On a coupled electro-chemomechanical model of gastric smooth muscle contraction

Common Pathophysiological Mechanisms and Treatment of Diabetic Gastroparesis

Diabetic gastroparesis (DGP) is a common complication of diabetes mellitus, marked by gastrointestinal motility disorder, a delayed gastric emptying present in the absence of mechanical obstruction. Clinical manifestations include postprandial fullness and epigastric discomfort, bloating, nausea, and vomiting. DGP may significantly affect the quality of life and productivity of patients. Research on the relationship between gastrointestinal dynamics and DGP has received much attention because of the increasing prevalence of DGP. Gastrointestinal motility disorders are closely related to a variety of factors including the absence and destruction of interstitial cells of Cajal, abnormalities in the neuro-endocrine system and hormone levels. Therefore, this study will review recent literature on the mechanisms of DGP and gastrointestinal motility disorders as well as the development of prokinetic treatment of gastrointestinal motility disorders in order to give future research directions and identify treatment strategies for DGP.

Regional differences in stomach stretch during organ filling and their implications on the mechanical stress response

As part of the digestive system, the stomach plays a crucial role in the health and well-being of an organism. It produces acids and performs contractions that initiate the digestive process and begin the break-up of ingested food. Therefore, its mechanical properties are of interest. This study includes a detailed investigation of strains in the porcine stomach wall during passive organ filling. In addition, the observed strains were applied to tissue samples subjected to biaxial tensile tests. The results show inhomogeneous strains during filling, which tend to be higher in the circumferential direction (antrum: 13.2%, corpus: 22.0%, fundus: 67.8%), compared to the longitudinal direction (antrum: 4.8%, corpus: 24.7%, fundus: 50.0%) at a maximum filling of 3500 ml. Consequently, the fundus region experienced the greatest strain. In the biaxial tensile experiments, the corpus region appeared to be the stiffest, reaching nominal stress values above 400 kPa in the circumferential direction, whereas the other regions only reached stress levels of below 50 kPa in both directions for the investigated stretch range. Our findings gain new insight into stomach mechanics and provide valuable data for the development and validation of computational stomach models.

Mechanical experimentation of the gastrointestinal tract: a systematic review

The gastrointestinal (GI) organs of the human body are responsible for transporting and extracting nutrients from food and drink, as well as excreting solid waste. Biomechanical experimentation of the GI organs provides insight into the mechanisms involved in their normal physiological functions, as well as understanding of how diseases can cause disruption to these. Additionally, experimental findings form the basis of all finite element (FE) modelling of these organs, which have a wide array of applications within medicine and engineering. This systematic review summarises the experimental studies that are currently in the literature (n = 247) and outlines the areas in which experimentation is lacking, highlighting what is still required in order to more fully understand the mechanical behaviour of the GI organs. These include (i) more human data, allowing for more accurate modelling for applications within medicine, (ii) an increase in time-dependent studies, and (iii) more sophisticated in vivo testing methods which allow for both the layer- and direction-dependent characterisation of the GI organs. The findings of this review can also be used to identify experimental data for the readers' own constitutive or FE modelling as the experimental studies have been grouped in terms of organ (oesophagus, stomach, small intestine, large intestine or rectum), test condition (ex vivo or in vivo), number of directions studied (isotropic or anisotropic), species family (human, porcine, feline etc.), tissue condition (intact wall or layer-dependent) and the type of test performed (biaxial tension, inflation-extension, distension (pressure-diameter), etc.). Furthermore, the studies that investigated the time-dependent (viscoelastic) behaviour of the tissues have been presented.

Neural regulation of slow waves and phasic contractions in the distal stomach: a mathematical model

Objective.Neural regulation of gastric motility occurs partly through the regulation of gastric bioelectrical slow waves (SWs) and phasic contractions. The interaction of the tissues and organs involved in this regulatory process is complex. We sought to infer the relative importance of cellular mechanisms in inhibitory neural regulation of the stomach by enteric neurons and the interaction of inhibitory and excitatory electrical field stimulation.Approach.A novel mathematical model of gastric motility regulation by enteric neurons was developed and scenarios were simulated to determine the mechanisms through which enteric neural influence is exerted. This model was coupled to revised and extended electrophysiological models of gastric SWs and smooth muscle cells (SMCs).Main results.The mathematical model predicted that regulation of contractile apparatus sensitivity to intracellular calcium in the SMC was the major inhibition mechanism of active tension development, and that the effect on SW amplitude depended on the inhibition of non-specific cation currents more than the inhibition of calcium-activated chloride current (kiNSCC= 0.77 vs kiAno1= 0.33). The model predicted that the interaction between inhibitory and excitatory neural regulation, when applied with simultaneous and equal intensity, resulted in an inhibition of contraction amplitude almost equivalent to that of inhibitory stimulation (79% vs 77% decrease), while the effect on frequency was overall excitatory, though less than excitatory stimulation alone (66% vs 47% increase).Significance.The mathematical model predicts the effects of inhibitory and excitatory enteric neural stimulation on gastric motility function, as well as the effects when inhibitory and excitatory enteric neural stimulation interact. Incorporation of the model into organ-level simulations will provide insights regarding pathological mechanisms that underpin gastric functional disorders, and allow forin silicotesting of the effects of clinical neuromodulation protocols for the treatment of these disorders.

Cervical Vagus Nerve Stimulation Disrupts Gastric Slow Wave Activity in Rats

Cervical vagus nerve stimulation (cVNS) is a promising neuromodulation therapy for treating symptoms of disease in peripheral organs. The rat is a common animal model for studying and trialing new applications of cVNS therapy, but the stomach and its activity in rats is less well characterized than other animals, such as pigs. We sought to investigate the effects of acute, in vivo cVNS on gastric bioelectrical activity as an intermediate step to computational modeling of the effects of cVNS on gastric smooth muscle electromechanical coupling. Here we show a method of detecting bioelectrical gastric slow wave events using a non-linear energy operator. The marked events are compared to the underlying bioelectrical slow wave activity.The mean propagation velocity before stimulation was 0.79 ± 0.31 mm s-1, and the mean interval was 17.4 ± 1.4 s. During cVNS, there was a significant increase in velocity (1.02 ± 0.69 mm s-1; p < 0.001), and decrease in interval (15.4 ± 2.9 s; p = 0.0196). At stimulation onset, premature slow waves were induced at an ectopic pacemaker location and waves originating at the ectopic and initial pacemaker sites continued to collide following the cessation of cVNS.This work forms the basis for more thorough investigation of the effects of cVNS on gastric bioelectrical slow wave activity and consequential smooth muscle contractions in rats. A better understanding of the effects of cVNS on gastric function will allow the refinement of cVNS therapy to target the stomach, and avoid off-target effects on the stomach.Clinical relevance- This work presents a signal processing and analysis approach for the investigation of cervical vagus nerve stimulation on gastric bioelectrical activity in rats. Vagus nerve stimulation may enable the control and amelioration of hunger, gastric emptying, or functional gastric disorders.

Eccentric muscle contractions: from single muscle fibre to whole muscle mechanics

Eccentric muscle loading encompasses several unique features compared to other types of contractions. These features include increased force, work, and performance at decreased oxygen consumption, reduced metabolic cost, improved energy efficiency, as well as decreased muscle activity. This review summarises explanatory approaches to long-standing questions in terms of muscular contraction dynamics and molecular and cellular mechanisms underlying eccentric muscle loading. Moreover, this article intends to underscore the functional link between sarcomeric components, emphasising the fundamental role of titin in skeletal muscle. The giant filament titin reveals versatile functions ranging from sarcomere organisation and maintenance, providing passive tension and elasticity, and operates as a mechanosensory and signalling platform. Structurally, titin consists of a viscoelastic spring segment that allows activation-dependent coupling to actin. This titin-actin interaction can explain linear force increases in active lengthening experiments in biological systems. A three-filament model of skeletal muscle force production (mediated by titin) is supposed to overcome significant deviations between experimental observations and predictions by the classic sliding-filament and cross-bridge theories. Taken together, this review intends to contribute to a more detailed understanding of overall muscle behaviour and force generation-from a microscopic sarcomere level to a macroscopic multi-joint muscle level-impacting muscle modelling, the understanding of muscle function, and disease.

Computational models of autonomic regulation in gastric motility: Progress, challenges, and future directions

The stomach is extensively innervated by the vagus nerve and the enteric nervous system. The mechanisms through which this innervation affects gastric motility are being unraveled, motivating the first concerted steps towards the incorporation autonomic regulation into computational models of gastric motility. Computational modeling has been valuable in advancing clinical treatment of other organs, such as the heart. However, to date, computational models of gastric motility have made simplifying assumptions about the link between gastric electrophysiology and motility. Advances in experimental neuroscience mean that these assumptions can be reviewed, and detailed models of autonomic regulation can be incorporated into computational models. This review covers these advances, as well as a vision for the utility of computational models of gastric motility. Diseases of the nervous system, such as Parkinson’s disease, can originate from the brain-gut axis and result in pathological gastric motility. Computational models are a valuable tool for understanding the mechanisms of disease and how treatment may affect gastric motility. This review also covers recent advances in experimental neuroscience that are fundamental to the development of physiology-driven computational models. A vision for the future of computational modeling of gastric motility is proposed and modeling approaches employed for existing mathematical models of autonomic regulation of other gastrointestinal organs and other organ systems are discussed.

A geometry model of the porcine stomach featuring mucosa and muscle layer thicknesses

The stomach is a vital organ responsible for food storage, digestion, and transport. Stomach diseases are of great economic and medical importance and require a large number of bariatric surgeries every year. To improve medical interventions, in silico modeling of the gastrointestinal tract has gained popularity in recent years to study stomach functioning. Because of the great structural and nutritional similarity between the porcine and human stomach, the porcine stomach is a suitable surrogate for the development and validation of gastric models. This study presents a realistic 3D geometry model of the porcine stomach based on a photogrammetric reconstruction of a real organ. Layer thicknesses of the stomach wall's mucosa and tunica muscularis were determined by more than 1900 manual measurements at different locations. Layer thickness distributions show mean mucosal and muscle thicknesses of 2.29 ± 0.45 mm and 2.83 ± 0.99 mm, respectively. In general, layer thicknesses increase from fundus (mucosa: 1.82 ± 0.19 mm, muscle layer: 2.59 ± 0.32 mm) to antrum (mucosa: 2.69 ± 0.31 mm, muscle layer: 3.73 ± 1.05 mm). The analysis of stomach asymmetry with respect to an idealized symmetrical stomach model, an approach often used in the literature, revealed volumetric deviations of 45%, 15%, and 92% for the antrum, corpus, and fundus, respectively. The present work also suggests an algorithm for the computation of longitudinal and circumferential directions at local points. These directions are useful for the implementation of material anisotropy. In addition, we present data on the passive pressure-volume relationship of the organ and perform an exemplary finite-element simulation, where we demonstrate the applicability of the model. We encourage others to utilize the geometry model featuring profound asymmetry for future model-based investigations on stomach functioning.

Three-dimensional multi-field modelling of gastric arrhythmias and their effects on antral contractions

The contraction activation of smooth muscle in the stomach wall (SW) is coordinated by slow electrical waves. The interstitial cells of Cajal (ICC), specialised pacemaker cells, initiate and propagate these slow waves. By establishing an electrically coupled network, each ICC adjusts its intrinsic pacing frequency to a single dominant frequency, to be a key aspect in modelling the electrophysiology of gastric tissue. In terms of modelling, additional fields associated with electrical activation, such as voltage-dependent calcium influx and the resulting deformation, have hardly been considered so far. Here we present a three-dimensional model of the electro-chemomechanical activation of gastric smooth muscle contractions. To reduce computational costs, an adaptive multi-scale discretisation strategy for the temporal resolution of the electric field is used. The model incorporates a biophysically based model of gastric ICC pacemaker activity that aims to simulate stable entrainment and physiological conduction velocities of the electrical slow waves. Together with the simulation of concomitant gastric contractions and the inclusion of a mechanical feedback mechanism, the model is used to study dysrhythmias of gastric slow waves induced by abnormal stretching of the antral SW. The model is able to predict the formation of stretch-induced gastric arrhythmias, such as the emergence of an ectopic pacemaker in the gastric antrum. The results show that the ectopic event is accompanied by smooth muscle contraction and, although it disrupts the normal propagation pattern of gastric slow electrical waves, it can also catalyse the process of handling indigestible materials that might otherwise injure the gastric SW.

Dynamic viscoelastic properties of porcine gastric tissue: Effects of loading frequency, region and direction

The gastric biomechanics influences digestive function as well as a range of topics of medical and scientific interests such as interaction between the stomach and gastric devices. Hence, the mechanical properties are essential for understanding gastric tissue and function in health and disease, and for the development of diagnostic or therapeutic devices. A key characteristic to be characterized is the time dependent mechanical tissue properties. The aim of this study was to characterize viscoelastic properties of the stomach across a frequency range. Longitudinal and circumferential stomach samples from the porcine fundus, corpus and antrum were pre-stretched 10 % and sinusoidally loaded with 10 % dynamic strain. The viscoelastic properties were assessed from 0.01 - 15 Hz using dynamic mechanical analysis. The storage moduli, loss moduli and tan δ had a significant second-order polynomial trend with increasing frequency. For the loss moduli, significant differences were observed between 0.01 and 15 Hz and between 0.05 and 15 Hz (p = 0.023 to 0.041). Significant differences were not found for storage moduli. Tan δ was frequency-independent, indicating that the two moduli varied proportionally. Fundus had significantly smaller storage moduli for longitudinal samples compared to corpus (p = 0.034) and antrum (p = 0.014) but was not significantly different for circumferential samples. Analysis of direction-dependency showed significant differences between longitudinal and circumferential samples (p = 0.002 to 0.042). The presented work provides insight into tensile viscoelastic properties of gastric tissue, which is useful for developing biomaterials, devices and computational models for device development specification calibrations.

Mathematical Modeling of Gastric Slow Waves During Electrical Field Stimulation

While neural modulation has been trialed as a therapy for functional gastric motility disorders, a computational model that guides stimulation protocol does not exist. In this work, a mathematical model of gastric slow wave activity, which incorporates the effects of neurotransmitter release during electrical field stimulation (EFS), was developed. Slow wave frequency responses due to the release of acetylcholine and slow wave amplitude responses due to the release of nitric oxide were modeled. The model was calibrated using experimental data from literature. A sensitivity analysis was conducted, which showed that the model yielded stable, periodic solutions for EFS frequencies in the range 0-20 Hz. A 25% increase in the input parameter (EFS frequency) from 5 Hz to 6.25 Hz resulted in a 5.2% increase in slow wave frequency and a 3.2 % decrease in slow wave amplitude. Simulated EFS showed that, for stimulation at 15 Hz, with blocking of the nitrergic neurotransmitter pathway the slow wave increased from the no stimulation scenario in frequency by only 2.4x compared to 2.7x when the nitrergic pathway was not blocked. A 21 % reduction in slow wave amplitude occurred when the cholinergic pathway was blocked, compared to a 46% reduction when no neurotransmitter pathways were blocked. Clinical relevance - This mathematical model is a step towards successful computational modeling of the effects ther-apeutic neural stimulation on the stomach. The model is also a tool for understanding of the physiology of neural stimulation.

Biomechanical constitutive modeling of the gastrointestinal tissues: a systematic review

The gastrointestinal (GI) tract is a continuous channel through the body that consists of the esophagus, the stomach, the small intestine, the large intestine, and the rectum. Its primary functions are to move the intake of food for digestion before storing and ultimately expulsion of feces. The mechanical behavior of GI tissues thus plays a crucial role for GI function in health and disease. The mechanical properties are characterized by a biomechanical constitutive model, which is a mathematical representation of the relation between load and deformation in a tissue. Hence, validated biomechanical constitutive models are essential to characterize and simulate the mechanical behavior of the GI tract. Here, a systematic review of these constitutive models is provided. This review is limited to studies where a model of the strain energy function is proposed to characterize the stress-strain relation of a GI tissue. Several needs are identified for more advanced modeling including: 1) Microstructural models that provide actual structure-function relations; 2) Validation of coupled electro-mechanical models accounting for active muscle contractions; 3) Human data to develop and validate models. The findings from this review provide guidelines for using existing constitutive models as well as perspective and directions for future studies.

Coupled experimental and computational approach to stomach biomechanics: Towards a validated characterization of gastric tissues mechanical properties

Gastric diseases are one of the most relevant healthcare problems worldwide. Interventions and therapies definition/design mainly derive from biomedical and clinical expertise. Computational biomechanics, with particular regard to the finite element method, provides hard-to-measure quantities during in-vivo tests, such as strain and stress distribution, leading to a more comprehensive and promising approach to improve the effectiveness of many different clinical activities. However, reliable finite element models of biological organs require appropriate constitutive formulations of building tissues, whose parameters identification needs an experimental campaign consisting in different tests on human tissues and organs. The aim of the reported here research activities was the identification of mechanical properties of human gastric tissues. Human gastric specimens were tested at tissue, sub-structural and structural levels, by tensile, membrane indentation and inflation tests, respectively. On the other hand, animal experimentations on tissue layers from literature pointed out the mechanical response at sub-tissue level during tensile loading conditions. In detail, the analysis of experimental results at sub-tissue and tissue levels led to a fibre-reinforced visco-hyperelastic constitutive formulation and to the identification of gastric layers mechanical behaviour. Results from experimentations on human samples were coupled with data derived from animal models. Data from sub-structural and structural experimentations were exploited to upgrade and validate the constitutive formulations and parameters. The developed investigations led to a reliable constitutive framework of human gastric tissues that both describe stomach mechanical functionality and allow computational investigations. Indeed, the comparisons among average computational data and experimental medians provided the following RMSEs (Root Mean Square Errors): 0.89 N, 0.15 N for corpus and fundus during membrane indentation test, respectively, and 0.44 kPa during inflation test. Accounting for the magnitude of experimental and computational data, the RMSEs can be considered low and acceptable because they concerned biological samples. In fact, biological tissues and structures are affected by a high inherent inter-samples' variability, which is detectable in both the geometrical configuration and the mechanical behaviour. The specific values of the here reported RMSEs ensured the reliability of the achieved parameters and the quality of the overall developed procedure. Reliable computational models of the gastric district could become efficient clinical tools to find out the main crucial aspects of bariatric procedures, such as the mechanical stimulation of gastric mechano-receptors. Moreover, the methods of computational biomechanics will permit to run the preliminary tests of new and innovative bariatric procedures, on one hand, predicting the successful rate and the effectiveness, and, on other hand, reducing the use of animal testing.

On a phase-field approach to model fracture of small intestine walls

We address anisotropic elasticity and fracture in small intestine walls (SIWs) with both experimental and computational methods. Uniaxial tension experiments are performed on porcine SIW samples with varying alignments and quantify their nonlinear elastic anisotropic behavior. Fracture experiments on notched SIW strips reveal a high sensitivity of the crack propagation direction and the failure stress on the tissue orientation. From a modeling point of view, the observed anisotropic elastic response is studied with a continuum mechanical model stemming from a strain energy density with a neo-Hookean component and an anisotropic component with four families of fibers. Fracture is addressed with the phase-field approach, featuring two-fold anisotropy in the fracture toughness. Elastic and fracture model parameters are calibrated based on the experimental data, using the maximum and minimum limits of the experimental stress-stretch data set. A very good agreement between experimental data and computational results is obtained, the role of anisotropy being effectively captured by the proposed model in both the elastic and the fracture behavior. STATEMENT OF SIGNIFICANCE: This article reports a comprehensive experimental data set on the mechanical failure behavior of small intestinal tissue, and presents the corresponding protocols for preparing and testing the samples. On the one hand, the results of this study contribute to the understanding of small intestine mechanics and thus to understanding of load transfer mechanisms inside the tissue. On the other hand, these results are used as input for a phase-field modelling approach, presented in this article. The presented model can reproduce the mechanical failure behavior of the small intestine in an excellent way and is thus a promising tool for the future mechanical description of diseased small intestinal tissue.

Influence of layer separation on the determination of stomach smooth muscle properties

Uniaxial tensile experiments are a standard method to determine the contractile properties of smooth muscles. Smooth muscle strips from organs of the urogenital and gastrointestinal tract contain multiple muscle layers with different muscle fiber orientations, which are frequently not separated for the experiments. During strip activation, these muscle fibers contract in deviant orientations from the force-measuring axis, affecting the biomechanical characteristics of the tissue strips. This study aimed to investigate the influence of muscle layer separation on the determination of smooth muscle properties. Smooth muscle strips, consisting of longitudinal and circumferential muscle layers (whole-muscle strips [WMS]), and smooth muscle strips, consisting of only the circumferential muscle layer (separated layer strips [SLS]), have been prepared from the fundus of the porcine stomach. Strips were mounted with muscle fibers of the circumferential layer inline with the force-measuring axis of the uniaxial testing setup. The force-length (FLR) and force-velocity relationships (FVR) were determined through a series of isometric and isotonic contractions, respectively. Muscle layer separation revealed no changes in the FLR. However, the SLS exhibited a higher maximal shortening velocity and a lower curvature factor than WMS. During WMS activation, the transversally oriented muscle fibers of the longitudinal layer shortened, resulting in a narrowing of this layer. Expecting volume constancy of muscle tissue, this narrowing leads to a lengthening of the longitudinal layer, which counteracted the shortening of the circumferential layer during isotonic contractions. Consequently, the shortening velocities of the WMS were decreased significantly. This effect was stronger at high shortening velocities.

Strategies to Refine Gastric Stimulation and Pacing Protocols: Experimental and Modeling Approaches

Gastric pacing and stimulation strategies were first proposed in the 1960s to treat motility disorders. However, there has been relatively limited clinical translation of these techniques. Experimental investigations have been critical in advancing our understanding of the control mechanisms that innervate gut function. In this review, we will discuss the use of pacing to modulate the rhythmic slow wave conduction patterns generated by interstitial cells of Cajal in the gastric musculature. In addition, the use of gastric high-frequency stimulation methods that target nerves in the stomach to either inhibit or enhance stomach function will be discussed. Pacing and stimulation protocols to modulate gastric activity, effective parameters and limitations in the existing studies are summarized. Mathematical models are useful to understand complex and dynamic systems. A review of existing mathematical models and techniques that aim to help refine pacing and stimulation protocols are provided. Finally, some future directions and challenges that should be investigated are discussed.

Relationships between serum electrolyte concentrations and ileus: A joint clinical and mathematical modeling study

Aim

Prolonged postoperative ileus (PPOI) occurs in around 15% of patients after major abdominal surgery, posing a significant clinical and economic burden. Significant fluid and electrolyte changes may occur peri‐operatively, potentially contributing to PPOI; however, this association has not been clearly elucidated. A joint clinical‐theoretical study was undertaken to evaluate peri‐operative electrolyte concentration trends, their association with ileus, and predicted impact on bioelectrical slow waves in interstitial cells of Cajal (ICC) and smooth muscle cells (SMC).

Methods

Data were prospectively collected from 327 patients undergoing elective colorectal surgery. Analyses were performed to determine associations between peri‐operative electrolyte concentrations and prolonged ileus. Biophysically based ICC and SMC mathematical models were adapted to evaluate the theoretical impacts of extracellular electrolyte concentrations on cellular function.

Results

Postoperative day (POD) 1 calcium and POD 3 chloride, sodium were lower in the PPOI group (p < 0.05), and POD3 potassium was higher in the PPOI group (p < 0.05). Deficits beyond the reference range in PPOI patients were most notable for sodium (Day 3: 29.5% ileus vs. 18.5% no ileus, p = 0.04). Models demonstrated an 8.6% reduction in slow‐wave frequency following the measured reduction in extracellular NaCl on POD5, with associated changes in cellular slow‐wave morphology and amplitude.

Conclusion

Low serum sodium and chloride concentrations are associated with PPOI. Electrolyte abnormalities are unlikely to be a primary mechanism of ileus, but their pronounced effects on cellular electrophysiology predicted by modeling suggest these abnormalities may adversely impact motility recovery. Resolution and correction of electrolyte abnormalities in ileus may be clinically relevant.