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Leonard L. Go, MD; Henri R. Ford, MD; Simon C. Watkins, PhD; Patrick J. Healey, MD; Craig T. Albanese, MD; Alice Donhalek, MSc; Richard L. Simmons, MD; Marc I. Rowe, MD

Arch Surg. 1994;129(11):1184-1190.

Abstract
Objective
To elucidate the mechanisms of bacterial translocation in animals fed a conventional formula by correlating transmucosal bacterial passage in vitro with the structural characteristics of the neonatal intestinal mucosa.

Design
Newborn rabbits were randomized to receive a conventional formula or breast milk. Bacterial translocation to the mesenteric lymph nodes, liver, and spleen was quantitated after 7 days, and transmucosal passage of bacteria was measured in vitro using the Ussing chamber. The mucosal membranes were examined by light, transmission electron, and confocal laser scanning microscopy.

Results
Bacterial passage was rarely seen in the breast milk-fed animals in contrast to the formula-fed animals. Unlike the normal-appearing membranes from breast milk—fed animals, the epithelial cells of formula-fed animals were vacuolated but healthy, with normal polarization and microvillus border by confocal laser scanning microscopy. Villi of formula-fed animals were less densely packed than those of the breast milk—fed animals. Bacterial adhesion, internalization, and transmucosal passage were seen only in membranes from formulafed animals. Transmission electron microscopy demonstrated bacteria incorporating into the epithelial surface through an active phagocytic process, with rearrangement of the actin cytoskeleton. Once internalized, these bacteria were seen within the cytoplasmic vacuoles and subsequently in the submucosa. No bacteria passed between epithelial cells.

Conclusion
Morphological changes in the intestinal mucosa of formula-fed newborn rabbits may increase permeability to bacteria.

(Arch Surg. 1994;129:1184-1190)

Footnotes
From the Departments of Surgery (Drs Go, Ford, Healey, Albanese, Simmons, and Rowe) and Cell Biology and Physiology (Dr Watkins and Ms Donhalek), University of Pittsburgh (Pa) School of Medicine.

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