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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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Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

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Abbreviations

SBS:

Short bowel syndrome

EN:

Enteral nutrition

PN:

Parenteral nutrition

JI:

Jejunoileal anastomosis anatomy

JC:

Jejunocolic anastomosis anatomy

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Acknowledgements

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.

Funding

This work was Funded by the Canadian Institutes of Health Research (Grant Number: MOP-126179).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Edmonton Health Academy, University of Alberta, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada

    Marihan Lansing, Justine M. Turner, Pamela Wizzard & Paul W. Wales

  2. Faculty of Medical Sciences, University of Toronto, Toronto, ON, Canada

    Celeste M. Lavallee

  3. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    David W. Lim

  4. Department of Pediatric Surgery, Kagoshima University, Sakuragaoka, Kagoshima, Japan

    Mitsuru Muto

  5. Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada

    Patrick N. Nation

  6. Departments of Pediatrics and Nutritional Sciences, University of Toronto, Toronto, ON, Canada

    Paul B. Pencharz

  7. Department of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, AB, Canada

    Celeste M. Lavallee & Ron O. Ball

  8. Division of General and Thoracic Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Paul W. Wales

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  1. Marihan Lansing
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  2. Justine M. Turner
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Corresponding author

Correspondence to Justine M. Turner.

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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.

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Lansing, M., Turner, J.M., Wizzard, P. et al. Plasma citrulline is not a biomarker for intestinal adaptation in short bowel syndrome, studied in piglets: a model for human neonates. Pediatr Surg Int 35, 657–663 (2019). https://doi.org/10.1007/s00383-019-04475-4

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