Effects of intravenous alcohol on motility of the duodenum and of the sphincter of Oddi

A journey to and with the stars: The pancreatic stellate cell story

The George E Palade Prize is the highest honour awarded by the International Association of Pancreatology, that recognises an individual who has made outstanding contributions to the understanding of the pancreas and pancreatic diseases. The 2023 Palade Prize was awarded to Professor Minoti Apte, University of New South Wales Sydney on September 16, 2023 during the Joint Meeting of the International Association of Pancreatology and the Indian Pancreas Club, held in Delhi, India. This paper summarises her Palade lecture wherein she reflects on her journey as a medical graduate, an academic and a researcher, with a particular focus on her team's pioneering work on pancreatic stellate cell biology and the role of these cells in health and disease. While there has been much progress in this field with the efforts of researchers worldwide, there is much still to be learned; thus it is a topic with ample scope for innovative research with the potential to translate into better outcomes for patients with pancreatic disease.

Effect of Ethanol Exposure on Slow Wave Activity and Smooth Muscle Contraction in the Rat Small Intestine

BACKGROUND

Ethanol ingestion causes a variety of gastrointestinal disturbances including motility alterations. Slow wave propagation coordinates gastrointestinal motility, and abnormal slow wave activity is thought to contribute to motility disorders. To date, however, little is known about the effect of acute ethanol on motility disturbances associated with slow wave activity.

AIM

To investigate the effect of ethanol on small intestine slow wave activity.

METHODS

Segments (3-5 cm long) were isolated from the rat duodenum, jejunum, and ileum and mounted in an organ bath superfused with a normal Tyrode solution or with 1, 3, or 5% ethanol containing Tyrode. The electrical activities were recorded using an array of 121 extracellular electrodes, and motility recordings were performed using a digital video camera.

RESULTS

The frequency and amplitude of slow wave activity were not altered at 1, 3, or 5% ethanol concentrations, but a significant drop in velocity was found at 3 and 5% ethanol. Furthermore, inexcitable areas appeared in a dose-dependent manner. Slow wave was sometimes also seen to propagate in a circular fashion, thereby describing a reentrant loop. Finally, in all duodenal, jejunal, and ileal segments, ethanol inhibited contractions and became fully quiescent at 3-5%.

CONCLUSIONS

These studies for the first time demonstrate that ethanol significantly inhibits slow wave and spike activity in a dose-dependent manner and could also initiate reentrant activities. Intestinal contractions were also inhibited in a dose-dependent manner. In conclusion, ethanol inhibits both slow wave activity and motor activity to cause ethanol-induced intestinal disturbances.

Clostridium perfringens epsilon toxin inhibits the gastrointestinal transit in mice

Epsilon toxin produced by Clostridium perfringens type B and D is a potent toxin that is responsible for a highly fatal enterotoxemia in sheep and goats. In vitro, epsilon toxin produces contraction of the rat ileum as the result of an indirect action, presumably mediated through the autonomic nervous system. To examine the impact of epsilon toxin in the intestinal transit, gastric emptying (GE) and gastrointestinal transit (GIT) were evaluated after intravenous and oral administration of epsilon toxin in mice. Orally administered epsilon toxin produced a delay on the GIT. Inhibition of the small intestinal transit was observed as early as 1 h after the toxin was administered orally but the effects were not observed after 1 week. Epsilon toxin also produced an inhibition in GE and a delay on the GIT when relatively high toxin concentrations were given intravenously. These results indicate that epsilon toxin administered orally or intravenously to mice transitorily inhibits the GIT. The delay in the GIT induced by epsilon toxin could be relevant in the pathogenesis of C. perfringens type B and D enterotoxemia.

Mechanisms of alcoholic pancreatitis

Alcoholic pancreatitis is a major complication of alcohol abuse. The risk of developing pancreatitis increases with increasing doses of alcohol, suggesting that alcohol exerts dose-related toxic effects on the pancreas. However, it is also clear that only a minority of alcoholics develop the disease, indicating that an additional trigger may be required to initiate clinically evident pancreatic injury. It is now well established that alcohol is metabolized by the pancreas via both oxidative and non-oxidative metabolites. Alcohol and its metabolites produce changes in the acinar cells, which may promote premature intracellular digestive enzyme activation thereby predisposing the gland to autodigestive injury. Pancreatic stellate cells (PSCs) are activated directly by alcohol and its metabolites and also by cytokines and growth factors released during alcohol-induced pancreatic necroinflammation. Activated PSCs are the key cells responsible for producing the fibrosis of alcoholic chronic pancreatitis. Efforts to identify clinically relevant factors that may explain the susceptibility of some alcoholics to pancreatitis have been underway for several years. An unequivocal, functionally characterized, association is yet to be identified in clinical studies, although in the experimental setting, endotoxin has been shown to trigger overt pancreatic injury and to promote disease progression in alcohol-fed animals. Thus, while the molecular effects of alcohol on the pancreas have been increasingly clarified in recent years, identification of predisposing or triggering factors remains a challenge.

In vitro alcohol dehydrogenase-mediated acetaldehyde production by aerobic bacteria representing the normal colonic flora in man

Excessive ethanol consumption has been related with the development of liver cirrhosis, as well as with rapid intestinal transit time and diarrhea. Moreover, heavy drinking is associated with an increased incidence of cancer of the oropharynx, larynx, esophagus, and colorectum. Acetaldehyde of microbial origin has recently been suggested as a possible pathogenic factor behind this alcohol-associated gastrointestinal morbidity. The present in vitro study was aimed to investigate alcohol dehydrogenase activity and acetaldehyde formation capacity of some major aerobic bacteria representing the normal colonic flora in man. Cytosolic alcohol dehydrogenase activity and cytosolic protein concentration were determined spectrophotometrically. Alcohol dehydrogenase activity was then calculated as nmoles of reduced substrate produced by milligrams of protein per minute. The ability of different bacteria to produce acetaldehyde was determined by incubating the intact bacterial suspension in closed vials containing ethanol (final concentration 22 mM) for 1 hr at 37 degrees C. The acetaldehyde formed during the incubation was analyzed by headspace gas chromatography. Marked differences in the alcohol dehydrogenase activity and acetaldehyde forming capacity were found among the strains tested. The alcohol dehydrogenase activity varied from 606 +/- 91 nmol/min/mg protein (Escherichia coli IH 50546) to 1 +/- 0.2 nmol/min/mg protein (E. coli IH 50817), and acetaldehyde formation varied from 1,717 +/- 2 nmol acetaldehyde/10(9) colony-forming units (Klebsiella oxytoca IH 35403) to 5 +/- 2 nmol acetaldehyde/10(9) colony-forming units (Pseudomonas aeruginosa ATCC 27853). There was a statistically significant correlation (r = 0.77; p < 0.001) between alcohol dehydrogenase activity and acetaldehyde production from ethanol, strongly suggesting the catalytic role of bacterial alcohol dehydrogenase in this reaction.

In vitro acetaldehyde formation by human colonic bacteria

Incubation of human colonic contents with various ethanol concentrations (2.75-44 mM) in vitro at 37 degrees C resulted in significant accumulation of acetaldehyde--a toxic and highly reactive compound. At pH 9.6, all samples produced notable acetaldehyde concentrations (58 (13) microM; mean (SEM)) even from the lowest (2.75 mM) ethanol concentration, and the production of acetaldehyde increased lin-early with rising ethanol concentration (r = 0.97; p < 0.005), reaching a peak concentration of 238 (37) microM at 44 mM ethanol. The formation of acetaldehyde took place rapidly, as almost 50% of acetaldehyde formed during the total eight hour incubation was detectable after one hour, and 75% of the total after four hours. Maximal acetaldehyde production from 22 mM ethanol occurred at pH 9.6 (160 (35) microM) but appreciable concentrations were also seen at pH 7.4 (110 (38) microM) and pH 6.0 (63 (19) microM). At pH 4.0, by contrast, acetaldehyde formation was negligible (17 (5) microM). 4-Methylpyrazole, a potent inhibitor of alcohol dehydrogenase, showed a decreasing effect on acetaldehyde production in vitro but first at a concentration of 100 mM. Considerable acetaldehyde production by human colonic bacteria--if it occurs also in vivo--could constitute a risk factor for rectal cancer in heavy drinkers and also provide a pathogenetic mechanism for alcohol induced diarrhoea.

Alcohol-induced pancreatic injury (Part 2). Evolution of pathogenetic theories

In Part I of this paper, features of alcoholic pancreatitis that are still poorly understood were reviewed and factors that might favor biliary-pancreatic reflux were summarized. Part II deals with additional pathogenetic schemes that might shed light on this perplexing disorder.

Effect of acute ethanol administration on diamine oxidase activity in the upper gastrointestinal tract of rat

The effect of a single dose (2 g/kg, body weight) of ethanol on diamine oxidase activity of the upper gastrointestinal tract was studied in fasted rats. Ethanol given by gastric intubation as a 10%, 20%, or 40% solution caused an early and transient increase in diamine oxidase activity in gastroduodenal fluid that was concentration-dependent. The 20% ethanol solution caused, at 3 and 6 hr, a diminution of enzyme activity in the wall of the stomach and duodenum, but not in that of the jejunum. Diamine oxidase activity in the gastroduodenal tract returned to control values at 12 hr, when ethanol had disappeared from the blood. The plasma enzyme activity diminished, starting from the first hour. The same dose of ethanol administered intravenously caused diminutions in diamine oxidase activity in the stomach and duodenum similar to those observed after gastric intubation. The enzyme decrease in the stomach and duodenum was not correlated with the gastroduodenal or blood ethanol levels. Pretreatment with pyrazole, an inhibitor of ethanol metabolism, prevented the ethanol-induced decrease in gastroduodenal enzyme activity, thus suggesting that this diminution was principally a consequence of ethanol oxidation. These results indicate that ethanol modifies in the gastroduodenal tract the activity of diamine oxidase the enzyme which regulates the physiologic activity of histamine in gastric secretion and oxidizes the toxic diamines of dietary and bacterial origin.