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Early Enteral Nutrition Preserves Intestinal Barrier Function through Reducing the Formation of Neutrophil Extracellular Traps (NETs) in Critically Ill Surgical Patients

BACKGROUND: The gut was suggested as the driver of critical illness and organ injury. Recently, excessive formation of neutrophil extracellular traps (NETs) was associated with mucosal inflammation. Direct investigation of intestinal mucosa is essential to illuminate the potential mechanism of gut b...

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Autores principales: Hu, Qiongyuan, Ren, Huajian, Hong, Zhiwu, Wang, Chenyang, Zheng, Tao, Ren, Yanhan, Chen, Kai, Liu, Song, Wang, Gefei, Gu, Guosheng, Wu, Xiuwen, Ren, Jianan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700037/
https://www.ncbi.nlm.nih.gov/pubmed/33294125
http://dx.doi.org/10.1155/2020/8815655
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author Hu, Qiongyuan
Ren, Huajian
Hong, Zhiwu
Wang, Chenyang
Zheng, Tao
Ren, Yanhan
Chen, Kai
Liu, Song
Wang, Gefei
Gu, Guosheng
Wu, Xiuwen
Ren, Jianan
author_facet Hu, Qiongyuan
Ren, Huajian
Hong, Zhiwu
Wang, Chenyang
Zheng, Tao
Ren, Yanhan
Chen, Kai
Liu, Song
Wang, Gefei
Gu, Guosheng
Wu, Xiuwen
Ren, Jianan
author_sort Hu, Qiongyuan
collection PubMed
description BACKGROUND: The gut was suggested as the driver of critical illness and organ injury. Recently, excessive formation of neutrophil extracellular traps (NETs) was associated with mucosal inflammation. Direct investigation of intestinal mucosa is essential to illuminate the potential mechanism of gut barrier in critically ill patients. We hypothesized that early enteral nutrition (EN) could decrease intestinal NETs and maintain the gut barrier. METHODS: Intestinal biopsies were obtained using biopsy forceps from critically ill surgical patients complicated with enterocutaneous fistula. Expressions of tight junction (TJ) proteins, mucosal inflammation, and apoptosis were evaluated. Moreover, NET-associated proteins were evaluated in intestinal specimens of patients by Western blot and immunofluorescence analysis. RESULTS: The intestinal barrier was significantly impaired in critically ill patients receiving early total parenteral nutrition (TPN), evidenced by intestinal villi atrophy, inflammatory infiltration, increased enterocyte apoptosis, and abnormal TJ expressions. Early EN significantly alleviated these intestinal injuries. In addition, we observed increased formation of the NET structure and elevated expressions of NET-associated proteins in intestines of critically ill surgical patients. Early EN was associated with the diminished presence of NETs and reduced expression of NET-associated proteins. Mechanically, analysis of the TLR4 pathway showed a significant increase in TLR4, NFκB, and MAPK signaling in patients receiving TPN when compared to those receiving early EN. CONCLUSION: The intestinal barrier is disrupted in the human gut during critical illness. Our data suggests that an increased NET structure was showed in the gut of critically ill surgical patients, and early EN treatment was associated with the reduction of NET formation and the preservation of mucosal immunity.
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spelling pubmed-77000372020-12-07 Early Enteral Nutrition Preserves Intestinal Barrier Function through Reducing the Formation of Neutrophil Extracellular Traps (NETs) in Critically Ill Surgical Patients Hu, Qiongyuan Ren, Huajian Hong, Zhiwu Wang, Chenyang Zheng, Tao Ren, Yanhan Chen, Kai Liu, Song Wang, Gefei Gu, Guosheng Wu, Xiuwen Ren, Jianan Oxid Med Cell Longev Research Article BACKGROUND: The gut was suggested as the driver of critical illness and organ injury. Recently, excessive formation of neutrophil extracellular traps (NETs) was associated with mucosal inflammation. Direct investigation of intestinal mucosa is essential to illuminate the potential mechanism of gut barrier in critically ill patients. We hypothesized that early enteral nutrition (EN) could decrease intestinal NETs and maintain the gut barrier. METHODS: Intestinal biopsies were obtained using biopsy forceps from critically ill surgical patients complicated with enterocutaneous fistula. Expressions of tight junction (TJ) proteins, mucosal inflammation, and apoptosis were evaluated. Moreover, NET-associated proteins were evaluated in intestinal specimens of patients by Western blot and immunofluorescence analysis. RESULTS: The intestinal barrier was significantly impaired in critically ill patients receiving early total parenteral nutrition (TPN), evidenced by intestinal villi atrophy, inflammatory infiltration, increased enterocyte apoptosis, and abnormal TJ expressions. Early EN significantly alleviated these intestinal injuries. In addition, we observed increased formation of the NET structure and elevated expressions of NET-associated proteins in intestines of critically ill surgical patients. Early EN was associated with the diminished presence of NETs and reduced expression of NET-associated proteins. Mechanically, analysis of the TLR4 pathway showed a significant increase in TLR4, NFκB, and MAPK signaling in patients receiving TPN when compared to those receiving early EN. CONCLUSION: The intestinal barrier is disrupted in the human gut during critical illness. Our data suggests that an increased NET structure was showed in the gut of critically ill surgical patients, and early EN treatment was associated with the reduction of NET formation and the preservation of mucosal immunity. Hindawi 2020-11-21 /pmc/articles/PMC7700037/ /pubmed/33294125 http://dx.doi.org/10.1155/2020/8815655 Text en Copyright © 2020 Qiongyuan Hu et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Hu, Qiongyuan
Ren, Huajian
Hong, Zhiwu
Wang, Chenyang
Zheng, Tao
Ren, Yanhan
Chen, Kai
Liu, Song
Wang, Gefei
Gu, Guosheng
Wu, Xiuwen
Ren, Jianan
Early Enteral Nutrition Preserves Intestinal Barrier Function through Reducing the Formation of Neutrophil Extracellular Traps (NETs) in Critically Ill Surgical Patients
title Early Enteral Nutrition Preserves Intestinal Barrier Function through Reducing the Formation of Neutrophil Extracellular Traps (NETs) in Critically Ill Surgical Patients
title_full Early Enteral Nutrition Preserves Intestinal Barrier Function through Reducing the Formation of Neutrophil Extracellular Traps (NETs) in Critically Ill Surgical Patients
title_fullStr Early Enteral Nutrition Preserves Intestinal Barrier Function through Reducing the Formation of Neutrophil Extracellular Traps (NETs) in Critically Ill Surgical Patients
title_full_unstemmed Early Enteral Nutrition Preserves Intestinal Barrier Function through Reducing the Formation of Neutrophil Extracellular Traps (NETs) in Critically Ill Surgical Patients
title_short Early Enteral Nutrition Preserves Intestinal Barrier Function through Reducing the Formation of Neutrophil Extracellular Traps (NETs) in Critically Ill Surgical Patients
title_sort early enteral nutrition preserves intestinal barrier function through reducing the formation of neutrophil extracellular traps (nets) in critically ill surgical patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700037/
https://www.ncbi.nlm.nih.gov/pubmed/33294125
http://dx.doi.org/10.1155/2020/8815655
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