Intestinal permeability and oxidative stress in patients with alcoholic pellagra

Junqueira-Franco, Márcia Varella Morandi; Troncon, L E A; Chiarello, Paula Garcia; Unamuno, Maria do Rosário Del Lama de; Jordão, Alceu Afonso; Vannucchi, Hélio

doi:10.1016/j.clnu.2006.03.010

Cited by 26 publications

(19 citation statements)

References 30 publications

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“…The dermatitis ranges from obvious scaly erythema to subtle changes that are often mistaken for the photo-damage typically seen in the elderly (Figure 1). Gastrointestinal (GI) involvement is thought to be due to generalized inflammation of the alimentary canal, with symptoms including stomatitis, glossitis, nausea, vomiting, constipation, abdominal pain, and ultimately, intractable diarrhea [30]. The diarrhea itself can contribute to ongoing malnourishment.…”

Section: Clinical Presentations: Classical and Atypical Pellagramentioning

confidence: 99%

Pellagrous encephalopathy presenting as alcohol withdrawal delirium: A case series and literature review

Oldham

Ivkovic

2012

Addict Sci Clin Pract

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BackgroundAlcohol withdrawal delirium (AWD) is associated with significant morbidity and mortality. Pellagra (niacin deficiency) can be a cause of delirium during alcohol withdrawal that may often be overlooked.ObjectivesWe present a three-patient case series of pellagrous encephalopathy (delirium due to pellagra) presenting as AWD.MethodsWe provide a brief review of pellagra’s history, data on pellagra’s epidemiology, and discuss pellagra’s various manifestations, particularly as related to alcohol withdrawal. We conclude by providing a review of existing guidelines on the management of alcohol withdrawal, highlighting that they do not include pellagrous encephalopathy in the differential diagnosis for AWD.ResultsThough pellagra has been historically described as the triad of dementia, dermatitis, and diarrhea, it seldom presents with all three findings. The neurocognitive disturbance associated with pellagra is better characterized by delirium rather than dementia, and pellagra may present as an isolated delirium without any other aspects of the triad.DiscussionAlthough endemic pellagra is virtually eradicated in Western countries, it continues to present as pellagrous encephalopathy in patients with risk factors for malnutrition such as chronic alcohol intake, homelessness, or AIDS. It may often be mistaken for AWD. Whenever pellagra is suspected, treatment with oral nicotinamide (100 mg three times daily for 3–4 weeks) prior to laboratory confirmation is recommended as an inexpensive, safe, and potentially life-saving intervention.

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Section: Clinical Presentations: Classical and Atypical Pellagramentioning

confidence: 99%

Pellagrous encephalopathy presenting as alcohol withdrawal delirium: A case series and literature review

Oldham

Ivkovic

2012

Addict Sci Clin Pract

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“…Antioxidants have been shown to normalize intestinal permeability in alcoholic patients (Varella Morandi Junqueira-Franco et al, 2006). We have also shown that alcohol increases intestinal epithelial cell permeability in vitro through an oxidant stress mediated mechanism (Banan et al, 1999; Banan et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Lactobacillus GG treatment ameliorates alcohol-induced intestinal oxidative stress, gut leakiness, and liver injury in a rat model of alcoholic steatohepatitis

Forsyth

Farhadi

Jakate

et al. 2009

Alcohol

360

244

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Since only 30% of alcoholics develop alcoholic liver disease (ALD), a factor other than heavy alcohol consumption must be involved in development of alcohol-induced liver injury. Animal and human studies suggest that bacterial products such as endotoxin are the second key co-factor and oxidantmediated gut leakiness is one of the sources of endotoxemia. Probiotics have been used to prevent and treat diseases associated with gut-derived bacterial products and disorders associated with gut leakiness. Indeed, "probiotic" Lactobacillus has been successfully used to treat alcohol-induced liver injury in rats. But, the mechanism of action of the potential beneficial effects of Lactobacillus in alcohol liver injury is not known. We hypothesized that probiotics could preserve normal barrier function in an animal model of ALD by preventing alcohol-induced oxidative stress and thus prevent development of hyperpermeability and subsequent alcoholic steatohepatitis. Male Sprague-Dawley rats were gavaged with alcohol twice daily (8gm/kg) for 10 weeks. In addition, alcoholic rats were also treated with once daily gavage of either 2.5 10 7 live Lactobacillus GG (LGG) or vehicle. Intestinal permeability (baseline and 10wk) was determined using a sugar bolus and GC analysis of urinary sugars. Intestinal and liver tissues were analyzed for markers of oxidative stress and inflammation. In addition livers were assessed histologically for severity of alcoholic steatohepatitis (ASH) and total fat (steatosis). Alcohol-LGG fed rats had significantly (p≤ .05) less severe ASH than alcohol-vehicle fed rats.LGG also improved alcohol-induced gut leakiness and significantly blunted alcohol-induced oxidative stress and inflammation in both intestine and the liver. LGG probiotic gavage significantly ameliorated alcoholic steatohepatitis in rats. This improvement was associated with reduced markers of intestinal and liver oxidative stress and inflammation and preserved gut barrier function. Our study provides a scientific rationale to test probiotics for treatment and/or prevention of alcoholic liver disease in man.

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“…A deficiency in niacin manifests itself with the disease, pellagra [30][31][32][33]. It is frequently associated with alcoholism as well as glossitis, scarlet stomatitis, diarrhea, dermatitis, and psychosis, as well as mental deficiency.…”

Section: Discussionmentioning

confidence: 99%

The influence of B-complex vitamins upon the prolongation of prothrombin time by acetaldehyde

Catazaro

Brecher²

2013

Blood Coagulation &Amp; Fibrinolysis

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Alcoholism plays a major role in the insufficient utilization or deficiency of the vitamin B-complex molecules, and the pathologies resulting therefrom. Thiamine, pyridoxamine, and folic acid, each contain primary amine functional groups, whereas nicotinamide and vitamin B12 contain amide groups, each of which are potential reactants with acetaldehyde (AcH), the primary intermediate in the metabolism of ethanol. In this current study, it is reported that prothrombin time (PT), which is prolonged in a fraction of the alcoholic population, can be modified (in the laboratory) when several B-complex vitamins and AcH are added successively to human plasma or are premixed prior to the addition to plasma. Particularly, thiamine, pyridoxamine, and folic acid, at 0.01 mol/l, when added successively with 44.7 mmol/l AcH to plasma, or when premixed prior to addition to plasma, produced a marked reduction in the anticoagulant effect of AcH. Nicotinamide had no effect on PT nor did mixtures with AcH effect PT. However, NAD, which contains a primary amine in its AMP moiety, reacted with AcH, lowering the latter's anticoagulant activity upon addition to plasma. Vitamin B12 did not affect PT. Interestingly, successive mixtures of vitamin B12 and AcH to plasma resulted in a small but statistically significant increase (P≤0.05) in the anticoagulant effect of AcH, whereas premixtures had no statistically significant effect (P>0.05). The decrease in anticoagulant activity of AcH in the presence of B-complex vitamins and NAD suggests that the primary amines in these molecules may form Schiff bases with AcH, thereby lowering both the free AcH concentration as well as the ability of the free vitamins/coenzymes to partake in essential physiological reactions.

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Intestinal permeability and oxidative stress in patients with alcoholic pellagra

Cited by 26 publications

References 30 publications

Pellagrous encephalopathy presenting as alcohol withdrawal delirium: A case series and literature review

Pellagrous encephalopathy presenting as alcohol withdrawal delirium: A case series and literature review

Lactobacillus GG treatment ameliorates alcohol-induced intestinal oxidative stress, gut leakiness, and liver injury in a rat model of alcoholic steatohepatitis

The influence of B-complex vitamins upon the prolongation of prothrombin time by acetaldehyde

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