Searching Biomarkers of Acute Intestinal Ischemic Injuries
Searching Biomarkers of Acute Intestinal Ischemic Injuries
The aim of the SURVIBIO study is to characterize accurate biomarkers for acute mesenteric
 ischemia, in particular at early stages.

 In the study, the development of biomarkers will be based on the analysis of human biological
 samples from patients and controls that will be conserved in a biological library. Samples
 will be analysed in the Laboratory for Vascular Translational Sciences (LVTS, Inserm U1148),
 in the Department of Biochemistry (Pr Puy, Dr Peoc'h), in Paris V university , in Imperial
 College of London (Pr Dumas), in Jacques Monod Institute and in Maastricht University Medical
 Center . The candidate markers will be determined according to an a priori method (form
 markers already described in the literature) and with no a priori strategy using -omics
 methods.
Acute intestinal ischemic injury (i3), or intestinal infarction, is an extremely severe
 condition that affects the intestine, with a mortality rate that is over 80%, and with major
 anatomical and functional consequences for the surviving patients, mainly because of
 intestinal resections, which are responsible for chronic intestinal failure, long term
 parenteral nutrition and an important financial impact on public health.

 Even though the incidence of i3 is largely underestimated (mainly because of the lack of
 knowledge of diagnostic), more than 1000 patients have been surveyed in Paris's hospital
 through Information Systems Medicalization Program (K550) searching in 2014. Furthermore, i3
 represents a digestive emergency for which the only known prognostic factors are the
 precocity of the diagnostic and treatment.

 Investigators have opened in January 2016 the first structure for intestinal vascular
 emergency (SURVI) within the Groups University Hospitals Paris-Nord Val de Seine. This unique
 and innovative intensive care structure, which is dedicated to the multidisciplinary
 treatment of acute mesenteric ischemia, doesn't have any equivalent, and allows the
 constitution of cohorts with biological and tissular bio-banking.

 SURVI provides the patients suffering from intestinal ischemia a "gut and life staving
 strategy", through a multimodal and multidisciplinary management (M3). M3 is based on a
 simple algorithm and it brings together experts in intestinal and vascular pathologies that
 come from different medical disciplines, such as gastroenterology, interventional radiology,
 vascular surgery, digestive surgery, anaesthesiology and cardiology.

 Therefore, the therapeutic strategies aim to limit the complications, to protect the viable
 intestine, and to remove the necrotic intestine.

 Beside the therapeutic strategy that is proposed by SURVI, improvement of the clinical
 treatment needs to be associated with the finding of new diagnostic tools of intestinal
 ischemia, that will have to be early, sensitive and specific, as it is the case for troponin
 in the context of myocardium ischemia.

 So far, no biomarker that is sensible and specific enough for the early diagnostic of
 intestinal ischemia has been found. The CT-scan which is the only diagnostic tool that allow
 investigators to confirm the diagnostic, in theory, presents a lack of sensibility for the
 early, not complicated and non-occlusive forms of the disease.

 The main prognostic factor of acute intestinal ischemia is the precocity of diagnostic and
 treatment. Indeed, the mortality rate sharply increases with the occurrence of intestinal
 necrosis. The problem is that the phases of the disease that precede intestinal necrosis are
 extremely difficult to diagnose without any biomarker that is sensible and specific enough.
 Therefore, it is of major importance for the clinician to be provided with one or more
 biomarker that will help to validate or invalidate the diagnostic of intestinal ischemia, in
 the context of any acute abdomen condition.

 The aim of the SURVIBIO study is therefore to characterize biomarkers for early diagnostic of
 acute mesenteric ischemia.

 In the prospective part of the study, the development of biomarkers will be based on analysis
 of human biological samples from patients and controls that will be conserved in a biological
 library and that will be analysed in the Laboratory for Vascular Translational Sciences
 (LVTS, Inserm U1148) and in the Department of Biochemistry (Pr Puy, Dr Peoc'h). Among the
 candidate markers, investigators will analyse I-FABP (molecule associated with enterocyte
 damage at the top of the intestinal villi), D-Lactate (which is specific of intestinal
 E.coli, and which indicates bacterial translocation, when found in the blood), Citrulline
 (which is a marker of the functional profile of enterocytes) and ischemia-modified albumin.

 In addition to this approach to "candidate" markers based on very brief data from the
 literature, investigators also wish to develop an unconventional approach, combining a
 medical approach of proteomics, combining tandem spectrometry with MALDI and establishment of
 cytokine profile via a multi-complex approach to the emergence of new potential diagnostic
 biomarkers. The profiles obtained for patients with ischemia are available at profiles
 obtained on "control" patients, unaffected.
Inclusion Criteria:

 -  age> 18 years

 -  Acute abdominal pain requiring an injected abdominal injected CT scan, at best at
 non-injected / early arterial / portal time

 -  Admitted or attended in Beaujon and / or Bichat hospitals

 -  Patient covered by a social security scheme

 -  Written consent

 Exclusion Criteria:

 • lack of abdominal CT scan