title: Effect of butyrate enemas on gene expression profiles and endoscopic/histopathological scores of diverted colorectal mucosa: A randomized trial.
abstract: BACKGROUND
  A temporary stoma is often created to protect a distal anastomosis in colorectal surgery. Short-chain fatty acids, mainly butyrate, are the major fuel source for the epithelium and their absence in the diverted tract may produce mucosal atrophy and inflammation.
  
  
  OBJECTIVE
  To investigate whether the administration of sodium butyrate enemas (Naburen(©), Promefarm, Italy) could prevent mucosal inflammation and atrophy and affect gene expression profiles after ileo/colostomy.
  
  
  METHODS
  We performed a randomized, double-blind, placebo-controlled clinical trial, in patients with enterostomy performed for inflammatory bowel disease, colorectal cancer or diverticulitis. Twenty patients were randomly allocated to receive 30ml of sodium butyrate 600mmol/L (group A) or saline (group B), b.i.d. for 30 days.
  
  
  RESULTS
  In group A endoscopic scores were significantly improved (p<0.01) while mucosal atrophy was reduced or unchanged; in group B mucosal atrophy was increased in 42.8% of patients. Despite the high dose of butyrate used, no short-chain fatty acids were detectable by gas chromatography-mass spectrometry in colorectal biopsies. Group A patients showed up-regulation of genes associated with mucosal repair such as Wnt signalling, cytoskeleton regulation and bone morphogenetic protein-antagonists.
  
  
  CONCLUSIONS
  Butyrate enemas may prevent the atrophy of the diverted colon/rectum, thus improving the recovery of tissue integrity.
authors.affiliation: Department of Neurofarba, University of Florence, Italy. Electronic address: cristina.luceri@unifi.it.
authors.forename: Cristina
authors.initials: C
authors.lastname: Luceri
authors.affiliation: Department of Neurofarba, University of Florence, Italy.
authors.forename: Angelo Pietro
authors.initials: AP
authors.lastname: Femia
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: Marilena
authors.initials: M
authors.lastname: Fazi
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Di Martino
authors.affiliation: Unit of Anatomy, Histology and Pathological Cytodiagnosis, S. Giovanni di Dio Hospital, Florence, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Zolfanelli
authors.affiliation: Department of Neurofarba, University of Florence, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Dolara
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tonelli
mesh_terms: D048868:Adaptor Proteins, Signal Transducing; D000328:Adult; D000368:Aged; D001284:Atrophy / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D020148:Butyric Acid / Q000008:administration & dosage / Q000494:pharmacology*; D003092:Colitis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D003106:Colon / Q000187:drug effects / Q000473:pathology; D003113:Colonoscopy; D003125:Colostomy / Q000009:adverse effects; D016207:Cytokines; D004311:Double-Blind Method; D004733:Enema; D005232:Fatty Acids, Volatile / Q000032:analysis; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000494:pharmacology*; D015870:Gene Expression / Q000187:drug effects*; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D036341:Intercellular Signaling Peptides and Proteins / Q000235:genetics; D007413:Intestinal Mucosa / Q000737:chemistry / Q000187:drug effects* / Q000473:pathology*; D047908:Intracellular Signaling Peptides and Proteins; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D011506:Proteins / Q000235:genetics; D012007:Rectum / Q000187:drug effects / Q000473:pathology; D059467:Transcriptome / Q000187:drug effects; D060449:Wnt Signaling Pathway / Q000235:genetics
chemical_list: D048868:Adaptor Proteins, Signal Transducing; D016207:Cytokines; D005232:Fatty Acids, Volatile; C495107:GREM2 protein, human; D005765:Gastrointestinal Agents; D036341:Intercellular Signaling Peptides and Proteins; D047908:Intracellular Signaling Peptides and Proteins; D011506:Proteins; C480733:SOSTDC1 protein, human; D020148:Butyric Acid
keywords: Bone morphogenetic protein (BMP) antagonists; Diversion colitis; Gene expression profiles; Inflammatory bowel disease; Topic butyrate