Expression of beta 7 integrins and other cell adhesion molecules on mouse lymphocytes and their modulation by a new cytokine, IL-2 receptor-inducing factor

We explored the role of a new cytokine, IL-2 receptor-inducing factor (IL-2RIF), in intestinal mucosal immunity and in the regulation of integrin beta 7 receptors on intestinal lymphocytes. Most SIEL (small intestine intraepithelial lymphocytes) were M290 (alpha M290 beta 7) positive, while only 10 to 15% of SIEL were R1-2 (alpha 4) positive. The expression of alpha 4 (R1-2) and beta 7 (M293) but not alpha M290 beta 7 integrin on SIEL was up-regulated by IL-2RIF. Incubating SIEL with IL-2RIF resulted in the up-regulation of CD45RB and down-regulation of CD44. About 50% of LPL (lamina propria lymphocytes) were alpha M290 beta 7 positive, while only 20% of LPL were alpha 4 positive. The expression of alpha M290 beta 7 integrin on LPL was down-regulated and alpha 4 and beta 7 integrin was up-regulated by IL-2RIF. Incubating LPL with IL-2RIF resulted in the up-regulation of CD44 and no significant change of CD11a, CD45, CD45RB, and ICAM-1. These results suggested that SIEL and LPL may play a different role in intestinal mucosal immunity and that IL-2RIF may play an important role in regulating the functions of integrins beta 7 on IEL and LPL.

Intestinal permeability: an overview

The noninvasive assessment of intestinal permeability in humans has a 20-year history. Because the tests are increasingly used in clinical practice and research and because there is much controversy, we reviewed the literature and outlined the potential and possible shortcomings of these procedures. Data was obtained from personal files and from a systemic search through MEDLINE and EMBASE. The principle of the differential urinary excretion of orally administered test markers is explained with reference to the desired physicochemical properties of the markers and how the principle can be exploited to allow assessment of various other gastrointestinal functions. The use of intestinal permeability tests for diagnostic screen for small bowel disease and assessment of responses to treatment, the pathogenesis of disease, normal intestinal physiology, and the effect of drugs and toxins on the intestine is described and reviewed. The controversy surrounding the anatomic location of the permeation pathways that the markers use is highlighted. Noninvasive tests of intestinal permeability have fulfilled early promises of usefulness in clinical practice and research. There is now a need for integrated research into the basic mechanisms of regulatory control of the intestinal barrier function.

Beta 7 integrins and other cell adhesion molecules are differentially expressed and modulated by TNF beta in different lymphocyte populations

To explore the role of beta 7 integrins subfamily and TNF beta in intestinal mucosal immunity and disease, we have examined the expression and modulation by TNF beta of beta 7 integrins and other cell adhesion molecules on mouse intestinal lymphocytes. Most of the small intestine intraepithelial lymphocytes (SIEL) and lamina propria lymphocytes (LPL) were M293 (beta 7) and M290 (alpha M290 beta 7) positive, whereas only 10-20% of SIEL and approximately 50% of LPL were R1-2 (alpha 4 beta 1/alpha 4 beta 7) positive. Only the expression of the R1-2 integrin was downregulated by TNF beta on SIEL. In contrast, expression of R1-2 was unaffected and expression of M290 was partially down-regulated by TNF beta on LPL. About 2-3% of spleen lymphocytes (SL) were M293, M290, and R1-2 positive, and on these cells expression of M290 (and M293) was strongly induced by TNF beta. CD45 expression was partially downregulated by TNF beta on SIEL, LPL, and SL, whereas the expression of ICAM-1 and CD45RB was upregulated by TNF beta only on SIEL. TNF beta strongly downregulated CD44 expression on SIEL, upregulated CD44 expression on LPL, and had no effect on CD44 on SL. These phenotypic differences and different responses to TNF beta modulation between SIEL, LPL, and SL may reflect differences in the microenvironments in which these cells reside and imply that SIEL and LPL may play different roles in intestinal immunity. Further, TNF beta may play an important role in regulating the function of beta 7 integrins and other cell adhesion molecules.

Mechanism of colonic permeation of inulin: is rat colon more permeable than small intestine?

BACKGROUND/AIMS

Colonic epithelium is considered to be relatively tight. The colonic "pore" diameter is 6 A; therefore, colonic epithelium has generally been considered to be impermeable to hydrophilic probes with a cross-sectional diameter of > 6 A. This study examined whether rat colon is permeable to inulin, a large hydrophilic macromolecule having a molecular weight of 5000 g/mol and a cross-sectional diameter of 15 A (hydration diameter, 20 A).

METHODS

The colonic permeation of inulin (10 mumol/L) in vivo was investigated by perfusion of rat colonic segments.

RESULTS

There was significant colonic permeation of inulin, but tissue retention of inulin was low. The net colonic flux of inulin was strongly dependent on net water flux, showing a strong solvent drag effect. Addition of 16,16-dimethyl prostaglandin E2 decreased water flux with a corresponding decrease in inulin flux; this process seemed to be mediated by 5'-cyclic adenosine monophosphate because both the phosphodiesterase inhibitor aminophylline and dibutyryl adenosine 5'-cyclic adenosine monophosphate decreased water and inulin flux in a parallel manner. Chenodeoxycholic and taurocholic acids decreased net mucosal-to-serosal water flux but increased inulin flux. The net colonic permeation rate of inulin was higher than the small intestinal permeation rate.

CONCLUSIONS

Rat colon is permeable to inulin. The higher net colonic permeability may be caused by differences in mucosal surface, permselectivity, solvent drag effect, and differences in net water fluxes of the colon and small intestine.

High-dose dextromethorphan in amyotrophic lateral sclerosis: phase I safety and pharmacokinetic studies

Much interest has focused on the role of glutamate-mediated excitotoxicity in the etiopathogenesis of amyotrophic lateral sclerosis (ALS). We therefore conducted a phase I study of high-dose dextromethorphan (DM) in ALS. DM is a selective, noncompetitive antagonist of the N-methyl-D-aspartate subtype of the glutamate receptor. Thirteen patients were given DM in an escalating dose fashion, to a target of 10 mg/kg/day or the maximum tolerable dose, and then maintained on this dose for up to 6 months. Total daily doses ranged from 4.8 to 10 mg/kg (median, 7 mg/kg). Side effects were dose limiting in most patients. The most common side effects were light-headedness, slurred speech, and fatigue. Detailed pharmacokinetic and neuropsychology studies were performed. This study demonstrates the feasibility of long-term administration of high-dose DM in ALS, as well as in other conditions associated with glutamate excitotoxicity.

Respiratory dysfunction in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder of the voluntary motor system. Involvement of the respiratory system is inevitable and leads to the development of respiratory failure, the usual cause of death in this disorder. ALS at present is incurable, and only symptomatic treatment is available. This article presents guidelines for the recognition and management of respiratory failure.

Mechanisms and sites of mannitol permeability of small and large intestine in the rat

Mannitol is commonly used as an intestinal permeability probe, yet the mechanisms of its penetration of the intestinal barrier are not entirely clear. Therefore, we studied mannitol's permeability of different segments of the intestine and studied the kinetics and influence of intraluminal factors on mannitol permeability in vivo in perfused intestinal segments of rats. There was linear relationship between permeability rate of mannitol and its luminal concentration (y = 7.2x + 1.7; r = 0.98), indicating that passive diffusion is involved in mannitol's permeability. Increased luminal fluid osmolarity from 0.3 to 0.6 osmol/liter resulted in decreased net water flux with a corresponding decrease in mannitol permeability in both jejunum and colon (P < 0.01), indicating the prominent influence of solvent drag on net mannitol permeability. The relationship between mannitol permeability and water absorption at different osmolarities was linear in the jejunum and colon. At luminal osmolarity of 0.3 osmol/liter, 34.6% of mannitol permeability was mediated by passive diffusion and 65.4% was mediated by solvent drag in the jejunum. Mannitol permeability was much more dependent on solvent drag in the colon (88.9%) than in the small intestine (65.4%). The net permeability rate of mannitol was similar in the jejunum and ileum but was much higher in the colon (P < 0.01). Addition of chenodeoxycholate (5 mM) to the perfusate resulted in a significant decrease in absorption of water (P < 0.01) with a corresponding decrease in mannitol permeability (P < 0.01). These studies indicate that mannitol permeability of the intestinal barrier is mediated by passive diffusion and solvent drag, with the latter accounting for a greater fraction of the total permeability.

Gastrointestinal complications of nonsteroidal anti-inflammatory drugs: prophylactic and therapeutic strategies

Nonsteroidal anti-inflammatory drugs (NSAIDs) are some of the most commonly used drugs in the Western world. Patients undergoing NSAID therapy often experience abdominal discomfort, and some of them develop serious complications, such as ulceration, perforation, or bleeding. Since serious complications of NSAID therapy can occur in relatively asymptomatic patients and abdominal symptoms do not serve as a signal of impending difficulties, there is a need for methods to identify those patients who may benefit from prophylactic therapy to prevent NSAID-induced injury. Therapy to prevent NSAID-associated gastrointestinal ulcerations is most effective when prostaglandins are used. H2-receptor antagonists prevent duodenal ulcerations but not gastric ulcerations. The role of omeprazole (hydrogen-potassium pump inhibitor) and sucralfate in the prevention of gastroduodenal ulcerations has not been firmly established. Healing of existing ulcerations in the face of continuing therapy with NSAIDs is marginally accelerated by H2-receptor antagonists, but the rate of healing in the presence of continued NSAID therapy is much slower than when NSAIDs are discontinued. Omeprazole may prove to accelerate the healing of NSAID-associated ulcerations even when NSAID therapy is continued, but more information is needed to substantiate this possibility. New methods are needed for early noninvasive detection of mucosal damage by NSAIDs and for the identification of individuals who should receive prophylactic therapy. New agents are also needed to provide cost-effective prophylaxis against the development of ulcerations and serious complications from NSAIDs.

Intestinal permeability in patients with Crohn's disease and ulcerative colitis and their first degree relatives

Increased intestinal permeability in patients with Crohn's disease and their first degree relatives has been proposed as an aetiological factor. The nine hour overnight urinary excretion of polyethyleneglycol-400 (PEG-400) and three inert sugars (lactulose, l-rhamnose, and mannitol) was used to test the permeation in 47 patients with Crohn's disease of whom 18 had at least one first degree relative with inflammatory bowel disease (2BD) and 52 patients with ulcerative colitis of whom 16 had at least one first degree relative with IBD. A total of 17 first degree relatives with IBD and 56 healthy first degree relatives were included. Thirty one healthy subjects not related to patients with IBD served as controls. No significant differences in PEG-400 permeation were found between the groups of patients, relatives, and controls, or between diseased and healthy relatives. The permeability to lactulose, rhamnose, and mannitol similarly did not differ between the three groups. This study challenges the previously reported findings of increased PEG-400 permeation in patients with Crohn's disease and in their healthy and diseased first degree relatives. There was no increase in permeability in a similar group of ulcerative colitis patients and their families.

Autoradiographic determination of permeation pathway of permeability probes across intestinal and tracheal epithelia

Mucosal permeability studies are used to assess intestinal and respiratory barrier functions. Our ability to interpret results of permeability studies are hampered by our lack of understanding of absorptive pathways of permeability markers. The aim of this study was to visually trace the pathway of permeability probes across the small intestinal and tracheal epithelia by using electron microscopic autoradiography and cytochemistry. We saw a constant rate of mucosal to serosal permeation of intestinal permeability probes polyethylene glycol 400 (PEG-400) and mannitol across the everted small intestinal sac and of the pulmonary permeability probe bovine serum albumin (BSA) across the tracheal epithelia. Electron microscopic tracing of the permeation pathways of tritiated PEG-400 and tritiated mannitol revealed that the majority of the probes traversed the intestinal epithelium paracellularly within 1 half distance (1650 A) of the intercellular space. It is interesting that we also found a small but significant transcellular transport of permeability probes. Goblet cells also absorbed permeability probes transcellularly, but in an "all or none" fashion. Similar pathways were identified in studies utilizing the commonly used pulmonary permeability probes iodine 125-labeled BSA and horseradish peroxidase to determine the routes of transfer in the airway epithelia. In the normal unperturbed trachea, these large permeability probes traversed the pulmonary epithelia transcellularly via endocytosis. On barrier disruption by cytochalasin D, the probes permeated predominantly via the paracellular pathway. This study also demonstrates some of the similarities and differences in transmucosal pathways shared by intestinal and pulmonary epithelia.

Uptake of riboflavin by intestinal basolateral membrane vesicles: a specialized carrier-mediated process

The mechanism of riboflavin (RF) uptake by intestinal basolateral membrane vesicles (BLMV) was examined in this study. BLMV were isolated by an established Percoll-gradient methodology from rabbit small intestine. Uptake of riboflavin was mainly the result of transport of the substrate into an osmotically active intravesicular space with less binding to membrane surfaces. Uptake of RF with time was similar in the presence of a Na+ and a K+ gradient (out > in) and was not significantly influenced by changes in incubation buffer pH. The initial rate of uptake of riboflavin as a function of concentration was saturable in both jejunal and ileal BLMV and occurred with apparent Km values of 5.0 microM and 4.4 microM and Vmax values of 91.6 and 60.8 pmol/mg protein per 5 s, respectively. Unlabeled riboflavin and the structural analogues lumiflavin, isoriboflavin and 8-aminoriboflavin all caused significant inhibition (but to different degrees) in the uptake of [3H]riboflavin. On the other hand, 8-hydroxyriboflavin, lumichrome, lumazine and D-ribose failed to inhibit [3H]riboflavin uptake. Trans-stimulation of [3H]riboflavin efflux from preloaded BLMV by unlabeled riboflavin or lumiflavin was also observed. Altering transmembrane electrical potential by anion substitution and valinomycin-induced K+ diffusion did not affect the riboflavin uptake process. These results demonstrate the existence of a specialized carrier-mediated mechanism for riboflavin uptake by intestinal BLMV. Furthermore, the system appears to transport the vitamin by a process which is Na(+)- and pH-independent, and electroneutral in nature.

Nonvasculitic, steroid-responsive mononeuritis multiplex

We report two patients with mononeuritis multiplex, both of whom had focal inflammation of the perineurium and endoneurium on sural nerve biopsy without necrosis of blood vessel walls, histologic evidence of lymphoid malignancy, or mycobacterial infection. The predominant early sensory symptoms were asymmetric pain and paresthesias; subsequently, muscle weakness developed. Electrophysiologic studies showed an asymmetric sensorimotor axon loss radiculoneuropathy with denervation of limb and paraspinal muscles. Spinal fluid protein was elevated in one patient. There was no cause or underlying systemic disease. Marked improvement occurred with steroid therapy.

The natural history of amyotrophic lateral sclerosis and the use of natural history controls in therapeutic trials

We analyzed the natural history of amyotrophic lateral sclerosis in 277 patients. Our goal was to develop a better understanding of the clinical disease and thus improve the design of therapeutic trials. The Tufts Quantitative Neuromuscular Exam (TQNE) was used as the primary assessment instrument. Our analysis suggested that although more observations are desirable, six monthly TQNEs were adequate to establish the rate of disease progression. We observed a spectrum of deterioration rates without definable subgroups. The striking linearity of deterioration was confirmed. We found a high correlation between deterioration rates in arm and leg strength for individual patients, but a wide range between different patients. Sex and the age at clinical onset did not affect the deterioration rate. As compared with patients without a positive family history, those with other affected family members had a slower loss in arm but not leg strength. We propose that natural history controls can be used effectively in the design of ALS therapeutic trials.