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Increased Gap Density Predicts Weakness of the Epithelial Barrier In Vivo by Confocal Laser Endomicroscopy in Indomethacin-Induced Enteropathy

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Abstract

Background and Aims

The intestinal epithelial barrier plays an important role in the pathogenesis of non-steroidal anti-inflammatory drug-induced enteropathy, and its disruption is often associated with increased cell shedding. The purpose of this report is to observe the gap density in indomethacin-induced small intestinal damage by confocal laser endomicroscopy (CLE) and to investigate the mechanisms involved in this process and how mucosal protectants improve intestinal epithelial barrier dysfunction. CLE is expected to provide a new way for evaluating non-steroidal anti-inflammatory drugs-induced enteropathy in humans and assessing drug efficacy.

Methods

Using the new technique of CLE, we established a method to evaluate, in real time, intestinal damage after the administration of indomethacin in Wistar rats by investigating the gap density in the small intestine. The mucosal protectant teprenone and acid-suppressant rabeprazole were then given by gavage before and after the administration of indomethacin, and the mechanisms affecting the intestinal epithelial barrier were investigated.

Results

Using CLE, gaps could be clearly observed and easily distinguished from goblet cells. Gap density was increased after the administration of indomethacin. During this process, the expression of tumor necrosis factor-α, nuclear factor-κB, and caspase-3 was up-regulated and the expression of tight junctions was down-regulated, which led to the damage of the epithelial barrier. Teprenone and rabeprazole could intervene in this pathway and protect the integrity of the epithelial barrier.

Conclusions

CLE can be objective, accurate, and real time in investigating gap density. Teprenone and rabeprazole can prevent indomethacin-induced intestinal lesions and protect the epithelial barrier by intervening in the tumor necrosis factor-α pathway. Gap density was expected to be an indicator of evaluating intestinal inflammation and drug efficacy.

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Acknowledgments

No financial support was received for this work from any company. This study was supported by a Natural Science Foundation Committee project (NSFC81170352).

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Authors and Affiliations

  1. Department of Gastroenterology, Qilu Hospital, Shandong University, No. 107, Wenhuaxi Road, Jinan, 250012, People’s Republic of China

    Sha Shi, Han Wang, Zhen Li, Fei-Xue Chen, Xiu-li Zuo & Yan-qing Li

  2. Department of Gastroenterology, Liaocheng People’s Hospital, Taishan Medical University, Liaocheng, 252000, Shandong Province, People’s Republic of China

    Sha Shi & Hui Gao

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  1. Sha Shi
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  2. Han Wang
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Correspondence to Xiu-li Zuo.

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Shi, S., Wang, H., Gao, H. et al. Increased Gap Density Predicts Weakness of the Epithelial Barrier In Vivo by Confocal Laser Endomicroscopy in Indomethacin-Induced Enteropathy. Dig Dis Sci 59, 1398–1405 (2014). https://doi.org/10.1007/s10620-014-3076-8

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  • DOI: https://doi.org/10.1007/s10620-014-3076-8

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