2005 Abstracts: Fecal Stream Is Essential for Adaptive Induction of Glucose-Coupled Na Transport (Glu/Na Tr) in the Remnant Ileum After Total Proctocolectomy (TPC)
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Fecal Stream Is Essential for Adaptive Induction of Glucose-Coupled Na Transport (Glu/Na Tr) in the Remnant Ileum After Total Proctocolectomy (TPC)
Sho Haneda, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
Background: TPC has been established as a standard procedure for ulcerative colitis and familial adenomatous polyposis. We previously demonstrated enhanced plasma aldosterone, ileal activation of epithelial sodium channels, and induction of 11b-hydroxysteroid dehydrogenase type 2 following TPC (AJP 276, Surgery 137). In addition, induction of sodium glucose co-transporter 1(SGLT1) was noticed only in total proctocolectomized, but not in aldosterone-infused nor sodium-depleted rats (J Gastrointestinal Surg. in press), suggesting that other than hyperaldosteronism may be required for its induction. Aim: To investigate whether fecal stream is essential for adaptive induction of Glu/Na Tr after TPC.
Materials and methods: Human paired mucosal samples (n=15) were obtained from patients with diverting loop-ileostomy after ileo-anal anastomosis when the loop-ileostomy was closed. Both the oral and anal mocosae adjacent to the stoma were taken and immediately mounted in Ussing chamber. Glu/Na Tr was measured as change in short-circuit current (¢Isc) after stepwise addition of glucose. Total RNA was extracted separately from the oral and anal mucosae. Expression of SGLT1 mRNA was determined by Nothern blot analysis. Comparative morphometric analysis was performed between the oral and anal mucosae by measuring the villous height and the crypt depth after hematoxylin-eosin staining of tissue sections (n=16). Result: When serial amount of glucose was added into the luminal side, Isc increased in a dose-dependent fashion and reached to plateau. Maximal ¢Isc was significantly greater in the oral mucosa than in the anal mucosa. Oral expression of SGLT1 mRNA was higher than that of the anal mucosa in all samples examined. Densitometric analysis revealed that the oral mucosa exhibited significantly higher SGLT1/b-actin mRNA ratio. When comparative morphometric analysis was performed, the villous height of the oral mucosa was significantly greater than that of the anal mucosa (513 vs 360ƒÊm). On the other hand, there was no significant difference between them in the crypt depth. Conclusion: Fecal stream is essential for adaptive induction of Glu/Na Tr in the remnant ileum after TPC. Watery diarrhea and frequent bowel movement just after the ileostomy closure and time-dependent improvement of them can be explained by the presence or absence of feces and fece-dependent SGLT1 induction in the distal ileum.
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