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Mast Cells Modulate the Immune Response and Redox Status of the Gastrointestinal Tract in Induced Venom Pathogenesis. Inflammation 2021; 45:509-527. [PMID: 34608585 DOI: 10.1007/s10753-021-01562-4] [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: 04/22/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
The pathogenesis of Androctonus autralis hector (Aah) scorpion venom involved cellular and molecular mechanisms resulting in multi-organ dysfunction. However, little is reported about the effects of venom on the gastrointestinal axis. Mast cells (MCs) are known to play a crucial role in modulating immune response of the gut. This study aims to investigate the involvement of this cell type in venom-induced gastric and intestinal disorders in a time course (3 and 24h). The obtained results revealed that Aah scorpion venom induced inflammatory cell infiltration as shown by the increase of the myeloperoxidase and eosinophil peroxidase activities. Overexpression of the c-kit receptor (CD117) severely imbalanced the redox status with depletion of antioxidant systemic accompanied by gastrointestinal tissue damage. Moreover, an increased level of lactate dehydrogenase in the serum was correlated with tissue injuries. Pharmacological inhibition of MCs targeting tyrosine kinase (TK) reduces the generation of reactive oxygen species and normalizes catalase, and gluthation S-transferase activities to their physiological levels. In addition, histopathological alterations were restored after pretreatment with c-kit receptor inhibitor associated with a considerable reduction of MC density. Interestingly, obtained results indicate that MCs might be involved in gastric modulation and intestinal inflammation through c-kit signaling following sub-cutaneous Aah venom injection.
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Activation mechanisms and multifaceted effects of mast cells in ischemia reperfusion injury. Exp Cell Res 2019; 376:227-235. [DOI: 10.1016/j.yexcr.2019.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/20/2019] [Accepted: 01/31/2019] [Indexed: 12/16/2022]
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Borges SC, Ferreira PEB, da Silva LM, de Paula Werner MF, Irache JM, Cavalcanti OA, Buttow NC. Evaluation of the treatment with resveratrol-loaded nanoparticles in intestinal injury model caused by ischemia and reperfusion. Toxicology 2018; 396-397:13-22. [PMID: 29427784 DOI: 10.1016/j.tox.2018.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 01/07/2023]
Abstract
The gastrointestinal tract is extremely sensitive to ischemia and reperfusion (I/R). Studies have reported that resveratrol (RSV) is able to combat damage caused by intestinal I/R. Because of its effectiveness in increasing the permanence and bioavailability of resveratrol in the intestinal epithelium, we investigated whether the effect of resveratrol-loaded in poly(anhydride) nanoparticles reduce oxidative stress and promote myenteric neuroprotection in the ileum of rats subjected to I/R. Physicochemical evaluations were performed on nanoparticles. The animals were divided into nine groups (n = 6/group) and treated every 48 h. Treatments with resveratrol (7 mg/kg of body weight) were applied 5 days before surgery and continued for 7 days after surgery (reperfusion period). The superior mesenteric artery was occluded to cause I/R injury. Oxidative stress, myeloperoxidase, nitrite, aspartate aminotransferase, alanine aminotransferase, immunolabeling of myenteric neurons and glial cells, and gastrointestinal transit was evaluated. Both nanoparticle formulations presented negative charge with homogeneous distribution, and the payload, showed an encapsulation efficiency of 60%. Resveratrol administered in free form prevented alterations that were caused by I/R. The results of the groups treated with RSV-loaded nanoparticles presented similar results to the group treated with free resveratrol. Treatment with empty nanoparticles showed that poly(anhydride) is not an ideal nanocarrier for application in in vivo models of intestinal I/R injury, because of hepatotoxicity that may be caused by epithelial barrier dysfunction that triggers the translocation of nanoparticles.
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Affiliation(s)
- Stephanie Carvalho Borges
- Department of Morphological Sciences, State University of Maringá, Colombo Avenue, 5790, CEP: 87020-900, Maringá, Paraná, Brazil
| | - Paulo Emílio Botura Ferreira
- Campus Uruguaiana, Federal University of Pampa, BR 472 - Km 592, CEP: 97508-000, Uruguaiana, Rio Grande do Sul, Brazil
| | - Luisa Mota da Silva
- Postgraduate Program in Pharmaceutical Sciences, University Vale of Itajaí, Uruguai Street, 458, CEP: 88302-901, Itajaí, Santa Catarina, Brazil
| | - Maria Fernanda de Paula Werner
- Department of Pharmacology, Federal University of Paraná, XV de Novembro Street, 1299, CEP 80.060-000, Curitiba, Paraná, Brazil
| | - Juan Manuel Irache
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, C/Irunlarrea 1, E-31008, Pamplona, Spain
| | - Osvaldo Albuquerque Cavalcanti
- Department of Pharmacology and Therapeutics, State University of Maringá, Colombo Avenue, 5790, CEP: 87020-900, Maringá, Paraná, Brazil
| | - Nilza Cristina Buttow
- Department of Morphological Sciences, State University of Maringá, Colombo Avenue, 5790, CEP: 87020-900, Maringá, Paraná, Brazil.
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Ohlsson B, Gustafsson R, Swahn F, Toth E, Veress B, Thorlacius H. Endoscopic full-thickness biopsy, a novel method in the work up of complicated abdominal symptoms. Therap Adv Gastroenterol 2017; 11:1756283X17730747. [PMID: 29383022 PMCID: PMC5784575 DOI: 10.1177/1756283x17730747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Gastrointestinal complaints without obvious organic causes confirmed by clinical laboratory analyses, endoscopy or radiology are often referred to functional entities. Irritable bowel syndrome (IBS) is the most common functional disorder in the gut. Careful examination of these patients may reveal other diagnoses of defined etiologies, e.g., enteric neuropathy, microscopic colitis, and primary Sjögre's syndrome. The present case describes a young patient with incapacitating gastrointestinal symptoms presumed to be IBS, who underwent endoscopic full-thickness biopsy in sigmoid colon. Histopathological examination revealed degenerative enteric neuropathy, possibly secondary to chronic ischemia.
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Affiliation(s)
- Bodil Ohlsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Jan Waldenström Street 15, S-205 02 Malmö, Sweden
| | - Rita Gustafsson
- Department of Gastroenterology, Skane University Hospital, Malmö, Sweden
| | - Fredrik Swahn
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Ervin Toth
- Department of Gastroenterology, Skane University Hospital, Malmö, Sweden
| | - Béla Veress
- Department of Cellular Pathology, Unilabs AB, Skövde, Sweden
| | - Henrik Thorlacius
- Department of Surgery, Lund University, Skane University Hospital, Malmö, Sweden
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Nogueira LT, Costa DVS, Gomes AS, Martins CS, Silva AMHP, Coelho-Aguiar JM, Castelucci P, Lima-Júnior RCP, Leitão RFC, Moura-Neto V, Brito GAC. The involvement of mast cells in the irinotecan-induced enteric neurons loss and reactive gliosis. J Neuroinflammation 2017; 14:79. [PMID: 28388962 PMCID: PMC5384042 DOI: 10.1186/s12974-017-0854-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 03/27/2017] [Indexed: 02/06/2023] Open
Abstract
Background The irinotecan (CPT-11) causes intestinal mucositis and diarrhea that may be related to changes in the enteric nervous system (ENS). In inflammatory condition, mast cells release a variety of pro-inflammatory mediators that can interact with the ENS cells. It has not been explored whether CPT-11 is able to alter the enteric glial and neuronal cell, and the role of mast cells in this effect. Therefore, this study was conducted to investigate the effect of CPT-11 on the enteric glial and neuronal cells, as well as to study the role of mast cells in the CPT-11-induced intestinal mucositis. Methods Intestinal mucositis was induced in Swiss mice by the injection of CPT-11 (60 mg/kg, i.p.) once a day for 4 days following by euthanasia on the fifth day. To investigate the role of mast cells, the mice were pretreated with compound 48/80 for 4 days (first day, 0.6 mg/kg; second day, 1.0 mg/kg; third day, 1.2 mg/kg; fourth day, 2.4 mg/kg) to induce mast cell degranulation before the CPT-11 treatment. Results Here, we show that CPT-11 increased glial fibrillary acidic protein (GFAP) and S100β gene and S100β protein expressions and decreased HuC/D protein expression in the small intestine segments. Concomitantly, CPT-11 enhanced tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels and inducible nitric oxide synthase (iNOS) gene expression, associated with an increase in the total number macrophages (positive cells for ionized calcium-binding adapter molecule, Iba-1) and degranulated mast cells in the small intestine segments and caused significant weight loss. The pretreatment with compound 48/80, an inductor of mast cells degranulation, significantly prevented these CPT-11-induced effects. Conclusions Our data suggests the participation of mast cells on the CPT-11-induced intestinal mucositis, macrophages activation, enteric reactive gliosis, and neuron loss. Electronic supplementary material The online version of this article (doi:10.1186/s12974-017-0854-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ludmila T Nogueira
- Department of Morphology, Federal University of Piauí, Teresina, Piauí, Brazil
| | - Deiziane V S Costa
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, Farias Delmiro street, Fortaleza, CE, 60430170, Brazil
| | - Antoniella S Gomes
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, Farias Delmiro street, Fortaleza, CE, 60430170, Brazil
| | - Conceição S Martins
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, Farias Delmiro street, Fortaleza, CE, 60430170, Brazil
| | - Angeline M H P Silva
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, Farias Delmiro street, Fortaleza, CE, 60430170, Brazil
| | - Juliana M Coelho-Aguiar
- Paulo Niemeyer Brain Institute, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | | | - Roberto C P Lima-Júnior
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Renata F C Leitão
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, Farias Delmiro street, Fortaleza, CE, 60430170, Brazil
| | - Vivaldo Moura-Neto
- Paulo Niemeyer Brain Institute, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Gerly A C Brito
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, Farias Delmiro street, Fortaleza, CE, 60430170, Brazil.
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Jönsson A, Sand E, Ekblad E, Ohlsson B. Long‑term follow‑up of buserelin‑induced enteric neuropathy in rats. Mol Med Rep 2016; 13:3507-13. [PMID: 26935850 PMCID: PMC4805092 DOI: 10.3892/mmr.2016.4968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/15/2016] [Indexed: 11/06/2022] Open
Abstract
A few patients have been shown to develop severe abdominal pain and gastrointestinal dysmotility during treatment with gonadotropin‑releasing hormone (GnRH) analogs. A rat model of enteric neuropathy has been developed by administration of the GnRH analog buserelin to rats. Loss of enteric neurons and ganglioneuritis throughout the gastrointestinal tract has been described, without other histopathological changes. The aim of the present study was to investigate the long‑term effects of this rat model on body weight, and on morphology and inflammatory changes in the gastrointestinal tract. Rats were administered subcutaneous injections of buserelin or saline once daily for 5 days and allowed to recover for 3 weeks. This regimen was repeated four times. The rats were weighed weekly and were sacrificed 16 weeks after the fourth treatment. The bowel wall was measured by morphometry, and the presence of enteric neurons, mast cells, eosinophils and T‑lymphocytes was evaluated. Buserelin‑treated rats were shown to have a lower body weight at sacrifice, as compared with the controls (P<0.05). Compared with controls, buserelin treatment caused loss of myenteric neurons in the ileum and colon (P<0.01), a thinner circular muscle layer in ileum (P<0.05) and longitudinal muscle layer in colon (P<0.05), increased number of eosinophils in the submucosa of the ileum (P<0.05), and an increased number of T‑lymphocytes in the submucosa and circular muscle layer of the fundus (P<0.01 and P<0.05, respectively) and circular muscle layer of the colon (P<0.05). Mast cells were equally distributed in the two groups. Thus, long‑term follow‑up of buserelin‑induced enteric neuropathy reveals reduced body weight, loss of myenteric neurons, thinning of muscle layers, and increased numbers of eosinophils and T‑lymphocytes in the gastrointestinal tract.
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Affiliation(s)
- Anette Jönsson
- Department of Clinical Sciences, Division of Internal Medicine, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden
| | - Elin Sand
- Department of Clinical Sciences, Division of Internal Medicine, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden
| | - Eva Ekblad
- Department of Experimental Medical Science, Neurogastroenterology Unit, BMC B11, Lund University, 221 84 Lund, Sweden
| | - Bodil Ohlsson
- Department of Clinical Sciences, Division of Internal Medicine, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden
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Sand E, Roth B, Weström B, Bonn P, Ekblad E, Ohlsson B. Structural and functional consequences of buserelin-induced enteric neuropathy in rat. BMC Gastroenterol 2014; 14:209. [PMID: 25496312 PMCID: PMC4275936 DOI: 10.1186/s12876-014-0209-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/28/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Women treated with gonadotropin-releasing hormone (GnRH) analogs may develop enteric neuropathy and dysmotility. Administration of a GnRH analog to rats leads to similar degenerative neuropathy and ganglioneuritis. The aim of this study on rat was to evaluate the early GnRH-induced enteric neuropathy in terms of distribution of neuronal subpopulations and gastrointestinal (GI) function. METHODS Forty rats were given the GnRH analog buserelin (20 μg, 1 mg/ml) or saline subcutaneously, once daily for 5 days, followed by 3 weeks of recovery, representing one treatment session. Two weeks after the fourth treatment session, the animals were tested for GI transit time and galactose absorption, and fecal weight and fat content was analyzed. After sacrifice, enteric neuronal subpopulations were analyzed. Blood samples were analyzed for zonulin and antibodies against GnRH and luteinizing hormone, and their receptors. RESULTS Buserelin treatment transiently increased the body weight after 5 and 9 weeks (p < 0.001). Increased estradiol in plasma and thickened uterine muscle layers indicate high estrogen activity. The numbers of both submucous and myenteric neurons were reduced by 27%-61% in ileum and colon. The relative numbers of neurons containing calcitonin gene-related peptide (CGRP), cocaine- and amphetamine-related transcript (CART), galanin, gastrin-releasing peptide (GRP), neuropeptide Y (NPY), nitric oxide synthase (NOS), serotonin, substance P (SP), vasoactive intestinal peptide (VIP) or vesicular acetylcholine transporter (VAchT), and their nerve fiber density, were unchanged after buserelin treatment, but the relative number of submucous neurons containing somatostatin tended to be increased (p = 0.062). The feces weight decreased in buserelin-treated rats (p < 0.01), whereas feces fat content increased (p < 0.05), compared to control rats. Total GI transit time, galactose absorption, zonulin levels in plasma, and antibody titers in serum were unaffected by buserelin treatment. CONCLUSIONS A marked enteric neuronal loss with modest effects on GI function is found after buserelin treatment. Increased feces fat content is suggested an early sign of dysfunction.
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Affiliation(s)
- Elin Sand
- Department of Clinical Sciences, Division of Internal Medicine Skåne University Hospital, Lund University, Inga Marie Nilssons street 32, S-205 02, Malmö, Sweden. .,Department of Experimental Medical Science, Neurogastroenterology Unit, BMC B11, Lund University, 221 84, Lund, Sweden.
| | - Bodil Roth
- Department of Clinical Sciences, Division of Internal Medicine Skåne University Hospital, Lund University, Inga Marie Nilssons street 32, S-205 02, Malmö, Sweden.
| | - Björn Weström
- Department of Biology, Functional Biology, Lund University, 221 00, Lund, Sweden.
| | - Peter Bonn
- Department of Medicinal Chemistry, CVMD, AstraZeneca, Mölndal, Sweden.
| | - Eva Ekblad
- Department of Experimental Medical Science, Neurogastroenterology Unit, BMC B11, Lund University, 221 84, Lund, Sweden.
| | - Bodil Ohlsson
- Department of Clinical Sciences, Division of Internal Medicine Skåne University Hospital, Lund University, Inga Marie Nilssons street 32, S-205 02, Malmö, Sweden.
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The role of mast cells in ischemia and reperfusion injury. Inflamm Res 2014; 63:899-905. [PMID: 25108401 DOI: 10.1007/s00011-014-0763-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/04/2014] [Accepted: 07/24/2014] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Ischemia and reperfusion (IR) injury is a challenging clinical problem that is triggered by ischemia in an organ followed by subsequent restoration of the blood supply. The effects of mast cell (MC) in IR injury are not totally clear. MATERIALS AND METHODS We review the body of literature on the role of MCs in IR injury based on an unrestricted Pubmed search for the descriptors "mast cell", "ischemia" and "reperfusion injury", as well as discuss implications for treatment and future directions. RESULTS Shortly after IR, chemicals released by MC can trigger vasoactive substance formation, tissue leakage, upregulation of adhesive molecules followed by leukocyte recruitment and infiltration, and pronecrotic pathway activation, among other physiologic changes. In the long term, MCs may influence tissue remodeling and repair as well as blood restoration after IR. Consistent with these findings, methods and drugs that target MCs have been shown to attenuate IR injury. CONCLUSION It has been demonstrated that MCs play a role in IR injury, but the mechanisms are complex and need to be further studied.
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Sand E, Voss U, Hammar O, Alm R, Fredrikson GN, Ohlsson B, Ekblad E. Gonadotropin-releasing hormone analog buserelin causes neuronal loss in rat gastrointestinal tract. Cell Tissue Res 2012; 351:521-34. [PMID: 23254679 DOI: 10.1007/s00441-012-1534-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 11/15/2012] [Indexed: 12/22/2022]
Abstract
Gonadotropin-releasing hormone (GnRH) analogs are given to women undergoing in vitro fertilization. Case reports describing the development of chronic intestinal pseudo-obstruction and auto-antibodies against GnRH after such treatment suggest a strong association between intestinal dysfunction and GnRH analogs. No experimental model for studying such a relationship is currently at hand. Our main goal was to investigate possible enteric neurodegeneration and titers of GnRH antibodies in response to repeated administration of the GnRH analog buserelin in rat. Rats were treated for 1-4 sessions with daily subcutaneous injections of buserelin or saline for 5 days, followed by 3 weeks of recovery. Buserelin treatment caused significant loss of submucous and myenteric neurons in the fundus, ileum, and colon. The loss of enteric neurons can, at least partly, be explained by increased apoptosis. No GnRH- or GnRH-receptor-immunoreactive (IR) enteric neurons but numerous luteinizing hormone (LH)-receptor-IR neurons were detected. After buserelin treatment, the relative number of enteric LH-receptor-IR neurons decreased, whereas that of nitric-oxide-synthase-IR neurons increased. No intestinal inflammation or increased levels of circulating interleukins/cytokines were noted in response to buserelin treatment. Serum GnRH antibody titers were undetectable or extremely low in all rats. Thus, repeated administrations of buserelin induce neurodegeneration in rat gastrointestinal tract, possibly by way of LH-receptor hyperactivation. The present findings suggest that enteric neurodegenerative effects of GnRH analog treatment in man can be mimicked in rat. However, in contrast to man, no production of GnRH auto-antibodies has been noted in rat.
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Affiliation(s)
- Elin Sand
- Department of Experimental Medical Sciences, Neurogastroenterology Unit, Lund University, BMC B11, 22184, Lund, Sweden.
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Anand P, Singh B, Jaggi AS, Singh N. Mast cells: an expanding pathophysiological role from allergy to other disorders. Naunyn Schmiedebergs Arch Pharmacol 2012; 385:657-70. [PMID: 22562473 DOI: 10.1007/s00210-012-0757-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 04/17/2012] [Indexed: 12/16/2022]
Abstract
The mast cells are multi-effector cells with wide distribution in the different body parts and traditionally their role has been well-defined in the development of IgE-mediated hypersensitivity reactions including bronchial asthma. Due to the availability of genetically modified mast cell-deficient mice, the broadened pathophysiological role of mast cells in diverse diseases has been revealed. Mast cells exert different physiological and pathophysiological roles by secreting their granular contents, including vasoactive amines, cytokines and chemokines, and various proteases, including tryptase and chymase. Furthermore, mast cells also synthesize plasma membrane-derived lipid mediators, including prostaglandins and leukotrienes, to produce diverse biological actions. The present review discusses the pathophysiological role of mast cells in different diseases, including atherosclerosis, pulmonary hypertension, ischemia-reperfusion injury, male infertility, autoimmune disorders such as rheumatoid arthritis and multiple sclerosis, bladder pain syndrome (interstitial cystitis), anxiety, Alzheimer's disease, nociception, obesity and diabetes mellitus.
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Affiliation(s)
- Preet Anand
- Department of Chemistry, Punjabi University, Patiala 147002, India
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Lewis JH. The risk of ischaemic colitis in irritable bowel syndrome patients treated with serotonergic therapies. Drug Saf 2011; 34:545-65. [PMID: 21663331 DOI: 10.2165/11590690-000000000-00000] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Ischaemic colitis (IC) is the most common form of ischaemic injury to the gastrointestinal (GI) tract. IC typically presents with the sudden onset of lower abdominal pain, cramping and rectal bleeding, and is usually self-limited with low morbidity, although it may cause gangrenous or fulminant colitis, especially when the right colon is involved. Multiple medical conditions, as well as several pharmacological agents, are associated with IC, including irritable bowel syndrome (IBS) and drugs used for its treatment that act on gut serotonin 5-HT receptors. These include the selective 5-HT(3) receptor antagonist alosetron, currently approved for the treatment of severe diarrhoea-predominant IBS in women who fail to respond to conventional treatment, and cilansetron, another 5-HT(3) receptor antagonist that is no longer in clinical development. In addition, the 5-HT(4) receptor partial agonist tegaserod, which was approved for the treatment of constipation-predominant IBS in women, was associated with IC in the postmarketing setting, as was renzapride, a 5-HT(4) agonist/5-HT(3) antagonist. Although several hypotheses have been proposed, the pathophysiological basis for development of IC with 5-HT(3) receptor antagonists or 5-HT(4) receptor agonists remains unknown. Of interest, several population-based studies demonstrated that a diagnosis of IBS (independent of serotonergic therapies) increases the risk of developing IC 2- to 4-fold. As a result, IBS patients with the acute onset of abdominal pain, tenderness, diarrhoea or lower intestinal bleeding, especially those with predisposing conditions or medications, should be evaluated promptly for IC. The management of IC remains supportive; most cases of non-gangrenous IC, as seen in the alosetron and tegaserod databases, have been transient and have resolved spontaneously without complications or death. Despite the small number of deaths associated with alosetron in patients with complications of constipation and because of the ongoing requirement to prescribe alosetron under a risk management plan, misconceptions persist regarding the definition, incidence, severity and outcome of IC in clinical trials and the postmarketing setting. In this article, the frequency and clinical characteristics of IC associated with the use of alosetron and other serotonergic agents are examined, evidence of an association between IC and IBS is reviewed, and a scoring system to aid in the diagnosis of IC in any clinical situation is proposed.
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Affiliation(s)
- James H Lewis
- Division of Gastroenterology, Georgetown University Medical Center, Washington, DC, USA
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Jiang W, Kirkup AJ, Grundy D. Mast cells drive mesenteric afferent signalling during acute intestinal ischaemia. J Physiol 2011; 589:3867-82. [PMID: 21669977 DOI: 10.1113/jphysiol.2011.209478] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Acute intestinal ischaemia stimulates visceral afferent nerves but the mechanisms responsible for this excitation are not fully understood. Mast cells may participate in this process as they are known to signal to mesenteric afferents during intestinal anaphylaxis and contribute to early inflammation and neuronal damage in response to cerebral ischaemia. We therefore hypothesised that mast cells are early responders to acute intestinal ischaemia and their activation initiates rapid signalling to the CNS via the excitation of mesenteric afferents. Primary afferent firing was recorded from a mesenteric nerve bundle supplying a segment of jejunum in anaesthetized adult rats. Acute focal ischaemia was produced by clamping theme senteric vessels for 8 min, and reperfusion followed removal of the vessel clip. Two episodes of ischaemia–reperfusion (I–R) separated by a 30 min interval were performed. Drugs or their vehicles were administered 10 min before the 2nd I–R episode. Ischaemia caused a reproducible, intense and biphasic afferent firing that was temporally dissociated from the concomitantly triggered complex pattern of intestinal motor activity. The L-type calcium channel blocker, nifedipine, significantly attenuated this afferent firing by a mechanism independent of its action on intestinal tone. Ischaemia-induced afferent firing was also abrogated by the mast cell stabilizer, doxantrazole, and the H1 histamine receptor antagonist, pyrilamine. In contrast, the nicotinic receptor antagonist, hexamethonium, and the N-type calcium channel toxin, ω-conotoxin GVIA, each reduced the ischaemia-evoked motor inhibition but not the concurrent afferent discharge. Similarly, the cyclooxygenase inhibitor, naproxen, had no effect on the ischaemic afferent response but reduced the intestinal tone shortly from the onset of ischaemia to the early period of reperfusion. These data support a critical role for mast cell-derived histamine in the direct chemoexcitation of mesenteric afferents during acute intestinal ischaemia, whereas enteric reflex mechanisms and cyclooxygenase products contribute primarily to ischaemia-induced changes in intestinal motility. Therefore, targeting mast cells may provide benefits in patients with abdominal pain resulting from an ischaemic insult to the gastrointestinal tract.
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Affiliation(s)
- Wen Jiang
- Department of Biomedical Science, Florey Building, Firth Court, University of Sheffield, Sheffield S10 2TN, UK
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Sand E, Themner-Persson A, Ekblad E. Corticotropin releasing factor-distribution in rat intestine and role in neuroprotection. ACTA ACUST UNITED AC 2010; 166:68-75. [PMID: 20801165 DOI: 10.1016/j.regpep.2010.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 07/01/2010] [Accepted: 08/20/2010] [Indexed: 01/07/2023]
Abstract
UNLABELLED Aims of the present study were to describe the distribution of corticotropin releasing factor (CRF) immunoreactivity in rat small and large intestines, to quantify the percentage of CRF-immunoreactive (CRF-IR) enteric neurons, to reveal possible CRF immunoreactivity in cultured myenteric neurons from rat ileum and to examine if additions of CRF, urocortin 1 (Ucn1), CRF antagonist or vasoactive intestinal peptide (VIP) affect neuronal survival in vitro. Co-localization of CRF- and VIP-immunoreactivity was examined, as well as a possible interplay between CRF and VIP in neuroprotection. Further we wanted to elucidate if mast cells affect neuronal survival via CRF signaling. Networks of CRF-containing nerve cell bodies and fibers were detected in rat intestine. CRF-IR neurons contained to a high degree also VIP. A low number of cultured myenteric neurons was CRF-IR. CRF, Ucn1 or CRF-antagonist did not promote neuronal survival of cultured myenteric neurons, while VIP significantly enhanced neuronal survival. Simultaneous presence of CRF attenuated the VIP mediated increase in neuronal survival. Co-culturing neurons and mast cells resulted in a marked reduction in neuronal survival, not executed via CRF signaling pathways. CONCLUSION CRF is present in enteric neurons and counteracts the neuroprotective effect of VIP in vitro.
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Affiliation(s)
- Elin Sand
- Department of Experimental Medical Science, Lund University, Lund, Sweden.
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Ravnefjord A, Pettersson M, Rehnström E, Martinez V. Acute colonic ischaemia in rats results in long-term structural changes without alterations of colonic sensitivity. Int J Exp Pathol 2008; 89:476-89. [PMID: 19134057 PMCID: PMC2669609 DOI: 10.1111/j.1365-2613.2008.00623.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 09/10/2008] [Indexed: 12/19/2022] Open
Abstract
Colonic ischaemia and mast cells have been involved in the pathophysiology of the functional gastrointestinal disorder irritable bowel syndrome, although the cause-effect relationships remain unknown. We assessed long-term histopathological and functional changes associated to an acute ischaemic episode (1 h) of the colon, followed by 8-week recovery, in rats. Functional colonic alterations [sensitivity during colorectal distension (CRD), compliance and propulsive motility] were assessed regularly during the recovery. Colonic histopathology (presence of inflammation, morphometric alterations and variations in neuronal density in the enteric nervous system) 8-week postischaemia was assessed. Following ischaemia, none of the functional parameters tested (motility, sensitivity and compliance) were affected. At necropsy, the colon presented an overall normal appearance with an increase in weight of the ischaemic area (mg/cm: 99 +/- 6; P < 0.05 vs. control: 81 +/- 4 or sham ischaemia: 81 +/- 3). Histopathological evaluations revealed the presence of a local infiltrate of mast cells in the area of ischaemia (nb of mast cells: 142 +/- 50; P < 0.05 vs. control, 31 +/- 14 or sham ischaemia: 40 +/- 16), without other significant alterations. Animals subjected to colonic ischaemia and treated 8 weeks later with the mast cell degranulator, compound 48/80, showed no changes in CRD-related pain responses. These studies show that acute colonic ischaemia is associated with the presence of a long-term local infiltration of mast cells, located within the serosa and muscle layers, despite the absence of functional changes, including colonic sensitivity. Considering the important pathophysiological functions of mast cells, the observed mast cell infiltration may be involved in ischaemia-induced functional changes yet to be characterized.
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Sand E, Themner-Persson A, Ekblad E. Mast cells reduce survival of myenteric neurons in culture. Neuropharmacology 2008; 56:522-30. [PMID: 19013185 DOI: 10.1016/j.neuropharm.2008.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 09/19/2008] [Accepted: 10/13/2008] [Indexed: 12/31/2022]
Abstract
Mast cell-nerve interactions play a key role in intestinal inflammation and irritable bowel disease. Loss of enteric neurons has been reported in inflammatory conditions but the contribution of mast cells in this event is unknown. To study neuronal survival and plasticity of myenteric neurons in contact with mast cells a co-culture system using myenteric neurons from rat small intestine and peritoneal mast cells was set up. Dissociated myenteric neurons were cultured for 4 days before addition of mast cells isolated by peritoneal lavage. Neuronal survival and expression of vasoactive intestinal peptide (VIP) and nitric oxide synthase (NOS) were studied by immunocytochemistry and neuronal cell counting. Myenteric neurons cultured without mast cells were used to study the rate of neuronal survival after the addition of various mast cell mediators, proteinase-activated receptor(2) (PAR(2)) agonist, VIP or corticosteroid. A striking mast cell-induced neuronal cell death was found after co-culturing. It was counteracted by the addition of mast cell stabiliser doxantrazole, protease inhibitors, PAR(2) antagonist FSLLRY-amide, corticosteroid or VIP. In myenteric neurons cultured without mast cells the PAR(2) agonist SLIGRL-amide, prostaglandin D(2) and interleukin (IL) 6 reduced neuronal survival while histamine, serotonin, heparin, IL1beta and tumour necrosis factor alpha had no effect; corticosteroid and VIP enhanced neuronal survival. The relative numbers of VIP-, but not NOS-expressing myenteric neurons increased after co-culturing. Mast cell-induced neuronal cell death is suggested to be mediated via PAR(2) activation, IL6 and prostaglandin D(2). Corticosteroid and VIP are neuroprotective and able to prevent cell death of myenteric neurons in co-culture.
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Affiliation(s)
- Elin Sand
- Department of Experimental Medical Science, Unit Neurogastroenterology, Lund University, BMC, B11, SE 22184 Lund, Sweden
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