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| Vol. 21, No. 18 |
| October 1, 1999 |
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Promoting a Healthy Intestinal Recovery After Traumatic Injury by Colleen O'Brien The University of Texas -Houston Medical School "The gut is an incredible immunologic organ," emphasizes Dr. Frederick Moore, chief of general surgery at The University of Texas -Houston Medical School, one of several major players at the Trauma Research Center, which just received a renewal NIH award for $4 million over the next four years. "Our hypothesis is that if you do not feed the GI tract, you place it in jeopardy for failure. But if you feed it too aggressively with enteral, (small intestine) tube feedings, then the bowel may die."
Dr. Moore collaborates with four other NIH grant co-principal investigators at the UT-Houston Medical School, including Dr. Frank Moody, Denton A. Cooley Professor of Surgery, and director of the Trauma Research Center; Dr. Norman Weisbrodt, professor, department of integrative biology and pharmacology; Dr. David Mercer, associate professor of surgery and chief of the surgical services at LBJ Hospital; and Dr. Bruce Kone, associate professor, internal medicine/renal diseases. Says Dr. Moody, who tracks intestinal pathogens, "The Trauma Research Center here at Memorial-Hermann is the largest in the country. It's a unique, multi-disciplinary entity that brings together numerous scientists from the basic sciences, as well as the clinical and surgical sides of medicine." Dr. Moore specializes in finding ways to prevent patients' demise. His focus is on averting the shock response in those who've had trauma and tremendous loss of blood to their internal organs, from slipping into ileus - basically the shutting down of the intestines - leading to infection and death. Multiple organ failure, or MOF, commonly occurs in trauma victims these experts will tell you. It's the leading cause of death where physical injury to the internal organs has occurred. And unlocking the role of the gut in MOF is the leading life-and-death puzzle for this team of experts. In the labs, co-investigator Dr. Norm Weisbrodt specializes in studying the gut's motility in cases of MOF. He uses nitric oxide to evaluate how much or how little it's needed in peristaltic action and how to regulate it after traumatic internal injury has occurred. Dr. David Mercer studies the inhibition of gastric acid secretion in cases with severe injury and sepsis and the resultant growth of harmful bacteria within the stomach. It's known, for instance that pneumonia will occur in 10-65 percent of ICU (intensive care unit) patients. Of those patients, the death rate is 13-55 percent. Dr. Bruce Kone studies samples of traumatized animal and human gut tissue at the molecular level. He and his associates hope to develop novel therapies to guide genetic MOF healing. Dr. Moore takes another bite of his ripe banana. "Oops, there's a brown spot. Slipping into my esophagus right now, down my alimentary canal and into my GI tract." Filled with immune cells, says Dr. Moore, his GI tract was now sampling antigens, or abnormal bacteria, from the banana. "That's how babies don't get infected when they're milking on their mother. Their mother has a mature immune system. It's processing all the antigens and the child is receiving the benefits of them through the breast milk. Until the baby gets old enough, it doesn't have an immune system." But the gut is processing all this and signaling to the rest of the body. That's the reason, Dr. Moore admits, that special, immune-enhancing diets fascinate him. "Somehow by feeding the gut with arginine, glutamine, omega-3 fatty acids and nucleic components, you're preventing infections." It's called immuno-nutrition, and Dr. Moore states it's really a medicine. Having worked with over 4,000 MOF patients over the years who've been fed enterally, Moore emphasized "What we know is that if we feed them early, they do better." The trick is, at what point do you intervene in the gut's function, and how much? "That's one of the keys to the puzzle we intend to find out."
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