Ultrastructural differences between diabetic and idiopathic gastroparesis

The ultrastructural changes in diabetic and idiopathic gastroparesis are not well studied and it is not known whether there are different defects in the two disorders. As part of the Gastroparesis Clinical Research Consortium, full thickness gastric body biopsies from 20 diabetic and 20 idiopathic gastroparetics were studied by light microscopy. Abnormalities were found in many (83%) but not all patients. Among the common defects were loss of interstitial cells of Cajal (ICC) and neural abnormalities. No distinguishing features were seen between diabetic and idiopathic gastroparesis. Our aim was to provide a detailed description of the ultrastructural abnormalities, compare findings between diabetic and idiopathic gastroparesis and determine if patients with apparently normal immunohistological features have ultrastructural abnormalities. Tissues from 40 gastroparetic patients and 24 age‐ and sex‐matched controls were examined by transmission electron microscopy (TEM). Interstitial cells of Cajal showing changes suggestive of injury, large and empty nerve endings, presence of lipofuscin and lamellar bodies in the smooth muscle cells were found in all patients. However, the ultrastructural changes in ICC and nerves differed between diabetic and idiopathic gastroparesis and were more severe in idiopathic gastroparesis. A thickened basal lamina around smooth muscle cells and nerves was characteristic of diabetic gastroparesis whereas idiopathic gastroparetics had fibrosis, especially around the nerves. In conclusion, in all the patients TEM showed abnormalities in ICC, nerves and smooth muscle consistent with the delay in gastric emptying. The significant differences found between diabetic and idiopathic gastroparesis offers insight into pathophysiology as well as into potential targeted therapies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92113/1/jcmm1451.pd

Diabetic autonomic neuropathy: evidence for apoptosis in situ in the rat

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75065/1/j.1365-2982.2004.00524.x.pd

Clinical‐histological associations in gastroparesis: results from the Gastroparesis Clinical Research Consortium

Background  Cellular changes associated with diabetic (DG) and idiopathic gastroparesis (IG) have recently been described from patients enrolled in the Gastroparesis Clinical Research Consortium. The association of these cellular changes with gastroparesis symptoms and gastric emptying is unknown. The aim of this study was to relate cellular changes to symptoms and gastric emptying in patients with gastroparesis. Methods  Earlier, using full thickness gastric body biopsies from 20 DG, 20 IG, and 20 matched controls, we found decreased interstitial cells of Cajal (ICC) and enteric nerves and an increase in immune cells in both DG and IG. Here, demographic, symptoms [gastroparesis cardinal symptom index score (GCSI)], and gastric emptying were related to cellular alterations using Pearson’s correlation coefficients. Key Results  Interstitial cells of Cajal counts inversely correlated with 4 h gastric retention in DG but not in IG (r = −0.6, P  = 0.008, DG, r = 0.2, P  = 0.4, IG). There was also a significant correlation between loss of ICC and enteric nerves in DG but not in IG (r = 0.5, P  = 0.03 for DG, r = 0.3, P  = 0.16, IG). Idiopathic gastroparesis with a myenteric immune infiltrate scored higher on the average GCSI (3.6 ± 0.7 vs 2.7 ± 0.9, P  = 0.05) and nausea score (3.8 ± 0.9 vs 2.6 ± 1.0, P  = 0.02) as compared to those without an infiltrate. Conclusions & Inferences  In DG, loss of ICC is associated with delayed gastric emptying. Interstitial cells of Cajal or enteric nerve loss did not correlate with symptom severity. Overall clinical severity and nausea in IG is associated with a myenteric immune infiltrate. Thus, full thickness gastric biopsies can help define specific cellular abnormalities in gastroparesis, some of which are associated with physiological and clinical characteristics of gastroparesis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92097/1/j.1365-2982.2012.01894.x.pd

Fermentable carbohydrate stimulates FFAR2-dependent colonic PYY cell expansion to increase satiety

Objective: Dietary supplementation with fermentable carbohydrate protects against body weight gain. Fermentation by the resident gut microbiota produces short-chain fatty acids, which act at free fatty acid receptor 2 (FFAR2). Our aim was to test the hypothesis that FFAR2 is important in regulating the beneficial effects of fermentable carbohydrate on body weight and to understand the role of gut hormones PYY and GLP-1. Methods: Wild-type or Ffar2/ mice were fed an inulin supplemented or control diet. Mice were metabolically characterized and gut hormone concentrations, enteroendocrine cell density measurements were carried out. Intestinal organoids and colonic cultures were utilized to substantiate the in vivo findings. Results: We provide new mechanistic insight into how fermentable carbohydrate regulates metabolism. Using mice that lack FFAR2, we demonstrate that the fermentable carbohydrate inulin acts via this receptor to drive an 87% increase in the density of cells that produce the appetite-suppressing hormone peptide YY (PYY), reduce food intake, and prevent diet-induced obesity. Conclusion: Our results demonstrate that FFAR2 is predominantly involved in regulating the effects of fermentable carbohydrate on metabolism and does so, in part, by enhancing PYY cell density and release. This highlights the potential for targeting enteroendocrine cell differentiation to treat obesity

Changes in the gastric enteric nervous system and muscle: A case report on two patients with diabetic gastroparesis

<p>Abstract</p> <p>Background</p> <p>The pathophysiological basis of diabetic gastroparesis is poorly understood, in large part due to the almost complete lack of data on neuropathological and molecular changes in the stomachs of patients. Experimental models indicate various lesions affecting the vagus, muscle, enteric neurons, interstitial cells of Cajal (ICC) or other cellular components. The aim of this study was to use modern analytical methods to determine morphological and molecular changes in the gastric wall in patients with diabetic gastroparesis.</p> <p>Methods</p> <p>Full thickness gastric biopsies were obtained laparoscopically from two gastroparetic patients undergoing surgical intervention and from disease-free areas of control subjects undergoing other forms of gastric surgery. Samples were processed for histological and immunohistochemical examination.</p> <p>Results</p> <p>Although both patients had severe refractory symptoms with malnutrition, requiring the placement of a gastric stimulator, one of them had no significant abnormalities as compared with controls. This patient had an abrupt onset of symptoms with a relatively short duration of diabetes that was well controlled. By contrast, the other patient had long standing brittle and poorly controlled diabetes with numerous episodes of diabetic ketoacidosis and frequent hypoglycemic episodes. Histological examination in this patient revealed increased fibrosis in the muscle layers as well as significantly fewer nerve fibers and myenteric neurons as assessed by PGP9.5 staining. Further, significant reduction was seen in staining for neuronal nitric oxide synthase, heme oxygenase-2, tyrosine hydroxylase as well as for c-KIT.</p> <p>Conclusion</p> <p>We conclude that poor metabolic control is associated with significant pathological changes in the gastric wall that affect all major components including muscle, neurons and ICC. Severe symptoms can occur in the absence of these changes, however and may reflect vagal, central or hormonal influences. Gastroparesis is therefore likely to be a heterogeneous disorder. Careful molecular and pathological analysis may allow more precise phenotypic differentiation and shed insight into the underlying mechanisms as well as identify novel therapeutic targets.</p

Myenteric plexus in the gastrointestinal tract of non-obese diabetic mice

The myenteric plexus was investigated in the gastrointestinal tract of pre-diabetic and diabetic nonobese diabetic (NOD) mice. The plexus was immunostained by the avidin-biotin complex method, using a general marker for nerve elements, namely protein geneproduct 9.5. The nerve fibres were quantified by pointcounting and the number of ganglia and their area were determined by image analysis. The relative volume density of the nerve fibres in duodenal muscularis propria was found to be significantly reduced in of both pre-diabetic and diabetic NOD mice. There was no statistical difference between controls and NOD mice regarding relative volume density of nerve fibres in antral and colonic muscularis propria. The number of myenteric ganglialmm baseline was significantly decreased in the duodenum of diabetic NOD mice, and showed a non-statistically significant tendency to decrease in pre-diabetic mice. In the antrum and colon, there was no difference between the controls and NOD mice regarding the number of ganglialmm baseline. Nor was there any significant difference between controls and NOD mice in the area of myenteric ganglia in either antrum, duodenum or colon. It is concluded that the changes in the duodenal myenteric plexus of NOD mice are prior to the onset of diabetes. It is suggested that the absence of changes in the antral and colonic myenteric plexus when using a general marker for neuroelements does not preclude a possible change in cholinergic, adrenergic or peptidergic innervation

Myenteric plexus of obese diabetic mice (an animal model of human type 2 diabetes)

The myenteric plexus of the gastrointestinal tract was investigated in the obese diabetic mouse, an animal model of human type 2 diabetes. Sections were immunostained by the avidin-biotin complex method, using a general nerve marker, protein gene product 9.5 (PGP 9.5), as well as antibodies to several important neurotransmitters. Computerized image analysis was used for quantification. When diabetic mice were compared with controls, no difference was found in the density of PGP 9.5-immunoreactive (IR) nerve fibres in antrum, duodenum or colon. In antrum and duodenum, diabetic mice showed a decreased number of vasoactive intestinal peptide (V1P)-IR neurons in myenteric ganglia as well a decreased relative volume density in myenteric plexus (though not significantly in antrum, p=0.073). No difference was found regarding VIP-IR nerves in colon. The volume density of nitric oxide synthase (NOS)-IR nerve fibres was decreased in antrum and duodenum of diabetic mice, whereas no difference was found in colon. The density of galanin-IR neme fibres was decreased in duodenum. Whereas neuropeptide Y (NPY)- and vesicular acetylcholine transporter (VAChT)-IR nerve fibres was increased in density in colon of diabetic mice, no difference was found in antrum and duodenum. Regarding substance P, there was no difference between diabetic and control mice in antrum, duodenum or colon. The present study shows that gut innervation is affected in this animal model of human type 2 diabetes. It is possible that the present findings may have some relevance for the gastrointestinal dysfunctions seen in patients with type 2 diabetes

Myenteric plexus in the gastrointestinal tract of non-obese diabetic mice

The myenteric plexus was investigated in the gastrointestinal tract of pre-diabetic and diabetic nonobese diabetic (NOD) mice. The plexus was immunostained by the avidin-biotin complex method, using a general marker for nerve elements, namely protein geneproduct 9.5. The nerve fibres were quantified by pointcounting and the number of ganglia and their area were determined by image analysis. The relative volume density of the nerve fibres in duodenal muscularis propria was found to be significantly reduced in of both pre-diabetic and diabetic NOD mice. There was no statistical difference between controls and NOD mice regarding relative volume density of nerve fibres in antral and colonic muscularis propria. The number of myenteric ganglialmm baseline was significantly decreased in the duodenum of diabetic NOD mice, and showed a non-statistically significant tendency to decrease in pre-diabetic mice. In the antrum and colon, there was no difference between the controls and NOD mice regarding the number of ganglialmm baseline. Nor was there any significant difference between controls and NOD mice in the area of myenteric ganglia in either antrum, duodenum or colon. It is concluded that the changes in the duodenal myenteric plexus of NOD mice are prior to the onset of diabetes. It is suggested that the absence of changes in the antral and colonic myenteric plexus when using a general marker for neuroelements does not preclude a possible change in cholinergic, adrenergic or peptidergic innervation