Up-regulation of endothelin-converting enzyme-1 in gastric mucosal inflammatory responses to Helicobacter pylori lipopolysaccharide

The study of memory and executive dysfunction in patients infected with Helicobacter pylori

Background Infectious agents are considered as potential causes of Alzheimer's disease. Recently, evidence of a high prevalence of Helicobacter pylori (H. pylori) infection in patients with Alzheimer's disease has been observed. The aim of this study was to investigate memory and executive function in H. pylori positive persons not suffering from Alzheimer's or other marked cognitive disorders. Methods This is a cross-sectional study. A total 140 participants were selected using purposive sampling from the patients within the age group of 18-60 years old at Fayyaz Bakhsh Hospital, Tehran in spring 2016. The participants were divided into two groups of H. pylori positive and negative according to results of the serologic tests to measure the levels of specific antibodies of IgA and IgG against H. pylori using ELISA method. They were subsequently assessed using two tests of Trail Making (TMT) part A and B and Wechsler Memory Scale - Third Edition. Data were analyzed using independent t-test and chi-square. The level of significance was considered P-value ≤ 0.05. Results Out of 140 participants, there were 41 male (29.3%) and 99 female (70.7%) among which 84 patients (60%) suffered from H. pylori infection (seropositive) and 56 patients (40%) were not infected. Comparison of the results using independent t-test showed a significant difference (P = 0.006) between the memory scores of patients (M: 106, SD: 8.12) and healthy ones (M: 112, SD: 1.12). In addition, the executive function showed there is a significant difference in the executive ability of seropositive individuals in the two age groups of 20-50 years old (Part A: M: 1.36, SD: 7.11, and Part B: M: 8.8, SD: 8.25 p = 0.01) and over 50 years old (Part A: M: 55, SD: 8.20, and Part B: M: 106, SD: 7.22, p = 0.009). Conclusion The results of this study showed that the infected patients have a lower cognitive performance in comparison to healthy individuals. In other words, H. pylori infection increases the prevalence of memory and executive dysfunction.

Neutral endopeptidase regulates neurogenic inflammatory responses induced by stimulation of human oral keratinocytes with bacterial lipopolysaccharide and nicotine

Neutral endopeptidase (NEP) is present on various epithelial cells and inactivates numerous physiologically active peptides. Neutral endopeptidase may regulate proinflammatory signals in oral mucosal epithelium. However, the function of NEP in oral mucosal epithelium is unknown. The present study investigated the action of NEP upon proinflammatory signals on human oral keratinocytes and the influence of endothelin-converting enzyme (ECE)-1, an enzyme similar to NEP, on the functions of NEP. Oral keratinocytes were cultured in medium containing inflammatory inducers [lipopolysaccharide (LPS) and nicotine], NEP inhibitors, and ECE-1/NEP inhibitors, either alone or in combination. The concentrations of substance P (SP) and interleukin-1β (IL-1β) were measured in the supernatant. Additionally, the concentrations of SP and IL-1β were measured in the supernatant of cells incubated with LPS or nicotine after transfection with NEP small interfering RNA (siRNA). The concentrations of SP and IL-1β were significantly increased in cells incubated with NEP inhibitors and, to a lesser extent, in cells incubated with ECE-1/NEP inhibitors, compared with controls (cells incubated with LPS or nicotine alone). The concentrations of SP and IL-1β in cells transfected with NEP siRNA were significantly augmented compared with controls. In conclusion, the present study demonstrated that NEP down-regulated the levels of SP and IL-1β produced from human oral keratinocytes, although ECE-1 may be partly related to the down-regulation.

Increased expression of endothelin-1 and endothelin receptor A in reflux esophagitis and Barrett's esophagus

Barrett's esophagus (BE) is considered a complication of the inflammation provoked by acid and bile reflux. Endothelin-1 (ET-1) expresses in various cells during inflammatory process. However, the role of ET-1 in human inflamed and uninflamed esophageal tissue is unknown. The present study aimed to examine the expression of ET-1 and its receptors in human reflux esophagitis (RE) and BE. Endoscopic biopsies of normal squamous epithelium (NSE) (n = 20), RE (n = 22), and long segment BE (n = 14) were obtained. The segmental degree of endoscopic and histopathological inflammation was graded, and immunohistochemistry and real-time quantitative polymerase chain reaction were used to determine the expression of ET-1 and endothelin receptor A (ET(A)R) and endothelin receptor B (ET(B)R). ET-1 and ET(A)R messenger RNA (mRNA) levels were higher in RE than in NSE (3.25 ± 1.78 vs. 1.10 ± 0.71, P = 0.000; 2.13 ± 1.06 vs. 1.12 ± 0.64, P = 0.001, respectively). In BE, relative ET-1 mRNA levels in the proximal segment were higher than in the distal segment (3.03 ± 1.83 vs. 1.16 ± 0.70, P = 0.004) and in normal esophageal epithelium (P = 0.002). There was no significantly difference of ET(A)R mRNA levels between the proximal segment and the distal segment (1.99 ± 1.28 vs. 1.14 ± 0.67, P = 0.072). ET(B)R mRNA expression was unaltered between the groups. Furthermore, immunohistochemistry demonstrated that ET-1 expression increased significantly in RE (51.18 ± 30.14) compared with those in NSE (21.10 ± 18.17, P = 0.000) and in distal BE segment (28.02 ± 24.92, P = 0.022). There were more ET-1 positive cells in proximal BE segment (50.07 ± 25.88) than in distal BE segment (P = 0.030) and in NSE (P = 0.001). ET-1 expression increased in a stepwise manner with the growing degree of inflammation, and there were significant differences between mild, moderate, and marked degree esophagitis (36.08 ± 27.84, 65.86 ± 11.82, 98.00 ± 8.49, P = 0.003, respectively). However, expression of receptors remained unchanged. This study demonstrates that over-expression of ET-1 and ET(A)R in esophagitis may be related to the inflammatory process. ET-1 may play a significant role in the progression of Barrett's metaplasia.

Periodontal disease and gene-expression levels of metalloendopeptidases in human buccal mucosal epithelium

BACKGROUND AND OBJECTIVE

Endopeptidases, such as neutral endopeptidase (NEP), endothelin-converting enzyme-1 (ECE-1) and a disintegrin and metalloprotease 17 (ADAM17), are believed to have various important roles in oral mucosal and epidermal tissue for the regulation of defensive biological responses in the oral cavity, and their expression and activity are influenced by various factors, including oral diseases. However, knowledge concerning these endopeptidases in the oral cavity has been minimal until now. This study focused on three metalloendopeptidases - NEP, ECE-1 and ADAM17 - in the oral buccal mucosal epithelium of patients with periodontal diseases and investigated the relationship between their gene-expression levels and periodontal disease.

MATERIAL AND METHODS

The levels of expression of NEP, ECE-1 and ADAM17 mRNAs in tissue samples collected from the oral buccal mucosal epithelium of 61 patients were investigated by relative quantification using real-time RT-PCR analysis. information on oral and systemic health was obtained from the clinical record of each patient.

RESULTS

Among the three groups, classified based on the diagnosis of periodontal diseases (healthy/gingivitis, early periodontitis and moderate/advanced periodontitis), the relative expression level of NEP mRNA was significantly increased in the early periodontitis group and in the moderate/advanced periodontitis group compared with that in the healthy/gingivitis group. Moreover, the relative expression levels of ECE1 and ADAM17 mRNAs were significantly increased in the moderate/advanced periodontitis group compared with those in the healthy/gingivitis group. The correlation coefficients between the mean relative expression levels of NEP and ECE1 mRNAs, NEP and ADAM17 mRNAs, and ECE1 and ADAM17 mRNAs were r = 0.758, r = 0.707 and r = 0.934, respectively (p < 0.001). Furthermore, among the oral-related factors, there was a significant correlation between the number of sites with probing pocket depths of more than 4 mm and of more than 6 mm and the relative expression levels of NEP, ECE1 and ADAM17 mRNAs. In stepwise logistic regression models, high relative expression levels of ECE1 and ADAM17 mRNAs were significantly associated with moderate/advanced periodontitis.

CONCLUSION

The present study suggests that the severity of periodontal disease may be associated with the expression of metalloendopeptidase genes, including NEP, ECE1 and ADAM17, in the buccal mucosal epithelium.

Lactobacilli inhibit interleukin-8 production induced by Helicobacter pylori lipopolysaccharide-activated Toll-like receptor 4

AIM: To investigate the effect of Lactobacillus bulgaricus (LBG) on the Toll-like receptor 4 (TLR4) pathway and interleukin-8 (IL-8) production in SGC-7901 cells treated with Helicobacter pyloriSydney strain 1 lipopolysaccharide (H pyloriSS1-LPS).

METHODS: SGC-7901 cells were treated with H pyloriSS1-LPS in the presence or absence of pretreatment for 1 h with viable LBG or supernatant recovered from LBG culture MRS broth (LBG-_S). Cellular lysates were prepared for Western blot with anti-TLR4, anti-transforming growth factor β-activated kinase 1 (TAK1), anti-phospho-TAK1, anti-nuclear factor κB (NF-κB), anti-p38 mitogen-activated protein kinase (p38MAPK), and anti-phospho-p38MAPK antibodies. The amount of IL-8 in cell culture medium was measured by ELISA.

RESULTS: H pyloriSS1-LPS up-regulated the expression of TLR4, stimulated the phosphorylation of TAK1, subsequently enhanced the activation of NF-κB and the phosphorylation of p38MAPK in a time-dependent manner, leading to augmentation of IL-8 production in SGC-7901 cells. Viable LBG or LBG-_S pretreatment attenuated the expression of TLR4, inhibited the phosphorylation of TAK1 and p38MAPK, prevented the activation of NF-κB, and consequently blocked IL-8 production.

CONCLUSION: H pyloriSS1-LPS induces IL-8 production through activating TLR4 signaling in SGC-7901 cells and viable LBG or LBG-_S prevents H pyloriSS1-LPS-mediated IL-8 production via inhibition of the TLR4 pathway.

Association of endothelin-converting enzyme-1b C-338A polymorphism with gastric cancer risk: a case-control study

To investigate the association between endothelin-converting enzyme-1b (ECE-1b) C-338A polymorphism and gastric cancer risk, we conducted a hospital-based case-control study of 256 gastric cancer cases and 256 controls matched on age and gender. The genotypes were identified by polymerase chain reaction-restriction fragment length polymorphism. We found that the genotype frequencies were significantly different (P=0.005) between cases and controls. Compared with the wild genotype CC, the variant genotypes (CA+AA) were associated with a 64% increased risk of gastric cancer [adjusted odds ratio (OR)=1.64, 95% confidence interval (CI) 1.15-2.33]. Further stratification analyses indicated that the increased risk was especially noteworthy in older subjects (age 58) (adjusted OR=1.91, 95% CI 1.18-3.09), women (adjusted OR=2.30, 95% CI 1.11-4.79) and non-smokers (adjusted OR=1.79, 95% CI 1.19-2.67). Our results suggest that the ECE-1b C-338A polymorphism may be associated with increased risk of gastric cancer.

Effects of lactobacillus on phosphorylated p38 mitogen-activated protein kinase and apoptosis in SGC-7901 cells treated with lipopolysaccharide of Helicobacter pylori

AIM: To investigate effects of lactobacillus bulgaricus (LBG) on the levels of phosphorylated p38 mitogen-activated protein kinase (P-p38MAPK) and apoptosis index (AI) in gastric cancer cell line SGC-7901 treated with lipopolysaccharide of H. pylori Sydney strain 1 (H. pylori SS1-LPS).

METHODS: Human gastric cancer cell line SGC-7901 was treated with H. pylori SS1-LPS at the concentration of 2.5×10³, 2.5×10⁴, 2.5 ×10⁵ EU/L, respectively, after pretreatment for 1 h with 10 mmol/L SB203580 (blocker of p38MAPK) or 1×10¹³ CFU/L LBG. The level of P-p38MAPK was analyzed by immunocytochemistry after 2 h of H. pylori SS1-LPS treatment. The cell activity was detected by MTT assay after 4、5 and 6 h of treatment, and the apoptosis was measured by flow cytometry at the 6^th hour.

RESULTS: H. pylori SS1-LPS inhibited cell activity (0.164 ± 0.028 vs 0.622 ± 0.068, P < 0.05) and up-regulated the level of P-p38MAPK (79.771 ± 1.424 vs 4.075 ± 0.135, P < 0.01) and AI value (10.000% ± 0.510% vs 4.175% ± 0.206%, P < 0.05) in a dose-dependent manner. The level of P-p38MAPK and AI value in SGC-7901 cells were not significantly different between LBG pretreatment group and the controls, and the cell activity and AI value were not markedly different between SB203580 pretreatment group and the controls.

CONCLUSION: H. pylori SS1-LPS may induce the apoptosis of SGC-7901 cells by activating the phosphorylation of p38MAPK, while LBG can prevent H. pylori SS1-LPS-induced apoptosis of SGC-7901 cells by inhibiting the phosphorylation of p38MAPK.

New insights into the roles of metalloproteinases in neurodegeneration and neuroprotection

Proteolytic enzymes constitute around 2% of the human genome and are involved in many stages of cell development from fertilization to death (apoptosis). The identification of many novel proteases from genome-sequencing programs has suggested them as potential new therapeutic targets. In addition, several well-characterized metallopeptidases were recently shown to possess new biological roles in neuroinflammation and neurodegeneration. As a result of these studies, metabolism of the neurotoxic and inflammatory amyloid peptide (Abeta) is considered as a physiologically relevant process with several metallopeptidases being suggested for the role of amyloid-degrading enzymes. These include the neprilysin (NEP) family of metalloproteinases (including its homologue endothelin-converting enzyme), insulin-degrading enzyme, angiotensin-converting enzyme, plasmin, and, possibly, some other enzymes. NEP also has a role in metabolism of sensory and inflammatory neuropeptides such as tachykinins and neurokinins. The existence of natural enzymatic mechanisms for removal of amyloid peptides has extended the therapeutic avenues in Alzheimer's disease (AD) and neurodegeneration. The proteolytic events underlying AD are highly compartmentalized in the cell and formation of amyloid peptide from its precursor molecule APP (amyloid precursor protein) takes place both within intracellular compartments and in the plasma membrane, especially in lipid raft domains. Degradation of amyloid peptide by metallopeptidases can also be both intra- and extracellular depending on the activity of membrane-bound enzymes and their soluble partners. Soluble forms of proteases can be secreted or released from the cell surface through the activity of "sheddases"-another group of proteolytic enzymes involved in key cellular regulatory functions. The activity of proteases involved in amyloid metabolism depends on numerous factors (e.g., genetic, environmental, age), and some conditions (e.g., hypoxia and ischemia) shift the balance of amyloid metabolism toward accumulation of higher concentrations of Abeta. In this regard, regulation of the activity of amyloid-degrading enzymes should be considered as a viable strategy in neuroprotection.

Alzheimer's disease and Helicobacter pylori infection: Defective immune regulation and apoptosis as proposed common links

Although degenerative diseases of the central nervous system, including Alzheimer's disease (AD), have an increasingly high impact on aged population their association with Helicobacter pylori (H. pylori) infection has not as yet been thoroughly researched. Current H. pylori infection appears to induce irregular humoral and cellular immune responses that, owing to the sharing of homologous epitopes (molecular mimicry), cross-react with components of nerves, thereby contributing and possibly perpetuating the apoptotic neural tissue damage observed in neurodegenerative diseases including AD. An association between AD and H. pylori infection has been recently addressed by two studies. A higher seropositivity for anti-H. pylori immunoglobulin G antibodies in 30 patients with AD than in 30 age-matched controls was reported in one study; this serological test, however, has limitations because it does not discriminate between current and old infections. In the other study, by introducing the histological method (the actual gold standard) for diagnosis of H. pylori infection, we reported a higher prevalence of H. pylori infection in 50 AD patients than in 30 anemic controls. This pathogen may influence the pathophysiology of AD by promoting platelet and platelet-leukocyte aggregation; releasing various pro-inflammatory and vasoactive substances; developing cross-mimicry with host antigens; producing reactive oxygen metabolites and circulating lipid peroxides; influencing the apoptotic process; and increasing, through induction of atrophic gastritis, homocysteine, which contributes to vascular disorders implicated in endothelial damage and neurodegeneration.

Endothelin-1-dependent leptin induction in gastric mucosal inflammatory responses to Helicobacter pylori lipopolysaccharide

Leptin, a multifunctional hormone that regulates food intake and energy expenditure, has emerged recently as an important modulator of gastric mucosal responses to Helicobacter pylori infection. We applied the animal model of H. pylori LPS-induced gastritis to investigate the role of endothelin-1 (ET-1) in the mucosal leptin production. We show that the histologic pattern of inflammation reached a maximum on the fourth day following the LPS and was reflected in a marked increase in the mucosal level of ET-1 and leptin. Therapeutic administration of phosphoramidon, an inhibitor of ECE-1 activity, led to a 61.2% decline in the mucosal ET-1 level and a 64.1% reduction in leptin, while the severity of mucosal inflammatory involvement increased by 28.6%. A drop in the level of leptin and the increase in severity of the inflammatory involvement elicited by the LPS was also attained in the presence of ET(A) receptor antagonist BQ610, but not the ET(B) receptor antagonist BQ788. Moreover, administration of ERK inhibitor, PD98059, in the presence of ET(B) receptor antagonist, but not the ET(A) receptor antagonist, caused reduction in the mucosal leptin level. Our findings are the first to implicate ET-1 as a key factor in up-regulation of gastric mucosal leptin-associated H. pylori infection. We also show that the effect of ET-1 on leptin production is a consequence of ET(A) receptor activation.

Up-regulation in endothelin-1 by Helicobacter pylori lipopolysaccharide interferes with gastric mucin synthesis via epidermal growth factor receptor transactivation

OBJECTIVE

Endothelin-1 (ET-1), a key mediator of inflammatory processes associated with bacterial infection, is a 21-amino acid peptide produced from a biologically inactive big ET-1 by the action of endothelin-converting enzyme-1 (ECE-1) that acts through G protein-coupled ET(A) and ET(B) receptors. Here we report on the role of ET-1 in the mediation of the detrimental influence of Helicobacter pylori on the synthesis of gastric mucin.

MATERIAL AND METHODS

Rat gastric mucosal cells were exposed to H. pylori key virulence factor, lipopolysaccharide (LPS).

RESULTS

The LPS inhibitory effect on gastric mucin synthesis was accompanied by a marked increase in ET-1 generation and enhancement in ECE-1 activity. Inhibition of ECE-1 with phosphoramidon not only led to the impedance of LPS-induced ET-1 generation, but also countered the detrimental effect of LPS on mucin synthesis. Moreover, the LPS inhibitory effect on mucin synthesis was blocked by ET(A) receptor antagonist BQ610, but not by ET(B) receptor antagonist BQ788. Furthermore, the LPS-induced suppression in gastric mucin synthesis was countered in a concentration-dependent fashion by PD153035 (81.7%), a specific inhibitor of epidermal growth factor receptor (EGFR) kinase as well as PP2 (69.8%), a selective inhibitor of tyrosine kinase Src responsible for ligand-independent EGFR transactivation.

CONCLUSIONS

Our findings are the first to show that the detrimental effect of H. pylori on gastric mucin synthesis is intimately linked to the events associated with ECE-1 up-regulation, enhancement in ET-1 production, and G protein-coupled ET(A) receptor activation that triggers the EGFR transactivation.

Role of Leptin in Modulation of Porphyromonas gingivalis Lipopolysaccharide-induced Up-regulation of Endothelin-1 in Salivary Gland Acinar Cells

Leptin, a pleiotropic cytokine that regulates food intake and metabolic and endocrine responses, has emerged recently as an important regulator of mucosal inflammatory responses to bacterial infection. In this study, we report that in sublingual salivary gland acinar cells leptin plays a role in the suppression of up-regulation in endothelin-1 (ET-1), induced by the LPS of a periodontopathic bacterium P. gingivalis. We show that P. gingivalisLPS detrimental effect on salivary mucin synthesis, associated with up-regulation (3.9-fold) in ET-1 generation and the enhancement (3.2-fold) in endothelin-converting enzyme-1 (ECE-1) activity, was subject to a dose-dependent suppression by leptin. The impedance by leptin of the LPS inhibitory effect on mucin synthesis was blocked by wortmannin, an inhibitor of PI3K, as well as by ERK inhibitor, PD98059. However, while the blockade of ERK led also to amplification in the impedance by leptin of the LPS-induced expression of ECE-1 and ET-1, the effect was not observed in the presence of wortmannin. The findings are the first to demonstrate that leptin counters the pathological consequences of P. gingivalisinfection on the synthesis of salivary mucin through the involvement in signaling events of PI3K and ERK pathways. We also show that the ERK cascade represents a critical signaling target for leptin in the LPS-induced up-regulation in ET-1.

Induction of apoptosis as a proposed pathophysiological link between glaucoma and Helicobacter pylori infection

Although apoptosis is equally important both for the development and for the maintenance of homeostasis in some adult tissues, it can also be associated with disease processes. Current studies indicate that apoptosis is a mechanism of cell death in several important ocular and gastrointestinal diseases including glaucoma, and Helicobacter pylori (H. pylori)-induced upper gastrointestinal disorders and/or extraintestinal diseases, including autoimmune and neurodegenerative ones (Sjögren's syndrome, Guillain-Barre syndrome or Parkinson's disease). Glaucoma is also associated with similar autoimmune and neurodegenerative disorders, characterized by apoptotic loss of specific populations of neurons. Recently, a high prevalence of H. pylori infection has been recognized in patients with chronic open-angle glaucoma. In addition, H. pylori eradication may positively influence glaucoma parameters, thereby suggesting a possible causal link between H. pylori and glaucoma. H. pylori infection may influence the pathophysiology of glaucoma by releasing various proinflammatory and vasoactive substances, as well as by influencing apoptotic process; parameters that may also exert their own effects in the induction and/or progression of glaucomatous neuropathy. Importantly, H. pylori infection and glaucoma share the Fas/FasL and the mitochondria-mediated apoptotic pathways, thereby proposing an apoptotic link in the pathophysiology of both diseases.

Protective effects of endothelin-1 antibody on stress induced lesion of gastric mucosa in rats

AIM

To explore the protective effects of endothelin-1 antibody (ET-1Ab) on acute gastric mucosa lesions induced by stress in rats.

METHODS

Stress ulcer induced by cold-restraint-stress(CRS) was used as model in this study, different dose ET-1Ab were administered by left femoral vein prior to stress so as to observe the effects of the drug on ET-1 levels in plasma and gastric mucosa, gastric mucosa blood flow(GMBF)and ulcer index(UI) of CRS rats.

RESULTS

(1) Compared with the normal control group, ET-1 levels of plasma and gastric mucosa and UI were increased significantly in the stress groups (116.2±4.7 mv and 125.1±4.2 mv vs 49.1±9.7 mv, 113.8±9.3 mv and 122.9±19.6 mv vs 52.3±10.3 mv, 28.6±1.85 mv and 51.2±5.93 mv vs 0, P<0.01), while GMBF were decreased markedly in stress groups (227.8±13.5 mv and 150.8±11.5 mv vs 405.8±23.3 mv, P<0.01).There was significantly positive correlation between ET-1 and UI (r = 0.96, P<0.01), and significantly negative correlation between ET-1 and GMBF(r = -0.91, P<0.01). (2) However, compared with the single-stress groups, ET-1 levels of plasma and gastric mucosa and UI were decreased significantly in ET-1Ab-stress groups (69.2±7.3 mv vs 116.2±24.7 mv, 80.6±12.3 mv vs 125.1±24.2 mv, 58.5±6.3 mv vs 113.8±29.3 mv, 68.9±9.6 mvvs 122.9±19.6 mv, 13.2±2.05 mv vs 28.6±1.85 mv, 25.8±3.62 mv vs 51.2±5.93 mv, P<0.01), GMBF were increased dramatically (329.8±16.3 mv vs 227.8±13.5 mv, 251.9±11.3 mv vs 150.8±1.5 mv, P<0.01), ET-1Ab can dose-dependently reduce levels of the ET-1 and UI, and improve GMBF significantly in cold-restraint-stress.

CONCLUSION

In the course of CRS-induced ulcers, endogenous ET-1 levels of plasma and gastric mucosa were increased significantly, and there were close relationship between ET-1 levels and UI. The increased ET-1 may involve in the pathogenesis of CRS-induced ulcers in rats by its vasoconstriction and marked reduction of GMBF. ET-1Ab can dose-dependently attenuate the degree of gastric mucosa lesions induced by CRS significantly. So it may have therapeutic effect for SU.

Up-regulation of gastric mucosal inflammatory responses to Helicobacter pylori lipopolysaccharide by aspirin but not indomethacin

Infection with Helicobacter pylori and the use of non-steroidal anti-inflammatory drugs (NSAIDs) are recognized as the two primary factors in the etiology of gastric disease. In this study, we applied the animal model of H. pylori-induced gastritis to assess the influence of NSAIDs on the course of mucosal inflammatory responses to H. pylori. Two days following intragastric application of H. pylori lipopolysaccharide, rats were divided into groups and administered daily for up to 8 days either indomethacin, aspirin or the vehicle, and their gastric mucosal tissue subjected to histological and biochemical assessment. H. pylori lipopolysaccharide elicited within 2 days a pattern of acute mucosal inflammatory responses accompanied by a massive epithelial cell apoptosis, and a marked increase in the expression of membrane-bound and soluble forms of TNF-alpha. The extent of mucosal inflammatory involvement reached a maximum by the 4th day and showed a decline by the 10th day; this was reflected in a 38.1% reduction in apoptosis, a 53.2% decline in membrane-bound TNF-alpha and a 63.8% decrease in soluble TNF-alpha. Compared to the vehicle controls, aspirin caused a 36.2% increase in the severity of the mucosal inflammatory involvement by the second day of administration and a 25.9% increase in the inflammatory involvement occurred by the 8th day; this effect of aspirin was accompanied by a significant (54.5%) induction in apoptosis, a 58.2% decline in membrane-bound TNF-alpha and a 61% increase in soluble TNF-alpha. In contrast, administration of indomethacin evoked only a marginal increase (5-7%) in apoptosis, and caused no discernible changes in the severity of gastric mucosal involvement and the expression of TNF-alpha forms elicited by H. pylori lipopolysaccharide. The findings indicate that aspirin, but not indomethacin, increases the severity of gastric mucosal inflammatory responses to H. pylori. This detrimental influence of aspirin appears to result from up-regulation in the mucosal expression of soluble form of TNF-alpha, which leads to the amplification of apoptotic events that potentiate gastric mucosal inflammatory reaction to H. pylori.

Relationship between Helicobacter pylori infection and glaucoma

OBJECTIVE

To determine the frequency of Helicobacter pylori (H. pylori) infection in glaucoma patients and in anemic control participants.

DESIGN

Prospective, nonrandomized, comparative study.

PARTICIPANTS

The authors investigated 32 patients with chronic open-angle glaucoma (COAG), 9 patients with pseudoexfoliation glaucoma (PEG), and 30 age-matched anemic control participants.

METHODS

Upper gastrointestinal endoscopy was performed to evaluate macroscopic abnormalities, and gastric mucosal biopsy specimens were obtained for the presence of H. pylori infection tested by rapid urease slide test (CLO test) and by Cresyl fast violet staining, Giemsa staining, or both. The presence of gastritis was classified in accordance with the Sydney system by using hematoxylin and eosin stain. In addition, intestinal metaplasia was evaluated with Alcian blue stain. Saliva samples were also tested by CLO. Serum was analyzed for the presence of H. pylori-specific IgG antibodies by enzyme-linked immunosorbent assay.

MAIN OUTCOME MEASURE

Histologic examination for the presence of H. pylori.

RESULTS

In 87.5% of the COAG patients, 88.9% of the PEG patients, and 46.7% of the anemic control participants, H. pylori infection was histologically confirmed (odds ratio, 8.00; chi-square, 11.81; P = 0.0006 and 9.14; chi-square, 5.01; P = 0.02, respectively). H. pylori was detected by urease test: (1) in the gastric mucosa in 71.9% of the COAG patients, in 77.8% of the PEG patients, and in 46.7% of the anemic control participants (P = 0.03 and P > 0.05, respectively); and (2) in the saliva in 37.5% of the COAG patients, in 55.6% of the PEG patients, and in 30% of the anemic control participants (P > 0.05). Sixty-eight percent of glaucoma patients and 30% of anemic control participants were seropositive for H. pylori (P = 0.002). When compared with anemic control participants, glaucoma patients exhibited less often endoscopic normal appearance of gastric mucosa (P = 0.01), and more often antral gastritis (P = 0.0004) or peptic ulcer disease (P = 0.01). Histologic grade 3 gastritis was observed only in the glaucoma patients (P = 0.03).

CONCLUSIONS

H. pylori infection seems more frequent in glaucoma patients. If confirmed, this may indicate either a common factor that causes susceptibilities to both glaucoma and H. pylori infection or that H. pylori may be a causal factor for developing glaucoma.

Role of endothelin-converting enzyme-1 in the suppression of constitutive nitric oxide synthase in rat gastric mucosal injury by indomethacin

BACKGROUND

Disturbances in nitric oxide generation and the release of a vasoactive peptide, endothelin-1 (ET-1), are well recognized early events in pathogenesis of NSAID-induced gastropathy. In this study using phosphoramidon, a potent inhibitor of endothelin-converting enzyme-1 (ECE-1), we investigated the influence of ET-1 on the expression of constitutive (cNOS) and inducible nitric oxide synthase (NOS-2) during gastric mucosal injury caused by indomethacin.

METHODS

The experiments were conducted with groups of rats pretreated intragastrically with phosphoramidon (10, 20, and 40 mg/kg) or vehicle, followed 30 min later by an intragastric dose of indomethacin (60 mg/kg). The animals were killed 4 h later and their mucosal tissue subjected to macroscopic damage assessment and biochemical measurements.

RESULTS

In the absence of phosphoramidon, indomethacin caused extensive multiple hemorrhagic lesions of glandular mucosa, accompanied by a 29.9-fold increase in epithelial cell apoptosis, a 13.3-fold increase in NOS-2 and a 5.5-fold decline in the activity of cNOS, while the mucosal expression of ECE-1 activity increased 4-fold and the level of ET-1 showed a 4.8-fold increase. Pretreatment with phosphoramidon produced dose-dependent reduction in the extent of mucosal damage caused by indomethacin, accompanied by a significant recovery in the expression of cNOS, and a marked decline in ECE-1, epithelial cell apoptosis and the mucosal level of ET-1. Phosphoramidon, however, had no effect on the indomethacin-induced increase in the mucosal expression of NOS-2.

CONCLUSIONS

The results suggest that suppression of ET-1 generation counters the mucosal drop in cNOS and the extent of gastric mucosal damage caused by indomethacin, but has no effect on the mucosal responses associated with up-regulation of NOS-2 expression. Hence, only cNOS plays a role in the protection of gastric mucosa against damage by NSAIDs.

Gastroduodenal mucosal defense

The gastroduodenal mucosa is a model system of defense with several structural levels and biologic strategies that are closely interrelated with each other to cope with the harmful ingredients of ingested food and the potentially deleterious effects of gastric acid and pepsin. Experimental and clinical research carried out during the review period added to the understanding of each component of the multiple mechanisms of gastroduodenal mucosal protection. In the first place, mucosal integrity is defended by the mucus gel barrier, the epithelial cell barrier, and the immune barrier. The properties of these barriers are maintained by adequate regulation of mucus production, bicarbonate secretion, mucosal microcirculation, and motor activity. These regulatory systems are alarmed by nociceptive neurons and the mucosal immune system which includes chemokine-secreting epithelial cells. The ultimate defense system is rapid repair of the injured mucosa under the control of several growth factors. Progressing insight into the network of mucosal defense not only will improve existing therapies of inflammation and ulceration but also will provide new leads for the management of functional diseases in the gastroduodenal region.

Induction of endothelin-converting enzyme-1 in gastric mucosal injury by idomethacin

Endothelin-1 (ET-1) is a 21-amino acid vasoactive peptide produced from a 39-amino acid biologically inactive peptide, big ET-1, by the action of endothelin-converting enzyme-1 (ECE-1). We investigated gastric mucosal expression of ECE-1 during a 16 h course of inflammatory responses associated with gastric mucosal injury caused by indomethacin. The extent of gastric mucosal damage reached a maximum 4 h following the drug, and was accompanied by a 3.9-fold enhancement in the expression of ECE-1 activity and a significant elevation in ET-1 (4.5-fold), TNF-alpha (11.3-fold), and apoptosis (29.9-fold). A 37.2% decrease in the severity of lesion 16 h following the drug was associated with a 44.5% reduction in the mucosal expression of ECE-1 activity and a decline in TNF-alpha (64%), ET-1 (65.2%), and apoptosis (72.3%). The results demonstrate that gastric mucosal injury by indomethacin is associated with up-regulation of ECE-1 expression, which leads to the enhancement of ET-1 production, induction of TNF-alpha, and triggering apoptotic events that disrupt gastric mucosal homeostasis.