Lawsonia intracellularis infected enterocytes lack sucrase-isomaltase which contributes to reduced pig digestive capacity.

Lawsonia intracellularis is endemic to swine herds worldwide, however much is still unknown regarding its impact on intestinal function. Thus, this study aimed to characterize the impact of L. intracellularis on digestive function, and how vaccination mitigates these impacts. Thirty-six L. intracellularis negative barrows were assigned to treatment groups (n = 12/trt): (1) nonvaccinated, L. intracellularis negative (NC); (2) nonvaccinated, L intracellularis challenged (PC); and (3) L. intracellularis challenged, vaccinated (Enterisol® Ileitis, Boehringer Ingelheim) 7 weeks pre-challenge (VAC). On days post-inoculation (dpi) 0 PC and VAC pigs were inoculated with L. intracellularis. From dpi 19-21 fecal samples were collected for apparent total tract digestibility (ATTD) and at dpi 21, pigs were euthanized for sample collection. Post-inoculation, ADG was reduced in PC pigs compared with NC (41%, P < 0.001) and VAC (25%, P < 0.001) pigs. Ileal gross lesion severity was greater in PC pigs compared with NC (P = 0.003) and VAC (P = 0.018) pigs. Dry matter, organic matter, nitrogen, and energy ATTD were reduced in PC pigs compared with NC pigs (P ≤ 0.001 for all). RNAscope in situ hybridization revealed abolition of sucrase-isomaltase transcript in the ileum of PC pigs compared with NC and VAC pigs (P < 0.01). Conversely, abundance of stem cell signaling markers Wnt3, Hes1, and p27Kip1 were increased in PC pigs compared with NC pigs (P ≤ 0.085). Taken together, these data demonstrate that reduced digestibility during L. intracellularis challenge is partially driven by abolition of digestive machinery in lesioned tissue. Further, vaccination mitigated several of these effects, likely from lower bacterial burden and reduced disease severity.

Improved Starch Digestion of Sucrase-deficient Shrews Treated With Oral Glucoamylase Enzyme Supplements.

BACKGROUND AND OBJECTIVE: Although named because of its sucrose hydrolytic activity, this mucosal enzyme plays a leading role in starch digestion because of its maltase and glucoamylase activities. Sucrase-deficient mutant shrews, Suncus murinus, were used as a model to investigate starch digestion in patients with congenital sucrase-isomaltase deficiency.Starch digestion is much more complex than sucrose digestion. Six enzyme activities, 2 α-amylases (Amy), and 4 mucosal α-glucosidases (maltases), including maltase-glucoamylase (Mgam) and sucrase-isomaltase (Si) subunit activities, are needed to digest starch to absorbable free glucose. Amy breaks down insoluble starch to soluble dextrins; mucosal Mgam and Si can either directly digest starch to glucose or convert the post-α-amylolytic dextrins to glucose. Starch digestion is reduced because of sucrase deficiency and oral glucoamylase enzyme supplement can correct the starch maldigestion. The aim of the present study was to measure glucogenesis in suc/suc shrews after feeding of starch and improvement of glucogenesis by oral glucoamylase supplements. METHODS: Sucrase mutant (suc/suc) and heterozygous (+/suc) shrews were fed with C-enriched starch diets. Glucogenesis derived from starch was measured as blood C-glucose enrichment and oral recombinant C-terminal Mgam glucoamylase (M20) was supplemented to improve starch digestion. RESULTS: After feedings, suc/suc and +/suc shrews had different starch digestions as shown by blood glucose enrichment and the suc/suc had lower total glucose concentrations. Oral supplements of glucoamylase increased suc/suc total blood glucose and quantitative starch digestion to glucose. CONCLUSIONS: Sucrase deficiency, in this model of congenital sucrase-isomaltase deficiency, reduces blood glucose response to starch feeding. Supplementing the diet with oral recombinant glucoamylase significantly improved starch digestion in the sucrase-deficient shrew.

Sucrase Breath Testing in Children Presenting With Chronic Abdominal Pain.

Sucrase deficiency has been implicated in chronic abdominal pain. Testing for sucrase deficiency generally involves invasive procedures or lengthy clinical visits, but now noninvasive kits that allow home testing are available to test for sucrase deficiency. In order to assess feasibility and utility of at-home testing, we reviewed our experience in 75 consecutive patients. All patients seen in the abdominal pain clinic had histories obtained in a standardized fashion and all had sucrase breath tests completed at home utilizing a commercially available kit. Testing was completed by 46 patients (61.3%). Tests were abnormal indicating sucrase deficiency in 34.8% of those completing testing. No symptoms were predictive of a positive test although there were trends of an association of an abnormal test with diarrhea and bloating. Our findings suggest that sucrase deficiency occurs frequently enough that more widespread testing and/or an empiric trial of sucrose and starch restriction should be considered.

Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens.

OBJECTIVES: Disaccharidase (DS) activity in duodenal biopsy specimens is the gold standard for diagnosing DS deficiency. We investigated strategies to reduce the need for DS testing and whether clinical or histopathologic factors predict DS deficiency. METHODS: A retrospective chart review analyzed 1,678 DS results in children, biopsy indication(s), and duodenal histopathology. RESULTS: One or more DSs were abnormal in 42.8%. Sufficient lactase predicted sucrase, palatinase, and maltase sufficiency (negative predictive value 97.7%). Three patients had sucrase-isomaltase deficiency (0.2%). DS deficiency was more common in biopsy specimens for positive celiac serology (78.0%). Villous blunting, intraepithelial lymphocytosis, and active inflammation predicted DS deficiency; a combination of any two had an 81.4% positive predictive value. CONCLUSIONS: Utilization could be reduced by only testing cases with normal duodenal histopathology and ongoing clinical suspicion for DS deficiency after reviewing pathology. In cases with suspected celiac disease and/or mucosal injury, DS deficiency is common and likely secondary, limiting test utility.

Gastrointestinal function, morphology, and immune status in uremia.

Individuals with chronic renal failure (CRF) may have a variety of gastrointestinal (GI) problems, including dyspepsia, acid peptic disease, and bacterial overgrowth. We investigated gastrointestinal function in 11 uremic patients, seven of whom were on dialysis three times a week and four who were not on dialysis. Ten normal subjects were studied as controls. The nutritional status of the patients did not differ from that of the control subjects. Seven patients demonstrated abnormal GI endoscopic findings, although none was severe; they also had prolonged oral-cecal transit times but had no evidence of bacterial overgrowth, and all had normal numbers of lymphocyte subpopulations within the intestinal mucosa. The patients had significantly reduced activities of mucosal sucrase and maltase but not of lactase. In spite of the reductions in these enzymatic activities, carbohydrate malabsorption was not evident in the CRF group, probably because of the vast reserve of the small intestine. No differences were noted between the groups in the activities of several intestinal peptidases. From these data, we concluded that GI function is essentially normal in patients with CRF and postulate that this normality, which is in contrast to previous findings, is related to recent advances in the clinical management of uremic patients.

Vestibular disorders caused by defective enzyme mechanisms in the small intestine.

A group of patients suffering from long periods of unsteadiness and presenting hyperreflexia in response to torsion swing and/or caloric stimulations were found to have abnormal results in glucose and lactose tolerance tests, but normal or reduced insulin liberation. Biopsies of the jejunal mucosa have shown abnormal enzyme activity or deficiencies in transport mechanisms. The use of a diet suited to each specific deficiency resulted in a high percentage of relief from the vestibular symptoms of these patients.

[A simple method to detect disaccharides deficiency]. / Métodos simples de detección de deficiencias de disacaridasas.

A simple method, easy to perform during an endoscopic procedure, fast and inexpensive, that allows detecting deficiencies in lactase, sucrase or maltase activities is presented. Briefly, method consists in placing a duodenal biopsy sample in an adequate vial containing lactose, sucrose or maltose solution during a few minutes, and then, adding a few drops of a glucose reactive from commercial origin. Presence of any enzymatic activity is demonstrated when released glucose from any of the disaccharides chosen reacts with the second reactive, turning solution to a red colour. Its utility is discussed and compared with other diagnostic methods.

[Congenital saccharase-isomaltase defect--diagnostic difficulties]. / Congenitalis saccharase-isomaltase defektus--a diagnózis nehézségei.

Seven patients with congenital sucrase-isomaltase deficiency corresponding to the known diagnostic criteria and five patients having combined disaccharidase deficiencies with unusual pattern characterized by more pronounced sucrase than lactase deficiency were found among 505 children investigated by first jejunal biopsy. On the base of the case histories, the complications and the comparative evaluation of patient and control groups' data (the latter consisted of nine untreated coeliacs) the congenital sucrase-isomaltase deficiency was found to make the patients to be especially susceptible to enteral infections and consequently to postinfectious intestinal damages. These complicated cases do not correspond to the classic diagnostic criteria of the congenital enzyme deficiency causing diagnostic errors. In order to avoid the misdiagnoses the authors suggest modification of the diagnostic criteria of congenital sucrase-isomaltase deficiency as follows: the diagnosis of congenital enzyme deficiency might be verified in spite of mild histological signs and hypolactasia if the degree of lactase deficiency repeatedly and significantly is exceeded by the degree of sucrase deficiency.

[Congenital saccharase-isomaltase deficiency: a six-year survey (author's transl)]. / Kongenitaler Saccharase-Isomaltase-Mangel. Beobachtungen über einen Zeitraum von 6 Jahren

Saccharase-isomaltase deficiency was discovered in five children. The diagnosis was made on the basis of an abnormal oral saccharose loading response and demonstrating decreased activity of intestinal saccharase and isomaltase in the presence of normal small-intestinal mucosa. Three children failed to thrive, and all had recurrent diarrhoea. The diagnosis was made in children aged six to twenty-two months. Treatment consisted of saccharose-free diet or feeding with an enzyme preparation, Bi-Myconase. Saccharose-containing foods were increasingly tolerated beyond the second year of life so that children aged 2 1/2 to 3 1/4 years no longer required special treatment.

TESS line: a laboratory line of the musk shrew (Suncus murinus, Insectivora), triple-homozygous for the curly hair (ch), cream coat-color (cr) and red-eyed dilution (rd) genes and segregating the sucrase deficients (suc/suc).

The TESS line, the first tester line of the Suncus has been developed. The TESS shrews are homozygous for three morphological mutant genes, ch, cr and rd. The gene (suc) for sucrase activity deficiency in intestinal brush-border membranes also exists in the line, and its frequency was 34.3%. The deficients could easily be identified by the drastic body-weight losing up to more than 15% of the initial weight, that aroused two days after replacement of the drinking water for its 10%-sucrose solution. The TESS shrews have been maintained as a closed-colony consisting of more than 30 individuals, and will be utilized in linkage analysis with the four loci (ch, cr, rd and suc).