title: Teduglutide-Stimulated Intestinal Adaptation Is Complemented and Synergistically Enhanced by Partial Enteral Nutrition in a Neonatal Piglet Model of Short Bowel Syndrome.
abstract: Teduglutide, a glucagon-like peptide-2 (GLP-2) analogue, is available for long-term use by parenteral nutrition (PN)-dependent adults to promote intestinal adaptation but is not approved for use in pediatric patients. The objective of this study was to assess teduglutide-stimulated induced intestinal adaptation, potential synergies with partial enteral nutrition (PEN), and distinct temporal markers of adaptation in a neonatal piglet model of short bowel syndrome (SBS).
  
  
  
  Neonatal piglets (48 hours old; n = 72) underwent an 80% jejunoileal resection and were randomized to 1 of 4 treatment groups, in a 2 × 2 factorial design, with PN or PEN (80% standard PN/20% standard enteral nutrition) and teduglutide (0.1 mg/kg/d) or control. Piglets received nutrient infusions for 4 hours, 48 hours, or 7 days.
  
  
  
  Teduglutide improved ( P < .05) mucosal surface area (villus height: duodenum, jejunum, ileum; crypt depth: ileum, colon; proliferation: duodenum, jejunum, ileum; colon; apoptosis: jejunum, ileum, colon) and acute nutrient processing capacity (glucose: duodenum, jejunum, ileum; glutamine: duodenum, jejunum). These effects were complemented and synergistically enhanced by PEN in both site and timing of action. Structural adaptations preceded functional adaptations, but crypt depth remained a strong indicator of adaptation, regardless of time.
  
  
  
  The combination of teduglutide and PEN enhances intestinal adaptation beyond that of either therapy alone.
authors: 1 Division of Nutritional Sciences, University of Illinois, Urbana, Illinois, USA.
authors: Jane K
authors: JK
authors: Naberhuis
authors: 1 Division of Nutritional Sciences, University of Illinois, Urbana, Illinois, USA.
authors: Andrew S
authors: AS
authors: Deutsch
authors: 1 Division of Nutritional Sciences, University of Illinois, Urbana, Illinois, USA.|2 Department of Food Science and Human Nutrition, University of Illinois, Urbana, Illinois, USA.
authors: Kelly A
authors: KA
authors: Tappenden
mesh_terms: D000222:Adaptation, Physiological / Q000187:drug effects*; D000818:Animals; D000831:Animals, Newborn; D017209:Apoptosis / Q000187:drug effects; D002454:Cell Differentiation / Q000187:drug effects; D049109:Cell Proliferation / Q000187:drug effects; D004195:Disease Models, Animal; D004750:Enteral Nutrition; D004847:Epithelial Cells / Q000187:drug effects / Q000378:metabolism; D005765:Gastrointestinal Agents / Q000494:pharmacology*; D007082:Ileum / Q000187:drug effects; D007421:Intestine, Small / Q000187:drug effects; D010288:Parenteral Nutrition; D010455:Peptides / Q000494:pharmacology*; D012778:Short Bowel Syndrome / Q000628:therapy*; D013552:Swine
chemical_list: D005765:Gastrointestinal Agents; D010455:Peptides; C494910:teduglutide
keywords: life cycle; neonates; nutrition; parenteral nutrition; pediatrics