POS0378 CCN1: AN ANGIOGENIC ACTOR IMPLICATED IN THE STRUCTURAL DAMAGES OF RHEUMATOID ARTHRITIS

Background:

We have previously shown that decreased expression of the deacetylase sirtuin-1 (SIRT1) contributes to the proliferative, activated and proangiogenic profile of endothelial cells (EC) in rheumatoid arthritis (RA) (1). The matricellular protein CCN1, characterized by proangiogenic and immunomodulatory properties, may be directly implicated in these processes, since its expression is negatively regulated by SIRT1 (1).

Objectives:

To study the implication of CCN1 in RA pathogenesis.

Methods:

CCN1 expression was assessed in ECs (25 RA and 10 controls) by quantitative RT-PCR, western blot and ELISA, in the synovial tissue (5 RA and 5 controls) by immunohistochemistry and immunofluorescence, and in the serum (205 RA and 20 controls) by ELISA. Invalidation of CCN1 in RA ECs was achieved through the use of shRNA and neutralizing monoclonal antibodies. The functional consequences of CCN1 invalidation in RA ECs were studied i) in vitro by the analysis of proliferation (cell impedance), tube formation in Matrigel and migration in Boyden chambers; and ii) in vivo in the murine model of tumor neoangiogenesis.

Results:

CCN1 mRNA and protein expression were increased by 1.72- (p = 0.012) and 7.2-fold (p=0.008) in RA ECs compared to controls, respectively. CCN1 concentrations were significantly increased in RA EC culture supernatants (930±153 vs. 359±199 pg/mL, p=0.007). CCN1 was overexpressed in the synovial tissue of RA patients (Figure 1A) and confocal microscopy analyses revealed a prominent CCN1 expression in the vascular endothelium (CD31 +) and T cells (CD3 +) (Figure 1B).

In vitro, recombinant TNF-α and IL-17 induced the mRNA and protein expression of CCN1 in RA ECs. CCN1 invalidation was associated with reduced proliferative capacities, delayed capillary tube formation and decreased migration of RA ECs (Figure 1E). In vivo, subcutaneous transplantation of CT26 tumor cells combined with RA ECs transfected with CCN1 shRNA to CB17 SCID mice was associated with a 51% reduction in tumor volume (p=0.008) and a 27% reduction in tumoral vascular density (p=0.032) compared with mice transplanted with MOCK transfected RA-ECs (Figure 1F).

Serum concentrations of CCN1 were significantly reduced in the serum of RA patients compared to controls (233±118 vs. 279±75 pg/mL, p=0.045) (Figure 1C). However, serum CCN1 concentrations were significantly higher in the presence of bone erosions (253±139 vs. 202±7 pg/mL, p=0.002) (Figure 1D) and correlated with radiographic Larsen score (r=0.3, p=0.001) and HAQ (r=0.25, p=0.012).

Conclusion:

CCN1 is overexpressed in ECs and the synovial tissue of patients with RA. CCN1 also regulate the functional properties of RA ECs and their angiogenic potential in vivo. CCN1 could represent a new therapeutic target, which is being evaluated in experimental models of erosive arthritis.

CCN1 may be a reliable biomarker of structural damages given the association between its serum concentrations and the extent of radiographic lesions. The performance of CCN1 serum levels to predict structural progression is under investigation.

References:

[1]Leblond et a, Ann Rheum Dis 2020.

Figure 1.

Implication of CCN1 in the pathogenesis of rheumatoid arthritis (RA). A, Representative immunohistochemistry staining for CCN1. B, Representative confocal microscopy analyses. C-D, CCN1 serum concentrations; statistical test: Student t test, ** p<0.01. E, Representative images of RA endothelial cell (EC) migration; Y-axis shows the number of migrated cells, statistical test: Wilcoxon test, * p<0.05. F, Representative subcutaneous tumors, Y-axis shows the fluorescence area in %, statistical test: Wilcoxon test, * p<0.05.

Disclosure of Interests:

None declared

Antimicrobial resistance in bacteria isolated from diseased horses in France

BACKGROUND

Horses are one of the potential reservoirs of antimicrobial resistance (AMR) determinants that could be transferred to human subjects.

OBJECTIVE

To describe the AMR patterns of major bacteria isolated from diseased horses in France.

STUDY DESIGN

Retrospective observational study.

METHODS

Data collected between 2012 and 2016 by RESAPATH, the French national surveillance network for AMR, were analysed. Only antimicrobials relevant in veterinary and human medicine for the isolated bacteria were considered. Mono- and multidrug resistance were calculated. The resistance proportions of major equine diseases were assessed and compared. Where data permitted, resistance trends were investigated using nonlinear analysis (generalised additive models).

RESULTS

A total of 12,695 antibiograms were analysed. The five most frequently isolated bacteria were Streptococcus spp., Escherichia coli, Pseudomonas spp., Staphylococcus aureus, Pantoea spp. and Klebsiella spp. The highest proportions of resistance to gentamicin were found for S. aureus (22.1%) and Pseudomonas spp. (26.9%). Klebsiella spp. and E. coli had the highest proportions of resistance to trimethoprim-sulfamethoxazole (15.5 and 26.2%, respectively). Proportions of resistance to tetracycline were among the highest for all the bacteria considered. Resistance to third-generation cephalosporins was below 10% for all Enterobacteriaceae. The highest proportions of multidrug resistance (22.5%) were found among S. aureus isolates, which is worrying given their zoonotic potential. From 2012 to 2016, resistance proportions decreased in Pseudomonas spp. isolates, but remained the same for S. aureus. For Streptococcus spp. and E. coli, resistance proportions to trimethoprim-sulfamethoxazole increased.

MAIN LIMITATIONS

Since antibiograms are not systematic analyses, any selection bias could impact the results.

CONCLUSIONS

Such studies are essential to estimate the magnitude of the potential threat of AMR to public health, to design efficient control strategies and to measure their effectiveness. These findings may also guide the initial empirical treatment of horse diseases.

Risk factor analysis of equine strongyle resistance to anthelmintics

Intestinal strongyles are the most problematic endoparasites of equids as a result of their wide distribution and the spread of resistant isolates throughout the world. While abundant literature can be found on the extent of anthelmintic resistance across continents, empirical knowledge about associated risk factors is missing. This study brought together results from anthelmintic efficacy testing and risk factor analysis to provide evidence-based guidelines in the field. It involved 688 horses from 39 French horse farms and riding schools to both estimate Faecal Egg Count Reduction (FECR) after anthelmintic treatment and to interview farm and riding school managers about their practices. Risk factors associated with reduced anthelmintic efficacy in equine strongyles were estimated across drugs using a marginal modelling approach. Results demonstrated ivermectin efficacy (96.3% ± 14.5% FECR), the inefficacy of fenbendazole (42.8% ± 33.4% FECR) and an intermediate profile for pyrantel (90.3% ± 19.6% FECR). Risk factor analysis provided support to advocate for FEC-based treatment regimens combined with individual anthelmintic dosage and the enforcement of tighter biosecurity around horse introduction. The combination of these measures resulted in a decreased risk of drug resistance (relative risk of 0.57, p = 0.02). Premises falling under this typology also relied more on their veterinarians suggesting practitionners play an important role in the sustainability of anthelmintic usage. Similarly, drug resistance risk was halved in premises with frequent pasture rotation and with stocking rate below five horses/ha (relative risk of 0.53, p < 0.01). This is the first empirical risk factor analysis for anthelmintic resistance in equids. Our findings should guide the implementation of more sustained strongyle management in the field.

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688 horses have been enrolled for Egg reduction rate measure.

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Ivermectin remains efficient but fendendazole is not any more.

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Evidence-based drenching and individual dosing lower resistance risk.

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Higher biosecurity is associated with higher drug efficacy.

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Premises with the least pasture constraints show higher drug efficacy.

West Nile virus epizootics in the Camargue (France) in 2015 and reinforcement of surveillance and control networks

West Nile virus (WNV) infection is a non-contagious disease mainly transmitted by the bites of infected mosquitoes from the genus Culex. The virus is maintained in a mosquito-bird-mosquito cycle, and can accidentally be transmitted to mammalian hosts. Among mammalian hosts, equines and humans are the most sensitive to WNV infection and can develop severe meningoencephalitis. As WNV infections are zoonotic and can be severe in humans and equines, West Nile fever is considered to be a public and animal health concern. After a silent period of almost ten years, WNV re-emerged in France at the periphery of the Camargue area during the summer of 2015, underlining the fact that the Camargue area creates favourable conditions for WNV emergence and amplification in France. The French Network for Epidemiological Surveillance of Equine Diseases (Réseau d'Épidémio-Surveillance en Pathologie Équine [RESPE]) facilitated the early detection of WNV cases in horses. In total, 49 horses were found to be infected; among them, 44 presented clinical signs, 41 with meningoencephalitis and three with hyperthermia only. Six horses among the 41 with nervous symptoms died from the disease or were euthanised (a case fatality rate of 14.6%). The authors describe the characteristics of the 2015 WNV epizootics, the early detection of the first WNV equine cases via the RESPE network and the coordination of WNV surveillance in France.

Coxiella burnetii Circulation in a Naturally Infected Flock of Sheep: Individual Follow-Up of Antibodies in Serum and Milk

The control of Q fever, a zoonotic disease caused by the Coxiella burnetii bacterium, remains a scientific challenge. Domestic ruminants are considered the main reservoir, shedding C. burnetii essentially through parturition products during abortion or birth. Sheep are particularly frequently associated with human outbreaks, but there are insufficient field data to fully understand disease dynamics and to instigate efficient control measures. A longitudinal follow-up study of a naturally infected sheep flock was performed (i) to investigate relationships between seropositivity and bacterial shedding in the vaginal mucus, (ii) to describe the kinetics of antibodies, including responses to vaccination, (iii) to monitor maternal antibodies in ewe lambs, and (iv) to compare serological results for milk and serum samples. For 8 months, we collected blood samples every 3 weeks from 11 aborting and 26 nonaborting dairy ewes, 20 nonaborting suckler ewes, and 9 ewe lambs. Individual milk samples were also obtained from lactating females. All serum and milk samples were tested by enzyme-linked immunosorbent assay (ELISA), whereas vaginal swabs were tested by quantitative PCR. We found that some dairy females did not seroconvert despite shedding C. burnetii in their vaginal mucus. Overall, antibody levels in adult females were found to remain stable over time, with exceptions during the mating and lambing periods. Maternal antibodies decreased during the first month after birth. Interestingly, antibody levels in milk were correlated with those in serum. This study provides valuable field data that will help improve Q fever surveillance and within-flock management measures.IMPORTANCE Field data are necessary to improve the surveillance, diagnosis, and sanitary management of Q fever in livestock. Here, we provide extensive serological data obtained from serum and milk samples from infected and vaccinated ewes belonging to a naturally infected flock of sheep. We show that antibody levels are stable over time and seropositivity and vaginal shedding are not clearly correlated, whereas antibody levels in milk are strongly correlated with those in serum. Accordingly, we find that antibody levels in bulk tank milk are consistent with the variations observed in the serum of dairy females over time. We report the existence of maternal antibody transmission to ewe lambs and we show that the presence of maternal antibodies at birth does not prevent the development of a serological response to vaccination at the age of 4 months. Finally, we report that adult ewes generally seroconvert after vaccination, including during pregnancy.

Comparative Risk Analysis of Two Culicoides-Borne Diseases in Horses: Equine Encephalosis More Likely to Enter France than African Horse Sickness

African horse sickness (AHS) and equine encephalosis (EE) are Culicoides-borne viral diseases that could have the potential to spread across Europe if introduced, thus being potential threats for the European equine industry. Both share similar epidemiology, transmission patterns and geographical distribution. Using stochastic spatiotemporal models of virus entry, we assessed and compared the probabilities of both viruses entering France via two pathways: importation of live-infected animals or importation of infected vectors. Analyses were performed for three consecutive years (2010-2012). Seasonal and regional differences in virus entry probabilities were the same for both diseases. However, the probability of EE entry was much higher than the probability of AHS entry. Interestingly, the most likely entry route differed between AHS and EE: AHS has a higher probability to enter through an infected vector and EE has a higher probability to enter through an infectious host. Consequently, different effective protective measures were identified by 'what-if' scenarios for the two diseases. The implementation of vector protection on all animals (equine and bovine) coming from low-risk regions before their importation was the most effective in reducing the probability of AHS entry. On the other hand, the most significant reduction in the probability of EE entry was obtained by the implementation of quarantine before import for horses coming from both EU and non-EU countries. The developed models can be useful to implement risk-based surveillance.

Prevalence of Anaplasma phagocytophilum in small rodents in France

Anaplasma phagocytophilum is an emerging zoonotic tick-borne pathogen affecting a wide range of mammals. Rodents are suspected to be natural reservoirs for this bacterium, but their role in the epidemiologic cycles affecting domestic animals and wild ungulates has not been demonstrated. This study aimed to improve our knowledge on A. phagocytophilum prevalence in Apodemus sylvaticus, A. flavicollis and Myodes glareolus using data collected in 2010 in one area in eastern France and in 2012-2013 in two others areas in western France. Rodents were captured in each site and infection was tested using qualitative real-time PCR assays on either blood or spleen samples. Prevalence showed high variability among sites. The highest prevalence was observed in the most eastern site (with an average infection rate of 22.8% across all species), whereas no rodent was found to be PCR positive in the south-west site and only 6.6% were positive in the north-west of France. Finally, a significant increase in prevalence was observed in autumn samples compared to spring samples in the north-west, but no change was found in the other two sites.

A spatiotemporal model to assess the introduction risk of African horse sickness by import of animals and vectors in France

Background

African horse sickness (AHS) is a major, Culicoides-borne viral disease in equines whose introduction into Europe could have dramatic consequences. The disease is considered to be endemic in sub-Saharan Africa. Recent introductions of other Culicoides-borne viruses (bluetongue and Schmallenberg) into northern Europe have highlighted the risk that AHS may arrive in Europe as well. The aim of our study was to provide a spatiotemporal quantitative risk model of AHS introduction into France. The study focused on two pathways of introduction: the arrival of an infectious host (PW-host) and the arrival of an infectious Culicoides midge via the livestock trade (PW-vector). The risk of introduction was calculated by determining the probability of an infectious animal or vector entering the country and the probability of the virus then becoming established: i.e., the virus’s arrival in France resulting in at least one local equine host being infected by one local vector. This risk was assessed using data from three consecutive years (2010 to 2012) for 22 regions in France.

Results

The results of the model indicate that the annual risk of AHS being introduced to France is very low but that major spatiotemporal differences exist. For both introduction pathways, risk is higher from July to October and peaks in July. In general, regions with warmer climates are more at risk, as are colder regions with larger equine populations; however, regional variation in animal importation patterns (number and species) also play a major role in determining risk. Despite the low probability that AHSV is present in the EU, intra-EU trade of equines contributes most to the risk of AHSV introduction to France because it involves a large number of horse movements.

Conclusion

It is important to address spatiotemporal differences when assessing the risk of ASH introduction and thus also when implementing efficient surveillance efforts. The methods and results of this study may help develop surveillance techniques and other risk reduction measures that will prevent the introduction of AHS or minimize AHS’ potential impact once introduced, both in France and the rest of Europe.

Electronic supplementary material

The online version of this article (doi:10.1186/s12917-015-0435-4) contains supplementary material, which is available to authorized users.

West Nile virus epidemiology and factors triggering change in its distribution in Europe

West Nile virus (WNV) has historically been considered among the least virulent members of the Japanese serogroup complex (family Flaviviridae, genus Flavivirus). The WNV natural cycle involves birds as the main amplifying hosts and several species of mosquito as vectors. Many outbreaks occurred during the past decade, causing severe human encephalitis in the Old World, and the virus has become established in many European countries. Emergence of WNV is difficult to predict and even more difficult to prevent. In this review, the latest information on the epidemiology, transmission dynamics and clinical aspects of WNV is presented, with particular focus on specific factors likely to trigger changes in the distribution of the disease in Europe, such as climate changes and their consequences on the potential vectors of WNV or bird migration routes. The control of some anthropogenic and environmental factors could help prevent extension and re-emergence of WNV epidemics.

Land cover, landscape structure, and West Nile virus circulation in southern France

The transmission of West Nile virus (WNV) is strongly influenced by environmental factors. In France, two endemic areas for WNV have been identified: Camargue and Var. The objective of our study was to test whether landscape characteristics could be associated with the risk of endemic circulation of WNV in these two ecologically different areas. Equine serological data collected during outbreaks in Var (2003) and Camargue (2004) were used. Both areas were marked out in cells of 5 km(2), and data were aggregated for each cell. Sixteen cells, classified as "high" level viral circulation, and 28 cells, classified as "low" level viral circulation were used for the analysis. The Corine Land Cover database (European Environment Agency) was used to evaluate, for each geographic cell, the area covered by 12 land cover classes, as well as the value of 5 landscape metrics (patch richness and density, edge density, the Shannon's diversity index, and interspersion and juxtaposition index (IJI). Multivariate linear generalized regression showed that IJI as well as the surface covered by heterogeneous agricultural areas were significantly higher in high level WNV circulation cells than in low level ones (p = 0.01 and 0.05 respectively). Both variables are indicators of a complex spatial biotope configuration that may favor the co-existence of competent vectors and reservoir hosts: the structure of the landscape thus appeared as a key element in WNV circulation. An internal validation was performed and the model was used to compute a risk map for the French Mediterranean coast. Cells with a probability > 0.8 of having a high level of viral circulation were found near Aix-en-Provence, Beziers, and Perpignan, areas where no serological study has yet been conducted. Equine cases reported in 2006 were all located in the neighborhood of cells having a > 0.8 probability for high WNV circulation status.

West Nile Virus Outbreak Detection Using Syndromic Monitoring in Horses

Recent outbreaks of West Nile virus-associated (WNV) diseases, both in the old World and Americas, underline the importance for early warning systems that rapidly identify emerging and re-emerging diseases and thus help in their control. Traditional approaches of disease monitoring become less reliable and increasingly costly when used for rare health-related events, such as WNV outbreaks in southern France. The objective of this work was to discuss methodological issues related to syndromic monitoring of WNV-associated disease in Camargue horses by veterinary practitioners. Tracking cases of equine encephalitis by veterinarians is an example of such syndromic monitoring of an emerging disease. Signs of illness, observed prior diagnostic confirmation, can be of interest because they may provide an early warning for WNV circulation in a given area and allow authorities to take appropriate preventive measures for public health.

Bird Species Potentially Involved in Introduction, Amplification, And Spread of West Nile Virus in A Mediterranean Wetland, The Camargue (Southern France)

West Nile virus (WNV) is a mosquito-transmitted Flavivirus with a transmission cycle involving birds as amplifying hosts. Wild birds are also believed to carry WNV over large distances and are able to introduce it into new areas during migration and dispersal. In this paper, our objective is to provide lists of birds potentially involved in the introduction, the amplification and the spread of WNV in the Camargue, a Mediterranean wetland in the south of France where several WNV outbreaks have occurred since the 1960s. Bird species were classified according to the following ecological factors: migratory status and provenance area, used biotopes, abundance and period of presence in the Camargue. The obtained lists of bird species potentially involved in the introduction, amplification and spread of WNV should prove useful to determine target species on which further studies on WNV ecology in birds could be focused.

Remote sensing based identification of environmental risk factors associated with West Nile disease in horses in Camargue, France

Geographic information system and remote sensing technologies were used to identify landscape features associated with risk of West Nile virus transmission as defined by the presence of confirmed horse cases. SPOT-4 images of Camargue area were used to generate a map of landscape categories of epidemic foci and the geographic information system was employed to determine the proportion of landscape components surrounding 10 horse case sites and 17 control sites. The spatio-temporal analysis of the cases outbreak gave the best results for a spatial window of 9 km and a temporal window of 18 days. Two clusters were identified (relative risk=3.35), both in the wet area of Camargue, near the town "Les Saintes Maries de la Mer". The first one was 4 km radius, the second 9 km. The relationships between the presence of cases and proportions of landscape categories were analyzed using generalized linear model. The best model indicated that rice fields and dry bushes, wet "sansouire" and open water were the major components of the landscape that were associated with the presence of West Nile virus cases.

[An epidemiological survey of equine anaplasmosis (Anaplasma phagocytophilum) in southern France]

Anaplasmosis is caused by the bacterium Anaplasma phagocytophilum and transmitted by Ixodes spp. ticks. According to some reports the disease can be introduced into disease-free zones by migrating birds. The purpose of this study was to evaluate the seroprevalence of A. phagocytophilum in horses in the Camargue. Data concerning 424 horses were gathered and the sera were tested for A. phagocytophilum and for piroplasmoses using an enzyme-linked immunosorbent assay and a complement fixation test, respectively. The seroprevalence rates were 11.3 % for A. phagocytophilum, 64.4 % for Theileria equi and 19.7% for Babesia caballi. Stallions were less likely to produce antibodies against A. phagocytophilumthan were females or geldings (odds ratio [OR] = 0.3; p = 0.021). The presence of swallows increased the risk of infections in stables (OR = 5.18; p = 0.011). Spatial analysis showed the existence of groups of infected stables along canals and rivers (p = 0.008). These results suggest an emergence of A. phagocytophilum in the Camargue.

Toxicokinetics of ergovaline in the horse after an intravenous administration

The toxicokinetics of ergovaline (an ergopeptine mycotoxin present in some grasses infected with endophytic fungus of the genus Neotyphodium) were studied after intravenous administration of a single dose of 15 microg/kg bwt in four gelding horses. Plasma ergovaline concentrations were measured by high performance liquid chromatography, and the kinetic data were described by a three-compartment model. The elimination half-life and the total clearance of ergovaline were found to be 56.83 +/- 13.48 min and 0.020 +/- 0.004 L/min x kg, respectively. According to the toxicological data previously reported in the horse, and in spite of the very low dose administered, clinical signs were observed, including excessive coolness of the ears and the nose, excessive sweating and prostration.

A retrospective evaluation of the causes of death of 448 insured French horses in 1995

Epidemiological studies should allow comparisons to be made of the prevalence of disease in populations from different countries, but the population characteristics and health problems in French horses are not well established. We have conducted a retrospective evaluation of the causes of death and vital characteristics of insured horses in France for the year 1995, with a view to comparison with published data from other countries. Files on 448 deceased horses were provided by nine insurance companies. Most of the animals were used for breeding (60%), followed by leisure (20%), eventing and racing (10% each). Physical characteristics were associated significantly with occupational categories. The overall mortality rate was 2.47%, and was due, in decreasing order, to foaling (24%), colic (21%) or locomotor (21%), cardiovascular (9%), neurological (8%), respiratory (5%) or infectious (4%) disease. Infectious disease was more frequent in younger animals (p < 0.05) and locomotor disease in racehorses (p < 0.01). Horses aged over 15 years had a lower incidence of colic (p <0.05). The cause of death was not significantly linked to breed, insurance value or season. Despite some selection bias, the study provides useful information about mortality in the French equine population.

The study of cutaneous melanomas in Camargue-type gray-skinned horses (2): epidemiological survey

An epidemiological survey was made on cutaneous melanomas occurring in Camargue-type, gray-skinned horses in southern France. The population investigated was composed of 264 horses, which were selected from the Camargue horse stud registry and were allowed to be examined by the owners. The presence of tumors was inspected macroscopically according to the standardized protocols of veterinary medicine specialists, and some tumors were subjected to macroscopic histopathological examination. The results indicated that: 1) the prevalence of melanomas in the overall population was 31.4%; 2) the odds ratio was obtained for an age class of 5-9 years, in which most melanomas were presumed to occur; 3) the incidence of melanomas was significantly correlated with age, giving a prevalence of 67% at ages > 15 years; 4) the size and number of tumorous lesions were significantly related to age; 5) little correlation was observed between melanoma incidence and gender; and 6) the most frequently occurring body site of these tumors was underneath the tail. Because of their frequent occurrence in shaded body regions, sun exposure was not likely to be a risk factor for melanoma formation in these horses. In view of the slightly darker skin pigmentation in these horses at younger ages, the unique characteristics of their melanocytes may be associated with melanoma formation.

Starch malabsorption and breath gas excretion in healthy humans consuming low- and high-starch diets

Dietary starch delivery to the colon and excretion in stools and the ability of unabsorbed carbohydrates to promote hydrogen and methane release in breath were evaluated in 6 volunteers during two 8-day periods on starch diets of 100 and 300 g, respectively. Significantly less starch was recovered from the terminal ileum by aspiration per 24 h during the low-starch period (4.1 +/- 0.3 vs. 9.5 +/- 1.1 g, mean +/- SEM, p less than 0.01). Unabsorbed glucose tended to rise during the high-starch period (2.7 +/- 0.8 vs. 1.1 +/- 0.3 g). Fecal outputs of starch, glucose, volatile fatty acids, and lactic acid were not significantly different during the two periods. Daily breath hydrogen excretion was unchanged (181.2 +/- 22.7 vs. 193.7 +/- 19.8 ml for the low- and high-starch periods, respectively), whereas breath methane excretion increased markedly in the three methane producers during the high-starch period (217.2 +/- 80.9 vs. 32.4 +/- 7.3 ml). Starch malabsorption in the healthy small intestine was moderate even with a high-starch diet and less than that previously estimated by indirect methods. Unabsorbed starch catabolism by the colonic flora does not seem to explain most of the breath hydrogen excretion.

Influence of chronic lactulose ingestion on the colonic metabolism of lactulose in man (an in vivo study)

The effects of a chronic load of nonabsorbable sugars on intracolonic bacterial metabolism of carbohydrates and on H2 breath excretion are disputed. However, most of the discussion relies on indirect evidence or on results of in vitro studies. Thus, we attempted to assess directly and in vivo the effects on intracolonic metabolism of lactulose of a chronic oral load of this nonabsorbable disaccharide. 20 g of lactulose was given orally twice daily during 8 d to eight normal volunteers. In all, breath H2 concentration was measured on days 1 and 8 after ingestion of the morning lactulose dose. In four subjects, stools were collected during 2 d at the beginning and at the end of the lactulose maintenance period to measure fecal pH and daily outputs of carbohydrates and beta-galactosidase. The four other subjects were intubated on days 1 and 8 to measure the pH and the concentrations of carbohydrates, lactic acid, and volatile fatty acids (VFA) in the distal ileum and cecal contents. Moreover, 14C-lactulose was added to cold lactulose and 14CO2 breath outputs determined. Pulmonary H2 excretion fell from day 1 to day 8 (P less than 0.05), whereas 14CO2 excretion increased (P less than 0.01). Fecal water pH, lactic acid, and VFA concentrations did not vary between the two stool collection periods. 24-h fecal weight, fecal water, and carbohydrate outputs showed a trend to decrease between days 1 and 2 and days 7-8, whereas beta-galactosidase activity rose markedly (P less than 0.01). No significant variations were observed for all parameters measured in ileal fluid. In the cecum, areas under the concentration curves decreased from day 1 to day 8 for lactulose, galactose, and fructose (P less than 0.01), while an increase was found for lactic acid (P less than 0.001), acetic acid (P less than 0.0001), and total VFA (P less than 0.001). Cecal fluid pH dropped faster (P less than 0.05) and to a lower level (P less than 0.05) on day 8 than on day 1. These data clearly show that a chronic load of a nonabsorbable sugar induces changes in colonic bacterial metabolic pathways resulting in a better efficiency of the flora to digest the carbohydrate.