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Published on: March 5, 2016
Multicomponent parenteral lipid emulsions do not prevent liver injury in neonatal pigs with obstructive cholestasis
Greg Guthrie1, Caitlin Vonderohe1, Valeria Meléndez Hebib1
1USDA-ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, USA.
Insights
Mixed lipid emulsions (MLE) may improve weight gain in infants with biliary atresia (BA) requiring parenteral nutrition (PN). While MLE-fed pigs with BA showed better growth, liver injury markers were similar to soy-based lipid emulsions (SLE).
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Neonatal Nutrition
- Surgical Research
Background:
- Biliary atresia (BA) often requires parenteral nutrition (PN), with soy-based lipid emulsions (SLE) potentially worsening cholestasis.
- Mixed lipid emulsions (MLE) may prevent cholestasis in infants without BA, but their efficacy in BA is unproven.
Purpose of the Study:
- To investigate the efficacy of MLE compared to SLE in a neonatal pig model of biliary atresia (BA) with complete bile duct obstruction.
Main Methods:
- Neonatal pigs underwent bile duct ligation (BDL) or sham surgery.
- Pigs received MLE, SLE via PN, or enteral formula.
- Weight gain, serum bile acids, and liver injury markers were assessed.
Main Results:
- MLE-fed pigs with BDL showed significantly greater weight gain than SLE-fed or formula-fed pigs.
- MLE-BDL pigs had higher serum bile acids and gamma-glutamyl transferase than SLE-BDL pigs.
- No significant differences in liver injury (ductular reaction, fibrosis) were found between MLE- and SLE-BDL groups.
Conclusions:
- MLE may be a superior lipid formulation for promoting weight gain in neonates with obstructive cholestasis like BA.
- Further research is needed to confirm MLE's long-term benefits and safety in BA patients.
Abstract:
Biliary atresia (BA) is a pediatric liver disease that often necessitates parenteral nutrition (PN) to support growth due to impaired liver function. While soy-based lipid emulsions (SLE) are commonly used in PN, they may contribute to cholestatic liver injury. In contrast, mixed lipid emulsions (MLE) show promise in preventing cholestasis in infants without BA, potentially by restoring bile flow. However, their effectiveness in patients of complete bile duct obstruction, as seen in BA, remains uncertain. To explore the potential benefits of MLE in BA, we utilized a neonatal pig model of bile duct ligation (BDL). Pigs underwent either BDL or sham surgery and were subsequently fed either MLE or SLE via PN, or enterally with formula. The MLE-BDL pigs exhibited significantly greater weight gain compared with those fed SLE or formula enterally. Additionally, MLE-BDL pigs showed higher serum bile acid and γ-glutamyl transferase concentrations compared with SLE-BDL pigs. However, no significant differences in liver injury, assessed by ductular reaction or fibrosis, were observed between MLE- and SLE-BDL pigs. Based on weight gain alone, MLE may be a superior lipid emulsion for use in neonates with obstructive cholestasis.
