Bacteria for optimal health.
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Apoptosis↗
Biomedical subjects
S Bengmark
Publications and source records attributed to S Bengmark.
Ecoimmunonutrition: a challenge for the third millennium.
Clinical enteral nutrition solutions, produced by mixing chemicals or defined nutrients, have repeatedly been shown to lack important ingredients; in the formulation of these solutions several key nutrients have simply been overlooked. The aim of this particular issue of the journal is to discuss some of these nutrients that were earlier neglected, but that today have proven to have key functions, especially in stress situations such as disease. The metabolism of the body is a complex system, one can not expect that supplying the body with one or a few chemicals, natural or synthetic, will lead to maximal health and performance. Most often an amalgam of substances is needed. Only natural food has the potential to supply most of the components needed, and thereby provide effective and successful nutrition. In stress situations such as premature life, disease, or aging, or extreme conditions such as exercise, eating normal food might not be enough; in these situations supplements will prove to be of the greatest value.
Animal Feed↗
Immunonutrition: role of biosurfactants, fiber, and probiotic bacteria.
Phospholipids constitute an important part of cellular membranes, and membrane fluidity and permeability are dependent on the fatty acid composition of the phospholipid. The composition, which changes with aging and disease is, to a large degree, influenced by nutrient supply. Phospholipids have been effective in protecting cellular membranes such as those of the gastrointestinal tract to an extent not much different from that observed with external supply of established mucosa-protective drugs such as misoprostol and sucralfate. Polar lipids have also been shown to be effective in preventing microbial translocation. The effect is further potentiated by an external supply of probiotic fibers such as pectin, guar gum, and oat gum. These and many other fibers also have documented strong mucosa preventive effects. Prebiotic bacteria such as Lactobacillus plantarum have demonstrated a strong ability to preserve food and prevent spoilage. In addition, L. plantarum seems to not only preserve key nutrients such as omega-3 fatty acids, but also increases its content during storage conditions. L. plantarum alone or in combination with various fibers has demonstrated a strong ability to reduce and eliminate potentially pathogenic microorganisms both in vitro and in vivo. It has recently been shown that L. plantarum possesses the ability to adhere to and colonize intestinal mucosa. It seems unique among the lactobacilli for L. plantarum to use mannose-specific adhesins, uncommon among gram-positive, but common among gram-negative bacteria, which makes it possible that L. plantarum competes with gram-negative other potential pathogens for receptor sites at the mucosal cell surfaces. Additionally, L. plantarum seems to be effective in eliminating nitrate and producing nitric oxide. These functions of L. plantarum are among the reasons why it has been used in combination with various fibers and polar lipids to recondition the gastrointestinal mucosa. For the purpose of a L. plantarum-containing formula being produced and tried, a treatment policy is regarded as an extension of the immunonutrition program and called ecoimmunonutrition.
Bacteria↗
Acute portal hypertension after gastric administration of ethanol in the pig.
A single gastric administration of 15 ml/kg of 40% ethanol to anesthetized pigs resulted in an increased portal venous blood pressure which increased with increasing blood alcohol levels. For the first 2 h there was no significant alteration in liver blood flow, but 3 h after the administration of ethanol, when portal blood pressure reached its highest values, liver blood flow had decreased. This was probably caused by increased hepatic vascular resistance as shown in electron thin-section phase-contrast microscopy which at this time showed marked hepatocyte swelling, narrowing of the sinusoids and platelet aggregates in small portal branches.
Acute Disease↗
Treatment of hypersplenism An experimental study in the rat.
Methylcellulose injected intraperitoneally into rats proved to give a splenomegaly combined with anemia and thrombocytopenia. The white blood cell count did not change during the treatment. The splenic parenchyma of the hypersplenic rats was then reduced by resection or splenic artery ligation to a different extent. The peripheral blood cell count was normalized after a one-third resection, whereas a more-than-two-thirds reduction of the splenic parenchyma caused infective complications in many rats. It was thus possible to treat the 'secondary hypersplenism' in the rat by a partial reduction of the splenic parenchyma and to avoid total splenectomy, much undesired with new immunologic knowledge.
Animals↗
The role of bile and bile acids in bacterial translocation in obstructive jaundice in rats.
Male Sprague-Dawley rats were randomly divided into five groups in which group 1 received a sham operation (controls), groups 2-5 underwent common bile duct ligation and transection 14 days before the experiments. Two days prior to the studies, animals in groups 1 and 2 received saline orally, while groups 3-5 received an oral administration of either cholic acid, deoxycholic acid or whole bile. Specimens were taken for bacterial culture, and blood was collected for endotoxin assay. The rate of positive bacterial cultures from mesenteric lymph nodes in jaundiced saline-treated animals was significantly higher (p < 0.05) as compared with both controls and the other jaundiced animals treated with either bile or bile acids. Assays were positive for endotoxin in the jaundiced saline-treated group, whereas they were negative in both controls and bile- or bile-acid-treated animals. We conclude that oral administration of cholic acid, deoxycholic acid or whole bile inhibited bacterial translocation and endotoxin absorption in obstructive jaundice in the rat.
Animals↗
Gastrointestinal surface protection and mucosa reconditioning.
BACKGROUND: There is increasing evidence that preservation of the ecology of the gastrointestinal tract and the surface protection system--surfactants, mucus, and fiber--is important for the outcome in postoperative trauma patients, patients after bone marrow and liver transplantation, and patients with HIV or AIDS. Approximately 50% of the nourishment of the small intestine and > 80% of the nourishment of the large intestine comes from the lumen. This is especially deleterious to the large intestine. Within less than a week of intestinal starvation--even in the presence of intense parenteral nutrition--a mucosal atrophy is observed, promoting translocation of potentially pathogenic microorganisms. Enteral nutrition is crucial to the outcome in many of these conditions. If however, such a nutrition is based on simple carbohydrates, peptides, amino acids, or fatty acids, most of the nutrition administered will be absorbed in the upper gastrointestinal tract. Complex fibers and proteins can be regarded as nutrients especially destined to the lower gastrointestinal tract. They are fermented by the probiotic flora, normally colonizing the colonic mucosa, and the necessary nutrients: short-chain fatty acids and amino acids such as arginine and glutamine are produced at the level of the colonic mucosa. Careless antibiotic treatment reduces or eliminates this flora, induces local mucosal starvation, and makes the patients vulnerable to opportunistic infections and microbial intestinal translocation. METHODS AND RESULTS: In this review the role of the different ingredients of the surface protection system are discussed. A program to recondition the intestines, particularly the colonic mucosa by resupply of species-specific lactobacilli, surfactants, amino acids (especially glutamine), and oat fiber (beta-glucans) is suggested. Extensive experience in animal models and early experience in a patient population are summarized and discussed. Oat has been chosen as a substrate for fermentation because it contains 100 times more of membrane lipids (surfactants) than any other food, has a favorable amino acid pattern (rich in glutamine), and is rich in water-soluble, fermentable-fiber beta-glucans. More than 1000 isolates of human-specific lactobacilli have been studied. Some strains, especially those of plantarum type, have proven effective in colonizing the colonic mucosa, suppressing the potentially pathogenetic flora, and may have other probiotic effects as well. CONCLUSION: A totally new enteral formula has been designed based on probiotic bacteria and fiber and aimed at colonizing the intestinal mucosa with a local probiotic effect and fermentation of fiber.
Animals↗
Role of topical phospholipids in the prophylaxis of silicone elastomer-associated infection in the abdominal cavity.
The present study evaluated the influence of phospholipids (phosphatidyl choline and phosphatidyl inositol) on the prevention of abdominal biomaterial-associated infection. Phospholipid-impregnated silicone elastomer (SE) fragments were either intraperitoneally implanted in rats or immersed in serum for 0, 4, and 14 days, and 3 x 10(9) cfu of 3H-labeled, live Escherichia coli were added in the peritoneal cavity or in vitro incubation medium. Three hours after incubation, the adherence of bacteria significantly decreased to phospholipid-impregnated SE fragments, which had been immersed/implanted for 0 and 4 days. However, the number of adhering bacteria did not differ between the impregnated and unimpregnated SE fragments after 14 days of immersion/implantation. A significantly lower number of adhering bacteria was noted on all unimpregnated SE fragments when phospholipid was supplemented in the peritoneal cavity or in vivo medium, compared with fragments with no supplement. The rate of bacterial DNA synthesis decreased significantly after incubation with phospholipid 2 h or more. Phospholipids did not further influence peritoneal morphology. Thus topical administration of phospholipids by impregnation to the surface of SE fragments or supplement in the incubation medium prevented bacterial adherence onto the SE fragments. This implies that the use of phospholipids might be a mode of preventing biomaterial-associated infections.
Administration, Topical↗
[A probiotic as an antagonist of bacterial translocation in experimental pancreatitis].
Infection is the most common cause of death in acute pancreatitis. Earlier studies have demonstrated that early enteral nutrition decreases microbial translocation, upregulates the immune function and reduces septic complications and mortality. Lactobacillus plantarum (Lp) has been shown to be effective in reducing egress of endotoxin and microbial strain that showed very high adherence power to gut mucosa. We adopted a model of acute pancreatitis induced by isolation and ligation of biliopancreatic duct in adult Lewis rats. Three groups were studied: A. control group (sham operation); B. induced pancreatitis, no further treatment; C. Induced pancreatitis + gavage with 5 ml/day of a suspension of Lp 299 v in a dose of 0.5-1.0 x 10(9)/ml during 4 days before and 4 days after induction of pancreatitis. All animals were sacrificed after 96 hours. Histological studies and microbiological analyses were performed. Forty out of 55 animals showed signs of severe pancreatitis on sacrifice after 96 hours. Only these animals were further studied. In group A, we found only 1/20 bacteria in mesenteric nodes (MN). Pathogenic microrganisms were found in the non-treated group in MN in 14/20 and in the pancreatic tissue in 10/20. In contrast, when kept on an umbrella of Lp 299 v, only 4/20 animals demonstrated growth of enteric bacteria in MN and 3/20 in pancreatic tissue. All of these results showed a significant reduction of infection in the treated groups. In our model, Lp 299 v is effective in preventing microbial translocation in experimental pancreatitis. Treatment with probiotic bacteria, such as Lactobacillus spp, seems to be a promising alternative as problems with antibiotic-resistant bacteria seem to accumulate.
Acute Disease↗
Use of pro-, pre- and synbiotics in the ICU--future options.
Although the word synbiotics was coined to describe the combined action of pre- and probiotics, the ability to, like antibiotics, control infection, the term is now increasingly used in a wider sense, as a name for all the substances released by microbial fermentation in the lower gut. One obvious reason is that most of the substances released seem to influence the immune defense, increase resistance to disease, and, most important, prevent complications to surgery such as infections and thrombosis. Protection layer of lactobacillus does not exist only on the GI tract mucosa, it is important at all exterior body surfaces including those of the eye, the nose, the mouth, the respiratory tract, the vagina, not to forget the skin. It is clearly reduced at all sites when the patient is in the settings of ICU. Each human being has his/her own unique microbial collection, especially of strains of Bifidobacterium and Lactobacillus, and it should be possible to identify an individual on the basis of his/her personal intestinal microflora. The flora seems always to be significantly reduced in the sick, especially in connection with severe disease, care in ICU, and in patients with little food intake or on parenteral nutrition. Supply of both pre- and probiotics can modify functions such as appetite, sleep, mood and circadian rhythm, and this most likely through metabolites produced by microbial fermentation in the gut. Supply of lactic acid bacteria (LAB) can also significantly reduce serum levels of a variety of toxins such as endotoxin. An umbrella of supplemented probiotics could provide to the patients with liver cirrhosis a tool to reduce septic manifestations and the incidence of bleeding. LAB are effective in controlling diarrhea of both bacterial and viral origin. A series of experimental studies and several uncontrolled clinical studies support the idea of using probiotics in patients with IBD. Ecoimmunonutrition with pre- pro- and synbiotics offer to be suitable tools in the new millennium.
Adult↗
[Enteral nutrition: past and future].
Perioperative nutrition has during the last century been transformed from a tool to provide calorie and nitrogen support to a tool to boost the immune system and increase resistance to complications. Despite all progress in medicine and surgery has perioperative morbidity, rate of infections, thrombosis and development of serosal adhesions remained the same as long as can be judged or at least during the last eighty years. Most prone to develop complications are persons above the age of 65 and persons with depressed immunity. About eighty percent of the immune system is localised in the gastrointestinal tract, which offers great opportunities for modulation through enterar nutrition. As the stomach has a tendency to develop postoperative paralysis, tube feeding is often necessary. Andresen demonstrated already in 1918 the advantages of enteral nutrition, which starts already on the table. Mulholland et al and Rhoads and co-workers demonstrated during the 1940s certain advantages of enteral tube feeding. Also works by Alexander, Fischer, Ryan and their co-workers supported the value of early enteral feeding, and suggested enteral feeding as an effective tool to boost the immune system. It was, however, works published in the early nineties by Moore et al and by Kudsk et al, which made surgeons more aware of the advantages of early enteral nutrition. Major surgery is known to have a high rate of complications. Uninterrupted perioperative nutrition, eg nutrition during the night before, during surgery and immediately after offers a strong tool to prevent complications. It is essential that the nutrition provides food also for the colon, e.g. fibres and healthy bacteria (probiotics) to ferment the fibre and boost the immune system.
Energy Intake↗
[Symbiotics: a new strategy in critically ill patients treatment].
Maintenance of the gut environment is a key factor in determining outcome in the care of critically ill and postoperative patients. It is especially important to maintain both gastrointestinal secretions, full o anti-infectious and anti-inflammatory compounds, and the gut flora. Prebiotics, usually polysaccharides, exhibit strong bio-activity and the ingestion of prebiotics has been shown to reduce the rate of infection and restore health in sick and postoperative patients. Probiotics may have at least five functions, all of great importance to the sick patients: the reduction or elimination of potentially pathogenic micro-organism of various kinds; the reduction or elimination of various toxins, mutagens, carcinogens, etc.; modulation of the innate and adaptive immune defence mechanisms; the promotion of apoptosis; and the release of numerous nutrient, antioxidant, growth, coagulation and other factors necessary for recovery. A combination of pre and probiotics is referred to as "synbiotics". Our experience of synbotic treatment in critically ill patients is limited, but cutting-edge results from studies of severe acute pancreatitis, chronic hepatitis and liver transplantation offer great hope for the future. This is especially importante as pharmaceutical treatment, including the use of antibiotics, has largely failed, and the medical world is in much need of new treatment paradigms.
Critical Illness↗
Mitomycin C and lipiodol do not improve the effect of intermittent hepatic artery occlusion on liver tumour growth. An experimental study in the rat.
The effect of Mitomycin C (MMC 2.0 mg/kg bw), lipiodol (0.2 ml/kg bw) and intermittent hepatic artery occlusion on liver tumour growth, as well as their possible interrelation, were studied in 29 rats. An adenocarcinoma was inoculated in the left liver lobe. After one week, the tumour size was measured and the rats then divided into five different groups of treatment. Intermittent hepatic artery occlusion was performed during five days for 1 hour daily alone, of initially in combination with MMC and lipiodol. One group was treated with MMC and lipiodol in combination and one group with lipiodol only. The tumour growth six days later was compared between the groups and with control rats. It was found that intermittent arterial occlusion significantly reduced the tumour growth (P = 0.01). However, the retarding effect of intermittent arterial occlusion on tumour growth was not significantly improved with additional treatment of MMC and lipiodol.
Adenocarcinoma↗
Prevention of adhesions by high molecular weight dextran in rats. Re-evaluation in nine experiments.
The efficacy of 32% dextran 70 (Hyskon) in the prevention of postoperative peritoneal adhesions was evaluated in nine different experiments in a total of 320 rats under standardised conditions. Hyskon reduced adhesion formation, only in rats that were also subjected to abrasion of the caecum. In the remaining eight experiments Hyskon was ineffective. We conclude that more extensive experimental and clinical studies are desirable before this agent is recommended for prophylaxis against adhesions; any prophylactic regimen should be tested in a wide range of experiments. In addition, analysis of the control data suggested that the stimulus for inducing adhesions in some experiments was so strong that it could not be countered by any prophylactic regimen. A new microsurgical method that resulted in a 50 per cent response and an equal number of low grade and high grade adhesions was used. This method is well suited for investigation of both the stimulatory and the inhibitory effects of a test agent.
Animals↗
The effect of pancreatic and intestinal venous blood on hepatic atrophy and compensatory hyperplasia in the rat.
Hepatotrophic effect of pancreatic and intestinal venous blood was studied in rats with mesocaval or distal splenocaval shunt following ligation of a branch of the portal vein supplying 70% of liver mass. Because 2/3 of liver mass was deprived of portal flow the nonligated liver lobes were not hypoperfused due to shunt procedure. During the first three postoperative days the DNA synthesis, mitotic index, and changes in relative weights were measured in both ligated (atrophied) and nonligated (compensatory hyperplasia) parts of the liver. It was found, that the restorative capacity of the liver existed in rats with selective portasystemic shunts. The stimulus to growth was greater in lobes supplied by intestinal venous blood compared to those perfused by pancreatic effluent. The increase in DNA synthesis occurred in lobes undergoing atrophy and the intensity of this response was also dependent on type of shunt since recirculation of intestinal blood by way of the hepatic artery inhibited atrophy to a greater extent than pancreatic venous effluent. Although the patency of arterial branches was confirmed the ligated lobes showed necrotic lesions. Systemic recirculation of intestinal venous blood far more inhibited necrosis than pancreatic venous blood.
Animals↗
Isolated intraperitoneal accumulation of bile after surgical or diagnostic procedures.
In 1969-1986 intraperitoneal accumulation of bile occurred in 21 patients after elective cholecystectomy or choledochotomy (n = 16) or percutaneous fine-needle cholangiography or biopsy (n = 5). The cause was established in all but one of the surgical cases, viz. T-tube removal (8), injury to the common bile duct (3), unrecognized aberrant bile duct (3) and leakage from liver biopsy (1). The intraperitoneal accumulation of bile led to laparotomy in 19 cases, when the median amount of bile found was 500 ml (range 100-3,500 ml). Mortality was nil, and only few and relatively minor complications could be attributed to the accumulation of bile--pleural effusion (2 cases), wound rupture (1), lower-limb venous thrombosis (1) and strictured hepatojejunostomy (1). There were no infectious complications. It is concluded that intraperitoneal accumulation of bile alone after elective surgical or invasive diagnostic procedures does not usually lead to severe complications, and that it seems distinctly less noxious than the bile peritonitis associated with acute cholecystitis.
Adolescent↗
A two-stage liver resection combined with longterm intraportal 5-FU infusion.
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Cecal Neoplasms↗
Changes in coagulation factors after hepatic artery ligation in dogs.
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Animals↗