Bacteria Penetrate the Inner Mucus Layer before Inflammation in the Dextran Sulfate Colitis Model

Protection of the large intestine with its enormous amount of commensal bacteria is a challenge that became easier to understand when we recently could describe that colon has an inner attached mucus layer devoid of bacteria (Johansson et al. (2008) Proc. Natl. Acad. Sci. USA 105, 15064-15069). The bacteria are thus kept at a distance from the epithelial cells and lack of this layer, as in Muc2-null mice, allow bacteria to contact the epithelium. This causes colitis and later on colon cancer, similar to the human disease Ulcerative Colitis, a disease that still lacks a pathogenetic explanation. Dextran Sulfate (DSS) in the drinking water is the most widely used animal model for experimental colitis. In this model, the inflammation is observed after 3-5 days, but early events explaining why DSS causes this has not been described.When mucus formed on top of colon explant cultures were exposed to 3% DSS, the thickness of the inner mucus layer decreased and became permeable to 2 microm fluorescent beads after 15 min. Both DSS and Dextran readily penetrated the mucus, but Dextran had no effect on thickness or permeability. When DSS was given in the drinking water to mice and the colon was stained for bacteria and the Muc2 mucin, bacteria were shown to penetrate the inner mucus layer and reach the epithelial cells already within 12 hours, long before any infiltration of inflammatory cells.DSS thus causes quick alterations in the inner colon mucus layer that makes it permeable to bacteria. The bacteria that reach the epithelial cells probably trigger an inflammatory reaction. These observations suggest that altered properties or lack of the inner colon mucus layer may be an initial event in the development of colitis

Colonic barrier function in ulcerative colitis - Interactions between ion and mucus secretion

Anion and mucus secretions have traditionally been looked upon as two separate parts of the epithelial defense system. The importance of anion secretion has been attributed to its role in creating the driving force for fluid secretion that flushes the epithelium from bacteria, while mucus secretion ensures protection via the mucus layer that forms a physical barrier between the bacteria and the epithelium. In addition to its role in fluid secretion it is becoming increasingly clear that anion secretion contributes to the regulation of mucus properties. This opens up for the possibility that alterations in epithelial transport can regulate the colonic barrier also via its effects on the mucus layer. The aim of the present thesis was to clarify how epithelial anion secretion regulates the intestinal mucus layer, and to delineate how these two systems are affected in Ulcerative colitis, the most common chronic inflammatory bowel disease. By using an in house developed ex vivo method for the study of mucus properties, it was shown that CFTR mediated bicarbonate secretion regulates many aspects of mucus properties in the mouse small intestine, including mucus growth, adherence and penetrability. In the colon, baseline mucus growth was CFTR independent whereas secretagogue (carbachol) induced mucus growth required a functioning CFTR channel. The impaired mucus growth seen in mice lacking a functional CFTR channel was probably not due to reduced mucus secretion since the exocytosis response to carbachol was unaffected. In WT colon, carbachol induced mucus exocytosis required functioning basolateral transport via NKCC1 and K+ channels. To test how epithelial transport and mucus properties were affect by inflammation, the barrier properties of the colonic mucus were studied in various murine colitis models (IL10-/-, TLR5-/-, NHE3-/-, C1GalT-/- and DSS induced colitis) and in UC patients. The results showed that all tested colitis models had signs of a defective mucus barrier, defined as abnormal amounts of bacteria in contact with the epithelium. Alterations in the mucus layer were also found in the human colon. Colonic biopsies from control patients secreted mucus that separated beads the size of bacteria from the epithelium, whereas biopsies from UC patients with acute disease secreted mucus that was penetrable to the beads. The majority of UC patients in remission secreted mucus with normal penetrability, while a subset of patients secreted mucus that was permeable to the beads. Also epithelial anion secretion was normal in the distal colon of UC patients in remission, but in the proximal colon the reactivity to secretagogues was shifted towards an increased forskolin response and a decreased carbachol response. In summary, the results from this thesis show that acute colitis makes the colonic mucus layer unable to physically separate bacteria from the epithelium. In the small intestine, CFTR mediated secretion regulates most aspect of mucus properties while in the colon only secretagogue-induced mucus growth seems to be CFTR dependent. In ulcerative colitis in remission, the epithelium of the proximal colon becomes more reactive to stimulation of the CFTR system, which may be a defense mechanism to reduce the degree of contact between bacteria and epithelium

Transcriptome signatures in Helicobacter pylori-infected mucosa identifies acidic mammalian chitinase loss as a corpus atrophy marker.

BACKGROUND: The majority of gastric cancer cases are believed to be caused by chronic infection with the bacterium Helicobacter pylori, and atrophic corpus gastritis is a predisposing condition to gastric cancer development. We aimed to increase understanding of the molecular details of atrophy by performing a global transcriptome analysis of stomach tissue. METHODS: Biopsies from patients with different stages of H. pylori infection were taken from both the antrum and corpus mucosa and analyzed on microarrays. The stages included patients without current H. pylori infection, H. pylori-infected without corpus atrophy and patients with current or past H. pylori-infection with corpus-predominant atrophic gastritis. RESULTS: Using clustering and integrated analysis, we found firm evidence for antralization of the corpus mucosa of atrophy patients. This antralization harbored gain of gastrin expression, as well as loss of expression of corpus-related genes, such as genes associated with acid production, energy metabolism and blood clotting. The analyses provided detailed molecular evidence for simultaneous intestinal metaplasia (IM) and spasmolytic polypeptide expressing metaplasia (SPEM) in atrophic corpus tissue. Finally, acidic mammalian chitinase, a chitin-degrading enzyme produced by chief cells, was shown to be strongly down-regulated in corpus atrophy. CONCLUSIONS: Transcriptome analysis revealed several gene groups which are related to development of corpus atrophy, some of which were increased also in H. pylori-infected non-atrophic patients. Furthermore, loss of acidic chitinase expression is a promising marker for corpus atrophy

Metabolic responses to intermittent hepatic dearterialization in the rat

Hepatic dearterialization is a palliative treatment for irresectable liver tumours. In the current study, the metabolic consequence of hepatic dearterialization were examined in the rat. Liver glycogen content was reduced to an average of 84% following 60 min dearterialization and was further reduced to an average of 16% following 60 min reperfusion. Plasma concentration of beta-hydroxybutyric acid was elevated by an average of 65% following 60 min hepatic dearterialization. In contrast, hepatic dearterialization did not alter cholesterol and triglyceride plasma levels. In addition, the hepatic activity of hepatic lipase was reduced by 29% after 60 min of hepatic dearterialization, a reduction which remained after 60 min of reperfusion. Clearance of intravenously administered antipyrine, which reflects the activity of liver microsomal enzymes, was reduced by 37% after 60 min of hepatic dearterialization. In conclusion hepatic dearterialization is accompanied by marked activity in the processes related to carbohydrate, lipid and xenobiotic metabolism. These effects should be taken into account when treating patients with hepatic dearterialization

Rotavirus Infection Is Not Associated with Small Intestinal Fluid Secretion in the Adult Mouse

In contrast to humans, adult but not infant small animals are resistant to rotavirus diarrhea. The pathophysiological mechanism behind this age-restricted diarrhea is currently unresolved, and this question was investigated by studying the secretory state of the small intestines of adult mice infected with rotavirus. Immunohistochemistry and histological examinations revealed that rotavirus (strain EDIM) infects all parts of the small intestines of adult mice, with significant numbers of infected cells in the ilea at 2 and 4 days postinfection. Furthermore, quantitative PCR revealed that 100-fold more viral RNA was produced in the ilea than in the jejuna or duodena of adult mice. In vitro perfusion experiments of the small intestine did not reveal any significant changes in net fluid secretion among mice infected for 3 days or 4 days or in those that were noninfected (37 ± 9 μl · h(−1) · cm(−1), 22 ± 13 μl · h(−1) · cm(−1), and 33 ± 6 μl · h(−1) · cm(−1), respectively) or in transmucosal potential difference (4.0 ± 0.3 mV versus 3.9 ± 0.4 mV), a marker for active chloride secretion, between control and rotavirus-infected mice. In vivo experiments also did not show any differences in potential difference between uninfected and infected small intestines. Furthermore, no significant differences in weight between infected and uninfected small intestines were found, nor were any differences in fecal output observed between infected and control mice. Altogether, these data suggest that rotavirus infection is not sufficient to stimulate chloride and water secretion from the small intestines of adult mice

Primary tumor volume and prognosis for patients with p16-positive and p16-negative oropharyngeal squamous cell carcinoma treated with radiation therapy

Background: The prescribed radiation dose to patients with oropharyngeal squamous cell carcinoma (OPSCC) is standardized, even if the prognosis for individual patients may differ. Easy-at-hand pre-treatment risk stratification methods are valuable to individualize therapy. In the current study we assessed the prognostic impact of primary tumor volume for p16-positive and p16-negative tumors and in relationship to other prognostic factors for outcome in patients with OPSCC treated with primary radiation therapy (RT). Methods: Five hundred twenty-three OPSCC patients with p16-status treated with primary RT (68.0 Gy to 73.1 Gy in 7 weeks, or 68.0 Gy in 4.5 weeks), with or without concurrent chemotherapy, within three prospective trials were included in the study. Local failure (LF), progression free survival (PFS) and overall survival (OS) in relationship to the size of the primary gross tumor volume (GTV-T) and other prognostic factors were investigated. Efficiency of intensified RT (RT with total dose 73.1 Gy or given within 4.5 weeks) was analyzed in relationship to tumor volume. Results: The volume of GTV-T and p16-status were found to be the strongest prognostic markers for LF, PFS and OS. For p16-positive tumors, an increase in tumor volume had a significantly higher negative prognostic impact compared with p16-negative tumors. Within a T-classification, patients with a smaller tumor, compared with a larger tumor, had a better prognosis. The importance of tumor volume remained after adjusting for nodal status, age, performance status, smoking status, sex, and hemoglobin-level. The adjusted hazard ratio for OS per cm3 increase in tumor volume was 2.3% (95% CI 0–4.9) for p16-positive and 1.3% (95% 0.3–2.2) for p16-negative. Exploratory analyses suggested that intensified RT could mitigate the negative impact of a large tumor volume. Conclusions: Outcome for patients with OPSCC treated with RT is largely determined by tumor volume, even when adjusting for other established prognostic factors. Tumor volume is significantly more influential for patients with p16-positive tumors. Patients with large tumor volumes might benefit by intensified RT to improve survival