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Positive regulatory effects of perioperative probiotic treatment on postoperative liver complications after colorectal liver metastases surgery: a double-center and double-blind randomized clinical trial.

Liu Z, Li C, Huang M, Tong C, Zhang X, Wang L, Peng H, Lan P, Zhang P, Huang N, Peng J, Wu X, Luo Y, Qin H, Kang L, Wang J - BMC Gastroenterol (2015)

Bottom Line: Postoperative outcome were recorded.And probiotics could also reduce the concentration of serum zonulin (P = 0.004) and plasma endotoxin (P < 0.001).Perioperative probiotics treatment could reduce the serum zonulin level, the rate of postoperative septicemia and maintain the liver barrier in patients undergoing CLM surgery. we propose a new model about the regulation of probiotics to liver barrier via clinical regulatory pathway.

View Article: PubMed Central - PubMed

Affiliation: Gastrointestinal Institute of Sun Yat-sen University, Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University (Guangdong Gastrointestinal Hospital), 26 Yuancun Erheng Road, Guangzhou, Guangdong, 510655, People's Republic of China. liuzhh26@mail.sysu.edu.cn.

ABSTRACT

Background: Colorectal liver metastases (CLM) occur frequently and postoperative intestinal infection is a common complication. Our previous study showed that probiotics could decrease the rate of infectious complications after colectomy for colorectal cancer. To determine the effects of the perioperative administration of probiotics on serum zonulin levels which is a marker of intestinal permeability and the subsequent impact on postoperative infectious complications in patients with CLM.

Methods: 150 patients with CLM were randomly divided into control group (n = 68) and probiotics group (n = 66). Probiotics and placebo were given orally for 6 days preoperatively and 10 days postoperatively to control group and probiotics group respectively. We used the local resection for metastatic tumor ,while for large tumor, the segmental hepatectomy. Postoperative outcome were recorded. Furthermore, complications in patients with normal intestinal barrier function and the relation with serum zonulin were analyzed to evaluate the impact on the liver barrier dysfunction.

Results: The incidence of infectious complications in the probiotics group was lower than control group. Analysis of CLM patients with normal postoperative intestinal barrier function paralleled with the serum zonulin level. And probiotics could also reduce the concentration of serum zonulin (P = 0.004) and plasma endotoxin (P < 0.001).

Conclusion: Perioperative probiotics treatment could reduce the serum zonulin level, the rate of postoperative septicemia and maintain the liver barrier in patients undergoing CLM surgery. we propose a new model about the regulation of probiotics to liver barrier via clinical regulatory pathway. We recommend the preoperative oral intake of probiotics combined with postoperative continued probiotics treatment in patients who undergo CLM surgery.

Trial registration: ChiCTR-TRC- 12002841 . 2012/12/21.

No MeSH data available.


Related in: MedlinePlus

Schematic diagram for the clinical regulatory pathway of probiotics.
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Fig3: Schematic diagram for the clinical regulatory pathway of probiotics.

Mentions: In our study, a double-center and double-blind randomized clinical trial was performed. Zonulin is a newly identified protein biomarker of barrier function [22,25,28]. Interestingly, we found the postoperative zonulin level (1.36 ± 0.50 ng/mg protein) of the control group was higher in CRC with liver metastases compared with that without liver metastases (1.08 ± 0.28 ng/mg protein) [1]. So we hypothesize liver barrier also contributed to the change of postoperative zonulin level in CLM. Results showed that PRO could efficiently lower the postoperative infection related complications in CLM patients with normal intestinal barrier function, which indicated that liver barrier dysfunction also contributed to the postoperative infection related complications of CLM patients. A novel concept of the “clinical regulatory pathway” (CP) was proposed [1], which was described as the mechanism by which a clinical treatment cause a series of sequenced molecular and clinical responses and just looks like the molecular signal transduction pathway. CP could link molecular signals and clinical outcomes more intuitively and vividly. So we drew a CP picture to elucidate the relation about PRO, liver barrier, intestinal barrier and postoperative infection related complications (Figure 3). We also promote the CP of the protective effects of PRO against postoperative infection related complications through the liver barrier in CLM patients: peri-operative administration of PRO might inhibit the p38 MAPK signaling pathway, which will extend the understanding of zonulin about its regulation on the barrier function after surgery [29-33].Figure 3


Positive regulatory effects of perioperative probiotic treatment on postoperative liver complications after colorectal liver metastases surgery: a double-center and double-blind randomized clinical trial.

Liu Z, Li C, Huang M, Tong C, Zhang X, Wang L, Peng H, Lan P, Zhang P, Huang N, Peng J, Wu X, Luo Y, Qin H, Kang L, Wang J - BMC Gastroenterol (2015)

Schematic diagram for the clinical regulatory pathway of probiotics.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4374379&req=5

Fig3: Schematic diagram for the clinical regulatory pathway of probiotics.
Mentions: In our study, a double-center and double-blind randomized clinical trial was performed. Zonulin is a newly identified protein biomarker of barrier function [22,25,28]. Interestingly, we found the postoperative zonulin level (1.36 ± 0.50 ng/mg protein) of the control group was higher in CRC with liver metastases compared with that without liver metastases (1.08 ± 0.28 ng/mg protein) [1]. So we hypothesize liver barrier also contributed to the change of postoperative zonulin level in CLM. Results showed that PRO could efficiently lower the postoperative infection related complications in CLM patients with normal intestinal barrier function, which indicated that liver barrier dysfunction also contributed to the postoperative infection related complications of CLM patients. A novel concept of the “clinical regulatory pathway” (CP) was proposed [1], which was described as the mechanism by which a clinical treatment cause a series of sequenced molecular and clinical responses and just looks like the molecular signal transduction pathway. CP could link molecular signals and clinical outcomes more intuitively and vividly. So we drew a CP picture to elucidate the relation about PRO, liver barrier, intestinal barrier and postoperative infection related complications (Figure 3). We also promote the CP of the protective effects of PRO against postoperative infection related complications through the liver barrier in CLM patients: peri-operative administration of PRO might inhibit the p38 MAPK signaling pathway, which will extend the understanding of zonulin about its regulation on the barrier function after surgery [29-33].Figure 3

Bottom Line: Postoperative outcome were recorded.And probiotics could also reduce the concentration of serum zonulin (P = 0.004) and plasma endotoxin (P < 0.001).Perioperative probiotics treatment could reduce the serum zonulin level, the rate of postoperative septicemia and maintain the liver barrier in patients undergoing CLM surgery. we propose a new model about the regulation of probiotics to liver barrier via clinical regulatory pathway.

View Article: PubMed Central - PubMed

Affiliation: Gastrointestinal Institute of Sun Yat-sen University, Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University (Guangdong Gastrointestinal Hospital), 26 Yuancun Erheng Road, Guangzhou, Guangdong, 510655, People's Republic of China. liuzhh26@mail.sysu.edu.cn.

ABSTRACT

Background: Colorectal liver metastases (CLM) occur frequently and postoperative intestinal infection is a common complication. Our previous study showed that probiotics could decrease the rate of infectious complications after colectomy for colorectal cancer. To determine the effects of the perioperative administration of probiotics on serum zonulin levels which is a marker of intestinal permeability and the subsequent impact on postoperative infectious complications in patients with CLM.

Methods: 150 patients with CLM were randomly divided into control group (n = 68) and probiotics group (n = 66). Probiotics and placebo were given orally for 6 days preoperatively and 10 days postoperatively to control group and probiotics group respectively. We used the local resection for metastatic tumor ,while for large tumor, the segmental hepatectomy. Postoperative outcome were recorded. Furthermore, complications in patients with normal intestinal barrier function and the relation with serum zonulin were analyzed to evaluate the impact on the liver barrier dysfunction.

Results: The incidence of infectious complications in the probiotics group was lower than control group. Analysis of CLM patients with normal postoperative intestinal barrier function paralleled with the serum zonulin level. And probiotics could also reduce the concentration of serum zonulin (P = 0.004) and plasma endotoxin (P < 0.001).

Conclusion: Perioperative probiotics treatment could reduce the serum zonulin level, the rate of postoperative septicemia and maintain the liver barrier in patients undergoing CLM surgery. we propose a new model about the regulation of probiotics to liver barrier via clinical regulatory pathway. We recommend the preoperative oral intake of probiotics combined with postoperative continued probiotics treatment in patients who undergo CLM surgery.

Trial registration: ChiCTR-TRC- 12002841 . 2012/12/21.

No MeSH data available.


Related in: MedlinePlus