Still in English…..on demand! The gastrointestinal tract and special nutrients……

June 9th, 2013 por

The gastrointestinal tract has a multitude of functions in addition to digestion. One important function is the ability to serve as a barrier against living organisms and antigens within the lumen; the so-called intestinal barrier function. The breakdown of this barrier may result in the crossing of viable bacteria and their products to mesenteric lymph nodes and more distant sites, a process known as bacterial translocation.

Increased intestinal permeability, bacterial translocation across the intestinal mucosa, and decreased mucosal integrity are associated with critical illness.  Loss of the gut mucosal barrier and subsequent translocation of bacteria from the gut have been implicated in the development of hypermetabolism, distant organ injury and sepsis.

The benefits of immune-modulating specific nutrients and formulas have been shown to up-regulate host immune responses, to modulate inflammatory responses, nitrogen balance and protein synthesis after injury. Although many of the current industrialized formulas contain a combination of arginine, n-3 fatty acids, glutamine, antioxidants, and nucleic acids, arginine per se has gained specific attention. Citrulline, as well as, glutamine are also important nutrients in such process. On the other hand, prebiotics and probiotics have also been used in order to enhance gastrointestinal function.

Arginine is a conditionally essential amino acid that plays an important role in the transport, storage, and excretion of nitrogen and in the disposal of ammonia via the urea cycle. In catabolic states such as trauma and sepsis, arginine may become essential because of alterations in its metabolism. Besides being a major nitrogen carrier and a component of proteins, it is a precursor for the synthesis of molecules with enormous biological importance, including urea, ornithine, polyamines, nitric oxide, creatine, agmatine, and many others. Arginine supplementation is effective in improving intestinal barrier function and vascular development. Pretreatment with arginine enhances survival and intestinal mucosal barrier function after intestinal mesenteric ischemia. Arginine-enriched diets protect gut mucosa from radiation-induced enteritis, as indicated by accelerated healing ability, as well as prevent bacterial translocation.

Citrulline, a conditionally essential, neutral and non-protein amino acid is produced by the intestine particularly from glutamine and degraded by the kidney to originate arginine. Therefore, it has been applied as a marker of intestinal and kidney function. Moreover, citrulline seems to regulate protein metabolism and urea production from arginine and to stimulate muscular synthesis. Because of its properties, citrulline can potentially replace arginine, thus avoiding the controversies associated with nitric oxide (NO) production after arginine supplementation. Under septic conditions, NO production seems to be associated with deleterious side effects such as vasodilatation and hypotension. Arginine levels decrease under catabolic states such as trauma and sepsis, thus arginine becomes essential to different processes such as wound healing, hormone production and immune response. However, high amounts of this amino acid are necessary to restore arginine levels in these critical situations, because of the degradation of arginine in the gastrointestinal tract and liver, which might trigger gastrointestinal discomfort.

Plasma glutamine levels have been shown to decrease by 58% after critical illness or injury and to remain decreased for up to three weeks.  This reduction could be caused by either increased consumption or insufficient production.In catabolic states, glutamine is released from muscle tissue to be the fuel source to the enterocytes and to rapidly dividing immune cells. Glutamine deficiency may impair lymphocyte and neutrophil function as well as lead to glutathione (GSH) depletion.  Thus, glutamine supplementation can potentially improve a variety of functions, including immune system effectiveness in fighting infection. Glutamine supplementation improves intestinal permeability in states of trauma, endotoxemia and ischemia/reperfusion.

There is substantial evidence to support the idea that the gut microbiota plays an important role in health and disease. A balanced microbiota protects the host against potentially pathogenic bacteria. The composition of the microbiota is unstable and may vary due to factors related to stressful states and medications; these factors can have deleterious effects.In these situations, the normal microbiota is rapidly replaced by an overgrowth of pathogenic organisms, and a simultaneous increase in mucosal barrier permeability is frequently observed.  Intestinal barrier dysfunction may provide an opportunity for the penetration of luminal antigens, like bacteria and their toxins; consequently, infectious complications are common. The translocation of bacteria and endotoxins across a leaky mucosa may be responsible for the release of systemic mediators and for the activation of immunologic cells that contribute to the development of systemic inflammation and multiple organ failure.

The beneficial effects of probiotics on the protection of gut mucosal dysfunction have been reported. Probiotic is defined as a ‘live microorganisms which when administered in adequate amounts confer a health benefit on the host.  On the other hand, prebiotics, non-digestible food ingredients that stimulate the growth and/or activity of bacteria, are very effective in attenuating chronic inflammatory conditions such as inflammatory bowel disease or obesity. In addition, these natural products are able to prevent or arrest tumor development, acting on the intestinal microbiota as well as potentiating the immune response.

Pre-, pro-, and symbiotic (prebiotics and probiotics) administration has been shown to ameliorate the immune response in aging. In particular, administration of a symbiotic to free-living elderly was able to potentiate the release of interleukin-8, thus increasing neutrophils in the host, perhaps explaining the reduced frequency of winter infections in the elderly.

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