[Plasma citrulline concentration as a biomarker of intestinal function in short bowel syndrome and in intestinal transplant]

An Pediatr (Barc). 2013 Oct;79(4):218-23. doi: 10.1016/j.anpedi.2013.02.007. Epub 2013 Mar 23.
[Article in Spanish]


Introduction: Citrulline is a non-essential amino acid produced solely in the enterocyte. The aim of this study was to analyse the role of serum citrulline as a biomarker of enterocyte load in children with intestinal failure due to short bowel syndrome (SBS) and its relationship to enteral adaptation.

Material and methods: Plasma citrulline concentration was determined by chromatography (normal value>15 μmol/L) in 57 patients (age 0.5-18 years) admitted to our Intestinal Rehabilitation Unit with intestinal failure. Those who were dehydrated, with renal insufficiency, or other conditions able to modify the results were excluded. Patients were divided into 4 groups: group i: SBS totally dependent on parenteral nutrition (PN); group ii: SBS under mixed enteral-parenteral nutrition; group iii: IF weaned from PN after a rehabilitation period; group iv: small bowel transplanted patients weaned from PN and taking a normal diet.

Results: The mean ± SD plasma citrulline values were: group i (n=15): 7.1 ± 4.1; group ii (n=11): 15.8 ± 8.9; group iii (n=13): 20.6 ± 7.5; group iv (n=25): 28.8 ± 10.1. Values were significantly lower in group i in comparison with groups ii-iii-iv (P<.001), and in group ii in comparison with groups iii-iv (P<.001). A low citrulline was associated with remnant small bowel length (P<.001, r=0.85). In group iv citrulline levels decreased >50% in 3 patients who developed moderate-severe rejection, and in one patient who developed viral enteritis.

Conclusions: 1. Plasma citrulline could be a sensitive and specific biomarker of the residual functional enterocyte load. 2. It is related to enteral feeding tolerance. 3. Its prognostic value in the process of intestinal adaptation and as a rejection marker in small bowel transplanted patients needs to be confirmed.

Keywords: Biomarcador; Biomarker; Citrulina; Citrulline; Fracaso intestinal; Intestinal failure; Intestinal transplantation; Nutrición parenteral; Parenteral nutrition; Short bowel syndrome; Síndrome de intestino corto; Trasplante intestinal.

Publication types

  • English Abstract

MeSH terms

  • Adolescent
  • Biomarkers / blood
  • Child
  • Child, Preschool
  • Citrulline / blood*
  • Enterocytes / physiology
  • Female
  • Humans
  • Infant
  • Intestines / physiopathology*
  • Intestines / transplantation*
  • Male
  • Postoperative Complications / blood*
  • Postoperative Complications / physiopathology*
  • Short Bowel Syndrome / blood*
  • Short Bowel Syndrome / physiopathology*


  • Biomarkers
  • Citrulline