GLP-2 analog teduglutide significantly reduces need for parenteral nutrition and stool frequency in a real-life setting

Schoeler, Marc; Klag, Thomas; Wendler, Judith; Bernhard, Simon; Adolph, M.; Kirschniak, Andreas; Goetz, Martin; Malek, Nisar P.; Wehkamp, Jan

doi:10.1177/1756284818793343

Cited by 34 publications

(38 citation statements)

References 37 publications

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“…After parenteral nutrition, the blood concentration of enterohormones such as GLP-2, GIP, and PYY were lower compared to enteral nutrition [48]. Consistent with established trophic effects of GLP-2 on the small intestine [94], evidence has been presented that application of GLP-2 or a GLP-2 agonist during parenteral nutrition reduces atrophy in the small intestine [73,180,346].…”

Section: Parenteral Nutritionmentioning

confidence: 59%

Glucose transporters in the small intestine in health and disease

Koepsell

2020

Pflugers Arch - Eur J Physiol

182

146

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Absorption of monosaccharides is mainly mediated by Na +-D-glucose cotransporter SGLT1 and the facititative transporters GLUT2 and GLUT5. SGLT1 and GLUT2 are relevant for absorption of D-glucose and D-galactose while GLUT5 is relevant for D-fructose absorption. SGLT1 and GLUT5 are constantly localized in the brush border membrane (BBM) of enterocytes, whereas GLUT2 is localized in the basolateral membrane (BLM) or the BBM plus BLM at low and high luminal D-glucose concentrations, respectively. At high luminal D-glucose, the abundance SGLT1 in the BBM is increased. Hence, D-glucose absorption at low luminal glucose is mediated via SGLT1 in the BBM and GLUT2 in the BLM whereas high-capacity D-glucose absorption at high luminal glucose is mediated by SGLT1 plus GLUT2 in the BBM and GLUT2 in the BLM. The review describes functions and regulations of SGLT1, GLUT2, and GLUT5 in the small intestine including diurnal variations and carbohydrate-dependent regulations. Also, the roles of SGLT1 and GLUT2 for secretion of enterohormones are discussed. Furthermore, diseases are described that are caused by malfunctions of small intestinal monosaccharide transporters, such as glucose-galactose malabsorption, Fanconi syndrome, and fructose intolerance. Moreover, it is reported how diabetes, small intestinal inflammation, parental nutrition, bariatric surgery, and metformin treatment affect expression of monosaccharide transporters in the small intestine. Finally, food components that decrease D-glucose absorption and drugs in development that inhibit or downregulate SGLT1 in the small intestine are compiled. Models for regulations and combined functions of glucose transporters, and for interplay between D-fructose transport and metabolism, are discussed.

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Section: Parenteral Nutritionmentioning

confidence: 59%

Glucose transporters in the small intestine in health and disease

Koepsell

2020

Pflugers Arch - Eur J Physiol

182

146

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“…According real life experiences improved stool consistency and frequency, as well as the sensation of thirst, were identified as early clinical markers of response. [8]. Reductions in parenteral support requirements were accompanied by significant increases in mean villus height and crypt depth in this cohort as assessed by direct measurement of biopsies obtained during endoscopy [9].…”

Section: Discussionmentioning

confidence: 77%

Early effectivity of Teduglutide for the Treatment of short bowel Sydrome – our first Clinical experience

Gombošová¹,

Krivuš²,

Lazúrová³

et al. 2021

AMCRCS

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Background Short bowel syndrome is an uncommon malabsorptive condition most frequently caused by massive surgical resection of the small intestine. Standard of care is home parenteral nutrition. Teduglutide, glucagon like peptide 2 analog, was approved to treat patients with short bowel syndrome, who are stable following a period of post-surgery intestinal adaptation. We report two cases of patients with short bowel syndrome on home parenteral nutrition, treated with teduglutide, novel advanced therapy. We monitored the effectiveness and tolerance of the new treatment. Teduglutide increases intestinal absorption, causes cryptal hyperplasia, villous hypertrophy, angiogenesis, and allows weaning from parenteral nutrition. We confirmed the early onset of treatment effectiveness in the 4th month. Early effectiveness of treatment allowed a reduction in the volume of home parenteral nutrition with an improvement in quality of life.

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“…It is important to note that teduglutide is generally used to reduce the amount of parenteral nutrition needed in SBS-IF patients, rather than to achieve enteral autonomy. In literature, the rate of enteral autonomy is generally described as low as 7% [9] , 12% [14] , 20% [10] , 21% [11] , and 33% [9] . However, the experience at our institution shows different results with most patients being able to achieve enteral autonomy.…”

Section: Discussionmentioning

confidence: 99%

“…Teduglutide is used daily by subcutaneous injection in a dose of 0.05 mg/kg and leads to the growth of intestinal mucosa by stimulating intestinal crypt cell growth and inhibiting enterocyte apoptosis, thereby leading to an increased intestinal surface. Common side effects of therapy include intestinal obstruction, biliary and pancreatic disease, fluid imbalance, and increased absorption of oral medications [1] , [9] , [10] , [11] . Teduglutide is used as a treatment for patients with SBS-IF, either after intestinal reconstruction or for patients who are ineligible for intestinal reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Bridging intestinal failure with Teduglutide – A case report

Schlager

Stift

Gartner

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance Intestinal failure (IF) describes the state of a person's gastrointestinal absorption capabilities becoming unable to absorb fluids and nutrients needed to sustain normal physiology, leading to severe comorbidities and if left untreated, to death. IF is most commonly seen as a result of short bowel syndrome (SBS). Teduglutide is a glucagon-like peptide 2 (GLP-2) analogue used in the treatment of patients with SBS and intestinal failure (IF) as a way to reduce the need for parenteral support. Teduglutide leads to the growth of intestinal mucosa by stimulating intestinal crypt cell growth and inhibiting enterocyte apoptosis. It is usually prescribed as a final treatment step after the diagnosis of SBS-IF is made. Case presentation In this case report we present a novel strategy for using teduglutide as a bridging therapy to intestinal reconstruction. The patient achieved enteral autonomy preoperatively, underwent surgery, and remained in enteral autonomy after intestinal reconstruction. Clinical discussion Teduglutide has been previously exclusively used as continuous therapy in SBS-IF, this is the first reported case of using teduglutide as bridging to intestinal reconstruction. The hypothesis of this approach was to achieve an adequate nutritional status for reconstruction without the disadvantages of parenteral support. Conclusion The controlled application of teduglutide can provide the benefits of preoperative nutritional optimization without the disadvantages of parenteral support and at the same time facilitate an earlier and easier intestinal reconstruction.

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GLP-2 analog teduglutide significantly reduces need for parenteral nutrition and stool frequency in a real-life setting

Cited by 34 publications

References 37 publications

Glucose transporters in the small intestine in health and disease

Glucose transporters in the small intestine in health and disease

Early effectivity of Teduglutide for the Treatment of short bowel Sydrome – our first Clinical experience

Bridging intestinal failure with Teduglutide – A case report

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