Adaptation of electrolyte transport in rat large intestine after proximal resection. II. Colon after 50% jejunoilectomy combined with cecectomy

Colonic GLP-2 is not sufficient to promote jejunal adaptation in a PN-dependent rat model of human short bowel syndrome

BACKGROUND

Bowel resection may lead to short bowel syndrome (SBS), which often requires parenteral nutrition (PN) due to inadequate intestinal adaptation. The objective of this study was to determine the time course of adaptation and proglucagon system responses after bowel resection in a PN-dependent rat model of SBS.

METHODS

Rats underwent jugular catheter placement and a 60% jejunoileal resection + cecectomy with jejunoileal anastomosis or transection control surgery. Rats were maintained exclusively with PN and killed at 4 hours to 12 days. A nonsurgical group served as baseline. Bowel growth and digestive capacity were assessed by mucosal mass, protein, DNA, histology, and sucrase activity. Plasma insulin-like growth factor I (IGF-I) and bioactive glucagon-like peptide 2 (GLP-2) were measured by radioimmunoassay.

RESULTS

Jejunum cellularity changed significantly over time with resection but not transection, peaking at days 3-4 and declining by day 12. Jejunum sucrase-specific activity decreased significantly with time after resection and transection. Colon crypt depth increased over time with resection but not transection, peaking at days 7-12. Plasma bioactive GLP-2 and colon proglucagon levels peaked from days 4-7 after resection and then approached baseline. Plasma IGF-I increased with resection through day 12. Jejunum and colon GLP-2 receptor RNAs peaked by day 1 and then declined below baseline.

CONCLUSIONS

After bowel resection resulting in SBS in the rat, peak proglucagon, plasma GLP-2, and GLP-2 receptor levels are insufficient to promote jejunal adaptation. The colon adapts with resection, expresses proglucagon, and should be preserved when possible in massive intestinal resection.

Differential jejunal and colonic adaptation due to resection and IGF-I in parenterally fed rats

Patients with severe short-bowel syndrome (SBS) often require long-term total parenteral nutrition (TPN) to maintain their nutritional status because of limited intestinal adaptation. Growth factors, including insulin-like growth factor I (IGF-I), are under investigation to promote intestinal adaptation and tolerance to oral feeding. We investigated structural and functional adaptation of the jejunum and colon in four groups of rats maintained with TPN for 7 days after a 60% jejunoileal resection and cecectomy or sham surgery and treatment with IGF-I or vehicle. Resection alone did not stimulate jejunal growth. IGF-I significantly increased jejunal mucosal mass, enterocyte proliferation, and migration rates. IGF-I decreased jejunal sucrase specific activity and reduced active ion transport and ionic permeability; resection alone had no effect. In contrast, resection significantly increased colonic mass and crypt depth but had no effect on active ion transport or ionic permeability. IGF-I had minimal effects on colonic structure. IGF-I but not resection stimulates jejunal adaptation, whereas resection but not IGF-I stimulates colonic growth in rats subjected to a model for human SBS. IGF-I treatment may improve intestinal adaptation in humans with SBS.

Role of rat large intestine in reducing diarrhea after 50% or 80% distal small bowel resection

The effects of intestinal resection on several intestinal parameters have been studied in the large intestine of rats one month after the surgical operation. The results show that both 50% and 80% distal small bowel resection increased net fluid absorption and mucosal permeability and caused expansion of the intercellular spaces of the large intestine. The increase in net fluid absorption was dependent upon the extent of the intestine removed. The cAMP and cGMP content of cecal and colonic mucosa were significantly reduced after jejunoilectomy. Changes in nucleotide levels were dependent on the length of the intestine resected. On the other hand, mucosa Na,K-ATPase specific activity was only increased in the cecum after 80% intestinal resection. The results are discussed in terms of adaptation to prevent diarrhea.

Regional distribution of Na-K-ATPase specific activity in the large intestine of the rat and man

Segmental heterogeneity of colonic electrolyte transport has been demonstrated in rat and man. We determined whether this is reflected by regional differences in Na-K-ATPase activity. In rats, Na-K-ATPase specific activity was significantly lower in the caecum than in the proximal colon, distal colon, and rectum. In man, biopsy specimens of macroscopically intact mucosa in 26 subjects showed no difference in Na-K-ATPase specific activity along the colon axis. We conclude that Na-K-ATPase distribution may contribute to electrolyte transport differences between rat caecum and colon but not between colonic segments in either rat or man. In an additional series of 11 patients with proximal intestinal resections colonic Na-K-ATPase specific activity was slightly but significantly higher than in controls, possibly representing an adaptive process.

Adaptation of electrolyte transport in rat large intestine after proximal resection. I. Cecum and colon after 60% jejunoilectomy

Electrolyte transport was studied in rat cecum and colon adapting to 60% resection of the small intestine. Four weeks after surgery, the absorbing gross surface area, dry and wet weight, net absorption in vivo of sodium, chloride and volume, net potassium secretion, transmural electrical potential difference and mucosal Na-K-ATPase specific activity were determined. In the cecum, all tissue mass parameters were increased compared to sham-operated controls. Net transport was stimulated per organ but not per unit mass, and potential difference and Na-K-ATPase remained unaffected. In the colon, surface area and wet weight increased slightly while dry weight and electrolyte transport were not influenced. Thus, by enlargement without a change in cell function, the cecum but not the colon contributes to electrolyte homoeostasis after 60% jejunoilectomy in the rat. Na-K-ATPase specific activity and electrical potential difference were higher in the colon than the cecum, suggesting segmental heterogeneity of the larger bowel with respect to Na-K-ATPase-linked active sodium absorption.