Stress Gastric Ulcers and Cytoprotective Strategies: Perspectives and Trends

Unlocking the potential of Radix Astragali and its active ingredients in gastric ulcer therapy

We studied the protective effects of Radix Astragali (RA) on gastric ulcer (GU). A literature search was conducted using databases from Web of Science, PubMed, Springer, ScienceDirect, Science Direct Chinese National Knowledge Infrastructure (CNKI), and Wanfang. The inclusion criteria for this study were limited to reports on the effects of RA, AS-IV, cycloastragenol, astragalus polysaccharide (APS), and astragalosides (AST) in the treatment of gastric ulcers. Any studies involving gastric lesions that were precancerous or cancerous were eliminated. The search period was from database inception through June 2024. The results suggested RA hold promiseas potential novel therapeutics for the therapy of GU.

Transcriptomic Insights Into Electroacupuncture Using Different Acupoint Combinations to Repair Mucosal Inflammatory Injury Induced in a Rat Model of Gastric Ulcer

Background

Electroacupuncture (EA) is a promising treatment for gastrointestinal disorders, yet the efficacy of different acupoint combinations remains mechanistically undefined. We evaluated the therapeutic effects of different acupoint combinations on mucosal inflammatory injury induced in a rat model of gastric ulcer (GU) and dissected its molecular mechanisms through transcriptomic profiling.

Methods

A GU rat model was established using hypothermic restrained water immersion stress. EA therapy was administered to the He-Mu (ST36-CV12), Shu-Mu (BL21-CV12), and Yuan-Luo (ST42- ST40) acupoint combinations for 5 days. EA therapeutic effects were evaluated by coat score, fecal moisture percentage, pain threshold, body mass, organ index, histopathological changes, serum level of oxidative stress, and inflammatory cytokine levels in gastric tissue. A transcriptome analysis identified the related differentially expressed genes (DEGs) and central signaling pathway. Real-time quantitative PCR and Western blot were performed to verify the mRNA and protein expression levels of the main genes in the central pathway.

Results

EA using different acupoint combinations differentially alleviated gastric mucosal injury in GU rats, with the He-Mu group exhibiting superior tissue damage alleviation, as well as inflammation and oxidative stress reductions. A Venn diagram transcriptome analysis revealed a shared central pathway among the three groups, corresponding to focal adhesion. Quantitative validation confirmed that the mRNA, protein, and phosphorylated protein expression of FAK, VCL, and EGFR-the core signal transduction factors of the focal adhesion pathway activated in gastric tissue after EA treatment-were upregulated, consistent with their therapeutic efficacy.

Conclusion

Our results demonstrated that the He-Mu acupoint combination exhibited superior therapeutic efficacy among the three acupoint combinations. EA using different acupoint combinations improved gastric mucosal injury to varying degrees, and was related to the focal adhesion pathway. The FAK, VCL, and EGFR are promising targets, and further studies are needed to elucidate their functional consequences in GU.

Sequential bowel necrosis and large gastric ulcer in a patient with a ruptured femoral artery: A case report

BACKGROUND

Severe bleeding as a result of a major vascular injury is a potentially fatal event commonly observed in the emergency department. Bowel necrosis and gastric ulcers secondary to ischemia are rare due to their rich blood supply. In this case, we present the case of a patient who was treated successfully following rupture of his femoral artery resulting in bowel necrosis and an unusually large gastric ulcer.

CASE SUMMARY

A 28-year-old male patient sustained a knife stab wound to the right thigh, causing rupture of his femoral artery and leading to massive bleeding. He underwent cardiopulmonary resuscitation and received a large blood transfusion. Abdominal surgeries confirmed bowel necrosis, and jejunostomy was performed. The necrotic intestine was removed, the remaining intestine was anastomosed, and the right thigh was amputated. After three surgeries, the patient's overall condition gradually improved, and the patient was discharged from the hospital. However, one day after discharge, the patient was admitted again due to dizziness and melena, and a gastroduodenoscopy revealed a giant banded ulcer. After 2 weeks of treatment, the ulcer had decreased in size without bleeding. Six months after the last surgery, enterostomy and reintroduction surgery were completed. The patient was fitted with a right lower limb prosthesis one year after surgery. After 3 years of follow-up, the patient did not complain of discomfort.

CONCLUSION

Trauma department physicians need to be aware of the possible serious complications involving the abdomen of trauma patients with massive bleeding.

Liuwei Anxiao San protects gastric mucosa from gastric ulcer in rats by regulating the JAK2/STAT3 pathway

Mongolian medicine prescriptions are recognized as promising gastroprotective agents. This study is to explore the effects and mechanisms of Liuwei Anxiao San (LAS) in gastric ulcer (GU). GU rat models were established using acetic acid, followed by treatment with LAS at different doses and/or the JAK2 agonist Coumermycin A1 (CA1). The ulcerous area and inhibition rates were calculated. The mucosal damage and cell apoptosis in gastric tissues were assessed by H&E and TUNEL staining. The activities of SOD, GSH-Px, and CAT, and MDA levels were measured. The levels of pro-inflammatory and anti-inflammatory factors were determined by ELISA. The activation of the JAK2/STAT3 pathway was determined by Western blot. As the results suggested, LAS dose-dependently ameliorated gastric mucosal damage and inhibited oxidative stress and inflammatory response, evidenced by increased activities of SOD, GSH-Px, and CAT, decreased MDA level, increment of anti-inflammatory factors and decrement of pro-inflammatory factors, and inhibited the activation of the JAK2/STAT3 pathway in GU rats. CA1 partly abolished the function of LAS on gastric mucosal injury, oxidative stress, and inflammation in GU rats. In conclusion, LAS protects against gastric mucosal injury in GU rats through inhibition of oxidative stress and inflammation by suppressing the JAK2/STAT3 pathway.

Astrocytes in the spinal cord contributed to acute stress-induced gastric damage via the gap junction protein CX43

Rat restraint water-immersion stress (RWIS) is a compound stress of high intensity and is widely used to study the pathological mechanisms of stress gastric ulcers. The spinal cord, as a part of the central nervous system, plays a dominant role in the gastrointestinal tract, but whether the spinal cord is involved in rat restraint water-immersion stress (RWIS)-induced gastric mucosal damage has not been reported. In this study, we examined the expression of spinal astrocytic glial fibrillary acidic protein (GFAP), neuronal c-Fos, connexin 43 (Cx43), and p-ERK1/2 during RWIS by immunohistochemistry and Western blotting. In addition, we intrathecally injected the astrocytic toxin L-a-aminoadipate (L-AA), gap junction blocker carbenoxolone (CBX), and ERK1/2 signaling pathway inhibitor PD98059 to explore the role of astrocytes in the spinal cord in RWIS-induced gastric mucosal damage and its possible mechanism in rats. The results showed that the expression of GFAP, c-Fos, Cx43, and p-ERK1/2 was significantly elevated in the spinal cord after RWIS. Intrathecal injection of both the astrocyte toxin L-AA and the gap junction blocker CBX significantly attenuated RWIS-induced gastric mucosal damage and decreased the activation of astrocytes and neurons induced in the spinal cord. Meanwhile, the ERK1/2 signaling pathway inhibitor PD98059 significantly inhibited gastric mucosal damage, gastric motility and RWIS-induced activation of spinal cord neurons and astrocytes. These results suggest that spinal astrocytes may regulate the RWIS-induced activation of neurons via CX43 gap junctions and play a critical role in RWIS-induced gastric mucosa damage through the ERK1/2 signaling pathway.

Preventive and therapeutic effects of an exopolysaccharide produced by Lacticaseibacillus rhamnosus on alcoholic gastric ulcers

Crude exopolysaccharides produced by Lacticaseibacillus rhamnosus SHA113 were previously found to exhibit anti-alcoholic gastric ulcer activity in mice, but their major active fraction, structural characteristics, and underlying mechanisms remain unknown. Here, LRSE1 was identified as the active exopolysaccharide fraction produced by L. rhamnosus SHA113 responsible for the above effects. Purified LRSE1 had a molecular weight of 4.9 × 104 Da and was comprised of L-fucose, D-mannose, D-glucuronic acid, d-glucose, D-galactose, and L-arabinose in the molar ratio of 2.4:6.5:1.2:1.00:0.3:0.6, respectively. The oral administration of LRSE1 resulted in a significant protective and therapeutic effect on alcoholic gastric ulcers in mice. These effects were identified to involve a reduction in reactive oxygen species, apoptosis, and the inflammatory response, increases in antioxidant enzyme activities, and increases in the phylum Firmicutes and decreases in the genera Enterococcus, Enterobacter, and Bacteroides in the gastric mucosa of mice. In vitro experiments showed that the administration of LRSE1 both inhibited apoptosis in GEC-1 cells via the TRPV1-P65-Bcl-2 pathway and inhibited the inflammatory response in RAW264.7 cells via the TRPV1-PI3K pathway. For the first time, we have identified the active exopolysaccharide fraction produced by Lacticaseibacillus that protects against alcoholic gastric ulcers and determined that its effect involves TRPV1-mediated pathways.

The role of peripheral serotonin and norepinephrine in the gastroprotective effect against stress of duloxetine

Duloxetine has been shown to produce gastroprotective effect against gastric ulcer induced by water immersion restraint stress (WIRS) via modulation of NADPH oxidases in the gastric mucosa and neurometabolites of central nucleus of amygdala. However, the underlying mechanism based on the basic pharmacological function of duloxetine-regulation on serotonin (5-HT) and norepinephrine (NE) remains unclear. Here, we found that 5-HT level in platelet-poor plasma (PPP) was decreased but NE level in plasma was increased in rats exposed to WIRS, while pretreatment with duloxetine increased 5-HT in PPP dose-dependently and decreased NE in plasma of rats after WIRS. We further showed that depletion of 5-HT by 4-chloro-DL-phenylalanine (PCPA) aggravated gastric mucosa damage and supplement of 5-HT alleviated gastric ulcers induced by WIRS. Blockade of NE receptors also mitigated the stress gastric ulcers. Using adrenalectomy and chemical blocking, we identified that it was NE from adrenal medulla rather than sympathetic nerve that was more critical in the gastroprotection of duloxetine, and intriguingly, glucocorticoid did not make a difference in WIRS-provoked gastric ulcers as a classic stress hormone. Together, our work demonstrated prophylactic protection of duloxetine from the stress gastric ulcer depended on enhancing peripheral 5-HT content and reducing NE from adrenal medulla, which provided insight into treatments of WIRS-induced gastric ulcer.

ADME-Tox Prediction and Molecular Docking Studies of Two Lead Flavonoids From the Roots of Tephrosia Egregia Sandw and the Gastroprotective Effects of Its Root Extract in Mice

Background: This study aimed to predict the pharmacokinetic and toxicological properties of lead flavonoids from the roots of T. egregia [praecansone A (1) and pongachalcone (2)], and to assess the gastroprotective effects and possible underlying mechanisms of the root extract in mice.Methods: Quantitative and qualitative data for in silico absorption, distribution, metabolism, and excretion (ADME) analyses of the two flavonoids were acquired from the SwissADME database. Toxicity assessment was performed with the ProTox-II server. To evaluate the putative interactions of both flavonoids with opioid receptors and NO protein, we acquired structures of the targets (&#x03BC;, &#x03BA;, and &#x03B4;-opioid receptors, and iNOS) in Homo sapiens from <a href="https://www.rcsb.org/">https://www.rcsb.org/</a>. For docking studies, AutoDock 4.2 was used for ligand and target arrangement, and AutoDock Vina was used for calculations. For in vivo assays, mice were pretreated (per os) with T. egregia (2, 20, or 200 mg/kg). After 60 min, 99.9% ethanol (0.2 mL) was injected (per os). At 30 min after ethanol injection, the mice were euthanized, and the gastric damage, gastric levels of hemoglobin, glutathione content, and activity of superoxide dismutase and catalase were evaluated. To elucidate T. egregia mechanisms, we used misoprostol, a prostaglandin analog; indomethacin, an inhibitor of prostaglandin synthesis; L-arginine, an NO precursor; L-NAME, an antagonist of NO synthase; naloxone, an opioid antagonist; and morphine, an opioid agonist.Results: In silico results showed that flavonoids (1) and (2) had favorable ADME properties and toxicity profiles, and exhibited satisfactory binding energies data (below &#x2212;6.0 kcal/mol) when docked into their targets (&#x03BC;, &#x03BA;, and &#x03B4;-opioid receptors, and iNOS). T. egregia decreased the ethanol-induced gastric damage and hemoglobin levels, and increased the glutathione content, and activity of superoxide dismutase and catalase. Naloxone and L-NAME, but not indomethacin, prevented T. egregia&#x2019;s effects, thus suggesting that opioid receptors and NO are involved in T. egregia&#x2019;s efficacy.Conclusions: Flavonoids (1) and (2) exhibited favorable pharmacokinetic properties, showing high lethal dose, 50% (LD50; 3,800 and 2,500 mg/kg, respectively) values. Neither flavonoid was found to be hepatotoxic, carcinogenic, or cytotoxic to human cells. In vivo assays indicated that T. egregia ameliorated oxidative stress levels, and its mechanism is at least partially based on opioid receptors and NO. T. egregia may therefore be considered as a new gastroprotective strategy.

Ethanolic extract of okra has a potential gastroprotective effect on acute gastric lesions in Sprague Dawley rats

Okra (Abelmoschus esculentus) has various bioactive components used for the treatment of different diseases such as gastritis and ulcers. This research aims to examine the anti-inflammatory and anti-ulcer attributes of okra extract against gastric lesions. Adult Sprague Dawley male albino rats were divided into five groups. The negative control (G1) received normal feed, positive control (G2) received ulcer-inducing drug aspirin 150 mg/kg of body weight (b.w), G3 group received reference drug omeprazole 20 mg/kg of b.w, G4 group received okra extract 250 mg/kg of b.w, and G5 group received 500 mg/kg of b.w. Acute gastric damage was induced in G1, G2, G3, and G4 using aspirin 150 mg/kg of b.w, during 14-day-long efficacy trials after that all the animals were sacrificed. Anti-ulcer parameters and histopathological analysis of stomachs were performed to evaluate the degree of recovery against tissue damage by the administration of okra extract. The obtained results indicated that the 500 mg/kg of b.w okra extract exerted a protective effect in aspirin-induced gastric ulcers by significantly (p < .05) reducing ulcer score, ulcer area, total acidity, and gastric volume, and significantly (p < .05) increasing gastric pH. Moreover, histopathological observation revealed that gastric mucosa was normal in G1, G3, G4, and G5; however, disruptions in the gastric epithelium were observed in G2. Congestion was observed in all groups except G1 and G5. Gastric pits and gastric glands were increased in size in G2 and G4. A higher concentration of okra extract (500 mg/kg of b.w) showed almost similar results when compared to the reference drug omeprazole.