Neopterin, kynurenine and tryptophan as new biomarkers for early detection of rectal anastomotic leakage.

Dušek, T; Örhalmi, J; Sotona, O; Krčmová, Lenka Kujovská; Javorská, Lenka; Dolejs, Josef; Paral, Jiri

doi:10.5114/wiitm.2018.73363

Cited by 7 publications

(6 citation statements)

References 28 publications

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“…In some studies, concentrations of NEO were specifically quantified in different diseased conditions and showed a positive correlation with the KT ratio and KYN, and inversely with TRP. 7 , 21 , 50 , 51 Neopterin is a marker of gut inflammation and immune system activation that is released by macrophages or monocytes, which activates the IDO pathway upon stimulation by interferon-gamma. 52 So a rise in the NEO level gives a good estimate of the endogenous production of interferon-gamma and thus upregulation of the KYN pathway in EED and undernutrition.…”

Section: Discussionmentioning

confidence: 99%

Plasma Kynurenine to Tryptophan Ratio Is Negatively Associated with Linear Growth of Children Living in a Slum of Bangladesh: Results from a Community-Based Intervention Study

Gazi

Das

Siddique

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Chronic exposure to infectious agents results in environmental enteric dysfunction-a significant contributor to childhood stunting. Low plasma tryptophan (TRP), increased kynurenine (KYN), and KYN-TRP (KT) ratio are associated with infections and chronic immune activation. We postulated that both these conditions are interlinked, and therefore aimed to identify the association between KT ratio and the linear growth of Bangladeshi children. A total of 480 stunted and at risk of being stunted children aged 12-18 months were enrolled and provided nutrition intervention for 90 days. Plasma samples were assessed using liquid chromatography tandem mass spectrometry to measure TRP and KYN concentrations. Multivariable linear regression with generalized estimating equations was applied to analyze association between the KT ratio and linear growth. Tryptophan, KYN, and KT ratio were significantly higher in stunted children than in children at risk of being stunted both at baseline and at the end of nutrition intervention. Following intervention, the median (interquartile range [IQR]) KYN concentration was significantly reduced from 4.6 (3.6, 5.4) μmol/L to 3.9 (0.3, 7.6) μmol/L, and median (IQR) KT ratio decreased from 104 (80.9, 131) to 92.8 (6.6, 247) in stunted children. We also found KT ratio to be negatively associated (coefficient = −0.7; 95% CI = −1.13, −0.26; P-value = 0.002) with linear growth. In addition, KYN and KT ratio were positively correlated with fecal neopterin and plasma C-reactive protein, whereas TRP was negatively correlated with both of these biomarkers and alpha-1-acid glycoprotein. Our findings imply that KT ratio is associated in the pathophysiology of stunting as well as with biomarkers of inflammation in Bangladeshi children.

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Section: Discussionmentioning

confidence: 99%

Plasma Kynurenine to Tryptophan Ratio Is Negatively Associated with Linear Growth of Children Living in a Slum of Bangladesh: Results from a Community-Based Intervention Study

Gazi

Das

Siddique

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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“…We have had some similar experience from a trial in gynaecological oncologic surgery [22]. Also, we have presented our results as a prediction of septic postoperative complication using kynurenine and neopterin as biomarkers [23]. In contrast with these above-mentioned studies, this pilot trial has been focused on a single component/detail in the ERAS methodology in postoperative care e the possible impact of a simple sugar infusion vs. total parenteral nutrition on inflammatory response intensity during the first four days postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Can early postoperative parenteral nutrition have some impact on postoperative inflammatory response intensity?

Kaška

Havel

Javorská

et al. 2021

Clinical Nutrition ESPEN

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Background and aims: Enhanced recovery after surgery (ERAS) is currently the modern perioperative method of care for improvement of post-surgery patient condition and for minimising various postoperative complications. A question of some negative impact of early postoperative parenteral nutrition on postoperative inflammatory response intensity has not clear-cut answer yet. This pilot project was focused on the possible influence of early parenteral nutrition on the intensity of inflammatory postoperative response to operating trauma in surgical patients. Elected as a model of these conditions were patients with colorectal cancer undergoing major surgery. Patients and methods: 45 patients (of whom 39 were analysed finally) operated for cancer of the large bowel were enrolled into the clinical, prospective, randomized, blinded, and monocentric trial -reference number 201811 S09P of the Ethics committee, University Hospital Hradec Kralove, Czech Republic. Patients were divided into two subgroups according to the type of nutrition: subgroup A e supplemented only with 10% glucose for supported mineral carrier; and subgroup B e supplemented with total parenteral nutrition. Samples of blood and urine were examined immediately after surgery, and on the first, second, and fourth days postoperatively. The inflammatory reaction was monitored by the serum or/and urine concentration of neopterin, tryptophan, and kynurenine, and their urinary ratios with creatinine. The results were analysed by multivariate analysis, and p-values 0.05 were considered statistically significant. Results: The final total of 39 patients comprised 20 from subgroup A and 19 from subgroup B. The intensity of the inflammatory response detected by the selected inflammatory markers (serum and urine concentrations of neopterin, kynurenine, tryptophan, their serum ratios, and their urinary ratios to creatinine) did not demonstrate statistically significant differences after early administration of the two alternative types of parenteral nutrition. Conclusions:The results of the study demonstrated the same or a very similar impact on the intensity of postoperative inflammatory response, regardless of whether the patient received intravenous administration of a small simple sugar infusion or total parenteral nutrition during early postoperative care.

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“…Can transanal examination of the low colorectal/coloanal anastomosis be useful? Another issue to consider is early follow-up using imaging methods to evaluate tissue vitality and monitoring levels of biomarkers [31], when there is suspicion of healing complications of the low anastomosis. A solution to at least some of these problems is studies with high quality methodology (not necessarily randomized studies) with a sufficient number of patients.…”

Section: Discussionmentioning

confidence: 99%

The significance of intraoperative fluorescence angiography in miniinvasive low rectal resections.

Škrovina¹,

Benčurik²,

Martínek³

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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Introduction: Anastomotic leak is a very serious complication in colorectal surgery. Tissue perfusion of the anastomosis plays an integral role in its multifactorial etiology. Fluorescence angiography using indocyanine green allows visualization of perfusion in real time. Aim: To evaluate the effectiveness of intraoperative fluorescence angiography as a tool to decrease the incidence of anastomotic leak after laparoscopic or robotic low resection of the rectum for cancer. Material and methods: Intraoperative fluorescence angiography was performed sequentially in 50 patients during low rectal resection for cancer with total mesorectal excision, primary anastomosis and protective ileostomy using laparoscopic or robotic technique. The results were compared to a historical control group of 50 patients with the same procedure without the use of fluorescence angiography. Results: The patient sets were comparable in basic demographic and clinical parameters. Intraoperative visualization of perfusion by fluorescence angiography was achieved in all patients without unwanted side-effects. In 6 (12%) patients, the resection line was adjusted based on the fluorescence angiography. The incidence of anastomotic leak was insignificantly lower in the group with fluorescence angiography (18% vs. 10%), which led to significantly shorter hospital stay. Other postoperative complications were comparable between the two groups. Conclusions: Fluorescence angiography using indocyanine green is a safe and effective method with the potential of reducing anastomotic leak during minimally invasive low resection of the rectum for cancer.

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Neopterin, kynurenine and tryptophan as new biomarkers for early detection of rectal anastomotic leakage.

Cited by 7 publications

References 28 publications

Plasma Kynurenine to Tryptophan Ratio Is Negatively Associated with Linear Growth of Children Living in a Slum of Bangladesh: Results from a Community-Based Intervention Study

Plasma Kynurenine to Tryptophan Ratio Is Negatively Associated with Linear Growth of Children Living in a Slum of Bangladesh: Results from a Community-Based Intervention Study

Can early postoperative parenteral nutrition have some impact on postoperative inflammatory response intensity?

The significance of intraoperative fluorescence angiography in miniinvasive low rectal resections.

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