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Dugbartey GJ, Nanteer D, Osae I. Nitric oxide protects intestinal mucosal barrier function and prevents acute graft rejection after intestinal transplantation: A mini-review. Nitric Oxide 2024; 149:1-6. [PMID: 38806106 DOI: 10.1016/j.niox.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 04/19/2024] [Accepted: 05/25/2024] [Indexed: 05/30/2024]
Abstract
Intestinal transplantation is a complex technical procedure that provides patients suffering from end-stage intestinal failure an opportunity to enjoy improved quality of life, nutrition and survival. Compared to other types of organ transplants, it is a relatively new advancement in the field of organ transplantation. Nevertheless, great advances have been made over the past few decades to the present era, including the use of ischemic preconditioning, gene therapy, and addition of pharmacological supplements to preservation solutions. However, despite these strides, intestinal transplantation is still a challenging endeavor due to several factors. Notable among them is ischemia-reperfusion injury (IRI), which results in loss of cellular integrity and mucosal barrier function. In addition, IRI causes graft failure, delayed graft function, and decreased graft and recipient survival. This has necessitated the search for novel therapeutic avenues and improved transplantation protocols to prevent or attenuate intestinal IRI. Among the many candidate agents that are being investigated to combat IRI and its associated complications, nitric oxide (NO). NO is an endogenously produced gaseous signaling molecule with several therapeutic properties. The purpose of this mini-review is to discuss IRI and its related complications in intestinal transplantation, and NO as an emerging pharmacological tool against this challenging pathological condition. i.
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Affiliation(s)
- George J Dugbartey
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana; Department of Physiology & Pharmacology, Accra College of Medicine, East Legon, Accra, Ghana; Department of Surgery, Division of Urology, London Health Sciences Center, Western University, London, Ontario, Canada; Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Center, Western University, London, Ontario, Canada.
| | - Deborah Nanteer
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Ivy Osae
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
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Moreira GA, Dias AIBDS, Cadena SMSC, Corrêa-Ferreira ML, Ioshii SO, Fachin CG. Use of sildenafil and L-arginine in an experimental rat model for the prevention of neonatal necrotizing enterocolitis. Sci Rep 2022; 12:6206. [PMID: 35418668 PMCID: PMC9008060 DOI: 10.1038/s41598-022-10323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/31/2022] [Indexed: 11/20/2022] Open
Abstract
Necrotizing enterocolitis (NEC) has a 45% mortality in neonatal intensive care units. This paper aimed to evaluate the isolated and combined effects of sildenafil and l-arginine in the prevention of necrotizing enterocolitis. Neonatal rats were fed formula milk and submitted to hypoxia under a 100% N2 atmosphere for 70 s. Then, animals were subjected to hypothermia (4 °C for 10 min), twice a day for 3 days. Forty neonatal rats were divided into five groups: negative control—not submitted to the protocol (n = 5), sildenafil group—NEC protocol (n = 9), l-arginine group—NEC protocol (n = 9), l-arginine and sildenafil group—NEC protocol (n = 9) and positive control—NEC protocol and intraperitoneal saline solution (n = 8). Jejunum and terminal ileus were removed for histopathologic and immunohistochemical Ki-67 analysis. Kruskal–Wallis test was used to analyze mortality, survival, body weight, intestinal injury score and Ki-67 proliferation index. All animals submitted to the protocol developed enterocolitis. Mortality rate was higher in group that received only l-arginine (p = 0.0293). The Ki-67 analysis showed a higher proliferative index in groups that received interventional drugs (p = 0.017). In conclusion, sildenafil and l-arginine were not effective to reduce intestinal injury.
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Affiliation(s)
- Gabriela Araujo Moreira
- Pediatric Surgery Department, Medical School, Federal University of Parana, Curitiba, R. Gen. Carneiro, 181 - Alto da Glória, Curitiba, PR, 80060-900, Brazil.
| | - André Ivan Bradley Dos Santos Dias
- Pediatric Surgery Department, Federal University of Parana, Curitiba, R. Gen. Carneiro, 181 - Alto da Glória, Curitiba, PR, 80060-900, Brazil
| | - Silvia Maria Suter Correia Cadena
- Biochemistry Department, Federal University of Parana Campus Polytechnic Center, Curitiba, Jardim das Américas, Curitiba, PR, 80050-540, Brazil
| | - Marília Locatelli Corrêa-Ferreira
- Biochemistry Department, Federal University of Parana Campus Polytechnic Center, Curitiba, Jardim das Américas, Curitiba, PR, 80050-540, Brazil
| | - Sergio Ossamu Ioshii
- Pathology Department, Federal University of Parana, Curitiba, R. Gen. Carneiro, 181 - Alto da Glória, Curitiba, PR, 80060-900, Brazil
| | - Camila Girardi Fachin
- Pediatric Surgery Department, Federal University of Parana, Curitiba, R. Gen. Carneiro, 181 - Alto da Glória, Curitiba, PR, 80060-900, Brazil
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L-ARGININE PREVENTS ISCHEMIC INJURY IN EXPLANTED RAT INTESTINAL REGIONS IN AN EX VIVO PERFUSION MODEL. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mustafa G, Cai CL, Bodkin D, Aranda JV, Beharry KD. Antioxidants and/or fish oil reduce intermittent hypoxia-induced inflammation in the neonatal rat terminal ileum. Prostaglandins Other Lipid Mediat 2021; 155:106565. [PMID: 34051366 DOI: 10.1016/j.prostaglandins.2021.106565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/29/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022]
Abstract
Intermittent hypoxia (IH) is associated with the pathogenesis of necrotizing enterocolitis (NEC). We tested the hypothesis that early supplementation with antioxidants and/or fish oil protects the terminal ileum from oxidative injury induced by neonatal IH. Newborn rats were exposed to neonatal IH from birth (P0) until P14 during which they received daily fish oil, coenzyme Q10 (CoQ10), glutathione nanoparticles (nGSH), fish oil + CoQ10, or olive oil. Pups were then placed in room air from P14 to P21 with no further supplementation. Terminal ileum was assessed for IH-induced injury and inflammatory biomarkers. Neonatal IH induced severe damage consistent with NEC, and was associated with oxidative stress and elevations in PGE2, PGF2α, TxB2, NOS-2 and TLR-4, effects that were ameliorated with nGSH and combination CoQ10+fish oil. Early postnatal supplementation with antioxidants and/or fish oil during neonatal IH may be favorable for preserving gut integrity and reducing oxidative injury.
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Affiliation(s)
- Ghassan Mustafa
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Charles L Cai
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Darren Bodkin
- Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Jacob V Aranda
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA; Department of Ophthalmology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Kay D Beharry
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA; Department of Ophthalmology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA.
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Fadl HO, Amin NM, Wanas H, El-Din SS, Ibrahim HA, Aboulhoda BE, Bocktor NZ. The impact of l-arginine supplementation on the enteral phase of experimental Trichinella spiralis infection in treated and untreated mice. J Parasit Dis 2020; 44:737-747. [PMID: 33184541 DOI: 10.1007/s12639-020-01245-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/12/2020] [Indexed: 12/16/2022] Open
Abstract
The role of nitric oxide (NO) in the immunopathological response during Trichinella spiralis (T. spiralis) infection remains controversial. The amino acid, l-arginine is a NO precursor commonly used by athletes and bodybuilders as a protein supplement. As to our knowledge, there are no published studies which have tested the effect of l-arginine on the intestinal phase of experimental trichinellosis. The present work aims to investigate the effect of l-arginine on the enteral phase of experimental T. spiralis infection in albendazole-treated and untreated mice. Forty BALB/C mice infected orally with T. spiralis larvae were divided into 4 groups as follows: Group A were infected and untreated (control) mice, Group B received albendazole alone, Group C received l-arginine alone, and Group D received both l-arginine and albendazole. Compared to the control group, l-arginine supplementation showed; a significant increase in the intestinal adult worm burden, a significantly high inducible NO synthase (iNOS) expression, elevated immune markers; tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ), and enhanced apoptosis. Albendazole treated-group had a significant reduction in the adult worm number (90.9%), while combined albendazole-arginine regimen showed a lower percentage of worm reduction (72.7%). During the enteral phase of T. spiralis infection, l-arginine supplementation should be taken cautiously, as it may modulate the proinflammatory immune response and subsequently affect the outcome of the infection and/or treatment.
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Affiliation(s)
- Hanaa O Fadl
- Medical Parasitology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Noha M Amin
- Medical Parasitology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanaa Wanas
- Pharmacology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.,Pharmacology and Toxicology Department, Faculty of Pharmacy, Taibah University, Medina, Kingdom of Saudi Arabia
| | - Shimaa Saad El-Din
- Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba A Ibrahim
- Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Basma Emad Aboulhoda
- Anatomy and Embryology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nardeen Zakka Bocktor
- Medical Parasitology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Silvares SG, Moron AF, Simões MDJ, Cintra ÁU, Montero EFDS, Araujo Júnior E, Martins JL. Histological analysis of the intestinal wall of newborn rats submitted to hypoxia and reoxygenation to evaluate the protective effect of N-Acetylcysteine. Acta Cir Bras 2020; 35:e202000401. [PMID: 32555935 PMCID: PMC7292620 DOI: 10.1590/s0102-865020200040000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/11/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose To evaluate the effect of N-Acetylcysteine (NAC) in newborn rats submitted to hypoxia and reoxygenation (H/R) conditions in an experimental model of necrotizing enterocolitis. Methods Eight pregnant rats and their 70 cubs were used (5 groups) and exposed to H/R conditions and received NAC at different times. The animals in the H/R groups were placed in a gas chamber (100% CO2) for 10 minutes and then reoxygenated for 10 minutes (100% O2), twice a day for the first three days of life, with a six-hour span between events. On the third day of life, the animals were anesthetized, laparotomized and the intestines were resected. Results The H/R and NAC groups showed changes in the intestinal wall in relation to the number, height and width of the villi when compared to the control group (p<0.0001), but with better preservation of structures in the NAC group. There were no differences between groups regarding the number (%) of mitoses. Conclusion The administration of NAC decreased the lesions in the intestinal wall of rats submitted to H/R, therefore suggesting that this drug can be used to prevent the development of necrotizing enterocolitis in newborns.
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Teixeira LC, Fujiki RTM, Souza CVCPD, Souza CMD, Mismetti MM, Artigiane-Neto R, Montero EFDS, Martins JL. Oxidative stress assessment in intestine of newborn rats submitted to hypoxia and reoxygenation with tadalafil. Acta Cir Bras 2019; 34:e201900407. [PMID: 31038585 PMCID: PMC6583938 DOI: 10.1590/s0102-865020190040000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/25/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose: To evaluate the functional and structural response of tadalafil effects in the intestinal mucosa, using an experimental model of hypoxia and reoxygenation injury in rats. Methods: The animals were divided into 4 groups: CTL, H/R, H/R+Td and M+Td. The newborn rats allocated in groups H/R, H/R+Td and M+Td were submitted twice a day, to a gas chamber with CO2 at 100% for 10 minutes and afterward reoxygenation with O2 at 98% for 10 minutes, in the three first days of life. Tadalafil dose was given to newborn of group H/R+Td and to the pregnant rat of group M+Td. Histological analysis was made with hematoxylin-eosin technique and oxidative stress through nitrite and nitrate levels and lipid peroxidation. Results: The histological analysis showed a reduction of mucosa alterations in the groups that received tadalafil. In the oxidative stress evaluation, occurred an increase of NO levels and less lipidic peroxidation in the ileum segments that received tadalafil. Conclusion: Tadalafil provides tissue protection when administered independently to both, pregnant or newborns.
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Affiliation(s)
- Luciana Cristina Teixeira
- Fellow Master degree, Postgraduate Program in Interdisciplinary Surgical Science, Universidade Federal de São Paulo (UNIFESP), Brazil. Technical procedures; acquisition, analysis and interpretation of data; manuscript preparation
| | - Renato Toshio Murashita Fujiki
- Graduate student, UNIFESP, Sao Paulo-SP, Brazil. Technical procedures; acquisition, analysis and interpretation of data; manuscript preparation
| | | | - Camila Mendes de Souza
- Graduate student, UNIFESP, Sao Paulo-SP, Brazil. Technical procedures; acquisition, analysis and interpretation of data; manuscript preparation
| | - Maysa Moreira Mismetti
- Graduate student, Faculdade de Medicina Santa Marcelina, Sao Paulo-SP, Brazil. Technical procedures; acquisition, analysis and interpretation of data; manuscript preparation
| | - Ricardo Artigiane-Neto
- Associate Professor, Head, Department of Pathology, UNIFESP, Sao Paulo-SP, Brazil. Histopathological examinations, critical revision, final approval
| | - Edna Frasson de Souza Montero
- Associate Professor, Surgical Gastroenterology Division, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Scientific and intellectual content of the study, critical revision, final approval
| | - José Luiz Martins
- Full Professor, Pediatric Surgery Division, UNIFESP, Sao Paulo-SP, Brazil. Scientific, intellectual, conception and design of the study; critical revision; final approval
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Navolotskaya EV, Sadovnikov VB, Zinchenko DV, Vladimirov VI, Zolotarev YA. Interaction of Cholera Toxin B Subunit with Rat Intestinal Epithelial Cells. RUSSIAN JOURNAL OF BIOORGANIC CHEMISTRY 2018. [DOI: 10.1134/s1068162018030123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Navolotskaya EV, Sadovnikov VB, Lipkin VM, Zav'yalov VP. Binding of cholera toxin B subunit to intestinal epithelial cells. Toxicol In Vitro 2018; 47:269-273. [DOI: 10.1016/j.tiv.2017.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/08/2017] [Accepted: 12/14/2017] [Indexed: 11/16/2022]
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Gomes RDOL, Artigiani R, Guimarães JDF, Nunes AP, Montero EFDS, Martins JL. Neonatal necrotizing enterocolitis rat model attenuated by a remote ischemic preconditioning in the pregnant. Acta Cir Bras 2017; 32:236-242. [PMID: 28403348 DOI: 10.1590/s0102-865020170030000008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/24/2017] [Indexed: 01/24/2023] Open
Abstract
Purpose: To evaluate the effect of remote ischemic preconditioning (r-IPC) administered to pregnant rats, in the ileum of newborn rats subjected to hypoxia and reoxygenation. Methods: We used three pregnant rats and their newborn rats distributed in three groups: 1) Control (C) - Newborn rats born from a pregnant rat which did not undergo any intervention; 2) Hypoxia-Reoxygenation (H/R) - Newborn rats born from a pregnant rat which did not undergo any intervention, and were subjected to hypoxia-reoxygenation; 3) Remote Ischemic Preconditioning (r-IPC) - newborn rats born from a pregnant rat which was subjected to remote ischemic preconditioning twenty-four hours before giving birth and the newborn rats were subjected to hypoxia-reoxygenation. Segments of ileum were prepared for histological analysis by HE and immunohistochemistry by the Ki67 to evaluate cell proliferation, crypt depth and villus height and evaluation of apoptosis by cleaved caspase-3. Results: The intensity of the lesions was lower in the r-IPC than in the H/R group, showing significant difference (p<0.01). The r-IPC group showed a higher proliferative activity compared to the H/R group (p<0.01), with deeper crypts (r-IPC > H/R - p < 0.05), and higher villi, showing significant difference (r-IPC > H/R - (p <0.01). The occurrence of apoptosis in the H/R group was lower in comparison to groups C and r-IPC, with significant difference (H/R < r-IPC; p<0.05). Conclusion: The remote ischemic preconditioning applied to the pregnant rat protected the ileum of newborn rats subjected to hypoxia and reoxygenation, with decreased intensity of the lesions in the ileum mucosa and preservation of proliferative activity, keeping the villus height and crypt depth similar to group C.
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Affiliation(s)
- Rúdnei de Oliveira Luciano Gomes
- Fellow PhD degree, Postgraduate Program in Interdisciplinary Surgical Science, Universidade Federal de São Paulo (UNIFESP), Sao Paulo-SP, Brazil. Design of the study, acquisition and interpretation of data, manuscript writing
| | - Ricardo Artigiani
- Associate Professor, Department of Pathology, UNIFESP, Sao Paulo-SP, Brazil. Histopathological examinations
| | - José de Freitas Guimarães
- Fellow PhD degree, Postgraduate Program in Interdisciplinary Surgical Science, Universidade Federal de São Paulo (UNIFESP), Sao Paulo-SP, Brazil. Design of the study, acquisition and interpretation of data, manuscript writing
| | - Adriana Porto Nunes
- Fellow PhD degree, Postgraduate Program in Interdisciplinary Surgical Science, Universidade Federal de São Paulo (UNIFESP), Sao Paulo-SP, Brazil. Design of the study, acquisition and interpretation of data, manuscript writing
| | - Edna Frasson de Souza Montero
- Associate Professor, Department of Surgery, Laboratory of Surgical Physiopathology (LIM-62), School of Medicine, Universidade de São Paulo (USP), and Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Intellectual and scientific content of the study, critical revision
| | - José Luiz Martins
- Full Professor, Department of Pediatric Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study, critical revision
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Talavera MM, Nuthakki S, Cui H, Jin Y, Liu Y, Nelin LD. Immunostimulated Arginase II Expression in Intestinal Epithelial Cells Reduces Nitric Oxide Production and Apoptosis. Front Cell Dev Biol 2017; 5:15. [PMID: 28299311 PMCID: PMC5331049 DOI: 10.3389/fcell.2017.00015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/14/2017] [Indexed: 01/03/2023] Open
Abstract
Increased production of nitric oxide (NO) and subsequent local cytotoxicity to mucosal epithelial cells has been proposed as a putative mechanism involved in the development of necrotizing enterocolitis (NEC). Intestinal epithelial cells (IECs) metabolize L-arginine to either nitric oxide (NO) by NO synthase (NOS) or to L-ornithine and urea by arginase. L-ornithine is the first step in polyamine synthesis important for cell proliferation, while NO production can lead to apoptosis. We hypothesized that in IECs immunostimulation increases both NOS and arginase expression, and that arginase activity mitigates NO production and apoptosis. Rat intestinal epithelial cells (rIEC-6) were immunostimulated by either incubation with lipopolysaccharide (LPS) alone for 24 h or by incubation with conditioned media (CM) for 24 h. CM was obtained from RAW 264.7 cells (a macrophage cell line) treated with LPS (E. coli 0127:B8; 1 μg/ml) for 4 h. The rIEC-6 stimulated with LPS or with CM had significantly higher levels of inducible NOS (iNOS) protein, NO production, and arginase II protein than did the control cells. Direct LPS stimulation of rIEC-6 produced a less robust increase in iNOS expression and NO (represented as nitrite percent of control) than did CM stimulation. Inhibition of arginase using Nω hydroxyl-L-arginine (NOHA) further increased stimulated NO production in rIEC-6. Viable cell numbers were significantly lower in CM stimulated cells after 24 h than in controls, and inhibition of arginase activity with NOHA resulted in a further significant decrease in viable cell numbers. We conclude that immunostimulated arginase expression of rIEC-6 cells tempers cytokine-induced iNOS-derived NO production and apoptosis.
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Affiliation(s)
- Maria M Talavera
- Center for Perinatal Research, The Research Institute at Nationwide Children's HospitalColumbus, OH, USA; Department of Pediatrics, The Ohio State UniversityColumbus, OH, USA
| | - Sushma Nuthakki
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital Houston, TX, USA
| | - Hongmei Cui
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital Columbus, OH, USA
| | - Yi Jin
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital Columbus, OH, USA
| | - Yusen Liu
- Center for Perinatal Research, The Research Institute at Nationwide Children's HospitalColumbus, OH, USA; Department of Pediatrics, The Ohio State UniversityColumbus, OH, USA
| | - Leif D Nelin
- Center for Perinatal Research, The Research Institute at Nationwide Children's HospitalColumbus, OH, USA; Department of Pediatrics, The Ohio State UniversityColumbus, OH, USA
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Freitas MALD, Gomes RDOL, Soares BLDF, Artigiani Neto R, Montero EFDS, Martins JL. Effects of maternal ischemic preconditioning in the colon of newborn rats submitted to hypoxia-reoxygenation insult. Acta Cir Bras 2015; 29:438-44. [PMID: 25054874 DOI: 10.1590/s0102-86502014000700005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/21/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the effects of maternal remote ischemic preconditioning (IPCr) in the colonic mucosa of newborn rats subjected to hypoxia and reoxygenation. METHODS Newborn Wistar rats were divided into three groups. Control Group (CG), Hypoxia and Reoxygenation Group (HRG) and Remote Ischemic Preconditioning Group (IPCrG). Hypoxia and reoxygenation was performed 2x per day, with an interval of 6 hours, on the 1st, 2nd and 3rd days of life, with 10 minutes of CO2 at 100%, followed by 10 minutes O2 at 100%(HRG/IPCrG). The maternal IPCr was performed 24 hours before delivery by applying a rubber band tourniquet to the left hind limb (IPCrG). Segments of the colon underwent histological (HE) and immunohistochemical analysis for caspase-3 and COX - 2. RESULTS The histological findings showed no intestinal mucosal damage in the CG group and severe lesions in HRG that was attenuated in the IPCrG (p<0.05). The expression of the apoptotic cells was lower in the HRG group than in the CG and IPCrG. The COX-2 expression was intense in HRG and attenuated in the IPCrG (p<0.05). CONCLUSIONS Maternal IPCr protected the colonic mucosa of newborn rats subjected to hypoxia and reoxygenation, reducing the morphological alterations and inflammatory response. It ameliorates the occurrence of apoptosis, keeping the physiological process of renewal and regeneration in the epithelial lining of the colonic mucosa.
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Affiliation(s)
| | | | | | | | | | - José Luiz Martins
- Department of Pediatric Surgery, EPM, UNIFESP, Sao Paulo, SP, Brazil
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Mitchell K, Lyttle A, Amin H, Shaireen H, Robertson HL, Lodha AK. Arginine supplementation in prevention of necrotizing enterocolitis in the premature infant: an updated systematic review. BMC Pediatr 2014; 14:226. [PMID: 25205007 PMCID: PMC4166475 DOI: 10.1186/1471-2431-14-226] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 09/04/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hypoxic-ischemic injury is thought to play a significant role in necrotizing enterocolitis (NEC). Nitric Oxide (NO) is the principal inhibitory neurotransmitter in the gut and is involved in regulation of mucosal blood flow and maintenance of mucosal integrity. NO is synthesized from L-arginine by NO synthases. Our primary objective was to determine the effectiveness of supplemental L-arginine versus placebo in prevention of NEC in preterm infants ≤ 34 weeks gestational age by systematic review of published randomized controlled trials (RCTs). METHODS This review included RCTs in which L-arginine was administered as a supplement to neonates to prevent NEC. Searches were conducted in OVID MEDLINE, EMBASE, PubMed, and CINAHL from their dates of inception to July, 2014. Inclusion criteria were informed parental consent, neonates born at ≤ 34 weeks gestation, and birth weight ≤ 1500 g. Exclusion criteria included neonates with severe congenital anomalies and inborn errors of metabolism. Incidence of NEC was the primary outcome measure. Whole data were analyzed by RevMan 5.1 (Update Software, Oxford, UK). Outcome data were analyzed to determine risk ratios, number needed to treat, confidence intervals, and test for overall effect. RESULTS Two trials including 425 neonates were eligible for this review. Of these, 235 neonates were included in the study. L-arginine had a 59% reduction in the incidence of stage II and III NEC (RR 0.41, 95% CI 0.20 to 0.85, NNT = 9) compared with placebo (P = 0.02). A similar finding was identified for all stages of NEC (60% reduction, RR 0.40, 95% CI 0.23 to 0.69, NNT = 5) (P = 0.001). At age 3 yrs, there was no significant difference between the 2 groups in terms of any neurodevelopmental disability (RR 0.65; 95% CI 0.23-1.83, P = 0.41). CONCLUSIONS L-arginine supplementation appears to be protective in prevention of NEC in preterm infants and without any significant impact on neurodevelopmental outcomes at 36 months of corrected age. With the addition of the results of one more study to the literature, an intriguing role for L-arginine supplementation continues to gain support. However, large multi-centre RCTs are needed before this can become common practice.
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Affiliation(s)
| | | | | | | | | | - Abhay K Lodha
- Department of Paediatrics, University of Calgary, Alberta Children's Hospital, Calgary T2N2T9, AB, Canada.
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Marin T, Josephson CD, Kosmetatos N, Higgins M, Moore JE. Feeding preterm infants during red blood cell transfusion is associated with a decline in postprandial mesenteric oxygenation. J Pediatr 2014; 165:464-71.e1. [PMID: 24948351 DOI: 10.1016/j.jpeds.2014.05.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 04/01/2014] [Accepted: 05/01/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the mesenteric tissue oxygenation response in preterm infants fed and not fed during red blood cell (RBC) transfusions. STUDY DESIGN Prospective, observational comparison of mesenteric oxygenation using near-infrared spectroscopy in preterm infants (<33 weeks' at birth) who were fed or not fed during RBC transfusion. Tissue oxygenation means were examined up to 48 hours after each transfusion event. RESULTS Mean mesenteric regional oxygen saturation (rSO2) slopes during RBC transfusion of fed (n = 9) vs not fed (n = 8) infants ranged from -0.23 to +0.23 (mean 0.04) with no differences between groups (P = .480). However, following transfusions, postprandial mesenteric oxygenation means significantly declined in infants fed during transfusion compared with infants not fed during transfusion (P < .001). Infants fed during RBC transfusion had a mean 2.16 point decrease in rSO2 mesenteric oxygenation with each sequential feeding post-transfusion, whereas infants not fed during RBC transfusion increased their rSO2 postprandial mesenteric oxygenation by a mean of 2.09 points. CONCLUSIONS Mesenteric tissue oxygenation during RBC transfusion is not influenced by feeding status. However, infants fed during RBC transfusion had, for the next 15 hours, decreasing postprandial mesenteric tissue oxygenation patterns compared with infants not fed during RBC transfusion. Feeding during RBC transfusions may increase the risk for mesenteric ischemia and the development of transfusion-related necrotizing enterocolitis in preterm infants.
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Affiliation(s)
- Terri Marin
- Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
| | - Cassandra D Josephson
- Departments of Pathology and Pediatrics, Emory University School of Medicine, Atlanta, GA; Department of Pathology, Children's Healthcare of Atlanta Blood and Tissue Services, Atlanta, GA
| | - Niki Kosmetatos
- Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - James E Moore
- Division of Neonatology, Department of Pediatrics, University of Texas, Southwestern, Dallas, TX
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Abstract
Necrotizing enterocolitis (NEC) is a disease primarily of prematurity characterized by partial or entire gut necrosis and is associated with significant mortality and morbidity. Recent studies report that approximately 25% to 35% of very low-birth-weight infants less than 1500 g receiving packed red blood cell transfusions develop temporally associated NEC, known as transfusion-related NEC (TR-NEC). Although there are many known risk factors for NEC, this article focuses on 3 contributing factors: packed red blood cell transfusions, enteral feedings, and gastrointestinal immaturity. Previous data suggest that these factors may interact to affect neonatal intestinal tissue oxygenation, which may lead to tissue ischemia, resulting in intestinal injury. This article presents a conceptual framework that combines current theoretical perspectives for TR-NEC, and reviews previous research examining related variables and how their interaction may increase the risk for TR-NEC development. In addition, incorporation of the proposed framework to guide future research and nursing care in this area is discussed.
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Abstract
Necrotizing enterocolitis (NEC) continues to be a devastating inflammatory disease of the newborn intestine. Despite advances in management, morbidity and mortality remain high. While it is clear that intestinal ischemia plays a large role in disease pathogenesis, attempts to link NEC to intestinal macrovascular derangement have been largely unsuccessful. More recently, there has been a concerted effort to characterize the pathologic changes of the intestinal microcirculation in response to intestinal injury, including NEC. This microcirculatory regulation is controlled by a balance of vasoconstrictor and vasodilator forces. Vasoconstriction is mediated primarily by endothelin-1 (ET-1), while vasodilation is mediated primarily by nitric oxide (NO). These chemical mediators have been implicated in many aspects of intestinal ischemic injury and NEC, with the balance shifting toward increased vasoconstriction associated with intestinal injury. With a proper understanding of these antagonistic forces, potential therapeutic avenues may result from improving this pathologic microcirculatory dysregulation.
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Polycarpou E, Zachaki S, Papaevangelou V, Tsolia M, Kyriacou A, Kostalos C, Kafetzis D. Oral L-arginine supplementation and faecal calprotectin levels in very low birth weight neonates. J Perinatol 2013; 33:141-6. [PMID: 22555780 DOI: 10.1038/jp.2012.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to determine the potential effect of oral L-arginine supplementation on intestinal inflammation in very low birth weight (VLBW) neonates, as estimated by faecal calprotectin levels. STUDY DESIGN The study enrolled 83 VLBW neonates with birth weight ≤1500 g and gestational age ≤34 weeks. In this double-blind study, 40 neonates received daily oral L-arginine supplementation of 1.5 mmol kg(-1) per day between the 3rd and 28th day of life, and 43 neonates placebo. Stool samples were collected on days 3, 14 and 28, and calprotectin was measured by enzyme-linked immunosorbent assay. RESULT Calprotectin values significantly decreased over time in both groups (P=0.032). No difference in faecal calprotectin values was recorded between neonates receiving arginine supplementation and neonates receiving placebo at days 3, 14 and 28. CONCLUSION Faecal calprotectin values decrease with increasing postnatal age in VLBW infants, but this is not related to arginine supplementation.
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Affiliation(s)
- E Polycarpou
- Neonatal Intensive Care Unit, 'Alexandra' Hospital, Athens, Greece.
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18
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Polycarpou E, Zachaki S, Tsolia M, Papaevangelou V, Polycarpou N, Briana DD, Gavrili S, Kostalos C, Kafetzis D. Enteral L-arginine supplementation for prevention of necrotizing enterocolitis in very low birth weight neonates: a double-blind randomized pilot study of efficacy and safety. JPEN J Parenter Enteral Nutr 2013; 37:617-22. [PMID: 23329787 DOI: 10.1177/0148607112471561] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is the most common acquired gastrointestinal disease in premature infants and has high mortality and morbidity. Endothelial nitric oxide is an important regulator of vascular perfusion and is synthetized from the amino acid L-arginine. Hypoargininemia is frequently observed in preterm neonates and may predispose them to NEC. Our objective was to determine the effect of enteral L-arginine supplementation on the incidence and severity of NEC in very low birth weight (VLBW) neonates. MATERIALS AND METHODS We conducted a parallel blind randomized pilot study, comprising VLBW neonates with birth weight ≤1500 g and gestational age ≤34 weeks. VLBW neonates were randomly assigned to receive enteral L-arginine supplementation (1.5 mmol/kg/d bid) between the 3rd and 28th day of life or placebo. Diagnosis and classification of NEC were done according to modified Bell's criteria. RESULTS Eighty-three neonates were randomized to the arginine (n = 40) or placebo (n = 43) group. No adverse effects were observed in neonates receiving L-arginine supplementation. The incidence of NEC stage III was significantly lower in the arginine-supplemented group (2.5% vs 18.6%, P = .030). CONCLUSIONS Enteral L-arginine supplementation of 1.5 mmol/kg/d bid can be safely administered in VLBW neonates from the 3rd to the 28th day of life. Enteral L-arginine supplementation appears to reduce the incidence of stage III NEC in VLBW infants. Larger studies are needed to further evaluate the effect of L-arginine supplementation in preventing NEC in VLBW infants.
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Affiliation(s)
- Elena Polycarpou
- Neonatal Intensive Unit, General District Hospital Athens "Alexandra," Athens, Greece
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19
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Athalye-Jape G, More K, Patole S. Progress in the field of necrotising enterocolitis – year 2012. J Matern Fetal Neonatal Med 2012; 26:625-32. [DOI: 10.3109/14767058.2012.746296] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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20
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Margaritis EV, Yanni AE, Agrogiannis G, Liarakos N, Pantopoulou A, Vlachos I, Papachristodoulou A, Korkolopoulou P, Patsouris E, Kostakis M, Perrea DN, Kostakis A. Effects of oral administration of (L)-arginine, (L)-NAME and allopurinol on intestinal ischemia/reperfusion injury in rats. Life Sci 2011; 88:1070-6. [PMID: 21565201 DOI: 10.1016/j.lfs.2011.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 03/21/2011] [Accepted: 03/30/2011] [Indexed: 10/18/2022]
Abstract
AIMS Intestinal ischemia/reperfusion (I/R) injury is implicated in many clinical conditions, and it performs a fundamental role in their pathophysiologies. Oral administration of antioxidants and nitric oxide (NO) donors ameliorate intestinal injury. Here, the effects of l-arginine, allopurinol and N(G)-nitro-l-arginine methyl ester (l-NAME) were investigated. MAIN METHODS One hundred twenty-eight male Wistar rats were separated into 4 groups and subjected to occlusion of the superior mesenteric artery for 60 min. The Control group did not receive any substance before the surgical operation. However, the 3 other groups received the following: l-arginine (800 mg/kg body weight; l-Arg group), l-NAME (50mg/kg; l-NAME group) or allopurinol (100mg/kg; Allo group). Each substance was given by mouth in 3 equal doses 24, 12 and 1h before the surgical operation. Each group was then divided into 4 subgroups, which underwent different durations of reperfusion (0, 1, 8 or 24h). At the end of each time point, blood and tissue samples were collected, and histological examinations were performed. Serum nitrite and catalase, intestinal tissue myeloperoxidase (MPO), inducible nitric oxide synthase (iNOS) and nitrotyrosine (NT) levels were determined. KEY FINDINGS At each reperfusion time point, the Allo group exhibited the mildest histological lesions in contrast to the l-NAME group, which showed the most severe lesions. MPO was decreased significantly in the Allo and l-Arg groups during reperfusion, and allopurinol administration caused earlier and stronger effect. iNOS and NT levels were higher in the l-Arg group and lower in the Allo group. Serum nitrite and catalase were increased in the l-NAME group after 24h. SIGNIFICANCE Oral administration of allopurinol exerted a strong and protective effect on the intestinal tissue that was subjected to I/R earlier than l-arginine. This finding was also supported with the MPO, iNOS and NT data.
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Affiliation(s)
- Eleftherios V Margaritis
- Laboratory of Experimental Surgery and Surgery Research "N. Christeas", Medical School, National and Kapodistrian University of Athens, Greece
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Gram negative bacteria are associated with the early stages of necrotizing enterocolitis. PLoS One 2011; 6:e18084. [PMID: 21445365 PMCID: PMC3062571 DOI: 10.1371/journal.pone.0018084] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 02/22/2011] [Indexed: 12/16/2022] Open
Abstract
Introduction Necrotizing enterocolitis (NEC) affects 5–10% of infants born weighing less than 1500 g. Most models of NEC recapitulate late-stage disease with gut necrosis and elevated inflammatory mediators. Evaluation of NEC at earlier, less lethal stages of disease will allow investigation of initial disease triggers and may advance our understanding of temporal relationships between factors implicated in NEC pathogenesis. In this manuscript, we describe our investigation of early NEC and test the hypothesis that bacteria and inflammatory mediators differ between animals with early NEC and disease free animals. Methods On DOL7 C3HeB/FeJ pups were fed liquid formula with 1×104Streptococcus thoraltensis, Serratia marcescens, and Pseudomonas aeruginosa every 3 h. To initiate NEC, pups underwent asphyxia (100% N2 for 90 s) and hypothermia (4°C for 10 min) after feeding. Pups were euthanized at 72 h. Intestines were collected for histologic NEC scoring and DNA/RNA extraction. Bacterial populations were identified by 16S rRNA pyrosequencing and principal component analysis (PCA). RNA isolates underwent QRT-PCR for Toll-like Receptor 4 (TLR4) and inducible nitric oxide synthase (iNOS). Results Despite histologic, intestinal damage in mice with NEC, no gross necrosis was observed suggesting early disease. QRT-PCR yielded no difference between groups in TLR4 or iNOS mRNA levels. PCA demonstrated relative clustering of microbial communities based on presence or absence of NEC. 16S pyrosequencing demonstrated similar phyla between groups (Firmicutes and Proteobacteria predominated in all animals). However, the colonic microbiota of animals with NEC had more Citrobacter (p<0.01), Klebsiella (p<0.05), and Tatumella (p<0.05), while that of animals without NEC had more Streptococcus (p<0.01) and Enterococcus (p<0.01). Conclusion Citrobacter, Klebsiella, and Tatumella are associated with NEC. Differential colonic bacteria were identified despite the lack of inflammatory mediator elevation traditionally associated with NEC. This suggests a temporal relationship between bacteria and inflammatory mediators such that alterations in gut microbiota are associated with early NEC, while inflammatory mediator elevation is associated with advanced NEC.
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Li H, Yan ZY. Analysis of amino acid neurotransmitters in hypothalamus of rats during cerebral ischemia-reperfusion by microdialysis and capillary electrophoresis. Biomed Chromatogr 2010; 24:1185-92. [DOI: 10.1002/bmc.1425] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sodhi C, Richardson W, Gribar S, Hackam DJ. The development of animal models for the study of necrotizing enterocolitis. Dis Model Mech 2008; 1:94-8. [PMID: 19048070 PMCID: PMC2562191 DOI: 10.1242/dmm.000315] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Necrotizing enterocolitis (NEC) is the leading cause of death and long-term disability from gastrointestinal disease in preterm infants, and is characterized by acute and chronic intestinal inflammation that may lead to systemic sepsis and multi-system organ failure. NEC typically develops in the preterm infant after the administration of tube feeds, although it may occasionally be seen in full-term babies. Despite extensive clinical experience in the management of patients with NEC, the underlying cellular and molecular mechanisms leading to its development remain incompletely understood. Several animal models have therefore been developed in a variety of species in order to study the pathogenesis of NEC and to develop more effective treatment strategies. This review seeks to examine the pros and cons of animal models that have been developed in the study of NEC over the past 30 years. It will highlight the various strengths and weaknesses of experimental approaches that have been used, and discuss potential directions for the development of such models for the future.
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Affiliation(s)
- Chhinder Sodhi
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA
- University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Ward Richardson
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA
- University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Steven Gribar
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA
- University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - David J. Hackam
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA
- University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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