Impaired intestinal immunity and barrier function: a cause for enhanced bacterial translocation in alcohol intoxication and burn injury

Choudhry, Mashkoor A.; Rana, Shadab N.; Kavanaugh, Michael J.; Kovacs, Elizabeth J.; Gamelli, Richard L.; Sayeed, Mohammed M.

doi:10.1016/j.alcohol.2004.05.004

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Volume 33, Issue 3 , Pages 199-208, July 2004

Impaired intestinal immunity and barrier function: a cause for enhanced bacterial translocation in alcohol intoxication and burn injury

Mashkoor A. Choudhry
- Center for Surgical Research, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Corresponding author. Center for Surgical Research, University of Alabama at Birmingham, Volker Hall G 094, 1670 University Boulevard, Birmingham, AL 35294, USA. Tel.: +1-205-975-9712; fax: +1-205-9759715.
Shadab N. Rana
- Center for Surgical Research, University of Alabama at Birmingham, Birmingham, AL 35294, USA
Michael J. Kavanaugh
- Burn and Shock Trauma Institute, Loyola University Chicago Medical Center, Maywood, IL 60153, USA
Elizabeth J. Kovacs
- Burn and Shock Trauma Institute, Loyola University Chicago Medical Center, Maywood, IL 60153, USA
- Alcohol Research Program, Loyola University Chicago Medical Center, Maywood, IL 60153, USA
- Department of Surgery, Loyola University Chicago Medical Center, Maywood, IL 60153, USA
- Department of Cell Biology, Neurobiology and Anatomy, Loyola University Chicago Medical Center, Maywood, IL 60153, USA
Richard L. Gamelli
- Burn and Shock Trauma Institute, Loyola University Chicago Medical Center, Maywood, IL 60153, USA
- Alcohol Research Program, Loyola University Chicago Medical Center, Maywood, IL 60153, USA
- Department of Surgery, Loyola University Chicago Medical Center, Maywood, IL 60153, USA
Mohammed M. Sayeed
- Burn and Shock Trauma Institute, Loyola University Chicago Medical Center, Maywood, IL 60153, USA
- Alcohol Research Program, Loyola University Chicago Medical Center, Maywood, IL 60153, USA
- Department of Surgery, Loyola University Chicago Medical Center, Maywood, IL 60153, USA

Received 9 March 2004; received in revised form 12 May 2004; accepted 19 May 2004.

Editor: T.R. Jerrells

Abstract

Alcohol intoxication is being recognized increasingly as the major factor in pathogenesis after burn injury. Findings from multiple studies support the suggestion that, in comparison with burn-injured patients who sustained injury in the absence of alcohol intoxication, burn-injured patients who sustained injury under the influence of alcohol exhibit higher rates of infection and are more likely to die. Thus, infection becomes the primary cause of death in burn-injured patients. Because the intestine is considered to be a major source of bacteria, studies in experimental animals have been designed to examine whether alcohol intoxication before burn injury enhances bacterial translocation from the intestine. Results of these studies have shown a several-fold increase in bacterial translocation from the intestine in the group of animals receiving combined insult of alcohol intoxication and burn injury compared with findings for the groups receiving either insult alone. Alcohol intoxication and burn injury independent of each other have also been shown to cause an increase in bacterial translocation. The gastrointestinal tract normally maintains a physical mucosal and immunologic barrier that provides an effective defense in keeping bacteria within the intestinal lumen. However, in injury conditions these defense mechanisms are impaired. Intestinal bacteria consequently gain access to extraintestinal sites. Intestine-derived bacteria are implicated in causing systemic infection and in subsequent multiple organ dysfunction in both immunocompromised patients and patients with injury, such as burn and trauma. In this article, we discuss three potential mechanisms that are likely to contribute to the increase in bacterial translocation in alcohol intoxication and burn injury: (1) increase in bacterial growth in the intestine, (2) physical disruption of mucosal barrier of the intestine, and (3) suppression of the immune defense in the intestine.

Keywords: Ethanol, Thermal injury, Infection, Mucosal immunity, Cell signaling