Stories about: intestinal disorders

A life-saving adjustment in IV nutrition cleared by the FDA

Fourteen years after Charles Rolfe received an experimental IV fish-oil solution, Omegaven has been approved by the FDA. (PHOTOS: WEBB CHAPPELL/ROLFE FAMILY)

In 2004, a surgeon and a hospital pharmacist went against the prevailing dogma. They began revising the IV nutrition formula being given to children unable to take food by mouth. In doing so, they saved many lives. Yet, it wasn’t until last month that their intervention, a new fat emulsion called Omegaven, gained formal approval from the Food and Drug Administration.

Children with intestinal failure due to gastroschisis, necrotizing enterocolitis or other diseases are typically placed on parenteral nutrition, an intravenous method of feeding. Without it, they would die. But prolonged use of IV nutrition — using the traditional formula — had a massive side effect: injury to the liver. The majority of children either died from liver failure or required a liver transplant.

By 2001, surgeon Mark Puder, MD, at Boston Children’s Hospital was tired of watching babies slowly die from liver disease that should be preventable. He suspected something needed to be adjusted in the IV nutrition formula — particularly the fat component, derived from soybean oil and known as Intralipid.

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Intestine chip models gut function, in disease and in health

villus-like projections growing in gut chip
Villus-like extensions formed by small intestinal cells from patient biopsies, protruding into the Intestine Chip’s luminal channel. (Credit: Wyss Institute at Harvard University)

The small intestine is much more than a digestive organ. It’s a major home to our microbiome, it’s a key site where mucosal immunity develops and it provides a protective barrier against a variety of infections. Animal models don’t do justice to the human intestine in all its complexity.

Attempts to better model human intestinal function began with intestinal “organoids,” created from intestinal stem cells. The cells, from human biopsy samples, form hollowed balls or “mini-intestines” bearing all the cell types of the intestinal lining, or epithelium. Recently, intestinal organoids helped reveal how Clostridium difficile causes such devastating gastrointestinal infections.

But while organoids have all the right cells, they don’t fully replicate the environment of a real small intestine. Real intestines are awash in bacteria and nutrients, are fed by blood vessels and are stretched and compressed by peristalsis, the intestines’ cyclical muscular contractions that push nutrients forward.

Efforts to recreate that environment led to the Intestine Chip. An early version, created by the Wyss Institute for Biologically Inspired Engineering, cultured cells from a human intestinal tumor cell line.

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Copper: How much is enough for children fed through an IV?

Just like today's pennies, our bodies have only a little bit of copper in them. But what we have, we need. Danielle Arsenault wants to understand how much copper is enough for children fed via an IV. (stevendepolo/Flickr)

Check the nutrition label on just about any packaged food, and you’ll see how much carbohydrate or salt, or how many calories, are lurking inside waiting for you. But that label won’t give you the whole nutritional picture. How much magnesium does your bag of chips contain? Or iodine, or copper?

These elements are all on the list of human micronutrients: nutrients that help maintain many of the critical biochemical processes within our cells. And while we only need them in very small amounts, micronutrient deficiencies can be devastating, even fatal.

Most of us get the micronutrients we need from our diet (chips aside), but for children whose digestive tracts can’t process regular food – such as those with intestinal disorders like short bowel syndrome (SBS) – getting the right amount of micronutrients is a different story. These children often often have to get all their nutrition intravenously through a process called parenteral nutrition (PN).

Since dieticians can tailor the nutrients given to a child on PN, you’d think that it would be easy to get the right amount of micronutrients, like copper, into the mix. But that isn’t necessarily so.

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