Persistent epithelial dysfunction and bacterial translocation after resolution of intestinal inflammation.

Epithelial secretion may play an important role in reducing bacterial colonization and translocation in intestine. If so, secretory dysfunction could result in increased susceptibility to infection and inflammation. We investigated whether long-term colonic secretory dysfunction occurs after a bout of colitis and if this is accompanied by an increase in bacterial colonization and translocation. Rats were studied 6 wk after induction of colitis with trinitrobenzene sulfonic acid when inflammation had completely resolved, and epithelial permeability was normal. Intestinal loops were stimulated with either Clostridium difficile toxin A or a phosphodiesterase inhibitor. In vitro, colonic tissue from previously sensitized rats was exposed to antigen (ovalbumin). Secretory responses to all three stimuli were suppressed in rats that had previously had colitis. These rats exhibited increased (16-fold) numbers of colonic aerobic bacteria and increased (>3-fold) bacterial translocation, similar to results in rats studied after resolution of enteritis. Postcolitis bacterial translocation was prevented by daily treatment with an inhibitor of inducible nitric oxide synthase. This study demonstrates that intestinal inflammation results in prolonged impairment of colonic epithelial secretion, which may contribute to increases in bacterial load and bacterial translocation. Epithelial dysfunction of this type could underlie an increased propensity for further bouts of inflammation, a hallmark of diseases such as inflammatory bowel disease.

Experimental colitis increases blood-brain barrier permeability in rabbits.

Extraintestinal manifestations of inflammatory bowel disease are numerous. This study examined the effects of two models of acute colitis on cerebral blood flow (CBF) and permeability of the blood-brain barrier in rabbits. CBF (measured with radiolabeled microspheres), or the extraction ratio or permeability-surface area (PS) product of the blood-brain barrier to fluorescein and FITC-dextran, was measured 48 h after colitis induction with acetic acid (HAc) or trinitrobenzene sulfonic acid (TNBS). PS product for fluorescein increased (P < 0.05) in TNBS colitis (1.33 x 10(-5) +/- 0.52 x 10(-5) ml/s and 0.48 x 10(-5) +/- 0.13 x 10(-5) ml/s (mean +/- SE) for treated (n = 14) and untreated (n = 10) animals, respectively. PS product for the larger FITC-dextran was not different in TNBS colitis (0.24 x 10(-5) +/- 0.09 x 10(-5) ml/s, n = 7) compared with untreated controls (0.19 x 10(-5) +/- 0.04 x 10(-5) ml/s, n = 8). PS product for fluorescein increased (P < 0.01) in HAc colitis compared with vehicle (2.66 x 10(-5) +/- 1.46 x 10(-5) ml/s and 0.33 x 10(-5) +/- 0.05 x 10(-5) ml/s, respectively; n = 6 in each group). The extraction of fluorescein from the blood to the brain increased by 75% during TNBS colitis when compared with vehicle (P < 0.05). CBF and cerebrovascular resistance did not change from the untreated control after TNBS colitis. Our data suggest that, irrespective of induction method, acute colitis increases the permeability of the blood-brain barrier to small molecules without changing CBF.

Temporal patterns of colonic blood flow and tissue damage in an animal model of colitis.

This study tested the hypothesis that altered colonic blood flow may contribute to tissue damage during the development of colitis in the rabbit. This was achieved by using radioactive microspheres to measure colonic blood flow at various times after colitis induction with trinitrobenzene sulfonic acid. Significant colonic damage occurred 6 hours post colitis induction and persisted throughout the 5 day study. Blood flow to the muscularis propria and mucosa/muscularis mucosae compartments increased significantly from 5 minutes until one hour post induction. At 6 and 12 hours post induction colonic blood flow returned to control levels before increasing again from 24 to 96 hours. This second increase in flow was, however, predominantly in the mucosa/muscularis mucosae compartment. Blood flow in the stomach and non-gastrointestinal tissues did not change significantly at any time. These data demonstrate that increased colonic blood flow may be disrupted in the early stages of colitis and that this coincides with the onset of significant damage. It is concluded that maintenance of elevated colonic blood flow throughout the development of colitis may help to ameliorate subsequent tissue injury.

TNF-alpha contributes to the pathogenesis of ethanol-induced gastric damage in cirrhotic rats.

Cirrhotic rats exhibit increased susceptibility to ethanol-induced gastric damage, but the underlying mechanism for this phenomenon remains unclear. Abnormalities of the gastric microcirculation have been reported that may contribute to the increased susceptibility to damage. Decreased gastric synthesis of prostaglandins also likely contributes to impaired mucosal defense in cirrhotic rats. Tumor necrosis factor-alpha (TNF-alpha) has been implicated in mucosal injury, and its synthesis can be inhibited by prostaglandins. Therefore, we hypothesized that TNF-alpha synthesis/ release is altered in cirrhotic rats and plays a role in the pathogenesis of ethanol-induced gastric damage. Cirrhosis was induced by bile duct ligation, whereas controls had sham operations. Topical application of 40% ethanol caused four times as much damage in cirrhotic rats than in controls. Basal plasma TNF-alpha levels did not differ between control and cirrhotic rats, although cirrhotic rats exhibited significantly higher levels of gastric TNF-alpha mRNA. Plasma TNF-alpha increased significantly in control and cirrhotic rats after ethanol administration. Inhibition of TNF-alpha synthesis/release with pentoxifylline, thalidomide, dexamethasone, or immunoneutralization of TNF-alpha (with anti-TNF-alpha) was found to significantly reduce the severity of ethanol-induced gastric mucosal damage in cirrhotic rats. We conclude that TNF-alpha contributes to the pathogenesis of ethanol-induced gastric damage in cirrhotic rats.

NO-naproxen vs. naproxen: ulcerogenic, analgesic and anti-inflammatory effects.

BACKGROUND: A novel class of nitric oxide-releasing nonsteroidal anti-inflammatory drug (NO-NSAID) derivatives has recently been described which exert anti-inflammatory activities but produce significantly less gastrointestinal injury than the parent NSAID from which they are derived. The present studies were performed to determine if a nitroxybutylester derivative of naproxen was less ulcerogenic to the gastrointestinal tract than its parent NSAID, and if it exerted comparable analgesic and anti-inflammatory properties to the parent NSAID. METHODS: The two drugs were compared in an acute gastric injury model, an antral ulcer model and after twice-daily administration for 18 days (small intestinal damage model). Anti-inflammatory activity was examined in the carrageenan-induced paw oedema model, while analgesia was examined in the acetic acid-induced writhing model. The pharmacokinetic profiles of naproxen vs. NO-naproxen were compared by HPLC analysis. RESULTS: NO-naproxen was found to produce significantly less gastric damage despite inducing similar increases in plasma TNF alpha to naproxen. With chronic administration, small intestinal damage was markedly less with NO-naproxen than with the parent NSAID. However, NO-naproxen exerted superior analgesic and comparable anti-inflammatory effects to naproxen. NO-naproxen was not completely converted to naproxen, but the reduced plasma levels of the latter was not the underlying reason for reduced gastrointestinal toxicity of NO-naproxen. CONCLUSION: NO-naproxen represents a novel, gastrointestinal-sparing NSAID derivative with superior analgesic and comparable anti-inflammatory properties to naproxen.

TNF-alpha facilitates inflammation-induced glucocorticoid secretion in rats with biliary obstruction.

AIMS: We investigated the role of TNF-alpha in inflammation-induced activation of the hypothalamic-pituitary-adrenal (HPA) axis in rats with cholestasis due to bile duct resection. METHODS: Acute inflammation was induced in bile duct or sham resected rats by subcutaneous injection of carrageenan and HPA axis activation was determined by measuring plasma ACTH and corticosterone levels in the absence or presence of TNF-alpha inhibition. RESULTS: Bile duct resected rats had a 2.4-fold elevation in basal circulating TNF-alpha levels compared to sham resected and unoperated controls. Acute inflammation induced by carrageenan injection resulted in a significant increase in plasma ACTH and corticosterone levels in bile duct resected and control rats in the absence of significant changes in plasma TNF-alpha levels. However, bile duct resected rats demonstrated blunted ACTH release coupled with augmented corticosterone secretion in response to carrageenan administration compared to control rats. Inhibition of TNF-alpha activity by pretreating rats with a specific TNF-antiserum or pentoxifylline did not alter inflammation-induced ACTH secretion in bile duct resected or control rats, or corticosterone secretion in control rats. However, anti-TNF treatments significantly attenuated the inflammation-induced rise in plasma corticosterone in bile duct resected rats. CONCLUSIONS: These results indicate that inflammation in rats with biliary obstruction is associated with blunted ACTH release coupled with augmented glucocorticoid secretion facilitated by TNF-alpha. Furthermore, these results suggest that what have been previously considered as low level elevations in circulating TNF-alpha levels can facilitate adrenal glucocorticoid secretion during the inflammatory response.

Tumor necrosis factor mediation of NSAID-induced gastric damage: role of leukocyte adherence.

Neutrophil adherence to the vascular endothelium has been suggested to be a critical event in the pathogenesis of nonsteroidal anti-inflammatory drug (NSAID)-induced gastric damage. Recently, increased plasma levels of tumor necrosis factor-alpha (TNF-alpha), which can increase leukocyte adherence, have been reported after administration of indomethacin. This study was performed to determine the relationship between plasma TNF-alpha levels, leukocyte adherence, and NSAID-induced gastric injury. Administration of indomethacin to rats resulted in a significant elevation of plasma TNF-alpha levels within 30 min and the development of gastric erosions. Pretreatment with dexamethasone and prostaglandin E2 almost completely prevented gastric injury and abolished the rise in plasma TNF-alpha. Pentoxifylline dose dependently reduced both gastric damage and plasma TNF-alpha. Similar effects were observed with three other TNF-alpha synthesis inhibitors and with an anti-TNF-alpha antisera. Pentoxifylline also significantly reduced the extent of antral ulceration induced by naproxen. However, pentoxifylline did not significantly affect indomethacin-induced leukocyte adherence. These results suggest that TNF-alpha plays a critical role in the pathogenesis of NSAID-induced gastric injury, but this cytokine may not be responsible for NSAID-induced leukocyte adherence.

Hapten-induced chronic colitis in the rat: alternatives to trinitrobenzene sulfonic acid.

Hapten-induced colitis is a widely used model for the study of the intestinal inflammation and for the testing of novel therapies. However, the hapten utilized in this model, trinitrobenzene sulfonic acid, is difficult to obtain in some countries. We therefore compared this hapten to two structurally related haptens to determine if they could be substituted for trinitrobenzene sulfonic acid in terms of inducing chronic colitis in the rat. Rats received one of the three haptens intracolonically, and the severity of colonic inflammation was assessed 3 and 14 days later. Dinitrobenzene sulfonic acid produced colonic inflammation and ulceration that was indistinguishable from that induced by trinitrobenzene sulfonic acid at both time points. On the other hand, dinitrochlorobenzene produced acute colitis (3 days postadministration), but by Day 14 this inflammation had subsided. Dinitrobenzene sulfonic acid and trinitrobenzene sulfonic acid produced comparable levels of granulocyte infiltration into the colon (as measured by tissue myeloperoxidase activity and histology) at both time points. These studies suggest that for studies of up to at least 2 weeks in duration, dinitrobenzene sulfonic acid and trinitrobenzene sulfonic acid produce comparable levels of colonic inflammation. Dinitrobenzene sulfonic acid therefore offers a useful and less expensive alternative to trinitrobenzene sulfonic acid.

Reactivation of hapten-induced colitis and its prevention by anti-inflammatory drugs.

Administration of a hapten together with a barrier breaker, such as ethanol, into the colon of a rat results in extensive mucosal injury and inflammation that bears some similarity to the colonic inflammation characterizing inflammatory bowel disease in humans. This inflammation and injury gradually subsides over the weeks after its induction. We have attempted to determine whether this colitis can be "reactivated" by administration of the hapten systemically weeks after its initial intracolonic administration. Six weeks after intracolonic administration of trinitrobenzene sulfonic acid (the hapten) in a vehicle of 50% ethanol, most of the colonic injury and inflammation had subsided. Intravenous administration of the hapten at 24-h intervals over 3 days resulted in reactivation of the colitis, with significant increases in macroscopic and histological damage scores (mucosal injury and inflammation) and a significant increase in granulocyte infiltration, as measured by tissue myeloperoxidase (MPO) infiltration, as measured by tissue myeloperoxidase (MPO) activity. The increase in MPO activity occurred only in the region previously exposed to the hapten. Intravenous administration of saline did not reactivate the colitis, nor did intravenous administration of the hapten to rats previously treated intracolonically with saline or the ethanol vehicle. Reactivation of colitis by hapten administration was not accompanied by activation of mucosal mast cells. Treatment with dexamethasone prevented the increase in colonic damage score and MPO activity elicited by intravenous hapten administration. Cyclosporin A reduced MPO activity, and 5-aminosalicylic acid reduced the colonic damage score, whereas lidocaine and two inhibitors of leukotriene synthesis did not significantly affect either of these parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Biosynthesis of platelet-activating factor in normal and inflamed human colon mucosa: evidence for the involvement of the pathway of platelet-activating factor synthesis de novo in inflammatory bowel disease.

1. Platelet-activating factor can be synthesized by two distinct biochemical pathways and is degraded by a number of enzymes, the first step of which is deacetylation by a specific acetyl hydrolase. 2. The biochemical pathway of platelet-activating factor synthesis de novo and the first step in platelet-activating factor degradation have been investigated for the first time in incubates of normal human colon mucosa and in inflamed mucosa from patients with inflammatory bowel disease. 3. In the presence of 100 mumol/l CDP-choline and 100 mumol/l hexadecyl acetyl glycerol, homogenates from inflamed mucosa synthesized significantly greater platelet-activating factor [851 +/- 574 pmol/mg of protein (mean +/- SEM) in 90 min incubation] than normal mucosa [105 +/- 61 pmol/mg of protein in 90 min incubation] (P < 0.05). 4. Under the same conditions of assay, the percentage turnover to inactive lyso-platelet-activating factor was similar in inflamed mucosa (35.5 +/- 9.4%) and normal mucosa (42.7 +/- 8.5%) in 90 min (P > 0.05). 5. The identity of platelet-activating factor was confirmed by HPLC, by its mobility on TLC and by the ability of WEB 2170, a selective platelet-activating factor receptor antagonist, to block its platelet-aggregatory action. 6. These findings confirm the presence of the pathway for the synthesis de novo of the potently proinflammatory platelet-activating factor in human colon mucosa in inflammatory bowel disease.

Catabolism of platelet-activating factor by human colonic mucosa. Calcium dependence of the catabolizing enzymes.

The catabolism of platelet-activating factor (PAF) and lyso PAF by a supernatant fraction of human colon mucosa homogenates has been studied in vitro. PAF is initially catabolized to lyso PAF by mucosal enzymes via removal of its acetyl group. Incubates in Ca(2+)-free Tris with EDTA showed that the acetyl hydrolase was Ca2+ independent. Addition of the hydrolase inhibitor, phenyl methyl sulphonyl fluoride, significantly reduced the catabolism of PAF. Lyso PAF was further catabolized in at least two ways. An acyl group was incorporated into the sn-2 position of lyso PAF to give 1-O-alkyl-2-acyl-sn-glycero-3-phosphocholine (alkyl acyl GPC); this step was Ca2+ independent as shown by omitting Ca2+ and adding EDTA to the incubate. Formation of alkyl acyl GPC was confirmed by HPLC. Alternatively, choline was removed from the head group of lyso PAF by a calcium-dependent lyso phospholipase D. Under the experimental conditions utilized a neutral lipid product was formed but significant amounts of the intermediate lysophosphatidic acid could not be detected. A substance with a chromatographic mobility of Rf = 0.8 on TLC plates having an intact phosphorylcholine head group was also formed but has not yet been identified. It is concluded that the human colon mucosa contains enzymes that actively catabolize pro-inflammatory PAF and lyso PAF.