|
Huan-Long Qin,
Tong-Yi Shen, Zhi-Guang Gao, Xiao-Bing Fan, Xiao-Min Hang, Yan-Qun
Jiang, Hui-Zhen Zhang, Department of Surgery, Shanghai Jiao Tong
University Affiliated Sixth People's
Hospital, Shanghai 200233, China
Supported by the National Natural Science Foundation of
China, No. 30471687
Correspondence to: Dr. Huan-Long Qin, Department of Surgery,
Shanghai Jiao Tong University Affiliated Sixth People's
Hospital, Shanghai 200233,
China. sshospy@public.sta.net.cn
Telephone: +86-21-64942226
Fax: +86-21-64368920
Received: 2004-11-23
Accepted: 2004-12-09
Abstract
Aim: To
investigate the effect of probiotics supplemented by gut on the
tight junctions of epithelial cells, barrier function and the
microflora of rats with abdominal infection.
Methods: After
the model of cecal ligation and perforation established, SD rats
were divided into two groups: parenteral nutrition (PN) group and
PN+probiotics (probiotics) group, PN solution was supplemented by
neck vein and probiotics was delivered via the jejunostomy tube for
five days. Vena cava blood and the homogenated tissue of liver, lung
and mesenteric lymph nodes were cultured to determine the bacterial
translocation rate (BTR). The ultra-structure of epithelial tight
junctions and microvilli of the gut were observed by electron
microscopy; occluding expression was measured by indirect-immune
fluorescence method; anaerobic bacterial growth by anaerobic culture
and DNA fingerprint of bacterial colonies of the feces by PCR.
Results: The
quantity of lactobacteria and bifydobacteria in probiotics group was
higher than that of PN group. The profiles of DNA fingerprint
expression in probiotics group were similar to that in the normal
group, a new 16S rDNA sequence appeared in the profile in PN group.
The occludin expression, the integrality of the gut epithelial tight
junction and microvilli in probiotics group were improved as
compared with PN group. The BTR and endotoxin in blood were reduced
more significantly in probiotics group as compared with PN group.
Conclusion: The
probiotics could improve the gut microflora disturbance, increase
occludin expression, maintain the gut epithelial tight junction and
decrease the bacterial translocations rate.
ã 2005
The WJG Press and Elsevier Inc. All rights reserved.
Key words: Lactobacillus; Gut microflora; Barrier function;
Abdominal infection
Qin HL, Shen TY, Gao ZG, Fan XB, Hang XM, Jiang YQ, Zhang HZ. Effect
of lactobacillus on the gut microflora and barrier function of the
rats with abdominal infection. World J Gastroenterol
2005; 11(17): 2591-2596
http://www.wjgnet.com/1007-9327/11/2591.asp
INTRODUCTION
Since 1980s, Schmidt and Martindale have agreed upon the
intestinal mucosa injury accomplished with bacterial and endotoxin
translocation (BT & ET), followed by the development of
endotoxemia, shock and multiple organ dysfunction syndrome (MODS),
and the markedly increased death rate due to severe illness[1].
Despite developments in antisepsis and antibiotic prophylaxis,
septic complications are common in surgical patients. It is known
that the majority of postoperative infections are caused by gut
derived organisms, some studies have focused their attention on the
functioning of the gut mucosal barrier and the role of the
indigenous gut microflora. There is good evidence from animal and in
vitro studies that alteration of the gastrointestinal microflora
with probiotic organisms can reduce the rate of BT to mesenteric
lymph nodes. Although the significance of BT in humans remains to be
determined, its postulated links with sepsis and multiple organ
failure make it an obvious target for therapeutic intervention.
In recent years, scientific knowledge in the
field of microbiology was expanded and it has been suggested that
the gastrointestinal microflora has a role in maintaining human
health[2].
The gastrointestinal ecology in normal subjects may be altered by
administration of live micro-organisms, termed probiotics. These
organisms have shown to inhibit the growth and adherence of
potentially pathogenic bacteria to enterocytes, an important step in
the process of BT. There is also an increasing evidence that
probiotic organisms can interact with the gut-associated lymphoid
tissue and influence the local mucosal and systemic immune function[3].
In addition, lactobacilli can secrete antimicrobial compounds called
bacteriocins which inhibit a broad spectrum of enteric organisms.
But, the mechanisms underlying the benefits derived from biotherapy
with probiotics have not been sufficiently elucidated, with
available data largely fragmentary and/or anecdotal. The present
study was to determine the effect of probiotics on the
micro-structure of tight junction and transmembrane protein-occludin
expression, gut microflora and bacterial translocation by parenteral
nutrition (PN) and probiotics supplemented by gut to the rats with
abdominal infection.
MATERIALS AND METHODS
The abdominal infection-PN rats model
Forty-nine SD rats weighing 250-320 g (FuDan University Medical
Animal Center, Shanghai) were allowed ad libitum intake of water and
standard rat food and subjected to alternate 12-h periods of dark
and night. After 16-h fasting, all rats were anesthetized with
intraperitoneal injections of 2% saline-ketamin injection liquid (30
mg/g weight). The rats were fixed in a supine position, and the
neck, interscapular and abdominal region were shared and prepared in
a sterile manner for catheterization and operation. The middle
abdomen was opened with 4-cm incision, the abdominal infection model
was established by cecum perforation and ligation (CPL)[4].
A silastic catheter (Ф1.2
mm) was placed by jejunostomy far away the cecum 30-40 cm, the
catheter was tunneled abdominal subcutaneously to the back, and the
abdominal incision was closed. A silastic catheter (0.6 mm inner
diameter, 1.0 mm outer diameter) was inserted through the external
jugular vein into the superior vena cava. The catheter was tunneled
subcutaneously to the midscapular region and guarded by the flexible
spring, and then hooked up to an infusion pump (B. Braun). The rats
were maintained in individual metabolic cages[5].
The nutrient solution was induced at a constant infusion rate by the
pump (2 mL/h) for 5 d during the study period. The trial was
approved by our institutional animal committees.
PN solution prepared
After catheterization and the operation was over, all rats received
intravenous 0.9% saline solution at 1.0 mL/h for 24-30 h to allow
enough time to recover from the anesthesia. Rats were divided into
two groups, group A (n = 7): received PN, the solution was
infused averagely, the amount of infusion solution was about 80 mL/d
during 1-5 d experimental period; group B (n = 8): PN +probiotic
during 1-5 d, the probiotic was infused by jejunostomy tube about 10
mL/d. Group A and B were isonitrogenous and isocaloric (Table 1).
The daily dose of amino acids was 2.5 g of nitrogen per kilogram,
and the amount of nonprotein calories given was 250 kcal/(kg·d) as 50% glucose and 20% Intralipid
(Energy Index 1:1). Multivitamins and electrolytes were also
included in PN solution. The rats were killed on the 6th
d in the morning for taking samples.
Table 1 PN solution
prepared (contents/100 mL)
| Prescription |
Dose |
| 50%
Glucose (mL) |
33
8.5% |
| Novamin
(mL) |
45
20% |
| Intralipid
(mL) |
17 |
| Soluvita
(mL) |
1 |
| Addamel
(mL) |
1 |
| 10%
KCl (mL) |
1 |
| 10%
NaCl (mL) |
1 |
| RI
(U) |
4 |
| Heparin
(U) |
40 |
| Non-protein
calorie (kJ) |
435 |
| (kcal) |
101 |
| Total
nitrogen (mg) |
630 |
Probiotic containing live lactobacillus
acidophilus (activity 1×108
cfu/mL) was supported by Shanghai Jiao
Tong University Only Limited Company, and infused about 10 mL/day by
jejunostomy tube thrice per day through 1-5 d.
Fecal bacterial anaerobic culture
The fecal sample (1 g) in cecum was placed in an anaerobic glove box
within 1 h of collection and homogenized
in prereduced brain-heart infusion broth and diluted from 10- to 10-8
fold. Portions (100 mL)
of each dilution were spread onto the surfaces of plates which
contained the following agar media and were incubated anaerobically
at 37 ℃:
supplemented brucella blood agar (2 d, total anaerobic CFU),
bacteroides bile esculin agar (2 d), egg yolk agar (after equal
volumes of 95% ethanol were added to the dilutions and the
preparations stood for 30 min to select for clostridial spores), and
Rogosa SL agar (Difco) (2 d for lactobacilli and 4 d for
bifidobacteria, after Lactobacillus colonies were marked at 2 d).
The dilutions were removed from the anaerobic glove box and were
used to inoculate (100 mL
inocula) plates which contained the following media and were
incubated aerobically at 37 ℃:
supplemented brucella blood agar (2 d, total aerobic CFU), MacConkey
agar (Difco) (1 d, enterobacteria), bile esculin azide agar (Difco)
(1 d, enterococci). To analyze the total Lactobacillus population,
10 colonies were picked randomly from a dilution agar plate
containing about 100 colonies. The bacterium colonies were counted
and identified by Microscan Autoscan-4 Machine (Dade Behringcom).
Gut bacterial DNA fingerprint profiles
The fecal samples in cecum from each subject were also examined by
PCR-denaturing gradient gel electrophoresis (DGGE) profiles. To
extract bacterial DNA, 1 mL of fecal homogenate in pH 7.0 phosphate
buffer (the buffer used for the azoreductase assay) was centrifuged
at 14 600 g for 5 min (5 ℃).
DNA was extracted from the resulting pellet with a Fast DNA kit (BIO
101, Vista, CA) by using CLS-TC (a cell lysis solution used for
animal tissues and bacteria). The V2-V3 region of the 16S
rDNA gene (positions from 339 to 539 in the Escherichia coli
gene) of bacteria in the fecal samples was amplified by using
primers bacteria ITS PS2 (5'-TG(C/T) ACA CACCGC CCG T-3'), PL2
(5'-GGG T(G/C/T) CCC CAT TC(A/G)G-3'). PCR was performed with 0.2-mL
tubes by using a PCR Express thermal cycler (Hybaid, Teddington,
UK). Each reaction mixture (50 mL)
contained reaction buffer (10 Mm [final concentration] Tris-HCl, 2.5
mmol/L [final concentration] MgCl2,
50 mmol/L [final concentration] KCl [pH 8.3]), each deoxynucleoside
triphosphate at a concentration of 200 mmol/L,
20 pmoL of each primer, 1 mL
of fecal DNA, and 2.5 U of Taq DNA polymerase (Boehringer, Mannheim,
Germany). The following amplification program was used: 94 ℃
for 3 min, 30 cycles consisting of 94 ℃
for 30 s, 56 ℃
for 30 s, and 68 ℃
for 60 s, and then 7 min at 68 ℃.
DGGE was performed by using a DCode universal mutation detection
system (Bio-Rad, Richmond, CA) and gels that were 16 cm×16 cm×1 mm; 6% polyacrylamide gels were prepared and electrophoresed
with 1×TAE buffer prepared from 50×TAE buffer (2 mol/L Tris base, 1 mol/L glacial
acetic acid, 50 mmol/L EDTA). The denaturing gradient was formed by
using two 6% acrylamide (acrylamide/bisacrylamide ratio, 37.5:1)
stock solutions (Bio-Rad). The gels contained a 22-55% gradient of
urea and formamide that increased in the direction of
electrophoresis. A 100% denaturing solution contained 400 mL/L
formamide and 7.0 mol/L urea. Electrophoresis was performed at 130 V
(constant voltage) and 60 ℃
for about 4.5 h. Electrophoresis was stopped when a xylene cyanol
dye marker reached the bottom of a gel. The gels were stained with
an ethidium bromide solution (5 mg/mL)
for 20 min, washed with deionized water, and reviewed by UV
transillumination[13].
Gut mucosa occludin indirect-immune fluorescence expression
The distal ileum and colon tissue were taken to determine the
occludin expression by indirect- immune fluorescence. Frozen tissue
was cut into 10-祄
sections, dried on positively
charged slides, washed with PBS, and
incubated at 37 ℃
for 30
min with 10% normal goat serum. Excess serum was blotted,
and the slides were incubated with a 1/50
dilution of primary
antibody for 1 h at 37 ℃.
The first antibody was sheep- anti-rats occludin antibody (Santa
Cruz). The slides with the second antibody anti-sheep IgG (Santa
Cruz) were then incubated
with FITC-conjugated goat anti-rabbit IgG
(1/20 dilution) for
30 min at 37 ℃
and washed again with PBS. All slides were
then mounted with 0.1% p-phenylenediamine
in PBS-glycerol and
coded before examination. Treated sections
were examined with
UV light in an incident-light fluorescent
microscope, and the
fluorescence pattern (focal, diffuse;
mesangial, loop) was defined.
Fluorescence intensity was graded as
negative, or 1+ through
4+. Control sections lacking primary
antibody were included
with each experiment. All sections were
examined by two authors
(Shen TY and Zhang HZ) independently. The
data were analyzed by HPIAS1000 high definition color image
manipulation system. Under the same expanding multiple (400),
occludin density was determined per field of vision by light-densimeter
(at least five fields per slide).
Tight junction of ileum and cecum by electron microscopy
One fixation procedure was used for conventional thin-section
electron microscopy. The fixation procedure involved incubation with
OsO4 alone (1% or 2% in phosphate buffer) at 0 ℃
for 30 min. After fixation, the ileum and cecum were washed
extensively in Veronal acetate buffer (90 mmol/L, pH 6.0), stained
by incubation at 0 ℃
for 60 min in uranyl-magnesium acetate (0.5%) in the same buffer,
washed again, dehydrated, and embedded. Thin sections were doubly
stained with uranyl acetate and lead nitrate and examined to observe
the change of tight junction and microvilli (2×104)
by Philip EM 400 electron microscopes.
Bacterial translocation rate of mesenteric lymph node and
remote organ
One milliliter blood from vena cava, 5 g tissue of mesenteric
lymphoside, liver and lung tissue, were collected, respectively, and
homogenized in a tube containing cardio-cerebral leachate that was
incubated at 35 ℃;
after 18-24 h, methylene blue-eosin staining method was adopted, and
continued to be cultured at 35 ℃;
after 18-24 h, the number of bacterium were counted.
Statistical analysis
Analysis of data was performed using c2
and t analysis, the experimental data were expressed as mean±SD of the sample and comparison between
treatment groups using one-way analysis of variance. P value
below 0.05 was considered statistically significant.
RESULTS
Death rate
The CPL model was established successfully in 49 SD rats, the total
death rate during 6 d was 69.3%; the death rate in PN group (78.7%)
was higher than that in probiotics group (50%, c2
= 4.204, P = 0.0403<0.05, Table
2).
Table 2 The death
rate of celiac infectional model both of two groups
| Group |
n |
Death |
Death
rate (%) |
| PN |
33 |
26 |
78.7 |
| Probiotics |
16 |
8 |
50a |
aP<0.05
vs PN group.
Amount of bacterial of fecal in the cecum
There were no marked differences of the gut bacterial strains in the
probiotics group as compared with PN group, P>0.05. But
the amount of lactobacteria and bifidobacteria increased, and the
amount of enterococci decreased in probiotics group as compared with
PN group, P<0.05 (Table 3).
Table 3 Change of
the kings of bacterium (1 g 10n/mL)
| |
PN
group |
Probiotics
group |
| Enterobacteria |
7.061±0.191 |
7.231±0.171 |
| Bifidobacteria |
8.006±0.272 |
8.313±0.303a |
| Lactobacteria |
5.416±0.304 |
5.713±0.178a |
| Enterococci |
5.702±0.373 |
5.056±0.355a |
aP<0.05
vs PN group.
DNA fingerprint profiles
The electrophoresis appearance of DNA sequence of the
profiles in PN group (lane 11-17) were less than that in the control
group (lane 9-10); lane 11, 14, 15 appeared of a new 16S rDNA
sequence in the profile (labeled in Figure 1). The sequence of
electrophoresis expression in probiotics group (lane 1-8) was
similar to that in the control group (lane 9-10).
Figure
1 (PDF) Gut
bacterium colony DNA fingerprint profiles. Lane M: Marker; lanes
1-8: Probiotics group; lanes 9 and 10: Control group; lanes 11-17:
PN group.
Gut mucosa occludin
expression
There are more occludin expressions in the probiotics group in the
surface, and intracellular and cell-internal of the epithelial cells
as compared with PN group (Figures 2A-D). The occludin positive
expression area per measured-window in probiotics group was higher
than that in PN group (t = -4.436, P = 0.001<0.01, t
= -2.429, P = 0.036<0.05, Table 4).
Table 4 Occludin
positive expression in two groups (A)
| Group |
n |
Intestinal
(%) |
Cecum
(%) |
| PN |
7 |
1.207±0.587 |
1.254±0.203 |
| Probiotics |
8 |
1.981±0.513a |
2.276±0.526b |
aP<0.05
vs PN group;
bP<0.01
vs PN group.
Figure 2
Intestinal and colon epithelial occludin expression. A:
Intestinal epithelium occludin expression decreased in PN group (200×);
B:
Intestinal epithelium occludin expression increased in probiotics
group (200×); C:
Colon epithelium occludin expression decreased in PN group (200×); D:
Colon epithelium occludin expression increased in probiotics group
(200×).
Tight junction and micro-villi micro-structure
There were more integrated tight junctions, less
mitochondrion endoplasm and micro-villi brushed in probiotics group
as compared with PN group (Figures 3A-D). The readability of the
tight junction in probiotics group was clearer than that in PN
group.
Figure
3 The
ultra-structure of the tight junction of the intestine and colon. A:
The tight junction of intestine was damaged seriously in PN group (5
000×); B:
The tight junction of intestine was damaged in probiotics group (5
000×); C:
The tight junction of colon junction was damaged seriously in PN
group (5 000×); D:
The tight junction of the colon was clear in probiotics group (5 000×).
Bacterium translocation rate (BTR) of mesentery lymph node (MLN) and
remote organ
Bacterium translocation rate (BTR) in PN group (60.7%) was higher
than that in probiotics group (34.3%, c2
= 4.1625, P = 0.0413<0.05,
Table 5).
Table 5 BTR of
mesenteric lymph node and remote organ
| Group |
n |
MLN
(g) |
Liver
(g) |
Lung
(g) |
Cava
blood (g) |
BTR
(%) |
| PN
(g) |
7 |
6 |
4 |
3 |
4 |
60.7 |
| Probiotics |
8 |
4 |
3 |
2 |
2 |
34.3a |
aP<0.05
vs PN group.
DISCUSSION
The role of commensal and probiotic bacterial in the physiology
of the gastrointestinal tract is not completely understood.
Probiotics are defined as "living
organisms, which upon ingestion in certain numbers exert health
benefits beyond inherent basic nutrition". The importance of a "health"
gut microbiota has been recognized for a long time but only recently
specific attention has been focused on the potential of probiotics
as preventative and therapeutic agents in gastrointestinal diseases.
The use of probiotics in animal models of inflammatory bowel disease
and in diarrhea of premature infants, severe burn patients, and
acute and chronic colitis has shown potential beneficial effects of
probiotic Lactobacilli, Bifydobacteria, and Saccharomyces. It is
known that stimulation by commensal bacterial antigens is crucial
for the normal development of the mucosal immune system and
maintenance of tolerance. Moreover, probiotics have shown to
attenuate or abolish tumor necrosis factor a stimulated interleukin
8 production in intestinal epithelial cells. The studies described
here show in addition that, by diverse mechanisms, living probiotics
are able to prevent or counteract the full spectrum of epithelial
dysfunction induced by an enteroinvasive pathogen. In the recent
years, more attention has been taken in the probiotics practice, and
has gained some certain results. Eizaguirre et al.[6],
gave Wistar rats with 80% intestinal resection infusion probiotics,
and decreased the gut bacterial translocation rate (BTR) to 43%.
Olah et al.[7],
reported that probiotics were used in the patients with acute
pancreatitis, and markedly decreased pancreatic second infection
rate and hospital stay time. Rayes et al.[8],
reported that patients with post-surgical severity that use
probiotics (L. plantarum 299, 109
cfu/d), might decrease postoperative
infection rate and shorten the time using antibiotics. However, the
data in this area are relatively sparse, and the detailed mechanism
based investigations of efficacy are largely lacking.
Traditionally, the fecal microflora has been
analyzed by using bacteriological culture methods. It has been
claimed that approximately 88% of the total microscopic counts of
bacterial cells can be cultivated from feces when appropriate
techniques are employed[9].
Our fecal anaerobic culture results showed that there were no marked
differences of the gut bacterial strains in the probiotics group as
compared with PN group, P>0.05. But the amount of
lactobacteria and bifydobacteria is increased, and the amount of
enterococci decreased in probiotics group as compared with PN group,
P<0.05. However, because the conditions of the anaerobic
culture was limited, only some local bacterium were determined by
quantitative analysis, and could not reflect the whole profiles of
gut preponderant bacterium colony. Fortunately, analysis of
terrestrial and aquatic ecosystems in more recent years has
benefited from the use of molecular biological methods with which
community profiles have been established. The molecular methods
involve the amplification by polymerase chain reactions (PCR) of 16S
ribosomal RNA genes (16S rDNA) from microbial DNA extracted from
samples collected from particular habitats[10,11].
It is important to note that the PCR-based and oligonucleotide probe
methods outlined above could differentiate between strains belonging
to the same bacterial species. Summaries of useful molecular typing
(genetic DNA fingerprinting) methods provided direct response to the
gut bacterial strains balance[11-13].
We measured the impact of consumption of this probiotic on the fecal
microflora by using PCR-DGGE, the results showed that the
electrophoresis DNA fingerprint expression reflecting the gut
bacterium variety in probiotics group were similar to the change of
DNA fingerprint of the control group, for rats that received PN
support the new 16S rDNA sequence appeared, and suggested that gut
flora imbalance existed. Our results suggested that in rats that
received PN a serious gut flora imbalance occurred, but the gut
microflora could be improved using probiotics.
The tight junctions of intestinal epithelial
cells form the most apical component of the junctional complex and
create a selective permeability barrier along the paracellular
pathway. Some experimental evidence suggests that occludin may be
vital in a functional capacity. It is reported that this complex
tight junction allows the paracellular diffusion of ions and small
solutes but excludes potentially toxic macromolecules and
micro-organisms, the permeability characteristics of a given barrier
can be dynamically altered by a variety of physiological,
pathological, and pharmacological stimuli. It has reached the same
recognition in international medicine that change of the occludin
protein presents not only the injury extent of tight junction under
the pathogenesis but also indicate the extent recovered from injury[14-17].
The present study of occludin expression by indirect-immune
fluorescence showed that there are more occludin expression of the
surface, intracellular and cell-internal of the epithelial cells in
probiotics group as compared with PN group. The occludin positive
expression area per measured-window in probiotics group
was higher than that in PN group. The expression of occludin
increased as the gut bacterium colony improved, moreover, the impact
of occluding expression on the colon was more effective than that on
the intestine in probiotics group. This result was consistent with
bacterium fixed in the colon and physiological actions. To better
understand the ultra-structure of TJ, the primary results by EM
found that the intestinal micro-villi were slightly brushed off,
mitochondrion endoplasm vacuole and obvious tight junction both of
intestinal and colon in probiotics group as compared with PN group;
meanwhile, the BTR of MLN and the remote organ in probiotic group
were less than that in PN group, the death rate in PN group was
higher than that in probiotics group. So, the prognostic of the rats
that received probiotics showed a marked improvement.
In summary, probiotics increased the expression
of transmembrane binding protein, maintain the structure of tight
junction, improved the gut bacterium colony disorder in the rats
with abdominal infection, decreased the BTR,and protected the
barrier function. Under PN supporting, it is easy to induce the gut
bacterium disorder and mucosa barrier injury, however, the gut
barrier function could be improved by using probiotics.
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Editor Guo SY Language
Editor Elsevier HK
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