title: The effects of perioperative probiotic treatment on serum zonulin concentration and subsequent postoperative infectious complications after colorectal cancer surgery: a double-center and double-blind randomized clinical trial.
abstract: BACKGROUND
  Zonulin is a newly discovered protein that has an important role in the regulation of intestinal permeability. Our previous study showed that probiotics can decrease the rate of infectious complications in patients undergoing colectomy for colorectal cancer.
  
  
  OBJECTIVE
  The objective was to determine the effects of the perioperative administration of probiotics on serum zonulin concentrations and the subsequent effect on postoperative infectious complications in patients undergoing colorectal surgery.
  
  
  METHODS
  A total of 150 patients with colorectal carcinoma were randomly assigned to the control group (n = 75), which received placebo, or the probiotics group (n = 75). Both the probiotics and placebo were given orally for 6 d preoperatively and 10 d postoperatively. Outcomes were measured by assessing bacterial translocation, postoperative intestinal permeability, serum zonulin concentrations, duration of postoperative pyrexia, and cumulative duration of antibiotic therapy. The postoperative infection rate, the positive rate of blood microbial DNA, and the incidence of postoperative infectious complications-including septicemia, central line infection, pneumonia, urinary tract infection, and diarrhea-were also assessed.
  
  
  RESULTS
  The infection rate was lower in the probiotics group than in the control group (P < 0.05). Probiotics decreased the serum zonulin concentration (P < 0.001), duration of postoperative pyrexia, duration of antibiotic therapy, and rate of postoperative infectious complications (all P < 0.05). The p38 mitogen-activated protein kinase signaling pathway was inhibited by probiotics.
  
  
  CONCLUSIONS
  Perioperative probiotic treatment can reduce the rate of postoperative septicemia and is associated with reduced serum zonulin concentrations in patients undergoing colectomy. We propose a clinical regulatory model that might explain this association. This trial was registered at http://www.chictr.org/en/ as ChiCTR-TRC-00000423.
authors.affiliation: Gastrointestinal Institute of Sun Yat-sen University, Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. liuzhh26@mail.sysu.edu.cn
authors.forename: Zhi-Hua
authors.initials: ZH
authors.lastname: Liu
authors.forename: Mei-Jin
authors.initials: MJ
authors.lastname: Huang
authors.forename: Xing-Wei
authors.initials: XW
authors.lastname: Zhang
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Nan-Qi
authors.initials: NQ
authors.lastname: Huang
authors.forename: Hui
authors.initials: H
authors.lastname: Peng
authors.forename: Pin
authors.initials: P
authors.lastname: Lan
authors.forename: Jun-Sheng
authors.initials: JS
authors.lastname: Peng
authors.forename: Zhen
authors.initials: Z
authors.lastname: Yang
authors.forename: Yang
authors.initials: Y
authors.lastname: Xia
authors.forename: Wei-Jie
authors.initials: WJ
authors.lastname: Liu
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.forename: Huan-Long
authors.initials: HL
authors.lastname: Qin
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D018988:Bacterial Translocation; D002772:Cholera Toxin / Q000097:blood*; D015179:Colorectal Neoplasms / Q000150:complications / Q000382:microbiology / Q000601:surgery; D003967:Diarrhea / Q000209:etiology / Q000503:physiopathology; D013505:Digestive System Surgical Procedures / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006242:Haptoglobins; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D020935:MAP Kinase Signaling System; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control*; D019936:Probiotics / Q000627:therapeutic use*; D011498:Protein Precursors; D018805:Sepsis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control
chemical_list: D006242:Haptoglobins; D011498:Protein Precursors; C408043:zonulin; D002772:Cholera Toxin