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Kazuhiko Fukatsu, MD, PhD; Andrew H. Lundberg, MD; M. Keith Hanna, MD; Yong Wu, MD; Henry G. Wilcox, PhD; D. Neil Granger, PhD; A. Osama Gaber, MD; Kenneth A. Kudsk, MD

Arch Surg. 1999;134:1055-1060.

Hypothesis  The levels of intestinal interleukin 10 and interleukin 4, inhibitors of intercellular adhesion molecule-1 (ICAM-1) expression, decline with total parenteral nutrition (TPN). These cytokine changes induced by lack of enteral nutrition may increase ICAM-1 expression, resulting in polymorphonuclear neutrophil accumulation in intestine.

Design  Prospective randomized experimental trials.

Setting  Laboratory.

Materials  Male mice.

Interventions  Sixty-three mice were randomized to chow, intravenous TPN, or intragastric TPN.

Main Outcome Measures  Experiment 1: After diet manipulation, iodine 125–labeled anti–ICAM-1 antibody and iodine 131–labeled nonbinding antibody were injected to quantify ICAM-1 expression on endothelial cells in the lung, liver, kidney, and small intestine. Measurement of myeloperoxidase was used to quantify polymorphonuclear neutrophil accumulation in the organs. Experiment 2: Intestine was harvested for both ICAM-1 and myeloperoxidase levels after chow refeeding of mice in the intravenous TPN group.

Results  In experiment 1, uninjured mice fed intravenous TPN showed significantly increased intestinal ICAM-1 expression and polymorphonuclear neutrophil accumulation with no significant changes in the lung, liver, or kidney. No changes occurred in mice fed chow or intragastric TPN. In experiment 2, reinstitution of enteral feeding returned intestinal ICAM-1 and myeloperoxidase levels to normal.

Conclusion  Gut changes associated with lack of enteral feeding induce endothelial changes and an immunologic response, which may influence subsequent responses to injury.

From the Departments of Surgery (Drs Fukatsu, Lundberg, Hanna, Wu, Gaber, and Kudsk) and Pharmacology (Dr Wilcox), The University of Tennessee, Memphis; and Department of Physiology and Biophysics, Louisiana State University Medical Center, Shreveport (Dr Granger).

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