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Markers may be key to success of bowel transplants
Posted 18 December 2009
Protein markers may be key to success of bowel transplants
Researchers at Prince Henry's Institute (PHI), in collaboration with the Murdoch Childrens Research Institute and The University of Melbourne, have discovered protein markers which may provide lifesaving clinical information for patients who require surgery that leaves them with little or no bowel.
The discovery, published in the Journal of Proteome Research, may eventually lead to a test which can predict which patients will adapt to major bowel reduction surgery and which patients might be considered for becoming a recipient of a bowel transplant.
"There are several hundred thousand proteins present in the human body. To track down the small group proteins linked to intestinal adaptation is very promising and demonstrates the potential of translating proteomics technology into clinical care" said study leader Dr Andrew Stephens, Prince Henry's Institute.
Major abdominal surgery, which leaves almost no bowel remaining, may be required for a variety of reasons. For some patients they may be born with intestines that don't work, others may require surgery as part of cancer treatment, serious health conditions or following an accident. The recovery time for those that have undergone the removal of most of their bowel often takes a number of years and requires intensive artificial nutrition delivered directly into the bloodstream. Whilst the bowel in many patients is ultimately able to adapt, for a significant number they are left with permanent intestinal failure.
In Australia about 130 patients, with intestinal failure, are now receiving long term intravenous nutrition, bypassing the usual process of eating and digestion. There are significant risks of this therapy and the economic cost of treating each patient is huge, up to $1 million dollars per patient per year.
Using highly specialised proteomics technology, the PHI researchers found that changes in some 60 proteins were linked to intestinal adaptation. The study looked at intestinal adaptation in pigs and the close similarity of the model with the human digestive system means that the discovery may soon be translated into medical benefits in a clinical setting.
The discovery is also timely. Whilst until recently the options for those patients who do not adapt to major bowel reduction surgery were limited, the prospect of Australia's first bowel transplant is on the horizon. Planning is currently underway at the Royal Children's Hospital and the Austin Hospital in Melbourne for Australia's first bowel transplant. A bowel transplant is a complex but potentially lifesaving option and critical to success will be to identify at the earliest stage in their care which patients would be best suited to a transplant.
The researchers at Prince Henry's Institute, the Murdoch Childrens Research Institute and The University of Melbourne will now explore if the protein markers can be developed into a simple test which can better determine which patients are likely to successfully adapt to major bowel surgery and which might be considered for a bowel transplant.
Further Information
Proteomic Analysis of the Intestinal Adaptation Response Reveals Altered Expression of Fatty Acid Binding Proteins Following Massive Small Bowel Resection Journal of Proteome Research (EPub 30/11/09)
Andrew Stephens, Prue M Pereira-Fantini, Guineva J Wilson, Russell G Taylor, Adam Rainczuk, Katie Meehan, Sarah Thomas, Magdy Sourial, Peter J Fuller, Peter G. Stanton, David M. Robertson, Julie E Bines