title: Preventively enteral application of immunoglobulin enriched colostrums milk can modulate postoperative inflammatory response.
abstract: Several studies demonstrated acute inflammatory response following traumatic injury. Inflammatory response during surgical interventions was verified by a significant increase of endotoxin plasma levels and a decrease of the endotoxin neutralizing capacity (ENC). However, the incidence of elevated endotoxin levels was significantly higher (89%) than detected bacterial translocation (35%). Thus parts or products of Gram-negative bacteria seem to translocate more easily into the blood circulation than whole bacteria. Along with the bacterial translocation, the inflammatory response correlated directly with the severity of the surgical intervention. In comparison after major and minor surgery Interleukin-6 (IL-6) and C-reactive protein (CRP) was also significantly different. Similar effects in mediator release were shown during endovascular stent graft placement and open surgery in infrarenal aortic aneurysm. Open surgery demonstrated a significant stronger endotoxin translocation and a decrease of ENC. Strategies to prevent translocation seem to be sensible. Colostrum is the first milk produced by the mammary glands within the first days after birth. It contains a complex system of immune factors and has a long history of use in traditional medicine. Placebo-controlled studies verified that prophylactic oral application of immunoglobulin-enriched colostrum milk preparation diminishes perioperative endotoxemia, prevents reduction of ENC and reduces postoperative CRP-levels, suggesting a stabilization of the gut barrier. This effect may be caused by immunoglobulin transportation by the neonatal receptor FcRn of the mucosal epithelium.In conclusion, there is an association of perioperative endotoxemia and the subsequent increase in mediators of the acute phase reaction in surgical patients. A prophylactic oral application of colostrum milk is likely to stabilize the gut barrier i.e. reduces the influx of lipopolysaccharides arising from Gram-negative bacterial pathogens and inhibits enterogenic endotoxemia. This appears to be a major mechanism underlying the therapeutic effect in patients at risk for Gram-negative septic shock.
authors.forename: Klaus
authors.initials: K
authors.lastname: Orth
authors.forename: Wolfram Trudo
authors.initials: WT
authors.lastname: Knoefel
authors.forename: Martijn
authors.initials: M
authors.lastname: van Griensven
authors.forename: Christiane
authors.initials: C
authors.lastname: Matuschek
authors.forename: Matthias
authors.initials: M
authors.lastname: Peiper
authors.forename: Holger
authors.initials: H
authors.lastname: Schrumpf
authors.forename: Peter Arne
authors.initials: PA
authors.lastname: Gerber
authors.forename: Wilfried
authors.initials: W
authors.lastname: Budach
authors.forename: Edwin
authors.initials: E
authors.lastname: Bölke
authors.forename: Bettina Alexandra
authors.initials: BA
authors.lastname: Buhren
authors.affiliation: Medical Faculty, Department of General, Visceral-, and Pediatric Surgery, Heinrich Heine Universität Düsseldorf, Germany University of Düsseldorf, Dusseldorf, Germany. Matthias.Schauer@med.uni-duesseldorf.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schauer
mesh_terms: D000818:Animals; D003126:Colostrum / Q000276:immunology*; D004750:Enteral Nutrition; D007136:Immunoglobulins / Q000627:therapeutic use*; D007249:Inflammation / Q000209:etiology* / Q000517:prevention & control*; D008892:Milk / Q000276:immunology*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000517:prevention & control*
chemical_list: D007136:Immunoglobulins