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Micronutrient Improvement of Epithelial Barrier Function in Various Disease States: A Case for Adjuvant Therapy. Int J Mol Sci 2022; 23:ijms23062995. [PMID: 35328419 PMCID: PMC8951934 DOI: 10.3390/ijms23062995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/01/2022] [Indexed: 02/04/2023] Open
Abstract
The published literature makes a very strong case that a wide range of disease morbidity associates with and may in part be due to epithelial barrier leak. An equally large body of published literature substantiates that a diverse group of micronutrients can reduce barrier leak across a wide array of epithelial tissue types, stemming from both cell culture as well as animal and human tissue models. Conversely, micronutrient deficiencies can exacerbate both barrier leak and morbidity. Focusing on zinc, Vitamin A and Vitamin D, this review shows that at concentrations above RDA levels but well below toxicity limits, these micronutrients can induce cell- and tissue-specific molecular-level changes in tight junctional complexes (and by other mechanisms) that reduce barrier leak. An opportunity now exists in critical care—but also medical prophylactic and therapeutic care in general—to consider implementation of select micronutrients at elevated dosages as adjuvant therapeutics in a variety of disease management. This consideration is particularly pointed amidst the COVID-19 pandemic.
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Urban F, Hajek K, Naber T, Anczykowski B, Schäfer M, Wegener J. P ETER-assay: Combined Impedimetric Detection of Permeability (P E) and Resistance (TER) of Barrier-Forming Cell Layers. Sci Rep 2020; 10:7373. [PMID: 32355192 PMCID: PMC7192940 DOI: 10.1038/s41598-020-63624-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/05/2019] [Indexed: 11/09/2022] Open
Abstract
Epithelial and endothelial barrier function is typically studied in vitro by growing the cells of interest on permeable supports that are sandwiched between two fluid compartments. This setup mimics the physiological situation with the cell layer as the diffusion barrier at the interface between two chemically distinct fluids. Routinely, the barrier function is quantitatively described by two key parameters: (i) the transepithelial or transendothelial electrical resistance (TER) as a measure of the permeability for small inorganic ions and (ii) the permeability coefficient (PE) as a descriptor of the permeability for molecular tracers. So far the two parameters have been determined in separate experiments. This study introduces a device that allows for simultaneous detection of PE and TER of the very same cell monolayer in one single experiment (PETER-assay). The novel approach is entirely based on AC impedance measurements in two different modes, so that TER and PE become available in real time. The new approach is demonstrated for three epithelial cell lines derived from the kidney (MDCK-I, MDCK-II, NRK) with very different barrier properties under stationary conditions and when challenged by barrier-breaking fungal toxin cytochalasin D. PETER provides an excellent time-resolution and completely automated data collection.
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Affiliation(s)
- Florian Urban
- Universitaet Regensburg, Institut fuer Analytische Chemie, Chemo- & Biosensorik, Universitaetsstr. 31, 93053, Regensburg (G), Germany
| | - Kathrin Hajek
- Universitaet Regensburg, Institut fuer Analytische Chemie, Chemo- & Biosensorik, Universitaetsstr. 31, 93053, Regensburg (G), Germany
| | - Tobias Naber
- Universitaet Regensburg, Institut fuer Analytische Chemie, Chemo- & Biosensorik, Universitaetsstr. 31, 93053, Regensburg (G), Germany
| | | | - Marcus Schäfer
- nanoAnalytics GmbH, Heisenbergstr. 11, 48149, Münster (G), Germany
| | - Joachim Wegener
- Universitaet Regensburg, Institut fuer Analytische Chemie, Chemo- & Biosensorik, Universitaetsstr. 31, 93053, Regensburg (G), Germany. .,Fraunhofer Research Institution for Microsystems and Solid State Technologies EMFT, 80686, Muenchen (G), Germany.
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Pao PJ, Emri E, Abdirahman SB, Soorma T, Zeng HH, Hauck SM, Thompson RB, Lengyel I. The effects of zinc supplementation on primary human retinal pigment epithelium. J Trace Elem Med Biol 2018. [PMID: 29523386 DOI: 10.1016/j.jtemb.2018.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Population-based and interventional studies have shown that elevated zinc levels can reduce the progression to advanced age-related macular degeneration. The objective of this study was to assess whether elevated extracellular zinc has a direct effect on retinal pigment epithelial cells (RPE), by examining the phenotype and molecular characteristics of increased extracellular zinc on human primary RPE cells. Monolayers of human foetal primary RPE cells were grown on culture inserts and maintained in medium supplemented with increasing total concentrations of zinc (0, 75, 100, 125 and 150 μM) for up to 4 weeks. Changes in cell viability and differentiation as well as expression and secretion of proteins were investigated. RPE cells developed a confluent monolayer with cobblestone morphology and transepithelial resistance (TER) >200 Ω*cm2 within 4 weeks. There was a zinc concentration-dependent increase in TER and pigmentation, with the largest effects being achieved by the addition of 125 μM zinc to the culture medium, corresponding to 3.4 nM available (free) zinc levels. The cells responded to addition of zinc by significantly increasing the expression of Retinoid Isomerohydrolase (RPE65) gene; cell pigmentation; Premelanosome Protein (PMEL17) immunoreactivity; and secretion of proteins including Apolipoprotein E (APOE), Complement Factor H (CFH), and High-Temperature Requirement A Serine Peptidase 1 (HTRA1) without an effect on cell viability. This study shows that elevated extracellular zinc levels have a significant and direct effect on differentiation and function of the RPE cells in culture, which may explain, at least in part, the positive effects seen in clinical settings. The results also highlight that determining and controlling of available, as opposed to total added, zinc will be essential to be able to compare results obtained in different laboratories.
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Affiliation(s)
- Po-Jung Pao
- Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, 11-43 Bath St, London EC1 V9EL, United Kingdom; Department of Structural and Molecular Biology, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
| | - Eszter Emri
- Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, 11-43 Bath St, London EC1 V9EL, United Kingdom; Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, United Kingdom.
| | - Safiya Bishar Abdirahman
- Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, 11-43 Bath St, London EC1 V9EL, United Kingdom.
| | - Talha Soorma
- Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, 11-43 Bath St, London EC1 V9EL, United Kingdom.
| | - Hui-Hui Zeng
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene Street, Baltimore, MD 21201, United States.
| | - Stefanie M Hauck
- Research Unit Protein Science, Helmholtz Zentrum München, German Research Center for Environmental Health(GmbH), Ingolstädter Landstraße 1, 85764 Oberschleißheim, Germany.
| | - Richard B Thompson
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene Street, Baltimore, MD 21201, United States.
| | - Imre Lengyel
- Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, 11-43 Bath St, London EC1 V9EL, United Kingdom; Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, United Kingdom.
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Zakrzewski SS, Fromm M, Schulzke JD, Günzel D. Zinc strengthens the jejunal barrier by reversibly tightening the paracellular route. Am J Physiol Gastrointest Liver Physiol 2017; 313:G537-G548. [PMID: 28864501 DOI: 10.1152/ajpgi.00355.2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 01/31/2023]
Abstract
During the postweaning period, piglets are prone to gastrointestinal infections. The resulting impairment of intestinal barrier function may cause diarrhea associated with growth retardation or even death of piglets. Orally applied Zn is commonly used to prevent and treat diarrhea, but its mode of action still needs to be elucidated. To analyze the molecular mechanism whereby Zn acts on porcine intestinal barrier function, ex vivo studies on piglet jejunum and accompanying in vitro studies on a porcine jejunal epithelial cell line, IPEC-J2/PS, were performed with electrophysiological tools. Feeding pharmacological Zn doses exerted no significant electrophysiologically ascertainable short- and long-term effects on jejunal barrier function ex vivo. However, in IPEC-J2/PS, basolateral Zn was cytotoxic since its application caused a release of lactate dehydrogenase and an irreversible breakdown of the epithelial barrier. In contrast, apical Zn application caused an immediate increase in paracellular resistance and a decrease in permeability to the paracellular marker fluorescein, reflecting overall barrier strengthening in vitro. Apical effects were fully reversible upon washout. This indicates that Zn supplemented to feed was completely washed out during ex vivo jejunum preparation. We conclude that there is no evidence for long-term barrier effects through prophylactic Zn supplementation and that extracellular Zn acts acutely and reversibly from the apical side via tightening the paracellular route, thus counteracting leak-flux diarrhea.NEW & NOTEWORTHY Therapeutically administered Zn successfully treats diarrhea in veterinary and human medicine. Here we present data that Zn strengthens the porcine jejunal epithelial barrier by reversibly tightening the paracellular route for inorganic ions and small solutes. Acute or long-lasting Zn effects on transcellular transport (Cl- secretion) were not detected. We therefore conclude that Zn is useful for acutely treating leak-flux diarrhea rather than secretory diarrhea. Suitability as prophylactic feed supplement, however, is questionable.
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Affiliation(s)
- Silke S Zakrzewski
- Institute of Clinical Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Fromm
- Institute of Clinical Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jörg D Schulzke
- Institute of Clinical Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dorothee Günzel
- Institute of Clinical Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Hajek K, Wegener J. Independent impedimetric analysis of two cell populations co-cultured on opposite sides of a porous support. Exp Cell Res 2017; 351:121-126. [PMID: 28087264 DOI: 10.1016/j.yexcr.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/07/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
The transepithelial or -endothelial electrical resistance (TEER) is a very common and routinely recorded parameter describing the expression of barrier-forming cell-cell contacts (tight junctions) in quantitative terms. To determine TEER, barrier-forming cell monolayers are cultured on porous filter supports that separate two fluid compartments. The frequency-dependent impedance of the cell layer is then recorded and analyzed by means of equivalent circuit modelling providing TEER and the cell layer capacitance. The latter serves as a quantitative indicator for membrane topography. When cells are co-cultured on opposite sides of such a porous support to model more complex biological barriers, TEER readings will integrate over both cell layers and the individual contributions are not assessable. This study describes the modification of commonly used porous filter inserts by coating their backside with a thin gold-film. When this gold-film is used as an additional electrode, both cell layers can be studied separately by impedance analysis. The electrical parameters of either cell layer are assessable independently by switching between different electrode combinations. The performance of this new approach is illustrated and documented by experiments that (i) follow the de novo formation of cell junctions between initially suspended cells and (ii) the manipulation of mature cell-cell junctions by cytoskeleton-active drugs. Both assays confirm that both cell layers are monitored entirely independently.
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Affiliation(s)
- Kathrin Hajek
- Institut für Analytische Chemie, Chemo- und Biosensorik, Universität Regensburg, Universitätsstr. 31, 93053 Regensburg, Germany
| | - Joachim Wegener
- Institut für Analytische Chemie, Chemo- und Biosensorik, Universität Regensburg, Universitätsstr. 31, 93053 Regensburg, Germany.
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Lee S, Kelleher SL. Molecular regulation of lactation: The complex and requisite roles for zinc. Arch Biochem Biophys 2016; 611:86-92. [DOI: 10.1016/j.abb.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/10/2016] [Accepted: 04/04/2016] [Indexed: 12/22/2022]
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Dembla S, Hasan N, Becker A, Beck A, Philipp SE. Transient receptor potential A1 channels regulate epithelial cell barriers formed by MDCK cells. FEBS Lett 2016; 590:1509-20. [DOI: 10.1002/1873-3468.12183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/18/2016] [Accepted: 04/10/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Sandeep Dembla
- Experimentelle und Klinische Pharmakologie und Toxikologie; Universität des Saarlandes; Homburg Germany
| | - Nouma Hasan
- Experimentelle und Klinische Pharmakologie und Toxikologie; Universität des Saarlandes; Homburg Germany
| | - Alexander Becker
- Experimentelle und Klinische Pharmakologie und Toxikologie; Universität des Saarlandes; Homburg Germany
| | - Andreas Beck
- Experimentelle und Klinische Pharmakologie und Toxikologie; Universität des Saarlandes; Homburg Germany
| | - Stephan Ernst Philipp
- Experimentelle und Klinische Pharmakologie und Toxikologie; Universität des Saarlandes; Homburg Germany
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Remodeling of Tight Junctions and Enhancement of Barrier Integrity of the CACO-2 Intestinal Epithelial Cell Layer by Micronutrients. PLoS One 2015; 10:e0133926. [PMID: 26226276 PMCID: PMC4520484 DOI: 10.1371/journal.pone.0133926] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/22/2015] [Indexed: 01/21/2023] Open
Abstract
The micronutrients zinc, quercetin, butyrate, indole and berberine were evaluated for their ability to induce remodeling of epithelial tight junctions (TJs) and enhance barrier integrity in the CACO-2 gastrointestinal epithelial cell culture model. All five of these chemically very diverse micronutrients increased transepithelial electrical resistance (Rt) significantly, but only berberine also improved barrier integrity to the non-electrolyte D-mannitol. Increases of Rt as much as 200% of untreated controls were observed. Each of the five micronutrients also induced unique, signature-like changes in TJ protein composition, suggesting multiple pathways (and TJ arrangements) by which TJ barrier function can be enhanced. Decreases in abundance by as much as 90% were observed for claudin-2, and increases of over 300% could be seen for claudins -5 and -7. The exact effects of the micronutrients on barrier integrity and TJ protein composition were found to be highly dependent on the degree of differentiation of the cell layer at the time it was exposed to the micronutrient. The substratum to which the epithelial layer adheres was also found to regulate the response of the cell layer to the micronutrient. The implications of these findings for therapeutically decreasing morbidity in Inflammatory Bowel Disease are discussed.
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Skrovanek S, DiGuilio K, Bailey R, Huntington W, Urbas R, Mayilvaganan B, Mercogliano G, Mullin JM. Zinc and gastrointestinal disease. World J Gastrointest Pathophysiol 2014; 5:496-513. [PMID: 25400994 PMCID: PMC4231515 DOI: 10.4291/wjgp.v5.i4.496] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/18/2014] [Accepted: 10/01/2014] [Indexed: 02/06/2023] Open
Abstract
This review is a current summary of the role that both zinc deficiency and zinc supplementation can play in the etiology and therapy of a wide range of gastrointestinal diseases. The recent literature describing zinc action on gastrointestinal epithelial tight junctions and epithelial barrier function is described. Zinc enhancement of gastrointestinal epithelial barrier function may figure prominently in its potential therapeutic action in several gastrointestinal diseases.
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Wang X, Valenzano MC, Mercado JM, Zurbach EP, Flounders CJ, Mullin JM. Zinc enhancement of LLC-PK(1) renal epithelial barrier function. Clin Nutr 2013; 33:280-6. [PMID: 23755840 DOI: 10.1016/j.clnu.2013.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 04/02/2013] [Accepted: 05/01/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Earlier work by our group and others has documented improvement of epithelial barrier function in human gastrointestinal models. Here we tested zinc's ability to improve a renal epithelial model. Our aim was to compare the functional and structural effects of zinc on the tight junctional (TJ) complexes of these two very distinct epithelial cell types. Zinc's ability to achieve barrier enhancement in very different epithelial cell types by action upon distinct molecular targets in each epithelial model may suggest a fundamental general role for supplemental zinc in epithelial barrier improvement throughout the body. METHODS Cell layers were exposed to 50 or 100 μM zinc on both cell surfaces for 48 h followed by measurement of transepithelial electrical resistance (Rt) and transepithelial (14)C-mannitol flux (Jm). TJ proteins in cell layers were analyzed by Western immunoblot. RESULTS AND CONCLUSIONS Zinc supplementation improved the basal TJ barrier function of LLC-PK1 renal cell layers, exemplified by increased Rt and decreased Jm. These zinc-induced changes were also accompanied by decreased NaCl dilution potentials. Of the tight junctional proteins that were tested (occludin, claudins 1, 2, 3, 4, and 5, and tricellulin), we did not observe a zinc-induced change in abundance of any of them, in detergent-soluble fractions of lysates of confluent differentiated cell layers. However, examination of cytosolic fractions showed concentration-dependent increases in the levels of claudins -2 and -4 in this compartment as a result of supplemental zinc. The effects of supplemental zinc on the tight junctional complexes and barrier properties of this renal epithelial model are contrasted with zinc effects on the CACO-2 gastrointestinal model.
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Affiliation(s)
- Xuexuan Wang
- Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | | | - Joanna M Mercado
- Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - E Peter Zurbach
- Department of Chemistry, Saint Joseph's University, 5600 City Avenue, Philadelphia, PA 19131, USA
| | - Christopher J Flounders
- School of Biomedical Engineering Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA
| | - James M Mullin
- Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA; Division of Gastroenterology, Lankenau Medical Center, Wynnewood, PA 19096, USA.
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Xu Z, Zhang C, Zhang Y, Yang X. Europium complexes as novel indicators of paracellular diffusion. Chem Biodivers 2013; 9:1916-22. [PMID: 22976980 DOI: 10.1002/cbdv.201100439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Measurement of paracellular permeation is an important assay for tight-junction investigations of drug toxicity, especially for metal-based drugs, and routine validation of the integrity of cell monolayers for models of drug absorption. Great efforts have been made in discovery and validation of novel paracellular diffusion indicators. In the present work, we prepared three Eu complexes, i.e., [Eu(dtpa)] (dtpa=diethylenetriaminepentaacetic acid), [Eu(dtpa)(BSA)], and [Eu(dtpa)(PLL)] (PLL=poly(L-lysine)), and tested their permeation properties on Madin-Darby canine kidney (MDCK) cells. The experimental results showed that all three probes were nontoxic to MDCK cells, permeated across MDCK monolayer exclusively via the paracellular pathways, and responded well to the changes on tight junction with high correlation of P(app) values to the decrease of trans-epithelial electric resistance (TEER). In addition, time-resolved fluorescence assays were conducted in a high-sensitivity and background-free mode. All these results confirmed the Eu complexes as novel and practical paracellular indicators.
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Affiliation(s)
- Zhihan Xu
- State Key Laboratories of Natural and Biomimetic Drugs and Department of Chemical Biology, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, PR China
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Wang X, Valenzano MC, Mercado JM, Zurbach EP, Mullin JM. Zinc supplementation modifies tight junctions and alters barrier function of CACO-2 human intestinal epithelial layers. Dig Dis Sci 2013; 58:77-87. [PMID: 22903217 DOI: 10.1007/s10620-012-2328-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 07/17/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Zinc deficiency is known to result in epithelial barrier leak in the GI tract. Precise effects of zinc on epithelial tight junctions (TJs) are only beginning to be described and understood. Along with nutritional regimens like methionine-restriction and compounds such as berberine, quercetin, indole, glutamine and rapamycin, zinc has the potential to function as a TJ modifier and selective enhancer of epithelial barrier function. AIMS The purpose of this study was to determine the effects of zinc-supplementation on the TJs of a well-studied in vitro GI model, CACO-2 cells. METHODS Barrier function was assessed electrophysiologically by measuring transepithelial electrical resistance (Rt), and radiochemically, by measuring transepithelial (paracellular) diffusion of 14C-D-mannitol and 14C-polyethyleneglycol. TJ composition was studied by Western immunoblot analyses of occludin, tricellulin and claudins-1 to -5 and -7. RESULTS Fifty- and 100-μM zinc concentrations (control medium is 2 μM) significantly increase Rt but simultaneously increase paracellular leak to D-mannitol. Claudins 2 and 7 are downregulated in total cell lysates, while occludin, tricellulin and claudins-1, -3, -4 and -5 are unchanged. Claudins-2 and -7 as well as tricellulin exhibit decreased cytosolic content as a result of zinc supplementation. CONCLUSIONS Zinc alters CACO-2 TJ composition and modifies TJ barrier function selectively. Zinc is one of a growing number of "nutraceutical" substances capable of enhancing epithelial barrier function, and may find use in countering TJ leakiness induced in various disease states.
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Affiliation(s)
- Xuexuan Wang
- Lankenau Institute for Medical Research, 100 W Lancaster Ave, Wynnewood, PA 19096, USA
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