Transforming growth factor-alpha stimulates enterocyte proliferation and accelerates intestinal recovery following methotrexate-induced intestinal mucositis in a rat and a cell culture model
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- Sukhotnik, I., Shteinberg, D., Ben Lulu, S. et al. Pediatr Surg Int (2008) 24: 1303. doi:10.1007/s00383-008-2271-0
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Recent evidence suggests that transforming growth factor-alpha (TGF-α) enhances enterocyte proliferation and exerts a gut trophic effect. The purpose of the present study was to evaluate the effect of TGF-α on enterocyte proliferation and intestinal recovery following methotrexate (MTX)-induced intestinal mucositis in rats and in Caco-2 cells.
Nonpretreated Caco-2 cells and those pretreated with MTX were incubated with increasing concentrations of TGF-α. Cell proliferation was determined by FACS cytometry. Adult rats were divided into three groups: control rats treated with vehicle, MTX rats treated with one dose (20 μg/kg) of MTX given intraperitoneally, and MTX-TGF-α rats treated with one dose of MTX followed by two doses of TGF-α (75 μg/kg a day). Three days after MTX injection, rats were sacrificed. Intestinal mucosal damage (Park’s score), mucosal structural changes, and enterocyte proliferation were measured at sacrifice. Western blotting was used to determine the level of extracellular signal-related kinase (ERK) protein, a marker of cell proliferation. A nonparametric Kruskal–Wallis ANOVA test was used for statistical analysis with P value less than 0.05 considered statistically significant.
The in vitro experiment demonstrated that treatment with TGF-α of Caco-2 cells resulted in a significant stimulation of cell proliferation in a dose-dependent manner. The in vivo experiment showed that treatment with TGF-α resulted in a significant increase in bowel and mucosal weight, DNA and protein content in jejunum and ileum, villus height in jejunum and ileum, crypt depth in ileum, and increased cell proliferation in jejunum and ileum compared to the MTX group. MTX-TGF-α rats also had a significantly lower intestinal injury score in ileum when compared to MTX animals. The increase in levels of cell proliferation in MTX-TGF-α rats corresponded with the increase in ERK protein levels in intestinal mucosa.
Treatment with TGF-α prevents mucosal injury, enhances ERK-induced enterocyte proliferation, and improves intestinal recovery following MTX-induced intestinal mucositis in rats. These findings correlated with the observation that TGF-α also caused a significant stimulation of cell proliferation in a Caco-2 cell culture model treated with MTX. These observations may have significant implications for the treatment of patients on chemotherapy who develop severe mucositis.