New growth factor therapies aimed at improving intestinal adaptation in short bowel syndrome.
Short bowel syndrome (SBS) is used to describe a condition of malabsorption and malnutrition resulting from the loss of absorptive area following massive small bowel resection. The key to improved clinical outcome after massive small bowel resection is the ability of the residual bowel to adapt. Although still in experimental stages, a major goal in the management of SBS may be the augmented use of growth factors to promote increased adaptation. A number of growth factors have been implicated in promoting the adaptation process. The best-described growth factors are reviewed: glucagon-like peptide-2 (GLP-2), epidermal growth factor (EGF), and growth hormone (GH). This article reviews the ability of recombinant GLP-2, EGF and GH to modulate structural and functional aspects of intestinal adaptation following small bowel resection. Although these growth factors have shown promise, small sample size, inconsistent measurement parameters and uncontrolled study designs have hampered the acquisition of strong data advocating the use of growth factor treatment for SBS. Multicenter trials using well-defined outcome measures to assess clinical efficacy are needed to direct the clinical indications, timing and duration of therapy and assess potential risks associated with growth factor therapies.
Pereira
Prue M
PM
Murdoch Children's Research Institute, Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia. prue.pereira@mcri.edu.au
Bines
Julie E
JE
D000222:Adaptation, Physiological / Q000187:drug effects; D000818:Animals; D004815:Epidermal Growth Factor / Q000627:therapeutic use*; D053767:Glucagon-Like Peptide 2; D004763:Glucagon-Like Peptides / Q000627:therapeutic use*; D013006:Growth Hormone / Q000627:therapeutic use*; D006133:Growth Substances / Q000627:therapeutic use; D006801:Humans; D007422:Intestines / Q000166:cytology / Q000187:drug effects* / Q000502:physiology; D051381:Rats; D011994:Recombinant Proteins / Q000627:therapeutic use; D012778:Short Bowel Syndrome / Q000188:drug therapy*
D053767:Glucagon-Like Peptide 2; D006133:Growth Substances; D011994:Recombinant Proteins; D004815:Epidermal Growth Factor; D004763:Glucagon-Like Peptides; D013006:Growth Hormone