Increased contribution by myofibrillar protein to whole-body protein breakdown according to severity of surgical stress

Impact of health and lifestyle food supplements on periodontal tissues and health

According to the new classification, periodontitis is defined as a chronic multifactorial inflammatory disease associated with dysbiotic biofilms and characterized by progressive destruction of the tooth-supporting apparatus. This definition, based on the current scientific evidence, clearly indicates and emphasizes, beside the microbial component dental biofilm, the importance of the inflammatory reaction in the progressive destruction of periodontal tissues. The idea to modulate this inflammatory reaction in order to decrease or even cease the progressive destruction was, therefore, a logical consequence. Attempts to achieve this goal involve various kinds of anti-inflammatory drugs or medications. However, there is also an increasing effort in using food supplements or so-called natural food ingredients to modulate patients' immune responses and maybe even improve the healing of periodontal tissues. The aim of this chapter of Periodontology 2000 is to review the evidence of various food supplements and ingredients regarding their possible effects on periodontal inflammation and wound healing. This review may help researchers and clinicians to evaluate the current evidence and to stimulate further research in this area.

The effects of elective abdominal surgery on protein turnover: A meta-analysis of stable isotope techniques to investigate postoperative catabolism

BACKGROUND & AIMS

Elective surgery induces skeletal muscle wasting driven by an imbalance between muscle protein synthesis and breakdown. From examination of diverse stable isotope tracer techniques, the dynamic processes driving this imbalance are unclear. This meta-analysis aimed to elucidate the mechanistic driver(s) of postoperative protein catabolism through stable isotope assessment of protein turnover before and after abdominal surgery.

METHODS

Meta-analysis was performed of randomized controlled trials and cohort studies in patients undergoing elective abdominal surgery that contained measurements of whole-body or skeletal muscle protein turnover using stable isotope tracer methodologies pre- and postoperatively. Postoperative changes in protein synthesis and breakdown were assessed through subgroup analysis of tracer methodology and perioperative care.

RESULTS

Surgery elicited no overall change in protein synthesis [standardized mean difference (SMD) -0.47, 95% confidence interval (CI): -1.32, 0.39, p = 0.25]. However, subgroup analysis revealed significant suppressions via direct-incorporation methodology [SMD -1.53, 95%CI: -2.89, -0.17, p = 0.03] within skeletal muscle. Changes of this nature were not present among arterio-venous [SMD 0.61, 95%CI: -1.48, 2.70, p = 0.58] or end-product [SMD -0.09, 95%CI: -0.81, 0.64, p = 0.82] whole-body measures. Surgery resulted in no overall change in protein breakdown [SMD 0.63, 95%CI: -0.06, 1.32, p = 0.07]. Yet, separation by tracer methodology illustrated significant increases in urinary end-products (urea/ammonia) [SMD 0.70, 95%CI: 0.38, 1.02, p < 0.001] that were not present among arterio-venous measures [SMD 0.67, 95%CI: -1.05, 2.38, p = 0.45].

CONCLUSIONS

Elective abdominal surgery elicits suppressions in skeletal muscle protein synthesis that are not reflected on a whole-body level. Lack of uniform changes across whole-body tracer techniques are likely due to contribution from tissues other than skeletal muscle.

Peripheral vein infusions of amino acids facilitate recovery after esophagectomy for esophageal cancer: Retrospective cohort analysis

Background

To investigate the efficacy of amino acid administration via peripheral veins in addition to conventional enteral feeding following esophagectomy.

Materials and methods

Retrospective analysis of data pertaining to 33 patients with esophageal cancer who underwent radical esophagectomy and satisfied the required nutrition control. Patients were divided into the amino acid group (n = 17) and control group (n = 16). Primary outcomes were albumin (Alb) and prealbumin (PreAlb) levels, urinary 3-methylhistidine/creatinine (3-MeHis/Cre) ratios, nitrogen balance, and weight; postoperative complications were noted as secondary outcomes.

Results

Alb levels were significantly higher in the amino acid group on postoperative day (POD)-14 (3.4 ± 0.3 vs. 3.1 ± 0.4 mg/dL in the control group, p = 0.018) and at 1 month after surgery (3.8 ± 0.4 vs. 3.5 ± 0.3 mg/dL, p = 0.045). No significant differences were observed in PreAlb and urinary 3-MeHis/Cre rates between the treatment groups. Body weights at 3 months postoperatively were decreased by 6% and 3% in the control and amino acid groups, respectively.

Conclusion

Peripheral venous administration of amino acids soon after surgical stress is an effective method for nutritional control.

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Radical resection for esophageal cancer is a highly invasive procedure.

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Enteral feeding has been used in postoperative period for esophagectomy.

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Peripheral vein infusion of amino acids is effective for post esophagectomy.

Protein hydrolysates and tissue repair

Protein hydrolysates provide a rich source of protein which is useful in situations where excess protein is needed, such as during repair of tissue damage. The consumption of protein hydrolysates has been shown to result in more rapid uptake of amino acids compared with whole proteins or free-form amino acid mixtures and some peptides in hydrolysates exhibit biological activity. Early studies showed that protein hydrolysates are more effectively utilised than intact proteins or amino acids. In addition, they promote a strong insulinotropic effect, which reduces protein breakdown and enhances muscle and tissue uptake of branched-chain amino acids. These effects contribute to benefits of protein hydrolysates for enhancing repair of tissue damage caused by surgery, ulcers, burns and muscle-damaging exercise. While there is evidence that protein hydrolysates may be useful for facilitating tissue repair, additional research is needed to further examine various roles of protein hydrolysates in this process.

Endocrine and immune effects of dexamethasone in unilateral total knee replacement

The effect of acute pre-surgery dexamethasone treatment on the inflammatory immune and endocrine responses to orthopaedic surgery was investigated. Whole blood samples were obtained before and 5 days after surgery for immune analysis, and serum was obtained before and 6 h, 3 days and 5 days after surgery for endocrine assessment. Dexamethasone did not affect the post-surgery granulocyte response, but inhibited the increase in monocyte count (an average increase of 38.5% was seen in the control group). Peak C-reactive protein concentration (3 days after surgery) was 51.4% lower in the dexamethasone group than in the control group. Dexamethasone had a major effect on cortisol concentrations and the cortisol:testosterone and cortisol:dehydroepiandrosterone ratios, but no effect on anabolic hormone concentrations. In conclusion, acute pre-surgery dexamethasone treatment may have beneficial effects in the post-surgery period, by limiting the extent of systemic inflammation and the cortisol response.

Effects of arginine-containing total parenteral nutrition on N balance and phagocytic activity in rats undergoing a partial gastrectomy

The present study investigated the effect of arginine (Arg)-containing parenteral nutrition on phagocytic activity to elucidate the possible roles of Arg in the secretion of anabolic hormones and N balance in rats undergoing gastrectomy. Rats were divided into two experimental groups and received total parenteral nutrition (TPN). The TPN solutions were isonitrogenous and identical in nutrient compositions except for differences in amino acid content. One group received conventional TPN, the other group replaced 2 % of the total energy as Arg. After receiving TPN for 3 d, one-third of the rats in each experimental group were killed as the baseline group. The remaining rats underwent a partial gastrectomy and were killed 1 or 3 d after surgery. The results showed that there were no differences in N balance, plasma growth hormone and insulin-like growth factor-1 levels between the two groups before or after surgery. The phagocytic activity of peritoneal macrophages was higher in the Arg group than in the control group 1 d after surgery. There were no differences in the phagocytic activities of blood polymorphonuclear neutrophils between the two groups at various time points. TNF-α levels in peritoneal lavage fluid were lower in the Arg group than in the control group on post-operative day 3. These results suggest that parenterally infused Arg enhances phagocytic activity and reduces the production of inflammatory mediators at the site of injury. However, Arg supplementation did not influence the secretion of anabolic hormones nor N balance in rats with a partial gastrectomy.

Effects of glutamine-containing total parenteral nutrition on phagocytic activity and anabolic hormone response in rats undergoing gastrectomy

AIM: To investigate the effect of glutamine (Gln)-containing parenteral nutrition on phagocytic activity and to elucidate the possible roles of Gln in the secretion of anabolic hormones and nitrogen balance in rats undergoing a gastrectomy.

METHODS: Rats with an internal jugular catheter were divided into 2 experimental groups and received total parenteral nutrition (TPN). The TPN solutions were isonitrogenous and identical in nutrient compositions except for differences in amino acid content. One group received conventional TPN (control), and in the other group, 25% of the total amino acid nitrogen was replaced with Gln. After receiving TPN for 3 d, one-third of the rats in each experimental group were sacrificed as the baseline group. The remaining rats underwent a partial gastrectomy and were killed 1 and 3 d, respectively, after surgery. Plasma, peritoneal lavage fluid (PLF), and urine samples were collected for further analysis.

RESULTS: The Gln group had fewer nitrogen losses 1 and 2 d after surgery (d1, 16.6±242.5 vs -233.4±205.9 mg/d, d2, 31.8±238.8 vs -253.4±184.6 mg/d, P<0.05). There were no differences in plasma growth hormone (GH) and insulin-like growth factor-1 levels between the 2 groups before or after surgery. The phagocytic activity of peritoneal macrophages was higher in the Gln group than in the control group 1 d after surgery (A 1185±931 vs 323±201, P<0.05). There were no differences in the phagocytic activities of blood polymorphonuclear neutrophils between the 2 groups at the baseline or on the postoperative days. No significant differences in interleukin-1β or interleukin-6 concentrations in PLF were observed between the 2 groups. However, tumor necrosis factor-α level in PLF was significantly lower in the Gln group than in the control group on postoperative d 3.

CONCLUSION: TPN supplemented with Gln can improve the nitrogen balance, and enhance macrophage phagocytic activity at the site of injury. However, Gln supplementation has no effect on phagocytic cell activity in the systemic circulation, GH and insulin-like growth factor-1 might not be responsible for attenuating nitrogen losses in rats with a partial gastrectomy.

Impact of surgical trauma on human skeletal muscle protein synthesis

Muscle protein catabolism is a considerable clinical problem following surgery. However, the impact of surgical trauma on muscle protein synthesis is not well characterized. In this pilot study, we therefore investigated whether the severity of surgical trauma is related to a decrease in muscle protein synthesis rate in humans. Metabolically healthy patients (n=28) were included in the study. Eight of the patients were day-care patients undergoing minor breast surgery (defined as minor surgery). The other 20 patients were subjected to major abdominal surgery and were therefore scheduled to stay overnight in the recovery room during the first postoperative night (defined as major surgery). Protein FSRs (fractional synthesis rates) in skeletal muscle were determined during a measurement period of 90 min before surgery and immediately after termination of surgery. FSR in skeletal muscle of the minor surgery patients was 1.72±0.25%/24 h before surgery and 1.67±0.29%/24 h after surgery (P=0.68). In the major surgery group, FSR was 1.62±0.30%/24 h before surgery and 1.57±0.40%/24 h (P=0.59) immediately following surgery. The observations made in this pilot study could not confirm a size-related decrease in muscle protein synthesis immediately following minor and major surgery. This finding is discussed in relation to confounders, postoperative course and to muscle protein degradation. The shortage of knowledge in this field is emphasized.

Effects of medium-chain triglyceride in parenteral nutrition on rats undergoing gastrectomy

This study was designed to investigate the effects of pre-infusion with total parenteral nutrition (TPN) using medium-chain triglyceride (MCT) versus long-chain triglyceride (LCT) emulsion as fat sources on hepatic lipids, inflammatory mediators and antioxidant capacity in rats undergoing gastrectomy. Rats with internal jugular catheter, were divided into two groups and received TPN. TPN supplied 300 kcal/kg/d with 39% of the energy provided as fat. All TPN solutions were isonitrogenous and identical in nutrient composition except for the fat emulsion, which was composed of MCT/LCT (1 : 1) or LCT. After receiving TPN for 5 days, the rats underwent partial gastrectomy and were sacrificed 24 h after surgery. The results of the study demonstrated that the MCL/LCT group had lower hepatic lipids than did the LCT group. No differences in interleukin-1beta, interleukin-6 and tumor necrosis factor-alpha in peritoneal lavage fluid were observed between the two groups. Erythrocyte glutathione peroxidase activity was significantly higher in the LCT group than the MCT/LCT group, although erythrocyte superoxide dismutase activity did not differ significantly between the two groups. These results suggest that infusion with MCT/LCT before an abdominal operation did not have an effect on modulating the production of inflammatory mediators in the location of the injurious stimulus. However, pre-infusion with MCT/LCT have beneficial effect in improving liver lipid metabolism and reducing oxidative stress in rats with gastrectomy.

Quantitation of urinary 3-methylhistidine excretion in growing dogs as an index of in vivo skeletal muscle catabolism

Purpose: To quantitate urinary 3-methylhistidine (3-mh) excretion as an index of in vivo muscle catabolism in dogs fed diets containing either normal or high protein levels.Methods: Twelve male, 5-month-old Beagle dogs were housed individually in metabolism cages and fed a non-meat, purified diet. They were divided into two diet groups of six dogs each, receiving 22.6% (NP) or 41.1% (HP) DM crude protein, respectively. Three dogs from each group received an intravenous injection of 385 +/- 29 kBq [14C] 3-mh. HCl. Urine and feces were collected daily until radioactivity returned to background levels (17 days). Urinary 3-mh was measured using an amino acid analyzer and percentage of bound 3-mh was estimated via acid hydrolysis.Results: Results are reported as means +/- SEM. 3-mh recovery in urine and feces of dogs were 263 +/- 28 kBq and 50.7 +/- 2.2 kBq and 327 +/- 45 kBq and 25.9 +/- 25.9 kBq for the NP and HP groups, respectively. The total cumulative 3-mh recoveries for the NP and HP groups were 81.8% +/- 2.8 and 91.4% +/- 2.7, respectively. Bound 3-mh accounted for 2.1 to 4.8% of urinary 14C-3-mh.Conclusions: Growing Beagle dogs excrete a higher percentage of 3-mh in feces (13.5% vs. 6.7%) when consuming the NP versus the HP diet. It appears that some of the 14C was lost in CO(2) and/or re-circulated in the body, as reported for sheep and pigs. We conclude that urinary 3-mh does not appear to be a quantitative index of in vivo muscle catabolism in growing dogs.

Alterations in N-acetylation of 3-methylhistidine in endotoxemic parenterally fed rats

N-methylhistidine (3-meH) is endogenously released during muscle catabolism and serves as a marker of protein turnover. In rats > 85% of 3-meH is excreted in the urine as the N-acetyl derivative. It has been reported that the percent of non-acetylated 3-meH (NA-3-meH) varies minimally with stress. To further evaluate these reports we randomized 39 male Sprague-Dawley rats (157-213 g) to receive parenteral nutrition only (PN) or PN plus continuous infusion of Escherichia coli 026:B6 lipopolysaccharide at 6 (LPS-6) or 12 (LPS-12) mg.kg-1.d-1 for 48 h. All animals received isocaloric and isonitrogenous PN 24 h before and throughout the study with water ad libitum. Total 3-meH excretion was significantly increased (P < 0.05) in the LPS-6 (470 +/- 136 micrograms/48 h) and LPS-12 (557 +/- 171 micrograms/48 h) groups versus the PN (331 +/- 126 micrograms/48 h) group. NA-3-meH differed significantly between the LPS-12 (218 /+- 89 micrograms/48 h, LPS-6 (94 +/- 48 micrograms/48 h), and PN (39 +/- 12 micrograms/48 h) groups (P < 0.05). Percent NA-3-meH increased significantly from 12.7 +/- 3.9% in the PN group to 19.8 +/- 8.0 and 39.9 +/- 12.8% in the LPS-6 and LPS-12 groups, respectively (P < 0.05). No significant changes in acetyl 3-meH were found between groups. These data suggest that either saturation or inhibition of acetylation pathways occurs with increasing levels of stress. Due to the disproportionate increases in NA-3-meH and percent NA-3-meH during endotoxemia, only total 3-meH should be used as an indicator of protein turnover in rats.