title: Modulation of intestinal inflammation by minimal enteral nutrition with amniotic fluid in preterm pigs.
abstract: BACKGROUND
  Necrotizing enterocolitis (NEC) is a severe inflammatory disorder, associated with the difficult transition from parenteral to enteral feeding after preterm birth. We hypothesized that minimal enteral nutrition (MEN) with amniotic fluid (AF), prior to enteral formula feeding, would improve resistance to NEC in preterm pigs.
  
  
  METHODS
  Experiment 1: IEC-6 cells were incubated with porcine (pAF) and human AF (hAF) to test AF-stimulated enterocyte proliferation and migration in vitro. Experiment 2: Cesarean-delivered, preterm pigs were fed parenteral nutrition and MEN with pAF, hAF, or control fluid (MEN-pAF, MEN-hAF, or MEN-CTRL; all n = 9) for 2 days before tissue collection. Experiment 3: Preterm pigs were fed MEN diets as in experiment 2, but followed by 2 days of enteral formula feeding, which predisposes to NEC (NEC-pAF, NEC-hAF, or NEC-CTRL; n = 10-12).
  
  
  RESULTS
  Both pAF and hAF stimulated enterocyte proliferation and migration in vitro. In experiment 2, MEN-pAF and MEN-hAF pigs showed increased body weight gain and reduced intestinal interleukin (IL)-8 and colonic IL-6 levels, indicating reduced inflammatory response. In experiment 3, body weight gain was highest in the 2 groups fed AF as MEN, but NEC incidences were similar (NEC-pAF) or increased (NEC-hAF) compared with controls.
  
  
  CONCLUSIONS
  Intake of pAF or hAF improved body growth and modulated intestinal inflammatory cytokines during a period of parenteral nutrition, but did not protect against later formula-induced NEC in preterm pigs. Further studies are required to show if MEN feeding with species-specific AF, combined with an optimal enteral diet (eg, human milk), will improve adaptation during the transition from parenteral to enteral feeding in preterm neonates.
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark.
authors.forename: Mette V
authors.initials: MV
authors.lastname: Østergaard
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark.
authors.forename: Stine B
authors.initials: SB
authors.lastname: Bering
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Jensen
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Thymann
authors.affiliation: Department of Animal Science, Faculty of Science and Technology, Aarhus University, Denmark.
authors.forename: Stig
authors.initials: S
authors.lastname: Purup
authors.affiliation: Department of Gynecology and Obstetrics, Hvidovre Hospital, Denmark.
authors.forename: Marie
authors.initials: M
authors.lastname: Diness
authors.affiliation: Department of Large Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark psa@life.ku.dk.
authors.forename: Per T
authors.initials: PT
authors.lastname: Sangild
mesh_terms: D000653:Amniotic Fluid; D000818:Animals; D000831:Animals, Newborn; D001835:Body Weight / Q000187:drug effects; D002460:Cell Line; D002465:Cell Movement; D049109:Cell Proliferation; D004750:Enteral Nutrition / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000178:diet therapy* / Q000276:immunology / Q000473:pathology / Q000517:prevention & control*; D020895:Enterocytes / Q000166:cytology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000178:diet therapy; D015850:Interleukin-6 / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D008297:Male; D011247:Pregnancy; D047928:Premature Birth; D013552:Swine; D016896:Treatment Outcome
chemical_list: D015850:Interleukin-6; D016209:Interleukin-8
keywords: amniotic fluid; immunonutrition; intestine; minimal enteral nutrition; necrotizing enterocolitis