We investigated the combined effect of glutamine (GLN) and growth hormone (GH) on bacterial translocation (BT) in sepsis. After single intraperitoneal injection of lipopolysaccharide (10 mg/kg), 48 rats were divided randomly into four groups of 12 animals each: the control group received chow orally; the GLN group received chow plus 10% GLN; GH group received chow plus GH; and the GLN/GH group received chow, 10% GLN, and GH. Twenty-four and 96 hr later, rats were sacrificed. Portal blood culture, bacterial colony counts of cultured mesenteric lymph nodes, mucosal thickness, malondialdehyde (MDA), and glutathione (GSH) levels in the gut mucosa were measured. There was no significant change of the rate of portal blood culture between all treatment groups at 24 and 96 hr. At 24 hr, the rats receiving combined treatment of GLN and GH showed lower bacterial colony counts and mucosal MDA levels than the control rats, and higher mucosal GSH levels than the control and GLN-treated rats. At 96 hr, rats treated with both GLN and GH exhibited lower bacterial colony counts and mucosal MDA levels, and higher mucosal thickness and GSH levels than control, GLN, or GH-treated rats. This study suggests that the combination of GLN and GH may synergistically reduce BT over time in sepsis.
Animals ; Bacteremia/etiology ; Bacteremia/microbiology ; Bacteremia/prevention & control ; Bacterial Translocation/drug effects* ; Comparative Study ; Drug Evaluation, Preclinical ; Drug Synergism ; Endotoxemia/drug therapy* ; Endotoxemia/microbiology ; Escherichia coli/isolation & purification* ; Glutamine/pharmacology* ; Glutamine/therapeutic use ; Glutathione/analysis ; Human Growth Hormone/pharmacology* ; Human Growth Hormone/therapeutic use ; Ileum/microbiology ; Ileum/pathology ; Intestinal Mucosa/microbiology ; Intestinal Mucosa/pathology ; Lipid Peroxidation/drug effects ; Lymph Nodes/microbiology ; Male ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins/pharmacology ; Recombinant Proteins/therapeutic use ; Sepsis/microbiology ; Sepsis/prevention & control* ; Specific Pathogen-Free Organisms

OBJECTIVETo evaluate the influence of preoperatively selected gut decontamination (SGD) on intestinally derived endotoxemia(ETM) in patients with rheumatic heart disease undergoing valve replacement operation with cardiopulmonary bypass(CPB).

METHODSThirty patients were randomly divided into control group and SGD group. The patients in control group underwent preoperative bowel preparation, i.e, diet preparation and enema. The patients in SGD group were administrated 100 mg Tobramycin, 40 mg garlicin and 20% Lactulose for 10 ml three times per day for 3 days besides routinely preoperative bowel preparation. Bacteria cultivation and identification and Gram staining of feces in both groups were used to evaluate species of intestinal flora and their ratios. The levels of endotoxin, D-lactate, TNF-alpha and complement 3 were determined at four time points of anesthetic induction, CPB end, 2 h after CPB, 24 h after CPB. And the related clinical biochemical and clinical markers were recorded.

RESULTSAerobic gram-negative bacilli (AGNB) ratio in post-SGD group decreased significantly as compared with that in control group and pre-SGD group (P less than 0.05). The level of D-lactate reduced significantly at time points of anesthetic induction and 2 h after CPB (P less than 0.05). Endotoxin levels of patients in both groups elevated significantly after CPB (P less than 0.05), and endotoxin levels of the patients in SGD group decreased significantly at points of CPB end (P less than 0.01) and 24 h after CPB (P less than 0.05) compared with those in control group. The levels of TNF-alpha and complement 3 were similar in both groups as well as clinical and biochemical markers.

CONCLUSIONSCPB induces endotoxemia, while the regime of SGD is an effective way to prevent endotoxemia but may not affect activation of inflammatory media and clinical outcomes.

Adult ; Allyl Compounds ; therapeutic use ; Cardiopulmonary Bypass ; adverse effects ; Decontamination ; Disulfides ; therapeutic use ; Endotoxemia ; prevention & control ; Humans ; Intestines ; microbiology ; Preoperative Care ; Rheumatic Heart Disease ; surgery ; Tobramycin ; therapeutic use