Plasma citrulline is not a biomarker for intestinal adaptation in short bowel syndrome, studied in piglets: a model for human neonates
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There are no in vivo methods to measure adaptation in neonatal short bowel syndrome (SBS). We evaluated citrulline (Cit) levels in neonatal piglet surgical models of SBS.
Piglets underwent 75% mid-intestinal resection with jejunoileal anastomosis (JI), 75% distal resection of ileum with jejunocolic anastomosis (JC) or sham surgery. Jugular and gastric catheters were inserted for parenteral and enteral nutrition. On D7, small intestine length and weight were measured, jejunum collected for histopathology and Cit level determined.
JI (n = 5) compared to JC (n = 5) had increased small intestinal length (JC − 17.5 cm; JI +22.0 cm; p = 0.02) and mass (JC 43.1 mg/cm/kg; JI 51.3 mg/cm/kg; p = 0.02), while Cit did not differ (JI 801.0 µM; JC 677.7 µM; p = 0.90). Including non-resected shams (n = 4), Cit correlated with length (R2 = 0.48; p = 0.006), but not for SBS alone (R2 = 0.11; p = 0.4), mass (R2 = 0.05; p = 0.5). A second experiment compared change in Cit levels from baseline to D7. Levels declined in sham (n = 8) and JC (n = 10) (sham − 110.1 µM; JC − 56.6 µM; p = 0.17), regardless of intestinal lengthening (sham 29.9 cm; JC − 10.4 cm; p = 0.002).
Citrulline levels predict large differences in intestinal length and ‘identify’ SBS. However, citrulline cannot discriminate between adaptation in JI and JC, nor predict intestinal lengthening.
KeywordsNeonates Short bowel syndrome Intestinal adaptation Citrulline
Short bowel syndrome
Jejunoileal anastomosis anatomy
Jejunocolic anastomosis anatomy
The authors wish to acknowledge the important contribution of Charlane Gorsak for technical assistance with the study and all the staff of the Swine Research and Technology Centre, University of Alberta.
This work was Funded by the Canadian Institutes of Health Research (Grant Number: MOP-126179).
Compliance with ethical standards
Conflict of interest
Author Marihan Lansing declares that she has no conflict of interest. JM Turner has research grant funding from GLyPharma Therapeutic, Inc., and from Empire Biotechnologies Inc. Author Pamela Wizzard declares that she has no conflict of interest. Author Celeste M. Lavallee declares that she has no conflict of interest. Author David W. Lim declares that he has no conflict of interest. Author Mitsuru Muto declares that he has no conflict of interest. Author Patrick N. Nation declares that he has no conflict of interest. Author Paul B. Pencharz declares that he has no conflict of interest. Author Ron O. Ball declares that he has no conflict of interest. Author Paul W. Wales has research grant funding from GLyPharma Therapeutic, Inc., and from Empire Biotechnologies Inc.
Human and animal rights
All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.
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