Sangild, Per Torp7; Ney, Denise M3; Sigalet, David L4; Vegge, Andreas5; Burrin, Douglas G6
1 Clinical and Experimental Nutrition, Department of Nutrition, Exercise and Sports, Faculty of Science, Københavns Universitet2 Comparative Paediatrics and Nutrition, Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, Københavns Universitet3 Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI4 Sidra Medical and Research Center, Doha5 Diabetes Pharmacology, Novo Nordisk A/S, Måløv6 USDA-ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas7 Comparative Paediatrics and Nutrition, Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, Københavns Universitet
Translational relevance and challenges
Intestinal failure (IF), due to short bowel syndrome (SBS), results from surgical resection of a major portion of the intestine, leading to reduced nutrient absorption, and need for parenteral nutrition (PN). The incidence is highest in infants and relates to preterm birth, necrotizing enterocolitis, atresia, gastroschisis, volvulus and aganglionosis. Patient outcomes have improved, but there is a need to develop new therapies for SBS and to understand intestinal adaptation after different diseases, resection types, nutritional interventions and growth factor therapies. Animal studies may help but careful evaluation of the cellular mechanisms, safety and translational relevance of new procedures are required. Distal intestinal resection, without a functioning colon, results in the most severe complications and adaptation may depend on the age at resection (preterm, term, young, adult). Clinically-relevant therapies have recently been suggested from studies in preterm and term PN-dependent SBS piglets, with or without a functional colon. Studies in rat and mice more easily allow exogenous or genetic manipulation of growth factors and their receptors (e.g. glucagon-like peptide 2, growth hormone, insulin-like growth factor 1, epidermal growth factor, keratinocyte growth factor). The greater size of rats, and especially young pigs, is an advantage for testing surgical procedures and nutritional interventions (e.g. PN, milk diets, long/short chain lipids, pre- and probiotics). Conversely, newborn pigs and weanling rats represent a translational advantage for infant SBS due to their immature intestine. A balance among practical, economical, experimental and ethical constraints determines the choice of SBS model for each clinical or basic research question.
American Journal of Physiology: Gastrointestinal and Liver Physiology, 2014, Vol 307, Issue 12