Transmural electrical potential difference of the human colon

Claudin-2 deficiency associates with hypercalciuria in mice and human kidney stone disease

The major risk factor for kidney stone disease is idiopathic hypercalciuria. Recent evidence implicates a role for defective calcium reabsorption in the renal proximal tubule. We hypothesized that claudin-2, a paracellular cation channel protein, mediates proximal tubule calcium reabsorption. We found that claudin-2-null mice have hypercalciuria due to a primary defect in renal tubule calcium transport and papillary nephrocalcinosis that resembles the intratubular plugs in kidney stone formers. Our findings suggest that a proximal tubule defect in calcium reabsorption predisposes to papillary calcification, providing support for the vas washdown hypothesis. Claudin-2-null mice were also found to have increased net intestinal calcium absorption, but reduced paracellular calcium permeability in the colon, suggesting that this was due to reduced intestinal calcium secretion. Common genetic variants in the claudin-2 gene were associated with decreased tissue expression of claudin-2 and increased risk of kidney stones in 2 large population-based studies. Finally, we describe a family in which males with a rare missense variant in claudin-2 have marked hypercalciuria and kidney stone disease. Our findings indicate that claudin-2 is a key regulator of calcium excretion and a potential target for therapies to prevent kidney stones.

Paracellular calcium transport across renal and intestinal epithelia

Calcium (Ca(2+)) is a key constituent in a myriad of physiological processes from intracellular signalling to the mineralization of bone. As a consequence, Ca(2+) is maintained within narrow limits when circulating in plasma. This is accomplished via regulated interplay between intestinal absorption, renal tubular reabsorption, and exchange with bone. Many studies have focused on the highly regulated active transcellular transport pathways for Ca(2+) from the duodenum of the intestine and the distal nephron of the kidney. However, comparatively little work has examined the molecular constituents creating the paracellular shunt across intestinal and renal epithelium, the transport pathway responsible for the majority of transepithelial Ca(2+) flux. More specifically, passive paracellular Ca(2+) absorption occurs across the majority of the intestine in addition to the renal proximal tubule and thick ascending limb of Henle's loop. Importantly, recent studies demonstrated that Ca(2+) transport through the paracellular shunt is significantly regulated. Therefore, we have summarized the evidence for different modes of paracellular Ca(2+) flux across renal and intestinal epithelia and highlighted recent molecular insights into both the mechanism of secondarily active paracellular Ca(2+) movement and the identity of claudins that permit the passage of Ca(2+) through the tight junction of these epithelia.

The development of colonic transport mechanisms in early life: evidence for reduced anion exchange

An anion exchange mechanism exists in colonic mucosa whereby chloride is absorbed and bicarbonate secreted. Using an in vivo non-equilibrium dialysis method we investigated rectal electrolyte movement in preterm neonates and older children. Our results show that anion exchange is poorly developed in infancy and appears to be absent in premature neonates, and suggest that complete maturation of this mechanism is not present until the end of the first year of life. This may render the young infant, and more especially the preterm infant, more susceptible to chloride depletion.

Evaluation of chloride/bicarbonate. Exchange in the human colon in vivo

During perfusion of a plasma-like solution, colonic absorption rate of chloride was much higher than the secretion rate of bicarbonate (34 vs. 3.5 meq/h, respectively). This might suggest that anion exchange (Cl/HCO3) accounts for only a small fraction of total chloride absorption. However, if the colon absorbs as well as secretes bicarbonate, this reasoning would underestimate the magnitude of the anion exchange. To see if the colon absorbs bicarbonate, we perfused a chloride-free solution (which would eliminate bicarbonate secretion via (Cl/HCO3 exchange) and found that the colon absorbed bicarbonate at a rate of 5.1 meq/h. Calculation of electrochemical gradients and measurement of luminal fluid PCO2 indicated that this bicarbonate absorption was mediated passively in response to electrical gradients, rather than via reversed Cl/HCO3 exchange or acid secretion. The combined results of the plasma-like and chloride-free perfusion experiments suggest Cl/HCO3 exchange at a rate of 8.6 meq/h (the sum of bicarbonate movements, 3.5 and 5.1 meq/h, observed in the two experiments). To obtain a second estimate under different experimental conditions, a choline chloride-choline bicarbonate (sodium-free) solution was perfused; with this solution, chloride and bicarbonate absorption dependent on active sodium transport should be eliminated or markedly reduced, and the magnitude of Cl/HCO3 exchange should be revealed. This experiment suggested a Cl/HCO3 exchange rate of 9.3 meq/h, similar to the first estimate. As chloride was absorbed at a rate of 34 meq/h during perfusion of the plasma-like solution, the Cl/HCO3 exchange provides for approximately one-fourth of total chloride absorption.

Absorption of short-chain fatty acids by the colon

Short-chain fatty acids (SCFAs) constitute the major solute fraction of normal stool water and are responsible for the diarrhea associated with carbohydrate (CHO) malabsorption. Although SCFA absorption from the human small bowel has been reported previously, the fate of SCFAs in the colon--their major site of production--was investigated in the present study. The colon of normal volunteers was perfused with neutral, isotonic solutions containing SCFA, 0-90 mM. Propionate was studied in detail with limited observations on acetate and n-butyrate. SCFA absorption was concentration-dependent; back diffusion of metabolic products, ketone bodies, was quantitatively insignificant. The transport process was accompanied by increased Na, K, and water absorption, by luminal alkalinization due to bicarbonate accumulation, and by a fall in lumen PCO2. The results are consistent with the existence of two mechanisms for colonic SCFA absorption: first, nonionic diffusion of protonated SCFA involving consumption of luminal CO2; this process accounts for about 60% of total SCFA absorption; and second, cellular uptake by ionic diffusion of the Na or K salt of the SCFA.

Correlation of variations in intraluminal pressure and potential differences in the perfused colen

To investigate the nature of variations in the large intestine potential differences, a continuous perfusion of isotonic saline was carried out in the colon of 14 rats. Intraluminal pressure and potential differences between the lumen and the peritoneal cavity were continuously and simultaneously recorded, while impedance of the system and respiration were also constantly monitored. To obtain a quantitative evaluation of the data, Fast Fouier Transform was performed on the signals and their derivatives which were auto- and cross-correlated. While there was no obvious relation between pressure and potential in the unperfused colon, there was clear visual qualirative evidence that, during steady state conditions of perfusion, an increase in intraluminal pressure was accompanied by a decrease in potential differences, while impedance of the recording system remained unchanged. Computer analysis disclosed four narrow ranges of stable frequencies for both pressure and potential. They were centred around 0-3, 1-75, 10-7, and 75 cycles per minute, the latter being synchronous with respiration. It is concluded that the variations of potential differences recorded during perfusion, a well-know phenomenon, are not electrical artefacts: the fast rhythm is probably induced by respiration, which increases intracolonic pressure and that, in turn, reduces the absolute value of potential differences, which remain negative mucosa versus serosa. The slower rhythms are synchronous for pressure and potential. Mechanisms responsible for the decrease in potential related to the increase in pressure remain unknown.

Rectal hyperpolarization following intestinal bypass for obesity

The electrical potential difference across the rectal mucosa in six shunt-operated women was compared with that obtained in 26 normal females. The potential difference was considerably increased in all the patients, whereas the plasma concentrations and the transmural fluxes of sodium, chloride, and potassium were within normal ranges. Based on measurements of plasma renin and plasma aldosterone concentrations in three of the patients, the possibility of secondary hyperaldosteronism could be ruled out.

Effect of luminal ions on the transepithelial electrical potential difference of human rectum

Skin electrodes are the most convenient reference electrodes for clinical measurements of electrical potential differences (pd) across the epithelium of the alimentary tract but the presence of an electrical charge on normal skin introduces an error. In the present study, by comparison with results obtained using subcutaneous and intravenous electrodes, it was shown that an intradermal injection of saline abolished the skin potential differences. This simple method, therefore, allows skin electrodes to be used to measure the true transepithelial potential differences of gut mucosa. The method was applied to investigate the effect on the rectal potential difference of altering the composition of the luminal solutions. Changes in the cations (sodium, potassium, magnesium) showed that sodium was the most important cationic determinant of the potential difference, especially when sodium absorption was stimulated by giving mineralocorticoids. Changes in the anions (chloride, iodide, bromide, nitrate, bicarbonate, sulphate, phosphate, citrate, and acetate) indicated that the molecular size of the anion rather than its chemical nature was the significant factor and suggested that the ions had to cross a barrier relatively impermeable to anions of radius greater than 3.5 to 4 A degrees . Changes in osmolality and glucose concentration were without effect.

Lithium-induced hyperpolarization of the human rectum in vivo

The transmucosal potential difference across the rectal mucosa was measured in 30 healthy subjects and in 13 psychiatric patients on lithium treatment for manic-depressive psychosis. It was significantly greater in the lithium-treated patients. A highly significant correlation was found between the potential difference and the serum lithium, and in all eight patients in whom it was measured before and one week after starting lithium treatment a rising potential difference was found. This phenomenon may possibly be explained in terms of resistance of the rectal mucosa to vasopressin.

Absorption of sodium and water by human rectum measured by a dialysis method

A dialysis method for the study of intestinal absorption is described. Its use has been assessed in animals and normal human subjects and it has been applied to the measurement of rectal transport of sodium and water.When the luminal solution was of high sodium concentration (145 m-equiv/1), the sodium influx rate (lumen to plasma) was about five times greater than the sodium efflux rate (plasma to lumen). The luminal sodium concentration associated with zero net sodium flux was very low (<15 m-equiv/1). As the mucosa was charged with the luminal side negative, the epithelium must therefore possess a powerful sodium absorbing ;pump'. With isotonic solutions in the lumen, the amount of water absorbed depended on the sodium concentration and when this was 30 m-equiv/1 or less, no significant water absorption was detectable. When, however, water absorption was altered by imposing osmotic gradients, sodium absorption was not significantly affected. The luminal solution tended to become issomolar with plasma; osmotic gradients across the epithelium did not develop. The particular transport properties of rectal epithelium enabling it to remove sodium from the lumen against considerable electrochemical gradients are well adapted to its function.

Electrical potentials of the sigmoid colon and rectum in irritable bowel syndrome and ulcerative colitis

Using a simple and rapid method, electrical potential differences across rectal and colonic mucosa have been measured at routine sigmoidoscopy in patients with irritable bowel syndrome and ulcerative colitis. In patients with irritable bowel syndrome, all of whom had diarrhoea, the mucosa was charged negatively on the luminal side and potential differences were not significantly different from those of normal subjects. In acute exacerbations of ulcerative colitis, the potential difference was reversed, the luminal side being positive. This characteristic change was seen even in mild attacks. The potential difference was usually restored to normal within a few weeks of commencing treatment. In some cases, however, it was persistently abnormal for months and failed to show the normal response to stimulation by the mineralocorticoid, fludrocortisone. The way in which measurements of potential difference can be useful in diagnosis, prognosis, and as a guide to treatment is discussed.