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Tatucu-Babet OA, Forsyth A, Udy A, Radcliffe J, Benheim D, Calkin C, Ridley EJ, Gantner D, Jois M, Itsiopoulos C, Tierney AC. Use of a sensitive multisugar test for measuring segmental intestinal permeability in critically ill, mechanically ventilated adults: A pilot study. JPEN J Parenter Enteral Nutr 2021; 46:454-461. [PMID: 33760268 DOI: 10.1002/jpen.2110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Increased intestinal permeability (IP) is associated with sepsis in the intensive care unit (ICU). This study aimed to pilot a sensitive multisugar test to measure IP in the nonfasted state. METHODS Critically ill, mechanically ventilated adults were recruited from 2 ICUs in Australia. Measurements were completed within 3 days of admission using a multisugar test measuring gastroduodenal (sucrose recovery), small-bowel (lactulose-rhamnose [L-R] and lactulose-mannitol [L-M] ratios), and whole-gut permeability (sucralose-erythritol ratio) in 24-hour urine samples. Urinary sugar concentrations were compared at baseline and after sugar ingestion, and IP sugar recoveries and ratios were explored in relation to known confounders, including renal function. RESULTS Twenty-one critically ill patients (12 males; median, 57 years) participated. Group median concentrations of all sugars were higher following sugar administration; however, sucrose and mannitol increases were not statistically significant. Within individual patients, sucrose and mannitol concentrations were higher in baseline than after sugar ingestion in 9 (43%) and 4 (19%) patients, respectively. Patients with impaired (n = 9) vs normal (n = 12) renal function had a higher L-R ratio (median, 0.130 vs 0.047; P = .003), lower rhamnose recovery (median, 15% vs 24%; P = .007), and no difference in lactulose recovery. CONCLUSION Small-bowel and whole-gut permeability measurements are possible to complete in the nonfasted state, whereas gastroduodenal permeability could not be measured reliably. For small-bowel IP measurements, the L-R ratio is preferred over the L-M ratio. Alterations in renal function may reduce the reliability of the multisugar IP test, warranting further exploration.
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Affiliation(s)
- Oana A Tatucu-Babet
- Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Adrienne Forsyth
- Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | - Andrew Udy
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.,Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jessica Radcliffe
- Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia.,Senior Scientist Group Nutrition, Immunity and Metabolism, Department of Nutrition and Gerontology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Potsdam, Germany
| | - Devin Benheim
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Melbourne, Australia
| | | | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.,Nutrition Department, Alfred Health, Melbourne, Australia
| | - Dashiell Gantner
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.,Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Markandeya Jois
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Melbourne, Australia
| | - Catherine Itsiopoulos
- Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia.,School of Health and Biomedical Sciences, College of STEM, RMIT University, Melbourne, Australia
| | - Audrey C Tierney
- Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia.,School of Allied Health and Health Implementation Science and Technology Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Acute haemodynamic changes during haemodialysis do not exacerbate gut hyperpermeability. Biosci Rep 2019; 39:BSR20181704. [PMID: 30898976 PMCID: PMC6477914 DOI: 10.1042/bsr20181704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 02/11/2019] [Accepted: 03/05/2019] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The gastrointestinal tract is a potential source of inflammation in dialysis patients. In vitro studies suggest breakdown of the gut barrier in uraemia leading to increased intestinal permeability and it is hypothesised that haemodialysis exacerbates this problem due to mesenteric ischaemia induced by blood volume changes during treatment. METHOD The effect of haemodialysis on intestinal permeability was studied in ten haemodialysis patients and compared with five controls. Intestinal permeability was assessed by measuring the differential absorption of four orally administered sugar probes which provides an index of small and whole bowel permeability. A multi-sugar solution (containing lactulose, rhamnose, sucralose and erythritol) was orally administered after an overnight fast. Plasma levels of all sugar probes were measured hourly for 10 h post-administration. In haemodialysis patients, the procedure was carried out twice - once on a non-dialysis day and once immediately after haemodialysis. RESULTS Area under curve (AUC) for lactulose:rhamnose (L:R) ratio and sucralose:erythritol (S:E) ratio was similar post-dialysis and on non-dialysis days. AUC for L:R was higher in haemodialysis patients compared with controls (0.071 vs. 0.034, P=0.001), AUC for S:E ratio was not significantly different. Levels of lactulose, sucralose and erythritol were elevated and retained longer in haemodialysis patients compared with controls due to dependence of sugars on kidney function for clearance. CONCLUSION We found no significant acute changes in intestinal permeability in relation to the haemodialysis procedure. Valid comparison of intestinal permeability between controls and haemodialysis patients was not possible due to the strong influence of kidney function on sugar levels.
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Sprooten RT, Lenaerts K, Braeken DC, Grimbergen I, Rutten EP, Wouters EF, Rohde GG. Increased Small Intestinal Permeability during Severe Acute Exacerbations of COPD. Respiration 2018; 95:334-342. [PMID: 29393240 PMCID: PMC5985742 DOI: 10.1159/000485935] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Disturbances of intestinal integrity, manifested by increased gastro-intestinal (GI) permeability, have been found in chronic obstructive pulmonary disease (COPD) patients during physical activity, often associated with intermittent hypoxic periods. Evidence about extrapulmonary organ disturbances, especially of the GI tract, during hospitalised acute exacerbation of COPD (AE-COPD) with hypoxaemic respiratory failure (RF) is lacking. OBJECTIVE The aim was to assess changes in GI permeability in patients with AE-COPD and during recovery 4 weeks later. METHODS All patients admitted to our hospital with AE-COPD accompanied by hypoxaemia at admission (PaO2 <8.7 kPa or O2 saturation <93%) were screened between October 2013 and February 2014. Patients with a history of GI or renal disease, chronic heart failure, or use of non-steroidal anti-inflammatory drugs in the 48 h before the test were excluded. GI permeability was assessed by evaluating urinary excretion ratios of the orally ingested sugars lactulose/L-rhamnose (L/R ratio), sucrose/L-rhamnose (Su/R ratio) and sucralose/erythritol (S/E ratio). RESULTS Seventeen patients with severe to very severe COPD completed the study. L/R ratio (×103) at admission of AE-COPD was significantly higher than in the recovery condition (40.9 [29.4-49.6] vs. 27.3 [19.5-47.7], p = 0.039), indicating increased small intestinal permeability. There were no significant differences in the individual sugar levels in urine nor in the 0- to 5-h urinary S/E and Su/R ratios between the 2 visits. CONCLUSION This is the first study showing increased GI permeability during hospitalised AE-COPD accompanied by hypoxaemic RF. Therefore, GI integrity in COPD patients is an attractive target for future research and for the development of interventions to alleviate the consequences of AE-COPD.
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Affiliation(s)
- Roy T.M. Sprooten
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kaatje Lenaerts
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Dionne C.W. Braeken
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- Ciro, Horn, the Netherlands
| | - Ilvy Grimbergen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Emiel F.M. Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- Ciro, Horn, the Netherlands
| | - Gernot G.U. Rohde
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Respiratory Medicine, Medical Clinic I, J.W. Goethe University Hospital, Frankfurt/Main, Germany
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Kurundkar AR, Killingsworth CR, McIlwain RB, Timpa JG, Hartman YE, He D, Karnatak RK, Neel ML, Clancy JP, Anantharamaiah GM, Maheshwari A. Extracorporeal membrane oxygenation causes loss of intestinal epithelial barrier in the newborn piglet. Pediatr Res 2010; 68:128-33. [PMID: 20442689 PMCID: PMC2914515 DOI: 10.1203/pdr.0b013e3181e4c9f8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is an important life-support system used in neonates and young children with intractable cardiorespiratory failure. In this study, we used our porcine neonatal model of venoarterial ECMO to investigate whether ECMO causes gut barrier dysfunction. We subjected 3-wk-old previously healthy piglets to venoarterial ECMO for up to 8 h and evaluated gut mucosal permeability, bacterial translocation, plasma levels of bacterial products, and ultrastructural changes in gut epithelium. We also measured plasma lipopolysaccharide (LPS) levels in a small cohort of human neonates receiving ECMO. In our porcine model, ECMO caused a rapid increase in gut mucosal permeability within the first 2 h of treatment, leading to a 6- to 10-fold rise in circulating bacterial products. These changes in barrier function were associated with cytoskeletal condensation in epithelial cells, which was explained by phosphorylation of a myosin II regulatory light chain. In support of these findings, we also detected elevated plasma LPS levels in human neonates receiving ECMO, indicating a similar loss of gut barrier function in these infants. On the basis of these data, we conclude that ECMO is an independent cause of gut barrier dysfunction and bacterial translocation may be an important contributor to ECMO-related inflammation.
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Affiliation(s)
- Ashish R Kurundkar
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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