Role of pancreatic trypsin in chronic esophagitis induced by gastroduodenal reflux in rats

Proteinase-activated receptors regulate intestinal functions in a segment-dependent manner in rats

Proteinases released e.g. during inflammatory or allergic responses affect gastrointestinal functions via proteinase-activated receptors such as PAR1 and PAR2. As the gastrointestinal tract exerts pronounced gradients along its longitudinal axis, the present study focuses on the effect of PAR1 and PAR2 agonists on electrogenic ion transport (measured as short-circuit current; I_sc), tissue conductance (G_t) and contractility of the longitudinal muscle layer of rats. In Ussing chamber experiments, the PAR1 agonist TFLLR-NH₂, which mimics the tethered ligand liberated after cleavage of the receptor, evoked only a modest increase in I_sc (<0.5 μEq·h^-1·cm^-2) in small intestine, but a strong increase (3-4 μEq·h^-1·cm^-2) in colon. Pretreatment with tetrodotoxin reduced the response of the colonic segments to the level of the small intestine. Thrombin, the natural activator of PAR1, was much less effective suggesting biased activation by this peptidase. A similar gradient along the longitudinal axis of the intestine was observed with trypsin, the endogenous activator of PAR2. Divergent actions of PAR1 activation by enzymatic cleavage or a mimetic peptide were also observed when recording isometric contractions of longitudinal muscle. For example, in the jejunum TFLLR-NH₂ concentration-dependently induced a contractile response, whereas thrombin showed only inconsistent effects. The PAR2 activator AC264613 induced a concentration-dependent decrease in muscle tone combined with an inhibition of phasic spontaneous contractions. PCR experiments and immunohistochemical stainings confirmed the expression of PAR1 and PAR2. The data implies that PAR1 and PAR2 functions vary depending on the intestinal segment.

Mucosal Two-Step Pathogenesis in Gastroesophageal Reflux Disease: Repeated Weakly Acidic Stimulation and Activation of Protease-Activated Receptor-2 on Mucosal Interleukin-8 Secretion

BACKGROUND

Activation of protease-activated receptor-2 (PAR2) is involved in the mucosal immune pathogenesis of gastroesophageal reflux disease (GERD) that is characterized by proinflammatory cytokines such as interleukin-8 (IL-8). PAR2 activation on epithelial cells induces epithelial IL-8 secretion and initiates mucosal inflammation.

METHODS

A human primary esophageal epithelial cell model was established to investigate the effects of repeated stimulation with weakly acidic solutions and subsequent PAR2 activation. After creating a monolayer, cells were incubated under weakly acidic conditions for 7 h followed by 17 h at pH 7.4. This short-term exposure was repeated once. After weakly acidic stimulation, PAR2 activation was achieved by a synthetic agonist at pH 7.4.

RESULTS

After repeated weakly acidic incubation, PAR2 transcript levels were 3.6-fold upregulated (p = 0.001) and IL-8 transcripts were 2.4-fold enhanced (p = 0.034) compared to nonstimulated controls, while IL-8 protein in the cell pellet and supernatant was not increased. Only the additional PAR2 activation upon pH stimulation led to increased IL-8 secretion into the supernatant.

CONCLUSIONS

We propose a 2-step mechanism in which repeated weakly acidic exposure leads to the upregulation of epithelial PAR2 expression. The subsequent activation of upregulated PAR2 contributes to the initiation of mucosal inflammation, which underlies the important role of esophageal epithelium in GERD pathogenesis.

Melatonin in Prevention of the Sequence from Reflux Esophagitis to Barrett's Esophagus and Esophageal Adenocarcinoma: Experimental and Clinical Perspectives

Melatonin is a tryptophan-derived molecule with pleiotropic activities which is produced in all living organisms. This "sleep" hormone is a free radical scavenger, which activates several anti-oxidative enzymes and mechanisms. Melatonin, a highly lipophilic hormone, can reach body target cells rapidly, acting as the circadian signal to alter numerous physiological functions in the body. This indoleamine can protect the organs against a variety of damaging agents via multiple signaling. This review focused on the role played by melatonin in the mechanism of esophagoprotection, starting with its short-term protection against acute reflux esophagitis and then investigating the long-term prevention of chronic inflammation that leads to gastroesophageal reflux disease (GERD) and Barrett's esophagus. Since both of these condition are also identified as major risk factors for esophageal carcinoma, we provide some experimental and clinical evidence that supplementation therapy with melatonin could be useful in esophageal injury by protecting various animal models and patients with GERD from erosions, Barrett's esophagus and neoplasia. The physiological aspects of the synthesis and release of this indoleamine in the gut, including its release into portal circulation and liver uptake is examined. The beneficial influence of melatonin in preventing esophageal injury from acid-pepsin and acid-pepsin-bile exposure in animals as well as the usefulness of melatonin and its precursor, L-tryptophan in prophylactic and supplementary therapy against esophageal disorders in humans, are also discussed.

Fatty acids in a high-fat diet potentially induce gastric parietal-cell damage and metaplasia in mice

BACKGROUND

Obesity is associated with risk of adenocarcinoma in the proximal stomach. We aimed to identify the links between dietary fat and gastric premalignant lesions.

METHODS

C57BL/6 mice were fed high fat diet (HFD), and gastric mucosa was histologically analysed. Morphological changes were also analysed using an electron microscope. Transcriptome analysis of purified parietal cells was performed, and non-parietal gastric corpus epithelial cells were subjected to single-cell gene-expression profiling. Composition of gastric contents of HFD-fed mice was compared with that of the HFD itself. Lipotoxicity of free fatty acids (FFA) was examined in primary culture and organoid culture of mouse gastric epithelial cells in vitro, as well as in vivo, feeding FFA-rich diets.

RESULTS

During ~8-20 weeks of HFD feeding, the parietal cells of the stomach displayed mitochondrial damage, and a total of 23% of the mice developed macroscopically distinct metaplastic lesions in the gastric corpus mucosa. Transcriptome analysis of parietal cells indicated that feeding HFD enhanced pathways related to cell death. Histological analysis and gene-expression profiling indicated that the lesions were similar to previously reported precancerous lesions identified as spasmolytic polypeptide-expressing metaplasia. FFAs, including linoleic acid with refluxed bile acids were detected in the stomachs of the HFD-fed mice. In vitro, FFAs impaired mitochondrial function and decreased the viability of parietal cells. In vivo, linoleic acid-rich diet, but not stearic acid-rich diet induced parietal-cell loss and metaplastic changes in mice.

CONCLUSIONS

Dietary lipids induce parietal-cell damage and may lead to the development of precancerous metaplasia.

An assessment of human gastric fluid composition as a function of PPI usage

The standard of care for chronic gastro‐esophageal reflux disease (GERD), which affects up to 40% of the population, is the use of drugs such as proton pump inhibitors (PPIs) that block the production of stomach acid. Despite widespread use, the effects of PPIs on gastric fluid remain poorly characterized. In this study, gastric fluid was collected from patients undergoing cardiac surgery who were not (n = 40) or were (n = 25) actively taking PPIs. Various enzymatic and immunoassays as well as mass spectrometry were utilized to analyze the concentrations of bile, gastricsin, trypsin, and pepsin in the gastric fluid. Proteomic analyses by mass spectrometry suggested that degradation of trypsin at low pH might account, at least in part, for the observation that patients taking PPIs have a greater likelihood of having high concentrations of trypsin in their gastric fluid. In general, the concentrations of all analytes evaluated varied over several orders of magnitude, covering a minimum of a 2000‐fold range (gastricsin) and a maximum of a 1 × 10⁶ –fold range (trypsin). Furthermore, the concentrations of various analytes were poorly correlated with one another in the samples. For example, trypsin and bile concentrations showed a significant (P < 0.0001) but not strong correlation (r = 0.54). Finally, direct assessment of bacterial concentrations by flow cytometry revealed that PPIs did not cause a profound increase in microbial load in the gastric fluid. These results further delineate the profound effects that PPI usage has on the physiology of the stomach.

Further delineating the profound effects that PPI usage has on the physiology of the stomach, gastric fluid was collected from patients undergoing cardiac surgery who were not (n = 40) or were (n = 25) actively taking PPIs. Proteomic analyses by mass spectrometry suggested that degradation of trypsin at low pH might account, at least in part, for the observation that patients taking PPIs have a greater likelihood of having high concentrations of trypsin in their gastric fluid. Direct assessment of bacterial concentrations by flow cytometry revealed that PPIs did not cause a profound increase in microbial load in the gastric fluid, contrary with results previously obtained using culture‐dependent methods.

The severity of duodeno-esophageal reflux influences the development of different histological types of esophageal cancer in a rat model

The mechanism through which each histological type of carcinoma arises from the esophageal mucosa remains unknown. This study was designed to investigate whether there is an association between the severity of duodeno-esophageal reflux and the histological type of esophageal cancer. A series of 120 male Fischer rats, weighing ∼180 g, were randomized to receive one of the following procedures: duodeno-forestomach reflux (DFR) with reduced exposure to duodenal contents, duodeno-esophageal reflux (DER) with increased exposure to duodenal contents and three control operations (DFR, DER control and sham). The reflux of bile was estimated with (99m)Tc-PMT scintigraphy. All animals were fed a standard diet without carcinogen. The esophageal mucosa was assessed 50 weeks after surgery for carcinoma. The median scanned fraction rate of duodeno-esophageal reflux was significantly lower for the rodents in the DFR group than those in the DER group. Five of 28 rodents in the DFR group and 17 of the 22 rodents in the DER group developed esophageal carcinoma. None of the controls developed carcinoma. The five rodents in the DFR group developed SCC. Of 22 esophageal carcinomas for the DER group, nine were SCC, 12 ADC and one was adenosquamous carcinoma. The fraction of esophageal SCC for the DFR group was significantly higher than that for the DER group, while the fraction of esophageal ADC for the DFR group was significantly lower than that for the DER group. These observations suggest that the severity of duodeno-esophageal reflux in rodents is related to the development of different histological types of esophageal carcinoma.

Dietary kaempferol suppresses inflammation of dextran sulfate sodium-induced colitis in mice

BACKGROUND

In ulcerative colitis (UC), reduction of inflammation may represent a key mechanism in UC therapy, and anti-inflammatory agents would be good candidates for preventing UC. Kaempferol, a natural flavonoid, is believed to have anti-inflammatory activities and has been shown to be potentially immune-modulatory.

AIMS

The aim of this study was to determine whether kaempferol alleviates the inflammatory responses of dextran sulfate sodium (DSS)-induced colitis in mice.

METHODS

Female C57BL/6J mice were divided into six groups: a negative control group, a DSS control group, and DSS + 0.1% or 0.3% kaempferol pre- or post-fed groups. At the end of the experimental period, clinical and biochemical markers were evaluated.

RESULTS

Plasma levels of NO and PGE(2) were significantly decreased in both the 0.3% kaempferol pre- and post-fed groups. The plasma LTB(4) level was profoundly decreased in all animals fed kaempferol. Colonic mucosa MPO activity was also suppressed in both the 0.3% kaempferol pre- or post-fed groups. TFF3 mRNA, a marker for goblet cell function, was up-regulated in kaempferol pre-fed animals.

CONCLUSIONS

These results indicate that kaempferol is an effective anti-inflammatory agent that protects colonic mucosa from DSS-induced UC. Dietary kaempferol fed prior to colitis induction was more effective to suppress some of the colitis-associated markers.

Gastroesophageal reflux disease--from reflux episodes to mucosal inflammation

Gastroesophageal reflux disease (GERD) affects 20-30% of the population in Western countries, and is one of the most common clinical problems in daily practice. GERD-associated functional and structural abnormalities are caused by recurrent exposure of the esophagus to acidic and nonacidic refluxate of gastric contents (containing duodenal and intestinal proteases as well as acid and gastric pepsin) from the stomach. Major progress has been made in the understanding of the molecular pathogenesis of GERD-associated mucosal inflammation, suggesting a complex and multifactorial pathogenesis and immune-mediated effects. This Review summarizes the complexity of mucosal pathogenesis, including microscopic changes, mucosal inflammation and GERD-specific molecular mediators, in the context of the clinical features and pathophysiological characteristics of GERD. The abnormal exposure of the esophagus to luminal contents leads to chronic mucosal inflammation that is characterized by the release of IL-8 specifically, as well as other proinflammatory mediators, from the esophageal mucosa. Evidence from animal studies indicates a stepwise inflammatory response by the epithelium, which attracts immune effector cells to infiltrate the mucosa. From bench to bedside, these novel molecular findings might provide new treatment options beyond current acid-suppressive therapy and the principle of inhibition of transient lower esophageal sphincter relaxation.

Inflammation and oxidative stress in gastroesophageal reflux disease

The etiology of esophageal mucosal injury is complex, since it may involve the reflux of gastric acid, bile acid, and pancreatic juice, external factors such as drugs and alcohol, or functional factors such as esophagogastric motility. The mechanism of esophageal mucosal injury has gradually been understood at the molecular biological level. It is particularly important that pro-inflammatory factors, such as inflammatory cytokines (interleukin-6 and -8), leukocytes and oxidative stress, have been demonstrated to be involved in the development of gastroesophageal reflux disease (GERD) including nonerosive reflux disease (NERD). In addition, nociceptors such as acid-sensitive vanilloid receptors, protease-activated receptors and substance P have also been implicated in the pathogenesis of neurogenic inflammation in NERD patients with esophageal hypersensitivity. The development of new therapy with anti-inflammatory and anti-oxidant effects is expected to assist in the treatment of intractable NERD/GERD and the prevention of carcinogenesis.

Does impaired gallbladder function contribute to the development of Barrett's esophagus and esophageal adenocarcinoma?

INTRODUCTION

Esophageal adenocarcinoma is aetiologically associated with gastro-esophageal reflux, but the mechanisms responsible for the metaplasia-dysplasia sequence are unknown. Bile components are implicated. Impaired gallbladder function may contribute to duodenogastric reflux (DGR) and harmful GERD.

AIMS

This study aims to compare gallbladder function in patients with Barrett's esophagus, adenocarcinoma, and controls.

METHODS

Three groups of patients, all free of gallstone disease, were studied. Group 1: (n = 15) were normal controls. Group 2: (n = 15) were patients with >3-cm-long segment of Barrett's esophagus. Group 3: (n = 15) were patients with esophageal adenocarcinoma. Using real-time ultrasonography unit, gallbladder volume was measured in subjects following a 10-h fast. Ejection fraction was calculated before and after standard liquid meal and compared between the groups.

RESULTS

The mean percentage reduction in gallbladder volume was 50% at 40 min in the adenocarcinoma group compared with 72.4% in the control group (p < 0.001). At 60 min, gallbladder filling had recommenced in the control group to 64.1% of fasting volume while continuing to empty with further reduction to 63% in the Barrett's group and to 50.6% (p = 0.008) in the adenocarcinoma group. The mean gallbladder ejection fraction decreased progressively from controls to Barrett's to adenocarcinoma and was significantly lower in Barrett's group (60.9%; p = 0.019) and adenocarcinoma group (47.9%; p < 0.001) compared with normal controls (70.9%).

CONCLUSION

Gallbladder function is progressively impaired in Barrett's esophagus and adenocarcinoma. Gallbladder malfunction increases duodenogastric reflux, exposing the lower esophagus to an altered chemical milieu which, in turn, may have a role in promoting metaplasia-dysplasia-neoplasia sequence in the lower esophageal mucosa.

Protease-activated receptor-2 agonists promote cell invasion and metastasis in human esophageal cancer cell line EC109

AIM: To determine the expression of protease activated receptor-2 (PAR-2) in human esophageal cell line EC109, and to evaluate the effects of PAR-2 activation on cell invasion and migration.

METHODS: The expression of PAR-2 protein and mRNA in EC109 cells was determined by immunocytochemistry and reverse transcription-polymerase chain reaction (RT-PCR), respectively. Methyl thiazol tetrazolium (MTT) assay, cell invasion and migration assay, semi-quantitative PCR and zymographic analysis were performed to examine whether endogenous PAR-2 activator trypsin and PAR-2 activating-peptide SLIGKV could alter cell proliferation, invasion, migration, and matrix metalloproteinase (MMP) production.

RESULTS: Both PAR-2 mRNA and protein were expressed in EC109 cells. PAR-2 mRNA was up-regulated in cells treated with trypsin or PAR-2-activating peptide SLIGKV (0.781 ± 0.045 and 0.653 ± 0.029 vs 0.491 ± 0.032, both P < 0.01), but not in those treated with control peptide VKGILS (P > 0.05). Trypsin and SLIGKV promoted the proliferation of EC109 cells in a dose- and time-dependent manner. No significant difference was noted in cell proliferation between untreated cells and cells treated with control peptide VKGILS. Treatment with trypsin or SLIGKV significantly increased the number of EC109 cells that passed through the Millicell inserts in the migration assay (72.5 ± 9.2 vs 31.6 ± 6.6, and 59.4 ± 8.7 vs 36.2 ± 9.8, both P < 0.01). Compared with untreated cells and cell treated with control peptide, trypsin and SLIGKV significantly increased the mRNA expression (0.719 ± 0.034 vs 0.341 ± 0.032, and 0.466 ± 0.042 vs 0.370 ± 0.021, both P < 0.01) and gelatinolytic activity (75.6 ± 6.1 vs 44.9 ± 4.2, and 60.4 ± 4.6 vs 39.3 ± 5.2, both P < 0.01) of MMP-9.

CONCLUSION: PAR-2 is expressed in EC109 cells. PAR-2 activation may be able to promote the invasion and metastasis of human esophageal carcimoma cells by stimulating MMP-9 production.

Effects of ecabet sodium on acute mixed reflux esophagitis in rats

OBJECTIVE

Ecabet sodium (ENa) is a drug that repairs epithelial cells in the digestive tract via selective adhesion to damaged tissue. While the principal cause of reflux esophagitis is gastroesophageal acid reflux, the involvement of duodenal juice has also been identified as an important factor. This study aimed to explore the effect of ENa in an acute mixed reflux esophagitis (AMRE) rat model.

MATERIAL AND METHODS

Eight-week-old male Wistar rats were used to prepare an AMRE model. There were four experimental groups: Group A (sham-operated rats), Group B (AMRE rats), Group C (AMRE rats dosed with ENa at 10 mg/kg), and Group D (AMRE rats dosed with ENa at 30 mg/kg). All rats were assessed for incidence of macroscopic esophageal lesions, esophagitis index, and pathological findings. Amylase activity, bile acid concentration in the digestive fluid retained in the esophagogastric lumen and ENa concentration in the esophageal mucosa were determined.

RESULTS

The incidence of esophagitis was 0% for Group A, 100% for Group B, 40% for Group C, and 20% for Group D. It was significantly lower for Groups C and D relative to Group B. The median esophagitis index was 0 for Group A, 58.2 for Group B, 0 for Group C, and 0 for Group D, and it was significantly lower for Groups C and D relative to Group B. The histological severity grade of esophagitis in Groups C and D was significantly less than that in Group B.

CONCLUSION

Treatment with ENa inhibited the development of AMRE in rats.

Proteinase-activated receptors 1 and 2 mediate contraction of human oesophageal muscularis mucosae

Proteinase-activated receptors 1 and 2 mediate contraction of the human gallbladder. In the present study, we investigated effects mediated by proteinase-activated receptors (PARs) in the human oesophagus by measuring contraction of muscularis mucosae strips isolated from the human oesophagus. Both PAR(1) agonists (thrombin, SFLLRN-NH(2) and TFLLR-NH(2)) and PAR(2) agonists (trypsin, 2-furoyl-LIGRLO-NH(2) and SLIGKV-NH(2)) caused concentration-dependent contraction. In contrast, PAR(1) and PAR(2) control peptides did not cause contraction. The existence of PAR(1) and PAR(2) in the human oesophageal muscularis mucosae was confirmed by immunohistochemistry and reverse transcription-polymerase chain reaction. On the other hand, PAR(4) agonists, GYPGKF-NH(2), GYPGQV-NH(2) and AYPGKF-NH(2), did not cause contraction or relaxation in resting or carbachol-contracted muscularis mucosae strips, suggesting that PAR(4) is not involved in human oesophageal motility. The contractile responses to SFLLRN-NH(2) and trypsin in the human oesophagus were insensitive to atropine and tetrodotoxin, indicating that the contractile response was not neurally mediated. Taken together, these results demonstrate that PAR(1) and PAR(2) but not PAR(4) mediate contraction in human oesophageal muscularis mucosae. PAR(1) and PAR(2) may influence human oesophageal motility.

Gastrointestinal roles for proteinase-activated receptors in health and disease

It has been almost a decade since the molecular cloning of all four members of the proteinase-activated receptor (PAR) family was completed. This unique family of G protein-coupled receptors (GPCRs) mediates specific cellular actions of various endogenous proteinases including thrombin, trypsin, tryptase, etc. and also certain exogenous enzymes. Increasing evidence has been clarifying the emerging roles played by PARs in health and disease. PARs, particularly PAR1 and PAR2, are distributed throughout the gastrointestinal (GI) tract, modulating various GI functions. One of the most important GI functions of PARs is regulation of exocrine secretion in the salivary glands, pancreas and GI mucosal epithelium. PARs also modulate motility of GI smooth muscle, involving multiple mechanisms. PAR2 appears to play dual roles in pancreatitis and related pain, being pro-inflammatory/pro-nociceptive and anti-inflammatory/anti-nociceptive. Similarly, dual roles for PAR1 and PAR2 have been demonstrated in mucosal inflammation/damage throughout the GI tract. There is also fundamental and clinical evidence for involvement of PAR2 in colonic pain. PARs are thus considered key molecules in regulation of GI functions and targets for development of drugs for treatment of various GI diseases.

New developments in the relationship between protease activated recerptor-2 and alimentary system diseases

Protease-activated receptor-2 (PAR-2) is a G-protein-coupled receptor, and its special molecule structure and activation way are similar to other protease-activated receptors. PAR-2 is widely distributed in alimentary system and series of effects are produced when it is activated by certain proteases. For example, PAR-2 exerts gastric mucosal cytoprotective effect, influences the secretion of digestive glands and movement of gastrointestinal tract, participates in the development of pancreatitis, and associates closely with malignant tumors in alimentary system. More and more researches are now focusing on the relationship between PAR-2 and alimentary system diseases.