Tamer SAĞIROĞLU, Şaban GÜRCAN, Yavuz Atakan SEZER, Serhat OĞUZ, Cengiz ERENOĞLU, Ahmet Rahmi HATİPOĞLU, Tülin YALTA, Doğan ALBAYRAK

Combined Effects of Tauroursodeoxycholic Acid and Glutamine on Bacterial Translocation in Obstructive Jaundiced Rats:

Background: Bacterial Translocation is believed to be an important factor on mortality and morbidity in Obstructive Jaundiced..Aims: We investigated the probable or estimated positive effects of tauroursodeoxycholic acid, which has antibacterial and regulatory effects on intestinal flora, together with glutamine on BT in an experimental obstructive jaundiced rat model. Study Design:Animal experimentation.Methods: Forty adult, male, Sprague Dawley rats were used in this study. Animals were randomised and divided into five groups of eight each: sham (Sh); control (common bile duct ligation, CBDL); and supplementation groups administered tauroursodeoxycholic acid (CBDL+T), glutamine (CBDL+G), or tauroursodeoxycholic acid plus glutamine (CBDL+TG). Blood and liver, spleen, MLN, and ileal samples were taken via laparotomy under sterile conditions for investigation of bacterial translocation and intestinal mucosal integrity and hepatic function tests on the tenth postoperative day. Results: There were statistically significant differences in BT rates in all samples except the spleen of the CBDL+TG group compared with the CBDL group (p=0.041, p=0.026, and p=0.041, respectively). Conclusion: It is essential to protect hepatic functions besides maintaining intestinal mucosal integrity in the active struggle against BT occurring in obstructive jaundice. The positive effect on intestinal mucosal integrity can be increased if glutamine is used with tauroursodeoxycholic acid, which also has hepatoprotective and immunomodulatory features.

PDF

___

1. Assimakopoulos SF, Vagi anos CE, Charonis A, Nikolopoulou VN, Scopa CD. Intestinal failure in obstructive jaundice. World J Gastroenterol 2005;11:3806-7.
2. Assimakopoulos SF, Scopa CD, Vagianos CE. Pathophysiology of increased intestinal permeability in obstructive jaundice. World J Gastroenterol 2007;13:6458-64. [CrossRef]
3. Assimakopoulos SF, Thomopoulos KC, Patsoukis N, Georgiou CD, Scopa CD, Nikolopoulou VN, et al. Evidence for intestinal oxidative stress in patients with obstructive jaundice. Eur J Clin Invest 2006;36:181-7. [CrossRef]
4. Seki S, Habu Y, Kawamura T, Takeda K, Dobashi H, Ohkawa T, et al. The liver as a crucial organ in the first line of host defense:the roles of Kupffer cells, natural killer (NK) cells and NK1.1 Ag+ T cells in T helper 1 immune responses. Immunol Rev 2000;174:35-46. [CrossRef]
5. Andersson R, Andersson B, Andersson E, Eckerwall G, Norden M, Tingstedt B. Immunomodulation in surgical practice. HPB 2006;8:116-23. [CrossRef]
6. Sileri P, Morini S, Sica GS, Schena S, Rastellini C, Gaspari AL, et al. Bacterial translocation and intestinal morphological findings in jaundiced rats. Dig Dis Sci 2002;47:929-34. [CrossRef]
7. Zulfikaroglu B, Zulfikaroglu E, Ozmen MM, Ozalp N, Berkem R, Erdogan S, et al. The effect of immunonutrition on bacterial translocation, and intestinal villus atrophy in experimental obstructive jaundice. Clinical Nutrition 2003;22:277-81. [CrossRef]
8. Magnotti LJ, Deitch EA. Burns, bacterial translocation, gut barrier function, and failure. J Burn Care Rehabil 2005;26:383-91. [CrossRef]
9. Margaritis VG, Filos KS, Michalaki MA, Scopa CD, Spiliopoulou I, Nikolopoulou VN, et al. Effect of oral glutamine administration on bacterial tanslocation, endotoxemia, liver and ileal morphology, and apoptosis in rats with obstructive jaundice. World J Surg 2005;29:1329-34. [CrossRef]
10. Karatepe O, Acet E, Battal M, Adas G, Kemik A, Altiok M, et al. Effects of glutamine and curcumin on bacterial translocation in jaundiced rats. World J Gastroenterol 2010;16:4313-20. [CrossRef]
11. Bildik N, Cevik A, Kadioglu B, Ekinci H, Altıntas M, Dalkilic G, et al. The effects of ursodeoxycholic acid and glutamine on bacterial translocation, liver functions and hepatic histopathology in rats with obstructive jaundice. Kartal Eğitim ve Araştırma Hastanesi Tıp Dergisi 2009;20:13-21.
12. Assimakopoulos SF, Vagianos CE, Patsoukis N, Georgiou C, Nikolopoulou V, Scopa CD. Evidence for intestinal oxidative stress in obstructive jaundice-induced gut barrier dysfunction in rats. Acta Physiol Scand 2004;180:177-85. [CrossRef]
13. Kaya O, Ozdemir F, Atlı M, Aslan V, Cagatay M, Anlar M, et al. The effects of ciprofloxacin and ursodeoxycholic acid on bacterial translocation in obstructive jaundice. Turk J Gastroenterol 2009;20:186-91.
14. Sheen-Chen SM, Hung KS, Ho HT, Chen WJ, Eng HL. Effect of glutamine and bile acid on hepatocyte apoptosis after bile duct ligation in the rat. World J Surg 2004;28:457-60. [CrossRef]
15. Steinberg SM. Bacterial translocation: what it is and what it is not. Am J Surg 2003;186:301-5. [CrossRef]
16. Abdeldayem H, Ghoneim E, Ahmad-El Refaei A, Abou-Gabal A. Obstructive jaundice promotes intestinal-barrier dysfunction and bacterial translocation: experimental study. Hepatol Int 2007;1:444-8. [CrossRef] 17. Kuru B, Dinc S, Altinok G, Aksoz T, Camlibel M, Gulcelik MA, et al. Effect
of Different Enteral Nutrients on Bacterial Translocation in Experimental Obstructive Jaundice. Eur Surg Res 2004;36:45-52. [CrossRef]
18. Aldemir M, Geyik MF, Kökoğlu OF, Büyükbayram H, Hoşoğlu S, Yağmur Y. Effects of ursodeoxycholic acid, glutamine and polyclonal immunoglobulins on bacterial translocation in common bile duct ligated rats. ANZ J Surg 2003;73:722-6. [CrossRef]
19. Setchell KDR, Rodrigues CMP, Podda M, Crosignani A. Metabolism of orally administered tauroursodeoxycholic acid in patients with primary biliary cirrhosis. Gut 1996;38:439-46. [CrossRef]
20. Benz C, Angermuller S, Otto G, Sauer P, Stremmel W, Stiehl A. Effect of tauroursodeoxycholic acid on bile acid-induced apoptosis in primary human hepatocytes. Eur J Clin Invest 2000;30:203-9. [CrossRef]
21. Ishizaki K, Kinbara S, Miyazawa N, Takeuchi Y, Hirabayashi N, Kasai H, et al. Effect of sodium tauroursodeoxycholate UR-906 on liver dysfunction in bile duct-ligated rats. Eur J Pharmacol 1997;333:207-13. [CrossRef]
22. Larghi A, Crosignani A, Battezzati PM, De Valle G, Allocca M, Invernizzi P, et al. Ursodeoxycholic and tauroursodeoxycholic acids for the treatment of primary biliary cirrhosis: a pilot crossover study. Aliment Pharmacol Ther 1997;11:409-14. [CrossRef]
23. Salvalaggio PRO, Campos ACL. Bacterial Translocation and Glutamine. Nutrition 2002;18:435-7. [CrossRef]
24. Wiest R, Rath HC. Gastrointestinal disorders of the critically ill. Bacterial translocation in the gut. Best Pract Res Clin Gastroenterol 2003;17:397-425. [CrossRef]
25. White JS, Hoper M, Parks RW, Clements WD, Diamond T. Glutamine improves intestinal barrier function in experimental biliary obstruction. Eur Surg Res 2005;37:342-7. [CrossRef]
26. Belmonte L, Coëffier M, Le Pessot F, Miralles-Barrachina O, Hiron M, Leplingard A, et al. Effects of glutamine supplementation on gut barrier, glutathione content and acute phase response in malnourished rats during inflammatory shock. World J Gastroenterol 2007;13:2833-40.
27. Ribeiro SR, Junior PEP, Miranda AC, Bromberg SH, Lopasso FP, Irya K. Weight loss and morphometric study of intestinal mucosa in rats after massive intestinal resection. Influence of a glutamineenriched diet. Rev Hosp Clin Fac Med Sao Paulo 2004;59:349-56. [CrossRef]
28. Roth E. Nonnutritive Effects of Glutamine. J Nutr 2008;138:2025-31.
29. Santos RGC, Viana ML, Generoso SV, Arantes RE, Correia MITD, Cardoso VN. Glutamine supplementation decreases intestinal permeability and preserves gut mucosa integrity in an experimental mouse model. JPEN J Parenter Enteral Nutr 2010;34:408-13. [CrossRef]
30. Aydogdu S. Kolestazda Medikal Tedavi. The Journal of Current Pediatrics 2006;4:125-32.
31. Zimmermann H, Reichen J. Ursodeoxycholate has no beneficial effect on liver function or histology in biliary cirrhosis in the rat. J Hepatol 1992:16;355-9. [CrossRef]
32. MacFie J. Enteral versus parenteral nutrition:the significance of bacterial translocation and gut barrier function. Nutrition 2000;16:606-11. [CrossRef]
33. Welsh FK, Ramsden CW, MacLennan K, Sheridan MB, Barclay GR, Guillou PJ, et al. Increased intestinal permeability and altered mucosal immunity in cholestatic jaundice. Ann Surg 1998;227:205-12. [CrossRef]
34. Kudsk KA. Immunonutrition in surgery and critical care. Annu Rev Nutr 2006;26:463-79. [CrossRef]
35. Alexander JW. Nutritional pharmacology in surgical patients. Am J Surg 2002;183:349-52. [CrossRef]
36. Miller AL. Therapeutic considerations of L-glutamine: a review of the literature. Altern Med Rev 1999;4:239-48.
37. Parks RW, Stuart Cameron CH, Gannon CD, Pope C, Diamond T, Rowlands BJ. Changes in gastrointestinal morphology associated with obstructive jaundice. J Pathol 2000;192:526-32. [CrossRef]