Effect of aging on the adaptive and proliferative capacity of the small bowel

Gene expression in the adapting small bowel after massive small bowel resection

BACKGROUND

Intestinal adaptation occurs in the residual bowel following the loss or resection of a proportion of the small bowel. The purpose of the adaptive response is to return absorptive and digestive properties to near normal levels. This study employed a rat model of massive small bowel resection (MSBR) to study the adaptive response in the residual terminal ileum and the jejunum. The time points were chosen to reflect changes in gene expression early on in the response, because these are the genes that alter to initiate and maximize the response observed during adaptation.

METHODS

Sprague Dawley rats underwent an 80% resection. Differential display polymerase chain reaction (DD-PCR) analysis was performed on mRNA extracted from the remnant ileum and jejunum 0, 1, 2, 4, and 7 days post-MSBR.

RESULTS

DD-PCR identified 11 genes that were possibly regulated following MSBR. Genes confirmed to be regulated were 16S ribosomal RNA, lymphocyte antigen 6 (LY6)-like molecule, Krüppel-like factor-3 (KLF-3), G-protein-binding protein (CRFG), system A transporter 2 (SAT2), and an intestine-specific gene (similar to mKIAA0493).

CONCLUSIONS

DD-PCR analysis showed regulation of a number of genes not previously known to be involved in adaptation after MSBR or previously characterized in the intestine. These genes may be important in bringing about the complement of changes seen during the adaptive response.

Aging is associated with decreased pancreatic acinar cell regeneration and phosphatidylinositol 3-kinase/Akt activation

BACKGROUND & AIMS

The effects of aging on pancreatic acinar cell proliferation have not been clearly defined. Phosphatidylinositol 3-kinase (PI3K)-mediated phosphorylation of Akt is a critical step for proliferation of various cell types and insulin secretion from pancreatic endocrine cells; however, its role in acinar cell proliferation is not known. The purpose of this study was to (1) delineate the effects of aging on pancreatic regeneration after partial pancreatectomy (Px) and (2) define the involvement of the PI3K/Akt pathway in pancreatic regeneration.

METHODS

Following partial Px, pancreatic regeneration and activation of the PI3K pathway were compared in young and aged mice. Activation of the PI3K/Akt pathway was evaluated by Akt phosphorylation (pAkt). The role of the PI3K pathway in pancreatic regeneration after partial Px was assessed by effects of a pharmacologic PI3K inhibitor wortmannin or small interfering RNA (siRNA) to the p85alpha regulatory subunit. To confirm further the critical role of the PI3K/Akt pathway in pancreatic acinar cell proliferation, IGF-1-mediated cell proliferation was determined in cultured acinar cells pretreated with wortmannin or p85alpha siRNA.

RESULTS

Pancreatic regeneration and pAkt expression after partial Px were significantly decreased with aging. Treatment with wortmannin or p85alpha siRNA reduced pancreatic regeneration after partial Px. The IGF-1-mediated cell proliferation in vitro was completely blocked by wortmannin or p85alpha siRNA but not by the MEK/ERK inhibitor PD98059.

CONCLUSIONS

PI3K/Akt activation plays a critical role in the regeneration of pancreatic acini after resection. Furthermore, pancreatic regeneration is markedly attenuated in the aged pancreas most likely because of decreased PI3K/Akt activation.

Novel and quantitative DNA dot-blotting method for assessment of in vivo proliferation

Immunohistochemical assessment of 5-bromo-2-deoxyuridine (BrdU) in tissue sections is a widely used method to evaluate cell proliferation in vivo. However, this method requires time-consuming preparation of paraffin sections and laborious counting of BrdU-labeled nuclei on multiple sections. Here, we report the development of a rapid and reliable method to quantitate BrdU incorporation in intestinal and liver tissues using a dot-blot method. In vivo models of colon or liver proliferation were used to analyze the usefulness and reliability of this new method. Mice were killed after BrdU injection, and genomic DNA was isolated from the tissues, denatured, and dot-blotted onto a nitrocellulose membrane. The incorporated BrdU was detected with a BrdU monoclonal antibody, and the signal intensity was densitometrically quantified. Results were compared with BrdU index determined by conventional immunohistochemistry on the same tissue samples. The patterns of colonic BrdU incorporation during fasting and refeeding, measured by the dot-blotting method and the immunohistochemical method, were similar. The BrdU incorporation in the regenerating liver after partial hepatectomy, evaluated by these two different methods, showed a strong correlation (R(2) = 0.91, P < 0.01). In addition, the inhibition of colon proliferation by the phosphoinositol 3-kinase inhibitor wortmannin was demonstrated by this dot-blotting method. In conclusion, the dot-blotting technique described in this report provides an accurate, more efficient, and possibly more reliable method for the assessment of in vivo proliferation compared with conventional immunohistochemical determination of BrdU-labeling index.

Critical care nursing for older adults: pathophysiological and functional considerations

The aging of the population brings into health care practice, including ICUs, an increasing prevalence of people with chronic conditions with corresponding expectations of eventual decline in function. These age-related health problems, however, do not have a precise moment of onset, nor a single and unambiguous cause. By their nature, chronic conditions do not have an end that can be modified easily, and ordinarily, they are related to parameters other than physiology alone. Aged individuals often are distinguished as a medicalized cohort on the basis of sheer numbers of comorbidities and predisposition toward frequent hospitalizations, without regard for the potential for adaptation to life despite complex health factors. Some care providers, health economists, and bioethicists propose using the existence of chronic conditions and assumed physical decompensation asa valid basis for restricting individuals and groups, by means of rationing, from consideration for intensive care and treatment. In view of studies demonstrating that covert rationing of ICU resources to critically ill older patients already is taking place, there isa need to continue to examine institutional policies that permit care providers to act as gatekeepers, ostensibly with benign intent, but presumably without patients' knowledge or acceptance. On the other hand, there is evidence that older ICU patients do equally well as younger and middle-aged patients in terms of discharge from the hospital with subsequent recovery of function. Thus, age alone is not a useful marker for limiting access to ICUs. Rather, a comprehensive evaluation is the foundation for diagnostic accuracy and health care decision-making for older individuals. Assessment and maintenance of the older person's functional status are fundamental concerns of geriatric and critical care specialists. Evaluation of an individual's baseline abilities in physical, mental, social, and psychological spheres is necessary before limitation of care realistically can be considered. Intensive care unit hospitalizations for catastrophic or critical illness are not necessarily terminal events. Ongoing functional assessment will help to illuminate the impact of chronicity on an older person's capacity for self care, and may help to guide health care decision-making regarding use of critical care resources. Accordingly, assuring equitable access to essential intensive care services, devoid of concerns about age constraints, will help to ensure the autonomy that is central to older adults' achievement of a fulfilling and productive old age.