title: The influence of extracorporeal membrane oxygenation therapy on intestinal mucosal barrier in a porcine model for post-traumatic acute respiratory distress syndrome.
abstract: BACKGROUND
  It is unclear at present whether extracorporeal membrane oxygenation (ECMO) therapy can improve intestinal mucous barrier function through increased perfusion. The present study establishes an animal model for post-traumatic acute respiratory distress syndrome (ARDS) and evaluates the effect of v-vECMO treatment on the intestinal mucosal barrier.
  
  
  METHODS
  Pulmonary contusion combined with ischemia-reperfusion injury was induced in 30 piglets. The animals were randomly divided into control, model, and ECMO groups. Serum I-FABP, D-lactate, and endotoxin were measured over a 24-h period. The jejunum and colon were collected post-mortem and evaluated histopathologically. The tissue was also examined using electron microscopy, and intestinal tight junction proteins (ZO-1 and occludin) were measured after 24 h of ECMO therapy. Mortality rate and cause of death were also recorded.
  
  
  RESULTS
  The serum markers evaluating the intestinal mucosal barrier deteriorated in the model group compared to the control group (p < 0.05). At 2 h, serum I-FABP, D-lactate, and endotoxin were significantly increased in the ECMO group compared to the model group (p < 0.05). At 12 h, I-FABP and D-lactate in the ECMO group dropped to model group levels. Serum D-lactate was slightly lower in the ECMO group (p > 0.05) and serum I-FABP was significantly lower than in the model group (p < 0.05) at 24 h. Similarly, serum endotoxin was slightly lower in the ECMO group than in the model group (p > 0.05) at 24 h. After 24 h of ECMO therapy, the occludin and ZO-1 protein concentrations in jejunum and colon mucosa increased moderately compared to that in the model group (p < 0.05). Morphologic structure of the jejunum and colon did not improved significantly after ECMO therapy. Finally, we observed that ECMO therapy moderately decreased mortality (25% vs. 50%).
  
  
  CONCLUSIONS
  Intestinal mucosal barrier continued to deteriorate in the model group. Although early ECMO therapy aggravates intestinal mucosal injury, the damage gradually improves later during therapy. The results show that ECMO therapy has a protective effect on the intestinal mucosal barrier in the later treatment stage.
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical school of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China. zhimolei@163.com.
authors.forename: Ling
authors.initials: L
authors.lastname: Ni
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical school of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China. Qiyichen2008@gmail.com.
authors.forename: Qiyi
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Catheter Room of Yongcheng People's Hospital of Henan Province, Yongcheng, Henan Province, China. kezhu19750511@163.com.
authors.forename: Ke
authors.initials: K
authors.lastname: Zhu
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical school of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China. shijl1206@gmail.com.
authors.forename: Jialiang
authors.initials: J
authors.lastname: Shi
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical school of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China. medcc.sjh@gmail.com.
authors.forename: Juanhong
authors.initials: J
authors.lastname: Shen
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical school of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China. jianfenggong@yahoo.cn.
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Gong
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical school of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China. tao1983@yahoo.cn.
authors.forename: Tao
authors.initials: T
authors.lastname: Gao
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical school of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China. yudrnju@163.com.
authors.forename: Wenkui
authors.initials: W
authors.lastname: Yu
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical school of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China. jieshoulivip@sina.com.
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical school of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China. NingLinju@hotmail.com.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D007413:Intestinal Mucosa / Q000378:metabolism*; D007583:Jejunum / Q000378:metabolism; D019344:Lactic Acid / Q000097:blood; D008297:Male; D015427:Reperfusion Injury / Q000150:complications / Q000378:metabolism; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology / Q000628:therapy*; D034421:Sus scrofa
chemical_list: D050556:Fatty Acid-Binding Proteins; D019344:Lactic Acid