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Effect of long-term oral glutamine supplements on small intestinal permeability in patients with Crohn's disease.

BACKGROUND: Glutamine is a major fuel and an important nitrogen source for the small intestinal cell. It plays a key role in maintaining mucosal cell integrity and gut barrier function. Increased permeability may be a factor in the pathogenesis of Crohn's disease and may be an interesting parameter in the follow-up of the disease. Therefore, the aim of this study was to examine whether oral glutamine supplements are able to restore an increased intestinal permeability in patients with Crohn's disease. METHODS: The inclusion criteria for the study were Crohn's disease and a disturbed small intestinal permeability for 51Cr-EDTA. Of 38 patients screened, 18 had an increased permeability (6 hours urinary excretion >1.1% of label recovered in urine). Fourteen patients were included in the study and were randomized to receive either oral glutamine (7 g three times per day; n = 7) or placebo (7 g glycine three times per day; n = 7) in addition to their normal treatment during a 4-week period. The study was performed in a double-blind manner. RESULTS: Baseline permeability (mean +/- SD) was 2.32%+/-0.77% dose in the glutamine group and 2.29%+/-0.67% dose in the placebo group. Permeability did not change significantly after glutamine (3.26%+/-2.15% dose) or after placebo (2.27%+/-1.32% dose). There was no significant effect on plasma glutamine, plasma glutamate, plasma ammonium, Crohn's disease activity index, C-reactive protein, or nutritional status. CONCLUSIONS: Oral glutamine supplements, in the dose administered, do not seem to restore impaired permeability in patients with Crohn's disease.

Administration, Oral↗

Lysophosphatidylcholine increases rat ileal permeability to macromolecules.

The influence of lysophosphatidylcholine (LPC) on macromolecular permeability in the distal ileum has been studied. Using a rat experimental model, we determined the intestinal permeability to different sized dextrans (3000-70 000 daltons) and bovine serum albumin (BSA) in the absence and presence of LPC. We also examined the morphology of the ileal mucosa after deposition of LPC in the gut lumen, and determined N-acetyl-beta-glucosaminidase, 5'-nucleotidase, and alkaline phosphatase activities in suspensions of isolated mucosal cells and different concentrations of LPC. We found that 20 mM LPC damaged the ileal mucosa and that it increased its permeability to all the molecules investigated. Moreover, mixtures of mucosal cells and 0.01-1 mM LPC showed increased N-acetyl-beta-glucosaminidase activity: the higher the LPC concentration, the higher the enzyme activity. These findings indicate that LPC, a naturally occurring surfactant in the intestine, might damage mucosal cells and release lysosomal enzyme activity, and that higher LPC concentrations may impair the mucosal barrier function and increase the gut permeability to macromolecules such as proteins. This could have relevance to the development of various disease states, in which increased intestinal absorption of macromolecules is of importance.

Animals↗

Host immune responses and intestinal permeability in patients with jaundice.

BACKGROUND: Systemic endotoxaemia is implicated in the development of complications associated with obstructive jaundice. The aims of these studies were to assess the systemic immune response to intervention in patients with jaundice and to compare the effects of surgical and non-surgical biliary drainage on host immune function and gut barrier function. METHODS: In the first study, 18 jaundiced and 12 control patients were studied to assess systemic immune responses before and after intervention. In the second study, immune responses and gut barrier function were assessed following surgical and non-operative biliary decompression in 45 patients with jaundice. RESULTS: Endotoxin antibody concentrations fell significantly in patients with jaundice immediately after surgical intervention, but not after non-operative biliary drainage. This decrease was associated with a significant increase in serum P(55) soluble tumour necrosis factor (sTNF) receptor concentration (5.3 versus 10.5 ng/ml; P < 0.001), urinary excretion of P(55) TNF receptors (21.4 versus 78.8 ng/ml; P = 0.002) and intestinal permeability (lactulose : mannitol ratio 0.032 versus 0.082; P = 0.048). Intestinal permeability was significantly increased in patients with jaundice compared with controls (0.033 versus 0.015; P = 0.002). CONCLUSION: These data suggest that obstructive jaundice is associated with impaired gut barrier function and activation of host immune function that is exacerbated by intervention. Surgery causes an exaggerated pathophysiological disturbance not seen with non-operative biliary drainage procedures.

Antibodies↗

Effects of budesonide on P-glycoprotein expression in intestinal cell lines.

BACKGROUND AND PURPOSE: P-glycoprotein (P-gp) is an important efflux transporter that supports the barrier function of the gut against invading antigens and against administered drugs. Since glucocorticoids, such as budesonide, are frequently used during inflammatory bowel disease we investigated how budesonide influences P-gp expression in different intestinal cell lines. EXPERIMENTAL APPROACH: LS180 and Caco-2 cells were incubated with budesonide and changes in P-gp expression were determined on mRNA, protein and functional level. The mRNA expression levels of glucocorticoid receptor (GR) and pregnane X receptor (PXR) were determined in these cell lines. PXR receptor was transiently transfected into Caco-2 cells. KEY RESULTS: Budesonide showed an induction of P-gp in LS180 cells and a down-regulation in Caco-2 cells. Expression levels of nuclear receptors revealed high expression of PXR only in LS180 cells and exclusive expression of GR in Caco-2 cells. Mifepristone, an anti-glucocorticoid, could not reverse the down-regulation of P-gp by budesonide in Caco-2 cells. In PXR-transfected Caco-2 cells the budesonide-mediated down-regulation of P-gp was abolished. Furthermore the expression of cytochrome P450 3A4 (CYP3A4), another PXR target gene, was induced in PXR-transfected Caco-2 cells after budesonide treatment. CONCLUSIONS AND IMPLICATIONS: Budesonide has the potential to influence MDR1 expression in vitro. In LS180 cells, the induction of MDR1 by budesonide probably is mediated via PXR. The mechanism of the down-regulation in Caco-2 cells still remains unclear, but GR does not seem to be involved. Further studies are required to evaluate how budesonide alters P-gp expression in vivo.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

[Metabolism and nutritional support after burn injury].

The nutritional status of the burn patient plays a major role in the ability to ward off an infectious challenge. The immune and inflammatory systems can be modulated by nutritional support, and therefore this article focuses on the nutritional support after burn injury. The hypermetabolic response that occurs after burn injury is characterized by a greater magnitude than that observed after any other form of trauma. The hypothesis that gut-or wound-derived bacterial translocation is one of the major triggers of the hypermetabolic response has attracted attention recently. The first set of goals of nutritional support is to prevent starvation and nutrient deficiencies, and the second is to provide the correct amount of nutrients prevent injury-related adverse physiologic complications. The route and timing of nutritional support are most important. Enteral alimentation appears to preserve the host immune function and to attenuate the hypermetabolic response by preserving the intestinal mucosal barrier. Immediate enteral feeding is superior to delayed enteral feeding, even though only limited amounts of enterally administered nutrients are absorbed during the early days postburn.

Bacterial Infections↗

Microbial and functional shifts between flare and remission in a single-center cohort of children with inflammatory bowel disease.

BACKGROUND: Gut microbial dysbiosis is central to the pathogenesis of inflammatory bowel disease (IBD). While gut microbiome differences between patients with and without IBD are well established, microbiome changes associated with disease activity and remission remain limited, particularly in paediatric populations. AIM: To examine intra-individual taxonomic and functional gut microbiome changes during transition from active flare to remission under maintenance immunosuppression in a pilot single-center Singapore cohort of children with IBD. METHODS: Paired stool samples and clinical data were collected from seven patients with paediatric IBD [5 Crohn's disease (CD), 2 ulcerative colitis; &#x2264; 18 years] during active disease/flare (visit 1; Pediatric CD Activity Index/Pediatric Ulcerative Colitis Activity Index &#x2265; 10) and subsequent clinical remission (visit 2; Pediatric CD Activity Index/Pediatric Ulcerative Colitis Activity Index < 10). Samples underwent shotgun metagenomic sequencing for high-resolution taxonomic profiling and functional annotation of Kyoto Encyclopaedia of Genes and Genomes pathways. RESULTS: Gut microbial diversity was reduced during flare compared to remission, with Actinobacteria abundance significantly higher in remission. Two distinct microbial clusters differentiated flare and remission states: The remission cluster was enriched with Bifidobacterium adolescentis, Bifidobacterium dentium, Lactobacillus gasseri, Faecalibacterium prausnitzii, while the flare state showed increased Klebsiella pneumoniae. Remission was further characterized by a downregulation of pathogenic microbes and an upregulation of beneficial microbes including a higher abundance of the butyrate producer Anaerostipes hadrus (P = 0.046). Microbial functional genes enriched in remission were predominantly associated with metabolic pathways including vitamin and cofactor biosynthesis, as well as carbohydrate, amino acid, and lipid metabolism. CONCLUSION: The transition from flare to remission in Singaporean children with IBD is characterized by functional remodeling of the gut microbiome, which may contribute to recovery processes related to intestinal barrier integrity, cellular maintenance, and tissue repair. Targeted modulation of the gut microbiome may help sustain remission in paediatric IBD.

Functional shift↗

The role of protein kinase C isoforms in modulating injury and repair of the intestinal barrier.

Gastrointestinal cells express a diverse group of protein kinase C (PKC) isoforms that play critical roles in a number of cell functions, including intracellular signaling and barrier integrity. PKC isoforms expressed by gastrointestinal epithelial cells consist of three major PKC subfamilies: conventional isoforms (alpha, beta1, beta2, and gamma), novel isoforms (delta, epsilon, theta, eta, and mu), and atypical isoforms (lambda, tau, and zeta). This review highlights recent discoveries, including our own, that some PKC isoforms in gastrointestinal epithelia monolayer cell culture are involved in injury to, whereas others are involved in protection of, intestinal barrier integrity. For example, certain PKC isoforms aggravate oxidative damage, whereas others protect against it. These findings suggest that the development of agents that selectively activate or inhibit specific PKC isoforms may lead to new therapeutic modalities for important gastrointestinal disorders such as cancer and inflammatory bowel disease.

Animals↗

[Zinc acts as a protective agent on the mucosal barrier in experimental TNBS colitis].

The aim of this study was to analyze the effect of enterally given zinc on the impaired epithelial barrier function in experimental TNBS colitis in rats. Rats in therapy group were zinc-fed in therapeutic dose. 48 hours after induction of TNBS colitis the rats were killed, the distal colon was resected and mounted into an Ussing chamber. The following electrophysiological measurements were carried out: 1. Flux measurements for Na+ and mannitol as a parameter of paracellular permeability, 2. Resistance measurements of the colon, distinguishing between pure epithelial resistance and resistance of the subepithelial tissue. In TNBS colitis we found a marked increase of both fluxes as a parameter of enhanced paracellular permeability (factor 3). Further there was a drastic reduction of total resistance, and especially of pure epithelial resistance indicating a massive epithelial barrier defect. In rats treated by zinc the increase of paracellular permeability was increased only by a factor of 2, and there was only a moderate decrease of resistance. For the first time we demonstrated zinc to have a protective effect on damaged mucosal barrier function in TNBS colitis. These results confirm the data collected in guinea pigs with malnutrition, whose intestinal integrity could be improved by zinc. Further studies are necessary in order to test whether this protective effect of zinc on mucosa barrier in experimental colitis may be relevant also in human ulcerative colitis.

Administration, Oral↗

Cellular signal level of cyclic AMP and functional integrity of the small bowel after ischemic preservation: an experimental pilot study in the rat.

The intestinal mucosa is one the tissues most sensitive to ischemia. Anoxia of the gut is known to result in an early impairment of cellular permeability and transcapillary barrier function upon reperfusion. In vitro, an increased permeability of endothelial cell monolayers could be shown to be related to a decrease in cellular content of cyclic AMP (cAMP). Thus, the present study was aimed at investigating the role of the cellular cAMP second messenger signal in the context of intestinal ischemia/reperfusion injury after cold preservation. Segments of the upper jejunum were isolated from Wistar rats with vascular pedicle and flushed with 10 ml of UW preservation solution. The intestinal lumen was rinsed with 10-15 ml of UW solution and the organ was stored immersed in UW solution at 4 degrees C for 4 or 18 h. After 18 h of cold ischemic storage structural and functional integrity of the preparation was tested by perfusion via the vascular system with modified Krebs-Henseleit buffer and the intestinal lumen with saline solution (containing 200 mg % of galactose) for 30 min. In half of the experiments, dibutyryl-cAMP a membrane permeable cAMP analogue, was admixed to the flush solution (2 mM). It was found that tissue levels of cAMP linearily decreased to 34% during 18 h of ischemic preservation in UW. Addition of dibutyryl cAMP significantly improved postischemic recovery of the intestinal preparations by decreasing cellular loss of lactic dehydrogenase (18.2 +/- 4.6 vs. 7.6 +/- 2.6 U/I) and improving intestinal absorbtion of galactose from the luminal circuit (0.18 +/- 0.14 vs. 0.36 +/- 0.14 mg %) after 30 min of oxygenated reperfusion, but was not effective to reduce transcapillary water loss into the gut lumen. It is concluded that the anoxia-related decrease of the cellular cAMP level may represent a codeterminator influencing postischemic recovery of the small bowel and that the control of the cAMP signal of ischemic intestines might improve the quality of cold preservation of the gut prior to transplantation.

Animals↗

Food proteins and gut mucosal barrier. II. Differential interaction of cow's milk proteins with the mucous coat and the surface membrane of adult and immature rat jejunum.

Two in vitro intestinal models were used to investigate postnatal maturational changes of the gut barrier functions. Microvillus membrane (MVM) preparations were studied for surface binding, and everted gut sacs were studied for mucous coat binding, breakdown and uptake of radioiodinated bovine serum albumin (BSA), and beta-lactoglobulin (beta-LG). Surface binding of these proteins to MVM was weak and nonspecific. There was more binding of both proteins to immature MVM (BSA: newborns, 2.74 +/- 0.52%, adults, 1.08 +/- 0.17%, p less than 0.001; beta-LG: newborns, 6.30 +/- 0.54%; adults, 2.05 +/- 0.07, p less than 0.001). In contrast to MVM binding characteristics, mucous coat binding of the cow's milk proteins to immature gut sacs was significantly less (BSA: preweanlings, 0.94 +/- 0.30 micrograms 125-I-protein Eq/mg mucosal protein; adults, 3.06 +/- 0.74, p less than 0.001; beta-LG: preweanlings, 5.61 +/- 1.48; adults, 9.83 +/- 1.33, p less than 0.001). Protein binding and uptake were correlated in the immature animals (r = 0.76, p less than 0.001 for BSA and r = 0.85, p less than 0.001 for beta-LG). More beta-LG was bound and taken up than BSA in the preweanlings (p less than 0.001). Trichloroacetic acid precipitation studies showed that, even in the immature rats, beta-LG was much more readily broken down by mucosa-associated enzymes than BSA. Immature animals showed less protein breakdown than adult controls. Decreased protein breakdown and mucous coat binding as well as increased MVM binding may account for the increased uptake of intact food antigens in the newborn.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Intestinal epithelial tight junctions as targets for enteric bacteria-derived toxins.

The application of a multidisciplinary approach to study bacterial pathogenesis, along with the recent sequencing of entire microbial genomes have made possible discoveries that are changing the way scientists view the bacterium-host interaction. Today, research on the molecular basis of the pathogenesis of infectious diarrheal diseases of necessity transcends established boundaries between microbiology, cell biology, intestinal pathophysiology, and immunology. Novel multidisciplinary approaches led to the discovery of new bacteria-host cell interactions involving signals regulating intestinal permeability through the modulation of cell cytoskeleton and intercellular tight junctions (TJ). A century ago, TJ were conceptualized as a secreted extracellular cement forming an absolute and unregulated barrier within the paracellular space. Biological studies of the past several decades have shown that TJ are dynamic structures subjected to structural changes that dictate their functional status under a variety of developmental, physiological, and pathological circumstances. To meet the many diverse physiological challenges to which the intestinal epithelial barrier is subjected, TJ must be capable of rapid and coordinated responses. This requires the presence of a complex regulatory system that orchestrates the state of assembly of the TJ multiprotein network. Many pathogenic bacteria exploit this system to accomplish their pathogenic strategies by ultimately modulating intestinal permeability.

Animals↗

Correlation of intestinal structure and function in HIV infection.

The gastrointestinal tract has great importance in HIV infection because of its role as a primary barrier to the external environment and consequent need for effective immune function. Many factors promote the development of diarrhea in HIV-infected individuals. Understanding the genesis of the symptom is key to formulating effective therapy. Ultimate control of the problem depends on preventing HIV replication and immune depletion, as well as avoiding the development of opportunistic enteric infections in patients with severe immune deficiency.

AIDS-Related Opportunistic Infections↗

Effect of Lactobacillus-fermented diets on bacterial translocation and intestinal flora in experimental prehepatic portal hypertension.

Spontaneous bacterial infections in cirrhosis and portal hypertension have been attributed to translocation of gut-derived bacteria, a process promoted by intestinal bacterial overgrowth and disruption of the gut mucosal barrier. Bacteriotherapy with Lactobacillus has been reported to correct bacterial overgrowth, stabilize mucosal barrier function, and decrease bacterial translocation in rat models of acute liver injury and failure. In this study we investigated the effect of Lactobacillus-supplemented diets on intestinal flora and on bacterial translocation rate in portal vein ligated rats. Lactobacillus-fermented milk (yogurt) containing at least 2 x 10(9) colony forming units/ml or placebo (water) was adminstrated by gavage twice daily (2 ml) for 9 days. Portal vein ligation was performed on day 7 of treatment. Bacterial translocation to mesenteric lymph nodes and quantification of intestinal flora was assessed by standard bacteriological cultures. Bacterial translocation was not significantly different between animals that received yogurt (82%) and those that received placebo (75%). Yogurt did not induce any significant changes in intestinal flora, whether it was produced with Lactobacillus acidophilus or Lactobacillus GG. In conclusion, in acute prehepatic portal hypertension, bacteriotherapy with Lactobacillus was unable to induce changes in bacterial translocation probably because it was unable to induce changes in bacterial flora.

Animals↗

Contributions of intestinal P-glycoprotein and CYP3A to oral bioavailability of cyclosporin A in mice treated with or without dexamethasone.

The contributions of P-glycoprotein (P-gp) and CYP3A to the oral bioavailability (BA) of cyclosporin A (CyA) were separately evaluated by using wild-type and mdr1a/1b knockout mice treated with dexamethasone (DEX). Mice were treated with DEX (1 or 75 mg/kg/day, i.p.) daily for 7 days, and the blood concentrations of CyA were measured after an i.v. or p.o. dose of CyA (10mg/kg) at 1.5h after the last DEX treatment. The BA values of CyA in wild-type and mdr1a/1b knockout mice were similar, 0.25 and 0.287, respectively. As regards expression of mdr1a and CYP3A mRNAs, expression of mdr1a mRNA was weakest in the duodenum, the main absorption site of CyA, along the whole intestine of wild-type mice, while expression of CYP3A was strongest in the duodenum of both types of mice. After treatment with 1 and 75 mg/kg DEX, the BA values decreased to 43 and 25% of the control in wild-type mice, respectively, and to 89 and 73% of the control in mdr1a/1b knockout mice, respectively. Expression of mdr1a mRNA in duodenum of wild-type mice was potently induced by DEX treatment. The expression of CYP3A mRNA in liver and duodenum of both strains was enhanced only by high-DEX treatment. These results suggest that P-glycoprotein plays only a small role in the absorption of CyA under physiological conditions, but the protein is readily induced by DEX and then functions as a more substantial absorption barrier to CyA than does CYP3A in the intestine.

ATP Binding Cassette Transporter, Subfamily B↗

Summary of round table conference: gut dysfunction in critical illness.

There is recent evidence that intestinal function is an important determinant in the outcome of critically ill patients. The barrier function is an important characteristic of the gut. Its workings are complex and it consists of epithelial, molecular, and immune components. The pathogenesis of gut dysfunction among critically ill patients is multifactorial, consisting of the quality and quantity of microorganisms, the permeability of the epithelium, and the extent of the vascular perfusion. A practical bedside measure of gut dysfunction is intolerance to enteral feedings. Potential therapies for gut dysfunction include the use of vasoactive drugs to enhance perfusion, selective decontamination to decrease bacteria and endotoxin, and the early and frequent administration of enteral nutrients.

Critical Illness↗

Divalent hapten-induced intestinal anaphylaxis in the mouse: uptake and characterization of a bystander protein.

We examined the mucosal barrier function during anaphylaxis induced by the hapten N,N'-di-2,4,dinitrophenyl-lysine (di-DNP-lysine) in BDF1 female mice immunized with dinitrophenylated Ascaris suum extract. Immunized mice were gavaged with 10 mg or 50 mg of ovalbumin (OVA) with or without N,N'-di-2,4,-DNP-lysine (di-DNP-lysine). Animals that received di-DNP-lysine underwent anaphylaxis and were observed to have significantly greater serum concentrations of immunoreactive OVA (iOVA) than control mice. The severity of anaphylaxis, which varied with the dose of di-DNP-lysine administered, influenced the uptake of OVA; greater amounts of iOVA were detected in serum of mice undergoing more severe anaphylaxis. On gel permeation of serum from both groups of mice, immunoreactive OVA was found to have a molecular size similar to native OVA. Di-DNP-lysine is a synthetic hapten that reliably induced anaphylaxis in sensitized animals challenged by gavage. Anaphylaxis resulted in the uptake into the circulation of greater quantities of an unrelated protein antigen present in the intestinal lumen. The protein antigen that was taken up into the circulation appeared to be intact and thus may have an influence on the development of the immune response, or lack thereof, to this bystander antigen.

Anaphylaxis↗

Nitric oxide inhibitable isoforms of adenylate cyclase mediate epithelial secretory dysfunction following exposure to ionising radiation.

BACKGROUND: Hyporesponsiveness of the intestinal epithelium to secretagogues occurs in different models of intestinal injury, including radiation enteropathy, and in human disease. While this impairment of barrier function has been linked to increased inducible nitric oxide synthase (iNOS) activity, the cellular target of NO in this phenomenon is not known, although recent studies suggest that some isoforms of adenylate cyclase are inhibited by NO. AIMS: To determine adenylate cyclase isoform distribution in colonic epithelial cells and, in particular, the physiological significance of NO inhibitable adenylate cyclase isoforms 5 and 6 in radiation induced epithelial secretory dysfunction. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR), immunocytochemistry, and immunohistochemistry were used to examine adenylate cyclase expression. The responsiveness of mouse colon to secretagogues 72 hours post-15 Gy gamma radiation or following in vitro exposure to NO donors was measured in Ussing chambers. Also, cAMP, cGMP, and ATP levels were measured. RESULTS: RT-PCR, immunocytochemistry, and immunohistochemistry showed that adenylate cyclase 5 was expressed in mouse colon, and isoforms 5 and 6 were expressed in human biopsies and intestinal epithelium. Pharmacological studies showed that these isoforms are functionally important in chloride secretion. NO mediated hyporesponsiveness to secretagogues is primarily a result of decreased adenylate cyclase activity, and not G(i) activation or decreased cellular ATP levels. CONCLUSIONS: NO inhibitable isoforms of adenylate cyclase are expressed in mouse and human secretory colonic epithelia, and appear to be the target of radiation induced NO to reduce the responsiveness to cAMP dependent secretagogues.

Adenosine Triphosphate↗

Effects of hyperoxia on bacterial translocation and mortality during gut-derived sepsis.

BACKGROUND: While hyperoxia is commonly used for treating carbon monoxide poisoning, chronic nonhealing ulcers, acute traumatic and chronically ischemic wounds, and refractory osteomyelitis, its efficacy is unproven in numerous clinical situations, including treatment during severe sepsis. OBJECTIVE: To test the effects of hyperoxia on bacterial translocation and mortality during gut-derived sepsis in a clinically relevant model of infection. METHODS: Balb/c mice were gavaged with 10(9) Escherichia coli and subjected to a 20% burn injury. Then, the animals were randomized to receive hyperoxia for different periods of time. Survival and the extent of translocation were determined, as well as intestinal histologic features. RESULTS: Hyperoxia treatment preserved gut morphology and improved gut barrier function, decreasing the amount of bacterial translocation. Short-term (4- or 8-hour) hyperoxia (100% oxygen) treatment improved survival only on day 1 after injury but did not affect the final outcome. Short-term (8-hour) hyperoxia (100% oxygen) plus 5-day 40% oxygen environment significantly improved long-term survival. CONCLUSION: Tissue pO2 may be an important regulator of gut barrier function. Hyperoxia treatment appears to play a major role in preserving gut barrier function.

Animals↗