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. 2015 Feb 15:10:20.
doi: 10.1186/s13019-015-0211-3.

The influence of extracorporeal membrane oxygenation therapy on intestinal mucosal barrier in a porcine model for post-traumatic acute respiratory distress syndrome

Ling Ni  1 , Qiyi Chen  2 , Ke Zhu  3 , Jialiang Shi  4 , Juanhong Shen  5 , Jianfeng Gong  6 , Tao Gao  7 , Wenkui Yu  8 , Jieshou Li  9 , Ning Li  10
Affiliations

The influence of extracorporeal membrane oxygenation therapy on intestinal mucosal barrier in a porcine model for post-traumatic acute respiratory distress syndrome

Ling Ni et al. J Cardiothorac Surg. .

Abstract

Background: It is unclear at present whether extracorporeal membrane oxygenation (ECMO) therapy can improve intestinal mucous barrier function through increased perfusion. The present study establishes an animal model for post-traumatic acute respiratory distress syndrome (ARDS) and evaluates the effect of v-vECMO treatment on the intestinal mucosal barrier.

Method: Pulmonary contusion combined with ischemia-reperfusion injury was induced in 30 piglets. The animals were randomly divided into control, model, and ECMO groups. Serum I-FABP, D-lactate, and endotoxin were measured over a 24-h period. The jejunum and colon were collected post-mortem and evaluated histopathologically. The tissue was also examined using electron microscopy, and intestinal tight junction proteins (ZO-1 and occludin) were measured after 24 h of ECMO therapy. Mortality rate and cause of death were also recorded.

Results: The serum markers evaluating the intestinal mucosal barrier deteriorated in the model group compared to the control group (p < 0.05). At 2 h, serum I-FABP, D-lactate, and endotoxin were significantly increased in the ECMO group compared to the model group (p < 0.05). At 12 h, I-FABP and D-lactate in the ECMO group dropped to model group levels. Serum D-lactate was slightly lower in the ECMO group (p > 0.05) and serum I-FABP was significantly lower than in the model group (p < 0.05) at 24 h. Similarly, serum endotoxin was slightly lower in the ECMO group than in the model group (p > 0.05) at 24 h. After 24 h of ECMO therapy, the occludin and ZO-1 protein concentrations in jejunum and colon mucosa increased moderately compared to that in the model group (p < 0.05). Morphologic structure of the jejunum and colon did not improved significantly after ECMO therapy. Finally, we observed that ECMO therapy moderately decreased mortality (25% vs. 50%).

Conclusion: Intestinal mucosal barrier continued to deteriorate in the model group. Although early ECMO therapy aggravates intestinal mucosal injury, the damage gradually improves later during therapy. The results show that ECMO therapy has a protective effect on the intestinal mucosal barrier in the later treatment stage.

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Figures

Figure 1
Figure 1
Effect of ECMO therapy on IFABP in serum in different time points. Value are ex pressed as mean+/− SD of each group. Compared with control group, *p < 0.05, compared with Molde group, #p < 0.05.
Figure 2
Figure 2
Effect of ECMO therapy on D-Lacate in serum in different time points. Value are expressed as mean+/− SD of each group. Compared with control group, *p < 0.05, compared with Model group, #p < 0.05.
Figure 3
Figure 3
Effect of ECMO therapy on endotoxin in serum in different time points. Value are expressed as mean+/− SD of each group. compared with control group, *p < 0.05, compared with Model group, #p < 0.05.
Figure 4
Figure 4
Tight junction proteins ZO-1 change in jejunum. The protein analysed by western blot with protein levels quantified by densitometry and normalized to GAPDH. compared with Control group, *p < 0.05.
Figure 5
Figure 5
Tight junction proteins ZO-1 change in colon. The protein analysed by western blot with protein levels quantified by densitometry and normalized to GAPDH. compared with Control group, *p < 0.05.
Figure 6
Figure 6
Tight junction proteins Occludin change in jejunum. The protein analysed by western blot with protein levels quantified by densitometry and normalized to GAPDH. compared with Control group, *p < 0.05.
Figure 7
Figure 7
Tight junction proteins Occludin change in colon. The protein analysed by western blot with protein levels quantified by densitometry and normalized to GAPDH. compared with Control group, *p < 0.05.
Figure 8
Figure 8
Histopathologic evaluation (×40) of jejunum and colon by HE staining in ARDS model pigs. Chiu’s scores in jejnum (A1) and colon (B1) experresed as mean ± SD of the controlgroup, model group, and ECMO group, with *p < 0.05, A2 and B2 represed pathologic changes in jejunum and colon, respectively.
Figure 9
Figure 9
Ultrastructural change in jejunum and colon using electron mocroscopy.
See this image and copyright information in PMC

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