Facteurs trophiques : perspectives thérapeutiques de l'utilisation des facteurs de croissance et pharmaconutriments dans l'insuffisance intestinale

During intestinal insufficiency, improving intestinal functions may limit the needs for prolonged parenteral nutrition. Gut trophicity is supported by the intake of nutrients, polyamines, and nitrogenous pharmaconutrients such as glutamine, arginine and ornithine oxoglurate, but also growth factors acting as hormones or locally. Intestinal cell proliferation is stimulated by growth hormone and glucagonlike peptide-2, as well as by the insulin growth factor, epidermal growth factor, transforming growth factor-alpha, while it is inhibited by transforming growth factor-beta. The evaluation of combined therapies with glutamine, growth hormone and a specialized diet in short bowel patients has yielded conflicting results. The clinical use of GLP-2, alone or in combination, looks promising but need to be evaluated. The knowledge about intestinal growth factors and pharmaconutrients is increasing rapidly and should lead to innovative therapeutic strategies of intestinal insufficiency.