On the one hand, small bowel ischemia is related to acute reduction of enterocyte mass and loss of gut barrier function by epithelial lifting of villi. On the other hand, systemic inflammatory response syndrome (SIRS) and sepsis could be linked to an acute dysfunction of enterocytes without enterocyte reduction. Citrulline is an amino acid mainly synthesized by small bowel enterocytes. Various contexts of chronic and acute reduction of enterocyte mass have been correlated with low plasma citrulline concentration. Critically ill patients with shock have an acute reduction of enterocyte mass and reduced gut citrulline synthesis, leading to a low plasma citrulline concentration. Acute intestinal failure could be defined as an acute reduction of enterocyte mass and/or acute dysfunction of enterocytes, associated or not with loss of gut barrier function. The influence of SIRS and acute renal failure on plasma citrulline concentration and the value of this concentration as an indicator of acute intestinal failure in critically ill patients must be further evaluated.

In critically ill patients, low plasma citrulline at 24 h is an independent factor of mortality and could be a marker of acute intestinal failure.

In critically ill patients, enterocyte damage is frequent, and it is significantly associated with shock and 28-day mortality. The link between intestinal fatty acid-binding protein and plasma citrulline concentrations in critically ill patients needs to be further evaluated.

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Guinea pig endometrial stromal cells were cultured in serum-free medium to assess the effects of growth factors and ovarian steroids on cell proliferation. When the cells were made quiescent by serum depletion, [3H]thymidine incorporation was increased by the addition of insulin plus epidermal growth factor (EGF), reaching a peak after 24 h of stimulation. This effect was dose-dependent. Both factors acted synergistically. Estradiol-17 beta (E2), either alone or with various concentrations of growth factors, had no mitogenic effect. Thus, cell proliferation appeared to be estrogen-insensitive, despite a high level of estrogen receptors (19,000 sites per cell). The integrity of these receptors was checked by transfecting cells with a plasmid containing an estrogen-responsive element linked to a CAT gene: E2-induced CAT activity was reduced by the antiestrogen ICI 164,384. Despite the presence of progesterone receptors, the cells, either primed with E2 or not, were not growth-stimulated by progesterone. E2 had no effect on cells cultured in the presence of dextran-coated charcoal-stripped serum. Thus, whatever the culture conditions, stromal cells with functional estrogen receptors were insensitive to the putative mitogenic effects of E2 and progesterone. However, they were highly responsive to the mitogenic effects of insulin and EGF.