The interstitial cells of Cajal and a gastroenteric pacemaker system

The importance of food quality, gut motility, and microbiome in SIBO development and treatment

The prevalence of small intestinal bacterial overgrowth (SIBO) is rising worldwide, particularly in nations with high rates of urbanization. Irritable bowel syndrome, inflammatory bowel illnesses, and nonspecific dysmotility are strongly linked to SIBO. Moreover, repeated antibiotic therapy promotes microorganisms' overgrowth through the development of antibiotic resistance. The primary cause of excessive fermentation in the small intestine is a malfunctioning gastrointestinal motor complex, which results in the gut's longer retention of food residues. There are anatomical and physiological factors affecting the functioning of the myoelectric motor complex. Except for them, diet conditions the activity of gastrointestinal transit. Indisputably, the Western type of nutrition is unfavorable. Some food components have greater importance in the functioning of the gastrointestinal motor complex than others. Tryptophan, an essential amino acid and precursor of the serotonin hormone, accelerates intestinal transit, and gastric emptying, similarly to fiber and polyphenols. Additionally, the effect of food on the microbiome is important, and diet should prevent bacterial overgrowth and exhibit antimicrobial effects against pathogens. Therefore, knowledge about proper nutrition is essential to prevent the development and recurrence of SIBO. Since the scientific world was unsure whether there was a long-term or potential solution for SIBO until quite recently, research on a number of the topics included in the article should be performed. The article aimed to summarize current knowledge about proper nutrition after SIBO eradication and the prevention of recurrent bacterial overgrowth. Moreover, a connection was found between diet, gut dysmotility, and SIBO.

The Effect of Shaoyao Gancao Decoction on Sphincter of Oddi Dysfunction in Hypercholesterolemic Rabbits via Protecting the Enteric Nervous System-Interstitial Cells of Cajal-Smooth Muscle Cells Network

Objective

This study observes the morphological changes in the enteric nervous system (ENS) – interstitial cells of Cajal (ICC) – smooth muscle cells (SMC) network in sphincter of Oddi dysfunction (SOD) in hypercholesterolemic rabbits following treatment with Shaoyao Gancao decoction (SGD), as well as the apoptosis of the ICC.

Methods

In this study, 48 healthy adult New Zealand rabbits are randomly divided into three groups (n = 16 in each group): the control, the model, and the SGD treatment groups. The hypercholesterolemic rabbit model is established. Hematoxylin and eosin staining, transmission electron microscopy, immunofluorescence, terminal deoxynucleotidyl transferase dUTP nick end labeling staining, immunohistochemistry, Western blot analysis, and reverse transcription-polymerase chain reaction are used to detect the morphological changes in the ENS–ICC–SMC network, the expression of apoptosis-related proteins in the ICC, and to observe the curative effect of SGD after treatment.

Results

Compared with the control group, the morphology and the ultrastructure of the SO are destroyed in the model group. In addition, the protein gene product 9.5 (PGP9.5), nitric oxide (NO), the SMCs, and the ICC all significantly decreased while substance P (SP) significantly increased. Compared with the model group, the SO morphology and ultrastructure are repaired in the SGD group. In addition, the PGP9.5, NO, the SMCs, and the ICC significantly increased while SP decreased. In addition, SGD may activate the stem cell factor (SCF)/c-Kit signaling pathway to treat SO dysfunction by up-regulating the expression of c-Kit and SCF. Similarly, this pathway restores SO by up-regulating the expression of Bcl2 and inhibiting cleaved caspase-3, Bax, and the tumor necrosis factor.

Conclusion

Shaoyao Gancao decoction can promote the recovery of sphincter of Oddi dysfunction in hypercholesterolemic rabbits by protecting the ENS–ICC–SMC network.

Cholesterol gallstones: Focusing on the role of interstitial Cajal-like cells

Cholesterol gallstone (CG) is a common, frequent biliary system disease in China, with a complex and multifactorial etiology. Declined gallbladder motility reportedly contributes to CG pathogenesis. Furthermore, interstitial Cajal-like cells (ICLCs) are reportedly present in human and guinea pig gallbladder tissue. ICLCs potentially contribute to the regulation of gallbladder motility, and aberrant conditions involving the loss of ICLCs and/or a reduction in its pacing potential and reactivity to cholecystokinin may promote CG pathogenesis. This review discusses the association between ICLCs and CG pathogenesis and provides a basis for further studies on the functions of ICLCs and the etiologies of CG.

Telocytes heterogeneity: From cellular morphology to functional evidence

Telocytes (TCs), located ubiquitously in the internal organs of vertebrates, are a heterogeneous, recently described, cell population of the stromal space. Characterized by lengthy cytoplasmic extensions that can reach tens of microns and are called telopodes (Tps), TCs are difficult to see using conventional microscopes. It was the electron microscopy which led to their first identification and Popescu's team the first responsible for the reconstructions indicating TCs 'organization' in a three-dimensional (3D) network that is believed to be accountable for the complex roles of TCs. Gradually, it became increasingly evident that TCs are difficult to characterize in terms of immunophenotype and that their phenotype is different depending on the location and needs of the tissue at one time. This review discusses the growing body of evidence accumulated since TCs were discovered and highlights how the complex interplay between TCs and stem cells might be of importance for tissue engineering and regenerative medicine.

Effect of Shuwei Decoction () on rats with functional dyspepsia

OBJECTIVE

To investigate the effects of Shuwei Decoction (, SWD) on gastric emptying, serum stem cell factor (SCF), the content of serum nitric oxide (NO), and structure change of interstitial cells of Cajal (ICC) in functional dyspepsia (FD) rats.

METHODS

Sixty Sprague Dawley rats were randomly divided into 6 groups: blank group (group A), model group (group B), mosapride group (group C), Muxiang Shunqi Pill (, MSP) group (group D), SWD low-dose group (group E), and SWD high-dose group (group F), 10 rats in each group. FD rat model was established by clasping rats' tails for 7 days, except the group A. After 3 days, group A and group B were given distilled water, and the medicated rats were given corresponding medicine for 14 days. The gastric emptying, structure change of ICC in gastric antrum by transmission electron microscope, the content of serum NO by nitrate reductant and SCF by enzyme linked immunosorbent assay were observed.

RESULTS

Compared with group A, the rats in group B delayed gastric emptying, serum SCF decreased, serum NO increased (P <0.05). Compared with group B, the rats in groups D, E and F were improved on gastric emptying, obviously increased on serum SCF, decreased on serum NO (P <0.05), and structure change of ICC in gastric antrum improved. Compared with group B, structure change of ICC of group E after treatment was improved and was closed to group A.

CONCLUSION

SWD recovered gastrointestinal motility of FD, possibly by regulating the levels of serum NO and SCF, and improving the structure of ICC in gastric antrum.

Up-regulation of the Ang II/AT1 receptor may compensate for the loss of gastric antrum ICC via the PI3k/Akt signaling pathway in STZ-induced diabetic mice

The classic renin-angiotensin system (RAS) is a complex system in which angiotensin II (Ang II) has been identified as an important endogenous regulator that influences both smooth muscle contraction and cell growth. Although a local RAS is known to exist in the gastrointestinal tract, it is unclear whether Ang II is involved in the loss of gastric interstitial cells of Cajal (ICC) in diabetic mice. The present study was designed to investigate the effect of Ang II on ICC survival in streptozotocin (STZ)-induced diabetic mice. Western blot, immunofluorescence, isometric muscle recording, enzyme-linked immunosorbent assay (ELISA) and a cell counting kit-8 were used in this research. Our results demonstrate that the c-Kit and membrane-bound stem cell factor (mSCF) protein expression levels in gastric smooth muscle were decreased in STZ-induced diabetic mice. However, the angiotensin receptor type 1 (AT1R) expression levels in gastric smooth muscle and angiotensin-converting enzyme (ACE) expression levels in gastric mucosa were increased. The effect of Ang II on the tonic contraction of gastric smooth muscle was potentiated in diabetic mice, and the plasma Ang II level was enhanced. Ang II increased mSCF expression, cell proliferation, and Akt-Ser473 phosphorylation in cultured gastric smooth muscle cells (GSMCs). These effects were reduced by specific inhibitors ZD7155 (an AT1R antagonist) and LY294002 (a PI3-kinase inhibitor). Our results suggest that Ang II increases mSCF expression and cell proliferation in cultured GSMCs in a PI3K/Akt signaling-dependent manner. ACE and AT1R up-regulation in the stomach may help compensate for ICC loss in STZ-induced diabetic mice.

Special cancer microenvironment in human colonic cancer: Concept of cancer microenvironment formed by peritoneal invasion (CMPI) and implication of subperitoneal fibroblast in cancer progression

Clinical outcomes of colorectal cancer are influenced not by tumor size, but by spread into the bowel wall. Although assessment of serosal involvement is an important pathological feature for classification of colon cancer, its diagnostic consistency has been questioned. Using elastic staining, we assessed elastic laminal invasion (ELI) for more objective stratification of deep tumor invasion around the peritoneal surface. In addition, pathological characteristic features of marked tumor budding, fibrosis, and macrophage infiltration in the tumor area with ELI was elucidated. This characteristic tumor area was termed cancer microenvironment formed by peritoneal elastic laminal invasion (CMPI). We elucidated histoanatomical layer-dependent heterogeneity of fibroblast in colonic tissue. Furthermore, subperitoneal fibroblasts (SPFs) play a crucial role in tumor progression and metastasis in CMPI. Our ELI and CMPI concept contributes not only to objective pathological diagnosis, but also sheds light on biological research of special cancer microenvironments detectable in human colorectal cancers. Herein, we describe the diagnostic utility of ELI and morphological alteration in advanced colorectal cancers to determine the phenomenon that occurs when tumors invade around the peritoneal surface. Next, biological research of CMPI is reviewed to stress the importance of pathological research to establish new biological concepts.

Effect of da-cheng-qi decoction on the repair of the injured enteric nerve-interstitial cells of cajal-smooth muscle cells network in multiple organ dysfunction syndrome

Wistar rats were randomly divided into control group, multiple organ dysfunction syndrome (MODS) group, and Da-Cheng-Qi decoction (DCQD) group. The network of enteric nerves-interstitial cells of Cajal- (ICC-) smooth muscle cells (SMC) in small intestine was observed using confocal laser scanning microscopy and transmission electron microscopy. The results showed that the numbers of cholinergic/nitriergic nerves, and the deep muscular plexus of ICC (ICC-DMP) and connexin43 (Cx43) in small intestine with MODS were significantly decreased. The network integrity of enteric nerves-ICC-SMC was disrupted. The ultrastructures of ICC-DMP, enteric nerves, and SMC were severely damaged. After treatment with DCQD, the damages were repaired and the network integrity of enteric nerves ICC-SMC was significantly recovered. In conclusion, the pathogenesis of gastrointestinal motility dysfunction in MODS in part may be due to the damages to enteric nerves-ICC-SMC network and gap junctions. The therapeutic mechanism of DCQD in part may be that it could repair the damages and maintain the integrity of enteric nerves ICC-SMC network.

Involvement of interstitial cells of Cajal in experimental severe acute pancreatitis in rats

AIM: To observe the changes in interstitial cells of Cajal (ICC) in rats with experimental severe acute pancreatitis (SAP).

METHODS: A total of twenty-four SD rats were randomly divided into two groups (n = 12), namely the sham (S) group and the SAP group; the SAP rat model was established by retrograde injection of 5% sodium taurocholate (1.0 mL/kg) into the pancreatic duct. Twenty-four hours later intestinal motility was assessed by testing small intestinal propulsion rate, and then the rats were sacrificed. The pancreas and jejunum were resected and underwent routine pathologic examination. Immunohistochemical staining was used to detect c-kit-positive cells in the jejunum. Expression of c-kit mRNA was detected by real-time polymerase chain reaction, and the expression of c-kit protein was evaluated by Western blotting. Ultrastructure of ICC was evaluated by transmission electron microscopy.

RESULTS: There was bleeding, necrosis and a large amount of inflammatory cell infiltration in pancreatic tissue in the SAP group, while in jejunal tissue we observed a markedly denuded mucosal layer, loss of villous tissue and a slightly dilated muscular layer. The small intestinal propulsion rate was 68.66% ± 2.66% in the S group and 41.55% ± 3.85% in the SAP group. Compared with the S group, the rate of the SAP group decreased sharply. The density of c-kit-positive cells in the SAP group was significantly lower than in the S group; the respective mean densities were 88.47 ± 10.49 in the S group and 56.11 ± 7.09 in the SAP group. The levels of c-kit protein and mRNA were 0.36 ± 0.04 and 1.29 ± 0.91 in the SAP group, respectively, which were significantly lower than those in the S group (0.53 ± 0.06, 0.64 ± 0.33, respectively). In the SAP group, ICC profiles showed the same change tendency, such as vacuolation of mitochondria, irregular vacuoles and loosened desmosome-like junctions.

CONCLUSION: Decreased c-kit-positive cells and ultrastructural changes in ICC resulting from blockade of the c-kit signaling pathway are involved in the intestinal dysmotility associated with SAP.

Structural basis for the selective permeability of channels made of communicating junction proteins

The open state(s) of gap junction channels is evident from their permeation by small ions in response to an applied intercellular (transjunctional/transchannel) voltage gradient. That an open channel allows variable amounts of current to transit from cell-to-cell in the face of a constant intercellular voltage difference indicates channel open/closing can be complete or partial. The physiological significance of such open state options is, arguably, the main concern of junctional regulation. Because gap junctions are permeable to many substances, it is sensible to inquire whether and how each open state influences the intercellular diffusion of molecules as valuable as, but less readily detected than current-carrying ions. Presumably, structural changes perceived as shifts in channel conductivity would significantly alter the transjunctional diffusion of molecules whose limiting diameter approximates the pore's limiting diameter. Moreover, changes in junctional permeability to some molecules might occur without evident changes in conductivity, either at macroscopic or single channel level. Open gap junction channels allow the exchange of cytoplasmic permeants between contacting cells by simple diffusion. The identity of such permeants, and the functional circumstances and consequences of their junctional exchange presently constitute the most urgent (and demanding) themes of the field. Here, we consider the necessity for regulating this exchange, the possible mechanism(s) and structural elements likely involved in such regulation, and how regulatory phenomena could be perceived as changes in chemical vs. electrical coupling; an overall reflection on our collective knowledge of junctional communication is then applied to suggest new avenues of research. This article is part of a Special Issue entitled: The Communicating junctions, roles and dysfunctions.

[Application of electrogastrography to public health]

In general, gastrointestinal motility tests cause pain; therefore, the establishment of noninvasive methods is desired. Noninvasive methods facilitate the measurement of motility close to the normal physiological state, can provide new findings, and may contribute to the development of associated fields. Electrogastrography (EGG) is a gastrointestinal motility test in which gastrointestinal electric activity is measured. Compared with other gastrointestinal motility measurement methods such as the gastric emptying and internal pressure measurement methods, EGG is noninvasive and allows measurement under minimum restriction; therefore, measurement for a long time is also possible. In addition, since gastrointestinal electric activity, which cannot be quantified using other methods, can be measured, EGG is applicable to the evaluation of the state of the body and pathological conditions, and may provide new findings such as those useful for the prevention of gastrointestinal dysfunction associated with various disorders. EGG is also useful for preventing disorders associated with abnormal gastrointestinal activity such as functional dyspepsia, which has been more frequently observed in recent years, and constipation, which is an extremely frequent complaint in the elderly. Thus, EGG is of marked importance in public health. However, the range of EGG utilizations and applications is still limited at present. Therefore, we outlined the measurement/analysis methods, the advantages and problems of EGG and electrogastroenterography (EGEG), described their clinical importance, and also commented on forefront studies on EGG and evaluated its prospects.

Morphological changes in network of enteric nerve-interstitial cells of Cajal-smooth muscle cells in rats with multiple organ dysfunction syndrome and therapeutic effects of Dachengqi decoction (大承气汤)

OBJECTIVE

To observe the effects of Dachengqi Decoction (大承气汤, DCQD) on morphological changes in the network of enteric nerve-interstitial cells of Cajal (ICCs)-smooth muscle cells (SMC) of enteric deep muscular plexuses (DMP) in the rats with multiple organ dysfunction syndrome (MODS).

METHODS

One hundred Wistar rats of both sexes weighing 200 to 250 g were randomly divided into the control group, MODS group, and DCQD group. The morphologic changes of enteric nerve-ICC-SMC network in the DMP of intestine was observed using c-Kit and vesicular acetylcholine transporter/neuronal nitric oxide synthase immunohistochemical double-staining with whole-mount preparation technique, confocal laser scanning microscopy, and electron microscopy.

RESULTS

Compared with the control group, the distribution and densities of cholinergic/nitrergic nerves and ICC in the DMP (ICC-DMP) of intestine in the MODS group were significantly decreased (P<0.01), and the network of cholinergic nerve-ICC-SMC was disrupted; and the ultrastructural features of ICC-DMP, enteric nerve, and SMC were severely damaged. After treatment with DCQD, the damage in the network of enteric nerve-ICC-SMC was significantly recovered. Compared with the MODS group, the distribution and densities of cholinergic/nitrergic nerves and ICC-DMP in the DCQD group were significantly increased (P<0.01); and the ultrastructural features of ICC-DMP, enteric nerve, smooth muscle cells were significantly recovered.

CONCLUSIONS

DCQD can improve the gastrointestinal motility in MODS. The mechanism may be related to the effect of repairing the damages in the network of enteric nerve-ICC-SMC.

High concentration of glucose enhances the expression of P2X7 purine receptor in interstitial cells of Cajal in vitro

AIM: To investigate the effects of high concentration of glucose on the expression of P2X₇ purine receptor in the interstitial cells of Cajal (ICC) in vitro and to explore the mechanisms underlying gastrointestinal dysmotility in diabetic mellitus.

METHODS: ICC were isolated from the intestine of newborn mice by enzymatic dissociation and centrifugation and cultured in an incubator containing 50 mL/L CO₂. Cultured ICC were identified by immunofluorescence staining using antibodies directed against c-Kit receptor and P2X₇ receptor. ICC were then divided into two groups: control group and experimental group, which were treated with normal and high concentrations of glucose, respectively. After treatment, cell morphology was observed under an inverted light microscope. The expression of P2X₇ receptor and c-Kit receptor mRNAs in ICC was detected by reverse transcription-polymerase chain reaction (RT-PCR).

RESULTS: Immunofluorescence staining demonstrated that both P2X₇ receptor and c-Kit receptor were positive on ICC cells. After treatment with high concentration of glucose, ICC became bigger, and cell processes became shorter. RT-PCR analysis proved the expression of P2X₇ receptor in ICC. The expression level of c-Kit receptor mRNA was weaker and that of P2X₇ receptor mRNA was stronger in the experimental group than in the control group.

CONCLUSION: P2X₇ receptor is expressed in ICC. Hyperglycemia may alter cell morphology, decrease the expression of c-Kit receptor, enhance the expression of P2X₇ receptor in ICC, and thereby play a role in the pathogenesis of gastrointestinal dysmotility in diabetic mellitus.

Alterations of Cajal cells in patients with small bowel atresia

PURPOSE

Interstitial cells of Cajal (ICC) are regarded as the pacemaker cells of the gastrointestinal tract. There are some well-designed studies investigating the structure and function of ICC subsequent to experimentally induced intestinal obstructions. However, it remains unclear whether reduction of number of ICC primarily leads to mechanical obstruction of the bowel such as seen in intestinal atresia. We aimed to investigate the number of ICC in proximal and distal parts of the atresias of patients with small bowel atresia.

PATIENTS AND METHODS

Twenty-one patients (13 male and 8 female; median age, 3 days; median gestation age, 38 weeks) with jejunal or ileal atresia underwent primary repair between 2001 and 2009. The demographic data were reviewed. The specimen of the distal and proximal parts of the atretic segments was investigated according to presence and number of ICC in the myenteric plexus using immunohistochemical methods. The jejunum segments of 14 newborns who died from causes other than bowel disease were examined as a control. Scoring and count systems were developed for the evaluation of ICC. A continuous layer of CD-117 immunoreactive Cajal cells around the myenteric plexus was scored as 3, whereas discontinuous and diminished Cajal cells were scored as 2. Few and sparse Cajal cells around the myenteric ganglia and in the muscle layer were scored as 1. If there was no Cajal cell at all, it was scored as zero. In addition, the number of ICC per field was counted. The scores and the numbers of ICC per field were compared in patients with small bowel atresia and control group.

RESULTS

All patients but one survived. One patient was lost because of congenital cardiac anomalies. The median score of control subjects was 3 (range, 1-3). Both the proximal and distal segments of the atretic bowel had a median score of 1 in patients with atresia. Twenty patients' score of proximal (95%) and 19 patients' score of distal bowel segment (90%) had an ICC score of 2 or less. Only 1 control subject (7%) had an ICC score of less than 2. Results were statistically significant in controls and patients. The mean number of ICC in the control group was 5.36 +/- 2.36; in distal segments of patients with atresia, it was 1.03 +/- 1.4; and in proximal segments, it was 0.82 +/- 1.56. The difference between the control group and the patients was statistically significant (P < .05).

CONCLUSION

We demonstrated a remarkable decrease of ICC in small bowel wall of patients with intestinal atresia; but we could not show whether the reduction of ICC is a primary event, which also participates in the pathogenesis of intestinal atresia, or whether the mechanical obstruction caused by any unknown etiology (eg, ischemia) leads to decrease in number of ICC.

Bombesin can minimize impairments of interstitial cells of Cajal induced by FK506 in small bowel transplantation

PURPOSE

Interstitial cells of Cajal (ICC) are known as intestinal pacemaker cells and express c-kit on their membrane. Previously, we reported that FK506 had neurotoxicity to enteric ganglia, and bombesin (BBS) preserved them against FK506. The aim of this study was to investigate whether ICC was impaired by FK506 and whether ICC was preserved by BBS against FK506.

METHODS

Twelve rats underwent allogeneic SBTx heterotopically and were divided into 2 groups as follows: group A underwent SBTx with FK506 and group B with FK506/BBS. All rats were administered FK506 daily. Either BBS or normal saline was infused continuously from day 14 to 28. Analysis of ICC was performed immunohistochemically with c-kit. Interstitial cells of Cajal were evaluated by counting the number of c-kit-positive clusters in each graft.

RESULTS

The expression of c-kit accumulated around 60% of PGP9.5-positive enteric ganglia. The number of c-kit-positive clusters in group A was 22.3 +/- 5.5 clusters per cross section (C/CS) and that in group B was 36.3 +/- 5.1 C/CS. Interstitial cells of Cajal were well preserved in group B. There was a significant difference between groups A and B (P <.001).

CONCLUSION

Interstitial cells of Cajal were impaired by FK506 in allografts, and BBS could minimize the impairment of ICC against FK506.

Sarcoma

Sarcomas comprise a heterogeneous group of mesenchymal neoplasms. They can be grouped into 2 general categories, soft tissue sarcoma and primary bone sarcoma, which have different staging and treatment approaches. This review includes a discussion of both soft tissue sarcomas (malignant fibrous histiocytoma, liposarcoma, leiomyosarcoma, synovial sarcoma, dermatofibrosarcoma protuberans, angiosarcoma, Kaposi sarcoma, gastrointestinal stromal tumor, aggressive fibromatosis or desmoid tumor, rhabdomyosarcoma, and primary alveolar soft-part sarcoma) and primary bone sarcomas (osteosarcoma, Ewing sarcoma, giant cell tumor, and chondrosarcoma). The 3 most important prognostic variables are grade, size, and location of the primary tumor. The approach to a patient with a sarcoma begins with a biopsy that obtains adequate tissue for diagnosis without interfering with subsequent optimal definitive surgery. Subsequent treatment depends on the specific type of sarcoma. Because sarcomas are relatively uncommon yet comprise a wide variety of different entities, evaluation by oncology teams who have expertise in the field is recommended. Treatment and follow-up guidelines have been published by the National Comprehensive Cancer Network (www.nccn.org).

Relationships between insulin resistance, blood glucose levels and gastric motility: an electrogastrography and external ultrasonography study

BACKGROUND

Detailed information concerning the influence of insulin resistance on gastrointestinal motility are not available.

METHODS

The relationship between insulin resistance and gastric motility and emptying, and changes in gastric motility with changes in blood glucose level were investigated using electrogastrography (EGG) and external ultrasonography in 20 non-diabetic subjects. The homeostasis model assessment ratio (HOMA-R) was used as an index of insulin resistance. The cut off value for HOMA-R was set at 1.7. Subjects with HOMA-R > or = 1.7 were the high HOMA-R group, and HOMA-R < 1.7 were the normal HOMA-R group. In the EGG data, a Fast Fourier Transform (FFT) analysis was performed, and the mean peak power was compared among brady-, normal-, and tachy-gastria.

RESULTS

In the fasting state, the ratios of brady-gastria in EGG and HOMA-R were significantly positively correlated, and the ratios of normal-gastria and HOMA-R were significantly negatively correlated. When glucose was intravenously administered, the ratio of normal-gastria was significantly decreased and the ratio of brady-gastria was significantly increased in subjects with a high HOMA-R. In a gastric emptying test by external ultrasonography, gastric emptying activity was significantly decreased in subjects with a high HOMA-R.

CONCLUSIONS

We conclude that insulin resistance induces abnormal gastric motility. Though abnormal gastric motility is related to HOMA-R, the findings herein suggest that incretin, showing insulin resistance, or an adipocyokine might be related to the differences in EGG in both groups. The relation between abnormal gastric motility and other serum parameters (incretin, adipocyokine, etc) would contribute to a better understanding of this process.

Submucosal endoscopy with mucosal flap safety valve

BACKGROUND

There is no reliable endoscopic method to selectively resect deeper layers of the gut wall or to access the peritoneal cavity and prevent peritoneal soiling.

OBJECTIVES

To determine the technical feasibility and safety of submucosal endoscopy with mucosal flap (SEMF) in accessing the peritoneal cavity through a large full-thickness gastric-muscle-wall resection.

DESIGN

Ex vivo feasibility exploration and survival animal study.

SETTINGS

Ex vivo samples were obtained from fresh harvested organs. In vivo procedures were conducted with the pigs under standard general anesthesia.

INTERVENTIONS

High-pressure carbon dioxide (CO(2)) injection and balloon dissection created a large submucosal working space for insertion of a cap-fitted endoscope. By using the EMR cap, a full-thickness resection of the muscularis propria was performed. This full-thickness defect was sealed with the overlying mucosal flap and the use of hemoclips or tissue anchors.

RESULTS

By using the SEMF technique in the ex vivo experiment, the gastric wall was successfully traversed in each stomach after submucosal dissection and full-thickness resection of the musclaris. Similarly, by using the SEMF technique in the in vivo procedures, the peritoneal cavity was successfully accessed and the defect was completely sealed by using the mucosal flap. All animals survived 1 week after the procedure. Ulceration was noted in 3 pigs, and a small bowel injury was noted in 1 pig. Leak testing was negative in all stomachs.

CONCLUSIONS

By using the SEMF technique, submucosal space endoscopy and deep-layer gastric-wall resection were successfully performed. Furthermore, the mucosa overlying the dissected submucosal space served as a safe flap valve, preventing peritoneal leakage.

Roux-en-Y or ‘uncut’ Roux procedure? Relation of intestinal migrating motor complex recovery to the preservation of the network of interstitial cells of Cajal in pigs

We designed a conscious pig model to investigate myoelectric activity and the number of interstitial cells of Cajal (ICC) in the proximal jejunum following the Roux-en-Y and 'uncut' Roux procedures in relation to clinical outcomes. Twelve male Polish White pigs (8 weeks old, 10-13 kg) underwent surgery under general anaesthesia first to implant bipolar electrodes and telemetry transmitters for continuous electromyography recordings and then, after 1 week recovery, to create Roux-en-Y (n = 6) and 'uncut' Roux loops (n = 6). Upper gut tissue specimens were studied for the expression of c-kit staining procedure to quantitatively identify the presence of interstitial cells of Cajal. The intestinal migrating motor complex was restored within 10.5 and 37 h in 'uncut' Roux and Roux-en-Y pigs, respectively (P < 0.05). During 2 weeks, the 'uncut' Roux piglets increased their body weight by 18.0%, whereas the Roux-en-Y piglets increased their body weight by only 7.3% (P < or = 0.05). Two weeks after surgery, the number of ICC located in the region of Auerbach's plexus was higher and adhesions in the abdominal cavity lower in the 'uncut' Roux group. In conclusion, in the pig model, preservation of smooth muscle and ICC network continuity in the proximal jejunum may play an important role in early postsurgical recovery.

Interstitial cells of Cajal in dysmotility in intestinal ischemia and reperfusion injury in rats

BACKGROUND

Intestinal ischemia and reperfusion (I/R) injury is an obligatory occurrence in small bowel transplantation. I/R may impair the normal gastrointestinal motility. Interstitial cells of Cajal (ICC) are known as pacemaker cells in the gastrointestinal tract. The aim of this study was to assess the role of ICC in the gastrointestinal motility in a rat model of I/R injury.

MATERIALS AND METHODS

Wistar rats were subjected to 30- or 80-min intestinal ischemia by occluding the mesenteric vessels followed by reperfusion. Small intestinal segments were resected at 12 h or 4 days. The spontaneous mechanical activity was evaluated by organ bath technique. Immunopositivity of c-Kit and PGP9.5 at the level of the myenteric plexus was evaluated as markers of ICC and enteric nerves, respectively.

RESULTS

In the bowel segment with 80-min ischemia followed by 12-h reperfusion, muscles showed a 25% reduction (P < 0.05) in the frequency of contractions compared to that with 30-min ischemia followed by 12-h reperfusion, whereas amplitude of contractions was not significantly different. This change was associated with a 70% decrease (P < 0.01) of c-Kit immunopositivity. These changes of intestinal motility pattern and distribution of c-Kit-positive cells were both recovered from 80-min ischemia followed by 4 days reperfusion. In contrast, the immunopositivity of PGP9.5 was not affected in any I/R injury group.

CONCLUSIONS

Transient functional changes in ICC were induced by prolonged I/R injury but they recovered after 4 days, suggesting a central role of ICC in both disrupting and restoring the normal gastrointestinal motility in I/R injury.

Update on Gastroparesis

Gastroparesis is a manifestation of diabetic autonomic neuropathy. Gastrointestinal autonomic neuropathy contributes to morbidity, mortality, reduced quality of life, and increased healthcare costs of a patient with diabetes mellitus. Complications from gastroparesis include ketoacidosis, infection, and bezoar formation. The gold standard for the diagnosis of gastroparesis is a gastric emptying study. Other tests and procedures may also be performed to eliminate other causes of the symptoms. In general, treatment involves dietary and lifestyle adjustment as well as pharmacological interventions. Gastric electrical stimulation has recently emerged as an effective strategy in the management of these patients. Research is evolving in this area to include the use of botulinum toxin to control symptoms of gastroparesis. Patients with gastroparesis can be frustrated with the symptoms they experience, the intensive treatment regimens they must follow, as well as the medical procedures they undergo during the course of their treatment. Quality of life is an important factor to consider when caring for and supporting these patients. This article will provide an overview of gastroparesis and the latest treatments available to improve gastric motility and prevent further complications.

Subset of cells immunopositive for neurokinin-1 receptor identified as arterial interstitial cells of Cajal in human large arteries

In the adventitia of large arteries, dendritic cells are located between nerve fibers, some of which contain substance P. The aim of the present study was to examine whether neurokinin 1 receptor (NK-1R) was expressed by dendritic cells in the arterial wall. Parallel sections of aortic and carotid artery segments were immunostained with anti-NK-1R and cell-type-specific antibodies. Dendritic cells in the arterial wall expressed NK-1R, albeit at a low level. Other cells, which intensely expressed NK-1R, were located along the border between the media and adventitia. They did not co-express any dendritic cell markers, including fascin, CD1a, S100, or Lag-antigen, and were negative for CD68, CD3, and mast cell tryptase. These NK-1R(+) cells were laser-capture microdissected and studied by means of electron-microscopic analysis. The microdissected cells were in direct contact with nerve endings, and their ultrastructure was typical of the interstitial cells of Cajal present in the gastrointestinal tract. Further systematic electron-microscopic analysis revealed that the cells displaying the features typical of interstitial cells of Cajal were a basic element of the human arterial wall architectonics. Arterial interstitial cells of Cajal were negative for c-kit but they expressed vasoactive intestinal peptide receptor 1 (VIPR1). Destructive alterations of contacts between arterial interstitial cells of Cajal and nerve endings were observed in arterial segments with atherosclerotic lesions. The functional significance of the arterial interstitial cells of Cajal and their possible involvement in atherosclerosis and other vascular diseases need clarification.

Embryonic development of the myenteric nerve plexus in the rat small intestine as revealed by light and scanning electron microscopy

This study was performed to clarify developmental changes in the structure of the myenteric nerve plexus in the rat small intestine. The small intestines of fetal and neonatal rats were examined by light microscopic immunohistochemistry for protein gene product 9.5 (PGP-9.5) and alpha-smooth muscle actin (alpha-SMA). Direct observation of the three-dimensional structure of the neuronal and muscular elements was accomplished by scanning electron microscopy of tissues after KOH treatment. At the embryonic day 14 (E14), PGP-9.5 immunopositive (neuronal) cells first appeared in the mesenchymal tissue outside an alpha-SMA positive (muscle) cell layer. These cells increased in number to form a thin and continuous sheet, which was sandwiched between the inner and outer muscular layers at E17. This neuronal layer consisted of immature ganglion cells associated with supportive (enteroglial) cells, and was gradually segregated into groups by incomplete separation through slit-like interruptions at E18. With the widening of these slits at E19, the neuronal sheet was observed as a ladder composed of transversely elongated ganglia and their connecting nerve strands, resulting in the typical structure of the myenteric nerve plexus. Fibroblastic cells of a peculiar shape appeared on the outer surface of the myenteric plexus at E19. These cells (presumably interstitial cells) interconnected their long branching projections to form a cellular network on the myenteric plexus until birth.

Effects of gastric pacing on gastric emptying and plasma motilin

AIM: To investigate the effects of gastric pacing on gastric emptying and plasma motilin level in a canine model of gastric motility disorders and the correlation between gastric emptying and plasma motilin level.

METHODS: Ten healthy Mongrel dogs were divided into: experimental group of six dogs and control group of four dogs. A model of gastric motility disorders was established in the experimental group undergone truncal vagotomy combined with injection of glucagon. Gastric half-emptying time (GEt_1/2) was monitored with single photon emission computerized tomography (SPECT), and the half-solid test meal was labeled with an isotope ^99mTc sulfur colloid. Plasma motilin concentration was measured with radioimmunoassay (RIA) kit. Surface gastric pacing at 1.1-1.2 times the intrinsic slow-wave frequency and a superimposed series of high frequency pulses (10-30 Hz) was performed for 45 min daily for a month in conscious dogs.

RESULTS: After surgery, GEt_1/2 in dogs undergone truncal vagotomy was increased significantly from 56.35 ± 2.99 min to 79.42 ± 1.91 min (P < 0.001), but surface gastric pacing markedly accelerated gastric emptying and significantly decreased GEt_1/2 to 64.94 ± 1.75 min (P < 0.001) in animals undergone vagotomy. There was a significant increase of plasma level of motilin at the phase of IMCIII (interdigestive myoelectrical complex, IMCIII) in the dogs undergone bilateral truncal vagotomy (baseline vs vagotomy, 184.29 ± 9.81 pg/ml vs 242.09 ± 17.22 pg/ml; P < 0.01). But plasma motilin concentration (212.55 ± 11.20 pg/ml; P < 0.02) was decreased significantly after a long-term treatment with gastric pacing. Before gastric pacing, GEt_1/2 and plasma motilin concentration of the dogs undergone vagotomy showed a positive correlation (r = 0.867, P < 0.01), but after a long-term gastric pacing, GEt_1/2 and motilin level showed a negative correlation (r = -0.733, P < 0.04).

CONCLUSION: Surface gastric pacing with optimal pacing parameters can improve gastric emptying parameters and significantly accelerate gastric emptying and can resume or alter motor function in a canine model of motility disorders. Gastric emptying is correlated well with plasma motilin level before and after pacing, which suggests that motilin can modulate the mechanism of gastric pacing by altering gastric motility.

Novel human, mouse and xenopus genes encoding a member of the RAS superfamily of low-molecular-weight GTP-binding proteins and its downregulation in W/WV mouse jejunum

BACKGROUND AND AIM

Interstitial cells of Cajal (ICC) are pacemakers and mediators of neurotransmission in gastroenteric smooth muscles. Interstitial cells of Cajal require cellular signaling via KIT, a receptor tyrosine kinase, for development and maintenance of cellular phenotype. Much of the evidence demonstrating the functions of ICC comes from studies of W/W V mutant mice, which have reduced KIT function. The aim of the present study was to differentially examine gene expression in the small intestines of wild-type and W/W V mice.

METHODS

RNA from the jejunum of wild-type and W/W V mice was analyzed using a differential gene display method.

RESULTS

One candidate gene, encoding a novel small GTPase of the RAS superfamily, was significantly suppressed both in fed and starved W/WV mice. The full-length clone of the murine gene and its human and xenopus counterparts were designated GTP-binding protein, 28 kDa (G28K). Human G28K cDNA encodes a protein of 258 amino acids with homology to the human cell division cycle 42/G25K protein. This gene is located at 1q42.11-q42.3. G28K was abundantly expressed in the human stomach and the small intestine. Semi-quantitative reverse transcription-polymerase chain reaction analysis revealed expression of G28K mRNA within single isolated ICC.

CONCLUSIONS

Gene analysis showed that G28K was differentially expressed in the small intestines of wild-type and W/W V mice. Interstitial cells of Cajal within the small intestine expressed mRNA for G28K. The specific downregulation of G28K in the jejunum of W/W V mice, and high expression in human intestinal tissue suggest that the G28K gene might be associated with ICC function in mice and in humans.

Effects of surface gastric pacing on gastric myoelectrical activity and plasma motilin in a canine model of gastric motility disorders

OBJECTIVE

To investigate the effects of surface gastric pacing on gastric myoelectrical activity and plasma motilin concentration in a canine model of gastric motility disorders.

METHODS

Ten healthy mongrel dogs were divided into two groups: an experimental group of six dogs and control group of four dogs. The model of gastric motility disorders was established in the experimental group with truncal vagotomy combined with injection of glucagon. Gastric serosal myoelectrical activity was recorded with a four-channel computer analysis device. Plasma motilin concentration was measured with a radioimmunoassay (RIA) kit. Surface gastric pacing at 1.1-1.2-fold the intrinsic slow-wave frequency superimposed with a series of high frequency pulses (10-30 Hz) was performed for 45 min daily for 1 month in the conscious dogs.

RESULTS

The basic electrical rhythm (BER) amplitude (2.32 +/- 0.35 mV) and propagation velocity (4.06 +/- 0.40 cm/s) of the dogs with bilateral truncal vagotomy in the fed state decreased more significantly than those of the controls (4.25 +/- 0.12 mV, 6.92 +/- 0.24 cm/s) (P < 0.03). After long-term surface gastric pacing, the BER amplitude (3.97 +/- 0.19 mV) and propagation velocity (5.57 +/- 0.48 cm/s) was increased significantly compared with before pacing (P < 0.05). Postprandial gastric dysrhythmias were provoked by large doses of glucagon; the percentage of regular slow waves of the dogs with vagotomy was markedly reduced from 67.4 +/- 6.2% at baseline to 10.0 +/- 6.7% (P < 0.001), and that of the control was also decreased from 87.1 +/- 6.9% to 35.0 +/- 11.0% (P < 0.01), but the entrainment of gastric slow waves was 100% by means of gastric pacing at optimal parameters. There was a significant increase in the plasma concentration of motilin at the phase III of the interdigestive myoelectrical complex (IMC III) in the dogs with bilateral truncal vagotomy (baseline vs vagotomy, 184.29 +/- 9.81 pg/mL vs 242.09 +/- 17.22 pg/mL; P< 0.01). However, the plasma motilin concentration (212.55 +/- 11.20 pg/mL; P < 0.02) was decreased significantly after long-term gastric pacing. Before gastric pacing the plasma motilin concentration showed an equally negative correlation with the BER amplitude, and propagation velocity in the dogs with vagotomy in the fed state (r = -0.473, r = -0.807, P < 0.04), but after long-term gastric pacing, the plasma motilin concentration showed an equally positive correlation with the BER amplitude and propagation velocity (r = 0.523, r = 0.896, P < 0.02).

CONCLUSIONS

Surface gastric pacing with optimal pacing parameters is able to entrain completely propagated slow waves, improve the parameters of gastric myoelectrical activity and normalize gastric dysrhythmias induced by a pharmacological agent. Surface gastric pacing might be useful in the treatment of gastric dysrhythmia. The gastric myoelectrical activity correlated well with the plasma motilin concentration before and after pacing, which suggests that motilin could modulate the effect of gastric pacing through alteration of the gastric myoelectrical parameters.

Modifiers of gastrointestinal motility of cattle

Little clinically relevant, evidence-based data about the effect of motility modifiers on the GI tract of cattle are currently available. Additionally, some of the published results seem to be contradictory. Three main facts explain this apparent discrepancy: (1) Results may not be transferred from one species to another, because presence, concentration, location, distribution, and function of specific receptors may differ significantly among species. (2) The lack of a significant effect on smooth muscle preparations in vitro does not necessarily exclude a certain drug's motility-modifying property on affected animals in vivo. Certain drugs bind to receptors outside the myenteric plexus. Others, such as lidocaine and adrenergic-, dopaminergic-, and opioid-antagonists increase only GI motility, if inhibitory reflexes or a hyperactive state of the inhibitory sympathetic nervous system preexists. (3) Effects of motility modifiers as found in healthy experimental animals in vivo may not be similar to those found in spontaneously diseased animals. Accurate and reliable data on the effect of modifiers of GI motility of cattle will be obtained only from double-blinded, evidence-based, in vivo studies on spontaneously affected animals. Because well-documented results from such studies are extremely rare, intensive research in this field is warranted in the future.

Differential gene expression profile in the small intestines of mice lacking pacemaker interstitial cells of Cajal

BACKGROUND

We previously identified eight known and novel genes differentially expressed in the small intestines of wild type and W/WV mice, which have greatly reduced populations of the interstitial cells of Cajal, that are responsible for the generation of electrical slow waves, by using a differential gene display method.

METHODS

By using the same method we isolated additional candidate genes that were specifically down- or up-regulated in W/WV mice. Novel transcripts were designated as DDWMEST.

RESULTS

We isolated seven candidates that were specifically down- or up-regulated in W/WV mice. Two novel transcripts, DDWMEST 1 and -91 were increased in both fed and fasted W/WV mice. Expression of another five genes was suppressed in W/WV mice: ARG2 (Arginase II), ONZIN (encoding leukemia inhibitory factor regulated protein), and three novel transcripts: DDWMEST62, -84, and -100. Together with the previous report, we identified fifteen differentially expressed genes in total in the small intestines of W/WV mice. Eight of these genes were reduced in the jejunums of W/WV mice compared to age matched wild type mice, whereas the other seven genes showed an increase in expression. Differential expression was the same in fasted and fed animals, suggesting that the differences were independent of the dietetic state of the animal.

CONCLUSIONS

Several known and novel genes are differentially expressed in the small intestines of W/WV mice. Differential gene comparison might contribute to our understanding of motility disorders associated with the loss of the interstitial cells of Cajal.

Differential gene expression in the murine gastric fundus lacking interstitial cells of Cajal

BACKGROUND

The muscle layers of murine gastric fundus have no interstitial cells of Cajal at the level of the myenteric plexus and only possess intramuscular interstitial cells and this tissue does not generate electric slow waves. The absence of intramuscular interstitial cells in W/WV mutants provides a unique opportunity to study the molecular changes that are associated with the loss of these intercalating cells.

METHOD

The gene expression profile of the gastric fundus of wild type and W/WV mice was assayed by murine microarray analysis displaying a total of 8734 elements. Queried genes from the microarray analysis were confirmed by semi-quantitative reverse transcription-polymerase chain reaction.

RESULTS

Twenty-one genes were differentially expressed in wild type and W/WV mice. Eleven transcripts had 2.0-2.5 fold higher mRNA expression in W/WV gastric fundus when compared to wild type tissues. Ten transcripts had 2.1-3.9 fold lower expression in W/WV mutants in comparison with wild type animals. None of these genes have ever been implicated in any bowel motility function.

CONCLUSIONS

These data provides evidence that several important genes have significantly changed in the murine fundus of W/WV mutants that lack intramuscular interstitial cells of Cajal and have reduced enteric motor neurotransmission.

Identification of cells expressing somatostatin receptor 2 in the gastrointestinal tract of Sstr2 knockout/lacZ knockin mice

Somatostatin is found in neurons and endocrine cells in the gastrointestinal tract. The actions of somatostatin are mediated by a family of G-protein-coupled receptors that compose five subtypes (SSTR1-5), each of which is encoded by a separate gene. lacZ "knockin" mice, in which the reporter gene lacZ was engineered into the genomic locus of Sstr2 by gene targeting, were used to examine the expression pattern of Sstr2 and identify potential targets for neurally released and hormonal somatostatin in the gastrointestinal tract. In the body of the stomach, a large proportion of epithelial cells and subpopulations of myenteric neurons expressed Sstr2. Double- or triple-labeling with antisera to H(+)K(+)ATPase (to identify parietal cells) and/or histidine decarboxylase (to identify enterochromaffin-like [ECL] cells) combined with beta-galactosidase staining revealed that both parietal cells and ECL cells expressed Sstr2, and these two cell types accounted for almost all of the Sstr2-expressing epithelial cells. Somatostatin inhibits gastric acid secretion. The presence of SSTR2 on both parietal and ECL cells suggests that somatostatin acting on SSTR2 may reduce acid secretion by both acting directly on parietal cells and by reducing histamine release from ECL cells. In the small and large intestine, subpopulations of neurons in the myenteric and submucosal plexuses expressed Sstr2, and many of the Sstr2-expressing myenteric neurons also showed SSTR2(a) immunostaining. Most of Sstr2-expressing neurons in the myenteric plexus showed nitric oxide synthase (NOS) immunoreactivity. Previous studies have shown that NOS neurons are descending interneurons and anally projecting, inhibitory motor neurons. Thus, somatostatin acting at SSTR2 receptors on NOS neurons might modulate descending relaxation.

Dual effects of cyclopiazonic acid on excitation of circular smooth muscle isolated from the guinea-pig gastric antrum

The effects of cyclopiazonic acid (CPA), a known Ca2+-pump inhibitor at internal stores, were investigated on electrical responses of the membrane of smooth muscle cells in small segments (0.3-0.5 mm long) of circular smooth muscle isolated from the guinea-pig gastric antrum. In most preparations, the membrane was spontaneously active with the generation of unitary potentials and regenerative slow potentials. Low concentrations (< 1 microM) of CPA did not alter either the membrane potential or the amplitude and frequency of slow potentials. CPA at a concentration of 1 microM initially increased the frequency of slow potentials, but this was followed by a decrease in the frequency as a result of sustained exposure to CPA, with no alteration of either the membrane potential or the amplitude of slow potentials. Higher concentrations of CPA (2-5 microM) depolarized the membrane and decreased the amplitude and frequency of slow potentials. CPA at higher than 10 microM abolished slow potentials with depolarization of the membrane. Intracellular electrical responses recorded simultaneously from paired cells were synchronized, indicating electrical coupling of the cells. Depolarization of the membrane with current stimuli through one electrode evoked regenerative slow potentials superimposed on the electrotonic potentials. The evoked slow potential had a refractory period of about 7 s. CPA (up to 10 microM) did not prevent the synchronization of paired cells. The refractory period for slow potentials was reduced by low concentrations of CPA (< 1 microM) and increased by higher concentrations of CPA (2-10 microM). These results suggest that lower concentrations of CPA produce excitatory actions on gastric smooth muscles due to a secondary effect of increased intracellular [Ca2+], while higher concentrations of CPA produce inhibitory actions as a result of reduced release of Ca2+ from depleted internal stores.