Plasma citrulline level as a biomarker for cancer therapy-induced small bowel mucosal damage.

Regimen-related mucosal toxicity is extremely common following cytotoxic chemotherapy and radiotherapy. Mucositis is as an important determinant of the inflammatory response and infectious complications in cancer treated patients. Most assessment scales for mucosal damage are focussed on oral mucositis, since it is easy to evaluate. Measuring gastrointestinal musocal damage objectively remains difficult because it cannot be seen directly or readily detected. One of potential non-invasive biomarkers of gastrointestinal mucosal damage is plasma citrulline level. Citrulline is an amino acid produced by small bowel enterocytes. Low concentration of free circulating citrulline signifies severe intestinal mucosal damage in humans with nonmalignant disorders, such as villous atrophy-associated diseases, short bowel syndrome, Crohn's disease, and is used in follow-up after small bowel transplantation. The plasma citrulline level is a reliable and objective biochemical marker of enterocyte mass and function in humans, and therefore can be used to monitor enterocyte toxicity resulting from chemotherapy and radiotherapy during anticancer therapy in patients with severely disturbed gut integrity.

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Plasma citrulline levels and acute cellular rejection early after small bowel transplantation in pigs

Veterinární Medicína ◽

10.17221/47/2009-vetmed ◽

2009 ◽

Vol 54 (No. 5) ◽

pp. 215-222 ◽

Cited By ~ 1

Author(s):

E. Honsova ◽

A. Lodererova ◽

P. Balaz ◽

M. Oliverius

Keyword(s):

Small Bowel ◽

Small Bowel Transplantation ◽

Intestinal Failure ◽

Acute Cellular Rejection ◽

Control Group ◽

Plasma Citrulline ◽

Potential Biomarker ◽

Histologic Evaluation ◽

Group B ◽

Cellular Rejection

Small bowel transplantations (SBT) are increasingly performed to treat patients with irreversible intestinal failure or short-bowel syndrome. Histologic evaluation of small bowel allograft biopsies is important for the diagnosis of acute cellular rejection (ACR). A reliable serological marker of ACR after SBT is still unknown. Recently, citrulline was identified as a potential biomarker of reduced enterocyte mass. The aim of our study was to analyze rejection and plasma citrulline levels early after SBT in pigs. 24 pigs were used and divided into four groups. Group A, autologous SBT (n = 3) as a control group; Group B, allogeneic SBT with tacrolimus monotherapy (n = 7); Group C, allogeneic SBT immunosuppressed with tacrolimus and sirolimus (n = 8); and Group D, without immunosuppresion (n = 6). The observation period was 30 days. Mucosal biopsies were obtained on Days 0, 3, 5, 7, 10, 14, 20, 28 and simultaneously plasma citrulline levels were measured. ACR was classified according to standardized grading schema on a scale of indeterminate, mild, moderate, and severe. There were no significant differences in citrulline plasma levels between cases with mild ACR and indeterminate for ACR. A significant decline in plasma citrulline levels occurred in cases of moderate and severe rejection. Plasma citrulline levels constituted a marker of more advanced injury of small bowel epithelium.

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Olmesartan Associated Enteropathy: Usefulness of Video Capsule Endoscopy in a Case With Doubtful Upper Endoscopic/Histological Picture

Current Drug Safety ◽

10.2174/1574886314666190923161406 ◽

2020 ◽

Vol 15 (1) ◽

pp. 65-68 ◽

Cited By ~ 1

Author(s):

Francesco Abbruzzi ◽

Ilaria Loconte ◽

Sonia Carparelli ◽

Enzo Ierardi ◽

Alfredo Di Leo ◽

...

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Villous Atrophy ◽

Video Capsule Endoscopy ◽

Watery Diarrhea ◽

Mosaic Pattern ◽

Diagnostic Features ◽

Non Invasive ◽

Before And After ◽

Diagnostic Work

Background: Olmesartan, an antihypertensive drug, may be associated with a severe “sprue-like enteropathy”. Objectives: To report a case of Olmesartan enteropathy demonstrated by video capsule endoscopy distally from the second duodenum along with the whole small bowel before and after drug withdrawal. Case Presentation: A 81-years-old man was referred for asthenia, chronic watery diarrhea and anasarca (ascites, pleural effusion and edemas of superior and inferior limb). The only comorbidity was hypertension treated with Olmesartan. All causes of infective and inflammatory chronic diarrhea were investigated and excluded. Upper endoscopy was normal; histological examination of the second portion of the duodenum showed moderate and patchy infiltration of lymphocytes at mucosal and intra-epithelial level with intermittent partial villous atrophy. The possibility of adverse drug reaction, estimated by Naranjo scale, showed a score of 7, indicating a strong probability. Olmesartan was then withdrawn. However, because of severe clinical general condition, we preferred to corroborate our diagnostic work-up by a non-invasive investigation, i.e. video capsule endoscopy, which showed jejunal and ileal mucosal alterations (mosaic pattern, diffuse hyperemia, severe edema, consequent apparent reduced lumen, diffuse thickening of intestinal folds, multiple erosions, patchy lymphangectasia). After 14 days, the resolution of anasarcatic state and hydroelectrolytic imbalances was observed. Nine months later, small-bowel video-capsule demonstrated mild mucosal hyperaemia and mosaic pattern. Conclusions: Our case could give new insights in the field of Olmesartan associated enteropathy by highlighting the possibility of distally main lesion location and, therefore, the usefulness of video capsule endoscopy in the presence of doubtful diagnostic features.

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