Ganglion cell changes in experimental stenosis of the gut

Interdependency between mechanical parameters and afferent nerve discharge in hypertrophic intestine of rats

Partial intestinal obstruction causes smooth muscle hypertrophy, enteric neuronal plasticity, motility disorders, and biomechanical remodeling. In this study we characterized the stimulus-response function of afferent fibers innervating the partially obstructed jejunum. A key question is whether changes in afferent firing arise from remodeled mechanical tissue properties or from adaptive afferent processes. Partial obstruction was created by placing a polyethylene ring for 2 wk in jejunum of seven rats. Sham obstruction was made in six rats and seven rats served as normal controls. Firing from mesenteric afferent nerve bundles was recorded during mechanical ramp, relaxation, and creep tests. Stress-strain, spike rate increase ratio (SRIR), and firing rate in single units were assessed for evaluation of interdependency of the mechanical stimulations, histomorphometry data, and afferent nerve discharge. Partial intestinal obstruction resulted in hypertrophy and jejunal stiffening proximal to the obstruction site. Low SRIR at low strains during fast distension and at high stresses during slow distension was found in the obstructed rats. Single unit analysis showed increased proportion of mechanosensitive units but absent high-threshold (HT) units during slow stimulation, decreased number of HT units during fast stimulation, and shift from HT sensitivity towards low threshold sensitivity in the obstructed jejunum. Biomechanical remodeling and altered afferent response to mechanical stimulations were found in the obstructed jejunum. Afferents from obstructed jejunum preserved their function in encoding ongoing mechanical stimulation but showed changes in their responsiveness. The findings support that mechanical factors rather than adaption are important for afferent remodeling.

Changes of smooth muscle contractile filaments in small bowel atresia

AIM: To investigate morphological changes of intestinal smooth muscle contractile fibres in small bowel atresia patients.

METHODS: Resected small bowel specimens from small bowel atresia patients (n = 12) were divided into three sections (proximal, atretic and distal). Standard histology hematoxylin-eosin staining and enzyme immunohistochemistry was performed to visualize smooth muscle contractile markers α-smooth muscle actin (SMA) and desmin using conventional paraffin sections of the proximal and distal bowel. Small bowel from age-matched patients (n = 2) undergoing Meckel’s diverticulum resection served as controls.

RESULTS: The smooth muscle coat in the proximal bowel of small bowel atresia patients was thickened compared with control tissue, but the distal bowel was unchanged. Expression of smooth muscle contractile fibres SMA and desmin within the proximal bowel was slightly reduced compared with the distal bowel and control tissue. There were no major differences in the architecture of the smooth muscle within the proximal bowel and the distal bowel. The proximal and distal bowel in small bowel atresia patients revealed only minimal differences regarding smooth muscle morphology and the presence of smooth muscle contractile filament markers.

CONCLUSION: Changes in smooth muscle contractile filaments do not appear to play a major role in postoperative motility disorders in small bowel atresia.

Differential changes in intrinsic innervation and interstitial cells of Cajal in small bowel atresia in newborns

AIM

To investigate morphological changes of the enteric nervous system (ENS) and the interstitial cells of Cajal (ICCs) in small bowel atresia.

METHODS

Resected small bowel specimens from affected patients (n = 7) were divided into three parts (proximal, atretic, distal). Standard histology and enzyme immunohistochemistry anti-S100, anti-protein gene product (PGP) 9.5, anti-neurofilament (NF), anti-c-kit-receptor (CD117) was carried out on conventional paraffin sections of the proximal and distal part.

RESULTS

The neuronal and glial markers (PGP 9.5, NF, S-100) were expressed in hypertrophied ganglia and nerve fibres within the myenteric and submucosal plexuses. Furthermore, the submucous plexus contained typical giant ganglia. The innervation pattern of the proximal bowel resembled intestinal neuronal dysplasia. The density of myenteric ICCs was clearly reduced in the proximal bowel, whereas a moderate number of muscular ICCs were found. The anti-CD117 immunoreaction revealed additional numerous mast cells. The distal bowel demonstrated normal morphology and density of the ENS, the ICCs and the mast cells.

CONCLUSION

The proximal and distal bowel in small bowel atresia revealed clear changes in morphology and density of the ENS and ICCs.

Spontaneous and bolus-induced motility in the chronically obstructed guinea-pig small intestine in vitro

Partial obstruction of the small intestine results in dysmotility and morphometric changes proximal to the site of obstruction. However, our understanding of the relation between the morphometric remodeling and change in the motility pattern during chronic obstruction is sparse. The aim of this study was to investigate the effect of partial chronic intestinal obstruction on motility, morphology, and collagen content proximal and distal to the site of obstruction. Twenty guinea-pigs with partial intestinal obstruction and eight sham-operated controls lived for four weeks. Spontaneous and bolus-induced motility was recorded in isolated intestinal segments proximal and distal to the site of obstruction using a perfused low-compliance pressure-measuring system in vitro. After the motility experiments, the specimens were fixed at 2 kPa luminal distension pressure and sampled for histomorphometric determination of luminal radius, layer thickness, and wall thickness. Total wall collagen was also determined. The area under the curve (AUC) of spontaneous contractions and the amplitude, frequency, and AUC for the bolus-induced motility were higher in the proximal segments of the banded animals compared to distal segments and to the intestinal segments in the control animals (P < 0.05). The radius-to-thickness ratio was lowest in the proximal segments of the obstructed animals (P < 0.01). The collagen content was three times higher proximal to the site of obstruction when compared to distal locations and to the controls (P < 0.01). The AUC at 2 ml bolus injections plotted against the radius-to-thickness ratio showed a strong association (r = 0.97 for control, and r = 0.99 for obstruction, P < 0.01). No correlation was found between the collagen content and AUC. In conclusion, partial intestinal obstruction in guinea pigs caused pronounced changes in morphology and motility. An association was found between the radius-to-thickness ratio and bolus-induced motility.

Biomechanical remodeling of the chronically obstructed Guinea pig small intestine

Small intestinal obstruction is a frequently encountered clinical problem. To understand the mechanisms behind obstruction and the clinical consequences, data are needed on the relation between the morphologic and biomechanical remodeling that takes place in the intestinal wall during chronic obstruction. We sought to determine the effect of partial obstruction on mechanical and morphologic properties of the guinea pig small intestine. Partial obstruction was created surgically in 2 groups of animals living for 2 and 4 weeks. Controls were sham operated and lived for 4 weeks. A combined impedance planimetry-high-frequency ultrasound system was designed to measure the luminal cross-sectional area and wall thickness. These measures were used to compute the circumferential stress and strain of the excised intestinal segments. The incremental elastic modulus was obtained by using nonlinear fitting of the stress-strain curve. Histologic analysis and the measurements of total wall collagen were also performed. The luminal cross-sectional area, wall thickness, and elastic modulus in circumferential direction increased in a time-dependent manner proximal to the obstruction site (P < 0.01), whereas no differences in these parameters were found distal to the obstruction site (P > 0.25). The circumferential stress-strain curves of the proximal segments in 2- and 4-week groups shifted to the left, indicating the intestinal wall became stiffer. Histologic examination revealed a massive increase in the thickness of the muscle layer especially the circular smooth muscle layer (P < 0.05). The collagen content proximal to the obstruction site was significantly larger in the partially obstructed animals compared to controls (P < 0.05). No difference was found distal to the obstruction site. Strong correlation was found between the collagen content and the elastic modulus at stress levels of 70 kPa stress (P < 0.01) and 10 kPa (P < 0.05) proximal to the obstruction site suggesting that the alteration of collagen has great impact on the mechanical remodeling. The morphologic and biomechanical remodeling likely influence the function of the intestine affected by partial obstructed intestine.

Motility disorder in experimentally obstructed intestine: relationship between muscularis inflammation and disruption of the ICC network

We designed a model of small intestinal obstruction in rats to investigate changes in intestinal contractility associated with the immunologically activated components in the tunica muscularis. Although histochemical study did not reveal any typical inflammatory signs such as leucocyte infiltration in the distended intestinal regions of model rats 2-3 weeks after surgical induction of intestinal obstruction, the number of ED2-positive macrophages appeared to be increased in the tunica muscularis. Expression of tumour necrosis factor (TNF)-alpha mRNA was also significantly increased, and the level of CD14 was also increased significantly in the tunica muscularis. Functional studies of distended intestinal muscle segments showed a marked decrease in absolute force stimulated by a cholinergic agent. In addition, the number of spontaneous rhythmic contractions was also reduced in the distended intestinal regions of the obstructed intestine, and this decrease was associated with a reduction in the number of interstitial cells of Cajal (ICC), as revealed by Kit-like immunoreactivity. These results suggest that, under the pro-inflammatory conditions of the tunica muscularis associated with intestinal obstruction, the release of bioactive substances, possibly from activated resident macrophages, may affect smooth muscle contractility. Furthermore, under these conditions, both the number and the function of neighbouring ICC may also be affected.

Aging of the myenteric plexus: neuronal loss is specific to cholinergic neurons

Neuron loss occurs in the myenteric plexus of the aged rat. The myenteric plexus is composed of two mutually exclusive neuronal subpopulations expressing, respectively, nitrergic and cholinergic phenotypes. The goal of the present study, therefore, was to determine if neuron loss is specific to one phenotype, or occurs in both. Ad libitum fed virgin male Fischer 344 rats of 3 and 24 months of age were used in each of two neuronal staining protocols (n=10/age/neuron stain). The stomach, duodenum, jejunum, ileum, colon, and rectum were prepared as whole mounts and processed with either NADPHd or Cuprolinic Blue to stain, respectively, the nitrergic subpopulation or the entire population of myenteric neurons. Neuron numbers and sizes were determined for each preparation. Neuron counts from 24-month-old rats were corrected for changes in tissue area resulting from growth. There was no age-related loss of NADPHd-positive neurons for any of the regions sampled, whereas significant losses of Cuprolinic Blue-labeled neurons occurred in the small and large intestines of 24-month-old rats. At the two ages, the average neuron sizes were similar in the stomach and small intestine for both stains, but neurons in the large intestine were significantly larger at 24 months. In addition, numerous swollen NADPHd-positive axons were found in the large intestine at 24 months. These findings support the hypothesis that age-related cell loss in the small and large intestines occurs exclusively in the cholinergic subpopulation. It appears, however, from the somatic hypertrophy and the presence of swollen axons that the nitrergic neurons are not completely spared from the effects of age.

Dendritic hypertrophy of Stach type VI neurons within experimentally altered ileum of pigs

Myenteric neurons were investigated morphometrically to answer the question if type-specific somal hypertrophy of type VI neurons in mechanically stressed ileum of pigs, which was known from an earlier study, is correlated with an increased dendritic arborization, that is, with dendritic hypertrophy. Muscular hypertrophy was induced in the ileum of two juvenile pigs by narrowing the gut circumference (mechanical stenosis) and by reversing a loop of ileum which results in an antiperistaltic segment (functional stenosis), respectively. After a survival time of 6 weeks, wholemounts from the pre- and poststenotic ileal regions, from the antiperistaltic segment as well as from an age matched control animal, were silver impregnated. Dendritic parameters of Stach types IV and VI neurons were recorded using a computer-aided morphometric program and analysed statistically. Type IV neurons showed no change of dendritic parameters, neither within control nor within stenosed ileal segments. In contrast, the type VI neurons displayed increased dendritic parameters within zones of muscular hypertrophy such as total dendritic length, numbers of dendrites, of dendritic branching points and of dendritic endings. We suggest that type VI neurons may participate as descending nitrergic interneurons or motorneurons in the control of muscular function, thus, undergoing plastic changes in case of experimental muscular hypertrophy. Type IV neurons which are involved in the regulation of mucosal processes were not affected by muscular hypertrophy.

Experimental hypertrophy of myenteric neurones in the pig: a morphometric study

Muscular hypertrophy in the ileum of two pigs aged 6 weeks was induced using two different surgical techniques, narrowing of the gut circumference (mechanical stenosis) and segmental reversal of an ileal loop which results in a persistent antiperistalsis of that segment (functional stenosis). These pigs were sacrificed 5-6 weeks postoperatively. Cross sections through the gut wall at various distances from the operation sites revealed marked muscular hypertrophy in the pre-stenotic regions and in the reversed segment. Whole mounts from pre- and post-stenotic, as well as reversed ileal regions, were silver- impregnated. The corresponding ileal region of a third, nonoperated pig served as control. Using a computer-aided morphometric device, somal areas of five morphological neurone types were measured at various distances orally and anally from the operation sites and along the control ileum. Values between hypertrophic and nonhypertrophic zones as well as between two corresponding zones of nonoperated ileum were compared statistically. Along the control ileum, values revealed no differences in soma sizes. Within the experimentally altered material, somal areas of type VI neurones showed marked hypertrophy related to the sites of muscular hypertrophy whereas the other types remained constant throughout (II, IV in segmental reversal) or showed slightly larger somal areas within the post-stenotic, nonhypertrophied zones (I, V, IV in stenosis). Additionally, within the reversed segment, neuronal perikarya of type I, II, IV and V neurones were larger as compared to the neighbouring regions. However, this enlargement of perikarya within the reversed segment may not be correlated with muscular hypertrophy but rather with the transections of intramural axons before reversing this segment. The results suggest that morphologically distinct neurone types may play different roles within the mechanically stressed small intestine and possibly also in the coordination of normal muscular function.

Enteric neuronal plasticity and a reduced number of interstitial cells of Cajal in hypertrophic rat ileum

BACKGROUND

Partial obstruction of the ileum causes a notable hypertrophy of smooth muscle cells and enteric neurones in the proximally located intestine.

AIMS

To study the expression of neuromessengers in the hypertrophic ileum of rat as little is known about neuromessenger plasticity under these conditions. To investigate the presence of interstitial cells of Cajal (ICC) in hypertrophic ileum.

METHODS

Ileal hypertrophy was induced by circumferential application of a strip of plastic film for 18-24 days. Immunocytochemistry, in situ hybridisation, nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase histochemistry, and ethidium bromide staining were used to investigate the number of enteric neurones expressing neuropeptides and nitric oxide synthase, and the frequency of ICC.

RESULTS

In the hypertrophic ileum several neuronal populations showed changes in their expression of neuromessengers. Myenteric neurones expressing vasoactive intestinal peptide (VIP), pituitary adenylate cyclase activating peptide, and galanin were notably increased in number. In submucous ganglia the number of VIP immunoreactive neurones decreased while those expressing VIP mRNA increased. NADPH diaphorase positive submucous neurones increased dramatically while the number of neuronal type nitric oxide synthase expressing ones was unchanged. The number of ICC decreased notably in hypertrophic ileum.

CONCLUSION

Enteric neurones change their levels of expression of neuromessengers in hypertrophic ileum. ICC are also affected. The changes are presumably part of an adaptive response to the increased work load.

Myenteric neurons with different projections have different dendritic tree patterns: a morphometric study in the pig ileum

Morphometric analysis was performed of two types of myenteric neurons with at first glance, very similar morphology, but different projections in the pig ileum. 50 type IV cells projecting vertically to the outer submucosal plexus, and 50 solitary type V neurons projecting aborally, within the myenteric plexus, were evaluated. Using a computer-aided morphometric device, the following parameters were recorded: somal area, longest somal diameter, number of primary dendrites, dendritic length, number of dendritic branching points and number of terminal segments. In addition to other significant differences, the most prominent discriminating parameter between the two populations of nerve cells estimated in this study was the length of the longest dendrite of each cell type. The longest dendrite of an individual type V neuron is a manifold longer than the corresponding somal diameter, in contrast to type IV neurons where it is at most twice the somal diameter. In addition, all type IV and type V single dendritic lengths were arranged in histogramms, where the type V dendrites showed two frequency peaks. Thus, we assume that solitary type V neurons can develop two populations of dendrites: a short and a long one. These results demonstrate that myenteric neurons with different projections (and hence different functions) display strikingly different dendritic morphology.

Progressive reorganization of the myenteric plexus during one year following reanastomosis of the ileum of the guinea pig

The enteric nervous system appears to play a pivotal role in the functional recovery of the gastrointestinal tract after partial resection and reanastomosis, but the structural changes following surgery are not fully understood. The present study was designed to clarify the processes of myenteric plexus regeneration up to one year after transection and reanastomosis of the ileum of the guinea pig. The following techniques were used: nicotinamide adenine dinucleotide (NADH) diaphorase histochemistry, immunostaining of neuron-specific enolase (NSE) in whole-mount preparations, and transmission electron microscopy. Two months after transection and reanastomosis, myenteric ganglion cells with NADH diaphorase reactions were scarce in the center of the lesion, and were less numerous in adjacent areas (3 mm in width) than in the control ileum. In the areas adjacent to the lesion, a few large extraganglionic neurons that did not completely compensate for the loss of ganglion neurons were observed. The remaining ileum showed no changes in NADH diaphorase staining pattern at this stage. Two to 12 months after transection and reanastomosis, ectopic large neurons gradually increased in number not only in the areas adjacent to the lesion but also in part of the remaining ileum, up to 10 cm from the lesion. Concomitantly, large ganglion neurons decreased in number in these areas. In other ileal regions (more than 10 cm distant from the site of transection), no obvious changes in NADH diaphorase staining were noted throughout the observation period. The outgrowth of NSE-containing nerve fibers from the severed stumps was seen two weeks after transection. Six weeks later, numerous bundles of fine nerve fibers with NSE were shown to interconnect the oral and anal cut ends of the myenteric plexus, but they exhibited no subsequent alterations. Transmission electron microscopy revealed that regenerating nerve fiber bundles appeared initially among irregularly arranged smooth muscle cells eight weeks after the operation, as expected from light-microscopic observations. These findings suggest that myenteric ganglion cell bodies, unlike myenteric nerve fibers, require a longer term of reconstruction than previously believed after transection and reanastomosis of the ileum of the guinea pig.

Chagas' disease

Chagas' disease, caused by Trypanosoma cruzi, is an important cause of morbidity in many countries in Latin America. The important modes of transmission are by the bite of the reduviid bug and blood transfusion. The organism exists in three morphological forms: trypomastigotes, amastigotes, and epimastigotes. The mechanism of transformation and differentiation is currently being explored, and signal transduction pathways of the parasites may be involved in this process. Parasite adherence to and invasion of host cells is a complex process involving complement, phospholipase, penetrin, neuraminidase, and hemolysin. Two clinical forms of the disease are recognized, acute and chronic. During the acute stage pathological damage is related to the presence of the parasite, whereas in the chronic stage few parasites are found. In recent years the roles of tumor necrosis factor, gamma interferon, and the interleukins in the pathogenesis of this infection have been reported. The common manifestations of chronic cardiomyopathy are arrhythmias and thromboembolic events. Autoimmune, neurogenic, and microvascular factors may be important in the pathogenesis of the cardiomyopathy. The gastrointestinal tract is another important target, and "mega syndromes" are common manifestations. The diagnosis and treatment of this infection are active areas of investigation. New serological and molecular biological techniques have improved the diagnosis of chronic infection. Exacerbations of T. cruzi infection have been reported for patients receiving immuno-suppressive therapy and for those with AIDS.

Nerve growth factor in the urinary bladder of the adult regulates neuronal form and function

Urethral obstruction produces increased voiding frequency (0.7 +/- 0.06 to 1.1 +/- 0.08 h-1) and hypertrophy of the urinary bladder (89 +/- 1.7 to 708 +/- 40 mg) with profound increments in the dimensions of afferent (4, 6) and efferent neurons (299 +/- 4.7 to 573 +/- 8.6 microns2) supplying this organ in the rat. We discovered that hypertrophied bladders of rat and human contain significantly more nerve growth factor (NGF) per milligram wet weight, protein, and DNA than normal bladders. The temporal correlation between NGF content, neuronal hypertrophy, and bladder weight was consistent with a role for this growth factor in the neurotrophic effects associated with obstruction. Autoimmunity to NGF abolished the hypertrophy of NGF-sensitive bladder neurons in the pelvic ganglion after obstruction. Relief of urethral obstruction reduced bladder size (349 +/- 78 mg), but neuronal hypertrophy (460.2 +/- 10.2 microns2) and elevated NGF levels were only partially reversed. Bladder hypertrophy (133 +/- 4.3 mg) induced by osmotic diuresis slightly increased ganglion cell area (365.2 +/- 6.1 microns2) and only doubled NGF content of the bladder. These findings provide important new evidence that parenchymal cells in the hypertrophied bladder can synthesize NGF and possibly other molecular messengers that act to alter the size and function of neurons in adult animals and man.

Changes in intestinal blood flow during the development of chronic large bowel obstruction

The effect of chronic progressive distal large bowel obstruction on intestinal blood flow was studied in 12 mini-pigs. Blood flow was measured by the techniques of xenon133 clearance and intracardiac injections of radiolabelled microspheres. Intestinal blood flow was increased in the left colon and ileum but decreased in the caecum. Blood was shunted from the mucosa to the muscle layers. The results suggest that primary anastomosis of the obstructed left colon is not contraindicated by haemodynamic considerations.

Size of neurons and glial cells in the intramural ganglia of the hypertrophic intestine of the guinea-pig

A quantitative light microscopic study has been carried out on the myenteric and submucosal ganglia of the guinea-pig ileum, after inducing hypertrophy of the wall with an experimental stenosis. The area of the profiles of nerve cells, of nerve cell nuclei and of glial nuclei, and the percentage area of the neuropil were measured, and the relative numbers of neurons and glial cells were estimated. The average size of neurons in both plexuses was greatly increased over the control values. Nearly half of the neuronal profiles measured over 500 microns2 in sectional area (less than 3% in the controls), and less than 1% measured less than 150 microns2 (21% in controls). The average size of glial nuclei (and presumably that of the glial cells too) was increased in the hypertrophic ganglia. The number of glial cells (relative to the number of neurons) was unchanged or slightly decreased in the hypertrophic myenteric ganglia; in contrast, it was markedly increased in the submucosal ganglia. In both ganglia the hypertrophy was accompanied by a decrease in the percentage volume of neuropil.

Hypertrophy of intestinal smooth muscle

Proximal to an experimental stenosis of the small intestine of rats and guinea-pigs a remarkable hypertrophy of the muscle coat develops 3-5 weeks after the operation. There is no increase in the length of the intestine but an overall increase in volume of the muscularis externa up to 10 times. This increase is accounted for by an increase in size and in number (by mitosis) of smooth muscle cells of both the longitudinal and circular layers. Bundles of newly-formed smooth cells appear in the serosa and are circularly arranged. In the hypertrophic smooth muscle cells of the circular layer the ratio of surface to volume is 0.80 (0.80 mum2 of cell surface for every mum3 of cell volume) as against 1.4 in the control muscle. The hypertrophic muscle cells have a highly developed sarcoplasmic reticulum and show a large number of nexuses. The density of innervation (number of axons per given number of smooth muscle cells) is smaller than in controls. Few collagen fibrils are visible in the extracellular space.

Hypertrophy of intestinal smooth muscle

Proximal to an experimental stenosis of the small intestine of rats and guinea-pigs a remarkable hypertrophy of the muscle coat develops 3-5 weeks after the operation. There is no increase in the length of the intestine but an overall increase in volume of the muscularis externa up to 10 times. This increase is accounted for by an increase in size and in number (by mitosis) of smooth muscle cells of both the longitudinal and circular layers. Bundles of newly-formed smooth cells appear in the serosa and are circularly arranged. In the hypertrophic smooth muscle cells of the circular layer the ratio of surface to volume is 0.80 (0.80 mum2 of cell surface for every mum3 of cell volume) as against 1.4 in the control muscle. The hypertrophic muscle cells have a highly developed sarcoplasmic reticulum and show a large number of nexuses. The density of innervation (number of axons per given number of smooth muscle cells) is smaller than in controls. Few collagen fibrils are visible in the extracellular space.