Apo AIV and Citrulline Plasma Concentrations in Short Bowel Syndrome Patients: The Influence of Short Bowel Anatomy.
BACKGROUND
Parenteral nutrition (PN) dependence in short bowel syndrome (SBS) patients is linked to the functionality of the remnant small bowel (RSB). Patients may wean off PN following a period of intestinal adaptation that restores this functionality. Currently, plasma citrulline is the standard biomarker for monitoring intestinal functionality and adaptation. However, available studies reveal that the relationship the biomarker with the length and function of the RSB is arguable. Thus, having additional biomarkers would improve pointing out PN weaning.


OBJECTIVE
By measuring concomitant changes in citrulline and the novel biomarker apolipoprotein AIV (Apo AIV), as well as taking into account the anatomy of the RSB, this exploratory study aims to a better understanding of the intestinal adaptation process and characterization of the SBS patients under PN.


METHODS
Thirty four adult SBS patients were selected and assigned to adapted (aSBS) and non-adapted (nSBS) groups after reconstructive surgeries. Remaining jejunum and ileum lengths were recorded. The aSBS patients were either on an oral diet (ORAL group), those with intestinal insufficiency, or on oral and home parenteral nutrition (HPN group), those with chronic intestinal failure. Apo AIV and citrulline were analyzed in plasma samples after overnight fasting. An exploratory ROC analysis using citrulline as gold standard was performed.


RESULTS
Biomarkers, Apo AIV and citrulline showed a significant correlation with RSBL in aSBS patients. In jejuno-ileocolic patients, only Apo AIV correlated with RSBL (rb = 0.54) and with ileum length (rb = 0.84). In patients without ileum neither biomarker showed any correlation with RSBL. ROC analysis indicated the Apo AIV cut-off value to be 4.6 mg /100 mL for differentiating between the aSBS HPN and ORAL groups.


CONCLUSIONS
Therefore, in addition to citrulline, Apo AIV can be set as a biomarker to monitor intestinal adaptation in SBS patients. As short bowel anatomy is shown to influence citrulline and Apo AIV plasma values, both biomarkers complement each other furnishing a new insight to manage PN dependence.
Departament de Bioquimica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.
M Dolores
MD
López-Tejero
Unitat de Nutrició i Dietètica, Servei d'Endocrinologia i Nutrició, Hospital Universitari de Bellvitge (HUB), IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Núria
N
Virgili
Departament de Bioquimica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.
Jordi
J
Targarona
MIXeSTAT S.L., Barcelona, Spain.
Jorge
J
Ruiz
Departament de Bioquimica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.
Natalia
N
García
Departament de Bioquimica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.
Denise
D
Oró
Sección de Errores Congénitos del Metabolismo-IBC, Servicio de Bioquímica y Genética Molecular, Hospital Clínic de Barcelona, CIBERER, IDIBAPS, Barcelona, Spain.
Judit
J
García-Villoria
Unitat de Nutrició i Dietètica, Servei d'Endocrinologia i Nutrició, Hospital Universitari de Bellvitge (HUB), IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Gloria
G
Creus
Unitat de Nutrició i Dietètica, Servei d'Endocrinologia i Nutrició, Hospital Universitari de Bellvitge (HUB), IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Ana M
AM
Pita
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