Effect of fiber and its fermentation on colonic adaptation after cecal resection in the rat

Enhanced Ghrelin Levels and Hypothalamic Orexigenic AgRP and NPY Neuropeptide Expression in Models of Jejuno-Colonic Short Bowel Syndrome

Short bowel syndrome (SBS) patients developing hyperphagia have a better outcome. Gastrointestinal endocrine adaptations help to improve intestinal functions and food behaviour. We investigated neuroendocrine adaptations in SBS patients and rat models with jejuno-ileal (IR-JI) or jejuno-colonic (IR-JC) anastomosis with and without parenteral nutrition. Circulating levels of ghrelin, PYY, GLP-1, and GLP-2 were determined in SBS rat models and patients. Levels of mRNA for proglucagon, PYY and for hypothalamic neuropeptides were quantified by qRT-PCR in SBS rat models. Histology and immunostaining for Ki67, GLP-1 and PYY were performed in SBS rats. IR-JC rats, but not IR-JI, exhibited significantly higher crypt depths and number of Ki67-positive cells than sham. Fasting and/or postprandial plasma ghrelin and PYY concentrations were higher, or tend to be higher, in IR-JC rats and SBS-JC patients than in controls. Proglucagon and Pyy mRNA levels were significantly enhanced in IR-JC rats. Levels of mRNA coding hypothalamic orexigenic NPY and AgRP peptides were significantly higher in IR-JC than in sham rats. We demonstrate an increase of plasma ghrelin concentrations, major changes in hypothalamic neuropeptides levels and greater induction of PYY in SBS-JC rats and patients suggesting that jejuno-colonic continuity creates a peculiar environment promoting further gut-brain adaptations.

Treatment of short-bowel syndrome

The present article reviews the current literature on the role of diet and other trophic factors in the treatment of short-bowel syndrome. Results using glutamine, growth hormone and glucagon-like peptide 2 are reviewed. Although experimental animal data would suggest that various growth factors are of benefit in the treatment of short-bowel syndrome, only a few clinical studies have made the same claim.

Magnitude of functional adaptation after intestinal resection

Intestinal adaptation after resection has been much studied, but rarely examined in an integrative context. Hence we assessed the effects of resection and subsequent adaptation on the quantitative relationship between dietary glucose load and gut capacity to transport glucose. The ratio of capacity to load is termed the "safety factor." Our objectives were to determine 1) the time course of intestinal adaptation after resection, 2) whether adaptation is quantitatively complete, 3) whether survival requires maintaining a safety factor of at least 1.0 for glucose transport, 4) the effect of altered energy demands on adaptation, and 5) the relationship between the amount of tissue removed and the magnitude of functional adaptation. We performed 80% resection of the small intestine on Sprague-Dawley rats and measured small intestinal glucose uptake capacity, dietary glucose load, and gut gross morphology at 1, 5, and 10 wk postsurgery. Nearly all aspects of adaptation were complete by 1 wk postsurgery. After resection, remnant small intestine mass increased by over fivefold within 1 wk, to reach 50-70% of its preresection value. However, mass-specific glucose uptake activity was reduced, so that intestinal regeneration restored uptake capacity to only 33% of control values. Increased energetic demands had only modest effects on intestinal adaptation. Although the safety factor for small intestinal glucose uptake remained <1.0 (i.e., capacity < load) after adaptation to resection, nearly all rats survived. Hindgut fermentation of nonabsorbed nutrients appeared to contribute to that survival, despite inadequate small intestinal capacity. After less massive resection surgeries (25, 50, and 75% resections), the percent increase in glucose uptake capacity increased with the amount of tissue removed.

Short-bowel syndrome

This article reviews the current literature on the role of diet and trophic factors in the treatment of short-bowel syndrome, focusing on both recent experimental and clinical advances over the past year. The abundance of experimental animal data would suggest that various growth factors and luminal nutrients are of benefit in the treatment of short-bowel syndrome, however there are only a few clinical studies with small numbers of patients that make the same claim.

Misexpression of the pancreatic homeodomain protein IDX-1 by the Hoxa-4 promoter associated with agenesis of the cecum

BACKGROUND & AIMS

The endoderm-specific homeodomain transcription factor IDX-1 is critical for pancreas development and for the regulation of islet cell-specific genes. During development, IDX-1 is expressed in the epithelial cells of the endoderm in the pancreatic anlage of the foregut. The aim of this study was to determine whether IDX-1 may have potential properties of a master homeotic determinant of pancreas and/or gut development.

METHODS

Transgenic mice were generated in which the expression of IDX-1 was misdirected by a promoter of the mesoderm-specific homeodomain protein Hoxa-4 known to express in the stomach and hindgut during development. The expectation was the formation of ectopic pancreatic tissue or alterations of gut patterning or morphology.

RESULTS

Although no ectopic induction of pancreatic markers was found in these transgenic mice, they manifested an altered midgut-hindgut union and agenesis of the cecum. Further, IDX-1 binds to the gut-specific homeodomain protein Cdx-2 and inhibits transactivation of the sucrase-isomaltase promoter by Cdx-2.

CONCLUSIONS

These findings further support the emerging understanding that interactions among different classes of homeodomain proteins, expressed in a spatially and temporally restricted manner during development, determine the pattern of organogenesis. A possible mechanism for the dysmorphogenesis of the proximal colon may be an inhibition of Cdx-2 actions by IDX-1.