Plasma citrulline concentration – a reliable noninvasive marker of functional enterocyte mass
Authors:
Martin Oliverius; Michal Kudla; Peter Baláž; Alexandros Valsamis
Authors‘ workplace:
Klinika transplantační chirurgie IKEM, Praha
Published in:
Čas. Lék. čes. 2010; 149: 160-162
Category:
Review Article
Overview
Small bowel disease encompasses a broad range of pathological states starting with functional disorders through inflammatory disease to morphological injury with possible intestine loss. Some of these conditions result in major loss of function presenting as intestinal failure. The term intestinal failure refers to a condition whereby the bowel is unable fulfil its basic function in the process of digestion and absorption of nutrients. Unlike other organs, where reliable laboratory markers of injury or failure are available, no such tests are currently on hand for the bowel. Determination of the plasma citrulline level is a reliable marker for assessing the mass of functional intestinal tissue. Citrulline is an amino acid formed almost exclusively in enterocytes and not present in food proteins. The liver has only a minimal effect on citrulline production. Eighty percent of citrulline is converted in the kidney to arginine. Its impaired renal clearance results in increased citrulline levels. Clinically relevant are decreased citrulline levels as they reflect a lack of functional mass of enterocytes. The aim of the present review is to summarize current knowledge and to define the value of determining plasma citrulline levels for the diagnosis of intestinal failure and, possibly, for monitoring the bowel function.
Key words:
intestinal failure, citrulline, bowel transplantation.
Sources
1. Crenn P, Messing B, Cynober L. Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction. Clin Nutr 2008; 27: 328–339.
2. Schellekens GA, de Jong BA, van den Hoogen FH, van den Putte LB, van Venrooij WJ. Citrulline is an Essentials konstituent of antigenic determinants recognized by rheumatoid arthritis-specific autoantibodies. J Clin Invest 1998; 101: 273–281.
3. Crenn P, Coudray-Lucas C, Thuillier F, Cynober L, Messing B. Postabsorptive plasma citrulline concentration is a marker of absorptive enterocyte mass and intestinal failure in humans. Gastroenterology 2000; 119: 1496–1505.
4. Papadia C, Sherwood RA, Kalantzis C, Wallis K, Volta U, Fiorini E, et al. Plasma citrulline concentration: a reliable marker of small bowel absorptive capacity independent of intestinal inflammation. Am J Gastroentrol 2007; 102: 1474–1482.
5. Kabrt J, Hyanek J, Stastna S, Pospisilova E. Plasma citruline concentration is a marker of small intestine failure. Biomed Papers 2003; 146(1): 75.
6. Dowling RH. Cellular and molecular basis of intestinal and pancreatic adaptation Scandinavian J Gastroenterol 1992; 193(Suppl): 64–67.
7. Tappenden KA. Mechanisms of enteral nutriet-enhanced intestinal adaptation. Gastroenterology 2006; 130(Suppl 1): S93–S99.
8. Rhoads JM, Plunkett E, Galanko J, Lichtman S, Taylor L, Maynor A, Weiner T, Freeman K, Guarisco JL, Wu GY. Serum citrulline levels correlate with enteral tolerance and bowel length in infants with short bowel syndrome. J Pediatr 2005; 146: 542–547.
9. Andres AM, Thompson J, Grant W, Botha J, Sunderman B, Antonson D, Langnas A, Sudan D. Repeat surgical bowel lengthening with the STEP procedure. Transplantation 2008; 85: 1294–1299.
10. Sudan D, Thompson J, Botha J, Grant W, Antonson D, Raynor S, Langnas A. Comparison of intestinal lengthening procedures for patients with short bowel syndrome. Ann Surg 2007; 246: 593–601.
11. Castanon M, Prat J, Saura L, Gomez L, Tarrado X, Iriondo M, Morales L. Nutritional and surgical management of short bowel syndrome. Our last 6 patients’ experience. Cir Pediatr 2006; 19: 151–155.
12. Kim HB, Lee PW, Garza J, Duggan C, Fauza D, Jaksic T. Serial transverse enteroplasty for short bowel syndrome: a case report. J Pediatr Surg 2003; 38: 881–885.
13. Chang RW, Javid PJ, Oh JT, Andreoli S, Kim HB, Fauza D, Jaksic T. Serial transverse enteroplasty enhances intestinal function in a model of short bowel syndrome. Ann Surg 2006; 243: 223–228.
14. Fryer JP. Intestinal transplantation: an update. Curr Opin Gastroenterol 2005; 21: 162.
15. Ischii T, Mazariegos GV, Bueno J, Ohwada S, Reyes J. Exfoliative rejection after intestinal transplntation in children. Pediatr Transplant 2003; 7: 185.
16. Sudan DL, Kaufmann SS, Shaw BW Jr, et al. Isolated intestinal transplantation for intestinal failure. Am J Gastroenterol 2000; 95: 1506.
17. David AI, Selvaggi G, Ruiz P, Gaynor JJ, Tryphonopoulos P, Kleiner GI, Moon JI, Nishida S, Pappas PA, Conanan L, Weppler D, Esquenazi V, Levi DM, Kato T, Tzakis AG. Blood citrulline level is an exclusionary marker for significant acute rejection after intestinal transplantation. Transplantation 2007; 84: 1077–1081.
18. Gondolesi GE, Kaufman SS, Sansaricq C, Magid MS, Raymond K, Iledan LP, Tao Y, Florman SS, LeLeiko NS, Fishbein TM. Defining normal plasma citrulline in intestinal transplant recipients. Am J Transplant 2004; 4: 414–418.
19. Dilloon L, Knabe D, Wu G. Lactate inhibits citruline and arginine synthesis from proline in pig enterocytes. Am J Physiol 1999; 276: G1079–G1086.
20. Gondolesi G, Ghirardo S, Raymond K, Hoppenhauer L, Surillo D, Rumbo c, Fisbein T, Sansaricq C, Sauter B. The value of plasma citruline to predict mucosal injury in intestinal transplantation. Am J Transplant 2006; 6: 2786–2790.
21. Yu HC, Tuteja S, Moon JI, Kleiner GI, Conanan L, Gaynor JJ, Kato T, Levi DM, Nishida S, Selvaggi G, Gandia C, Weppler D, Esquenazi V, Ruiz P, Miller J, Tzakis AG. Utilization of dried blood spot citrulline level as a noninvasive method for monitoring graft function following intestinal transplantation. Transplantation 2005; 80: 1729–1733.
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Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain managementArticle was published in
Journal of Czech Physicians
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