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Alternate mucosal immune system: organized Peyer's patches are not required for IgA responses in the gastrointestinal tract.

The progeny of mice treated with lymphotoxin (LT)-beta receptor (LTbetaR) and Ig (LTbetaR-Ig) lack Peyer's patches but not mesenteric lymph nodes (MLN). In this study, we used this approach to determine the importance of Peyer's patches for induction of mucosal IgA Ab responses in the murine gastrointestinal tract. Immunohistochemical analysis revealed that LTbetaR-Ig-treated, Peyer's patch null (PP null) mice possessed significant numbers of IgA-positive (IgA+) plasma cells in the intestinal lamina propria. Further, oral immunization of PP null mice with OVA plus cholera toxin as mucosal adjuvant resulted in Ag-specific mucosal IgA and serum IgG Ab responses. OVA-specific CD4+ T cells of the Th2 type were induced in MLN and spleen of PP null mice. In contrast, when TNF and LT-alpha double knockout (TNF/LT-alpha-/-) mice, which lack both Peyer's patches and MLN, were orally immunized with OVA plus cholera toxin, neither mucosal IgA nor serum IgG anti-OVA Abs were induced. On the other hand, LTbetaR-Ig- and TNF receptor 55-Ig-treated normal adult mice elicited OVA- and cholera toxin B subunit-specific mucosal IgA responses, indicating that both LT-alphabeta and TNF/LT-alpha pathways do not contribute for class switching for IgA Ab responses. These results show that the MLN plays a more important role than had been appreciated until now for the induction of both mucosal and systemic Ab responses after oral immunization. Further, organized Peyer's patches are not a strict requirement for induction of mucosal IgA Ab responses in the gastrointestinal tract.

Animals↗

Diagnosis and treatment of cytomegalovirus disease in transplant patients based on gastrointestinal tract manifestations.

Infection due to cytomegalovirus is a substantial cause of morbidity and mortality in immunocompromised patients. In particular, cytomegalovirus infection has been associated with a significant detrimental effect on patient and allograft survival after solid-organ transplantation. We are evaluating a new antiviral agent, ganciclovir 9-[1,3-dihydroxy-2-2 propoxymethyl] guanine (DHPG), used in solid-organ transplant recipients who developed life-threatening cytomegalovirus infections. Between March 1, 1987, and June 30, 1989, we treated 93 solid-organ transplant patients who developed tissue-invasive cytomegalovirus disease. From this group of patients we have identified 14 patients with primary gastrointestinal cytomegalovirus disease who received treatment with DHPG. Tissue diagnosis was made by endoscopy of the upper gastrointestinal tract (11 patients) or colonoscopy (three patients). Invasive cytomegalovirus disease was identified prior to severe complications of the gastrointestinal tract in all but one patient, who suffered colonic perforation prior to treatment with DHPG and subsequently died of bacterial sepsis. While 13 of the 14 patients improved after treatment with DHPG, four patients required additional treatments for recurrent cytomegalovirus disease and recovered. No DHPG toxicity was observed. We believe treatment with DHPG is indicated in this patient population, but that further studies are indicated to fully define the impact of this recommendation on both patient and allograft survival after solid-organ transplantation.

Abdominal Pain↗

Characterization of Ara h 1 by two-dimensional electrophoresis immunoblot and recombinant techniques: new digestion experiments with peanuts imitating the gastrointestinal tract.

Peanut allergy belongs to the food allergies which are not associated with aeroallergens. It permanently affects children as well as adults. Peanuts can cause IgE-mediated life-threatening hypersensitivity reactions of the immediate type. The identification and characterization of peanut allergens are preconditions for answering the question how the allergens, which interact with the gastrointestinal tract, are presented to the immune system. This would be an important contribution to the clarification of the pathomechanism of food allergy. The identification and characterization of peanut allergens are performed by electrophoresis/immunoblot techniques with patient IgE, monoclonal antibodies and the lectin ConA. Ara h 1 is identified by N-terminal sequencing of the whole molecule and LysC cleavage products. Ara h 1 is a ConA-reactive 66-kD glycoprotein which consists of a variety of isoallergens and isoforms. Peanut experiments mimicking digestion in the gastrointestinal tract clearly demonstrate the releasability of peanut allergens in the mouth and the resistance of Ara h 1 to degradation under treatment with artificial gastric fluid.

Allergens↗

Cell-specific expression of mitochondrial carbonic anhydrase in the human and rat gastrointestinal tract.

Mitochondrial carbonic anhydrase V (CA V) in liver provides HCO3- to pyruvate carboxylase for the first step in gluconeogenesis and HCO3- to carbamyl phosphate synthetase I for the first step in ureagenesis. Because carbamyl phosphate synthetase I and ornithine transcarbamylase are also expressed in enterocytes, we tested the hypothesis that CA V is expressed in the gastrointestinal tract in addition to liver. Polyclonal rabbit antisera were raised against a polypeptide of 17 C-terminal amino acids of human CA V and against purified recombinant mouse isozyme and were used in Western blotting and immunoperoxidase staining of human and rat tissues. Immunohistochemistry showed that CA V is expressed cell-specifically in the alimentary canal mucosa from stomach to rectum. Immunoreactions for CA V were detected in the parietal cells and gastrin-producing G-cells of the stomach and in intestinal enterocytes. Western blotting of human and rat gastrointestinal tissues with isozyme-specific antibodies showed positive signals for CA V with the expected molecular mass. The findings in human tissues paralleled those in rat. The cell-specific pattern of CA V expression suggests a role for CA V in alimentary canal physiology. We propose that mitochondrial CA V participates in the detoxification of ammonia produced in the gastrointestinal tract by providing bicarbonate to carbamyl phosphate synthetase I. (J Histochem Cytochem 47:517-524, 1999)

Animals↗

[Breakdown of dietary proteins in the gastrointestinal tract of the adult rat].

Adult rats were examined for the time course of inactivation of antigenic determinants of tritium-labeled bovine serum albumin (BSA) or chicken ovalbumin administered intragastrically. Immunoreactive protein in the perfusates was determined according to the amount of the radioactive label retained by the immunosorbent. Antigenic determinants of protein disintegrated very rapidly after protein penetrated the gastrointestinal tract. Within 20 minutes after administration their amount did not exceed 12% of the dose administered. BSA disintegrated more rapidly than ovalbumin. At the same time after 20, 60 and 180 min an insignificant amount (about 1%) of immunoreactive protein penetrated the distal part of the small and large intestines. The amount of high-molecular fragments in all the parts of the gastrointestinal tract exceeded the discovered amount of immunoreactive protein. The data obtained indicate that a small amount of foreign food antigens is capable of overcoming the barrier of the cavitary proteolysis and of reaching those parts of the intestine where they can be absorbed in the intact form.

Animals↗

Site-specific gene expression of nNOS variants in distinct functional regions of rat gastrointestinal tract.

5' mRNA variants of neuronal nitric oxide synthase (nNOS) are generated either by alternative promoter usage resulting in different mRNAs that encode for the same protein (nNOSalpha) or alternative splicing encoding NH(2)-terminally truncated proteins (nNOSbeta/gamma) that lack the PDZ/GLGF domain for protein-protein interaction of nNOSalpha. We studied the expression of 5' nNOS mRNA forms and nNOS-interacting proteins (postsynaptic density protein-95; PSD-95) in the rat gastrointestinal tract and analyzed the more distinct localization of nNOS protein variants in the duodenum by immunohistochemistry with COOH- and NH(2)-terminal nNOS antibodies. 5' nNOS mRNA variants showed a site-specific expression along the gastrointestinal tract with presence of all forms (nNOSalpha-a, -b, -c; nNOSbeta) in the muscle layer of esophagus, stomach, duodenum, longitudinal muscle layer of jejunum/ileum, proximal colon, and rectum. In contrast, a lack of nNOSalpha-a and nNOSbeta mRNA was observed in pylorus, circular muscle layer of jejunum/ileum, and cecum. Expression of nNOSalpha and nNOSbeta cDNAs revealed proteins of ~155 kDa and 135/125 kDa, respectively. Immunohistochemistry showed a differential distribution of COOH- and NH(2)-terminal nNOS immunoreactivity in distinct layers of rat duodenum, suggesting a cell-specific expression and distinct compartmentalization of nNOS proteins. Observed distribution of 5' nNOS mRNA variants and proteins argue for a complex control of nNOS expression by usage of separate promoters, cell- and site-specific splicing mechanisms, and translational initiation. These mechanisms could be involved in gastrointestinal motor diseases and may explain the phenotype of nNOSalpha knockout mice with gastric stasis and pyloric stenosis, due to a total loss of nNOS in the pyloric sphincter region.

Alternative Splicing↗

Mouse hepatocyte growth factor activator gene: its expression not only in the liver but also in the gastrointestinal tract.

A cDNA encoding mouse hepatocyte growth factor activator (HGFA) has been cloned by RT-PCR, based on the screening result from the database of expressed sequence tags. Subsequently, its gene was cloned from a mouse genomic bacterial artificial chromosome library using the cDNA as a probe. Sequencing analysis revealed that mouse HGFA protein deduced from the cDNA, similar to its human and rat counterparts, has two epidermal growth factor-like domains, type 1 and 2 fibronectin homology domains, a single kringle domain and a catalytic domain of serine proteinase, and the gene consists of 14 exon spanning approximately 7.5 kb. Interestingly, mouse HGFA mRNA was detected not only in the liver but also in the gastrointestinal tract by RNA blot analysis. Since hepatocyte growth factor (HGF) is up-regulated in the damaged gastrointestinal mucosa, our present data suggest that HGFA might activate proHGF directly in the gastrointestinal mucosa and play an important role in wound repair throughout the gastrointestinal tract.

Amino Acid Sequence↗

Absorption of lefradafiban from different sites of the gastrointestinal tract.

AIMS: Fibrinogen receptor antagonists show a close relationship between plasma concentrations and inhibitory effect. Optimal efficacy at an acceptable bleeding risk requires low inter- and intrasubject variability on low peak trough fluctuation in receptor occupancy and therefore also of plasma concentrations. Therefore, the enteral absorption of lefradafiban, an orally available fibrinogen receptor antagonist prodrug, was investigated after local administrations to different sites of the gastrointestinal tract in order to investigate the feasibility of an oral extended release formulation. METHODS: Twelve healthy male subjects received in a randomised, open-labelled, four-period crossover trial four consecutive administrations of lefradafiban: 1. orally; 2. administration into the jejunum, 3. administration into the lower jejunum/ileum (300 cm distally to the teeth), and 4. administration into the lumen of the sigmoid region (30 cm proximally to the anus). Local intestinal administrations were performed through a gastrointestinal tube. RESULTS: Compared with oral administration, ratios [mean (two-sided 90% confidence intervals)] of maximum drug plasma concentrations and AUC(0,24 h) of fradafiban were 1.05 (0.80, 1.39) and 1.06 (0.85,1.31) after jejunal, 0.98 (0.75,1.30) and 0.98 (0.79,1.21) after ileal, 0.52 (0.39,0.69) and 0.68 (0.55,0.85) after colonic administration. Urinary excretion of fradafiban was about 16% of the dose after oral, jejunal and ileal applications whereas after rectal administration about 11% were excreted. CONCLUSIONS: Lefradafiban is absorbed throughout the entire gastrointestinal tract. Therefore, an extended release formulation seems to be feasible with regard to bioavailability.

Administration, Oral↗

Immunohistochemical localization of Clostridium perfringens beta2-toxin in the gastrointestinal tract of horses.

Clostridia-associated intestinal disease in horses was generally reported to be due to infection with Clostridium perfringens type A, which harbors the cpa-encoded alpha-toxin. A recent study demonstrated a high incidence of beta2-toxigenic C. perfringens in horses suffering or dying from typhlocolitis, suggesting that this novel type of C. perfringens might play an important role in typhlocolitis and possibly other equine intestinal diseases. A retrospective study was conducted to assess the presence of the beta2-toxin in tissues of the equine gastrointestinal tract. Monospecific polyclonal antibodies against recombinant beta2-toxin were produced in rabbits and used to demonstrate the beta2-toxin in sections of the gastrointestinal tract by immunohistochemical methods. Sections from 69 horses were stained and beta2-toxin was observed immunohistochemically in 40 animals. Sections from the stomach, small intestine, and large intestine were positive. Immunopositivity for beta2-toxin was significantly associated with presence of beta2-toxigenic bacteria. This investigation demonstrates local production of beta2-toxin and suggests that immunohistochemistry using antitoxin antibodies represents a useful diagnostic method in those cases where isolation of bacteria and polymerase chain reaction typing is not feasible. Although the association between the presence of beta2-toxin and development of gastrointestinal disease in horses remains uncertain, the findings of this study indicate that the potential causal relationship warrants further investigation.

Animals↗

A major role for carbon monoxide as an endogenous hyperpolarizing factor in the gastrointestinal tract.

Carbon monoxide (CO) is proposed as a physiological messenger. CO activates cGMP and has a direct effect on potassium channels. Both actions of CO lead to hyperpolarization of a cell's resting membrane potential, suggesting that CO may function as a hyperpolarizing factor, although direct evidence is still lacking. Here we take advantage of the known membrane potential gradient that exists in the muscle layers of the gastrointestinal tract to determine whether CO is an endogenous hyperpolarizing factor. We find that heme oxygenase-2-null mice have depolarized smooth muscle cells and that the membrane potential gradient in the gut is abolished. Exogenous CO hyperpolarizes the membrane potential. Regions of the canine gastrointestinal tract that are more hyperpolarized generate more CO and have higher heme oxygenase activity than more depolarized regions. Our results suggest that CO is a critical hyperpolarizing factor required for the maintenance of intestinal smooth muscle membrane potential and gradient.

Animals↗

The zero-stress state of the gastrointestinal tract: biomechanical and functional implications.

The stresses and strains that remain in an organ when the external load is removed (the no-load state) are called residual stresses and strains. They can be relieved by cutting up the organ to obtain the zero-stress configuration. This phenomenon was demonstrated more than 15 years ago in cardiovascular research but until recently it was not realized by the gastrointestinal research community. The function of the gastrointestinal tract is to propel food by peristaltic motion, which is a result of the interaction of the tissue forces in the wall and the hydrodynamic forces in the food bolus. To understand the tissue forces, it is necessary to know the stress-strain relationships of the tissues that must be measured in reference to the zero-stress state. It has become clear that the zero-stress configuration of the gastrointestinal tract is very different from that of the no-load condition and that the zero-stress state is sensitive to structural and mechanical remodeling. The purpose of this review is to describe the basic theory and experiments of residual stress and to explore its physiological and pathophysiological implications in the gastrointestinal system.

Animals↗

Evaluation of submucosal upper gastrointestinal tract lesions by endoscopic ultrasound.

The proper diagnosis of submucosal upper gastrointestinal tract mass lesions by endoscopy or barium study is difficult. Differentiation between submucosal tumors, vascular structures, and extrinsic organs is often impossible. We performed endoscopic ultrasound examination of 91 patients with upper gastrointestinal submucosal mass lesions. Endoscopic ultrasound was accurate in determining the site of origin in 48 of 50 cases where pathology or angiography comparison was available. Leiomyoma, lipoma, varices, and carcinoma had characteristic ultrasonographic findings. Endoscopic ultrasound is a useful procedure in the evaluation of upper gastrointestinal submucosal mass lesions.

Endoscopy, Gastrointestinal↗

Telangiectasias of the upper gastrointestinal tract. Report of six cases and review.

Telangiectasias of the upper gastrointestinal tract are probably being recognized more frequently now simply because of current high awareness of their existence. In six patients reported here, the condition was recognized in three because of recurrent upper gastrointestinal hemorrhage and in three during endoscopic evaluation for epigastric pain. Two of the six patients shared the features of gastric and/or duodenal telangiectasia, advanced age, and aortic valve disease. Two patients were treated with endoscopic coagulation, with no success in one. Laser, when available, may prove to be the most effective therapeutic tool for this entity.

Aged↗

Calcium-selective ion channel, CaT1, is apically localized in gastrointestinal tract epithelia and is aberrantly expressed in human malignancies.

CaT1 is a highly selective calcium entry channel that has been proposed to be responsible for apical calcium entry in the vitamin D-regulated transcellular pathway of Ca(2+) absorption; however, the lack of a CaT1 antibody suitable for immunohistochemistry has prevented the direct testing of this hypothesis by the localization of CaT1 protein in the gastrointestinal tract and other tissues. In this study, we developed two CaT1 antibodies and have used them to establish for the first time that CaT1 localizes to the apical membrane of intestinal absorptive cells, thereby providing the first direct evidence that this protein is in fact an apical entry channel in the gastrointestinal tract. In addition, we found that CaT1 protein is highly expressed in a number of exocrine organs including pancreas, prostate, and mammary gland, suggesting an, as yet, unrecognized role in secretory epithelia. Finally, we found CaT1 protein to be present at elevated levels in comparison with normal tissues in a series of prostate, breast, thyroid, colon, and ovarian carcinomas, consistent with previous reports of up-regulation of CaT1 mRNA in prostate cancer tissues. Our findings indicate that CaT1 is likely to serve as a component of transcellular calcium transport mechanisms in many tissues and epithelial cancers.

Amino Acid Sequence↗

Management of foreign bodies in the gastrointestinal tract: an analysis of 104 cases in children.

BACKGROUND AND STUDY AIMS: Ingested foreign bodies may be managed by endoscopy, observation, or surgery. The aim of the study was to investigate the methods of removal of foreign bodies according to type and location, success rates, and complications. PATIENTS AND METHODS: The charts of 104 children who had ingested foreign bodies were retrospectively reviewed. RESULTS: Of the patients, 80 (76.9%) were managed endoscopically. The overall success rate for endoscopic management was 98.8%. There were no complications during endoscopic interventions. In 23 cases the foreign bodies spontaneously passed through the gastrointestinal tract (22.1%). Surgical removal of a foreign body was done in only one case (0.96%). The majority of the foreign bodies which were located in the upper gastrointestinal tract could be removed endoscopically regardless of the nature of the material. Foreign bodies in the small and large intestine tended to pass through spontaneously without complications. CONCLUSIONS: It appears that the endoscopic approach is the preferable method for the extraction of upper gastrointestinal foreign bodies in child patients because of its high success rate, and that foreign bodies in the small and large intestine tend to be passed spontaneously without complications.

Adolescent↗