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

Acid-base disorders after orthotopic bladder replacement: comparison of an ileal neobladder and an ileal conduit

Objectives: For many years, creation of an orthotopic neobladder after cystectomy has been popular. In the present study, we measured the extent of metabolic acidosis in patients with ileal neobladders compared with ileal conduits and defined risk factors for development of metabolic acidosis.

Methods: We retrospectively studied 95 patients, who underwent radical cystectomy and urinary diversion to treat invasive bladder cancer from January 2001 to December 2014 at Hallym University Kangnam Sacred Heart Hospital, through investigation of acid-base balance, serum electrolyte levels and renal function one month and one year after operation.

Results: One month after the operation, metabolic acidosis was found from 18 patients (31.0%) in an ileal neobladder group and from 4 (14.8%) in an ileal conduits group. One year after the operation, the numbers became 11 (22.9%) and 2 (10.0%), respectively. However, there was not a statistical difference. The blood biochemical profiles of the two groups did not differ significantly after urinary diversion. Logistic analysis revealed that lower estimated glomerular filtration rate (eGFR) was associated with metabolic acidosis at one month (odds ratio, OR = 0.94 [0.91–0.97]; p < 0.001) and one year (OR = 0.94 [0.92–0.97]; P = 0.001) after urinary diversion. In multivariate analysis, lower eGFR is a significant risk factor for metabolic acidosis at one month.

Conclusions: Patients with ileal neobladders and conduits are at the similar risk of metabolic acidosis. A close association between renal function and development of metabolic acidosis was observed, especially stronger in an early period after operation.

News from the end of the gut--how the highly segmental pattern of colonic HCO₃⁻ transport relates to absorptive function and mucosal integrity

A number of transport mechanisms in the colonic epithelium contribute to HCO₃⁻ movement across the apical and basolateral membranes, but this ion has been largely regarded as a by-product of the transport functions it is involved in, such as NaCl or short chain fatty acid (SCFA) absorption. However, emerging data points to several specific roles of HCO₃⁻ for colonic epithelial physiology, including pH control in the colonic surface microenvironment, which is important for transport and immune functions, as well as the secretion and the rheological properties of the mucus gel. Furthermore, recent studies have demonstrated that colonic HCO₃⁻ transporters are expressed in a highly segmental as well as species-specific manner. This review summarizes recently gathered information on the functional anatomy of the colon, the roles of HCO₃⁻ in the colonic epithelium, colonic mucosal integrity, and the expression and function of HCO₃⁻ transporting mechanisms in health and disease.

Cellular localization of NKCC2 and its possible role in the Cl- absorption in the rat and human distal colonic epithelia

Recently, we demonstrated the expression of NKCC2, an absorptive isoform of NKCC specifically expressed in the kidney, in the rat gastrointestinal tract including the distal colonic mucosa. This study aims to investigate its localization in colonic epithelia and possible role in the colonic ion transport. Reverse transcription polymerase chain reaction (RT-PCR), Western blotting, and immunohistochemistry were used to investigate the expression and localization of NKCC2. The role of NKCC2 on the colonic ion transport was examined by mean of short-circuit current (I(SC)) monitoring. The results indicated that NKCC2 was expressed in the apical region of the epithelia in rat distal colon and human sigmoid colon. NKCC1, which is a secretive NKCC isoform, was localized predominantly in the basolateral membrane, which has been well documented. Serosal (basolateral) administration of bumetanide, an inhibitor of both NKCC1 and NKCC2, inhibited serosal forskolin-induced I(SC) increase by 66% but enhanced the luminal (apical) forskolin-induced I(SC) response by 63%. Furthermore, the blocking of epithelial Na(+) channels by apical addition of amiloride (10 μmol/L), K(+) channels by tetraethylammoniumion (TEA) (5 mmol/L), or glibenclimide (0.1 mmol/L) did not affect apical forskolin-induced I(SC) increase, excluding the involvement of cations, Na(+) and K(+), in the I(SC) response. The luminal forskolin-induced I(SC) increase was enhanced markedly by the apical pretreatment with bumetanide or the reduction of apical Cl(-) concentration by 114% and 198%, respectively, which were inhibited by apical addition of glibenclimide (1 mmol/L) by more than 60%. This finding suggests the involvement of an anion. Furthermore, the removal of basolateral HCO(3)(-) reduced apical forskolin-induced I(SC) by more than 75% indicated that the apical forskolin-induced I(SC) increase in rat distal colon was mediated by Cl(-) absorption and HCO(3)(-) secretion. In conclusion, NKCC2 is expressed widely in the colonic epithelium in rat distal colon and human sigmoid colon, especially in the apical membrane. It involves the process of colonic Cl(-) absorption coupled with HCO(3)(-) secretion.

Indirect evidence for increased mechanosensitivity of jejunal secretomotor neurones in patients with idiopathic bile acid malabsorption

AIM

The interdigestive motor rhythm, the migrating motor complex (MMC), is accompanied by active secretion of chloride during periods of distally propagating maximal motor activity (MMC phase III). We studied the behaviour of this system in bile acid malabsorption (BAM), a relative common cause of chronic diarrhoea. We measured motor activity and transmucosal potential difference (PD, reflecting active chloride secretion), in the proximal jejunum in healthy controls (n = 18) and in a group of patients with BAM (n = 11). The phase III-generated voltage was related to the degree of BAM quantified by the (75)SeHCAT test.

METHODS

We used a multi-channel intestinal infusion system to simultaneously measure jejunal pressure and PD. Saline passing calomel half-cells was infused into the jejunum and subcutaneously. Pressure and PD were recorded in the fasting state and after a test meal.

RESULTS

In the absence of motor activity, jejunal PD was not significantly different from zero in either group. During MMC phase III, PD reached significantly higher mean and peak levels in BAM patients. The product of MMC phase III length multiplied by voltage, over 3 h, was also significantly higher in BAM patients (controls: median 307 mV x cm, range 70-398; BAM: median 511, range 274-2271, P < 0.01). This value was also significantly correlated with the degree of BAM as reflected by the (75)SeHCAT test (P < 0.05).

CONCLUSION

Phase III induced jejunal secretion may be upregulated in BAM patients, resulting in overload of colonic reabsorption capacity.

Bicarbonate secretion: a neglected aspect of colonic ion transport

Understanding of the mechanism of colonic electrolyte transport has markedly increased over the past three decades. This article provides a brief summary of the critical features of Na, Cl, and K transport in the large intestine and how these processes may be altered in diarrhea. Less understood is the mechanism of colonic HCO3 secretion. Recent progress in the regulation of HCO3 secretion in the distal colon is summarized with emphasis on the interrelationship between Cl-dependent, short-chain fatty acid (SCFA)-dependent, and cAMP-induced HCO3 secretion. cAMP down-regulates Cl-dependent HCO3 secretion, while SCFA stimulates HCO3 secretion but also inhibits both Cl-dependent and cAMP-induced HCO3 secretion. As SCFAs are the primary anions in stool, it is likely that SCFA-dependent HCO3 secretion is the primary mechanism of HCO3 secretion in the mammalian colon. Future studies will undoubtedly provide increased understanding of the mechanism of HCO3 secretion in health and disease.

Three distinct mechanisms of HCO3- secretion in rat distal colon

HCO(3)(-) secretion has long been recognized in the mammalian colon, but it has not been well characterized. Although most studies of colonic HCO(3)(-) secretion have revealed evidence of lumen Cl(-) dependence, suggesting a role for apical membrane Cl(-)/HCO(3)(-) exchange, direct examination of HCO(3)(-) secretion in isolated crypt from rat distal colon did not identify Cl(-)-dependent HCO(3)(-) secretion but did reveal cAMP-induced, Cl(-)-independent HCO(3)(-) secretion. Studies were therefore initiated to determine the characteristics of HCO(3)(-) secretion in isolated colonic mucosa to identify HCO(3)(-) secretion in both surface and crypt cells. HCO(3)(-) secretion was measured in rat distal colonic mucosa stripped of muscular and serosal layers by using a pH stat technique. Basal HCO(3)(-) secretion (5.6 +/- 0.03 microeq.h(-1).cm(-2)) was abolished by removal of either lumen Cl(-) or bath HCO(3)(-); this Cl(-)-dependent HCO(3)(-) secretion was also inhibited by 100 microM DIDS (0.5 +/- 0.03 microeq.h(-1).cm(-2)) but not by 5-nitro-3-(3-phenylpropyl-amino)benzoic acid (NPPB), a Cl(-) channel blocker. 8-Bromo-cAMP induced Cl(-)-independent HCO(3)(-) secretion (and also inhibited Cl(-)-dependent HCO(3)(-) secretion), which was inhibited by NPPB and by glibenclamide, a CFTR blocker, but not by DIDS. Isobutyrate, a poorly metabolized short-chain fatty acid (SCFA), also induced a Cl(-)-independent, DIDS-insensitive, saturable HCO(3)(-) secretion that was not inhibited by NPPB. Three distinct HCO(3)(-) secretory mechanisms were identified: 1) Cl(-)-dependent secretion associated with apical membrane Cl(-)/HCO(3)(-) exchange, 2) cAMP-induced secretion that was a result of an apical membrane anion channel, and 3) SCFA-dependent secretion associated with an apical membrane SCFA/HCO(3)(-) exchange.

Abnormal passive chloride absorption in cystic fibrosis jejunum functionally opposes the classic chloride secretory defect

Due to genetic defects in apical membrane chloride channels, the cystic fibrosis (CF) intestine does not secrete chloride normally. Depressed chloride secretion leaves CF intestinal absorptive processes unopposed, which results in net fluid hyperabsorption, dehydration of intestinal contents, and a propensity to inspissated intestinal obstruction. This theory is based primarily on in vitro studies of jejunal mucosa. To determine if CF patients actually hyperabsorb fluid in vivo, we measured electrolyte and water absorption during steady-state perfusion of the jejunum. As expected, chloride secretion was abnormally low in CF, but surprisingly, there was no net hyperabsorption of sodium or water during perfusion of a balanced electrolyte solution. This suggested that fluid absorption processes are reduced in CF jejunum, and further studies revealed that this was due to a marked depression of passive chloride absorption. Although Na+-glucose cotransport was normal in the CF jejunum, absence of passive chloride absorption completely blocked glucose-stimulated net sodium absorption and reduced glucose-stimulated water absorption 66%. This chloride absorptive abnormality acts in physiological opposition to the classic chloride secretory defect in the CF intestine. By increasing the fluidity of intraluminal contents, absence of passive chloride absorption may reduce the incidence and severity of intestinal disease in patients with CF.

Mechanism(s) of chloride transport in human distal colonic apical membrane vesicles

Previous studies from our laboratory have demonstrated the presence of an electroneutral Cl-/HCO3- exchange process across the human proximal colonic apical membrane vesicles (AMV). However, very little is known about the mechanism(s) of chloride transport in the apical membrane of the human distal colon. Utilizing AMV purified from organ donor distal colonic mucosa and a rapid Millipore filtration technique, the mechanisms of 36Cl- uptake into these vesicles were examined. Outwardly directed OH and HCO3 gradients markedly increased the uptake of 36Cl- into these vesicles, demonstrating a transient accumulation over the equilibrium uptake. Voltage clamping in the presence of K+/valinomycin reduced the OH and HCO3- gradient-stimulated 36Cl- uptake into these vesicles by approximately 30% indicating that the conductive Cl- uptake pathway was present in these vesicles along with the electroneutral exchange process. Under voltage-clamped conditions, the inhibitors the bicarbonate transporters, DIDS and SITS (1 mM), inhibited OH and HCO3- gradient-stimulated 36Cl- uptake by approximately 50%. Acetazolamide showed small but significant inhibition of chloride uptake. Amiloride, bumetanide, and furosemide failed to inhibit 36Cl- uptake. Chloride uptake into these vesicles exhibited saturation kinetics with an apparent Km for chloride of 16.7 mM and a Vmax of 5.9 nmol/mg/15 sec. Chloride, acetate, nitrate, but not sulfate (50 mM each), inhibited 5 mM 36Cl- uptake. Inwardly directed gradients of Na+, K+ or both together did not stimulate chloride uptake into these vesicles indicating that the uptake of Cl- and Na+ in human distal colonic AMV does not involve Na-Cl or Na-K-2Cl cotransport. In conclusion, these studies demonstrate that Cl- transport across the apical membranes of human distal colon involves both conductive pathway and electroneutral Cl-/HCO3- (OH-) exchange processes. In view of our previous demonstration of a Na+/H+ exchange process in these AMV, we propose that the operation of dual ion exchange mechanisms of Na+/H+ and Cl-/HCO3- is the primary mode of electroneutral NaCl absorption across the apical membranes of the enterocytes of the human distal colon.

HCO(3)(-) secretion in the rat colonic crypt is closely linked to Cl(-) secretion

BACKGROUND & AIMS

The mechanism of colonic HCO(3)(-) secretion has not been established largely because of a lack of experimental methods for its detailed study. The present studies were designed to establish whether the isolated, perfused crypt of the rat distal colon is an excellent model to study HCO(3)(-) movement and the mechanism of colonic HCO(3)(-) secretion.

METHODS

HCO(3)(-) secretion was determined in isolated, microperfused crypts by measuring [HCO(3)(-)] by microcalorimetry on nanoliter samples.

RESULTS

Net HCO(3)(-) absorption was observed during lumen and bath perfusion with an HCO(3)(-)-Ringer solution. Vasoactive intestinal polypeptide (60 nmol/L), acetylcholine (100 nmol/L), or dibutyryl adenosine 3',5'-cyclic monophosphate (DBcAMP, 0.5 mmol/L) induced active HCO(3)(-) secretion that required bath but not lumen HCO(3)(-)/CO(2). DBcAMP-stimulated HCO(3)(-) secretion was not affected by acetazolamide, an inhibitor of carbonic anhydrase. Removal of lumen Cl(-) did not alter DBcAMP-stimulated HCO(3)(-) secretion but reduced fluid secretion. DBcAMP-stimulated HCO(3)(-) secretion was closely linked to active Cl(-) secretion because HCO(3)(-) secretion was substantially reduced by removal of bath Cl(-), by addition of bath bumetanide, an inhibitor of Na-K-2Cl cotransport and Cl(-) secretion, and by addition of lumen NPPB, a Cl(-) channel inhibitor.

CONCLUSIONS

These studies establish that colonic crypt HCO(3)(-) secretion (1) is not a result of an apical membrane Cl(-)-HCO(3)(-) exchange, (2) is tightly associated with Cl(-) secretion, and (3) primarily occurs via an apical membrane Cl(-) channel.

A functional CFTR protein is required for mouse intestinal cAMP-, cGMP- and Ca(2+)-dependent HCO3- secretion

1. Most segments of the gastrointestinal tract secrete HCO3-, but the molecular nature of the secretory mechanisms has not been identified. We had previously speculated that the regulator for intestinal electrogenic HCO3- secretion is the cystic fibrosis transmembrane regulator (CFTR) channel. To prove this hypothesis, we have now measured HCO3- secretion by pH-stat titration, and recorded the electrical parameters of in vitro duodenum, jejunum and ileum of mice deficient in the gene for the CFTR protein ('CF-mice') and their normal littermates. 2. Basal HCO3- secretory rates were reduced in all small intestinal segments of CF mice. Forskolin, PGE2, 8-bromo-cAMP and VIP (cAMP-dependent agonists), heat-stable enterotoxin of Escherichia coli (STa), guanylin and 8-bromo-cGMP (cGMP-dependent agonists) and carbachol (Ca2+ dependent) stimulated both the short-circuit current (Isc) and the HCO3- secretory rate (JHCO3-) in all intestinal segments in normal mice, whereas none of these agonists had any effect on JHCO3- in the intestine of CF mice. 3. To investigate whether Cl(-)-HCO3- exchangers, which have been implicated in mediating the response to some of these agonists in the intestine, were similarly active in the small intestine of normal and CF mice, we studied Cl- gradient-driven 36Cl- uptake into brush-border membrane (BBM) vesicles isolated from normal and CF mouse small intestine. Both the time course and the peak value for 4,4'-diisothiocyanostilbene-2',2-disulphonic acid (DIDS)-inhibited 36Cl- uptake was similar in normal and CF mice BBM vesicles. 4. In summary, the results demonstrate that the presence of the CFTR channel is necessary for agonist-induced stimulation of electrogenic HCO3- secretion in all segments of the small intestine, and all three intracellular signal transduction pathways stimulate HCO3- secretion exclusively via activation of the CFTR channel.

Chloride transport in human proximal colonic apical membrane vesicles

The mechanism(s) of Cl- transport across the human colonic apical membranes are not well understood. Apical membrane vesicles (AMV) purified from organ donor proximal colonic mucosa and a rapid millipore filtration technique were utilized to study 36Cl- uptake into these vesicles. Outwardly directed OH- and HCO3- gradient stimulated 36Cl- uptake into these vesicles demonstrating a transient accumulation over equilibrium uptake. Voltage clamping the membrane potential of the vesicles or making them inside positive with K+/valinomycin failed to influence chloride uptake, indicating that the conductive Cl- uptake pathway is minimal in proximal colonic AMV. Anion exchange inhibitors, DIDS and SITS (1 mM) inhibited OH- and HCO3- stimulated 36Cl- uptake by approximately 60%. Furosemide also demonstrated a small but significant inhibition of chloride uptake. Amiloride, bumetanide and acetazolamide (1 mM) failed to inhibit 36Cl uptake. HCO3- and pH gradient stimulated 36Cl- uptake exhibited saturation kinetics with an apparent Km for chloride of 4.0 +/- 0.7 mM and Vmax of 17.8 +/- 3.9 nmol/mg per min. Bromide, chloride, nitrate and acetate (50 mM each) inhibited 5 mM 36Cl uptake. Inwardly directed gradients of Na+, K+, or Na+ and K+ did not stimulate 36Cl- uptake into these vesicles, indicating that uptake of Na+ and Cl- in human proximal colonic AMV does not involve Na-Cl or Na-K-2Cl cotransport. The above findings indicate that chloride transport in human proximal colonic AMV involves an electroneutral Cl-HCO3- (OH-) exchange process. In view of the previous demonstration of Na+-H+ antiporter in these vesicles, dual ion exchange mechanism of Na+-H+ and Cl-HCO3- in apical membrane domain of human colonocytes is postulated to be the primary mechanism for NaCl absorption in the human proximal colon.

Electrolyte fluxes in the gut and oral rehydration solutions

This article provides a brief overview of the normal physiology of water and electrolyte fluxes across the gut as a prerequisite for understanding the pathologic disturbances occurring with diarrheal illnesses. In turn, the rationale for the use of oral rehydration solutions in diarrheal disorders is explored.

Metabolic consequences of sigmoidocystoplasty in children

Recent reports have shown that metabolic acidosis is a possible complication in patients who undergo augmentation enterocystoplasty. We studied 30 patients with neurogenic bladder who underwent sigmoidocystoplasty. Follow-up ranged from 1 to 10 years; all the patients showed normal renal function. We found significant hyperchloremic acidosis in 10% and borderline acidosis in 27% of the patients. Abnormalities of calcium and phosphorus balance were noted in 16.5% and 43% of the patients respectively, and more frequently in acidolic patients, which might be the result of activation of the bony buffers and might cause delayed growth in children. Close follow-up of all patients with enterocystoplasty is required, and oral bicarbonate is indicated when acidosis is detected.

An apical permeability barrier to NH3/NH4+ in isolated, perfused colonic crypts

Fermentation of nonabsorbed nutrients in the colon generates high concentrations of NH3/NH4+ in the colonic lumen. NH3 is a small, lipophilic neutral weak base that readily permeates almost all cell membranes, whereas its conjugate weak acid NH4+ generally crosses membranes much more slowly. It is not known how colonocytes maintain intracellular pH in the unusual acid-base environment of the colon, where permeant acid-base products of fermentation exist in high concentration. To address this issue, we hand dissected and perfused single, isolated crypts from rabbit proximal colon, adapting techniques from renal-tubule microperfusion. Crypt perfusion permits control of solutions at the apical (luminal) and basolateral (serosal) surfaces of crypt cells. We assessed apical- vs. basolateral-membrane transport of NH3/NH4+ by using fluorescent dyes and digital imaging to monitor intracellular pH of microvacuolated crypt cells as well as luminal pH. We found that, although the basolateral membranes have normal NH3/NH4+ permeability properties, there is no evidence for transport of either NH3 or NH4+ across the apical borders of these crypt cells. Disaggregating luminal mucus did not increase the transport of NH3/NH4+ across the apical border. We conclude that, compared to the basolateral membrane, the apical border of crypt colonocytes has a very low permeability-area product for NH3/NH4+. This barrier may represent an important adaptation for the survival of crypt cells in the environment of the colon.

Gastric conduit urinary diversion in normal dogs. Part II, Hypochloremic metabolic alkalosis

Gastric conduit urinary diversion was performed in 10 dogs after complete cystectomy. Four dogs were euthanatized on day 30 because of hypochloremic metabolic alkalosis and renal failure. Hematologic and biochemical changes in six dogs evaluated for 120 days were compatible with hypochloremic metabolic alkalosis. The continuous loss of hydrochloric acid from the gastric conduit resulted in significant increases in arterial blood pH, PaCO2, anion gap, TCO2, and the concentration of HCO3-. There were significant decreases in PaO2 and the serum concentrations of chloride and potassium. Deterioration of renal function resulted in all dogs. It was concluded that hypochloremic metabolic alkalosis makes gastric conduit urinary diversion unsatisfactory for clinical use in dogs.

Abnormalities of colonic mucin secretion and metabolic changes after internal urinary diversion for bladder exstrophy. A prospective study

Ten patients with different types of internal urinary diversion for bladder exstrophy were studied prospectively in order to assess metabolic abnormalities and morphological, histochemical and lectin binding changes in the colorectal mucosa. The histochemical and/or lectin binding changes which were found in the majority of patients were identical to those observed in premalignant and malignant conditions of the colon. In some cases they were detectable 3 years after the initial examination but were completely absent from the colorectal mucosa of normal subjects. Metabolic disturbances (metabolic acidosis, increased anion gap, hyperchloraemia) were observed in a substantial number of asymptomatic patients. These findings stress the need for regular endoscopic, histological and metabolic follow-up in these patients and for life-long treatment with bicarbonate or citrate.

Water handling in the human distal colon in vitro: role of Na+, Cl- and HCO3-

The minute by minute net water movement (Jw) was measured, in the human distal colon in vitro, simultaneously with the transepithelial potential difference (PD) and short circuit current (SCC) with the following results: (1) An absorptive Jw (+0.36 +/- 0.04 microliters/(min.cm2)) was observed, in 21 cases, when the colon was mounted between two identical standard salines (Na+ 140, Cl- 110, HCO3- 25 mequiv./L) and in the presence of a hydrostatic pressure gradient (delta P) of 13 cm of H2O (mucosal side positive). (2) This absorptive Jw was a linear function of the applied delta P or the imposed osmotic transepithelial gradient (Phydr = 0.22 +/- 0.03 cm/s; Posm = 0.0020 +/- 0.005 cm/s; n = 6). (3) A fraction of this Jw was independent of the presence of any hydrostatic, osmotic or chemical gradient while associated with a serosal side positive and partially amiloride sensitive PD (11.3 +/- 1.8 mV). (4) Both Jw and PD were dependent on the presence of Na+ in the incubating media. (5) Replacement of Cl- by SO(4)2- did not change the absorptive Jw, but increased the observed PD and the transepithelial resistance. (6) HCO3- removal strongly reduced the SCC and PD together with an important increase in Jw. Unexpectedly, other 9 colon fragments spontaneously showed a secretory Jw when mounted between two identical standard salines (-0.55 +/- 0.11 microliters/(min.cm2). In these experiments it was observed that: (7) The tissue moved water against the imposed delta P (13 cm of H2O), while the associated PD (+11.9 +/- 2.1 mV) was similar to the one observed in absorptive fragments. (8) As in the case of absorptive preparations, PD, SCC and the transport associated Jw fell to zero in the absence of Na+. (9) When SO(4)2- replaced Cl-, secretory Jw reversed to absorptive Jw, together with an increase in PD and resistance. In both absorptive and secretory preparations it was finally observed that: (10) norepinephrine (5 x 10(-6) M) decreased SCC and increased the absorptive Jw in a tightly parallel manner (half-times for each response: SCC = 11.4 +/- 2.1 min; Jw = 11.4 +/- 2.0 min, n = 4) and (11) 8-Br cyclic AMP (10(-3) M) increased SCC while simultaneously decreasing the absorptive Jw. It is concluded that the observed Jw in the distal human colon in vitro results from the complex addition of osmotic, hydrostatic and transport associated driving forces. The transport-associated Jw has absorptive and secretory components.(ABSTRACT TRUNCATED AT 400 WORDS)

Cellular basis for defective electrolyte transport in inflamed human colon

Electrolyte transport pathways in distal colonic mucosa from patients with noninflammatory and inflammatory (ulcerative colitis, Crohn's colitis) disease of the large bowel were studied in vitro with electrophysiological techniques. Noninflamed tissues exhibited substantial amiloride-sensitive electrogenic sodium transport. In contrast, inflamed but structurally intact tissues exhibited only a modest degree of electrogenic sodium transport, significant increases in total tissue conductance and apical membrane conductance, and a 100% increase in the arachidonic acid content of the cell membrane fraction of mucosal homogenates. Replacement of chloride with gluconate decreased total tissue conductance to a greater extent in inflamed than in noninflamed tissues, and total tissue conductance was higher in inflamed than in noninflamed tissues in the presence of transepithelial potassium and sodium gradients, suggesting enhanced mucosal "leakiness" to anions and cations in acute colitis. Apical addition of nystatin virtually abolished amiloride-sensitive apical sodium uptake in both groups, indicating that the ionophore formed channels in the apical membrane of noninflamed and diseased mucosa. Additional studies showed that mucosal inflammation decreased maximal activity of the basolateral sodium pump by 76%. Thus, defects in the biophysical properties of colonic epithelial cell membranes are likely to be important factors in the pathogenesis of diarrhea in ulcerative and Crohn's colitis.

H+ and HCO3- flux across apical surface of rat distal colon

Colonic ion transport is postulated to occur via simultaneous operation of Na(+)-H+ exchange and Cl(-)-HCO3- exchange. Accordingly H+ and HCO3- should be transported simultaneously by the colon. To assess simultaneous H+ and HCO3- transport, net acid-base flux was measured in isolated segments of rat distal colon. When both tissue surfaces were bathed in symmetrical solutions containing Cl-, net base was secreted (-1.0 +/- 0.1 mu eq.cm-2.h-1). Cl- substitution with gluconate in the mucosal medium caused net base flux to switch from secretion to absorption (2.0 +/- 0.2 mu eq.cm-2.h-1). To evaluate whether base absorption was dependent on H+ secretion via Na(+)-H+ exchange, mucosal Na+ was substituted with N-methylglucamine, and amiloride, an inhibitor of Na(+)-H+ exchange, was applied. Na+ substitution and 1 mM amiloride inhibited base absorption by 37 and 38%, respectively, suggesting operation of Na(+)-H+ exchange. Because base absorption persisted, an additional mechanism was considered, HCO3- absorption via Cl(-)-HCO3- exchange. This was evaluated with an inhibitor of Cl(-)-HCO3- exchange 4-acetamido-4'-isothiostilbene-2,2'-disulfonic acid (SITS). SITS (1 mM) inhibited HCO3- absorption by 40%. The effects of amiloride and SITS were additive, suggesting that the Na(+)-H+ and Cl(-)-HCO3- exchangers operate simultaneously. Amiloride also inhibited H+ secretion when net HCO3- was secreted, suggesting that the direction of HCO3- movement does not influence Na(+)-H+ exchange activity. These data suggest that the colon transports both H+ and HCO3- across the apical surface via Na(+)-H+ exchange and Cl(-)-HCO3- exchange; H+ is secreted via Na(+)-H+ exchange, whereas HCO3- can be secreted or absorbed via Cl(-)-HCO3- exchange.

Segmental heterogeneity of basal and aldosterone-induced electrogenic Na transport in human colon

Recent in vitro studies in human colon have demonstrated marked segmental differences in electrogenic Na transport. In the present study, the Na channel blocker amiloride was used further to characterise basal and aldosterone-induced electrogenic Na transport in isolated human distal and proximal colon. Bathed in NaCl Ringer solution, distal and proximal colon exhibited similar basal electrical properties, but the amiloride-sensitive short-circuit current (Isc) was 200% greater in the distal than in the proximal segment. Bathed in choline-Cl Ringer solution, total Isc decreased by 97% in distal colon and by 88% in proximal colon, indicating that Na dependent transport process(es) account almost entirely for the Isc in both segments. Substituting Na2SO4 for NaCl Ringer solution (i) increased amiloride-sensitive Isc by 56% (p less than 0.01) in distal colon but had no effect on amiloride-sensitive Isc in proximal colon, and (ii) decreased amiloride-insensitive Isc in distal and proximal colon by 52% (p less than 0.05) and 81% (p less than 0.001) respectively. After the addition of nystatin to the apical membrane, the relationship between total Isc and mucosal Na concentration indicated that the activity of the basolateral membrane Na pump was similar in both colonic segments. In a further series of experiments, exposure of distal colon to 1 mumol/l aldosterone for 5 h increased total Isc by 52% (p less than 0.05), which reflected stimulation of its amiloride-sensitive component; in contrast, aldosterone had no effect on proximal colon.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of enteric neural stimulation on chloride transport in human left colon in vitro

Nonpathological segments of muscle-stripped left colon from patients undergoing surgery for carcinoma, diverticulitis, or other causes were set up in flux chambers in order to determine the influence of intrinsic neurons on ion transport. In the basal state, both sodium and chloride were actively absorbed, and there was no significant residual ion flux. Electrical field stimulation of the intrinsic mucosal innervation evoked an increase in short-circuit current that was dependent on stimulus frequency and strength. The response was mimicked by scorpion venom, which is known to depolarize neurons, and was nearly abolished by tetrodotoxin, which prevents neurotransmitter release. Atropine reduced, but did not abolish, the response to neural stimulation. Carbachol, aminophylline, and theophylline significantly increased short-circuit current above basal levels. Electrical field stimulation evoked an increase in short-circuit current that could be accounted for by a decrease in net chloride absorption without any significant effect on sodium absorption or residual ion flux. These results suggest that ion transport in the human left colon is regulated by intrinsic submucosal cholinergic neurons as well as other neuronal types, and activation of these nerves could provide the basis for certain diarrheal disorders.

Effect of systemic pH on models of altered ileal transport in the rat

Decreases in arterial pH markedly increase sodium, chloride, and water absorption in the normal ileum and can reverse ongoing cholera toxin-induced secretion. In the current study we examined whether these effects of pH are evident in other models of ileal secretion, and in a model of increased absorption. Rats were anesthetized and transport was measured in ileal loops during respiratory acidosis and alkalosis. Decreases in arterial pH increased absorption equally in control loops and in adjacent loops perfused with a Ringer's solution containing ST toxin (cyclic guanosine monophosphate-mediated secretion), hypertonic mannitol (passive, osmotically mediated secretion), or glucose. Decreases in arterial pH increased absorption in a similar way in loops exposed to cholera toxin (cyclic adenosine monophosphate-mediated secretion) that were then perfused with glucose-Ringer's solution. Alterations in arterial and luminal pH did not affect glucose absorption. These results suggest that the effect of arterial pH on ileal absorption occurs by a mechanism that is independent of these various means of altering transport.

Ureterocolonic anastomosis in ten dogs with transitional cell carcinoma

Ureterocolonic anastomosis (UCA) was performed in 10 dogs with transitional cell carcinoma of the urinary bladder trigone or the urethra, or both. All grossly visible tumor was excised. All of the dogs recovered from anesthesia and surgery and had anal continence with no urine leakage. One dog died of undetermined causes 7 days after surgery. Nine dogs survived 1 to 5 months. The owners of eight of the dogs considered their dog's quality of life to be acceptable. Four dogs were euthanatized because of neurologic disease, three of which also had nausea and vomiting. The neurologic and gastrointestinal signs may have been caused by hyperammonemia, metabolic acidosis, and uremia. Blood ammonia levels were elevated in two dogs with neurologic signs. Hyperchloremic metabolic acidosis that was reversible with bicarbonate therapy was diagnosed in five dogs. All of the dogs were azotemic because of intestinal recycling of urea. Serum creatinine concentrations increased in four dogs after surgery. Drug-induced renal disease may have developed in two dogs. Pyelonephritis developed in five kidneys, two of which had outflow obstruction and two had bilateral hydroureteronephrosis before the UCA. In this small number of dogs, surgical excision of transitional cell carcinoma was not curative with six dogs having confirmed metastatic lesions at the time of death.

Bicarbonate secretion in rat distal colon in vitro: a measurement technique

To study HCO3- secretion in rat distal colon, we utilized a technique that permits control of electrical and chemical transepithelial gradients. With symmetrical solutions (pH 7.4, [HCO3-] 25 mM, and CO2 tension 40 mmHg) bathing both tissue surfaces and under short-circuit conditions, HCO3- secretion remained stable for greater than 4 h at 1 mueq. h-1.cm-2. As the mucosal solution was alkalinized, the serosal solution was acidified at 3.1 mueq.h-1.cm-2. Ninety-four percent of serosal acidification was accounted for by the rate of metabolic lactic acid generation and transepithelial HCO3- secretion. Clamping transepithelial voltage reversibly affected net HCO3- secretion, and a linear relationship existed between clamped mucosal voltage and net HCO3- flux (r = 0.99); mucosal voltage of -68 mV completely inhibited net secretion. The apparent permeability coefficient of the colon to HCO3- is 2.8 X 10(-6) cm/s. One millimolar ouabain completely inhibited net HCO3- secretion. Acetazolamide (10(-4) M) inhibited secretion by approximately 50%, whereas a 10(-3) M concentration inhibited secretion by 90%. These data demonstrate that net colonic HCO3- secretion can be measured without imposed electrical and chemical gradients and that this flux is voltage sensitive and depends on carbonic anhydrase and Na+-K+-ATPase activities.

Metabolic acidosis after bladder replacement: comparison of severity and reversibility in ileal and colonic reservoirs

Metabolic acidosis developed frequently after ureterosigmoidostomy and rectosigmoid bladder construction but has been reported rarely after the newer methods of continent urinary diversion which also employ intestinal reservoirs. We created an animal model in which to compare the metabolic effects of bladder replacement with segments of ileum or colon and the potential for reversing these derangements with nicotinic acid and chlorpromazine. One year after six dogs' bladders were replaced by colon (three) or ileum (three), all dogs appeared in excellent health and were free of urinary tract obstruction and clinical infection. Both groups of dogs were severely acidotic with diminished arterial pH and arterial and venous total CO2 concentrations although normal serum electrolytes and creatinine concentrations were maintained. Both groups of dogs absorbed approximately one half the urinary sodium, chloride and urea presented to their intestinal reservoirs. After treatment with nicotinic acid and chlorpromazine, the metabolic status of both groups of animals improved. Although nicotinic acid reduced urinary excretion of electrolytes more effectively than chlorpromazine, nicotinic acid was not more effective for reversing metabolic acidosis. When nicotinic acid was provided as an adjunct to sodium bicarbonate therapy in two animals acidosis was corrected at reduced doses of sodium bicarbonate. Based upon this work in an animal model, there does not appear to be a metabolic advantage to intestinal reservoirs which incorporate ileum versus colon. However, asymptomatic patients with normal serum electrolytes and creatinine concentrations may be acidotic. The effects of long term mild acidosis are unknown. However, if therapy is required to prevent diminution of whole body buffers or changes in bone density specific therapy with nicotinic acid or chlorpromazine may reduce the requirement for alkali for correction of metabolic acidosis.

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

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

The transport of electrolytes in the gut and the use of oral rehydration solutions

This presentation summarizes the recent advances in knowledge of the physiologic and pathophysiologic process underlying the transport of electrolytes across the small intestine and formulate a rationale for the use of oral electrolyte solutions in diarrheal diseases.

Segmental variability of membrane conductances in rat and human colonic epithelia. Implications for Na, K and Cl transport

The membrane conductances in proximal and distal segments of rat and human colon were studied with microelectrodes, nystatin, ion channel blockers and Cl replacement. The results reveal that (1) in rat colon, total conductance (Gt) is greater in the proximal segment than in the distal segment, reflecting greater values of apical (Ga) and paracellular shunt (Gs) conductances in the proximal segment; in contrast, in human colon, Gt and its individual membrane components are similar in the proximal and distal segments, and lower than the corresponding values in rat colon; (2) amiloride sensitive apical Na conductances are absent in rat proximal colon, rat distal colon, and human proximal colon, but in human distal colon amiloride produces changes consistent with blockade of an apical Na conductance and inhibition of electrogenic Na transport; (3) a TEA-sensitive apical K conductance may be present in rat proximal colon (a K secretory epithelium), but not in rat distal colon (a K absorptive epithelium) or in either segment of human colon; and (4) in rat colon, replacement of mucosal and serosal Cl produces changes consistent with a substantial paracellular shunt permeability to Cl which is more marked in the proximal segment, whereas in human colon Cl replacement results in changes which suggest a relatively small paracellular shunt permeability to Cl which is similar in both segments. These data indicate marked segmental differences in Na, K and Cl transport in rat and human colon, and emphasise the hazards of applying models of colonic electrolyte transport in one species to another.

Intracellular pH regulation in rabbit renal medullary collecting duct cells. Role of chloride-bicarbonate exchange

The renal medullary collecting duct (MCD) secretes protons into its lumen and HCO3 into its basolateral space. Basolateral HCO3 transport is thought to occur via Cl/HCO3 exchange. To further characterize this Cl/HCO3 exchange process, intracellular pH (pHi) regulation was monitored in freshly prepared rabbit outer MCD cells. Cells were separated by protease digestion and purified by Ficoll gradient centrifugation. pHi was estimated fluorometrically using the entrapped intracytoplasmic pH indicator, 6-carboxyfluorescein. Cells were preincubated in bicarbonate-containing solutions and then abruptly diluted into bicarbonate-free media. The MCD cell pHi response to abrupt removal of CO2/HCO3 included an initial alkalinization due to rapid CO2 efflux, followed by an acidification due to HCO3 efflux and a gradual recovery to the resting pHi of 7.24 +/- 0.06 partly due to the action of a plasma membrane H+-ATPase. The initial alkalinization required a CO2/HCO3 gradient and did not occur in the presence of acetazolamide. The acidification phase required intracellular HCO3 and extracellular Cl, which was consistent with a Cl/HCO3 exchange. MCD HCO3 efflux exhibited saturable kinetics for extracellular Cl, with a Michaelis constant (Km) of 29.9 +/- 7.7 mM. HCO3 efflux also exhibited preference for halides over NO3, SCN, and gluconate, and striking sensitivity to disulfonic stilbene and acetazolamide inhibition, with an apparent K1 of 5 X 10(-7) M for DIDS. The final pHi recovery required intracellular ATP, which indicated that Cl/HCO3 and H+-ATPase activities are present in the same cells in these suspensions. The results provide direct evidence for MCD Cl/HCO3 exchange and describe some of the properties of this transport process.

Electrolyte and acid base imbalance in patients with rectosigmoid bladder

The aim of the present investigation was to study systemic metabolic consequences following rectosigmoid bladder (RSB) operation. RSB after cystectomy has recently been employed with increasing frequency in the Urologic Clinic of the University of Rome inasmuch as, compared with ureterosigmoidostomy (USS), it shows a lower incidence of complications. Acid base balance, serum electrolytes and renal function were studied in 22 patients submitted to RSB and in 25 submitted to USS. Urine from patients with RSB and urine-feces mixture from patients with USS was also analyzed. Metabolic acidosis occurred in 86 per cent of patients with RSB and in 80 per cent of patients with USS but was significantly less severe (p less than 0.01) in patients with RSB (pH 7.34 +/- SD 0.04) than in those with USS (pH 7.29 +/- 0.07). This finding corresponded to a significantly lower intestinal loss of HCO3- in the RSB than in the USS group. The frequency of hyperchloremia was very low in both groups of patients whereas the incidence of an increased anion gap was surprisingly high. Data obtained demonstrate that metabolic acidosis develops even after RSB surgery thus indicating that the reduction in the area of the colonic mucosa in contact with the urine is not in itself sufficient to prevent the metabolic changes. Nevertheless patients with RSB were usually asymptomatic, insofar as metabolic alterations were not severe in any of the cases. In conclusion, RSB ensures good functional results and may be considered a satisfactory solution in those patients in whom radical cystectomy is mandatory. Nonetheless, even in these patients, constant clinical surveillance and monitoring of the metabolic situation is necessary.

Localization of carbonic anhydrase activity in the developing rat colon

Carbonic anhydrase activity was localized histochemically by light and electron microscopy in the proximal and distal colon of developing rats. Fixed tissue was taken for normal morphology and carbonic anhydrase localization from fetal (20-22 days gestation), suckling (1-19 days postnatal), weanling (20-25 days postnatal), and adult rats. The proximal colon had distinct villi at birth which were diminished between days 5 and 11 postnatally. The distal colon lacked villi at birth but had rudimentary crypts (ridges and furrows) which were replaced during the suckling period by a flat mucosa interspersed with true crypts. Carbonic anhydrase first appeared in both proximal and distal colonic epithelial cells on the day of birth (22 days gestation). Goblet cells were nonreactive at each developmental period. In neonatal rats, epithelial cells in the upper half of the villi of the proximal colon and on the surface and upper crypts of the distal colon were positive for carbonic anhydrase throughout the cytoplasm. Cells at the villar base (proximal colon) or in the deep crypt (distal colon) had reaction product in the intercellular spaces but not the cytoplasm. By 11 days postnatal, cytoplasmic reaction product was present in proximal colonic cells in the upper three-fourths of the crypt and was concentrated in a heavy band in the apical cytoplasm. In the distal colon, cytoplasmic positive cells did not extend as deeply into the crypts and the apical banding pattern was weak. Intercellular spaces in the deeper crypt epithelium were positive in both proximal colon and distal colon, suggesting a membrane-bound carbonic anhydrase. It was concluded that carbonic anhydrase appeared suddenly at birth and was continuously present in mid- to upper-crypt (or upper villus in early neonatal proximal colon) non-goblet cells into adulthood. This suggests a functional role for carbonic anhydrase in chloride-bicarbonate exchange across the neonatal and adult colonic mucosa.

An evaluation of the significance of microscopic colitis in patients with chronic diarrhea

Some patients with chronic idiopathic diarrhea have an apparent nonspecific inflammation of colonic mucosa, even though their colons appear normal by barium enema and colonoscopy. This has been referred to as microscopic colitis. However, the significance of this finding is unclear, because the ability of pathologists to accurately distinguish mild degrees of abnormality has not been established. Furthermore, even if the mucosa of these patients is nonspecifically inflamed, it is not known whether this is associated with deranged colonic function that could contribute to the development of chronic diarrhea. To assess these questions, we first examined colonic biopsy specimens in a blinded fashion, comparing biopsy results from patients with microscopic colitis with biopsy specimens from subjects in two control groups. This analysis revealed that colonic mucosa from six patients with microscopic colitis was in fact abnormal. For example, their mucosa contained an excess of both neutrophiles and round cells in the lamina propria, cryptitis, and reactive changes. These and other differences were statistically significant. Second, colonic absorption, measured by the steady state nonabsorbable marker perfusion method, was severely depressed in the patients. For example, mean water absorption rate was 159 ml/h in normal subjects and was reduced to only 26 ml/h in six patients with microscopic colitis. Results of net and unidirectional electrolyte fluxes and of electrical potential difference suggested that colonic fluid absorption was abnormal because of reduced active and passive sodium and chloride absorption and because of reduced Cl/HCO3 exchange. Small intestinal fluid and electrolyte absorption was abnormally reduced in two of the six patients, suggesting the possibility of coexistent small intestinal involvement in some of these patients. We conclude that nonspecific inflammation of colonic mucosa is associated with a severe reduction of colonic fluid absorption, and that the latter probably contributes to the development of chronic diarrhea.

Hormonal regulation of electrolyte and water transport in the colon

The colon participates in water and electrolyte homeostasis by the absorption of sodium (Na) and water as well as by potassium (K) secretion. The primary step of colonic transport is the active Na transport via a transcellular route. Steroidal hormones considerably increase Na absorption by utilizing two mechanisms: (1) passive Na entry into the cells in enhanced by an increased membrane permeability; (2) active transport capacity is increased by a stimulation of ATPase synthesis. Mineralocorticoid versus glucocorticoid actions of steroids have not yet been clearly differentiated; parallel influences are possible. Active chloride (Cl) secretion is found in the colon under certain pathological conditions and is induced by a number of factors, e.g., hormones produced by pancreas tumors. Cellular events involve a rise of intracellular cAMP and calcium (Ca) concentrations, and altered Cl permeabilities. Functional changes of colonic epithelial cells caused by hormones assume a significant role in the etiology of diarrhea, as well as in compensatory processes by which an intestinal loss of electrolytes and water is prevented.