The corticotropin-releasing factor system in inflammatory bowel disease: prospects for new therapeutic approaches

Methylation Status of Corticotropin-Releasing Factor (CRF) Receptor Genes in Colorectal Cancer

The corticotropin-releasing factor (CRF) system has been strongly associated with gastrointestinal pathophysiology, including colorectal cancer (CRC). We previously showed that altered expression of CRF receptors (CRFRs) in the colon critically affects CRC progression and aggressiveness through regulation of colonic inflammation. Here, we aimed to assess the potential of CRFR methylation levels as putative biomarkers in CRC. In silico methylation analysis of CRF receptor 1 (CRFR1) and CRF receptor 2 (CRFR2) was performed using methylome data derived by CRC and Crohn's disease (CD) tissues and CRC-derived circulating cell-free DNAs (ccfDNAs). In total, 32 and 33 differentially methylated sites of CpGs (DMCs) emerged in CRFR1 and CRFR2, respectively, between healthy and diseased tissues. The methylation patterns were verified in patient-derived ccfDNA samples by qMSP and associated with clinicopathological characteristics. An automated machine learning (AutoML) technology was applied to ccfDNA samples for classification analysis. In silico analysis revealed increased methylation of both CRFRs in CRC tissue and ccfDNA-derived datasets. CRFR1 hypermethylation was also noticed in gene body DMCs of CD patients. CRFR1 hypermethylation was further validated in CRC adjuvant-derived ccfDNA samples, whereas CRFR1 hypomethylation, observed in metastasis-derived ccfDNAs, was correlated to disease aggressiveness and adverse prognostic characteristics. AutoML analysis based on CRFRs methylation status revealed a three-feature high-performing biosignature for CRC diagnosis with an estimated AUC of 0.929. Monitoring of CRFRs methylation-based signature in CRC tissues and ccfDNAs may be of high diagnostic and prognostic significance in CRC.

Chronic Stress, Inflammation, and Colon Cancer: A CRH System-Driven Molecular Crosstalk

Chronic stress is thought to be involved in the occurrence and progression of multiple diseases, via mechanisms that still remain largely unknown. Interestingly, key regulators of the stress response, such as members of the corticotropin-releasing-hormone (CRH) family of neuropeptides and receptors, are now known to be implicated in the regulation of chronic inflammation, one of the predisposing factors for oncogenesis and disease progression. However, an interrelationship between stress, inflammation, and malignancy, at least at the molecular level, still remains unclear. Here, we attempt to summarize the current knowledge that supports the inseparable link between chronic stress, inflammation, and colorectal cancer (CRC), by modulation of a cascade of molecular signaling pathways, which are under the regulation of CRH-family members expressed in the brain and periphery. The understanding of the molecular basis of the link among these processes may provide a step forward towards personalized medicine in terms of CRC diagnosis, prognosis and therapeutic targeting.

CRH promotes human colon cancer cell proliferation via IL-6/JAK2/STAT3 signaling pathway and VEGF-induced tumor angiogenesis

Corticotrophin-releasing hormone (CRH) has been demonstrated to participate in various diseases. Our previous study showed that its receptor CRHR1 mediated the development of colitis-associated cancer in mouse model. However, the detailed mechanisms remain unclear. In this study, we explored the oncogenetic role of CRH/CRHR1 signaling in colon cancer cells. Cell proliferation and colony formation assays revealed that CRH contributed to cell proliferation. Moreover, tube formation assay showed that CRH-treated colon cancer cell supernatant significantly promoted tube formation of human umbilical vein endothelial cells (HUVECs). And these effects could be reversed by the CRHR1 specific antagonist Antalarmin. Further investigation showed that CRH significantly upregulated the expressions of interlukin-6 (IL-6) and vascular endothelial growth factor (VEGF) through activating nuclear factor-kappa B (NF-κB). The CRH-induced IL-6 promoted phosphorylation of janus kinase 2 (JAK2) and signal transducers and activators of transcription 3 (STAT3). STAT3 inhibition by Stattic significantly inhibited the CRH-induced cell proliferation. In addition, silence of VEGF resulted in declined tube formation induced by CRH. Taken together, CRH/CRHR1 signaling promoted human colon cancer cell proliferation via NF-κB/IL-6/JAK2/STAT3 signaling pathway and tumor angiogenesis via NF-κB/VEGF signaling pathway. Our results provide evidence to support a critical role for the CRH/CRHR1 signaling in colon cancer progression and suggest its potential utility as a new therapeutic target for colon cancer.

Pharmacotherapy in smoking cessation: Corticotropin Releasing Factor receptors as emerging intervention targets

Smoking represents perhaps the single most important health risk factor and a global contributor to mortality that can unquestionably be prevented. Smoking is responsible for many diseases, including various types of cancer, chronic obstructive pulmonary disease, coronary heart disease, peripheral vascular disease and peptic ulcer, while it adversely affects fetal formation and development. Since smoking habit duration is a critical factor for mortality, the goal of treatment should be its timely cessation and relapse prevention. Drug intervention therapy is an important ally in smoking cessation. Significant positive steps have been achieved in the last few years in the development of supportive compounds. In the present review, we analyze reports studying the role of Corticotropin Releasing Factor (CRF), the principle neuroendocrine mediator of the stress response and its two receptors (CRF1 and CRF2) in the withdrawal phase as well as in the abstinence from nicotine use. Although still in pre-clinical evaluation, therapeutic implications of these data were investigated in order to highlight potential pharmaceutical interventions.

Diminished expression of CRHR2 in human colon cancer promotes tumor growth and EMT via persistent IL-6/Stat3 signaling

BACKGROUND & AIMS

Chronic inflammation promotes development and progression of colorectal cancer (CRC). We explored the distribution of Corticotropin-Releasing-Hormone (CRH)-family of receptors and ligands in CRC and their contribution in tumor growth and oncogenic EMT.

METHODS

mRNA expression of CRH-family members was analyzed in CRC (N=56) and control (N=46) samples, 7 CRC cell lines and normal NCM460 cells. Immunohistochemical detection of CRHR2 was performed in 20 CRC and 5 normal tissues. Cell proliferation, migration and invasion were compared between Urocortin-2 (Ucn2)-stimulated parental and CRHR2-overexpressing (CRHR2+) cells in absence or presence of IL-6. CRHR2/Ucn2-targeted effects on tumor growth and EMT were validated in SW620-xenograft mouse models.

RESULTS

CRC tissues and cell lines showed decreased mRNA and protein CRHR2 expression compared to controls and NCM460, respectively. The opposite trend was shown for Ucn2. CRHR2/Ucn2 signaling inhibited cell proliferation, migration, invasion and colony formation in CRC-CRHR2+ cells. In vivo, SW620-CRHR2+ xenografts showed decreased growth, reduced expression of EMT-inducers and elevated levels of EMT-suppressors. IL-1b, IL-6 and IL-6R mRNAs where diminished in CRC-CRHR2+ cells, while CRHR2/Ucn2 signaling inhibited IL-6-mediated Stat3 activation, invasion, migration and expression of downstream targets acting as cell cycle- and EMT-inducers. Expression of cell cycle- and EMT-suppressors was augmented in IL-6/Ucn2-stimulated CRHR2+ cells. In patients, CRHR2 mRNA expression was inversely correlated with IL-6R and vimentin levels and metastasis occurrence, while positively associated with E-cadherin expression and overall survival.

CONCLUSIONS

CRHR2 downregulation in CRC supports tumor expansion and spread through maintaining persistent inflammation and constitutive Stat3 activation. CRHR2^low CRC phenotypes are associated with higher risk for distant metastases and poor clinical outcomes.

Functional dyspepsia and brain-gut peptides

Functional dyspepsia (FD) is a frequently occurring gastrointestinal disorder, but its etiology and pathogenesis are still unclear because it is associated with multiple factors. As a typically physical and psychological disease, the role of psychological factors in the pathogenesis of FD involves the brain-gut axis, mainly abnormal stimulation processing by the central nervous system and abnormal levels of brain-gut peptides. Brain-gut peptides are the molecular basis of the action of the brain-gut axis, and the brain-gut axis affects the occurrence of FD by regulating the levels of brain-gut peptides. So far, 15 brain-gut peptides associated with FD have been found, which are predominantly expressed in the hypothalamus, medulla oblongata, spinal cord and gastrointestinal mucosa. The aim of this study is to clarify the relationship between brain-gut peptide levels and the occurrence of FD based on brain-gut peptide in terms of their secretion and mechanisms of action.

Production of corticotropin-releasing factor and urocortin from human monocyte-derived dendritic cells is stimulated by commensal bacteria in intestine

AIM: To examine whether commensal bacteria are a contributing cause of stress-related mucosal inflammation.

METHODS: Human peripheral blood monocyte-derived dendritic cells (MoDCs) were stimulated by commensal bacterial strains, including Escherichia coli, Clostridium clostridioforme, Bacteroides vulgatus (B. vulgatus), Fusobacterium varium (F. varium), and Lactobacillus delbrueckii subsp. bulgaricus. After incubation, corticotropin-releasing factor (CRF) and urocortin 1 (UCN1) mRNA in the cells was examined by real-time reverse transcription polymerase chain reaction. Supernatants from the cells were tested for CRF and UCN1 using an enzyme-linked immunosorbent assay.

RESULTS: Both CRF and UCN1 were significantly augmented by B. vulgatus and F. varium at both the mRNA and protein levels. In particular, B. vulgatus stimulated human MoDCs, resulting in extremely high levels of CRF and UCN1.

CONCLUSION: Stimulation of MoDCs by B. vulgatus and F. varium may be associated with CRF/UCN1-related intestinal disorders, such as irritable bowel syndrome and inflammatory bowel disease.

Effect of corticotropin-releasing factor on expression of tight junction proteins in intestinal epithelial cells

AIM: To investigate the effect of corticotropin-releasing factor on the expression of tight junction proteins in intestinal epithelial cells.

METHODS: HT-29 cells pretreated with corticotrophin-releasing factor (CRF) at a concentration of 20 ng/mL for 24 h were stimulated with LPS at a concentration of 100 ng/mL for 24 h, and cellular extracts were harvested to measure the expression of ZO-1, ZO-2, Occludin, cldn1, cldn2, cldn3 and cldn4 by enzyme-linked immunosorbent assay (ELISA). Subsequently, groups of HT-29 cells were stimulated with CRF at a concentration of 0, 1, 10 or 20 ng/mL for 24 h, or pretreated with nuclear factor κB (NF-κB) inhibitor diethylmaleate (DEM, 1 mmol/L) and then incubated with CRF at a concentration of 20 ng/mL for 24 h. Each group was then stimulated with LPS at a concentration of 100 ng/mL for 24 h, and the expression of cldn2 protein was detected by Western blot.

RESULTS: The expression of ZO-1, ZO-2, Occludin, cldn1, cldn3 and cldn4 was changed slightly (all P > 0.05) while the expression of cldn2 was markedly increased (P < 0.05) in HT-29 cells after exposure to both LPS and CRF. CRF significantly increased the expression of cldn2 in HT-29 cells in a dose-dependent manner, while NF-κB inhibitor DEM could block this effect.

CONCLUSION: CRF significantly increases the expression of cldn2 in HT-29 cells in a dose-dependent manner, and NF-κB activation is involved in CRF-induced cldn2 expression. CRF has no effect on the expression of ZO-1, ZO-2, Occludin, cldn1, cldn3 and cldn4 in HT-29 cells.

Role of mast cells in mucosal diseases: current concepts and strategies for treatment

Mast cells are well known for their role in type I hypersensitivity. However, their role in the immune system as well as their pathophysiological role in other diseases is underacknowledged. The role of mast cells in inflammatory bowel disease, allergic contact dermatitis and asthma is illustrated in this review. The contribution of mast cell activation in these diseases is controversial and two alternative means are proposed: activation via stress response pathways and immunoglobulin-free light chains. Activation of the mast cells leads to release of preformed mediators and to generation of other potent biological substances that have both physiological and pathophysiological effects. The role of these mediators in the aforementioned diseases is also outlined in this review. When the roles of mast cells are better understood, drugs specifically targeting mast cells may be developed to effectively treat a wide range of diseases.

Corticotropin-releasing factor receptor subtype 2 in human colonic mucosa: Down-regulation in ulcerative colitis

AIM: To assess corticotropin-releasing factor receptor 2 (CRF₂) expression in the colon of healthy subjects and patients with ulcerative colitis (UC).

METHODS: We examined CRF₂ gene and protein expression in the distal/sigmoid colonic mucosal biopsies from healthy subjects and patients with UC (active or disease in remission), human immunodeficiency virus (HIV) and functional bowel disease (FBD) by reverse transcription-polymerase chain reaction and immunofluorescence.

RESULTS: Gene expression of CRF₂ was demonstrated in the normal human colonic biopsies, but not in the human colorectal adenocarcinoma cell line Caco2. Receptor protein localization showed immunoreactive CRF₂ receptors in the lamina propria and in the epithelial cells of the distal/sigmoid biopsy samples. Interestingly, CRF₂ immunoreactivity was no longer observed in epithelial cells of patients with mild-moderately active UC and disease in remission, while receptor protein expression did not change in the lamina propria. No differences in CRF₂ expression profile were observed in distal/sigmoid intestinal biopsies from HIV infection and FBD patients, showing no signs of inflammation.

CONCLUSION: The down-regulation of the CRF₂ receptor in the distal/sigmoid biopsies of UC patients is indicative of change in CRF₂ signalling associated with the process of inflammation.

Activation of TLR4 by CRF in human intestinal epithelial cells is mediated by the CRF2 receptor

AIM: To investigate the effect of corticotrophin-releasing factor (CRF) on the expression of toll-like receptor 4 (TLR4) in human intestinal epithelial cell line HT-29.

METHODS: HT-29 cells were divided into eight groups: non-treated group, LPS group (treated with 20 μg/L LPS for 24 h), CRF group (treated with 20 μg/L CRF for 24 h), LPS plus CRF group (pretreated with 20 μg/L CRF for 12 h and then treated with 20 μg/L LPS for 12 h), astressin 2B plus CRF group (pretreated with 20 μg/L astressin 2B for 12 h and then treated with 20 μg/L CRF), antalarmin plus CRF group (pretreated with 20 μg/L antalarmin for 12 h and then treated with 20 μg/L CRF), astressin 2B plus LPS group (pretreated with 20 μg/L astressin 2B for 12 h and then treated with 20 μg/L LPS), and antalarmin plus LPS group (pretreated with 20 μg/L antalarmin for 12 h and then treated with 20 μg/L LPS). The expression of TLR4 mRNA and protein was detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting, respectively. The secretion of interleukin-8 in the culture supernatants was determined by enzyme-linked immunosorbent assay (ELISA).

RESULTS: CRF could induce the expression of TLR4 in HT-29 cells and result in increased interleukin-8 secretion (P < 0.05). CRFR2 antagonist astressin 2B inhibited the expression of LR4 (P < 0.05, CRF+LPS group vs CRF group), while CRF1 antagonist antalarmin had no significant effect on the expression of TLR4 (P > 0.05, CRF+LPS group vs CRF group).

CONCLUSION: The induction of TLR4 expression by CRF in human intestinal epithelial cells is mediated by the CRF2 receptor.

The corticotropin releasing factor system in the kidney: perspectives for novel therapeutic intervention in nephrology

The adaptation to endogenous and exogenous stress stimuli is crucial for survival but also for the onset of various diseases in humans. Corticotropin releasing factor (CRF) system is the major regulator of stress response and homeostasis. The members of this family of peptides extend their actions also outside CNS to the periphery where they may affect various body systems independently, acting via vagal and/or autocrine/paracrine pathways. In search for peripheral targets, kidney has rarely been studied separately, regarding expression and action of CRF and CRF-related peptides. We reviewed the existing literature concerning expression and action of the CRF system in normal and pathological renal tissue and explored possible clinical implications in nephrology. CRF system components are expressed in the kidney of experimental animals and in humans. The intrarenal distribution is reported to be equally extensive, suggesting a physiological or pathophysiological role in renal function and in the occurrence of renal disease. Urocortins have given multiple interesting observations in experimental models of renal disease and clinical studies, showing robust effects in renal regulation mechanisms. We summarize the relevant data and put them in context, proposing applications with clinical significance in the field of hypertension, diabetic nephropathy, chronic kidney disease, cardiorenal syndrome, and peritoneal dialysis.

Maternal inhibition of infant behavioral response following isolation in novel surroundings and inflammatory challenge

During isolation in a novel environment, guinea pig pups gradually begin to display passive behavior that appears to be mediated by proinflammatory activity, that is, "sickness behavior.". Administration of substances that increase proinflammatory activity [corticotropin-releasing factor (CRF), lipopolysaccharide (LPS)] prior to isolation induces passive behavior from the beginning of the isolation episode. Here, we show that reunion with the mother in the novel environment rapidly and potently suppresses the passive behavior of isolated pups (Experiment 1); inhibits the passive behavior of pups administered CRF (10 µg, subcutaneous; Experiment 2); and inhibits the passive behavior of male, though not female, pups administered LPS (250 µg/kg, intraperitoneal; Experiment 3). Together these findings suggest that the presence of the mother either recruits other processes that moderate the impact of proinflammatory processes on brain mechanisms mediating the passive response or initiates compensatory mechanisms that counter the effect of proinflammatory activity. Further, the results suggest that for physically ill animals of social species, the adaptive advantage that accrues from maintaining normal social interactions may sometimes outweigh the advantage gained by engaging in sickness behavior.

Neonatal maternal separation in male rats increases intestinal permeability and affects behavior after chronic social stress

Prolonged maternal separation in rats has several effects on health and behavior. Here we investigated how maternal separation might interact with social stress in adulthood on behavior and gastrointenstinal permeability. The effects of either daily 180 min long term pup-dam separation (LMS) during the stress hyporesponsive period or daily 10 min brief maternal separation (BMS) on behavior, corticosterone and intestinal permeability were investigated, compared to a non-handling (NH) condition in male offspring. The animals from each separation condition were then randomly assigned to adult stress and control conditions, where the stress condition was exposure to 14 days of social instability (CSI). Sucrose preference, elevated plus maze behavior and corticosterone were measured. Colitis was experimentally induced by dextran sulfate sodium for 7 days, followed by measurement of intestinal permeability using the (51)CrEDTA method. Granulocyte marker protein was measured in feces and colons were examined histologically for inflammation. Prior to the social stress, the LMS offspring showed elevated corticosterone levels, lower elevated plus maze activity and less fluid consumption. After social stress, corticosterone levels were suppressed in LMS animals and again they showed less fluid consumption. LMS animals had significantly higher intestinal permeability, but only when also exposed to the social stress in adulthood. The current results support a two-hit model, whereby early life events interact with adult life events in altering animals' vulnerability.

Mapping the CRF-urocortins system in human osteoarthritic and rheumatoid synovial fibroblasts: effect of vasoactive intestinal peptide

In addition to the brain and pituitary gland, the corticotrophin-releasing factor (CRF) system is expressed in peripheral tissues. In this study we characterize the expression of CRF, urocortins (UCN1, UCN2, and UCN3), and their receptors (CRFR1 and CRFR2) in osteoarthritis (OA) and rheumatoid arthritis (RA) fibroblast-like synoviocytes (FLS). Moreover, we analyze the vasoactive intestinal peptide (VIP) effect on the CRF system, as well as its physiological consequences on mediators of inflammatory/destructive processes. CRF and UCNs exhibit differential pattern in OA and RA-FLS. By real-time PCR we detected more expression of CRF and UCN1 in RA, and UCN2 and UCN3 in OA, while the CRFR2 expression was similar. In RA-FLS VIP treatment resulted in a significant decrease of the proinflammatory peptides, CRF and UCN1, and a significant increase of the potential anti-inflammatory agents, UCN3 and CRFR2. Using Western blot assays, we showed that the ratio between phospho-CREB (p-CREB) and c-AMP response element-binding (CREB) is higher in OA and significantly lower in RA-FLS after VIP treatment, with consequences upon cAMP response element in CRF and UCN1 genes. Real-time PCR and EIA proved that VIP significantly inhibits cycloxygenase-2 (COX-2) and prostaglandin E2 (PGE2) in RA-FLS. In all cases, we consider significant data when P < 0.05. These data indicate a role of endogenous CRF, UCNs, and CRFR2 in the OA and RA joint microenvironment. We confirm the anti-inflammatory function of VIP, through the modulation of the expression of CRF system that impacts in a reduction of mediators with inflammatory/destructive functions, supporting its therapeutic potential in rheumatic diseases.

Proinflammatory activity and the sensitization of depressive-like behavior during maternal separation

When guinea pig pups are isolated for a few hours in a novel environment, they exhibit a distinctive passive behavioral response that appears to be mediated by proinflammatory activity. Recently, we observed that pups separated on two consecutive days show an enhanced (sensitized) passive response on the second day. In Experiment 1, pups receiving intracerebroventricular infusion of 50 ng of the anti-inflammatory cytokine interleukin-10 prior to a first separation failed to show a sensitized behavioral response to separation the next day. In Experiment 2, pups separated on Days 1 and 2, or just 2, showed an increase in passive responding during separation on Day 5. Pups injected with the bacterial antigen lipopolysacchride (LPS; 75 μg/kg body weight, intraperitoneal) prior to separation on Day 1 showed an increase in passive behavior several days later not shown by pups injected with saline prior to Day 1 separation. However, injection of LPS without separation on the first day did not enhance responding during an initial separation on the second day. These results suggest that immune activation is necessary, but not sufficient, to account for the sensitization of passive behavior of isolated guinea pig pups the following day, that boosting proinflammatory activity during an initial separation may promote sensitization several days later, and that the sensitized response persists for at least several days.

Behavioral effects of peripheral corticotropin-releasing factor during maternal separation may be mediated by proinflammatory activity

When guinea pig pups are separated from their mothers in a novel environment, an initial period of active behavior (vocalizing, locomotor activity) wanes after an hour or so and is replaced by a second, passive stage characterized by a crouched stance, closed eyes, and extensive piloerection. If pups are given a peripheral injection of 7-14μg of corticotropin-releasing factor (CRF) prior to testing, the passive behaviors occur immediately upon separation. We found that intracerebroventricular infusion of 1-10μg of CRF did not increase passive behavior relative to vehicle infusion, but that peripheral injection of the anti-inflammatory cytokine, interleukin-10, attenuated the passive behavior induced by peripheral CRF injection. These results together with previous findings suggest that peripheral CRF administration affects behavior of separated guinea pig pups through a mechanism that involves peripheral proinflammatory activity. The possible role of endogenous peripheral CRF in the behavioral response of untreated pups during maternal separation is considered.

Anti-inflammatory effect of vagus nerve stimulation in a rat model of inflammatory bowel disease

Vagus nerve stimulation of afferents is used as an adjunctive treatment for drug-resistant epilepsy and depression. In addition, anti-inflammatory properties of vagus nerve stimulation have been reported in various experimental models of inflammation but not in colitis. These effects are thought to be mediated via peripheral release of acetylcholine from the vagus and subsequent activation of macrophages. Our aim was to evaluate in rats the anti-inflammatory effects of chronic vagus nerve stimulation on colonic inflammation. Colitis was induced by intracolonic instillation of trinitrobenzene sulfonic acid. Vagus nerve stimulation (left cervical) was performed in freely moving animals 3 h per day for five consecutive days. Assessment of colonic inflammation was obtained using physiological (e.g. body weight, temperature and locomotor activity) parameters, macroscopical (area of lesions), histological, and biological parameters (e.g. myeloperoxidase activity, cytokine and cytokine-related mRNAs), both at the level of the damaged colon and the colon immediately above. A global multivariate index of colitis was then generated for a better characterization of colonic inflammation. Vagus nerve stimulation reduced the degree of body weight loss and inflammatory markers as observed above the lesion by histological score and myeloperoxidase quantification. This anti-inflammatory effect was also demonstrated by the improvement of the multivariate index of colitis. These data argue for an anti-inflammatory role of vagus nerve stimulation chronically performed in freely moving rats with colitis and provide potential therapeutic applications for patients with inflammatory bowel diseases.

Corticotropin-releasing factor signaling and visceral response to stress

Stress may cause behavioral and/or psychiatric manifestations such as anxiety and depression and also impact on the function of different visceral organs, namely the gastrointestinal and cardiovascular systems. During the past years substantial progress has been made in the understanding of the underlying mechanisms recruited by stressors. Activation of the corticotropin-releasing factor (CRF) signaling system is recognized to be involved in a large number of stress-related behavioral and somatic disorders. This review will outline the present knowledge on the distribution of the CRF system (ligands and receptors) expressed in the brain and peripheral viscera and its relevance in stress-induced alterations of gastrointestinal and cardiovascular functions and the therapeutic potential of CRF(1) receptor antagonists.

Influence of Bifidobacterium on the intestinal microflora and corticotropin-releasing factor in rats following chronic psychological stress

AIM: To determine the influence of chronic psychological stress on intestinal microflora and corticotropin-releasing factor (CRF) and to investigate the protective effects of Bifidobacterium on intestinal function in rats.

METHODS: Fifty female Sprague-Dawley rats were randomly and equally divided into five groups: normal group, stress group, Bifidobacterium group, Smecta group, and Bifidobacterium plus Smecta group. All these groups were subjected to either water avoidance stress (WAS) or normal condition for 2 h per day for 7 consecutive days. The in vivo intestinal permeability was evaluated by measuring urinary sucralose and other sugar probes including lactulose and mannitol using capillary column gas chromatography (CCGC). Some representative genera of gut flora in rat feces were counted on selective culture medium plates. The mesenteric lymph nodes (MLN) were removed, homogenized and cultured to determine bacterial translocation. The contents of serum CRF and adrenocorticotrophic hormone (ACTH) were determined by enzyme-linked immunosorbent assay (ELISA).

RESULTS: Compared with the normal group, the number of Escherichia coli (7.347 ± 0.277 vs 7.078 ± 0.229, P < 0.05), the 24-h urinary concentration of mannitol (5.097% ± 0.453% vs 4.718% ± 0.399%, P < 0.05), the rate of bacterial translocation to the MLN (40% vs 10%, P < 0.05), and the levels of CRF (300.8 ng/L ± 34.3 ng/L vs 267.0 ng/L ± 32.3 ng/L, P < 0.05) and ACTH (6.79 ng/L ± 0.651 ng/L vs 5.68 ng/L ± 0.799 ng/L, P < 0.05) increased significantly in the stress group. In comparison with the stress group, the number of Escherichia coli (7.044 ± 0.281 vs 7.347 ± 0.277, P < 0.05) and bacteroid (9.075 ± 0.393 vs 9.485 ± 0.306, P < 0.05); the rate of bacterial translocation to the MLN (10% vs 40%, P < 0.05) and ACTH level (5.92 ng/L ± 0.477 ng/L vs 6.79 ng/L ± 0.651 ng/L, P < 0.05) decreased significantly in the Bifidobacterium intervention group.

CONCLUSION: The disturbance of intestinal microflora occurs and CRF increases significantly in rats suffered from chronic psychological stress. Bidifobacterium could alleviate the disturbance of gut microflora caused by chronic psychological stress and partly restore intestinal barrier function.

[Brain-gut interactions]

Our digestive tract has an autonomous functioning but also has a bidirectional relation with our brain known as brain-gut interactions. This communication is mediated by the autonomous nervous system, i.e., the sympathetic and parasympathetic nervous systems, with a mixed afferent and efferent component, and the circumventricular organs located outside the blood-brain barrier. The vagus nerve, known as the principal component of the parasympathetic nervous system, is a mixed nerve composed of 90% afferent fibers, which has physiological roles due to its putative vegetative functions. The vagus nerve has also anti-inflammatory properties both through the hypothalamic pituitary adrenal axis (through its afferents) and the cholinergic anti-inflammatory pathway (through its efferents). The sympathetic nervous system has a classical antagonist effect on the parasympathetic nervous system at the origin of an equilibrated sympathovagal balance in normal conditions. The brain is able to integrate inputs coming from the digestive tract inside a central autonomic network organized around the hypothalamus, limbic system and cerebral cortex (insula, prefrontal, cingulate) and in return to modify the autonomic nervous system and the hypothalamic pituitary adrenal axis in the frame of physiological loops. A dysfunction of these brain-gut interactions, favoured by stress, is most likely involved in the pathophysiology of digestive diseases such as irritable bowel syndrome or even inflammatory bowel diseases. A better knowledge of these brain-gut interactions has therapeutic implications in the domain of pharmacology, neurophysiology, behavioural and cognitive management.

Stress-related modulation of inflammation in experimental models of bowel disease and post-infectious irritable bowel syndrome: role of corticotropin-releasing factor receptors

The interaction between gut inflammatory processes and stress is gaining increasing recognition. Corticotropin-releasing factor (CRF)-receptor activation in the brain is well established as a key signaling pathway initiating the various components of the stress response including in the viscera. In addition, a local CRF signaling system has been recently established in the gut. This review summarize the present knowledge on mechanisms through which both brain and gut CRF receptors modulate intestinal inflammatory processes and its relevance towards increased inflammatory bowel disease (IBD) activity and post-infectious irritable bowel syndrome (IBS) susceptibility induced by stress.