Acute effects of the glucagon-like peptide 2 analogue, teduglutide, on intestinal adaptation in short bowel syndrome

J Pediatr Gastroenterol Nutr. 2014 Jun;58(6):694-702. doi: 10.1097/MPG.0000000000000295.

Abstract

Neonatal short bowel syndrome following massive gut resection is associated with malabsorption of nutrients. The intestinotrophic factor glucagon-like peptide 2 (GLP-2) improves gut function in adult patients with short bowel syndrome, but its effect in pediatric patients remains unknown. Our objective was to test the efficacy of the long-acting synthetic human GLP-2 analogue, teduglutide (ALX-0600), in a neonatal piglet jejunostomy model. Two-day-old pigs were subjected to resection of 50% of the small intestine (distal part), and the remnant intestine was exteriorized on the abdominal wall as a jejunostomy. All pigs were given total parenteral nutrition for 7 days and a single daily injection of the following doses of teduglutide: 0.01 (n = 6), 0.02 (n = 6), 0.1 (n = 5), or 0.2 mg · kg · day (n = 6), and compared with placebo (n = 9). Body weight increment was similar for all 4 teduglutide groups but higher than placebo (P < 0.05). There was a dose-dependent increase in weight per length of the remnant intestine (P < 0.01) and fractional protein synthesis rate in the intestine was increased in the 0.2 mg · kg · day group versus placebo (P < 0.001); however, functional and structural endpoints including activity of digestive enzymes, absorption of enteral nutrients, and immunohistochemistry (Ki67, villin, FABP2, ChgA, and GLP-2R) were not affected by the treatment. Teduglutide induces trophicity on the remnant intestine but has limited acute effects on functional endpoints. Significant effects of teduglutide on gut function may require a longer adaptation period and/or a more frequent administration of the peptide. In perspective, GLP-2 or its analogues may be relevant to improve intestinal adaptation in pediatric patients with short bowel syndrome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Physiological / drug effects*
  • Animals
  • Body Weight / drug effects
  • Disease Models, Animal
  • Dose-Response Relationship, Drug
  • Female
  • Gastrointestinal Agents / pharmacology
  • Gastrointestinal Agents / therapeutic use*
  • Glucagon-Like Peptide 2 / pharmacology
  • Glucagon-Like Peptide 2 / therapeutic use*
  • Glucagon-Like Peptide-2 Receptor
  • Growth / drug effects
  • Intestine, Small / drug effects*
  • Intestine, Small / growth & development
  • Intestine, Small / metabolism
  • Jejunostomy
  • Organ Size / drug effects
  • Parenteral Nutrition, Total
  • Peptides / pharmacology
  • Peptides / therapeutic use*
  • Protein Biosynthesis / drug effects
  • Receptors, Glucagon / metabolism*
  • Short Bowel Syndrome / drug therapy*
  • Short Bowel Syndrome / metabolism
  • Swine

Substances

  • ALX-0600
  • Gastrointestinal Agents
  • Glucagon-Like Peptide 2
  • Glucagon-Like Peptide-2 Receptor
  • Peptides
  • Receptors, Glucagon
  • teduglutide