Small intestinal mucosa changes, including epithelial cell proliferative activity, of children receiving total parenteral nutrition (TPN)

T. M. Rossi1,2,3, P. C. Lee3,2,1, C. Young3,1,2, A. Tjota3,1,2
1Department of Pediatrics, Division of Gastroenterology and Nutrition, Children's Hospital of Buffalo, Buffalo
2Department of Pediatrics, Medical College of Wisconsin, Milwaukee
3Department of Pathology, Children's Hospital of Buffalo, Buffalo

Tóm tắt

We examined the small intestinal histology disaccharidase activities as well as the incorporation of [3H]thymidine into DNA of biopsies maintained in organ culture from seven children (ages 9 months to 5 years) receiving total parenteral nutrition (TPN). Three children suffered from inflammatory bowel disease and received TPN for one month (short term). Four required long-term TPN (>9 months) for short-bowel syndrome. DNA was extracted from the samples following serial precipitation with perchloric acid. Results were compared to those from 22 age-matched children investigated for abdominal pain or chronic diarrhea. Short-term TPN resulted in slightly lower lactase, sucrase, and palatinase activities that were not statistically different from controls. Long-term TPN resulted in focal mild villus atrophy and a decrease in disaccharidase activity in two patients. Biopsies from long-term TPN patients incorporated less thymidine compared to those of controls (P<0.001) when data was expressed per total biopsy (3.6±1.1 vs. 8.4±1.1 fmol) or per milligram of tissue (1.0±0.12 vs 2.7±0.7 fmol). The above data are in general agreement with the hypoplastic effect of TPN in animals. However, in children, much longer periods of TPN are required to realize the changes.

Từ khóa


Tài liệu tham khảo

Dworkin LD, Levine GM, Farber NJ, Spector MH: Small intestinal mass of the rat is partially determined by indirect effects of intraluminal nutrition. Gastroenterology 71:626–630, 1976

Hugbes CA, Dowling RH: Speed of onset of adaptive mucosal hypoplasia and hypofunction in the intestine of parenterally fed rats. Clin Sci 59:317–327, 1980

Spector MH, Levine GM, Deren JJ: Direct and indirect effects of dextrose and amino acids on gut mass. Gastroenterology 72:706–710, 1977

Galluser M, Doffoel M, Lacombe G, Raul F: Imbalance between jejunum and ileum in the response of brush border hydrolases to oral feeding after intravenous alimentation in rats. J Parenter Enter Nutr 13:37–40, 1989

Levine GM, Deren JJ, Steiger E, Zinno R: Role of oral intake in maintenance of gut mass and disaccharidase activities. Gastroenterology 67:975–982, 1974

Eastwood GL: Small bowel morphology and epithelial proliferation in intravenously alimented rabbits. Surgery 82:613–620, 1977

Heird WC, Tsang HL, MacMillan R, Kaplan R, Rosensweig M: Comparative effects of total parenteral nutrition, oral feeding, and starvation on rat small intestine. Pediatr Res 8:107, 1974

Dowling RH, Both CC: Structure and functional changes following small intestinal resection in the rat. Clin Sci 32:139–149, 1967

Booth CC, Evans KT, Menzies T, Street DF: Intestinal hypertrophy following partial resection of the bowel in the rat. Br J Surg 46:403, 1959

Flint JM: The effects of extensive resection of the small intestine. Bull Johns Hopkins Hosp 23:127–143, 1912

Weser E, Hernandez MH: Studies of small bowel adaptation after intestinal resection in the rat. Gastroenterology 60:69–75, 1971

Levine GM, Deren JJ, Yezdimir M: Small bowel resection: Oral intake is the stimulus for hyperplasia. Dig Dis Sci 21:542–546, 1976

Morin CL, Ling V, Van Caillie M: Role of oral intake on intestinal adaptation after small bowel resection in growing rats. Pediatr Res 12:268–271, 1978

Guedon C, Schmitz E, Lerebours E, Metayer J, Audran E, Hemet J, Colin R: Decreased brush border hydrolase activities without gross morphologic changes in human intestinal mucosa after prolonged total parenteral nutrition of adults. Gastroenterology 90:373–378, 1986

Dahlqvist A: Method for assay of intestinal disaccharidase. Anal Biochem 7:18–25, 1964

Lowry OH, Rosebrough NJ, Farr AL, Randall RJ: Protein measurement with the Folin-phenol reagent. J Biol Chem 193:265–275, 1951

Tajiri H, Klein R, Lebenthal E, Lee PC: Oral feeding of isolated lectins from red kidney bean stimulates rat small intestinal mucosal DNA synthesis and crypt cell division. Dig Dis Sci 33:(11)1364–1369, 1988

Ingkaran N, Robinson K, Prathap K: Cow's milk protein-sensitive enteropathy. Arch Dis Child 53:20–26, 1978

Lin CH, Rossi TM, Heitlinger LA, Lerner A, Riddlesberger MM, Lebenthal E: Nutritional assessment of children with short-bowel syndrome receiving home parenteral nutrition. Am J Dis Child 141:1093–1098, 1987

Lin CH, Lerner A, Rossi TM, Feld LG, Riddlesberger MM, Lebenthal E: Effects of parenteral nutrition on whole body and extremity composition in children and adolescents with active inflammatory bowel disease. J Parenter Enter Nutr 13(4):366–371, 1989

Rossi TM: Effects of total parenteral nutrition on the digestive organs.In Total Parenteral Nutrition: Indications, Utilization, Complications and Pathophysiological Considerations. E Lebenthal (ed). New York, Raven Press, 1986, pp 173–184

Reif S, Tano M, Oliverio R, Young C, Rossi T: Total parenteral nutrition-induced steatosis: reversal by parenteral lipid infusion. J Parenter Enter Nutr 15(1):102–104, 1991

Rossi TM, Lee PC, Lebenthal E: Nutrition and exocrine pancreatic function in infancy: Effects of total parenteral nutrition and first degree malnutrition. Pancreas 2(4):463–469, 1987

Brown HO, Levine M, Lipkin M: Inhibition of intestinal epithelial cell renewal and migration induced by starvation. Am J Physiol 205(5):868–872, 1963

Altmann GG: Influence of starvation and refeeding on mucosal size and epithelial renewal in the rat small intestine. Am J Anat 133:391–400, 1963

McManus JPA, Isselbacker KJ: Effect of fasting versus feeding on the rat small intestine. Gastroenterology 59(2):214–221, 1972

Johnson LR: Regulation of gastrointestinal mucosal growth. Physiol Rev 68:456–502, 1970

Altmann GG: Influence of bile and pancreatic secretions on the size of the intestinal villi in the rat. Am J Anat 132:167–178, 1971

Hughes CA, Bates T, Dowling RH: Cholecystokinin and secretion prevent the intestinal mucosal hypoplasia of total parenteral nutrition in the dog. Gastroenterology 75(1):34–41, 1978

Vanderhoof JA, Burkley KT, Antonson DL: Potential for mucosal adaptation following massive small bowel resection in 3-week-old versus 8-week-old rats. J Pediatr Gastroenterol Nutr 2:672–676, 1983

Shulman RJ, Burrin DG: Total parenteral nutrition energy composition affects small intestinal disaccharidase activity in the newborn miniature pig. J Parent Enter Nutr 15:560–563, 1991

Shulman RJ: Effect of different total parenteral nutrition fuel mixes on small intestinal growth and differentiation in the infant miniature pig. Gastroenterology 95:85–92, 1988

Biasco G, Callegari C, Lami F, Minarini A, Miglioli M, Barabara L: Intestinal morphological changes during oral refeeding in a patient previously treated with total parenteral nutrition for small bowel resection. Am J Gastroenterol 79(8):585–588, 1984

Klein RM: Models for the study of cell proliferation in the developing gastrointestinal tract. J Pediatr Gastroenterol Nutr 5(4):513–516, 1986

Menard D, Arsenault P: Explant culture of human fetal small intestine. Gastroenterology 88:691–700, 1985

Scott J, Peters TJ: Protection of epithelial function in human jejunum cultured with hydrocortisone. Am J Physiol 244:G532-G540, 1983