Ability of lactulose breath test results to accurately identify colorectal polyps through the measurement of small intestine bacterial overgrowth

BACKGROUND

While colorectal polyps are not cancerous, some types of polyps, known as adenomas, can develop into colorectal cancer over time. Polyps can often be found and removed by colonoscopy; however, this is an invasive and expensive test. Thus, there is a need for new methods of screening patients at high risk of developing polyps.

AIM

To identify a potential association between colorectal polyps and small intestine bacteria overgrowth (SIBO) or other relevant factors in a patient cohort with lactulose breath test (LBT) results.

METHODS

A total of 382 patients who had received an LBT were classified into polyp and non-polyp groups that were confirmed by colonoscopy and pathology. SIBO was diagnosed by measuring LBT-derived hydrogen (H) and methane (M) levels according to 2017 North American Consensus recommendations. Logistic regression was used to assess the ability of LBT to predict colorectal polyps. Intestinal barrier function damage (IBFD) was determined by blood assays.

RESULTS

H and M levels revealed that the prevalence of SIBO was significantly higher in the polyp group than in the non-polyp group (41% vs 23%, P < 0.01; 71% vs 59%, P < 0.05, respectively). Within 90 min of lactulose ingestion, the peak H values in the adenomatous and inflammatory/hyperplastic polyp patients were significantly higher than those in the non-polyp group (P < 0.01, and P = 0.03, respectively). In 227 patients with SIBO defined by combining H and M values, the rate of IBFD determined by blood lipopolysaccharide levels was significantly higher among patients with polyps than those without (15% vs 5%, P < 0.05). In regression analysis with age and gender adjustment, colorectal polyps were most accurately predicted with models using M peak values or combined H and M values limited by North American Consensus recommendations for SIBO. These models had a sensitivity of ≥ 0.67, a specificity of ≥ 0.64, and an accuracy of ≥ 0.66.

CONCLUSION

The current study made key associations among colorectal polyps, SIBO, and IBFD and demonstrated that LBT has moderate potential as an alternative noninvasive screening tool for colorectal polyps.

Differentiation between alcohol-associated cirrhosis and hepatitis B-associated cirrhosis based on hepatic complications and psychological symptoms

Background

The prognosis of and occurrence of complications in patients with different clinical features of cirrhosis differ, and cirrhosis with different etiologies has varying clinical characteristics. The aim of this study was to describe the liver function markers, hepatic complications, and psychological features differentiating patients with hepatitis B virus (HBV) infection-related and alcohol-related cirrhosis.

Materials and Methods

This was a retrospective and observational study that analyzed the medical data of inpatients with alcohol-related or HBV infection-related cirrhosis from May 2014 to May 2020. Markers of liver function, portal hypertension, and psychological symptoms were compared between the two groups.

Results

Patients with alcohol-related cirrhosis showed higher Self-Rating Anxiety Scale scores and prevalence of hypoproteinemia, fatty liver, and depression than those with HBV infection-related cirrhosis (all P < 0.05). After adjustment for potential confounders, patients with alcohol-related cirrhosis also showed higher risks of increased total cholesterol (odds ratio [OR] =2.671, 95% confidence interval [CI]: 1.160-6.151, P = 0.021), increased high-density lipoprotein-cholesterol (OR = 2.714, 95% CI: 1.009-7.299, P = 0.048), and fatty liver (OR = 2.713, 95% CI: 1.002-7.215, P = 0.048); however, splenomegaly and splenectomy were significantly associated with HBV infection-related cirrhosis (OR = 2.320, 95% CI: 1.066-5.050, P = 0.034).

Conclusion

Patients with alcohol-related cirrhosis were more likely to develop hyperlipidemia, fatty liver, and psychological symptoms, whereas those with HBV-related cirrhosis had a higher risk of splenomegaly.

Effects of Washed Microbiota Transplantation on Serum Uric Acid Levels, Symptoms, and Intestinal Barrier Function in Patients with Acute and Recurrent Gout: A Pilot Study

INTRODUCTION

Gut dysbiosis has been reported to be closely associated with gout. Washed microbiota transplantation (WMT) is considered as an effective way to restore a healthy gut microbiota with less adverse events than the conventional fecal microbiota transplantation. In this study, we aimed to evaluate the effects of WMT on serum uric acid levels, symptoms, and the intestinal barrier function in patients with acute and recurrent gout.

METHODS

We performed a pilot study of WMT for acute and recurrent gout. The primary outcome was the changes in the serum uric acid level and gout symptoms. The secondary outcomes included the changes in levels of diamine oxidase (DAO), D-lactic acid, and endotoxin.

RESULTS

Eleven patients received WMT treatment. The averaged serum uric acid levels in patients with gout reduced after WMT (p = 0.031), accompanied with a decrease in the frequency and duration time of acute gout flares (p < 0.01). The levels of DAO, D-lactic acid, and endotoxin were higher in patients than in healthy donors (p < 0.05). After WMT treatment, the levels of DAO and endotoxin decreased (p < 0.05).

CONCLUSIONS

WMT is effective for reducing serum uric acid levels and improving gout symptoms in patients with gout and contributes to improve their impaired intestinal barrier function.

Serum Lactate Dehydrogenase Is a Sensitive Predictor of Systemic Complications of Acute Pancreatitis

BACKGROUND

Acute pancreatitis (AP) is a common and potentially life-threatening inflammatory disease that can cause various complications, including systemic inflammatory response syndrome (SIRS), pleural effusion, ascitic fluid, myocardial infarction, and acute kidney injury (AKI). However, there is still a lack of rapid and effective indicators to assess the disease. The aim of this study was to investigate the associations of high serum lactate dehydrogenase (LDH) levels with AP severity and systemic complications.

METHODS

AP patients treated from July 2014 to December 2020 were retrospectively enrolled. They were divided into elevated (n = 93) and normal (n = 143) LDH groups. Their demographic data, clinical data, hospital duration, and hospital expenses were analyzed. Linear and binary logistic regression analyses were used to determine whether elevated LDH is a risk factor for AP severity and complications after adjusting for confounders.

RESULTS

There were significant differences in AP severity scores (Ranson, MODS, BISAP, APACHE II, and CTSI), hospital duration, hospital expenses, and the incidences of complications (SIRS, pleural effusion, ascitic fluid, myocardial infarction, and AKI) between the elevated and normal LDH groups. After adjusting for confounders, elevated LDH was associated with AP severity scores and hospital duration and expenses (based on linear regression analyses) and was a risk factor for the occurrence of AP complications and interventions, that is, diuretic and vasoactive agent use (based on binary logistic regression analyses).

CONCLUSIONS

Elevated LDH is associated with high AP severity scores and high incidences of complications (SIRS, pleural effusion, ascitic fluid, myocardial infarction, and AKI).

Changes in oral flora of patients with functional dyspepsia

To explore the changes in oral flora in people with functional dyspepsia (FD). Unstimulated saliva was collected from 21 FD patients diagnosed according to the Rome IV criteria and from 12 healthy controls (HCs) for 16SrRNA sequencing. The pH of saliva samples and community periodontal index (CPI) were tested. The prevalence of small intestinal bacterial overgrowth (SIBO) was obtained by the methane-and hydrogen-based breath test. At the phylum level, FD patients had a higher relative abundance of Spirochaetes and a lower relative abundance of Fusobacteria, TM7 and Proteobacteria than HCs (p < 0.01). In the saliva, Kingella and Abiotrophia genus levels showed significant changes between the FD and HC groups (p < 0.01). Salivary species level marker Intermedia was significantly different between FD and HC groups (p < 0.01). The oral pH of FD patients was higher than that of HCs (p < 0.01). The mean CPI of the FD group was 1.52 and that of the HC group was 0.17 (p < 0.01). Moreover, 71.4% of the FD group was positive for SIBO. The oral flora of FD patients was different from that of HCs. Spirochaetes, Kingella, Abiotrophia, and Intermedia may be diagnostic indicators of FD.

Washed microbiota transplantation reduces proton pump inhibitor dependency in nonerosive reflux disease

BACKGROUND

The pathogenesis of gastroesophageal reflux disease (GERD) is closely associated with the intestinal bacteria composition and their metabolites.

AIM

To investigate whether washed microbiota transplantation (WMT) improves symptoms of nonerosive reflux disease (NERD) with proton pump inhibitor (PPI) dependency.

METHODS

Patients with recurrent NERD and PPI dependency at the First Affiliated Hospital of Guangdong Pharmaceutical University from 2017 to 2018 were included and divided into a WMT or PPI group treated with PPI with/without WMT. The endpoint was NERD symptom frequency evaluated 1 mo after WMT using reflux disease questionnaire (RDQ) and GERD questionnaire (GERDQ) scores, remission time, PPI dose, and the examination of intestinal mucosal barrier function.

RESULTS

In the WMT (n = 15) and PPI (n = 12) groups, the total remission rate at 1 mo after treatment was 93.3% vs 41.7%. Compared with the PPI group, the WMT group showed better results in GERDQ (P = 0.004) and RDQ (P = 0.003) and in remission months (8 vs 2, P = 0.002). The PPI dose was reduced to some extent for 80% of patients in the WMT group and 33.3% in the PPI group. In 24 patients, intestinal mucosal barrier function was examined before treatment, and changes in the degree of damage were observed in 13 of these patients after treatment. Only one of the 15 patients had minor side effects, including a mushy stool two or three times a day, which resolved on their own after 1 wk.

CONCLUSION

This study is the first to demonstrate that WMT may be safe and effective for relieving NERD symptoms and reducing PPI dependency and recurrence.

Multi-donor multi-course faecal microbiota transplantation relieves the symptoms of chronic hemorrhagic radiation proctitis: A case report

RATIONALE

There are many treatments for chronic hemorrhagic radiation colorectal inflammation, but only a few treatments are supported by high-quality research evidence. Studies have shown that the occurrence and development of radiation proctitis are closely associated with the intestinal flora. Animal studies have indicated that faecal microbiota transplantation (FMT) can improve radiation enteropathy in a mouse model.

PATIENT CONCERNS

A 45-year-old female patient suffered from recurrent hematochezia and diarrhea for half a year after radiotherapy and underwent recurrent transfusion treatments. Colonoscopy showed obvious congestion of the sigmoid colon and rectal mucosa, a smooth surface, and bleeding that was easily induced by touch, which are consistent with radiation proctitis. The pathological findings revealed chronic mucosal inflammation. The magnetic resonance imaging examination of the pelvic cavity with a plain scan and enhancement showed changes after radiotherapy and chemotherapy, and no obvious tumor recurrence or metastasis was found. The laboratory examinations excluded pathogen infection.

DIAGNOSES

Based on the history and examinations, the final diagnosis of this patient was chronic hemorrhagic radiation proctitis.

INTERVENTIONS

The patient was treated with a total of 4 individual courses of FMT.

OUTCOMES

After the six-month follow-up, her hematochezia, abdominal pain and diarrhea were relieved. Furthermore, 16S rRNA sequencing of the feces showed that the intestinal bacterial composition of the patient obviously changed after FMT and became similar to that of the donors.

LESSONS

This case report shows that FMT can relieve the symptoms of hematochezia and diarrhea by changing the bacterial community structure in patients with chronic hemorrhagic radiation proctitis.

Treatment of COVID-19 patients suspected with gut microbiota dysbiosis with washed microbiota transplantation: study protocol for a randomized controlled trial.. [DOI: 10.21203/rs.3.rs-56663/v1]

BACKGROUND: Coronavirus disease 2019 (COVID-19) is often accompanied by gastrointestinal symptoms, which is related to gut microbiota dysbiosis (GMD). Whether washed microbiota transplantation (WMT) is effective in COVID-19 patients suspected with GMD by restoring gut microbiota is unknown. This study is designed to explore the efficacy and safety of WMT in COVID-19 patients suspected with GMD.METHODS: COVID-19 patients suspected with GMD will be randomly divided to receive routine treatment (group A) or receive routine treatment and WMT (group B). The frequency of WMT will be once a day for three consecutive days. Nucleic acid test, imaging examination, and tests related to organ functions, homeostasis, inflammatory response, intestinal barrier function and immunity will be performed at admission, 1, and 2 weeks after treatment and on the day of discharge. The clinical efficacy and safety of WMT in COVD-19 suspected with GMD and the effects of WMT on the organ function, homeostasis, inflammatory response, intestinal barrier function and immunity of the patients will be evaluated. The primary outcome will be the clinical efficacy, as reflected by the SARS-Cov-2 infection status, gastrointestinal symptoms and the recovery of the disease. The secondary outcomes will be the effects of WMT on the organ function, homeostasis, inflammatory response, intestinal barrier function and immunity of the patients, as well as occurrence of adverse events during WMT.DISCUSSION: In the proposed protocol, WMT is expected to be efficacious and safe for the treatment of COVID-19 patients suspected with GMD, and the therapeutic effect is expected to be associated with the improvement of intestinal barrier function, inflammatory response and immunity. Findings from this study may open up a new way for the prevention and treatment of COVID-19 suspected with GMD.TRIAL REGISTRATION: Chinese Clinical Trial Registry – URL: http://www.chictr.org.cn/index.aspx. Registration number: ChiCTR2000032737. Registered 9 May 2020.

The Efficacy of Washed Microbiota Transplantation on Helicobacter pylori Eradication: A Pilot Study

AIM

The fecal microbiota transplantation by washed preparation was recently coined as washed microbiota transplantation (WMT). This pilot study is aimed at exploring the feasibility and efficacy of WMT on Helicobacter pylori eradication.

METHODS

Consecutive patients who had been treated with WMT for various indications and who were positive for H. pylori infection before WMT treatment but had never received eradication therapy for H. pylori infection were invited to take a follow-up ¹³C-urea breath test. The associations of demographic, clinical factors, and laboratory indicators for gastric function and intestinal barrier function with the therapeutic effect were determined.

RESULTS

A total of 32 eligible patients were included, and the overall H. pylori eradication rate was 40.6% (13/32). Patients with H. pylori eradication had a higher pepsinogen ratio (PGR) than those without (13.00 ± 6.97vs.8.31 ± 3.733; P = 0.02). Female patients had a higher, albeit not statistically significant, eradication rate than male patients (53.85% vs. 31.58%; P = 0.208). Compared with lower gastrointestinal tract delivery route, middle gastrointestinal tract delivery route seems to be a more suitable way for the treatment of H. pylori infection (58.33% vs 16.67%; P = 0.152). There was no significant difference in other demographic and clinical factors between patients with and without H. pylori eradication.

CONCLUSION

H. pylori infection is eradicated in a proportion of patients who have received WMT. An increased pre-WMT PGR appears to be associated with the therapeutic effect. Further studies are required to confirm the efficacy of WMT, especially in combination with currently recommended regimens in randomized controlled trials.

Hair regrowth following fecal microbiota transplantation in an elderly patient with alopecia areata: A case report and review of the literature

BACKGROUND

Alopecia areata is a hair loss disease associated with genetics, autoimmunity, and other factors. There is an intriguing link between alopecia areata and gut dysbiosis. Fecal microbiota transplantation (FMT) has been recommended to treat Clostridium difficile (previously known as Clostridioides difficile) infection, and has also shown potentials in the treatment of inflammatory bowel disease, irritable bowel syndrome, and non-alcohol fatty liver disease.

CASE SUMMARY

An 86-year-old man, with a history of sigmoid colon carcinoma, suffered from recurrent abdominal pain and distension, and diarrhea for six months, with inappetence. At admission, he was also diagnosed with depression. Upon physical examination, the patient presented with a 1.5 cm × 2.0 cm alopecia areata on his right occiput. Due to the negative results of laboratory testing, capsule endoscopy, and colonoscopy, the patient was diagnosed with noninfectious diarrhea, depressive disorder, and patchy alopecia areata. Considering that noninfectious diarrhea in the elderly patient was mainly caused by gut dysbiosis, he was given six rounds of FMT. His diarrhea improved remarkably one month after FMT, with improved appetite and disappearance of abdominal pain, distension, and depressive symptoms. Surprisingly, he reported new hair growth on the affected region of his scalp, with some of his white hair gradually turning to black, without taking any other therapies for alopecia areata before and after FMT.

CONCLUSION

FMT might act as a potential therapy for patients who suffer from alopecia areata. Large and well-designed studies are required to confirm the role of FMT in alopecia areata.

[Chronic liver disease increases with damage to intestinal barrier function]

Objective: To probe into the correlation between chronic liver disease and intestinal barrier function. Methods: 1 491 cases of hospitalized patients were enrolled, of which 741 cases were of chronic liver diseases, including 397 cases of fatty liver diseases, 230 cases of chronic hepatitis, 114 cases of liver cirrhosis, and 750 cases of non-hepatic diseases. All admitted patients' intestinal barrier function like diamine oxidase (DAO), D-lactate, lipopolysaccharide, and biochemical indicators of liver functions were tested. According to different data, statistical analysis was done using t-test, ANOVA, Dunnett's test, χ (2) test of fourfold table, Pearson's correlation, and binary logistic regression. Results: The intestinal barrier dysfunction was more likely to occur in the chronic liver disease group than that of non-hepatic disease group [54.15% (379/741) vs. 18.53% (139/750), χ (2) = 193.58, P < 0.001]. The correlation analysis between biochemical indicators of liver function and intestinal barrier function in chronic liver disease group showed that alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), and total bilirubin levels were more susceptible to intestinal barrier dysfunction than those with normal indexes (P < 0.05 ). GGT had stimulated DAO (P < 0.05, OR > 1), D-lactate (P < 0.05, OR > 1), lipopolysaccharide (P < 0.05, OR > 1), ALT and AST. Conclusion: Chronic liver disease increases with damage to intestinal barrier function.

Type 2 Diabetes Mellitus Is Associated with More Serious Small Intestinal Mucosal Injuries

BACKGROUND

Clinical and experimental research has revealed that diabetes mellitus (DM) is characterized by intestinal hypomotility, gut microbial dysbiosis, increased gut permeability, microcirculation disorders, circulatory changes, and dysfunction of intestinal stem cells, which may be linked to inflammation of intestinal mucosa. However, the relationship between type 2 DM (T2DM) and macroscopic small intestinal mucosal injuries is still unclear. Therefore, we retrospectively studied capsule endoscopy data to determine the relationship between T2DM and small intestinal mucosal injuries.

MATERIALS AND METHODS

We compared the records of 38 T2DM patients with those of 152 non-DM patients for small intestinal mucosal injuries. Different types of mucosal injuries and Lewis scores were compared between T2DM and non-DM patients. The relationships between patients with or without different types of diabetic complications and the Lewis score was assessed. Moreover, the relationships between insulin resistance and Lewis score, between HbA1c and Lewis score, were also both assessed.

RESULTS

The prevalence of a villous edema in subjects with T2DM was significantly higher than in those without DM (P < 0.001), but incidence of ulcers was not different (P = 1.000). With T2DM, the Lewis score was also significantly higher (P = 0.002). In addition, subjects with diabetic nephropathy showed significantly higher Lewis scores than patients without diabetic nephropathy (P = 0.033). In Pearson's correlation tests, the homeostasis model assessment of insulin resistance (HOMA-IR) value was correlated positively with the Lewis score (γ = 0.175, P = 0.015), but no statistical correlation was found between HbA1c level and Lewis score (γ = 0.039, P = 0.697).

CONCLUSIONS

Subjects with T2DM, especially those with diabetic nephropathy, have higher Lewis scores and more serious small intestinal mucosal lesions.

Effect of piperlonguminine on expression of peroxiredoxin-4 gene in rats with acute pancreatitis

AIM: To observe the effect of piperlonguminine on the expression of peroxidoxin-4 (Prdx-4) in pancreatic tissue and serum levels of inflammatory mediators.

METHODS: Thirty SD rats were randomly divided into a sham operated group (SO group), an SAP group and a piperlonguminine group (P group) with 10 rats in each group. A rat acute pancreatitis model was established by retrograde injection of 5% sodium tauroeholate (0.1 mL/100 g) into the biliopancreatic duct. Sodium tauroeholate was replaced with saline in the SO group. Piperlonguminine (5 mg/kg) was injected intraperitoneally in the P group after model development. The rats were sacrificed 12 h after operation, and pancreatic tissue samples were taken to detect the tissue wet/dry ratio, the expression level of Prdx-4 mRNA and histopathological changes. Serum levels of amylase (AMS) and interferon-γ (IFN-γ) were also measured.

RESULTS: The wet/dry ratio, AMS, IFN-γ and Prdx-4 mRNA in the SO group were significantly lower than those in the SAP group, but these indexes in the P group were significantly higher than those in the SO group (P < 0.05). The pancreatic histopathologic score in the P group was lower than that of the SAP group (3.86 ± 1.24 vs 8.24 ± 1.67, P < 0.05), but higher than that of the SO group (P < 0.05).

CONCLUSION: Piperlonguminine can not only reduce the levels of AMS, IFN-γ and Prdx-4 mRNA but also improve pancreatic pathological damage. Piperlonguminine alleviates pancreatitis via an anti-inflammatory effect.

Dexamethasone treatment upregulates glutamyl prolyl tRNA synthetase expression in liver tissue of rats with severe acute pancreatitis-associated liver injury

AIM: To investigate the effect of dexamethasone (DEX) on the expression of glutamyl prolyl tRNA synthetase (EPRS) in liver tissue of rats with severe acute pancreatitis (SAP)-associated liver injury.

METHODS: Ninety-six SD rats were randomly divided into an SAP model group, a sham operation (SO) group, and a DEX treatment group. Sodium taurocholate was used to induce SAP in rats of the model group and DEX group. Dexamethasone was given by intramuscular injection at 0.5 mg/100 g in the DEX group. Rats in each group were killed at different points (2, 6, 12, and 24 h) after treatment for further analysis. HE staining was used to observe liver damage. Serum amylase (AMS) content was measured by iodine colorimetric method. ELISA was used to detect the expression of liver nuclear factor κB (NF-κB) and interferon-γ (IFN-γ). The expression of EPRS was detected by immunohistochemical staining.

RESULTS: The SAP group suffered more severe inflammatory exudation than the SO group as revealed by liver HE staining. The DEX group had a decreased pathological score compared with the SAP group (P = 0.025). Serum AMS was significantly lower in the DEX group than in the SAP group (P = 0.0013). NF-κB expression at 6 h was significantly lower (P = 0.047), but IFN-γ expression at 6 h was significantly higher in the DEX group than in the SAP group (P = 0.038). The DEX group had significantly increased EPRS expression at 6 h as shown by immunohistochemistry (P < 0.01).

CONCLUSION: Hepatic EPRS expression is increased at 6 h after dexamethasone treatment in SAP rats.

JAK-STAT signaling pathway and acute pancreatitis

The pathogenesis of acute pancreatitis has long been an important research topic. In acute pancreatitis, cytokines and growth factors bind to Janus kinase (JAK) related receptors, and activate JAKs. The activated JAKs phosphorylate the tyrosine residues of the receptor. The downstream signal transducers and activators of transcription (STAT) then bind to the specific site of the phosphorylated JAK receptor complexes, leading to the activation of STATs. The activated STATs detach from the receptor complexes and translocate to the nucleus to regulate the expression of Bcl-2, Bcl-X(L), Mcl-1 and other genes, thereby participating in the pathogenesis of pancreatitis. Such signal transduction can be terminated by the dephosphorylation of STATs. At present, more and more clinical experiments and animal studies have shown that the JAK-STAT pathway is closely related with acute pancreatitis. In this article, we will review the structure, distribution, and function of JAK-STAT signaling pathway as well as the role of JAK-STAT signaling pathway in the pathogenesis of acute pancreatitis.

PTD-NBD polypeptide down-regulates expression of NF-κB p65 in inflammatory pancreatic acinar cell injury in rats

AIM: To examine the effect of PTD-NBD polypeptide on the expression of nuclear factor κB (NF-κB) p65 in inflammatory pancreatic acinar cell injury in rats.

METHODS: Rat pancreatic acinar cells were isolated, cultured, and divided into a normal control group, an acute pancreatitis (AP) group and a PTD-NBD polypeptides group. An in vitro model of AP was induced by treating rat pancreatic acinar cells with lipopolysaccharide (10 mg/L). Cell morphological changes were observed, and the contents of amylase, superoxide dismutase (SOD) and IL-1β in culture medium were tested. Expression of NF-κB p65 mRNA and protein in cells was detected by RT-PCR and Western blot 6 and 12 h after modeling, respectively.

RESULTS: Compared to the control group, pancreatic acinar cell swelling and death were increased (6 h: 8.9 ± 0.34 vs 1.1 ± 0.13; 12 h: 9.4 ± 0.26 vs 1.2 ± 0.15, both P < 0.05), the contents of amylase (6 h: 2135.8 ± 347.2 vs 873.5 ± 91.6; 12 h: 3299.6 ± 217.7 vs 917.7 ± 101.9, both P < 0.05) and IL-1β (6 h: 84.9 ± 15.7 vs 39.3 ± 7.9; 12 h: 95.6 ± 17.1 vs 38.9 ± 5.2, both P < 0.05) were increased and the contents of SOD were decreased in culture medium (6 h: 116.3 ± 30.3 vs 176.2 ± 21.6; 12 h: 101.5 ± 25.6 vs 173.6 ± 27.9, P < 0.05), and the expression of NF-κB p65 in pancreatic acinar cells was increased (P < 0.05) in the AP group at 6 and 12 h after modeling. Compared to the AP group, pancreatic acinar cell swelling and death were lessened (6 h: 6.8 ± 0.23 vs 8.9 ± 0.34; 12 h: 7.5 ± 0.19 vs 9.4 ± 0.26, both P < 0.05), the contents of SOD were raised (6 h: 137.6 ± 27.4 vs 116.3 ± 30.3; 12 h: 144.3 ± 23.6 vs 101.5 ± 25.6, both P < 0.05) and the contents of amylase (6 h: 1951.5 ± 211.7 vs 2135.8 ± 347.2; 12 h: 1761.3 ± 231.5 vs 3299.6 ± 217.7, both P < 0.05) and IL-1β (6 h: 66.8 ± 11.6 vs 84.9 ± 15.7; 12 h: 54.8 ± 21.2 vs 95.6 ± 17.1, both P < 0.05) were decreased in culture medium, and the expression of NF-κB p65 mRNA and protein was down-regulated in the PAT-NBD polypeptide group (P < 0.05).

CONCLUSION: PTD-NBD polypeptide can inhibit LPS-induced activation of NF-κB p65, down-regulate IL-1β expression and up-regulate SOD content, thereby reducing inflammatory pancreatic acinar cell injury.

Advances in understanding the role of gene mutations in the pathogenesis of hyperlipidemic acute pancreatitis

Acute pancreatitis (AP) is a common disorder that manifests as acute abdomen and has an extremely high mortality rate. At present, the pathogenesis of AP has become a hot topic of research but has not been completely clarified yet. The relationship between hyperlipidemia (HL) and AP has attracted wide attention. Gene mutations, especially mutations in the lipoprotein lipase (LPL), glycosylphosphatidylinositol anchored high density lipoprotein-binding protein 1 (GPIHBP1) and apolipoprotein A-V (apoA-V) genes, are closely associated with the pathogenesis of HL and recurrent pancreatitis. In this article, we will review the recent progress in understanding the role of gene mutations in the pathogenesis of hyperlipidemic AP (HLAP).

Inhibitory effects of cell-permeable PTD-NBD peptide on lipopolysaccharide-induced inflammation of pancreatic acinar cell line AR42J

AIM: To explore the effects of cell permeable PTD-NBD peptide on rat pancreatic acinus AR42J cell induced by lipopolysaccharide.

METHODS: AR42J cell lines were stimulated by lipopolysaccharide with a dose of 10 mg/L for 24 h. The wild type PTD-NBD peptide was incubated with AR42J cells with different concentrations (10-1-102 mg/L) before the inflammation induced by lipopolysaccharide. At the same time, the mutant type PTD-NBD peptide, PTD and NBD peptide were used as control peptide fragments. The expressions of ICAM-1 and IL-1β mRNA were detected using reverse transcription-polymerase chain reaction (RT-PCR), and IL-1β protein was measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS: The PTD-NBD (WT) peptide inhibited the expression of ICAM-1 and IL-1β mRNA (0.449 ± 0.088, 0.526 ± 0.077), but also decreased the IL-1β protein level (278.82 ± 61.80 ng/L) in a dose-dependent manner. NBD (1.132 ± 0.069), PTD- NBD (MT) (1.158 ± 0.095) and PTD (1.206 ± 0.078) did not inhibit the expression of ICAM-1 mRNA. NBD (0.993 ± 0.065), PTD- NBD (MT) (1.143 ± 0.086) and PTD (1.128 ± 0.117) did not inhibit the expression of IL-1β mRNA. NBD (898.08 ± 74.65 ng/L), PTD-NBD (MT) (945.25 ± 42.49 ng/L) and PTD (947.86 ± 38.66 ng/L) failed to inhibit the expression of IL-1β protein.

CONCLUSION: The wild type PTD-NBD peptide is able to inhibit the expression of ICAM-1and IL-1β induced by LPS on AR42J cell lines in a dose-dependent manner. We confirmed PTD-NBD peptide can take effect on acinus cell directly. The result showed the early event and new therapeutic pathway of acute pancreatitis.

Cell-permeable Tat-NBD peptide attenuates rat pancreatitis and acinus cell inflammation response

AIM

To investigate the effects of Tat-NEMO-binding domain (NBD) peptide on taurocholate-induced pancreatitis and lipopolysaccharide (LPS)-stimulated AR42J acinus cells inflammatory response in rats.

METHODS

Sodium taurocholate (5%) was used to induce the pancreatitis model. Forty-eight rats from the taurocholate group received an intravenous bolus of 13 mg/kg Tat-NBD (wild-type, WT) peptide, Tat-NBD (mutant-type, MT) peptide, NBD peptide or Tat peptide. The pancreatic histopathology was analyzed by hematoxylin staining. LPS was added to the culture medium to stimulate the AR42J cells. For pretreatment, cells were incubated with different peptides for 2 h before LPS stimulation. Expression of IL-1beta and TNF-alpha mRNA was analyzed using a semi-quantitative reverse-transcript polymerase chain reaction (RT-PCR) method. IL-1beta and TNF-alpha protein in culture medium were detected by enzyme linked immunosorbent assay (ELISA). NF-kappaB DNA-binding in pancreas was examined by electrophoretic mobility shift assays. P65 expression of AR42J was determined by Strept Actividin-Biotin Complex (SABC) method.

RESULTS

Pretreatment with Tat-NBD (WT) peptide at a concentration of 13 mg/kg body wt showed beneficial effect in pancreaitis model. LPS (10 mg/L) resulted in an increase of IL-1beta mRNA, IL-1beta protein, TNF-alpha mRNA and TNF-alpha protein, whereas significantly inhibitory effects were observed when cells were incubated with Tat-NBD (WT). Consisting with p65 expression decrease analyzed by SABC method, NF-kappaB DNA-binding activity significantly decreased in Tat-NBD (WT) pretreatment group, especially at the largest dose. No significant changes were found in the control peptide group.

CONCLUSION

Our result supports that active NF-kappaB participates in the pathogenesis of STC-induced acute pancreatitis in rats. Tat-NBD (WT) peptide has anti-inflammatory effects in this model and inhibits the inflammation of acinus simulated by LPS.

Nuclear factor kappa B: A marker of chemotherapy for human stage IV gastric carcinoma

AIM: To detect the nuclear factor kappa B (NF-κB) condition in human stage IV gastric carcinoma patients and to explore the correlation between NF-κB activation and survival of these patients after chemotherapy.

METHODS: Expression of NF-κB-p65 was determined by immunohistochemical analysis. Activity of NF-κB DNA-binding in carcinoma tissue was detected by electrophoretic mobility shift assay. Kaplan-Meier survival analysis was performed to show the relation between NF-κB and progression-free survival (PFS) or overall survival (OS) of the patients.

RESULTS: The positive expression rate of NF-κB-p65 in 60 gastric cancer tissue samples was 76.7% (46/60). The expression of NF-κB-p65 was reduced in adjacent carcinoma and normal tissue samples. Electrophoretic mobility shift assay (EMSA) analysis showed a strong activation of NF-κB in cancer tissue samples. A survival difference was found in NF-κB-p65 positive and negative patients. NF-κB-p65 expression was negative in cancer tissue samples (n = 14). PFS was 191.40 ± 59.88 d and 152.93 ± 16.99 d, respectively, in patients with positive NF-κB-p65 expression (n = 46) (P = 0.4028). The survival time of patients with negative and positive NF-κB-p65 expression was 425.16 ± 61.61 d and 418.85 ± 42.98 d, respectively (P = 0.7303). Kaplan-Meier analysis showed no significant difference in PFS or OS. The 46 patient tissue which positive NF-κB-p65 expression was found in the tissue samples from the 46 patients whose PFS and OS were 564.89 ± 75.94 d and s 352.37 ± 41.32 d, respectively (P = 0.0165).

CONCLUSION: NF-κB is activated in gastric carcinoma tissue, which is related to the OS after chemotherapy.

Activation of nuclear factor-κB and intervention of NBD peptides in rats with severe acute pancreatitis

AIM: To study the role of nuclear factor-kappa B (NF-κB) and reactive oxygen species (ROS) in rats with severe acute pancreatitis (SAP), and to evaluate the effect of NF-κB essential modifier binding domain (NBD) peptides on this model.

METHODS: Sodium taurocholate (50 g/L, 1 mL/kg body weight) was retrogradely injected into rats' biliopancreatic ducts to induce the SAP model. Sixty-four rats were randomly divided into 4 groups: sham operation group, SAP group, TAT-NBD (WT) peptides group and TAT-NBD (MT) peptides group. The drugs were intraperitoneally injected into the rats 30 minutes before the operation. The changes of NF-κB P65 protein in pancreas, pancreatic histopathology, serum amylase, and malondialdehyde (MDA), total-superoxide dismutase (T-SOD) in pancreas were evaluated 6 and 12 h after operation.

RESULTS: In comparison with that in the sham operation group, the expression of NF-κB p65 protein was significantly enhanced in the SAP group at 6 or 12 h (49.3 ± 2.2 vs 4.3 ± 1.4, 65.8 ± 1.8 vs 5.0 ± 1.3, both P < 0.05); the production of MDA was also increased (212.7 ± 12.5 vs 87.7 ± 7.5, 296.8 ± 13.3 vs 96.2 ± 8.3, both P < 0.05); however, the activity of T-SOD was lowered (88 ± 10 vs 183 ± 10, 65 ± 7 vs 194 ± 10, both P < 0.05). In comparison with that in the SAP group, the expression of NF-κB p65 protein (25.9 ± 2.3, 38.9 ± 2.6) or the production of MDA (102.5 ± 10.4, 164.5 ± 12.2) was markedly decreased in the TAT-NBD (WT) group, while the activity of T-SOD was notably increased (153 ± 11, 168 ± 12) (P < 0.05); the histological scores for pancreas were also reduced (5.04 ± 0.41 vs 8.71 ± 0.45, 5.45 ± 0.34 vs 10.31 ± 1.23, both P < 0.05); the level of serum amylase had no obvious change. The above indexes had no marked changes in the TAT-NBD (MT) group.

CONCLUSION: NF-κB is over-activated and the production of ROS increases in SAP rats. NBD peptides could selectively inhibit the activation of NF-kappa B, the production of ROS, and thus lessen the inflammatory inury during SAP.

Robust increase of cutaneous sensitivity, cytokine production and sympathetic sprouting in rats with localized inflammatory irritation of the spinal ganglia

We investigated the role and mechanisms of inflammatory responses within the dorsal root ganglion (DRG) in the development of chemogenic pathological pain. DRG inflammation was induced by a single deposit of the immune activator zymosan in incomplete Freund's adjuvant in the epidural space near the L5 DRG via a small hole drilled through the transverse process. After a single zymosan injection, rats developed bilateral mechanical hyperalgesia and allodynia which began by day 1 after surgery, peaked at days 3-7, and lasted up to 28 days. The number of macrophages in ipsilateral and contralateral DRGs increased significantly, lasting over 14 days. Robust glial activation was observed in inflamed ganglia. Cytokine profile analysis using a multiplexing protein array system showed that, in normal DRG, all but interleukin (IL)-5, IL-10 and granulocyte-macrophage colony stimulating factor (GM-CSF) were detectable with concentrations of up to 180 pg/mg protein. Local inflammatory irritation selectively increased IL-1beta, IL-6, IL-18, monocyte chemoattractant protein-1 (MCP-1), and growth-related oncogene (GRO/KC) up to 17-fold, and decreased IL-2 and IL-12 (p70) up to threefold. Inflaming the DRG also remarkably increased the incidence of spontaneous activity of A- and C-fibers recorded in the dorsal root. Many of the spontaneously active A-fibers exhibited a short-bursting discharge pattern. Changes in cytokines and spontaneous activity correlated with the time course of pain behaviors, especially light stroke-evoked tactile allodynia. Finally, local inflammation induced extensive sprouting of sympathetic fibers, extending from vascular processes within the inflamed DRG. These results demonstrate the feasibility of inducing chronic localized inflammatory responses in the DRG in the absence of traumatic nerve damage, and highlight the possible contribution of several inflammatory cytokines/chemokines to the generation of spontaneous activity and development and persistence of chemogenic pathologic pain.

Sialic acid contributes to hyperexcitability of dorsal root ganglion neurons in rats with peripheral nerve injury

Axonal injury of the dorsal root ganglion (DRG) neurons may alter the synthesis of certain membrane proteins that are responsible for the development of abnormal hyperexcitability. The external domains of most of these membrane proteins are sialylated. Because sialic acid carries heavy negative charges, the increase of sialylated proteins may increase neurons' negative surface charges, which will have predictable effects on the voltage-gated channels, and affect the excitability of injured neurons. Using intracellular electrophysiological recording, we demonstrated that following chronic constriction injury (CCI) of the sciatic nerve, Aalpha/beta DRG neurons become hyperexcitable, as indicated by a more depolarized resting membrane potential (Vm) and a lowered threshold current (TIC). More interestingly, the excitability of injured DRG neurons was reduced substantially when the extracellular sialic acid was removed by pretreatment with neuraminidase. The Vm was less depolarized and the TIC increased robustly as compared to the CCI neurons without neuraminidase treatment. However, desialylation of normal, intact neurons had no significant effect on the Vm and less effect on the TIC. Our results suggest that the hyperexcitability of injured sensory neurons may be associated with increased negatively charged sialic acid residues on the surface of the neuronal somata.

Sialic acid contributes to generation of ectopic spontaneous discharges in rats with neuropathic pain

Ectopic spontaneous discharges (ESD) of teased myelinated fibers were recorded from the sciatic nerve proximal to the site of 'chronic constriction nerve injury' in the rat. Ca(2+), Mg(2+), Mn(2+), Ni(2+), La(3+) and some positively charged organic compounds (hexamethonium and poly-lysine) when applied topically to the injured site abolished or significantly reduced the rate of ESD. After enzymatic removal of sialic acid by neuraminidase (2 units/ml), the ESD was silenced in 11, reduced in four and unchanged in four of 19 fibers. However, divalent cations failed to depress the reappeared ESD evoked by 4-aminopyridine in the desialylated silenced fibers. Moreover, the mean incidence of ESD was significantly reduced after neuraminidase treatment. These results indicate that an increase in negative charges on the external membrane surface of injured neuron caused by sialylation is a key factor in ESD generation.