Malfunction of intestinal mucus and mucus production

Role of the mucosal barrier in toxin/microbial attachment to the gastrointestinal tract

An important component of bacterial infection of the gastrointestinal tract, particularly when enterotoxin disruption of gut function occurs, relates to the interaction of the bacterium and toxin with the intestinal surface. Adherence or attachment of bacteria lead to colonization and toxic/invasive diarrhoeal states. The purpose of this review is to consider the intestinal mucosal barrier as a deterrent to microbial/toxin attachment, particularly emphasizing the mucosal surface itself, which includes the mucus coat and microvillous membrane. Consequences of mucosal barrier deficiency, particularly the incomplete development of the mucosal barrier, result in bacterially induced diarrhoeal states such as toxigenic diarrhoea and necrotizing enterocolitis. To illustrate the importance of the mucosal barrier as a factor in controlling the external environment containing bacteria and bacterial toxins, recent research in our laboratory on the development of the mucosal barrier is presented. This compares mucosal surface functional control of antigen/toxin attachment and penetration with mucosal surface compositional changes. Finally, evidence of a preliminary nature will be provided to suggest that modifications of the underdeveloped mucosal barrier of the immature intestine by the ingestion of breast milk may act to prevent pathological interactions between the gut and microbes/toxins.

Intestinal permeability in pediatric gastroenterology

The role of the physiologic barrier function of the small bowel and its possible role in health and disease has attracted much attention over the past decade. The intestinal mucosal barrier for luminal macromolecules and microorganism is the result of non-immunologic and immunologic defense mechanisms. The non-immunologic mechanisms consist of intraluminal factors such as gastric acid, proteolytic activity, and motility and of mucosal surface factors like mucin and the microvillous membrane. The immunologic mechanisms include secretary IgA and cell-mediated immunity. Both types of mechanism are not completely mature at birth. Maturation of this barrier is not finished before the 2nd year of life. One of the aspects of the mucosal barrier function can be estimated by the intestinal permeability (IP) for macromolecules. We use the differential sugar absorption test (SAT), in which the ratio of urinary excretion of a relatively large molecule, lactulose, is compared with that of a relatively small molecule, mannitol, after oral ingestion. Although the small intestine is permeable to certain macromolecules in normal developmental conditions, an increased IP could be involved in the pathophysiology of several diseases, including infectious diarrhea, food allergy, celiac disease, and Crohn's disease. It can be concluded that IP, as measured with the SAT, reflects the state of the mucosal barrier and is altered in several gastrointestinal diseases. The SAT is a non-invasive IP test that can be of diagnostic help to demonstrate alterations in the small-mucosal barrier function and may be useful to evaluate therapeutic interventions.(ABSTRACT TRUNCATED AT 250 WORDS)

Intestinal mucins and cholesterol uptake in vitro

A mucus material, secreted by intestinal segments, with a high affinity for cholesterol, has been isolated and chemically characterized. The mucin contained 11% carbohydrate, largely as glucosamine, galactose and N-acetylneuraminic acid, and 19% lipid, of which 86% was unesterified fatty acid. The isolated material readily bound cholesterol in a stoichiometric manner. Conditions known to enhance cholesterol absorption in vivo also decreased mucin complexing to cholesterol in vitro. This association of cholesterol and intestinal surface mucin also occurred during incubations of intestinal segments with dispersed cholesterol, resulting in a high level of intestinal adsorption, with little or no cellular absorption of the sterol. However, when cholesterol was solubilized in simple or complex micelles containing bile salts, surface adsorption of cholesterol was reduced and net absorption was increased. The results suggest that surface mucin binding of cholesterol may represent at least one major diffusion limitation to cholesterol absorption in the intestine.