Citrulline levels following proximal versus distal small bowel resection.
OBJECTIVE
Citrulline, a nonprotein amino acid synthesized by enterocytes, is a biomarker of bowel length and the capacity to wean from parenteral nutrition. However, the potentially variant effect of jejunal versus ileal excision on plasma citrulline concentration [CIT] has not been studied. This investigation compared serial serum [CIT] and mucosal adaptive potential after proximal versus distal small bowel resection.


METHODS
Enterally fed Sprague-Dawley rats underwent sham operation or 50% small bowel resection, either proximal (PR) or distal (DR). [CIT] was measured at operation and weekly for 8 weeks. At necropsy, histologic features reflecting bowel adaptation were evaluated.


RESULTS
By weeks 6-7, [CIT] in both resection groups significantly decreased from baseline (P<0.05) and was significantly lower than the concentration in sham animals (P<0.05). There was no difference in [CIT] between PR and DR at any point. Villus height and crypt density were higher in the PR than in the DR group (P≤0.02).


CONCLUSIONS
[CIT] effectively differentiates animals undergoing major bowel resection from those with preserved intestinal length. The region of intestinal resection was not a determinant of [CIT]. The remaining bowel in the PR group demonstrated greater adaptive potential histologically. [CIT] is a robust biomarker for intestinal length, irrespective of location of small intestine lost.
Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Ivan M
IM
Gutierrez
Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Jeremy G
JG
Fisher
Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Offir
O
Ben-Ishay
Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Brian A
BA
Jones
Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Kuang Horng
KH
Kang
Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Melissa A
MA
Hull
Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Nick
N
Shillingford
Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
David
D
Zurakowski
Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Biren P
BP
Modi
Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA. Electronic address: tom.jaksic@childrens.harvard.edu.
Tom
T
Jaksic
D000818:Animals; D015415:Biomarkers / Q000097:blood; D002956:Citrulline / Q000097:blood* / Q000378:metabolism; D020895:Enterocytes / Q000378:metabolism; D007082:Ileum / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D007413:Intestinal Mucosa / Q000378:metabolism*; D007583:Jejunum / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D011897:Random Allocation; D017207:Rats, Sprague-Dawley
D015415:Biomarkers; D002956:Citrulline
Biological markers; Citrulline; Intestinal adaptation; Intestinal failure; Short bowel syndrome