根据“肠-肾轴”理论治疗慢性肾脏病的研究进展

有研究报道在慢性肾脏病的发生发展过程中可发现一系列肠道变化,并有学者用"肠-肾轴"理论阐述肾脏病中肠道的变化以及疾病过程中肾脏与肠道之间的联系,提示调节肠道菌群或可成为治疗慢性肾脏病的新方法。本文根据"肠-肾轴"理论,综述了在慢性肾脏病发展过程中肠道出现的变化,如肠内代谢物异常、肠道损伤以及肠道菌群失调等。以慢性肾脏病发生发展过程中肠道的异常变化为治疗切入点,总结了以大黄为主的中药在调节肠道功能、修复肠道屏障、纠正肠道代谢物异常等方面具有的显著疗效,为治疗慢性肾脏病及减少并发症等提供新的治疗思路和新方法。     

The effect of auxiliary conditions on intestinal unstirred layer diffusion modelled by numerical simulation.

Estimation of intestinal unstirred layer thickness usually involves inducing transmural potential difference changes by altering the content of the solution used to perfuse the small intestine. Osmotically active solutes, such as mannitol, when added to the luminal solution diffuse across the unstirred water layer (UWL) and induce osmotically dependent changes in potential difference. As an alternative procedure, the sodium ion in the luminal fluid can be replaced by another ion. As the sodium ion diffuses out of the UWL, the change in concentration next to the intestinal membrane alters the transmural potential difference. In both cases, UWL thickness is calculated from the time course of the potential difference changes, using a solution to the diffusion equation. The diffusion equation solution which allows the calculation of intestinal unstirred layer thickness was examined by simulation, using the method of numerical solutions. This process readily allows examination of the time course of diffusion under various imposed circumstances. The existing model for diffusion across the unstirred layer is based on auxiliary conditions which are unlikely to be fulfilled in the same intestine. The present simulation additionally incorporated the effects of membrane permeability, fluid absorption and less than instantaneous bulk phase concentration change. Simulation indicated that changes within the physiologically relevant range in the chosen auxiliary conditions (with the real unstirred layer length kept constant) can alter estimates of the apparent half-time. Consequently, changes in parameters unassociated with the unstirred layer would be misconstrued as alterations in unstirred layer thickness.     

Antioxidative flavonoid quercetin: implication of its intestinal absorption and metabolism

Quercetin is a typical flavonoid ubiquitously present in fruits and vegetables, and its antioxidant effect is implied to be helpful for human health. The bioavailability of quercetin glycosides should be clarified, because dietary quercetin is mostly present as its glycoside form. Although quercetin glycosides are subject to deglycosidation by enterobacteria for the absorption at large intestine, small intestine acts as an effective absorption site for glucose-bound glycosides (quercertin glucosides). This is because small intestinal cells possess a glucoside-hydrolyzing activity and their glucose transport system is capable of participating in the glucoside absorption. A study using a cultured cell model for intestinal absorption explains that the hydrolysis of the glucosides accelerates their absorption in the small intestine. Small intestine is also recognized as the site for metabolic conversion of quercetin and other flavonoids as it possesses enzymatic activity of glucuronidation and sulfation. Modulation of the intestinal absorption and metabolism may be beneficial for regulating the biological effects of dietary quercetin.     

Intestinal anion exchange in teleost water balance

Simultaneous measurements of all major electrolytes including HCO3(-) and H+ as well as water demonstrated that fluids absorbed by the anterior intestine of the marine gulf toadfish under in vivo-like conditions on an overall net basis are hypertonic at 380 mOsm and acidic ([H+] = 27 mM). This unusual composition of fluids absorbed across the intestinal epithelium is due to the unusual intestinal fluid chemistry resulting from seawater ingestion and selective ion and water absorption along the gastro-intestinal tract. Measurement under near symmetrical conditions with high NaCl concentrations and low MgSO4 concentrations revealed absorption of iso-osmotic and much less acidic fluids by the intestinal epithelium, a situation resembling that of other water absorbing leaky vertebrate epithelia. Reduced luminal NaCl concentrations seen in vivo results in lower absolute water absorption rates but higher Cl-/HCO3(-) exchange rates which are associated with higher net H+ absorption rates. It appears that apical anion exchange is important for net Cl- uptake by the marine teleost intestine especially when luminal NaCl concentrations are low and/or when MgSO4 concentrations are high. Observations indicate that fluid absorption from solutions of low NaCl but high MgSO4 concentrations is energetically more demanding than absorption from NaCl rich solutions at the level of the intestinal epithelium. Furthermore, the high luminal MgSO4 concentration which is an unavoidable consequence of seawater ingestion projects a demand for renal and branchial compensation for intestinal MgSO4 uptake and absorption of hypertonic and acidic fluid by the intestine.     

Water absorption and bicarbonate secretion in the intestine of the sea bream are regulated by transmembrane and soluble adenylyl cyclase stimulation

In the marine fish intestine luminal, HCO₃ ^? can remove divalent ions (calcium and magnesium) by precipitation in the form of carbonate aggregates. The process of epithelial HCO₃ ^? secretion is under endocrine control, therefore, in this study we aimed to characterize the involvement of transmembrane (tmACs) and soluble (sACs) adenylyl cyclases on the regulation of bicarbonate secretion (BCS) and water absorption in the intestine of the sea bream (Sparus aurata). We observed that all sections of sea bream intestine are able to secrete bicarbonate as measured by pH?CStat in Ussing chambers. In addition, gut sac preparations reveal net water absorption in all segments of the intestine, with significantly higher absorption rates in the anterior intestine that in the rectum. BCS and water absorption are positively correlated in all regions of the sea bream intestinal tract. Furthermore, stimulation of tmACs (10???M FK?+?500???M IBMX) causes a significant decrease in BCS, bulk water absorption and short circuit current (Isc) in a region dependent manner. In turn, stimulation of sACs with elevated HCO₃ ^? results in a significant increase in BCS, and bulk water absorption in the anterior intestine, an action completely reversed by the sAC inhibitor KH7 (200???M). Overall, the results reveal a functional relationship between BCS and water absorption in marine fish intestine and modulation by tmACs and sAC. In light of the present observations, it is hypothesized that the endocrine effects on intestinal BCS and water absorption mediated by tmACs are locally and reciprocally modulated by the action of sACs in the fish enterocyte, thus fine-tuning the process of carbonate aggregate production in the intestinal lumen.     

Contribution of solvent drag through intercellular junctions to absorption of nutrients by the small intestine of the rat

The lumen of the small intestine in anesthetized rats was recirculated with 50 ml perfusion fluid containing normal salts, 25 mM glucose and low concentrations of hydrophilic solutes ranging in size from creatinine (mol wt 113) to Inulin (mol wt 5500). Ferrocyanide, a nontoxic, quadrupally charged anion was not absorbed; it could therefore be used as an osmotically active solute with reflection coefficient of 1.0 to adjust rates of fluid absorption, Jv, and to measure the coefficient of osmotic flow, Lp. The clearances from the perfusion fluid of all other test solutes were approximately proportional to Jv. From Lp and rates of clearances as a function of Jv and molecular size we estimate (a) the fraction of fluid absorption which passes paracellularly (approx. 50%), (b) coefficients of solvent drag of various solutes within intercellular junctions, (c) the equivalent pore radius of intercellular junctions (50 A) and their cross sectional area per unit path length (4.3 cm per cm length of intestine). Glucose absorption also varied as a function of Jv. From this relationship and the clearances of inert markers we calculate the rate of active transport of glucose, the amount of glucose carried paracellularly by solvent drag or back-diffusion at any given Jv and luminal glucose concentration and the concentration of glucose in the absorbate. The results indicate that solvent drag through paracellular channels is the principal route for intestinal transport of glucose or amino acids at physiological rates of fluid absorption and concentration. In the absence of luminal glucose the rate of fluid absorption and the clearances of all inert hydrophilic solutes were greatly reduced. It is proposed that Na-coupled transport of organic solutes from lumen to intercellular spaces provides the principal osmotic force for fluid absorption and triggers widening of intercellular junctions, thus promoting bulk absorption of nutrients by solvent drag. Further evidence for regulation of channel width is provided in accompanying papers on changes in electrical impedance and ultrastructure of junctions during Na-coupled solute transport.     

Novel physiological function of fructooligosaccharides

Two key properties of short chain fructooligosaccharides (sc-FOS) which lead to physiological functions are indigestibility in the small intestine and fermentability in the colon. Sc-FOS is converted into short chain fatty acids (SCFAs) by intestinal bacteria in the colon and absorbed. Through the metabolic pathway, sc-FOS improves gastrointestinal (GI) condition such as relief from constipation, formation of preferable intestinal microflora and intestinal immunomodulation those are known as prebiotics' function. Besides improvement of GI condition, dietary sc-FOS influences on calcium and magnesium absorption in the colon. A major mineral absorption site is the small intestine, but the colon also works as a Ca and Mg absorption site with an aid of SCFAs made from sc-FOS. Furthermore dietary sc-FOS influences on bioavailability of soy-isoflavones. Plasma and urinal concentration of Genistein and Daidzein, aglycones of Daidzin and Genistin, are higher in the rat fed with sc-FOS than the control rat. An additive effect of dietary isoflavone and sc-FOS was observed on the bone mineral density in OVX mice and moreover sc-FOS increased ceacal beta-glycosidase activity and equol production. These results suggest that FOS increase the bioavailability of isoflavones.     

Regulation of intestinal glucose transport.

The small intestine is capable of adapting nutrient transport in response to numerous stimuli. This review examines several possible mechanisms involved in intestinal adaptation. In some cases, the enhancement of transport is nonspecific, that is, the absorption of many nutrients is affected. Usually, increased transport capacity in these instances can be attributed to an increase in intestinal surface area. Alternatively, some conditions induce specific regulation at the level of the enterocyte that affects the transport of a particular nutrient. Since the absorption of glucose from the intestine is so well characterized, it serves as a useful model for this type of intestinal adaptation. Four potential sites for the specific regulation of glucose transport have been described, and each is implicated in different situations. First, mechanisms at the brush-border membrane of the enterocyte are believed to be involved in the upregulation of glucose transport that occurs in streptozotocin-induced diabetes mellitus and alterations in dietary carbohydrate levels. Also, factors that increase the sodium gradient across the enterocyte may increase the rate of glucose transport. It has been suggested that an increase in activity of the basolaterally located Na(+)-K+ ATPase could be responsible for this phenomena. The rapid increase in glucose uptake seen in hyperglycemia seems to be mediated by an increase in both the number and activity of glucose carriers located at the basolateral membrane. More recently, it was demonstrated that mechanisms at the basolateral membrane also play a role in the chronic increase in glucose transport observed when dietary carbohydrate levels are increased. Finally, alterations in tight-junction permeability enhance glucose absorption from the small intestine.(ABSTRACT TRUNCATED AT 250 WORDS)     

Modulation of caudal intestinal permeability in the rat during infection by the tapeworm Hymenolepis diminuta.

Bidirectional movement of solutes between the intestinal lumen and systemic circulation is restricted by tissue barriers that may be altered under conditions such as intestinal infection. In a study using an in vitro everted sac preparation to assess small intestinal permeability in a lumen-to-serosa direction, 51Cr-EDTA movement was compared regionally in the jejunum and ileum of rats infected and uninfected by tapeworms. Whereas jejunal segments showed no significant differences in permeability to 51Cr-EDTA at 6, 15, or 32 days postinfection (dpi), ileal segments displayed an increased permeability on 15 and 32 dpi, but not 6 dpi. The alterations in permeability were not reversed 1 wk after removal of the tapeworm from the intestine. In conclusion, the strictly lumen-dwelling tapeworm infection allows increased movement of molecules from the lumen into ileal, but not jejunal, tissues by 15 dpi.     

Regulation mechanisms of intestinal secretion: implications in nutrient absorption

Intestinal secretion is a normal phenomenon, indispensible to solubilize and dilute nutrients and to maintain fluidity in the intestinal lumen. Enterotoxins and certain drugs may disrupt the proabsorptive status maintained by the small intestine under physiologic conditions. Hormones found in nervous and specialized intestinal enterochromaffin cells are responsible, in part, for secretion of fluid into the lumen. Afferent vagal nerve impulses mediated by 5-hydroxytryptamine (serotonin; 5-HT), vasoactive intestinal peptide (VIP) and substance P are the major agents of secretory stimulation. Toxins from pathogenic bacteria, especially some strains of E. coli and V. cholerae, trigger a secretory response and a chain of events involving cGMP and cAMP which result in chloride secretion, coupled to sodium and fluid efflux into the lumen. If secretion is unchecked by natural mechanisms or medications, the consequences are diarrhea, with potential dehydration, hyponatremia and ultimately death. Introduction of absorbable nutrients in the intestinal lumen has a major antisecretory action, both by a nutrient-gene interaction and by proabsorptive hormone expression. In additon, during the absorptive process water is carried into the enterocyte together with solutes. Hydrolysis-resistant peptides of dietary origin and ingested soluble fiber may also have a proabsorptive effect. The gastrointestinal system has a variety of antisecretory or proabsorptive hormonal and protein agonists that balance the outflow of fluid and electrolytes. The more extensively studied are neuropeptide Y/peptide YY (NPY/PYY) and the antisecretory factor (AF). Nitric oxide (NO), a short-lived second messenger, has a major role in secretion by activating cGMP. The intracellular concentration of NO may regulate the absorptive/secretory status of the small intestine, either stimulating absorption or inducing secretion. Specifically targeted 5-HT receptor antagonist drugs and other pharmacologic agents have been clinically tried for the treatment of severe diarrhea, drug-induced malabsorption and reversal of cellular damage.     

Orally Administered Therapeutic Peptide Delivery: Enhanced Absorption Through the Small Intestine Using Permeation Enhancers

Peptide therapeutics (PTs) is generally regarded as highly effective macromolecule therapeutics at very low concentrations. The main issues surrounding the administration of PTs is guaranteeing that they are bioavailable, reach the desired therapeutic index and distribute throughout the body effectively. The oral administration, a non-invasive route, of PTs is considered a major complication due to inadequate oral absorption through biological membranes such as the small intestine epithelium due to presystemic proteolytic enzymatic activity. PTs bioavailability is further diminished in the systemic circulation due to low stability in the plasma and rapid excretion from the body. Many alternative routes can be considered non-invasive such as transdermal and nasal routes, but this review focuses on the oral route, specifically the small intestine region of the gastrointestinal tract. Although this region has the highest density of proteolytic enzymes, it contains tight junctions which have the lowest trans-epithelial electrical resistance throughout the body; thus paracellular transport of these large PTs can be achieved more readily. The use of a natural polysaccharide polymer, such as trimethyl chitosan (TMC), which enhances the bioavailability of these PTs through the small intestine, will also be discussed in great detail. TMC has been considered because it could potentially solve many of the mechanistic and chemical problems associated with oral therapeutic peptide administration. The safety of orally administered PTs through the small intestinal epithelium employing a polymer such as TMC is also discussed as this is a significant issue for regulatory bodies.     

Functional aquaporin diversity in plants

Due to the fact that most plants are immobile, a rapid response of physiological processes to changing environmental conditions is essential for their survival. Thus, in comparison to many other organisms, plants might need a more sophisticated tuning of water balance. Among others, this is reflected by the comparable large amount of aquaporin genes in plant genomes. So far, aquaporins were shown to be involved in many physiological processes like root water uptake, reproduction or photosynthesis. Their classification as simple water pores has changed according to their molecular function into channels permeable for water, small solutes and/or gases. An adjustment of the corresponding physiological process could be achieved by regulation mechanisms. Concerning aquaporins these range from posttranslational modification, molecular trafficking to heteromerization of aquaporin isoforms. The aim of this review is to underline the function of the four plant aquaporin family subclasses with regard to the substrate specificity, regulation and physiological relevance.     

Comparison of nonelectrolyte permeability patterns in several epithelia

Summary Reflection coefficients ('s) have been determined for 13 to 36 non-electrolytes in goldfish gallbladder, bullfrog gallbladder, bullfrog intestine, and guineapig intestine. These results have been compared with the results of similar previous studies in rabbit gallbladder, bullfrog choroid plexus, and guinea-pig gallbladder to determine types of species variation, organ variation, and individual variation. Two principal types of variation were established: (1) Branched solutes are much less permeant than straight-chain analogues in gallbladders of all four species studied, whereas this effect is small in intestine and negligible in choroid plexus. This variation in degree of discrimination against branched solutes is attributed to variation in closeness of packing of membrane lipids. (2) In certain epithelia, small polar solutes are more permeant than expected from their bulk nonpolar-solvent/water partition coefficients and from their size. This feature is very marked in rabbit gallbladder, somewhat marked in guineapig gallbladder and intestine and in bullfrog choroid plexus, apparent mainly just for formamide (the smallest polar nonelectrolyte) in bullfrog intestine, and virtually absent in goldfish and bullfrog gallbladders. Analysis of individual variability in preparations of guinea-pig intestine and rabbit gallbladder from different animals shows covariation in 's of small polar nonelectrolytes uncorrelated with variation in 's of other solutes. Small polar solutes, in epithelia where their permeability is as expected from size and from nonpolar-solvent/water partition coefficients, resemble other solutes in having markedly temperature-dependent 's (high apparent activation energies of permeation), but have nearly temperature-independent 's (low activation energies, as for diffusion in aqueous solution) in epithelia where their permeability is enhanced. These findings suggest that additional size-restricted permeation pathways by-passing membrane lipid (pores) are present in some tissues and smaller or virtually absent in others.     

Water and NaCl absorption by the intestine of the tilapiaSarotherodon mossambicus adapted to fresh water or seawater and the possible role of prolactin and cortisol

Summary Rates of intestinal water, sodium and chloride absorption in tilapia, adapted to fresh water (FW) and seawater (SW), were measured in vitro, using noneverted sacs made from the anterior, middle and posterior intestinal regions. The anterior intestine from SW fish showed considerably less water, sodium and chloride absorption compared with that seen in FW fish. The middle intestine showed either minimal absorption or some secretion in both FW and SW. In the posterior intestine, water absorption was only limitedly affected by SW-adaptation, but sodium and chloride absorption rates were significantly lower in SW fish. Reductions in water absorption were already evident in the anterior intestine 24 h after transfer to 1/3 SW but reached lower levels 3 to 5 days following transfer to 100% SW. Thus, the anterior intestine of tilapia responds to increased environmental salinity by decreasing uptake of ions, whereas the posterior intestine maintains similar water absorption in both FW and SW, although ion absorption is lower in SW.Prolactin administration to SW fish augmented sodium and water absorption in the anterior intestine but had no effect on chloride absorption. In contrast, cortisol administration to FW fish decreased absorption of sodium, chloride and water to levels usually seen in SW fish. The observed effects of these hormones in tilapia intestinal absorption may be confined to the specialized anterior intestinal region in this species; hormonal effects on the rest of the intestine were not examined.     

Functional aquaporin diversity in plants

Due to the fact that most plants are immobile, a rapid response of physiological processes to changing environmental conditions is essential for their survival. Thus, in comparison to many other organisms, plants might need a more sophisticated tuning of water balance. Among others, this is reflected by the comparable large amount of aquaporin genes in plant genomes. So far, aquaporins were shown to be involved in many physiological processes like root water uptake, reproduction or photosynthesis. Their classification as simple water pores has changed according to their molecular function into channels permeable for water, small solutes and/or gases. An adjustment of the corresponding physiological process could be achieved by regulation mechanisms. Concerning aquaporins these range from posttranslational modification, molecular trafficking to heteromerization of aquaporin isoforms. The aim of this review is to underline the function of the four plant aquaporin family subclasses with regard to the substrate specificity, regulation and physiological relevance.     

The role of glutaminase in the small intestine

Glutaminase is the enzyme which hydrolyses glutamine, the main respiratory fuel of the intestine, to yield glutamate and ammonia. Glutaminase has a central role in intestinal metabolism: the products of the reaction catalyzed by glutaminase can be transaminated, catabolized to yield energy or used for the biosynthesis of pyrimidine nucleotides. Experimental treatments which deprive the intestine of glutamine induce intestinal atrophy. In this review, attention is paid to the role of glutaminase in intestinal metabolism. Background information on the structure, kinetics and distribution of glutaminase precede a discussion of the metabolism of glutamine within the intestine. In closing, we review the factors known to regulate glutaminase activity and emphasise that the regulation of glutaminase within the intestine is poorly understood.     

Osmoregulation and epithelial water transport: lessons from the intestine of marine teleost fish

For teleost fish living in seawater, drinking the surrounding medium is necessary to avoid dehydration. This is a key component of their osmoregulatory strategy presenting the challenge of excreting excess salts while achieving a net retention of water. The intestine has an established role in osmoregulation, and its ability to effectively absorb fluid is crucial to compensating for water losses to the hyperosmotic environment. Despite this, the potential for the teleost intestine to serve as a comparative model for detailed, integrative experimental studies on epithelial water transport has so far gone largely untapped. The following review aims to present an assessment of the teleost intestine as a fluid-transporting epithelium. Beginning with a brief overview of marine teleost osmoregulation, emphasis shifts to the processing of ingested seawater by the gastrointestinal tract and the characteristics of intestinal ion and fluid transport. Particular attention is given to acid–base transfers by the intestine, specifically bicarbonate secretion, which creates the distinctly alkaline gut fluids responsible for the formation of solid calcium carbonate precipitates. The respective contributions of these unique features to intestinal fluid absorption, alongside other recognised ion transport processes, are then subsequently considered within the wider context of the classic physiological problem of epithelial water transport.     

Microbial-host interactions specifically control the glycosylation pattern in intestinal mouse mucosa

The glycosylation of the intestinal cell layer is thought to control several key functions of the gut such as vectorial transports, defence against microbial agents or immunological processes. It has been assumed that the gut microflora may modulate the glycosylation pattern of the intestinal cell layer. However, there is no direct evidence for this regulatory process. The first goal of this work was to establish the germ-free mice intestinal glycosylation baseline using a histochemical approach and a panel of ten lectins with defined glycan specificities to tissue sections prepared from various cellular compartments of the small and large intestine. Using this baseline, we have studied the contribution of the gut microflora on the carbohydrate composition of glycoconjugates of intestinal cells by comparing the germ-free and conventional mice glycosylation patterns. Analysis of the germ-free mice intestinal glycosylation baseline revealed that the expression of glycans depends on the proximodistal gradient (small to large intestine) and on the cell lineage (absorptive, goblet, crypt, and Paneth cells), indicating that mice are able to create and maintain a strict topological and cell lineage-specific regulation of glycosyltransferase expression. By comparing germ-free and conventional mice, we find that the gut microflora specifically modulates the gut glycosylation pattern, quantitatively as well as qualitatively by changing the cellular and subcellular distribution of glycans. This is the first report in mice to directly demonstrate the critical contribution of microflora to intestinal glycosylation, a key characteristic of the gut.