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Hankel J, Mößeler A, Hartung CB, Rath S, Schulten L, Visscher C, Kamphues J, Vital M. Responses of Ileal and Fecal Microbiota to Withdrawal of Pancreatic Enzyme Replacement Therapy in a Porcine Model of Exocrine Pancreatic Insufficiency. Int J Mol Sci 2022; 23:11700. [PMID: 36233002 PMCID: PMC9570030 DOI: 10.3390/ijms231911700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
Little is known regarding the interplay between microbiota and pancreas functions in humans as investigations are usually limited to distal sites, namely the analyses of fecal samples. The aim of this study was to investigate both ileal and fecal microbiota in response to pancreatic enzyme replacement therapy (PERT) in a porcine model of exocrine pancreatic insufficiency (EPI). PERT was stopped for ten days in ileo-cecal fistulated minipigs with experimentally induced EPI (n = 8) and ileal digesta as well as fecal samples were obtained before withdrawal, during withdrawal and after the reintroduction of PERT. Profound community changes occurred three days after enzyme omission and were maintained throughout the withdrawal phase. A reduction in α-diversity together with relative abundance changes in several taxa, in particular increases in Bifidobacteria (at both sites) and Lactobacilli (only feces) were observed. Overall, dysbiosis events from the ileum had accumulating effects in distal parts of the gastrointestinal tract with additional alterations occurring only in the colon. Changes were reversible after continuing PERT, and one week later, bacterial communities resembled those at baseline. Our study demonstrates the rapid and profound impacts of enzyme withdrawal in bacterial communities, contributing to our understanding of the interplay between pancreas function and microbiota.
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Affiliation(s)
- Julia Hankel
- Institute for Animal Nutrition, University of Veterinary Medicine Hannover, 30173 Hanover, Germany
| | - Anne Mößeler
- Institute for Animal Nutrition, University of Veterinary Medicine Hannover, 30173 Hanover, Germany
- Institute for Animal Nutrition and Dietetics, Vetsuisse-Faculty, 8057 Zürich, Switzerland
| | - Clara Berenike Hartung
- Institute for Animal Nutrition, University of Veterinary Medicine Hannover, 30173 Hanover, Germany
| | - Silke Rath
- Microbial Interactions and Processes Group, Helmholtz Centre for Infection Research, 30628 Braunschweig, Germany
| | - Lisa Schulten
- Institute for Animal Nutrition, University of Veterinary Medicine Hannover, 30173 Hanover, Germany
| | - Christian Visscher
- Institute for Animal Nutrition, University of Veterinary Medicine Hannover, 30173 Hanover, Germany
| | - Josef Kamphues
- Institute for Animal Nutrition, University of Veterinary Medicine Hannover, 30173 Hanover, Germany
| | - Marius Vital
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, 30625 Hannover, Germany
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Schubert DC, Mößeler A, Ahlfänger B, Langeheine M, Brehm R, Visscher C, Abd El-Wahab A, Kamphues J. Influences of exocrine pancreatic insufficiency on nutrient digestibility, growth parameters as well as anatomical and histological morphology of the intestine in a juvenile pig model. Front Med (Lausanne) 2022; 9:973589. [PMID: 36160141 PMCID: PMC9505903 DOI: 10.3389/fmed.2022.973589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/24/2022] [Indexed: 11/20/2022] Open
Abstract
In a pig model, pancreatic duct ligation (PL) leads to a complete loss of exocrine function, causing an exocrine pancreatic insufficiency (EPI) without affecting endocrine function, allowing research of clinical effects and therapy options. This study aimed to investigate effects of experimentally induced EPI in juvenile pigs on digestion and intestinal morphology. Eight female juvenile cross-bred pigs (BW 54.8 kg at the start of the study) were included. Three animals were considered as a control (CON group), and in five animals the ductus pancreaticus accessorius was ligated (PL group). During the 10-week trial period, body weight and body measurements were recorded regularly. At the end of the trial, gastrointestinal tract (GIT) was investigated macroscopically and histologically and weight and digesta samples of individual segments were obtained. The pigs in the CON showed a significantly higher apparent total tract digestibility of crude protein and crude fat (87.8 and 79.9%, respectively) compared to PL (52.4 and 16.6%, respectively). Significant differences were noted in relative weights of duodenum, jejunum and colon (with and without digesta) and also in absolute weights of jejunum and colon. The mean number of nuclei in the transverse section in stratum circulare were significantly higher in all intestinal segments in CON compared to PL. Overall, EPI results in impaired nutrient digestibility with a greater filling of the GIT with digesta. The elongation of the small intestine does not represent "stretching" of the intestine, but rather increased synthesis of intestinal tissue.
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Affiliation(s)
- Dana Carina Schubert
- Institute for Animal Nutrition, University of Veterinary Medicine Hannover, Foundation, Hanover, Germany
| | - Anne Mößeler
- Institute for Animal Nutrition, University of Veterinary Medicine Hannover, Foundation, Hanover, Germany
- Vetsuisse Faculty, Institute of Animal Nutrition and Dietetics, University of Zurich, Zurich, Switzerland
| | - Bianca Ahlfänger
- Institute for Animal Nutrition, University of Veterinary Medicine Hannover, Foundation, Hanover, Germany
| | - Marion Langeheine
- Institute for Anatomy, University of Veterinary Medicine Hannover, Foundation, Hanover, Germany
| | - Ralph Brehm
- Institute for Anatomy, University of Veterinary Medicine Hannover, Foundation, Hanover, Germany
| | - Christian Visscher
- Institute for Animal Nutrition, University of Veterinary Medicine Hannover, Foundation, Hanover, Germany
| | - Amr Abd El-Wahab
- Institute for Animal Nutrition, University of Veterinary Medicine Hannover, Foundation, Hanover, Germany
- Department of Nutrition and Nutritional Deficiency Diseases, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
| | - Josef Kamphues
- Institute for Animal Nutrition, University of Veterinary Medicine Hannover, Foundation, Hanover, Germany
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Luu AM, Brock A, Ritz S, Junghänel S, Aldag I, Edskes S, Hartmann M, Hessler M, Praktiknjo M, Arnemann P, Ertmer C, Uhl W, Schnekenburger J, Herzog T. Long term follow-up of a simplified and less burdened pancreatic duct ligation model of exocrine pancreatic insufficiency in Goettingen Minipigs. BMC Gastroenterol 2020; 20:403. [PMID: 33256637 PMCID: PMC7706062 DOI: 10.1186/s12876-020-01541-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/16/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pancreatic duct ligation in a minipig model leads to exocrine pancreatic insufficiency (EPI). This allows the study of digestive processes and pancreatic enzyme replacement therapies. However, detailed descriptions of the surgical procedure, perioperative management, a determination of exocrine pancreatic insufficiency are scarce in the literature. Data of the long-term health status of minipigs upon EPI induction are still not available. Therefore, the present study describes in detail an experimental approach to the induction of exocrine pancreatic insufficiency via pancreatic duct ligation in minipigs and the long term follow up of the animal's health state. METHODS 14 Goettingen minipigs underwent pancreatic duct ligation via midline laparotomy for the induction of exocrine pancreatic insufficiency. Fecal fat content, fat absorption, chymotrypsin levels, body weight and blood vitamin and glucose levels were determined. RESULTS Exocrine pancreatic insufficiency was successfully induced in 12 Goettingen minipigs. Two minipigs failed to develop exocrine insufficiency most likely due to undetected accessory pancreatic ducts. All animals tolerated the procedure very well and gained weight within 8 weeks after surgery without requiring pancreatic enzyme replacement therapy. The follow up for approx. 180 weeks showed a stable body weight and health state of the animals with normal blood glucose levels (Table 1). From approx. 130 weeks post pancreatic duct ligation, all animals were supplemented with pancreatic enzymes and vitamins resulting in blood concentrations almost within the reference range. CONCLUSIONS Pancreatic duct ligation in minipigs is an excellent method of inducing exocrine pancreatic insufficiency. It is important to identify and ligate accessory pancreatic ducts since persistence of accessory ducts will lead to maintenance of exocrine pancreatic function. The EPI model caused no persistent side effects in the animals and has the potential to be used in long-term EPI studies with up to 100 weeks post-OP without supplementation with enzymes and vitamins.
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Affiliation(s)
- Andreas Minh Luu
- Department of General Surgery, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Alexander Brock
- Biomedizinisches Technologiezentrum, Westfaelische Wilhelms-Universitaet Muenster, Mendelstrasse 17, 48149 Muenster, Germany
| | - Sabrina Ritz
- Biomedizinisches Technologiezentrum, Westfaelische Wilhelms-Universitaet Muenster, Mendelstrasse 17, 48149 Muenster, Germany
| | - Sandra Junghänel
- Biomedizinisches Technologiezentrum, Westfaelische Wilhelms-Universitaet Muenster, Mendelstrasse 17, 48149 Muenster, Germany
| | - Ingo Aldag
- Cilian AG, Johann Krane Weg 42, 48149 Muenster, Germany
| | - Stella Edskes
- Cilian AG, Johann Krane Weg 42, 48149 Muenster, Germany
| | | | - Michael Hessler
- Klinik Für Anaesthesiologie, Operative Intensivmedizin Und Schmerztherapie, Universitaetsklinikum Muenster, Albert Schweitzer Campus 1, Gebaeude A1, 48149 Muenster, Deutschland
| | - Michael Praktiknjo
- Department of Internal Medicine, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Philip Arnemann
- Klinik Für Anaesthesiologie, Operative Intensivmedizin Und Schmerztherapie, Universitaetsklinikum Muenster, Albert Schweitzer Campus 1, Gebaeude A1, 48149 Muenster, Deutschland
| | - Christian Ertmer
- Klinik Für Anaesthesiologie, Operative Intensivmedizin Und Schmerztherapie, Universitaetsklinikum Muenster, Albert Schweitzer Campus 1, Gebaeude A1, 48149 Muenster, Deutschland
| | - Waldemar Uhl
- Department of General Surgery, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Juergen Schnekenburger
- Biomedizinisches Technologiezentrum, Westfaelische Wilhelms-Universitaet Muenster, Mendelstrasse 17, 48149 Muenster, Germany
| | - Torsten Herzog
- Department of General Surgery, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
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Mary F, Moesseler A, Khodorova N, Foucault-Simonin A, Benamouzig R, Tomé D, Gregory PC, Gaudichon C. Metabolic markers of protein maldigestion after a 15N test meal in minipigs with pancreatic exocrine insufficiency. Am J Physiol Gastrointest Liver Physiol 2018; 314:G223-G230. [PMID: 29074486 DOI: 10.1152/ajpgi.00218.2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The effect of pancreatic exocrine insufficiency (PEI) on protein malabsorption is little documented, partly due to methodological barriers. We aimed to validate biomarkers of protein malabsorption using a 15N test meal in a minipig model of PEI. Six pancreatic duct-ligated minipigs were used as a model of PEI and four nonoperated animals as a control. All animals were equipped with an ileocecal reentrant cannula. Minipigs were given a test meal containing [15N]casein. The PEI animals repeated the test three times, in the absence of any pancreatic enzymes, or after pancreatic substitution at two levels [ A or B: 7,500 or 75,000 (lipase) and 388 or 3881 (protease) FIP U]. Ileal chyme, urine, and blood were collected postprandially. Nitrogen and 15N were measured in digestive and metabolic pools. We obtained a gradient of ileal protein digestibility from 29 ± 11% in PEI to 89 ± 6% in the controls and a dose- dependent response of enzymes. Insulin and gastric inhibitory polypeptide secretions were decreased by PEI, an effect that was counteracted with the enzymes at level B. The total recovery of 15N in urinary urea and plasma proteins was 14 ± 5.1% in the control group and decreased to 5.5 ± 2.1% by PEI. It was dose dependently restored by the treatment. Both 15N recovery in plasma and urine were correlated to protein digestibility. We confirm that the 15N transfer in those pools is a sensitive marker of protein malabsorption. Nevertheless, an optimization of the test meal conditions would be necessary in the view of implementing a clinical test. NEW & NOTEWORTHY We designed an intervention study to create a gradient of ileal protein digestibility in minipigs with pancreatic exocrine insufficiency and to validate reliable metabolic markers using a 15N oral meal test. 15N recovery in plasma proteins and to a higher extent in urine was sensitive to protein malabsorption. This test is minimally invasive and could be used to reveal protein malabsorption in patients.
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Affiliation(s)
- Florence Mary
- UMR PNCA, AgroParisTech, INRA, Université Paris Saclay , Paris , France
| | - Anne Moesseler
- Institute for Animal Nutrition, University of Veterinary Medicine Hannover, Foundation , Hanover , Germany
| | - Nadezda Khodorova
- UMR PNCA, AgroParisTech, INRA, Université Paris Saclay , Paris , France
| | | | - Robert Benamouzig
- UMR PNCA, AgroParisTech, INRA, Université Paris Saclay , Paris , France
| | - Daniel Tomé
- UMR PNCA, AgroParisTech, INRA, Université Paris Saclay , Paris , France
| | | | - Claire Gaudichon
- UMR PNCA, AgroParisTech, INRA, Université Paris Saclay , Paris , France
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Black-Box Gastrointestinal Tract-Needs and Prospects of Gaining Insights of Fate of Fat, Protein, and Starch in Case of Exocrine Pancreatic Insufficiency by Using Fistulated Pigs. Nutrients 2017; 9:nu9020150. [PMID: 28212351 PMCID: PMC5331581 DOI: 10.3390/nu9020150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/13/2017] [Indexed: 11/16/2022] Open
Abstract
Exocrine pancreatic insufficiency (EPI) results in the maldigestion and malabsorption of nutrients. The digestive processes in humans and other monogastric species like rat and pig are characterized by a predominantly enzymatic digestion within the small intestine and microbial fermentation located in the hindgut. For protein, it is doctrine that only prececally absorbed amino acids can be transferred to the amino acid pool of the host, while postileal absorption of nitrogen-containing compounds occurs mainly in the form of ammonia, being a burden rather than a benefit for the organism. The pig is an established animal model for humans to study digestive processes. As digestion is markedly impaired in case of EPI the use of an appropriate animal model to study the effects of this disease and to optimize treatment and dietetic measures is of special interest. By using an animal model of experimentally-induced EPI allowing differentiating between digestive processes in the small as well as in the large intestine by use of ileo-cecal fistulated animals, marked effects of EPI on prececal digestion of starch and protein could be shown. The data indicatethat estimation of digestibility of nutrients over the entire digestive tract results in a distinct overestimation of enzymatic digestion of starch and protein. Therefore, this model clearly shows that protein and starch digestion are significantly reduced in case of EPI although this cannot be detected on a fecal level. As postileal fermentation of starch is associated not only with energy losses but also with intensive gas production, this is of special interest to minimize meteorism and improve wellbeing of patients.
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Gregory PC, Hoffmann K, Kamphues J, Möeler A. The Pancreatic Duct Ligated (Mini)pig as a Model for Pancreatic Exocrine Insufficiency in Man. Pancreas 2016; 45:1213-26. [PMID: 27623555 DOI: 10.1097/mpa.0000000000000674] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Modern therapy of pancreatic exocrine insufficiency (PEI) using pancreatic enzyme replacement therapy (PERT) has largely been very effective and has greatly helped in improving the nutritional status of patients with PEI and in increasing the life expectancy in cystic fibrosis. It is believed that the use of predictable large animal models could play an important role in assessing and developing new therapies. This article reviews the pancreatic duct ligated (adult) minipig as a chronic model of total PEI, with a detailed look at the influence of PEI and response to PERT on prececal compared to fecal digestibility, to directly investigate effects on protein and starch digestion and absorption. In addition, the piglet with PEI is reviewed as a model for PEI in young patients with the aim of further improving the therapy and nutritional status of young patients with cystic fibrosis.
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Affiliation(s)
- Peter Colin Gregory
- From the *Abbott Laboratories GmbH; and †Institute for Animal Nutrition, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
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Oral Supplementation with a Special Additive of Retinyl Palmitate and Alpha Tocopherol Reduces Growth Retardation in Young Pancreatic Duct Ligated Pigs Used as a Model for Children Suffering from Exocrine Pancreatic Insufficiency. Int J Mol Sci 2016; 17:ijms17101642. [PMID: 27690005 PMCID: PMC5085675 DOI: 10.3390/ijms17101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/07/2016] [Accepted: 09/18/2016] [Indexed: 11/17/2022] Open
Abstract
Pancreatic exocrine insufficiency (PEI) is a disease of diverse aetiology-e.g., majority of patients suffering from cystic fibrosis (CF) show PEI congenitally. Malnutrition and malabsorption of nutrients impair growth and nutritional status. As reduced fat digestion leads to a deficiency of fat-soluble vitamins the supplementation is standard, but absorption is a critical point in PEI-patients. The pancreatic duct ligated (PL) pig is an established model for PEI in humans and has been proven to be a suitable model to compare different vitamin additives for supplementation. In a former study, PEI caused distinct growth retardation in young piglets, but did not affect growth in older ones. Our study hypothesised that this age-dependent effect is caused by exhausted body reserves of fat-soluble vitamins and, therefore, extra supply reduces growth retardation. PEI was induced by PL at the age of seven (PL-7) or 16 weeks (PL-16). Controls (C) underwent a sham surgery. Some PL-7 pigs (PL-7 + Vit) were fed a special vitamin additive. PEI reduced the mean final body weight (kg) at 26 weeks of age significantly with lower effect in PL-16-pigs (C:117; PL-7:49.5; PL-7 + Vit:77.1; PL-16:96.4). Extra vitamin supply resulted in an increased growth and normalised serum concentration of alpha-tocopherol, underlining the importance of special supplementation in PEI-patients.
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Mößeler A, Beyerbach M, Kamphues J. Effect of pancreatic exocrine insufficiency on composition of depot fat tissue – Study on pancreatic duct–ligated pigs used as a model for humans affected by pancreatic exocrine insufficiency. J Anim Sci 2016. [DOI: 10.2527/jas.2015-9721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mößeler A, Herrmann J, Burmester M, Breves G, Kamphues J. Changes in small intestinal morphometry and electrogenic nutrient transport in young pigs with pancreatic exocrine insufficiency. J Anim Sci 2016. [DOI: 10.2527/jas.2015-9724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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The effects of dietary oil inclusion and oil source on apparent digestibility, faecal volatile fatty acid concentration and manure ammonia emission. ACTA ACUST UNITED AC 2016. [DOI: 10.1017/s135772980005462x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAn investigation was conducted to test the hypothesis that dietary oil inclusion increases ammonia nitrogen (NH3-N) emission from the manure, due to a negative effect of either unsaturated or saturated oil on microbial activity in the intestine. Dietary oil was included at 45 g/kg, as either crude palm oil (PO), soya oil (SO) or a 50: 50 SO: PO blend (OB), to a basal barley-soya-wheat diet (control) at the expense of dextrose and maize starch. Diets were formulated to contain 13·2 MJ digestible energy per kg and 11·0 g/kg lysine. Four boars were assigned to each dietary treatment, and were transferred to metabolism crates (mean live weight, 74·0 (± 2·89) kg) following 14 days dietary acclimatization. Urine and faeces were collected separately over a 5-day digestibility/nitrogen (N) balance period and a 2-day manure collection period. Inclusion of dietary oil increased apparent digestibility of oil (P < 0·01) and decreased the apparent digestibility of dry matter (P < 0·01) and gross energy (P < 0·05). Dietary oil did not affect the apparent digestibility of nitrogen, acid-detergent fibre, neutral-detergent fibre or hemicellulose. Apparent digestibility of oil was lower when oil was included as PO compared with SO and OB (P < 0·001). The concentration of faecal volatile fatty acid (VFA) was similar in all treatments, although the acetic: propionic acid ratio was lower when oil was included as PO and OB compared with SO (P < 0·05). N balance, manure N concentration and NH3-N emission was not affected by oil inclusion or oil source. In conclusion, dietary oil inclusion reduced apparent dry matter and energy digestibilities, although no effect on fermentation was indicated by digestibility of fibre or faecal VFA content. Consequently, ammonia emission was not affected by dietary oil included at 45 g/kg.
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Aloulou A, Schué M, Puccinelli D, Milano S, Delchambre C, Leblond Y, Laugier R, Carrière F. Yarrowia lipolytica Lipase 2 Is Stable and Highly Active in Test Meals and Increases Fat Absorption in an Animal Model of Pancreatic Exocrine Insufficiency. Gastroenterology 2015; 149:1910-1919.e5. [PMID: 26327131 DOI: 10.1053/j.gastro.2015.08.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 07/10/2015] [Accepted: 08/20/2015] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS Pancreatic exocrine insufficiency (PEI) reduces pancreatic secretion of digestive enzymes, including lipases. Oral pancreatic enzyme replacement therapy (PERT) with pancreatin produces unsatisfactory results. The lipase 2 produced by the yeast Yarrowia lipolytica (YLLIP2; GenBank: AJ012632) might be used in PERT. We investigated its ability to digest triglycerides in a test meal and its efficacy in reducing fecal fat in an animal model of PEI. METHODS YLLIP2 was produced by genetically engineered Y lipolytica and purified from culture media. YLLIP2 or other gastric (LIPF) and pancreatic (PNLIPD) lipases were added to a meal paste containing dietary triglycerides, at a range of pH values (pH 2-7), with and without pepsin or human bile and incubated at 37°C. We collected samples at various time points and measured lipase activities and stabilities. To create an animal model of PEI, steatorrhea was induced by embolization of the exocrine pancreas gland and pancreatic duct ligation in minipigs. The animals were given YLLIP2 (1, 4, 8, 40, or 80 mg/d) or pancreatin (100,000 US Pharmacopeia lipase units/d, controls) for 9 days. We then collected stool samples, measured fat levels, and calculated coefficient of fat absorption (CFA) values. RESULTS YLLIP2 was highly stable and poorly degraded by pepsin, and had the highest activity of all lipases tested on meal triglyceride at pH 4-7 (pH 6 with bile: 94 ± 34 U/mg; pH 4 without bile: 43 ± 13 U/mg). Only gastric lipase was active and stable at pH 3, whereas YLLIP2 was sensitive to pepsin hydrolysis after pH inactivation. From in vitro test meal experiments, the lipase activity of YLLIP2 (10 mg) was estimated to be equivalent to that of pancreatin (1200 mg; 100,000 US Pharmacopeia units) at pH 6. In PEI minipigs, CFA values increased from 60.1% ± 9.3% before surgery to 90.5% ± 3.2% after administration of 1200 mg pancreatin (P < .05); CFA values increased to a range of 84.6% ± 3.0% to 90.0% ± 3.8% after administration of 4-80 mg YLLIP2 (P < .05). CONCLUSIONS The yeast lipase YLLIP2 is stable and has high levels of activity against test meal triglycerides in a large pH range, with and without bile. Oral administration of milligram amounts of YLLIP2 significantly increased CFA values, similar to that of 1.2 g pancreatin, in a minipig model of PEI.
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Affiliation(s)
- Ahmed Aloulou
- CNRS-Aix-Marseille Université-UMR7282 Enzymology at Interfaces and Physiology of Lipolysis, Marseille, France; Laboratoires Mayoly Spindler SAS, Chatou, France
| | - Mathieu Schué
- CNRS-Aix-Marseille Université-UMR7282 Enzymology at Interfaces and Physiology of Lipolysis, Marseille, France; Proteabio Europe SAS, Langlade, France
| | | | | | | | - Yves Leblond
- Laboratoires Mayoly Spindler SAS, Chatou, France
| | - René Laugier
- CNRS-Aix-Marseille Université-UMR7282 Enzymology at Interfaces and Physiology of Lipolysis, Marseille, France; AP-HM, Gastroenterology Department, La Timone Hospital, 13005 Marseille, France
| | - Frédéric Carrière
- CNRS-Aix-Marseille Université-UMR7282 Enzymology at Interfaces and Physiology of Lipolysis, Marseille, France.
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Starch Origin and Thermal Processing Affect Starch Digestion in a Minipig Model of Pancreatic Exocrine Insufficiency. Gastroenterol Res Pract 2015; 2015:872872. [PMID: 26064101 PMCID: PMC4443780 DOI: 10.1155/2015/872872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 11/18/2022] Open
Abstract
Although steatorrhea is the most obvious symptom of pancreatic exocrine insufficiency (PEI), enzymatic digestion of protein and starch is also impaired. Low praecaecal digestibility of starch causes a forced microbial fermentation accounting for energy losses and meteorism. To optimise dietetic measures, knowledge of praecaecal digestibility of starch is needed but such information from PEI patients is rare. Minipigs fitted with an ileocaecal fistula with (n = 3) or without (n = 3) pancreatic duct ligation (PL) were used to estimate the rate of praecaecal disappearance (pcD) of starch. Different botanical sources of starch (rice, amaranth, potato, and pea) were fed either raw or cooked. In the controls (C), there was an almost complete pcD (>92%) except for potato starch (61.5%) which was significantly lower. In PL pcD of raw starch was significantly lower for all sources of starch except for amaranth (87.9%). Thermal processing increased pcD in PL, reaching values of C for starch from rice, potato, and pea. This study clearly underlines the need for precise specification of starch used for patients with specific dietetic needs like PEI. Data should be generated in suitable animal models or patients as tests in healthy individuals would not have given similar conclusions.
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Mößeler A, Gregory PC, Loock H, Beyerbach M, Kamphues J. Endogenous praecaecal and total tract losses of nitrogen in pancreatic duct-ligated minipigs. Arch Anim Nutr 2015; 69:98-112. [PMID: 25690557 DOI: 10.1080/1745039x.2015.1009612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The pancreatic duct-ligated minipig (PL) is an established model of pancreatic exocrine insufficiency (PEI) with a significant decrease of nutrient digestibility. This study aimed to quantify and compare endogenous losses of nitrogen (N) (ileal and faecal) in minipigs receiving an almost N-free diet. Altogether, 12 Göttingen minipigs (7 PL and 5 control animals) fitted with an re-entrant ileo-caecal fistula were used. In Study 1, ileal digesta was collected over a period of 12 h on seven consecutive days, including one 24 h collection, when animals were fed a diet containing 0.49 g N/kg dry matter (DM). In Study 2, faeces were collected for 10 consecutive days. In Group PL, the amount and DM content of ileal digesta were higher (p < 0.05), while N concentration was lower than in the Control. The ileo-caecal N flux [g/kg DM intake] was about 2.5 times higher in Group PL (5.47 ± 1.15) than in the Control (1.91 ± 0.59) (p < 0.05). The amount of faeces did not differ, but faecal N losses were higher in Group PL (p < 0.05). Endogenous faecal N losses [g N/kg DM intake] of the Control group (1.17 ± 0.72) were comparable with earlier studies, while those of Group PL were 2.6 times higher (3.09 ± 1.34). In contrast, urinary excretion of N did not differ between the Control and Group PL. In conclusion, PEI caused markedly increased endogenous N losses. Therefore, the impact of reduced digestibility of nutrients on endogenous N losses might be relevant for apparent protein digestibility rates and should be taken into account.
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Affiliation(s)
- Anne Mößeler
- a Institute for Animal Nutrition , University of Veterinary Medicine Hannover, Foundation , Hannover , Germany
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Mösseler A, Kramer N, Becker C, Gregory PC, Kamphues J. Prececal digestibility of various sources of starch in minipigs with or without experimentally induced exocrine pancreatic insufficiency. J Anim Sci 2013; 90 Suppl 4:83-5. [PMID: 23365290 DOI: 10.2527/jas.53773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Low prececal digestibility of starch leads to a higher starch flux into the hindgut, causing a forced microbial fermentation, energy losses, and meteorism. For exocrine pancreatic insufficiency (EPI), lack of pancreatic amylase can be compensated mostly by hindgut fermentation of starch. Even in pigs with complete loss of pancreatic secretion, starch digestibility over the entire tract is reaching levels of controls. To optimize diets for human patients with EPI, the proportion of starch that is digested by the ileum is important. Minipigs were fitted with an ileocecal reentrant fistula (n = 8) to determine prececal digestibility of starch. In 5 minipigs the pancreatic duct was ligated (PL) to induce EPI; 3 minipigs served as controls (Con). Various starch sources were tested in a 1-d screening test; therefore, disappearance rate (DR) instead of digestibility was used. Test meals consisted of 169 g DM of a basal diet plus 67.5 g DM of the starch (without thermal treatment; purified; starch content of 89 to 94.5%) and Cr(2)O(3). The test meal contained (% of DM) starch, 67; crude fat, 1.69; CP, 15; crude fiber, 2.0; and Cr(2)O(3), 0.25. In PL, prececal DR of starch was lower than in Con (P < 0.05) for all starch sources. In Con, prececal DR of starch was almost complete (>90%) but was lower (P < 0.05) for potato (Solanum tuberosum) starch (75.4%). In PL, prececal DR of starch was higher (P < 0.05) for wheat (Triticum aestivum) starch (61.2%) than corn (Zea mays) starch (43.0%) and rice (Oryza sativa) starch (29.2%) and intermediate for potato and field pea (Pisum sativum) starch. For patients with EPI, wheat starch seems favorable due to the higher prececal digestibility whereas raw corn and rice starch should be avoided.
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Affiliation(s)
- A Mösseler
- Institute for Animal Nutrition, University of Veterinary Medicine, Hannover, Foundation, Germany.
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Mösseler A, Schwarzmaier T, Grunemann J, Gregory PC, Höltershinken M, Kamphues J. The growing pancreatic duct ligated pig as a model for exocrine pancreatic insufficiency in children: investigations to achieve sufficient vitamin A and vitamin E supply. J Anim Sci 2013; 90 Suppl 4:321-3. [PMID: 23365367 DOI: 10.2527/jas.53775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Human patients suffering from exocrine pancreatic insufficiency (EPI) are susceptible to deficiencies in fat-soluble vitamins. In children with cystic fibrosis, EPI is common and aspects of sufficient vitamin supply are of special interest. The aim of this study was to determine the best application form to maintain vitamin A and E levels in the physiological range in growing pigs with EPI (induced by pancreatic duct ligation) as a model for children. The pancreatic duct was ligated (PL) in twelve 8-wk-old pigs; 4 sham-operated pigs served as controls (Con). Pigs (n = 16) were individually housed and fed a diet containing 13,393 IU vitamin A and 122 mg vitamin E/kg DM. The PL pigs (n = 12) were divided into 3 groups (n = 4) 2 wk after surgery: PL-0, without extra vitamin supply; PL+ORAL, 90,000 IU vitamin A and 600 mg vitamin E/kg of DM plus emulsifier E 484 added to the diet; and PL+IM, intramuscular injection of vitamin A (5,250 IU) and vitamin E [aqueous; 3.15 mg/(kg BW · wk)] plus 700 mg vitamin E (oily)/(animal · wk). All PL pigs were supplemented with the pancrelipase Creon (19.8 g = 1,048,727 IU lipase/kg feed) beginning 2 wk after ligation of the pancreatic duct. Pigs were euthanized at 16 wk of age. Tocopherol levels (mg/kg DM) in liver were reduced (P ≤ 0.005) in PL-0 and PL+IM (6.91 and 8.61, respectively) whereas PL+ORAL did not differ from Con (27.4 and 25.8, respectively; P ≥ 0.77). Compared to control pigs (241 ± 14.1 mg vitamin A/kg DM of liver), the concentration of vitamin A (mg/kg DM) in liver was lower (P < 0.003) in PL-0 (136 ± 18.5) but higher (P < 0.003) in PL+ORAL (375 ± 50.0). In the group PL+IM a high individual variation was observed (288 ± 142 mg vitamin A/kg DM of liver). Extra dietary supply of high doses of vitamin A and E with an efficient emulsifier was adequate to maintain vitamin A and E in liver tissue within reference values. The present data underline the need for extra supplementation of vitamin A and E in juvenile patients with EPI and indicate that oral application is suitable.
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Affiliation(s)
- A Mösseler
- Institute of Animal Nutrition, University of Veterinary Medicine Hannover, Foundation, Germany.
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The effectiveness of enzymatic replacement therapy measured by turbidimetry and the lipaemic index in exocrine pancreatic insufficient young, growing pigs, fed a high-fat diet. Adv Med Sci 2009; 54:7-13. [PMID: 19648084 DOI: 10.2478/v10039-009-0011-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Conventionally, the management of exocrine pancreatic insufficiency (EPI) involves the consumption of a specific diet as well as the replacement of pancreatic enzymes, the effectiveness of which is usually measured by a classical method of blood analyses of non-esterified fatty acids (NEFA) and triglycerides (TG). Dietary supplementation with a pancreatic enzyme preparation (PEP), in conjunction with a high-fat diet, on growth performance, digestibility and absorption (analysed using turbidimetry) of dietary fat in pigs with EPI was investigated. MATERIALS/METHODS EPI was developed by surgical ligation of the pancreatic duct of six male pigs, 6 weeks of age. The pigs were fed a high fat diet (twice daily). A PEP containing 1800 mg entero-coated pancreatin was included in the high fat meals. Blood, urine and faecal samples were collected. The urine and faeces were analysed for dry matter, crude protein and fat content. The lipaemic index and plasma lipid profiles were assessed. RESULTS EPI completely stopped growth of the pigs. Treatment with PEP significantly increased (P<0.05) growth and body mass as well as the digestibility of dry matter and crude protein. PEP significantly improved the co-efficient of fat absorption, the lipaemic index (measured by turbidimetry methods) and caused significant changes in plasma nonesterified fatty acids and triglyceride concentrations. CONCLUSIONS The short term enzymatic replacement therapy together with a high fat meal has immediate beneficial effects on diet digestibility and on the growth retardation observed in EPI pigs. The turbidimetry method used to measure lipaemic index is a reliable, quick and efficient technique in measuring plasma lipid profiles and thus a good tool for assessing fat absorption.
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Mösseler A, Bergemann J, Becker C, Stemme K, Gregory PC, Kamphues J. NBT-PABA test to assess efficiency and kinetics of substituted proteolytic enzyme action in pancreatic duct ligated minipigs. J Anim Physiol Anim Nutr (Berl) 2008; 92:399-404. [PMID: 18477323 DOI: 10.1111/j.1439-0396.2008.00823.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The NBT-PABA test is an established method for diagnosis of pancreatic exocrine insufficiency. In the present study the NBT-PABA test was used to test and compare the efficacy of two multienzyme preparations (product A and B) differing in galenic preparation in minipigs in which pancreatic exocrine insufficiency (PEI) was induced by pancreatic duct ligation. Without enzyme substitution no distinct increase in PABA was found in blood after oral administration of NBT-PABA. Administration of both enzyme preparations led to a clear dose dependent rise in PABA-concentrations in blood. Interestingly, the two preparations showed different time curves of serum PABA concentration, indicating differences in the kinetic of proteolytic enzyme action. It is concluded that the NBT-PABA test can be a very useful test for indirectly evaluating proteolytic enzyme efficacy in vivo, and also gives information about the kinetics of enzyme action, not only the end-result of enzyme action (like digestibility trials which were used traditionally). A single test is performed in a few hours and there is no need for fistulated animals.
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Affiliation(s)
- A Mösseler
- Institute of Animal Nutrition, University of Veterinary Medicine, Foundation, Hannover, Germany.
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Compensatory digestion of fat, protein and starch (rates and amounts) in the large intestine of minipigs in case of reduced precaecal digestion due to pancreatic duct ligation — A short review. Livest Sci 2007. [DOI: 10.1016/j.livsci.2007.01.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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van den Borne JJGC, Weström BR, Kruszewska D, Botermans JAM, Svendsen J, Woliński J, Pierzynowski SG. Exocrine pancreatic secretion in pigs fed sow's milk and milk replacer, and its relationship to growth performance. J Anim Sci 2007; 85:404-12. [PMID: 17235025 DOI: 10.2527/jas.2006-243] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to quantify and compare the effects of sow's milk and 2 milk replacer diets (containing clotting or non-clotting protein sources) on exocrine pancreatic secretion, plasma cholecystokinin, and immunoreactive cationic trypsin in pigs. In addition, the relationship between exocrine pancreatic secretion and growth in milk-fed pigs was studied. In a changeover experiment, 9 chronically catheterized pigs of 6.6 +/- 0.19 kg of BW were studied for 3 wk. Pigs were assigned to each of 3 diets. Exocrine pancreatic secretion was measured from the third to the seventh day on each diet. The protein content and trypsin activity of the pancreatic juice were measured. Blood samples were taken at 10 min before and after milk ingestion and were analyzed for cholecystokinin and immunoreactive cationic trypsin. Pancreatic protein and trypsin secretion did not differ between pigs fed sow's milk and those fed milk replacer, but the volume secreted was less for the pigs fed sow's milk (0.75 vs. 1.03 mL x kg(-1) x h(-1); P < 0.01). A postprandial response to milk intake was not observed. The 2 milk replacer diets did not affect exocrine pancreatic secretion differently. The average exocrine pancreatic secretion (volume, 0.94 mL x kg(-1) x h(-1); protein, 4.28 mg x kg(-1) x h(-1); trypsin, 1.65 U x kg(-1) x h(-1)) was intermediate between literature values for suckling and weaned pigs. Plasma cholecystokinin was elevated (approximately 18 pmol x L(-1)) and showed low correlations with the pancreatic secretion traits. Plasma immunoreactive cationic trypsin was not significantly related to any of the pancreatic secretion traits and should therefore not be used as an indicator for exocrine pancreatic function in milk-fed pigs. Exocrine pancreatic secretion varied substantially among individual pigs (protein, 0.22 to 13.98 mg x kg(-1) x h(-1)). Pancreatic protein and trypsin secretion showed a positive, nonlinear relationship with performance traits. It was concluded that neither specific sow's milk ingredients nor the protein source are responsible for a low pancreatic protein secretion in suckling pigs. Exocrine pancreatic secretion was positively correlated with ADG in pigs at an identical milk intake.
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Abstract
A primary function of the pancreas is to produce digestive enzymes that are delivered to the small intestine for the hydrolysis of complex nutrients. Much of our understanding of digestive enzymes comes from studies in animals. New technologies and the availability of the sequence of the human genome allow for a critical review of older reports and assumptions based on animal studies. This report updates our understanding of human pancreatic digestive enzymes with a focus on new insights into the biology of human proteases, lipases and amylases.
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Affiliation(s)
- David C Whitcomb
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Kammlott E, Karthoff J, Stemme K, Gregory P, Kamphues J. Digestibility rates of major and trace elements in pancreatic duct-ligated pigs. J Anim Physiol Anim Nutr (Berl) 2005; 89:109-12. [PMID: 15787980 DOI: 10.1111/j.1439-0396.2005.00540.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ligation of pancreatic duct in pigs leads to a severe maldigestion of calcium and magnesium. Substitution of missing enzymes results in a 'normalization' of the digestibility rates of these elements. In comparison to controls the pre-caecal phosphorus digestibility decreased, but the total digestibility rates increased, after ligation of the pancreatic duct. Furthermore, the total amount of absorbed phosphorus was significantly higher in pancreatic duct ligated pigs. Further studies have to be carried out to investigate, whether phosphorus in exocrine pancreatic insufficiency is excreted with urine, as in this study the observed Ca:P-ratio in blood was in a physiological range. Without a forced renal excretion of phosphorus, consequences and risks (e.g. secondary hyperparathyroidism) of the regulation have to be considered. Regarding the elements sodium, potassium and chloride, an increased faecal excretion could be observed in pancreatic duct ligated pigs. As a substitution with enzyme products led to digestibility rates similar to those in controls, no losses of electrolytes have to be feared. Even though pancreatic juice seems to have influences on the digestibility of investigated trace elements (copper, zinc, iron and manganese), it did not lead to severe imbalances in the corresponding mineral metabolism.
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Affiliation(s)
- E Kammlott
- Institute of Animal Nutrition, University of Veterinary Medicine, D-30173 Hannover, Germany
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