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Giorgetti A, Nyilima S, Stoffel NU, Moretti D, Mwasi E, Karanja S, Zeder C, Speich C, Netland C, Jin Z, Zimmermann MB, Brittenham GM. Stable iron ( 58Fe) isotopic measurements in Kenyan toddlers during 3 months of iron supplementation demonstrate that half of the iron absorbed is lost. Br J Haematol 2024; 204:2057-2065. [PMID: 38302093 DOI: 10.1111/bjh.19319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
Increased iron loss may reduce the effectiveness of iron supplementation. The objective of this study was to determine if daily oral iron supplementation increases iron loss, measured using a stable isotope of iron (58Fe). We enrolled and dewormed 24 iron-depleted Kenyan children, 24-27 months of age, whose body iron was enriched and equilibrated with 58Fe given at least 1 year earlier. Over 3 months of supplementation (6 mg iron/kg body weight [BW]/day), mean (±SD) iron absorption was 1.10 (±0.28) mg/day. During supplementation, 0.55 (±0.36) mg iron/day was lost, equal to half of the amount of absorbed iron. Supplementation did not increase faecal haem/porphyrin or biomarkers of enterocyte damage and gut or systemic inflammation. Using individual patient data, we examined iron dose, absorption and loss among all available long-term iron isotopic studies of supplementation. Expressed in terms of body weight, daily iron loss was correlated significantly with iron absorption (Pearson's r = 0.66 [95% confidence interval 0.48-0.78]) but not with iron dose (r = 0.16 [95% CI -0.10-0.40]). The results of this study indicate that iron loss is increased with daily oral iron supplementation and may blunt the efficacy of iron supplements in children. This study was registered at ClinicalTrials.gov as NCT04721964.
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Affiliation(s)
- Ambra Giorgetti
- Laboratory of Human Nutrition, ETH, Zurich, Switzerland
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Suzane Nyilima
- Public and Community Health Department, Jomo Kenyatta University, Nairobi, Kenya
| | - Nicole U Stoffel
- Laboratory of Human Nutrition, ETH, Zurich, Switzerland
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Diego Moretti
- Nutrition Group, Swiss Distance University of Applied Sciences, Regensdorf, Switzerland
| | - Edith Mwasi
- Paediatric Department, Msambweni District Hospital, Msambweni, Kwale County, Kenya
| | - Simon Karanja
- Public and Community Health Department, Jomo Kenyatta University, Nairobi, Kenya
| | | | | | | | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, ETH, Zurich, Switzerland
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Gary M Brittenham
- Department of Paediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Liu F, Smith AD, Wang TTY, Pham Q, Hou P, Cheung L, Yang H, Li RW. Phospholipid-rich krill oil promotes intestinal health by strengthening beneficial gut microbial interactions in an infectious colitis model. Food Funct 2024; 15:2604-2615. [PMID: 38356343 DOI: 10.1039/d3fo04980a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Krill oil (KO) is rich in bioactive ingredients including phospholipids, omega-3 fatty acids, and astaxanthin. While health benefits and roles of KO in modulating lipid metabolism are well documented, its ability to alleviate symptoms related to infectious colitis and modulate gut microbial interactions is still largely unknown. Here we used a multi-omics approach, including transcriptome, microbiome, and metabolome analyses, to understand how KO mediates gut microbial interactions and promotes epithelial healing in an infectious colitis model. KO reversed the infection-induced intestinal hyperplasia to baseline. KO dampened intestinal inflammation via multiple targets, mediating several proinflammatory pathways, including IL17 signaling, and reducing luminal histamine levels. KO supplementation enriched butyrate-producing bacteria, including Roseburia and Clostridium, and strengthened beneficial microbial interactions in the gut microbial community. Supplementation with phospholipid-rich KO also increased microbial phylogenetic diversity. KO enhanced mucosal barrier function by increasing the production of Muc6 and the antimicrobial peptide, Leap2. KO played an active role during epithelial healing by inhibiting the expression of granzyme K while increasing the expression of a colitis protective factor, Dclk1. Together, our findings demonstrate that KO rich in omega-3 phospholipids can play a protective role in infectious colitis and should be considered a dietary option for promoting gut health.
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Affiliation(s)
- Fang Liu
- College of Public Health, Zhengzhou University, Zhengzhou, China.
| | - Allen D Smith
- USDA-ARS, Diet, Genomics, and Immunology Laboratory, Beltsville Human Nutrition Research Center, Beltsville, MD, USA
| | - Thomas T Y Wang
- USDA-ARS, Diet, Genomics, and Immunology Laboratory, Beltsville Human Nutrition Research Center, Beltsville, MD, USA
| | - Quynhchi Pham
- USDA-ARS, Diet, Genomics, and Immunology Laboratory, Beltsville Human Nutrition Research Center, Beltsville, MD, USA
| | - Pengfen Hou
- Affilated Hospital of Qingdao Binhai University, Qingdao, China
| | - Lumei Cheung
- USDA-ARS, Diet, Genomics, and Immunology Laboratory, Beltsville Human Nutrition Research Center, Beltsville, MD, USA
| | - Haiyan Yang
- College of Public Health, Zhengzhou University, Zhengzhou, China.
| | - Robert W Li
- USDA-ARS, Animal Parasitic Diseases Laboratory, Beltsville, MD, USA
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3
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Ming Z, Gong AY, Wang Y, Zhang XT, Li M, Mathy NW, Strauss-Soukup JK, Chen XM. Involvement of Cryptosporidium parvum Cdg7_FLc_1000 RNA in the Attenuation of Intestinal Epithelial Cell Migration via Trans-Suppression of Host Cell SMPD3. J Infect Dis 2019; 217:122-133. [PMID: 28961856 DOI: 10.1093/infdis/jix392] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/03/2017] [Indexed: 01/05/2023] Open
Abstract
Intestinal infection by Cryptosporidium parvum causes inhibition of epithelial turnover, but underlying mechanisms are unclear. Previous studies demonstrate that a panel of parasite RNA transcripts of low protein-coding potential are delivered into infected epithelial cells. Using in vitro and in vivo models of intestinal cryptosporidiosis, we report here that host delivery of parasite Cdg7_FLc_1000 RNA results in inhibition of epithelial cell migration through suppression of the gene encoding sphingomyelinase 3 (SMPD3). Delivery of Cdg7_FLc_1000 into infected cells promotes the histone methyltransferase G9a-mediated H3K9 methylation in the SMPD3 locus. The DNA-binding transcriptional repressor, PR domain zinc finger protein 1, is required for the assembly of Cdg7_FLc_1000 into the G9a complex and associated with the enrichment of H3K9 methylation at the gene locus. Pathologically, nuclear transfer of Cryptosporidium parvum Cdg7_FLc_1000 RNA is involved in the attenuation of intestinal epithelial cell migration via trans-suppression of host cell SMPD3.
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Affiliation(s)
- Zhenping Ming
- Department of Medical Parasitology, School of Basic Medical Sciences, Wuhan University, Hubei, China.,Department of Medical Microbiology and Immunology, School of Medicine
| | - Ai-Yu Gong
- Department of Medical Microbiology and Immunology, School of Medicine
| | - Yang Wang
- Department of Medical Microbiology and Immunology, School of Medicine
| | - Xin-Tian Zhang
- Department of Medical Microbiology and Immunology, School of Medicine
| | - Min Li
- Department of Medical Microbiology and Immunology, School of Medicine
| | - Nicholas W Mathy
- Department of Medical Microbiology and Immunology, School of Medicine
| | | | - Xian-Ming Chen
- Department of Medical Microbiology and Immunology, School of Medicine
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Ming Z, Gong AY, Wang Y, Zhang XT, Li M, Li Y, Pang J, Dong S, Strauss-Soukup JK, Chen XM. Trans-suppression of host CDH3 and LOXL4 genes during Cryptosporidium parvum infection involves nuclear delivery of parasite Cdg7_FLc_1000 RNA. Int J Parasitol 2018; 48:423-431. [PMID: 29438669 DOI: 10.1016/j.ijpara.2017.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 12/21/2022]
Abstract
Intestinal infection by Cryptosporidium parvum causes significant alterations in the gene expression profile in host epithelial cells. Previous studies demonstrate that a panel of parasite RNA transcripts of low protein-coding potential are delivered into infected host cells and may modulate host gene transcription. Using in vitro models of human intestinal cryptosporidiosis, we report here that trans-suppression of the cadherin 3 (CDH3) and lysyl oxidase like 4 (LOXL4) genes in human intestinal epithelial cells following C. parvum infection involves host delivery of the Cdg7_FLc_1000 RNA, a C. parvum RNA that has been previously demonstrated to be delivered into the nuclei of infected host cells. Downregulation of CDH3 and LOXL4 genes was detected in host epithelial cells following C. parvum infection or in cells expressing the parasite Cdg7_FLc_1000 RNA. Knockdown of Cdg7_FLc_1000 attenuated the trans-suppression of CDH3 and LOXL4 genes in host cells induced by infection. Interestingly, Cdg7_FLc_1000 was detected to be recruited to the promoter regions of both CDH3 and LOXL4 gene loci in host cells following C. parvum infection. Host delivery of Cdg7_FLc_1000 promoted the PH domain zinc finger protein 1 (PRDM1)-mediated H3K9 methylation associated with trans-suppression in the CDH3 gene locus, but not the LOXL4 gene. Therefore, our data suggest that host delivery of Cdg7_FLc_1000 causes CDH3 trans-suppression in human intestinal epithelial cells following C. parvum infection through PRDM1-mediated H3K9 methylation in the CDH3 gene locus, whereas Cdg7_FLc_1000 induces trans-suppression of the host LOXL4 gene through H3K9/H3K27 methylation-independent mechanisms.
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Affiliation(s)
- Zhenping Ming
- Department of Medical Parasitology, School of Basic Medical Sciences, Wuhan University, Hubei, China; Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, United States
| | - Ai-Yu Gong
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, United States
| | - Yang Wang
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, United States
| | - Xin-Tian Zhang
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, United States
| | - Min Li
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, United States
| | - Yao Li
- Department of Medical Parasitology, School of Basic Medical Sciences, Wuhan University, Hubei, China
| | - Jing Pang
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, United States
| | - Stephanie Dong
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, United States
| | - Juliane K Strauss-Soukup
- Department of Chemistry, Creighton University College of Arts and Sciences, Omaha, NE, United States
| | - Xian-Ming Chen
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, United States.
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Wang Y, Gong AY, Ma S, Chen X, Strauss-Soukup JK, Chen XM. Delivery of parasite Cdg7_Flc_0990 RNA transcript into intestinal epithelial cells during Cryptosporidium parvum infection suppresses host cell gene transcription through epigenetic mechanisms. Cell Microbiol 2017; 19. [PMID: 28655069 DOI: 10.1111/cmi.12760] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/02/2017] [Accepted: 06/22/2017] [Indexed: 02/06/2023]
Abstract
Cryptosporidial infection causes dysregulated transcription of host genes key to intestinal epithelial homeostasis, but the underlying mechanisms remain obscure. Previous studies demonstrate that several Cryptosporidium parvum (C. parvum) RNA transcripts are selectively delivered into epithelial cells during host cell invasion and may modulate gene transcription in infected cells. We report here that C. parvum infection suppresses the transcription of LRP5, SLC7A8, and IL33 genes in infected intestinal epithelium. Trans-suppression of these genes in infected host cells is associated with promoter enrichment of suppressive epigenetic markers (i.e., H3K9me3). Cdg7_FLc_0990, a C. parvum RNA that has previously demonstrated to be delivered into the nuclei of infected epithelial cells, is recruited to the promoter regions of LRP5, SLC7A8, and IL33 genes. Cdg7_FLc_0990 appears to be recruited to their promoter regions together with G9a, a histone methyltransferase for H3K9 methylation. The PR domain zinc finger protein 1, a G9a-interacting protein, is required for the assembly of Cdg7_FLc_0990 to the G9a complex and gene-specific enrichment of H3K9 methylation. Our data demonstrate that cryptosporidial infection induces epigenetic histone methylations in infected cells through nuclear transfer of parasite Cdg7_Flc_0990 RNA transcript, resulting in transcriptional suppression of the LRP5, SLC7A8, and IL33 genes.
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Affiliation(s)
- Yang Wang
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, USA
| | - Ai-Yu Gong
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, USA
| | - Shibin Ma
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, USA
| | - Xiqiang Chen
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, USA
| | | | - Xian-Ming Chen
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, USA
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Senger S, Sapone A, Fiorentino MR, Mazzarella G, Lauwers GY, Fasano A. Celiac Disease Histopathology Recapitulates Hedgehog Downregulation, Consistent with Wound Healing Processes Activation. PLoS One 2015; 10:e0144634. [PMID: 26649570 PMCID: PMC4674131 DOI: 10.1371/journal.pone.0144634] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/21/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In celiac disease (CD), intestinal epithelium damage occurs secondary to an immune insult and is characterized by blunting of the villi and crypt hyperplasia. Similarities between Hedgehog (Hh)/BMP4 downregulation, as reported in a mouse model, and CD histopathology, suggest mechanistic involvement of Hh/BMP4/WNT pathways in proliferation and differentiation of immature epithelial cells in the context of human intestinal homeostasis and regeneration after damage. Herein we examined the nature of intestinal crypt hyperplasia and involvement of Hh/BMP4 in CD histopathology. METHODS AND FINDINGS Immunohistochemistry, qPCR and in situ hybridization were used to study a cohort of 24 healthy controls (HC) and 24 patients with diagnosed acute celiac disease (A-CD) intestinal biopsies. In A-CD we observed an increase in cells positive for Leucin-rich repeat-containing G protein-coupled receptor 5 (LGR5), an epithelial stem cell specific marker and expansion of WNT responding compartment. Further, we observed alteration in number and distribution of mesenchymal cells, predicted to be part of the intestinal stem cells niche. At the molecular level we found downregulation of indian hedgehog (IHH) and other components of the Hh pathway, but we did not observe a concurrent downregulation of BMP4. However, we observed upregulation of BMPs antagonists, gremlin 1 and gremlin 2. CONCLUSIONS Our data suggest that acute CD histopathology partially recapitulates the phenotype reported in Hh knockdown models. Specifically, Hh/BMP4 paradigm appears to be decoupled in CD, as the expansion of the immature cell population does not occur consequent to downregulation of BMP4. Instead, we provide evidence that upregulation of BMP antagonists play a key role in intestinal crypt hyperplasia. This study sheds light on the molecular mechanisms underlying CD histopathology and the limitations in the use of mouse models for celiac disease.
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Affiliation(s)
- Stefania Senger
- Center for Mucosal Immunology and Biology Research, Massachusetts General Hospital for Children and Celiac Program at Harvard Medical School, Charlestown, Massachusetts, United States of America
| | - Anna Sapone
- Center for Mucosal Immunology and Biology Research, Massachusetts General Hospital for Children and Celiac Program at Harvard Medical School, Charlestown, Massachusetts, United States of America
- Celiac Center, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maria Rosaria Fiorentino
- Center for Mucosal Immunology and Biology Research, Massachusetts General Hospital for Children and Celiac Program at Harvard Medical School, Charlestown, Massachusetts, United States of America
| | - Giuseppe Mazzarella
- Institute of Food Sciences, National Research Council (CNR), Avellino, 83100, Italy
| | - Gregory Y. Lauwers
- Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, United States of America
| | - Alessio Fasano
- Center for Mucosal Immunology and Biology Research, Massachusetts General Hospital for Children and Celiac Program at Harvard Medical School, Charlestown, Massachusetts, United States of America
- * E-mail:
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Zemljic M, Pejkovic B, Krajnc I, Lipovsek S. Biological pathways involved in the development of inflammatory bowel disease. Wien Klin Wochenschr 2014; 126:626-33. [PMID: 25256178 DOI: 10.1007/s00508-014-0592-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 08/09/2014] [Indexed: 02/07/2023]
Abstract
Apoptosis, autophagy and necrosis are three distinct functional types of the mammalian cell death network. All of them are characterized by a number of cell's morphological changes. The inappropriate induction of cell death is involved in the pathogenesis of a number of diseases.Pathogenesis of inflammatory bowel diseases (ulcerative colitis, Crohn's disease) includes an abnormal immunological response to disturbed intestinal microflora. One of the most important reason in pathogenesis of chronic inflammatory disease and subsequent multiple organ pathology is a barrier function of the gut, regulating cellular viability. Recent findings have begun to explain the mechanisms by which intestinal epithelial cells are able to survive in such an environment and how loss of normal regulatory processes may lead to inflammatory bowel disease (IBD).This review focuses on the regulation of biological pathways in development and homeostasis in IBD. Better understanding of the physiological functions of biological pathways and their influence on inflammation, immunity, and barrier function will simplify our expertice of homeostasis in the gastrointestinal tract and in upgrading diagnosis and treatment.
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Affiliation(s)
- Mateja Zemljic
- Institute of Anatomy, Histology and Embryology, Faculty of Medicine, University of Maribor, Ljubljanska 5, 2000, Maribor, Slovenia,
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Yang YL, Serrano MG, Sheoran AS, Manque PA, Buck GA, Widmer G. Over-expression and localization of a host protein on the membrane of Cryptosporidium parvum infected epithelial cells. Mol Biochem Parasitol 2009; 168:95-101. [PMID: 19631240 PMCID: PMC2752322 DOI: 10.1016/j.molbiopara.2009.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 06/26/2009] [Accepted: 07/13/2009] [Indexed: 12/30/2022]
Abstract
The genus Cryptosporidium includes several species of intestinal protozoan parasites which multiply in intestinal epithelial cells. The impact of this infection on the transcriptome of cultured host cells was investigated using DNA microarray hybridizations. The expression of 14 genes found to be consistently up- or down-regulated in infected cell monolayers was validated with RT PCR. Using immunofluorescence we examined the expression of Protease Activated Receptor-2, which is encoded by one of the up-regulated genes. In infected cells this receptor localized to the host cell membrane which covers the intracellular trophozoites and meronts. This observation indicates that the composition of the host cell membrane is affected by the developing trophozoite, a phenomenon which has not been described previously.
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Affiliation(s)
- Yi-Lin Yang
- Tufts Cummings School of Veterinary Medicine, Division of Infectious Diseases, 200 Westboro Road, North Grafton, MA 01536, USA
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Lebeis SL, Sherman MA, Kalman D. Protective and destructive innate immune responses to enteropathogenic Escherichia coli and related A/E pathogens. Future Microbiol 2008; 3:315-28. [DOI: 10.2217/17460913.3.3.315] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Enteropathogenic Escherichia coli, enterohemorrhagic E. coli (O157:H7) and Citrobacter rodentium are classified as attaching and effacing (A/E) pathogens based on their ability to adhere to intestinal epithelium, destroy microvilli and induce pedestal formation at the site of infection. A/E bacterial infections also cause acute diarrheal episodes and intestinal inflammation. The use of model systems has led to an understanding of the innate immune response to A/E pathogens. The innate immune system plays a protective role, initiating a productive antibody response, directly killing bacteria and inducing repair mechanisms following tissue damage caused by infection. However, hyperactivation of the innate immune system can have negative consequences, including exacerbated tissue destruction following neutrophil infiltration. Here we review how innate immune cell types, including neutrophils, macrophages and dendritic cells, orchestrate both protective and destructive responses. Such information is crucial for the development of therapeutics that can mitigate destructive inflammatory responses while accentuating those that are protective.
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Affiliation(s)
- Sarah L Lebeis
- Microbiology & Molecular Genetics Graduate Program, Emory University School of Medicine, 615 Michael Street, Whitehead Research Building #155, Atlanta, GA 30322, USA and, Department of Pathology & Laboratory Medicine, Emory University School of Medicine, 615 Michael Street, Whitehead Research Building #144, Atlanta, GA 30322, USA
| | - Melanie A Sherman
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, 615 Michael Street, Whitehead Research Building #144, Atlanta, GA 30322, USA
| | - Daniel Kalman
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, 615 Michael Street, Whitehead Research Building #144, Atlanta, GA 30322, USA
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Werneck-Silva AL, Alvares EP, Gama P, Damião AOMC, Osaki LH, Ogias D, Sipahi AM. Intestinal damage in strongyloidiasis: the imbalance between cell death and proliferation. Dig Dis Sci 2006; 51:1063-9. [PMID: 16865572 DOI: 10.1007/s10620-006-8010-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Accepted: 07/14/2005] [Indexed: 12/25/2022]
Abstract
Strongyloidiasis is an endemic tropical parasitosis caused by Strongyloides stercoralis that also affects immigrants in nontropical countries. The nematode colonizes the duodenum and upper jejunum, inducing mucosal alterations. Because integrity is essential for a functional barrier, we aimed to study apoptosis and proliferation in the small bowel epithelium infected with S. stercoralis. We evaluated 23 patients and 17 controls. Apoptotic cells were detected by TUNEL and M30 immunolabelling, whereas proliferation was scored by Ki67 immunostaining and mitotic counting. Infection increased apoptotic indices in duodenum and jejunum (P < 0.001). Conversely, it decreased cell proliferation in both segments (P < 0.001). Our results showed that intestinal strongyloidiasis promotes an imbalance between cell death and proliferation. This is the first evidence of disruption of the epithelial kinetics with S. stercoralis infection, though the mechanisms remain unclear. Furthermore, our results support the idea that strongyloidiasis disturbs the mucosal integrity and can compromise the intestinal barrier.
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Affiliation(s)
- Ana Luiza Werneck-Silva
- Department of Gastroenterology, School of Medicine, Laboratory of Investigation (LIM 07), University of São Paulo, São Paulo, Brazil
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11
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Kelly P, Bajaj-Elliott M, Katubulushi M, Zulu I, Poulsom R, Feldman RA, Bevins CL, Dhaliwal W. Reduced gene expression of intestinal alpha-defensins predicts diarrhea in a cohort of African adults. J Infect Dis 2006; 193:1464-70. [PMID: 16619196 PMCID: PMC2629849 DOI: 10.1086/503747] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Accepted: 11/17/2005] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Human defensin (HD) 5 and HD6, both Paneth cell alpha-defensins, contribute to the antimicrobial barrier against intestinal infection. We have previously demonstrated that levels of both HD5 and HD6 mRNA were reduced in adults living in urban Zambia, compared with those in adults living in London. The aim of the present study was to determine, during 2 years of follow-up, whether alpha-defensin expression in Zambian adults is related to susceptibility to diarrhea. METHODS We analyzed intestinal biopsy samples from a longitudinal cohort study conducted in 83 Zambian adults by quantitative reverse-transcription polymerase chain reaction, Western blotting, immunohistochemistry, and in situ hybridization, and we measured the incidence of diarrhea. RESULTS Levels of HD5 and HD6 mRNA in Paneth cells varied between participants, over time, and seasonally and were strongly correlated with mucosal architecture. Gene expression was almost exclusively restricted to Paneth cells. The median (interquartile range) HD5 mRNA level was 6.0 (5.6-6.7) log10 transcripts/microg of total RNA among 18 participants who experienced diarrhea within 2 months after biopsy-sample collection, compared with 6.8 (6.2-7.3) log10 transcripts/microg of total RNA among 94 participants who did not (P=.006). A similar observation was made for HD6. CONCLUSIONS These data indicate that intestinal alpha-defensin expression is dynamic and seasonal and suggest that susceptibility to intestinal infection is related to alpha-defensin expression.
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Affiliation(s)
- Paul Kelly
- Centre for Adult and Paediatric Gastroenterology, Institute of Cell and Molecular Science, Barts and The London School of Medicine, Department of Infectious and Tropical Diseases, United Kingdom.
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12
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Maresca M, Miller D, Quitard S, Dean P, Kenny B. Enteropathogenic Escherichia coli (EPEC) effector-mediated suppression of antimicrobial nitric oxide production in a small intestinal epithelial model system. Cell Microbiol 2006; 7:1749-62. [PMID: 16309461 DOI: 10.1111/j.1462-5822.2005.00587.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In vivo studies with the mouse-specific member of the attaching and effacing (A/E) family of pathogens raised the possibility that these non-invasive enteric pathogens can specifically inhibit inducible nitric oxide synthase (iNOS) expression to prevent the production of antimicrobial nitric oxide (NO). In this study we use polarized Caco-2 cells, a model of human small intestinal epithelia, to (i) demonstrate conclusively that an A/E member, human specific enteropathogenic Escherichia coli (EPEC), can inhibit cytokine-induced iNOS expression, (ii) show that this activity is dependent on the delivery of effector molecules into host cells and (iii) investigate the mechanism of inhibition. Analysis of the level of iNOS-related mRNA, protein and NO production demonstrated that EPEC can inhibit iNOS expression at the transcriptional, by direct and indirect mechanisms, and post-transcriptional levels. This transcriptional block was linked to the failure of the iNOS-related transcriptional factor NF-kappaB, but not STAT1, to undergo phosphorylation-associated activation. A selective pressure to prevent iNOS production was evidenced by the finding that iNOS activity had a potent antimicrobial effect on adherent but not non-adherent bacteria. Moreover, given the central role NF-kappaB plays in transcribing genes associated with early host immune responses, this inhibitory mechanism presumably represents an important role in pathogenesis. Our study also provides insights into the nature of NO production in response to bacterial infection as well as the role of the locus of enterocyte effacement (LEE)-encoded effector molecules in inhibiting iNOS expression.
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Affiliation(s)
- Marc Maresca
- Institute for Cell and Molecular Biosciences, Medical School, University of Newcastle, Framlington Place, Newcastle upon Tyne, NE24HH, UK
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Bode L, Eklund EA, Murch S, Freeze HH. Heparan sulfate depletion amplifies TNF-alpha-induced protein leakage in an in vitro model of protein-losing enteropathy. Am J Physiol Gastrointest Liver Physiol 2005; 288:G1015-23. [PMID: 15604198 DOI: 10.1152/ajpgi.00461.2004] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Protein-losing enteropathy (PLE), the excessive loss of plasma proteins through the intestine, often correlates with the episodic loss of heparan sulfate (HS) proteoglycans (HSPG) from the basolateral surface of intestinal epithelial cells. PLE onset is often associated with a proinflammatory state. We investigated whether loss of HS or treatment with the proinflammatory cytokine TNF-alpha directly causes protein leakage and whether a combination of both exacerbates this process. We established the first in vitro model of PLE and measured the flux of albumin/FITC through a monolayer of intestinal HT29 or Caco-2 cells grown on transwells and determined the integrity by transepithelial electrical resistance (TER). Loss of HS from the basolateral surface, either by heparanase digestion or by inhibition of HS synthesis, increased albumin flux 1.58 +/- 0.09-fold and reduced TER by 23.4 +/- 6.5%. TNF-alpha treatment increased albumin flux 4.04 +/- 0.03-fold and reduced TER by 75.7 +/- 4.7% but only slightly decreased HS content. The combined effects of HS loss and TNF-alpha treatment were not only additive, but synergistic, with a 7.00 +/- 0.11-fold increase in albumin flux and a 83.9 +/- 8.1% reduction of TER. Coincubation of TNF-alpha with soluble HS or heparin abolished these synergistic effects. Loss of basolateral HS directly causes protein leakage and amplifies the effects of the proinflammatory cytokine TNF-alpha. Our findings imply that loss of HSPGs renders patients more susceptible to PLE and offer a potential explanation for the favorable response some PLE patients have to heparin therapy.
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Affiliation(s)
- Lars Bode
- The Burnham Institute, Glycobiology and Carbohydrate Chemistry Program, 10901 N. Torrey Pines Rd., La Jolla, California 92037, USA
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Augustin MT, Kokkonen J, Karttunen TJ. Evidence for increased apoptosis of duodenal intraepithelial lymphocytes in cow's milk sensitive enteropathy. J Pediatr Gastroenterol Nutr 2005; 40:352-8. [PMID: 15735492 DOI: 10.1097/01.mpg.0000151748.07469.bf] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Enterocyte apoptosis induced by activated intraepithelial lymphocytes (IELs) is increased in celiac disease (CD). A lesser increment in intraepithelial lymphocytes associated with normal villous structure is also characteristic of cow's milk sensitive enteropathy (CMSE), but no information is available about the apoptosis rate of this condition. METHODS Endoscopic biopsy samples of 21 children with untreated CMSE were compared with samples from 15 children with CD and 18 controls. Apoptosis was analyzed using the TUNEL technique and the M30 antibody from duodenal bulb and mid-duodenum samples. Ki-67 was used to detect the proliferation rate and CD3(+) to count the overall number of T lymphocytes. RESULTS In the mid-duodenum, CMSE patients showed a significantly increased intraepithelial and lamina propria density of TUNEL(+) cells, but no difference in the density of M30(+) epithelial cells was seen compared with controls. In CD subjects, TUNEL(+) counts in mid-duodenal villous epithelium were increased. CD3(+) intraepithelial lymphocytes were increased in both CMSE and CD and correlated with TUNEL(+) and M30(+) counts among all patients. No increase in proliferation rate was seen in CMSE, and no significant correlations between apoptosis and proliferation rates were detected. CONCLUSIONS The observed increase in TUNEL(+) counts and the absence of any increase in M30(+) cells suggest that the apoptosis rate of intraepithelial lymphocytes, but not of enterocytes, is increased in the small IELs in CMSE. However, the number of intraepithelial lymphocytes is still elevated in CMSE, indicating that a disturbance of homeostasis of intraepithelial lymphocytes is important in its pathogenesis.
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Affiliation(s)
- Merja T Augustin
- Department of Pathology, University of Oulu, Oulu University Hospital, Oulu, Finland.
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Cuperus R, Schäppi MG, Shah N, Lindley KJ, Milla PJ, Smith VV. Hypertrophic eosinophilic gastroenteropathy is associated with reduced enterocyte apoptosis. Histopathology 2005; 46:73-80. [PMID: 15656889 DOI: 10.1111/j.1365-2559.2005.02050.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIMS To investigate the cause of grossly elongated villi in four children presenting with obstruction due to a novel form of eosinophilic gastroenteropathy in which there was profound hyperplasia of the intestinal villi with grossly increased villous/crypt ratio and prominent mucosal eosinophilia. Increased eosinophils were also present in the muscularis propria and submucosa. All had intermittent diarrhoea and signs of a protein-losing enteropathy. METHODS AND RESULTS The cause of the grossly elongated villi was investigated by studying enterocyte proliferation (Ki67), survival factors (bcl-2) and apoptosis (TUNEL) in these patients (n = 4) and normal (jejunum n = 6, ileum n = 6) and disease (n = 6) controls. The most remarkable finding was that apoptotic enterocytes were undetectable in the elongated villi. CONCLUSIONS It seems likely that a defect in the regulation of apoptosis of the epithelium occurs which could explain the remarkable hyperplasia of the villi seen.
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Affiliation(s)
- R Cuperus
- Gastroenterology, Great Ormond Street Hospital for Children NHS Trust, London, UK
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Campbell DI, Murch SH, Elia M, Sullivan PB, Sanyang MS, Jobarteh B, Lunn PG. Chronic T cell-mediated enteropathy in rural west African children: relationship with nutritional status and small bowel function. Pediatr Res 2003; 54:306-11. [PMID: 12788978 DOI: 10.1203/01.pdr.0000076666.16021.5e] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Previous studies from The Gambia have shown that poor childhood growth is resistant to all but the most intense nutritional intervention and highly dependent on small bowel permeability related to enteropathy. We thus aimed to characterize the mucosal inflammatory response in rural Gambian children in relation to intestinal permeability and nutritional status. Small bowel biopsies were taken from 38 rural Gambian children (age, 0.5-3 y) with a range of nutritional and clinical states (median weight z score, -4.6; range, 0.5 to -6.4), 75% of whom had diarrhea. Morphometry was performed with immunohistochemical analysis for a range of lineage and activation markers, including proinflammatory and regulatory cytokines, and related to current clinical status and gut permeability. Comparison was made with 19 age-matched U.K. controls. All Gambian children, regardless of nutritional status, had evidence of chronic cell-mediated enteropathy with crypt hyperplasia, villous stunting, and high numbers of intraepithelial lymphocytes. CD25+ cells were 20-fold higher than in U.K. controls. Although small bowel architecture was independent of nutritional status, T cell numbers rose and B cell numbers fell with worsening nutrition, and mucosal cytokine production became biased toward a proinflammatory response, with progressive decrease of transforming growth factor-beta expression. Tropical enteropathy predates the onset of marasmus and is characterized by a cell-mediated TH1 response. Protein-energy malnutrition is associated with reduction of regulatory immune responses in the mucosal microenvironment, potentially impairing the mechanisms of oral tolerance.
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Latcham F, Merino F, Lang A, Garvey J, Thomson MA, Walker-Smith JA, Davies SE, Phillips AD, Murch SH. A consistent pattern of minor immunodeficiency and subtle enteropathy in children with multiple food allergy. J Pediatr 2003; 143:39-47. [PMID: 12915822 DOI: 10.1016/s0022-3476(03)00193-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Although immunoglobulin (Ig)E-mediated allergies are readily identifiable, non-IgE-mediated allergies present more diagnostic difficulty. We performed a formal retrospective analysis to determine whether there is a recognizable clinical pattern in children. METHODS We studied 121 children (mean age, 17.3 months) with multiple food allergies who were recruited on the basis of adequate immunological assessment by using case notes and parental questionnaire. RESULTS Group 1 (n=44) had rapid reactions to dietary antigens, of whom 41 also showed delayed reactions. Group 2 (n=77) had delayed reactions only. Mean IgE was increased in group 1 but both groups otherwise shared a pattern of increased IgG1, decreased IgG2/4, and low-normal IgA. Lymphocyte subsets were skewed, with an increased percentage of CD4 and CD19 and decreased CD8 and natural killer cells. Gastroesophageal reflux, esophagitis, subtle enteropathy, and constipation were frequent in both groups. Of 55 exclusively breast-fed infants, 44 sensitized before weaning. Twenty-one of the mothers suffered from autoimmunity. CONCLUSIONS There appears to be a recognizable pattern of immune deviation and minor enteropathy in children with multiple food allergy, irrespective of the speed of reactions. Disturbed gut motility is particularly common, as is a maternal history of autoimmunity.
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Affiliation(s)
- Frances Latcham
- Centre for Paediatric Gastroenterology and Department of Dietetics and Histopathology, Royal Free and University College School of Medicine, London, United Kingdom
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Groos S, Reale E, Hünefeld G, Luciano L. Changes in epithelial cell turnover and extracellular matrix in human small intestine after TPN. J Surg Res 2003; 109:74-85. [PMID: 12643847 DOI: 10.1016/s0022-4804(02)00094-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The atrophy and architectural remodeling of the jejunal mucosa arising in adults receiving total parenteral nutrition (TPN) has been suggested to originate from a disturbance in tissue homeostasis. The present study aims at examining (1) whether there are differences in proliferation and apoptosis of epithelial cells between enterally and parenterally nourished patients and (2) whether the distribution pattern of extracellular matrix (ECM) proteins known to influence cell turnover along the the crypt-villus axis is changed after TPN. METHODS The mitotic frequency and the proliferation index [using an antibody against Ki-67 antigen (MIB 1)] were determined on epoxy semithin and paraffin sections, respectively. Morphological techniques and the TUNEL assay were applied to detect apoptotic events. Immunolocalization of collagen IV, laminin, fibronectin, tenascin, and collagen VI was performed on cryosections. RESULTS After TPN the cell renewal was significantly enhanced, while epithelial cell death was drastically reduced. The comparison of TPN and EN patients revealed differences in the distribution patterns of the ECM proteins laminin, fibronectin, and tenascin along the crypt-villus axis. Moreover, after TPN an increased expression of collagen types IV and VI was observed. CONCLUSIONS TPN in human adults is associated with alterations in epithelial cell turnover and changes in expression and/or localization of ECM proteins. Thus, the inverted route of nutrient supply in patients might modify environmental tissue conditions, which may influence the interactions between intestinal epithelial cells and the extracellular matrix.
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Affiliation(s)
- Stephanie Groos
- Department of Microscopic Anatomy, Center of Anatomy, Hannover Medical School, Hannover, Germany.
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Heemskerk VH, van Heurn LWE, Farla P, Buurman WA, Piersma F, ter Riet G, Heineman E. Effect of IGF-rich colostrum on bowel adaptation in neonatal piglets with short bowel syndrome. J Pediatr Gastroenterol Nutr 2002; 34:47-51. [PMID: 11753164 DOI: 10.1097/00005176-200201000-00011] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Insulin-like growth factor 1 (IGF-1), a polypeptide growth factor with mitogenic effects on intestinal epithelial crypt cells occurs naturally in high concentrations in colostrum. The hypothesis for this study was that colostrum rich in IGF-1 could promote small bowel adaptation in neonatal piglets with short bowel syndrome. METHODS Twenty-four piglets, aged 7 days, underwent 75% small bowel resection and were fed 525 kJ x kg(-1) x d(-1) (125 kcal) of colostrum-based formula (Rs(+)) or placebo formula (Rs(-)). Immunoglobulin G (IgG) accounted for 35% of the protein and was compensated with casein and whey protein in the control feed. The piglets were weighed daily and killed 28 days after surgery. Bowel samples were taken at surgery and at death. RESULTS Relative body-weight increase did not differ between the Rs(+) and Rs(-) group (84% +/- 9% vs. 90% +/- 12%, P = 0.83). There was a significant relative increase in crypt depth in the Rs - compared with the Rs + group (201% +/- 15% vs. 147% +/- 17%, P = 0.02) and total protein (mg/cm bowel) (482 +/- 51 vs. 278 +/- 46, P = 0.008). Increase in villus length, DNA/RNA content, and mitotic index did not differ between groups. CONCLUSION Colostrum supplement rich in IGF-1 has no benefits over protein-enriched feed with respect to growth and bowel adaptation in neonatal piglets with short bowel syndrome.
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Affiliation(s)
- V H Heemskerk
- Department of Surgery, the University of Maastricht, Maastricht, The Netherlands
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Barshack I, Goldberg I, Chowers Y, Weiss B, Horowitz A, Kopolovic J. Immunohistochemical analysis of candidate gene product expression in the duodenal epithelium of children with coeliac sprue. J Clin Pathol 2001; 54:684-8. [PMID: 11533074 PMCID: PMC1731505 DOI: 10.1136/jcp.54.9.684] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Coeliac sprue is a chronic disease, in which there is a characteristic mucosal lesion of the small intestine and impaired nutrient absorption, which improves upon the withdrawal of wheat gliadins and related grain proteins from the diet. Biopsy specimens demonstrate diffuse enteritis with pronounced atrophy or total loss of villi. There is also a long term risk of malignant disease. AIMS To compare the immunoexpression of DCC (deleted in colon cancer), p53, E-cadherin, and beta-catenin in the duodenal mucosa of children with coeliac disease with that seen in children with no evidence of small intestinal disease. METHODS To gain more insight into the genetic and immunohistochemical alterations of the duodenal epithelium in coeliac disease, 21 endoscopic biopsies from children with coeliac disease and 10 duodenal biopsies from children without coeliac disease were immunohistochemically evaluated for p53, DCC, E-cadherin, and beta-catenin. RESULTS DCC expression was not reduced in patients with coeliac disease compared with those without coeliac disease. p53 positive nuclear immunostaining was seen in seven of the 21 patients with coeliac disease. Positive nuclear staining was seen mainly in the deep and the lateral aspects of the crypts. All patients in the control group were negative for p53. In nine and three of the 21 patients with coeliac disease, respectively, the immunohistochemical expression of E-cadherin and beta-catenin was reduced. However, both E-cadherin and beta-catenin immunostaining in the control group was not altered. CONCLUSIONS E-cadherin and beta-catenin were reduced in the duodenal epithelium of children with coeliac disease when compared with normal mucosa. p53 was overexpressed in the duodenal mucosa of patients with coeliac disease. The reduced expression of E-cadherin and beta-catenin and p53 overexpression may contribute to the morphological changes seen in the small intestinal mucosa in coeliac disease.
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Affiliation(s)
- I Barshack
- Department of Pathology, The Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
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21
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Luperchio SA, Schauer DB. Molecular pathogenesis of Citrobacter rodentium and transmissible murine colonic hyperplasia. Microbes Infect 2001; 3:333-40. [PMID: 11334751 DOI: 10.1016/s1286-4579(01)01387-9] [Citation(s) in RCA: 214] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Here we review the history, clinical significance, pathology and molecular pathogenesis of Citrobacter rodentium, the causative agent of transmissible murine colonic hyperplasia. C. rodentium serves as an important model pathogen for investigating the mechanisms controlling attaching and effacing pathology, epithelial hyperproliferation, and tumor promotion in the distal colon of the mouse.
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Affiliation(s)
- S A Luperchio
- Division of Bioengineering and Environmental Health, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Room 56-787B, Cambridge, Massachusetts 02139, USA
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Maiuri L, Ciacci C, Raia V, Vacca L, Ricciardelli I, Raimondi F, Auricchio S, Quaratino S, Londei M. FAS engagement drives apoptosis of enterocytes of coeliac patients. Gut 2001; 48:418-24. [PMID: 11171836 PMCID: PMC1760155 DOI: 10.1136/gut.48.3.418] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Villus atrophy is the most distinctive sign of untreated coeliac disease (CD) and epithelial apoptosis is considered to be involved in this stage of the coeliac lesion. The extent of villus atrophy is, however, not homogeneous and patients with patchy or mild lesions have been described. AIMS To address: (a) the degree of "patchiness" in untreated CD patients; and (b) to clarify if apoptosis, and eventually which trigger drives it, causes epithelial damage. PATIENTS Twenty of 40 untreated, 14 treated coeliac patients, and 15 controls received five or more multiple duodenal biopsies; the remaining 20 untreated CD patients had no more than three biopsies. METHODS All biopsies were analysed to monitor the presence of a "flat" mucosa. Biopsies of 14 untreated, 10 treated coeliacs, and seven controls were cultured with or without gliadin. DNA fragmentation was studied by terminal deoxynucleotidyl transferase (TdT) mediated dUTP digoxigenin nick end labelling (TUNEL), and FAS and Ki67 expression by immunohistochemistry. Antiendomysium antibodies (EMA) were surveyed in biopsy culture supernatants. RESULTS A pattern of patchy duodenal lesions was observed in all untreated CD patients biopsied up to five times. High enterocyte FAS expression, and a high number of TUNEL+ and Ki67+ enterocytes were detected in areas with villus atrophy but not in those with a normal morphology (p<0.001). Conversely, EMA in culture supernatants and signs of immunological activation were present in all untreated CD biopsies. In vitro gliadin challenge increased the number of TUNEL+ and Ki67+ enterocytes (p<0.001 v cultures with medium alone) only in "flat" biopsies. Neutralising anti-FAS monoclonal antibodies were found to control gliadin induced enterocyte apoptosis (p>0.01) while agonist anti-FAS monoclonal antibody increased it (p<0.001). CONCLUSIONS Patchy lesions are observed in untreated CD mucosa and epithelial FAS engagement is a key trigger in driving villus atrophy in CD.
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Affiliation(s)
- L Maiuri
- Department of Paediatrics, University Federico II, Naples, Italy
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Groisman GM, Sabo E, Meir A, Polak-Charcon S. Enterocyte apoptosis and proliferation are increased in microvillous inclusion disease (Familial microvillous atrophy). Hum Pathol 2000. [DOI: 10.1016/s0046-8177(00)80011-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Maiuri L, Ciacci C, Auricchio S, Brown V, Quaratino S, Londei M. Interleukin 15 mediates epithelial changes in celiac disease. Gastroenterology 2000; 119:996-1006. [PMID: 11040186 DOI: 10.1053/gast.2000.18149] [Citation(s) in RCA: 182] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS Villous atrophy and crypt proliferation are key epithelial features of untreated celiac disease. We tried to define whether cytokines such as interleukin (IL)-15, IL-2, IL-4, and IL-7, which share chains of their receptors, could influence the epithelial modifications. METHODS Duodenal biopsy specimens (14 treated and 13 untreated celiac patients, 7 controls) were cultured in vitro for 24 hours with or without gliadin (1 mg/mL), IL-15, IL-7, IL-4, or IL-2 (10 ng/mL). Tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma were also used in some specimens of untreated celiacs. Epithelial expression of Ki67, FAS, and transferrin receptor (TFR) was detected by immunohistochemistry, and apoptosis by TUNEL technique (percentage of positive enterocytes). IL-15-positive cells were detected by immunohistochemistry in celiac disease and control biopsy specimens; presence of IL-15 was also determined by semiquantitative polymerase chain reaction. RESULTS Only IL-15 induced enterocyte expression of Ki67, TFR, and FAS in treated celiac (P<0.01 vs. medium) and enterocyte apoptosis in untreated celiac disease specimens. Anti-IL-15 monoclonal antibodies neutralized gliadin-induced enterocyte TFR and FAS expression in treated celiac and enterocyte apoptosis in untreated celiac disease specimens (P<0.05 vs. gliadin). IL-15-positive cells were increased in untreated celiacs (P<0.001 vs. treated celiacs and controls). CONCLUSIONS IL-15 is involved in the modulation of epithelial changes in celiac disease, indicating that this cytokine has an unforeseen role in the pathologic manifestations of celiac disease.
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Affiliation(s)
- L Maiuri
- Department of Pediatrics, University "Federico II," Naples, Italy
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Abstract
A syndrome of chronic diarrhea, vomiting, and failure to thrive was described 35 years ago. The syndrome was caused by damage in the jejunum after ingestion of cow's milk. Symptoms appeared in young infants shortly after introduction of cow's milk formula. Patients had moderate steatorrhea, decreased absorption of D-xylose, and, often, iron-deficiency anemia and hypoproteinemia. They had strong IgA and IgG antibodies to cow's milk. IgE antibodies to cow's milk were negative, as a rule. Indicators of cell-mediated immune reaction to cow's milk proteins were often positive. Patients were tolerant to cow's milk by the age of 3 years. Malabsorption was due to damage to the jejunal mucosa: Varying villus atrophy was associated with inflammation in surface epithelium and lamina propria. The epithelial cell renewal rate increased. Surface epithelial cells decreased in height, with short, furry microvilli and large aggregates of lysozymes. The number of intraepithelial lymphocytes was markedly increased, but normalized during cow's milk elimination. Most of these lymphocytes had alpha/beta T-cell receptors, and many were cytotoxic. Some specimens had an increase in gamma/delta T-cell receptor-bearing cells. In the lamina propria, CD4+ cells predominated, and some of them were activated. IgA- and IgM-containing cells were markedly increased during cow's milk exposure, but IgE cells were not abnormal. The density of eosinophils was moderately increased. Secretion of interferon-gamma by cells isolated from patients' intestines was markedly increased. Morphologic and immunologic findings suggest that T-cell-mediated reaction to proteins in cow's milk is present in the small intestines of patients with this syndrome and causes this enteropathy.
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Affiliation(s)
- E Savilahti
- Hospital for Children and Adolescents, University of Helsinki, Finland
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Newman JV, Zabel BA, Jha SS, Schauer DB. Citrobacter rodentium espB is necessary for signal transduction and for infection of laboratory mice. Infect Immun 1999; 67:6019-25. [PMID: 10531262 PMCID: PMC96988 DOI: 10.1128/iai.67.11.6019-6025.1999] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Citrobacter rodentium is the causative agent of transmissible murine colonic hyperplasia and contains a locus of enterocyte effacement (LEE) similar to that found in enteropathogenic Escherichia coli (EPEC). EPEC espB is necessary for intimate attachment and signal transduction between EPEC and cultured cell monolayers. Mice challenged with wild-type C. rodentium develop a mucosal immunoglobulin A response to EspB. In this study, C. rodentium espB has been cloned and its nucleotide sequence has been determined. C. rodentium espB was found to have 90% identity to EPEC espB. A nonpolar insertion mutation in C. rodentium espB was constructed and used to replace the chromosomal wild-type allele. The C. rodentium espB mutant exhibited reduced cell association and had no detectable fluorescent actin staining activity on cultured cell monolayers. The C. rodentium espB mutant also failed to colonize laboratory mice following experimental inoculation. The espB mutation could be complemented with a plasmid-encoded copy of the gene, which restored both cell association and fluorescent actin staining activity, as well as the ability to colonize laboratory mice. These studies indicate that espB is necessary for signal transduction and for colonization of laboratory mice by C. rodentium.
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Affiliation(s)
- J V Newman
- Division of Bioengineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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Heemskerk VH, van Heurn LW, Farla P, Buurman WA, Piersma F, ter Riet G, Heineman E. A successful short-bowel syndrome model in neonatal piglets. J Pediatr Gastroenterol Nutr 1999; 29:457-61. [PMID: 10512408 DOI: 10.1097/00005176-199910000-00016] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND With the higher survival rate of premature neonates as a result of improved neonatal intensive care, the incidence of necrotizing enterocolitis, and thus the incidence of short-bowel syndrome, is increasing. An appropriate animal model resembling the (premature) neonate with short-bowel syndrome suitable for clinically relevant neonatal bowel adaptation and intervention studies, is not available at present. The purpose of this study was the development of a short-bowel syndrome model that mimics the clinical state of the affected neonatal patient. METHODS Sixteen 7-day-old piglets received either a small bowel transection (group A) or a 75% resection (group B). The piglets were fed 125 kcal/kg body weight per day, including additional electrolytes. The animals were weighed daily and were killed 28 days after surgery. Bowel samples were obtained at both time points. RESULTS Mortality rates in groups A and B were 0% and 8%, respectively. Body weight gain was significantly higher in group A than in group B (156% vs. 93%; P = 0.01). Jejunal villus length was higher in group B than in group A (74% vs. -2%; P = 0.006), and crypt depth was higher in group B in both jejunum (201% vs. 67%; P = 0.001) and ileum, (197% vs. 20%; P = 0.001), than in group A. CONCLUSIONS In 7-day-old piglets 75% small bowel resection leads to a clinical short-bowel syndrome, demonstrated by reduced weight gain and typical changes in bowel adaptation parameters. The excellent survival of the animals provides a possibility for the study of bowel adaptation in a neonatal model as well as in intervention studies.
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Affiliation(s)
- V H Heemskerk
- Department of Surgery, University of Maastricht, The Netherlands
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Murch SH, Fertleman CR, Rodrigues C, Morgan G, Klein NJ, Meadows N, Savidge TC, Phillips AD, Walker-Smith JA. Autoimmune enteropathy with distinct mucosal features in T-cell activation deficiency: the contribution of T cells to the mucosal lesion. J Pediatr Gastroenterol Nutr 1999; 28:393-9. [PMID: 10204503 DOI: 10.1097/00005176-199904000-00009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Autoimmune enteropathy is normally characterised by crypt hyperplastic villous atrophy with enterocyte autoantibodies, activation of mucosal lymphocytes and increased epithelial HLA-DR. This case involved a severely affected Portuguese infant who was found to have lymphocyte activation deficiency and demonstrated correspondingly distinct mucosal features. METHODS A female infant of nonconsanguineous parents was treated for vomiting and diarrhoea, first with milk exclusion and then with parenteral nutrition. Lymphocyte subsets and immunoglobulin concentrations were normal, but in vitro testing showed no activation in response to phytohaemagglutinin, Candida, or purified protein derivative, although the response to interleukin (IL)-2 was intact. Interleukin-2 deficiency was excluded. Analysis of jejunal biopsy specimens revealed only mild villous blunting with absent goblet cells, normal epithelial proliferation, and no crypt hyperplasia. The dense infiltrate of CD8+ and CD4+ T lymphocytes showed normal CD2 and CD3 expression but no activation or proliferation markers. HLA-DR was not increased on epithelium or lymphocytes. Thus, in addition to in vitro evidence for lymphocyte activation deficiency, the mucosal specimens showed no evidence of in situ T-cell activation. RESULTS After development of overwhelming septicaemia, the patient died at 18 months, just before a planned bone marrow transplant. CONCLUSIONS These findings confirm significant heterogeneity within autoimmune enteropathy. Formal immune function testing should be performed in all affected infants to identify T-cell activation deficiencies. The distinct mucosal findings suggest that activated T cells usually induce the crypt hyperplastic villous atrophy characteristic of classic autoimmune enteropathy.
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Affiliation(s)
- S H Murch
- University Department of Paediatric Gastroenterology, Royal Free Hospital, London, United Kingdom
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Kim JM, Eckmann L, Savidge TC, Lowe DC, Witthöft T, Kagnoff MF. Apoptosis of human intestinal epithelial cells after bacterial invasion. J Clin Invest 1998; 102:1815-23. [PMID: 9819367 PMCID: PMC509131 DOI: 10.1172/jci2466] [Citation(s) in RCA: 242] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Epithelial cells that line the human intestinal mucosa are the initial site of host invasion by bacterial pathogens. The studies herein define apoptosis as a new category of intestinal epithelial cell response to bacterial infection. Human colon epithelial cells are shown to undergo apoptosis following infection with invasive enteric pathogens, such as Salmonella or enteroinvasive Escherichia coli. In contrast to the rapid onset of apoptosis seen after bacterial infection of mouse monocyte-macrophage cell lines, the commitment of human intestinal epithelial cell lines to undergo apoptosis is delayed for at least 6 h after bacterial infection, requires bacterial entry and replication, and the ensuing phenotypic expression of apoptosis is delayed for 12-18 h after bacterial entry. TNF-alpha and nitric oxide, which are produced as components of the intestinal epithelial cell proinflammatory program in the early period after bacterial invasion, play an important role in the later induction and regulation of the epithelial cell apoptotic program. Apoptosis in response to bacterial infection may function to delete infected and damaged epithelial cells and restore epithelial cell growth regulation and epithelial integrity that are altered during the course of enteric infection. The delay in onset of epithelial cell apoptosis after bacterial infection may be important both to the host and the invading pathogen since it provides sufficient time for epithelial cells to generate signals important for the activation of mucosal inflammation and concurrently allows invading bacteria time to adapt to the intracellular environment before invading deeper mucosal layers.
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Affiliation(s)
- J M Kim
- Laboratory of Mucosal Immunology, Department of Medicine, University of California, San Diego, La Jolla, California 92093-0623, USA
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Abstract
Adverse reactions to foods involving abnormal immune reactions to food antigens occur in 2-7% of the North American population; the numbers are perhaps higher in children. Both IgE-mediated and non-IgE-mediated allergic responses occur. IgE-mediated allergic responses to foods are the most dramatic and perhaps the most easily diagnosed type of food allergy. Non-IgE-mediated food hypersensitivity is more chronic, less acute, less obvious in its clinical presentation, and often more difficult to diagnose. It usually presents in infants between one week and three months of age with vomiting and diarrhea, although irritability, poor feeding, and failure to thrive are not uncommon. A thorough history and physical examination are often key in establishing a diagnosis of food protein hypersensitivity. In non-IgE-mediated disease, skin tests and immunological studies are not helpful. Eliminating the food allergen is the only means of dealing with a food allergy in most patients. About 85% of infants who have formula protein intolerance will outgrow their symptoms somewhere between 1 month and 3 years of age, older children and adults are somewhat less likely to lose their sensitivity, although approximately one-third will after 1-2 years of dietary restriction.
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Capristo E, Mingrone G, Addolorato G, Greco AV, Corazza GR, Gasbarrini G. Differences in metabolic variables between adult coeliac patients at diagnosis and patients on a gluten-free diet. Scand J Gastroenterol 1997; 32:1222-9. [PMID: 9438320 DOI: 10.3109/00365529709028151] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Coeliac patients often have nutrient malabsorption with nutritional status impairment, but no report on their energy requirements is available. In this study body composition, dietary habits, basal energy expenditure, and substrate oxidation were investigated in patients with the classic form of coeliac disease. METHODS Sixteen untreated and 18 adult coeliac patients on a gluten-free diet participated in the study. Body composition was assessed by anthropometry and bioimpedance. Energy expenditure was measured by indirect calorimetry. A food diary over 7 days was collected. RESULTS Coeliac patients showed reduced body weight components but not a different fat-free mass percentage compared with age- and sex-matched healthy volunteers. Basal metabolic rate normalized by fat-free mass (BMR/FFM) was higher in coeliac patients than in controls. Untreated patients showed a significantly higher non-protein respiratory quotient with regard to both treated patients (P < 0.01) and controls (P < 0.05), an increased percentage of carbohydrate intake, and a good correlation between lipid faecal loss and carbohydrate oxidation (Spearman R = 0.74; P < 0.01). CONCLUSIONS Both groups of patients had lower fat mass and FFM content than controls. The preferential carbohydrate oxidation in untreated patients might be a result of both lipid malabsorption and high carbohydrate intake.
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Affiliation(s)
- E Capristo
- Institute of Internal and Geriatric Medicine, Universitá Cattolica del Sacro Cuore, Rome, Italy
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Phillips AD, Frankel G. Mechanisms of gut damage by Escherichia coli. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1997; 11:465-83. [PMID: 9448911 DOI: 10.1016/s0950-3528(97)90027-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This chapter primarily concerns three main categories of diarrhoeagenic Escherichia coli, enteropathogenic (EPEC), enterohaemorrhagic (EHEC) and enteroaggregative (EAEC) E. coli. They have distinctive virulence factors and vary in the enteropathies they produce. The molecular biological approach has opened up the complex way in which they interact with the intestine. EPEC and EHEC show a subversive approach to colonization in that they adapt the host cell to their requirements in the formation of the attaching effacing lesion. EAEC appear to co-opt the host defence system to produce a biofilm-like colony and currently go unrecognized in routine laboratories.
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Affiliation(s)
- A D Phillips
- University Department of Paediatric Gastroenterology, Royal Free Hospital, London, UK
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Frankel G, Phillips AD, Hicks S, Dougan G. Royal Society of Tropical Medicine and Hygiene meeting at Manson House, London, 14 December 1995. Enteropathogenic Escherichia coli--mucosal infection models. Trans R Soc Trop Med Hyg 1996; 90:347-52. [PMID: 8882174 DOI: 10.1016/s0035-9203(96)90502-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The formation of attaching and effacing (A/E) lesions is central to the pathogenesis of enteropathogenic Escherichia coli (EPEC)-mediated disease in humans and Citrobacter rodentium-mediated transmissible colonic hyperplasia in mice. Closely related outer membrane proteins, known as intimins, are required for formation of the A/E lesion by both EPEC and C. rodentium. In this study we found similar ultrastructural damage in small intestinal biopsies from an EPEC-infected child and large bowel specimens from C. rodentium-infected mice. The C. rodentium-infected large bowel biopsies revealed massive hyperplastic reactions and the infected human small intestinal biopsies showed an increase in total crypt cell number and mitotic index. EPEC-infected small intestinal organ cultures revealed bacteria adhering in a localized pattern and evidence of A/E lesions. Covaspheres coated with a biologically active cell-binding domain of intimin also adhered to cells in a localized fashion but did not induce the characteristic A/E lesions.
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Affiliation(s)
- G Frankel
- Department of Biochemistry, Imperial College of Science, Technology and Medicine, London, UK
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