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Development of gastrointestinal mucosal barrier. II. The effect of natural versus artificial feeding on intestinal permeability to macromolecules.

We have recently reported that the intestinal transport of intact macromolecules into the circulation decreases with age presumably due to maturation of mucosal barrier factors. To extend this observation and determine the effect of natural versus artificial feeding on maturation of intestinal mucosal "barrier function" we conducted experiments which assessed both macromolecular transport and epithelial cell morphology. To study barrier function, we gavage fed a physiologic quantity (100 mg) of bovine serum albumin (BSA) to weight-matched breast- and bottle-fed infant rabbits at 1 and 2 wk of age and quantitated intestinal macromolecular transport by measuring circulating plasma concentrations of the intact antigen 4 hr later. a significant decrease (P less than 0.02) in immunoreactive bovine serum albumin (I-BSA) concentration was noted in breast-fed (6.12 +/- 0.77 micrograms I-BSA per ml plasma) compared with bottle-fed (9.19 +/- 0.93 micrograms I-BSA per ml plasma) animals at one wk. However, at 2 wk, no difference could be demonstrated between the two groups. Furthermore, small intestinal morphology evaluated by light and electron microscopy was similar in both groups each age. To determine if the lower plasma I-BSA noted at one wk in naturally fed animals was related to the presence of anti-BSA antibodies in breast milk and/or in plasma of the pups, breast milk and plasma from the breast-fed animals was evaluated by counterimmunoelectrophoresis and hemagglutination. No anti-BSA antibodies were detected. Moreover, plasma from breast- and artificially fed rabbits not gavage fed BSA contained no I-BSA. These data suggest that intestinal transport of antigens in the immediate neonatal period is decreased earlier in breast- as compared to bottle-fed animals. Therefore, we suggest that breast milk may exert a protective function to control the transport of potentially antigenic molecules into the systemic circulation of newborn animals by either facilitating the early maturation of intestinal barrier function or by providing passive barrier factors until the newborn's natural barrier can develop.

Animal Feed↗

High-molecular-weight polyethylene glycol prevents lethal sepsis due to intestinal Pseudomonas aeruginosa.

BACKGROUND & AIMS: During stress, erosion of protective intestinal mucus occurs in association with adherence to and disruption of the intestinal epithelial barrier by invading opportunistic microbial pathogens. The aims of this study were to test the ability of a high-molecular-weight polyethylene glycol compound, polyethylene glycol 15-20, to protect the intestinal epithelium against microbial invasion during stress. METHODS: The ability of polyethylene glycol 15-20 to protect the intestinal epithelium against the opportunistic pathogen Pseudomonas aeruginosa was tested in cultured Caco-2 cells. Bacterial virulence gene expression, bacterial adherence, and transepithelial electrical resistance were examined in response to apical inoculation of P. aeruginosa onto Caco-2 cells. Complementary in vivo studies were performed in a murine model of lethal sepsis due to intestinal P. aeruginosa in which surgical stress (30% hepatectomy) was combined with direct inoculation of P. aeruginosa into the cecum. RESULTS: High-molecular-weight polyethylene glycol (polyethylene glycol 15-20) conferred complete protection against the barrier-dysregulating effects of P. aeruginosa in Caco-2 cells. Intestinal application of polyethylene glycol 15-20 in stressed mice protected against the lethal effects of intestinal P. aeruginosa. Mechanisms of this effect seem to involve the ability of polyethylene glycol 15-20 to distance P. aeruginosa from the intestinal epithelium and render it completely insensate to key environmental stimuli that activate its virulence. CONCLUSIONS: High-molecular-weight polyethylene glycol has the potential to function as a surrogate mucin within the intestinal tract of a stressed host by inhibiting key interactive events between colonizing microbes and their epithelial cell targets.

Animals↗

Biologic therapy for inflammatory bowel disease.

Despite all of the advances in our understanding of the pathophysiology of inflammatory bowel disease (IBD), we still do not know its cause. Some of the most recently available data are discussed in this review; however, this field is changing rapidly and it is increasingly becoming accepted that immunogenetics play an important role in the predisposition, modulation and perpetuation of IBD. The role of intestinal milieu, and enteric flora in particular, appears to be of greater significance than previously thought. This complex interplay of genetic, microbial and environmental factors culminates in a sustained activation of the mucosal immune and non-immune response, probably facilitated by defects in the intestinal epithelial barrier and mucosal immune system, resulting in active inflammation and tissue destruction. Under normal situations, the intestinal mucosa is in a state of 'controlled' inflammation regulated by a delicate balance of proinflammatory (tumour necrosis factor [TNF]-alpha, interferon [IFN]-gamma, interleukin [IL]-1, IL-6, IL-12) and anti-inflammatory cytokines (IL-4, IL-10, IL-11). The mucosal immune system is the central effector of intestinal inflammation and injury, with cytokines playing a central role in modulating inflammation. Cytokines may, therefore, be a logical target for IBD therapy using specific cytokine inhibitors. Biotechnology agents targeted against TNF, leukocyte adhesion, T-helper cell (T(h))-1 polarisation, T-cell activation or nuclear factor (NF)-kappaB, and other miscellaneous therapies are being evaluated as potential therapies for IBD. In this context, infliximab is currently the only biologic agent approved for the treatment of inflammatory and fistulising Crohn's disease. Other anti-TNF biologic agents have emerged, including CDP 571, certolizumab pegol (CDP 870), etanercept, onercept and adalimumab. However, ongoing research continues to generate new biologic agents targeted at specific pathogenic mechanisms involved in the inflammatory process. Lymphocyte-endothelial interactions mediated by adhesion molecules are important in leukocyte migration and recruitment to sites of inflammation, and selective blockade of these adhesion molecules is a novel and promising strategy to treat Crohn's disease. Therapeutic agents that inhibit leukocyte trafficking include natalizumab, MLN-02 and alicaforsen (ISIS 2302). Other agents being investigated for the treatment of Crohn's disease include inhibitors of T-cell activation, peroxisome proliferator-activated receptors, proinflammatory cytokine receptors and T(h)1 polarisation, and growth hormone and growth factors. Agents being investigated for treatment of ulcerative colitis include many of those mentioned for Crohn's disease. More controlled clinical trials are currently being conducted, exploring the safety and efficacy of old and new biologic agents, and the search certainly will open new and exciting perspectives on the development of therapies for IBD.

Animals↗

Cutaneous thermal injury alters macromolecular permeability of rat small intestine.

The intestinal epithelium normally provides a barrier function that prevents absorption of potentially harmful materials from the intestinal lumen. It has been postulated but never demonstrated that a cutaneous thermal injury will result in increased small-intestinal permeability. In a standardized 20% body surface area full-thickness scald injury, with polyethylene glycol 3350 and horseradish peroxidase used as permeability probes, small-intestinal permeability was examined regionally in an everted intestinal sac model. In the normal animals, the upper (proximal) and lower (distal) small intestine were less permeable to these probes than the middle segment. Within 6 hours after the injury, an increase in the mucosal uptake and transmural permeability was seen in all three small-intestinal segments; the most dramatic increase in permeability occurred in the ileum, p less than 0.01. The maximum increase in permeability was seen at 18 hours, and permeability was normal by 72 hours after the injury. This increase in intestinal permeability may represent a transient failure of the intestinal barrier function and may allow absorption of potentially toxic macromolecules from the intestinal lumen into the portal circulation early after thermal injury. Absorption of these macromolecules, such as endotoxin, may be potentially harmful by direct toxic actions or potentially helpful by activation of the immune system.

Animals↗

Probiotics: effects on immunity.

The gastrointestinal tract functions as a barrier against antigens from microorganisms and food. The generation of immunophysiologic regulation in the gut depends on the establishment of indigenous microflora. This has led to the introduction of novel therapeutic interventions based on the consumption of cultures of beneficial live microorganisms that act as probiotics. Among the possible mechanisms of probiotic therapy is promotion of a nonimmunologic gut defense barrier, which includes the normalization of increased intestinal permeability and altered gut microecology. Another possible mechanism of probiotic therapy is improvement of the intestine's immunologic barrier, particularly through intestinal immunoglobulin A responses and alleviation of intestinal inflammatory responses, which produce a gut-stabilizing effect. Many probiotic effects are mediated through immune regulation, particularly through balance control of proinflammatory and anti-inflammatory cytokines. These data show that probiotics can be used as innovative tools to alleviate intestinal inflammation, normalize gut mucosal dysfunction, and down-regulate hypersensitivity reactions. More recent data show that differences exist in the immunomodulatory effects of candidate probiotic bacteria. Moreover, distinct regulatory effects have been detected in healthy subjects and in patients with inflammatory diseases. These results suggest that specific immunomodulatory properties of probiotic bacteria should be characterized when developing clinical applications for extended target populations.

Adjuvants, Immunologic↗

Metabolism of vasopressin, oxytocin, and their analogues in the human gastrointestinal tract.

The bioavailability from the gastrointestinal tract of peptides as large as nonapeptides is very low, which may be attributed to extensive lumenal and mucosal degradation. The aim of the present study was to investigate the stability of the neurohypophyseal hormones arginine-vasopressin (AVP), oxytocin (OT), and their synthetic analogues in human intestinal contents, small intestinal brush-border membranes, and gastric, rectal, and colonic plasma membranes. Peptides were incubated in gastrointestinal contents from healthy volunteers and in human intestinal mucosa homogenates. The extent of degradation was determined by reversed-phase high performance liquid chromatography (HPLC). AVP was rapidly degraded in the ileum fractions of the intestinal contents whereas 50% of the analogue 1-deamino-8-D-arginine vasopressin (dDAVP) remained intact after 35 min. The degradation was pH dependent, and a concentration-dependent inhibition was observed when aprotinin, a proteinase inhibitor, was preincubated with contents from the ileum. No degradation of AVP, dDAVP, or oxytocin analogues was observed in the mucosa homogenate from the stomach. The peptides were found to be rather slowly degraded by intestinal microvilli membranes and colonic and rectal plasma membranes. This degradation occurred essentially when reduced glutathione 10(-4) M was added to the incubations. In conclusion, the major enzymatic barrier to intestinal absorption of OT, VP, and their analogues is present in the intestinal juice and not in the mucosa, which, however, constitutes a major physical barrier to peptide transport.

Adult↗

Effects of somatostatin analogues and vitamin C on bacterial translocation in an experimental intestinal obstruction model of rats.

The passage of viable endogenous bacteria and their products across the intact intestinal mucosal barrier, disseminating to the mesenteric lymph nodes, peritoneal cavity, spleen, liver, and circulation, is defined as bacterial translocation. Intestinal obstruction induces bacterial translocation due to mucosal disruption, motility dysfunction, and increased intestinal volume, leading to bacterial overgrowth. In a rat model of intestinal obstruction, the effects of both high-dose vitamin C (350 microg/kg), an antioxidant agent known to have a cytoprotective effect in ischemia-reperfusion injury, and somatostatin (20 microg/kg), a gastrointestinal antisecretory agent, in preventing bacterial translocation were studied. Both intestinal and liver samples from the rats was observed, and it was found that the rate of bacterial translocation was 100% in the control group, and only 43% for the rats who were given intraperitoneal vitamin C and somatostatin. The difference was statistically significant. In conclusion, we are convinced that vitamin C and somatostatin analogues may have protective effects against bacterial translocation in mechanical bowel obstruction.

Animals↗

Cardiopulmonary bypass in humans--jejunal mucosal perfusion increases in parallel with well-maintained microvascular hematocrit.

BACKGROUND: An imbalance between splanchnic oxygen supply and demand occurs during cardiopulmonary bypass (CPB) in man, which might disrupt the intestinal mucosal barrier function. The aim of the present study was to evaluate the effects of mild hypothermic CPB on intestinal mucosal perfusion in man undergoing cardiac surgery. Additionally we aimed to identify variables, which independently could predict changes of intestinal mucosal microcirculatory variables during CPB. METHODS: Jejunal mucosal perfusion (JMP), jejunal mucosal hematocrit (JMHt), red blood cell (RBC) velocity and arteriolar vasomotion using endoluminal jejunal laser Doppler flow metry were studied in eight cardiac surgical patients before and during CPB at a temperature of 34 degrees C. RESULTS: Cardiopulmonary bypass and the accompanied hemodilution (25-30%) induced a 44% increase in JMP (P < 0.05) and a 42% increase in RBC velocity (P < 0.01), with no change in JMHt. The oscillation amplitude of JMP, at a fundamental frequency of 2.8 cycles min(-1), increased with 175% (P < 0.05) during CPB. Splanchnic oxygen extraction increased by 64% during CPB (P < 0.05). Stepwise multiple regression analysis identified systemic hematocrit, arterial O2 and CO2 tension and splanchnic oxygen extraction as independent predictors of RBC velocity during CPB (R2=0.63, P < 0.001). The oscillation amplitude of JMP was predicted by RBC velocity and splanchnic oxygen extraction (R2= 0.68, P <0.0001). CONCLUSIONS: The increase in RBC velocity and enhanced arteriolar vasomotion, as well as maintained jejunal mucosal hematocrit, are microcirculatory, compensatory mechanisms for the splanchic oxygen supply/demand mismatch seen during cardiopulmonary bypass in humans.

Aged↗

[Study on morphological change in intestinal mucosa from injury to repair after hemorrhagic shock].

OBJECTIVE: To study on morphological changes in mucosa of the small and large intestine mucosa after resuscitation of hemorrhagic shock. METHODS: The morphological changes in intestinal mucosa were observed under light and electron microscope, including the histology of intestinal mucosa, determination of height of villi and evaluation of mucosa damage index in the different phases after traumatic-hemorrhagic shock. RESULTS: Mucosa epithelial injury was obvious in small intestine were even at 0 hour, becoming more serious in 1 hour up to 3 hours. The tissue repair began after 3 hours, though the injury was still serious. Most of the inJured mucosa began to repair after 6 hours, and completed in 24 hours. The condition of the large intestine was similar to that of the small intestine, but the injury was less severe. The mucosal thickness and the height of villi were diminished after 1 hour of shock, but there was no obvious change in the colon. CONCLUSION: In the early phase after hemorrhagic shock, intestinal mucosal barrier are subJected to damage, but it could repair and recover in a short time. Compare with small intestine, large intestine have stronger potentiality against injury.

Animals↗

The role of the mucus gel layer in intestinal bacterial translocation.

The mucus gel layer is thought to be a vital component of the intestinal mucosal barrier. The purpose of this study is to determine if decreasing mucus production following ischemia and reoxygenation of the intestinal mucosa would alter bacterial translocation in an in vitro rat mucosal model. Clonidine was used to decrease mucus production associated with an ischemia/reoxygenation insult. Bacterial translocation was studied in a modified Ussing chamber using Escherichia coli K100. The quantity of mucus produced, as well as the incidence and quantity of bacteria translocating was measured. In the clonidine-treated animals, there was a significant decrease in the amount of mucus produced compared to the control animals. The clonidine animals also had a higher quantity of bacteria translocating during the reoxygenation period compared to the control animals. The mucus gel layer is protective against in vitro translocation of bacteria following an ischemia/reoxygenation insult.

Animals↗

Passage of molecules through the wall of the gastrointestinal tract. II. Application of low-molecular weight polyethyleneglycol and a deterministic mathematical model for determining intestinal permeability in man.

The intestinal permeability to low molecular weight polyethyleneglycol (PEG) has been evaluated by means of a simple mathematical model and computer-aided curve-fitting procedures. Macrogolum 400, a mixture of 11 PEGs with molecular weights ranging from 194 to 634 daltons, was taken together with a liquid meal and a six-hour portion of urine collected. The different PEGs were then extracted from the urine, separated from each other by gas-liquid chromatography, and the relative peak area of each individual PEG determined. The distribution of different PEGs in the urine was then compared with the original PEG-distribution in three different ways: (1) by comparing the median values of the molecular weights, (2) by comparing the mean and standard deviation after curve fitting to the normal distribution, and (3) by curve fitting to mathematical filter functions demonstrating molecular exclusion due to size. It thus appeared that molecules were excluded both in the high and in the low molecular weight range, possibly by a combined effect of the intestinal permeability barrier and an escape to other compartments than the urine. However, relatively more of the larger PEGs passed from the intestine to the urine in a patient with Crohn's disease than in an apparently healthy individual.

Adult↗

Reduced gene expression of intestinal alpha-defensins predicts diarrhea in a cohort of African adults.

BACKGROUND: Human defensin (HD) 5 and HD6, both Paneth cell alpha-defensins, contribute to the antimicrobial barrier against intestinal infection. We have previously demonstrated that levels of both HD5 and HD6 mRNA were reduced in adults living in urban Zambia, compared with those in adults living in London. The aim of the present study was to determine, during 2 years of follow-up, whether alpha-defensin expression in Zambian adults is related to susceptibility to diarrhea. METHODS: We analyzed intestinal biopsy samples from a longitudinal cohort study conducted in 83 Zambian adults by quantitative reverse-transcription polymerase chain reaction, Western blotting, immunohistochemistry, and in situ hybridization, and we measured the incidence of diarrhea. RESULTS: Levels of HD5 and HD6 mRNA in Paneth cells varied between participants, over time, and seasonally and were strongly correlated with mucosal architecture. Gene expression was almost exclusively restricted to Paneth cells. The median (interquartile range) HD5 mRNA level was 6.0 (5.6-6.7) log10 transcripts/microg of total RNA among 18 participants who experienced diarrhea within 2 months after biopsy-sample collection, compared with 6.8 (6.2-7.3) log10 transcripts/microg of total RNA among 94 participants who did not (P=.006). A similar observation was made for HD6. CONCLUSIONS: These data indicate that intestinal alpha-defensin expression is dynamic and seasonal and suggest that susceptibility to intestinal infection is related to alpha-defensin expression.

Adult↗

IFN-gamma modulation of epithelial barrier function. Time course, reversibility, and site of cytokine binding.

The single cell-thick intestinal epithelium forms a crucial barrier between the host and environment, and is modeled in vitro by a monolayer of polarized, highly differentiated T84 epithelial cells impermeable to most macromolecules because of functional intercellular tight junctions. Absence of a permeability defect across the monolayer, either transcellular or paracellular, is indicated by development of a transepithelial electrical resistance of > or = 1000 ohm-cm2, reported to be markedly diminished by exposure to a T lymphocyte cytokine, IFN-gamma. We sought to define this phenomenon in four ways by determining its duration and reversibility; the uniqueness of type II (gamma) IFN as opposed to type I (alpha) IFN; the surface of the polarized columnar epithelium likely involved in responding to IFN-gamma; and whether a specific surface membrane receptor on the epithelial cell participates in the response. Using a special apparatus that allows differential cytokine exposure of monolayer surfaces, our data demonstrate 1) only the monolayer's basolateral surface is IFN-gamma responsive, whereas the apical (microvillous) surface is no; 2) the alteration in electrical resistance of epithelium is prolonged (5 days), even after a single (24 h) exposure to IFN-gamma, but nevertheless is reversible; 3) the effect is likely receptor-ligand mediated, because it can be partially blocked by IFN-gamma receptor-specific monoclonal Ig; 4) an alteration in tight junction function (a paracellular pathway) rather than cell necrosis or a transcellular pathway is responsible for IFN-gamma-induced monolayer dysfunction because permeability to a 44,000-Da macromolecule (horseradish peroxidase) did not increase, and intracytoplasmic T84 cell enzymes were not released into the media; and 5) the biologic phenomenon could not be induced by a species (alpha) of class I IFN, making IFN-gamma reasonably unique in this regard. Given the proximity; activation status, and capacity of T lymphocytes for cytokine production in mucosa, we suggest that IFN-gamma-induced changes in epithelial permeability may be a major cause of altered intestinal barrier function in vivo.

Antibodies, Monoclonal↗

Bacterial translocation from the gastrointestinal tract.

Bacterial translocation is defined as the passage of viable indigenous bacteria from the gastrointestinal tract to extraintestinal sites, such as the mesenteric-lymph-node complex, liver, spleen and bloodstream. Three major mechanisms promote bacterial translocation: intestinal bacterial overgrowth, deficiencies in host immune defenses and increased permeability or damage to the intestinal mucosal barrier.

Animals↗

Corticosteroids impair intestinal epithelial wound repair mechanisms in vitro.

BACKGROUND: Despite enormous progress in the medical treatment of inflammatory bowel diseases (IBD), corticosteroids still represent the most effective drugs in the management of acute IBD. Unfortunately, surgical intervention under concomitant therapy with corticosteroids is often complicated by impaired intestinal wound healing. Our aim was to assess the effects of the corticosteroids prednisolone and budesonide on different aspects of intestinal epithelial wound healing in vitro to identify potential causes for impaired intestinal wound healing under corticosteroid therapy. METHODS: The effects of both corticosteroids on intestinal epithelial cell function were studied in non-transformed small intestinal epithelial intestinal epithelial cell line IEC-6 cells and human colon cancer-derived HT-29 cells. Effects on epithelial migration were assessed using an in vitro wounding model. Effects on epithelial cell proliferation were assessed using colorimetric 3(4,5-dimethylthiazolyl-2)-2,5-diphenyl tetrazolium bromide (MTT) assays. Transforming Growth Factor beta (TGFbeta) mRNA and protein expression were determined by semi-quantitative RT-PCR and ELISA. RESULTS: Prednisolone and budesonide caused a significant dose-dependent inhibition of intestinal epithelial cell migration and proliferation in IEC-6 and HT-29 cells. Both corticosteroids induced apoptosis of intestinal epithelial cells in a dose-dependent fashion. Neither corticosteroid modulated the expression of TGFbeta mRNA and the synthesis of TGFbeta peptide. However, both corticosteroids stimulated the bioactivation of latent TGFbeta peptide. CONCLUSIONS: Prednisolone and budesonide inhibit intestinal epithelial cell restitution and proliferation in vitro. Both processes play a key role in the rapid resealing of the mucosal barrier following intestinal injury. Thus, impaired intestinal epithelial wound healing under corticosteroid therapy in vivo may be caused by inhibition of intestinal epithelial cell restitution and proliferation.

Anti-Inflammatory Agents↗

Crohn's disease and Escherichia coli. A new approach in therapy to maintain remission of colonic Crohn's disease?

Involvement of pathogenic or potentially pathogenic bacteria in the pathogenesis of inflammatory bowel disease has long been suggested because, among other reasons, the inflammatory response resembles that in infectious bowel diseases. Elevated antibody levels to pathogen antigens and a changed metabolic activity of the intestinal microflora have been detected in patients with Crohn's disease. Several studies have revealed a possible etiologic link between intestinal microorganisms and inflammatory bowel disease. Therefore, several therapeutic strategies, including reduction or dilution of bacterial components in the intestine by antibiotics or intestinal lavage, respectively, inactivation of inflammatory bacterial products, and reconstitution of intestinal microflora have been employed, substantiating the idea that dysfunction of the intestinal mucosal barrier and an alteration of bacterial composition contribute to the inflammatory disease. However, the beneficial effect of restoration of the physiologic intestinal microflora in colonic inflammation by exogenous administration of a viable nonpathogenic bacterium has not been investigated before in a placebo-controlled study. Promising results came from the present pilot study in which the nonpathogenic Escherichia coli strain Nissle 1917 was tested for efficacy and tolerance in maintaining remission in patients with colonic Crohn's disease. Application of the physiologic bacteria reduced the risk for relapse and minimized the need for glucocorticoids. Therefore we are convinced that in Crohn's disease parts of the intestinal microflora, including the host's immune response toward indigenous flora or an impairment of the gut flora's metabolic activity are involved in the development or at least in the onset of relapse from remissive of colonic Crohn's disease. However, more data are necessary to prove the benefit of E. coli strain Nissle 1917 as a new therapy to maintain remission of colonic Crohn's disease.

Biological Therapy↗

Enteroinvasive bacteria alter barrier and transport properties of human intestinal epithelium: role of iNOS and COX-2.

BACKGROUND & AIMS: Various invasive pathogens cause diarrhea, but the mechanism(s) are poorly understood. We hypothesized that nitric oxide and prostaglandins might modulate chloride secretory and barrier properties of the infected intestinal epithelium and that diarrhea is caused, in part, by altered expression of inducible NO synthase (iNOS) and cyclooxygenase 2 (COX-2). METHODS: Studies were conducted in human intestinal epithelial cell lines (HT29/cl.19A, Caco-2, and T84). Cells were infected with enteroinvasive Escherichia coli (EIEC 029:NM) or Salmonella dublin (SD), or nonpathogenic, noninvasive bacteria (Streptococcus thermophilus [ST] and Lactobacillus acidophilus [LA]). Infected cells and controls were tested for transepithelial resistance, chloride secretion, prostaglandin E2, guanosine 3',5'-cyclic monophosphate and adenosine 3',5'-cyclic monophosphate, and protein expression. RESULTS: Cells infected with EIEC or SD, but not uninfected controls or ST/LA-exposed monolayers, showed a progressive reduction in transepithelial resistance starting at 6-12 hours. Infected HT29/cl.19A and Caco-2 cells, but not T84 cells, also showed an increase in total nitrite. Expression of iNOS, and consequently COX-2, was also increased, followed by increased production of prostaglandins and cyclic nucleotides. Furthermore, basal and stimulated chloride secretory responses to various agonists were enhanced in HT29/cl.19A and Caco-2 cells after infection with enteroinvasive bacteria, and this effect was reversed for some agonists by iNOS or COX-2 inhibitors. Increased expression of cystic fibrosis transmembrane conductance regulator and NKCC1 was also observed in EIEC or SD-infected cells vs. controls, secondary to NO synthase activity. CONCLUSIONS: Up-regulation of iNOS and COX-2 by enteroinvasive bacteria can modulate chloride secretion and barrier function in intestinal epithelial cells. Thus, these enzymes represent possible therapeutic targets in infectious diarrhea.

Adenylyl Cyclase Inhibitors↗

The role of the intestinal microflora for the development of the immune system in early childhood.

The intestinal tract performs many different functions; in addition to absorption and digestion it is also the body's largest organ of host defence. Part of the intestinal mucosal barrier function is formed by a common mucosal immune system which provides communication between the different mucosal surfaces of the body. The intestine also contains a microbial ecosystem with a large body of microbes, 1-11/2 kg in an adult. The microbes and their activity have a major impact on the development and functioning of the intestinal immune system and vice versa. This mutual influence also affects the host beyond the intestine. The intestinal colonisation with a balanced microflora is of main importance for the correct development of the immune system. The importance of the intestinal microflora is most clearly seen in germfree animals, but also diseases like atopy are associated with disturbances in the intestinal microflora. This often manifests itself in a low number of bifidobacteria. The use of probiotics or prebiotics to correct this imbalance and modulate the immune activity has received increasing scientific documentation. The precise mechanisms behind these immune modulatory activities are not well understood and require further investigation.

Bifidobacterium↗