1 concentrations and ApoB concentrations were comparable in TG-rich and TG-poor chyle. However, triglyceride concentrations differed significantly between the two groups (P < 0.01 ). 10% and 100% TG-rich chyle and TG-poor chyle, incubated with 1 ng/ml LPS decreased TNF-o~ production significantly as compared to incubation with 1 ng/mL LPS only.
Chyle
Mean(-+standarderrorof themean)TNF-c~production
10%TG-rich 591 ± 197pg/mL (P
There was no significant difference in the inhibition of TNF-(z production between the two different (TG-rich and TG-poor) chyle groups. Conclusion: HDL and LDL appear to be more important for endotoxin neutralization in human chyle than triglycerides.