Back Clinic Gut and Intestinal Health. The health of an individual’s gut determines what nutrients are absorbed along with what toxins, allergens, and microbes are kept out. It is directly linked to the health of the whole body. Intestinal health could be defined as optimal digestion, absorption, and assimilation of food. But this is a job that depends on many other factors. More than 100 million Americans have digestive problems. Two of the top-selling drugs in America are for digestive problems, and they run in the billions. There are more than 200 over-the-counter (OTC) remedies for digestive disorders. And these can and do create additional digestive problems.
If an individual’s digestion is not working properly, the first thing is to understand what is sending the gut out-of-balance in the first place.
A low-fiber, high-sugar, processed, nutrient-poor, high-calorie diet causes all the wrong bacteria and yeast to grow in the gut and damages the delicate ecosystem in your intestines.
Overuse of medications that damage the gut or block normal digestive function, i.e., acid blockers (Prilosec, Nexium, etc.), anti-inflammatory medication (aspirin, Advil, and Aleve), antibiotics, steroids, and hormones.
Undetected gluten intolerance, celiac disease, or low-grade food allergies to foods such as dairy, eggs, or corn.
Chronic low-grade infections or gut imbalances with overgrowth of bacteria in the small intestine, yeast overgrowth, parasites.
Toxins like mercury and mold toxins damage the gut.
Lack of adequate digestive enzyme function from acid-blocking medications or zinc deficiency.
Stress can alter the gut’s nervous system, cause a leaky gut, and change the normal bacteria.
Visits for intestinal disorders are among the most common trips to primary care doctors. Unfortunately, most, which also includes most doctors, do not recognize or know that digestive problems wreak havoc in the entire body. This leads to allergies, arthritis, autoimmune disease, rashes, acne, chronic fatigue, mood disorders, autism, dementia, cancer, and more. Having proper gut and intestinal health is absolutely central to your health. It is connected to everything that happens in the body.
Dietary fat has several essential functions in the human body. First, it functions as a supply of energy and structural components for the cells and second, it functions as a regulator of gene expression, which influences lipid, carbohydrate, and protein metabolism, along with cell growth and differentiation. The effects of fatty acids on gene expression are cell-specific and influenced by structure and metabolism. Fatty acids interact with the genome. They regulate PPAR, and the activity or nuclear abundance like SREBP. Fatty acids bind directly with one another to regulate gene expression.
What’s the role of fatty acids towards disease pathogenesis?
Alternately, fatty acids behave on gene expression through their effects on specific enzyme-mediated pathways, such as cyclooxygenase, lipoxygenase, protein kinase C, or sphingomyelinase signal transduction pathways, or through pathways that require changes in tissue lipid to lipid raft composition which affect G-protein receptor or tyrosine kinase-linked receptor signaling. Additional definition of these fatty acid-regulated pathways can offer insight into the role dietary fat plays in human health as well as the beginning and growth of many chronic diseases, such as coronary artery disease and atherosclerosis, dyslipidemia and inflammation, obesity and diabetes, cancer, major depressive disorders, and schizophrenia. The effects of fatty acids on gene expression, however, have been widely described on inflammatory bowel disease, or IBD.
Fatty Acids and Gene Expression
The effect of fatty acids on gene expression was previously determined to result mainly from changes in tissue phospholipids or eicosanoid production. More recently, the discovery of nuclear receptors; such as peroxisome proliferator-activated receptors, or PPARs, and their regulation by fatty acids, has significantly altered this view. PPARs are ligand activated transcription factors that upon heterodimerization with the retinoic X receptor, or RXR, comprehend PPAR response elements in the promoter regions of different genes, that have an impact on gene transcription. PPARs bind various ligands, including nonsteroidal anti inflammatory medications, or NSAIDS, thiazolidinediones (antidiabetic agents) along with PUFAs and their metabolites. Several subtypes of the receptor are recognized (?,?,?) and are expressed in several different cells. PPAR? is extracted from the adrenal gland, with most of its numbers observed in the colon.
PPAR? has been implicated in the regulation of inflammation, and it has become a potential therapeutic goal in treating inflammatory diseases, such as IBD. It has been suggested that people with ulcerative colitis, or UC, have a mucosal deficit in PPAR? that could bring about the development of their own disease. Analysis of the mRNA and proteins within colonic biopsies demonstrated decreased levels of PPAR? in UC patients in comparison with Crohn’s patients or healthy subjects.
Using colon cancer lines, it has been demonstrated that PPAR ligands attenuate cytokine gene expression by inhibiting NF-?B via an I?B determined mechanism. Further research studies imply that PPAR activators inhibit COX2 by interruption with NF-?B. PPARs impair interactions with STAT and other signaling pathways as well as the AP-1 signaling pathway.
Animal studies support using PPAR for autoimmune inflammation. Inflammation decreased by ligands for PPAR. The direction of PPAR and RXR agonists synergistically reduced TNBS-induced colitis, together with improved macroscopic and histologic scores, reductions in TNF? and IL-1? mRNA, and diminished NF-?B DNA binding actions. Though clinical evidence is limited, the results of an open source research study with rosiglitazone, a PPAR? ligand as therapy for UC, demonstrated that 27 percent of patients achieved remission after 12 weeks of therapy. Thus, PPAR? ligands may represent a cure for UC, where double-blind, placebo-controlled, randomized trials have been warranted.
Of substantial curiosity, the capability to regulate PPAR nutritionally has been examined. Dietary PUFA demonstrated an impact during the regulation of transcription factors on gene expression. Fatty acid regulation of PPAR was originally detected by Gottlicher et al.. A choice of fatty acids, like eicosanoids, and metabolites are proven to activate PPAR. Both PPAR? and PPAR? bind mono- and polyunsaturated fatty acids. Thus, the anti inflammatory effects of n3 PUFA may entail PPAR and its interruption with NF?B, rather than only changes in eicosanoid synthesis.
Conclusion
Fatty acids regulate gene expression involved in lipid and energy metabolism. Polyunsaturated fatty acids, or PUFA, though not saturated or polyunsaturated FA, suppress the induction of lipogenic genes by inhibiting their expression and processing of SREBP-1c. This impact of PUFA suggests that SREBP-1c may regulate the synthesis of fatty acids to glycerolipids, among others. PPARalpha has a role in the adaptation to fasting by inducing ketogenesis in mitochondria. During fasting, fatty acids are considered as ligands of PPARalpha. Dietary PUFA, except for 18:2 n-6, are extremely prone to induce fatty acid oxidation enzymes through PPARalpha because of specific mechanisms. Signaling functions of PPARalpha pPARalpha is needed for controlling the synthesis of fatty acids. Further research is needed to conclude the full effects of fatty acids in relation to the regulation of transcription factors for gene expression in inflammatory bowel disease, or IBD.
Information referenced from the National Center for Biotechnology Information (NCBI) and the National University of Health Sciences. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
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Inflammatory bowel disease, or IBD, is a term used to describe inflammation of the gastrointestinal mucosa of unknown etiology. There are a selection of hypotheses associated to the development and perpetuation of IBD. Three main theories emerge from the literature. The first implicates a persistent intestinal infection; the second demonstrates that the upcoming signs of IBD are due to a defective mucosal barrier to luminal antigens; and the next suggests a dysregulated host immune response to ubiquitous antigens.
What are the nutritional components, if any, behind inflammatory bowel disease?
It is believed that IBD has both genetic and environmental components, therefore it’s immunologically mediated. Information gathered from IBD patients showing cytokine profiles, permeability defects, response to treatment and natural history of disease, may indicate a heterogeneous group of disorders that fall under the headings of ulcerative colitis, or UC, and Crohn’s disease, or CD. Previous epidemiological data on diet in UC and CD are conflicting, partly as a result of the heterogeneity of those diseases, making it difficult to get reliable statistics and publication bias, such as in the case of negative structures from breastfeeding.
Glutamine, Fiber and Fatty Acids
Diets high in glutamine, a significant source of energy for enterocytes, in addition to being the preferred fuel of the small intestine, are used with varying success. Glutamine is bekieved to exert its trophic effects on the small intestine by increasing protein synthesis and producing alanine for enteric gluconeogenesis. There is proof that glutamine protects the small intestinal mucosa during acute disease. However, oral glutamine supplements do not restore to normal the increased intestinal permeability discovered in patients with CD and these supplements do not beneficially affect the sufferers’ CDAI or C-reactive protein, also abbreviated as CRP, levels. Similarly, a randomized controlled trial demonstrated no benefit was connected to the usage of glutamine-enriched polymeric formulas in children with CD.
In animal research studies, dietary fiber has been implicated in keeping the integrity of the intestine, as well as in preventing bacterial translocation from the gut to the mesenteric lymph nodes. Short-chain fatty acids (SCFA, C1 to C6 natural fatty acids), are created by the fermentation of dietary polysaccharides in the common anaerobic bacteria in the colon. These SCFA are a source of energy for the colonocytes, which together improve sodium and water absorption, and promote blood circulation. Decreased quantities of SCFA, particularly butyrate, and a defect in the oxidation of butyrate from colonocytes, are indicated as a mechanism in the pathogenesis of inflammatory bowel disease. Evidence to support that concept requires the observation of the oxidation of C-labelled butyrate, demonstrated to decrease in patients with active UC in comparison with healthy controls. However, researchers have failed to reveal the differences between UC patients and controls in the oxidation of rectally administered C-labelled butyrate.
TPN supplemented with SCFA improved function adaptation to intestinal resection in rats. It remains to be discovered when patients with short bowel syndrome may make the most of SCFA.
Butyrate (C4 fatty acid) administered to UC patients contributed to remission levels like corticosteroids and mesalamine. In patients with CD, both intestinal biopsies and lamina propria cells packaged with butyrate had substantially decreased levels of inflammatory cytokines (TNF), possibly due to a reduction in NF?B stimulation and I?B degradation.
Eicosanoids are inflammatory mediators, which have also been implicated in the pathogenesis of chronic inflammatory damage in the intestine. Specimens from patients with IBD show enhanced eicosanoid formation. High dietary intake of omega-6 polyunsaturated fatty acids, abbreviated as PUFAs, which reduces omega-3 intake, and may contribute to IBD development. The benefits of fish oil, which contain n3 fatty acids, that were shown in certain inflammatory disorders, such as psoriasis and rheumatoid arthritis. Epidemiological observations of this very low prevalence of IBD in Japanese and Inuit populations consuming substantial n3 fatty acid fish provided a justification for utilizing n3 fatty acids in IBD. The n3 fatty acids are considered to compete with n6 fatty acids as precursors of eicosanoid synthesis. The n3 products reveal a series of 5 leukotrienes, which have considerably less physiological activity when compared with the arachidonate established series 4 counterparts. In addition, fish oil might have an anti inflammatory effect.
Rats fed with fish oil that had TNBS-induced inflammatory lesions in the intestine showed less prostaglandin- and leukotriene-mediated resistant response. Parenteral lipid emulsions enhanced with n3 fatty acids reduce diarrhea, weaken morphological changes and decreased colonic concentrations of inflammatory mediators in an animal model of acetic acid induced colitis.
Loeschke et al conducted a placebo-controlled trial of n3 fatty acids in preventing relapse in UC. Patients in remission who got n3 fatty acids experienced fewer relapses than did those receiving placebo. Unfortunately, the favorable results of this research study did not last throughout the total amount of the two year research, possibly due to diminished compliance punctually. In a multicenter placebo controlled relapse prevention trial, Belluzzi et al found a significant drop in the relapse rate in CD patients given an exceptional formula designed to allow postponed ileal release of n3 fatty acids. A fish oil diet has been shown to increase eicosapentanoic and docosahexanoic acids in the intestinal mucosal lipids of IBD sufferers, also demonstrating a reduction in arachadonic acid. A gain in the synthesis of leukotriene B5 along with a 53 percent decrease of leukotriene B4 was shown in UC patients, whereas the fish oil treatment revealed a nonsignificant trend to faster remission. Fish oil supplementation results in clinical improvement of active mild to moderate disease, but was not associated with a significant reduction in leukotriene B4 production. Consequently, fish oil supplementation of the diet may provide some short-term benefit to people with CD or UC. Using probiotics and prebiotics has received much attention; the interested reader is referred to recent reviews in this area.
Clinical Implications
It is widely known that nutritional deficiencies are common in people with CD and UC, and people have to be expected, diagnosed and treated. There are no special diets which may be recommended for all patients with IBD; dietary therapy needs to be individualized. TPN or TEN may be necessary to restore nutrient equilibrium in selected IBD patients with malnutrition, but in adults these interventions do not provide an essential decision to modify disease activity. The omega-3 PUFAs in fish oil may reduce disease activity in UC and CD when used at the short term together with regular medical therapy. Their mechanism of action is to enhance the activity of the amino acids PPAR, or peroxisome proliferator-activated receptors, in the intestine, inhibiting the AP-1 signaling pathway and NF-?B, weakening pro-inflammatory cytokine receptor expression. Future research will focus on the identification and use of certain dietary lipids to reduce intestinal inflammatory activity and also to maintain long-term disease remission.
Information referenced from the National Center for Biotechnology Information (NCBI) and the National University of Health Sciences. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
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Inflammatory bowel disease is an umbrella term used to describe a group of gastrointestinal diseases characterized by chronic, ongoing inflammation of all or part of the gastrointestinal tract, or GI tract, such as Crohn’s disease, or CD, and ulcerative colitis, UC. While many factors have been determined to cause inflammatory bowel disease, research studies have concluded that nutrition can increase the risk of gastrointestinal diseases, including inflammatory bowel disease.
How does nutrition affect inflammatory bowel disease?
Nutrient deficiencies are common among individuals with inflammatory bowel disease, or IBD. Both complete parenteral and enteral nutrition can provide significant supportive treatment for patients with IBD, however, in adults those alone may not be helpful as a form of primary treatment. Clinical intervention using omega-3 polyunsaturated fatty acids found in fish oil could be beneficial for the nutritional regulation of IBD patients and recent research studies have emphasized the function of PPAR on NF?B action towards its possible beneficial impact on dietary lipids for overall intestinal functioning.
Nutrition in Inflammatory Bowel Disease
Specific antibody isotypes of essential milk proteins are located in both UC and CD patients. In CD, the antibodies are associated with disease. Although cultural origin, rather than the IBD disease condition, seems to be the primary cause of lactose intolerance, the avoidance of milk products by IBD patients is extensive. Lack of breast-feeding during infancy was associated with CD but not UC. Additionally, higher carbohydrate intake was recorded in CD. Others have suggested a deficiency of dietary fiber as a predisposing factor for IBD. The growth of UC has also been associated with higher intakes of polyunsaturated fatty acids (MUFA), n6 polyunsaturated fatty acids (n6 PUFA), sulphur-containing diets and vitamin B6.
Deficiencies
Inflammatory bowel disease is related to several nutritional deficiencies, such as anemia, hypoalbuminemia, hypomagnesia, hypocalcemia and hypophosphatemia, including deficiencies in folic acid, niacin, vitamins A, B12, C, and D, in addition to deficiencies of iron, magnesium and zinc. Further research studies are needed to determine if reduced levels of micronutrients are of some significance to the result of gastrointestinal diseases. Plasma antioxidant concentrations are lower in IBD patients, especially those who have an active form of the disease. Antioxidant action, evaluated by measuring selenium levels and erythrocyte glutathione peroxidase activity, is inversely associated with inflammatory biomarkers, such as TNF?. Hyperhomocysteinemia is more prevalent in patients with IBD, and is characterized with low serum as well as reduced concentrations of vitamin B12, folate and B6.
Several mechanisms are responsible for the malnutrition observed in IBD patients. Primarily, there’s a decline in the oral consumption of nutrients due to abdominal pain and anorexia. Second, the mucosal inflammation and related diarrhea reduces blood, protein, minerals, electrolytes and trace components. Paradoxically, multiple resections or bacterial vaginosis might have an adverse nutrient impact; and finally, herbal remedies may also cause malnutrition. By way of instance, sulfasalazine reduces nitric acid absorption, and corticosteroids reduce calcium absorption in addition to negatively impacting protein metabolism. Alterations in energy metabolism may result in increased resting energy expenditure and lipid oxidation in patients with inflammatory bowel disease. There are many effects of malnutrition and each can decrease bone mineral density, in addition to growth retardation and delayed sexual maturity in children. Osteoporosis may also be involved as a consequence of pro-inflammatory cytokine profiles.
Nutritional treatment may take on a range of forms including Total Parenteral Nutrition (TPN) and Complete Enteral Nutrition (TEN). The diets used are elemental, polymeric, and exception diets. Elemental diets contain nutrients reduced to their fundamental elements: amino acids, such as proteins, sugar for carbs, and short-chain triglycerides, such as fats. Polymeric formulas contain entire proteins, such as nitrogen, glucose polymers for carbs and long-chain triglycerides for fat or starch.
Total Parenteral Nutrition (TPN)
Using TPN for the nutritional regulation of IBD is based on specific theoretical benefits, including how: gut rest may be beneficial since it reduces motor and transportation function in the diseased intestine; a drop in antigenic stimulation can remove the immunologic reactions to food, particularly in the presence of diminished intestinal permeability; TPN promotes protein synthesis in the gut which provides cell renewal, recovery, and alteration of impaired immunocompetence.
Researchers demonstrated remission rates of 63 percent to 89 percent with TPN in a large retrospective collection of CD patients which were difficult in standard medical management. But, Matuchansky et al highlighted that there have been high relapse rates (40%-62%) after two decades. It’s been implied that TPN be utilized exclusively in a nutritionally supportive function. In UC, there’s absolutely no evidence for much better results with TPN. Though remission rates of 9 percent to 80 percent are reported, TPN provided to patients with acute colitis seems to be beneficial as perioperative nutritional support. In patients with moderate disease, TPN is significantly more successful but isn’t better than steroid treatment, and so the invasiveness and price of TPN are unjustified. Any advantages related to TPN might be due to the nutritional regulation, rather than gut rest, as gut rest alone has no impact on disease activity. Accordingly, though TPN has a function in patients using a non-functioning gut or the brief gut syndrome because of excess resections, TPN is of limited use as a primary treatment in IBD. This isn’t designed to be an extensive breakdown of TPN, but it needs to be cautioned that in specialist centers, TPN is associated with complications like sepsis and cholestatic liver disease.
Total enteral nutrition (TEN), Elemental & Defined Formula Diets
TEN prevents possible toxic dietary variables and antigenic exposure, because there are only amino acids, sugar or oligosaccharides and very low lipid content. TEN isn’t associated with cholestasis, biliary sludge or gallstone formation, as can be observed with TPN. Atrophy of the small intestinal mucosa was discovered in animal models receiving long-term TPN, yet this atrophy is prevented with TEN. Additionally, a 6-wk TPN therapy in dogs led to marked decrease in pancreatic fat, a reduction in small intestinal mass as well as a decline in intestinal disaccharidase activity in puppies. Because of this, TEN is more preferable than TPN.
The subject of nutrition in gastrointestinal disorders which occur in IBD has been recently reviewd. In comparison to TPN, enteral nutrition yielded similar outcomes towards preventing and combating malnutrition. Though Voitk et al suggested that elemental diets could be an effective treatment for IBD, enteral nutrition as a primary therapy has failed to produce consistent results in several clinical trials. It’s correct that quite a few trials have shown remission levels in CD patients getting elemental diets, like the rates observed with prostate cancer treatment. But, it’s important to note that greater remission rates were detected in patients receiving steroid therapy versus standard diets when including all of the diet category fall outs (i.e., in an intent-to-treat foundation). The question remains concerning the best means of assessing the results when a sizable proportion of individuals receiving diet treatment fall out due to unpalatibility or intolerance. What’s more, a few research studies have demonstrated no distinction with elemental diets compared to steroid treatment. In children, elemental diets have been associated with higher linear gain, whereas in adults those diets maintain nitrogen equilibrium. The use of supplements in the context of pediatric onset illness was also reviewed. Therefore, enteral nutrition is simpler to use, is less costly, and it’s also a far better choice than TPN. Unfortunately, its unpalatability limits individual agreement, but with powerful encouragement this might be partly overcome.
The fat composition of enteral diets can influence the results that are obtained in the several clinical trials. Elemental diets include a reduced fat content, although a lot of healthier diets generally contain more fat, such as more lactic acid, which can be a precursor for the synthesis of possible pro-inflammatory eicosanoids.
Defined formula diets are often more palatable and more affordable than would be the elemental diets. When some researchers reported no gaps between utopian and defined formula diets in patients with severe CD, Giaffer et al discovered elemental diets are far more successful for active CD. A randomized double-blind study in Crohn’s patients revealed that elemental and polymeric, or characterized, diets differing only in their own source of nitrogen, were equally effective in lessening the Crohn’s disease activity index, or CDAI, also inducing clinical remission. Though defined formula diets supply less gut rest, they have the possible benefit of exposing the GI tract to the typical dietary substrates, which permit thereby for the complete manifestation of intestinal, biliary and pancreatic action. In animal research, it has also been discovered that luminal nutrition has trophic impacts on the intestine.
Can there be a beneficial effect of supplementing polymeric formulas with TGF-?1? In pediatric CD, reductions in pro-inflammatory cytokine concentrations and mRNA, paired with an up-regulation of TGF-? mRNA, was associated with enhanced macroscopic and microscopic mucosal inflammation. A meta-analysis along with a Cochrane review have demonstrated that in adults, corticosteroids are more effective than enteral diet treatment. It’s uncertain what is the use of supplements in adults with CD, even though there are some signs in Japan that enteral nutrition enjoys support as principal treatment. In contrast to this generally agreed part in adults of enteral nutrition being used to enhance the patient’s nutritional status because its principal advantage, in children with CD enteral nutrition has a far clearer benefit to enhance clinical, biochemical and growth parameters, and may as well have a steroid sparing effect.
Information referenced from the National Center for Biotechnology Information (NCBI) and the National University of Health Sciences. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
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It has currently been accepted that the interaction between environmental factors, and that of certain genes, can influence the destructive immune response characterized in many autoimmune diseases. As a matter of fact, approximately less than 10 percent of those people with a higher genetic susceptibility to disease may actually develop autoimmunity. This implies a solid environmental cause behind the beginning of the autoimmune process. Environmental factors have also been believed to likely affect the results of the process as well as the rate of development of autoimmune diseases. One theory is that intestinal luminal antigens absorbed through the gut might be involved in the pathogenesis of autoimmune diseases. The intestinal epithelium is the largest mucosal surface in the human body and it provides a connection between the external environment and the mammalian host.
What environmental factors cause autoimmune diseases?
Healthy, mature intestinal mucosa with its absolute tight junctions, or TJs, is the most significant barrier for the passage of macromolecules, as seen on Figure 1. In a physiological state, quantitatively small but immunologically active antigens can cross the mucosal barrier. These antigens are absorbed through the mucosa via two practical paths. The massive collection of absorbed proteins, amounting to about 90 percent, cross the intestinal barrier throughout the transcellular pathway followed by lysosomal degradation which converts the proteins into smaller, non-immunogenic peptides. The remaining proteins are then carried as entire proteins, causing antigen-specific immune responses in the body. This occurrence utilizes the Microfold (M) cell pathway or the paracellular pathway, which requires a subtle but complex balance of intercellular TJs that can result in antigenic tolerance.
Figure 1
After the integrity of the intestinal barrier are compromised, best known as TJ disassembly, an immune response to environmental antigens that spanned the gut mucosa can grow, leading to autoimmune diseases or allergies. The cells that play a vital part in this immune response lie in close proximity to the intestinal epithelial barrier. Another critical component for this immune response is the human leukocyte antigen, or HLA, system. HLA class I and II genes encode the antigen presenting cell (APC) glycoprotein receptors that present antigens to T cells in the intestinal mucosa. Susceptibility to up to 50 diseases, such as celiac disease, or CD, and type 1 diabetes, or T1D, has been associated with certain HLA class I or class II alleles. A typical denominator of these diseases is the occurrence of numerous preexisting conditions which can lead to autoimmunity. The first is a hereditary susceptibility for the host immune system to recognize, and potentially misinterpret, an environmental antigen introduced within the gastrointestinal tract, or GI tract. Second, the host needs to be exposed to the antigen. Finally, the antigen needs to be introduced into the gastrointestinal mucosal immune system, following its M-cell passage or paracellular passage, usually blocked by TJ competency, from the intestinal lumen to acquire the intestine submucosa. In most instances, higher intestinal permeability precedes disease and triggers an abnormality in antigen delivery which triggers an immune response, ultimately causing autoimmunity. Researchers have therefore hypothesized that genes, environment, and decreased intestinal barrier function are all critical to develop autoimmune diseases, especially CD and T1D.
Gliadin as an Environmental Factor of Autoimmune Diseases
Celiac Disease
Gluten is a well-known environmental factor that triggers celiac disease. It is the gliadin fraction of wheat germ and equal alcohol-soluble proteins in distinct grains, known as prolamins, which are connected to the growth of intestinal damage. A standard characteristic of the prolamins of wheat, rye, and barley is a greater content of glutamine (>30%) and proline (>15%), whereas the non-toxic prolamins of rice and corn have decreased glutamine and proline content. However, the environmental factor that influenced the development CD is complex and unknown. Some aspects of gluten consumption might help determine the risk of CD incidence, particularly in: the amount of gluten intake, the higher the amount, the larger the risk; the caliber of consumed gluten, a few grains contain more hazardous epitopes than others; and the pattern/timing of infant feeding. Recent research studies suggest that the pattern of infant nutrition might have a very important role on the development of the CD as well as that of other autoimmune diseases. Breastfeeding is believed to delay or reduce the possibility of developing CD. The positive effects of breast milk may be attributed to its influence on the microbial colonization procedure for the own newborn’s intestine. The genus Bifidobacterium is predominant in the feces of breast-fed infants, while a larger variety of bacterial groups, including Bacteroides, Streptococcus, Clostridium, etc., are found in the fecal microbiota of all formula-fed infants. Changes in the composition of the intestinal microbiota also occur as a consequence of the following changes from breastfeeding or formula feeding to weaning and even the introduction of solid food. Alterations in the intestinal balance between favorable and possibly harmful bacteria have also been associated with allergy symptoms, type 1 diabetes and inflammatory bowel diseases, among others.
Type 1 Diabetes
It is believed that genetically predisposed individuals develop T1D after encountering one or more environmental factors of the disease. Fast improvements could be made in disease prevention and treatment if these environmental factors were identified. Amongst the others, gliadin has only been the subject of a series of research studies that aim at establishing its part in the pathogenesis of type 1 diabetes. Early introduction of gliadin-containing cereals were reported to raise the prospect of islet cell autoimmunity in humans. Gliadin-specific, lamina propria-derived T cells play an important role in the pathogenesis of CD. The same HLA class II haplotype, DQ (? 1 * 0501, �1 * 0201), that can be connected with gliadin peptides in CD is also one of two HLA class II haplotypes inherited most frequently by people with T1D. There are also signs of immunological activity in the intestine of T1D patients: jejunal specimens from T1D patients have been found to consist of much higher doses of interferon gamma (IFN?)- and tumor necrosis factor-alpha (TNF-?) positive cells in contrast to people with healthy controls, suggesting an inflammatory response. Still another study found substantially increased manifestation of HLA-DR and HLA-DP molecules on intestinal villi of jejunal specimens from T1D patients in comparison with specimens from healthy controls. Recent evidence confirmed these findings by assessing the mucosal immune response to gliadin in the jejunum of patients with T1D. Small intestinal biopsies from children with T1D were cultured with gliadin and evaluated for epithelial infiltration and lamina propria T-cell activation. The caliber of intraepithelial CD3+ cells and of lamina propria CD25+ mononuclear cells has been higher in jejunal biopsies from T1D patients versus control subjects. In the patients’ biopsies cultured with enzymatically treated gliadin, there was epithelial infiltration by CD3 cells, a more significant growth in lamina propria CD25+ and CD80+ cells, enhanced manifestation of lamina propria cells favorable into ligand and receptor molecules ?4/?7 and ICAM 1, along with enhanced expression of CD54 and crypt HLA-DR. Also, ?4 positive T cells have been recovered in the pancreatic islets of an T1D person, providing an immediate connection between gliadin-activated T cells and destruction of pancreatic islet cells.
Findings from research studies using non-obese diabetic, or NOD, mice in addition to the BioBreeding diabetes-prone, or BBDP, rats have also implicated wheat gliadin as a nutritional supplement diabetogen. In BBDP rats, gliadin vulnerability is accompanied by increased intestinal permeability, and changes in gut microbiota composition, as seen on Figure 2., presumably allow food antigens to grow in contact with all the underlying lamina propria. Feeding NOD mice and BBDP rats a gluten free hydrolyzed casein diet resulted in a delay and decline in T1D development. Interestingly, these T1D animal models additionally demonstrated the moment of exposure to wheat proteins is quite important to the development of T1D. Delaying the vulnerability of diabetogenic wheat proteins by prolonging the breastfeeding period decreased T1D expansion from the BBDP rats. What is more, exposing neonatal rats or mice to diabetogenic wheat components or bacterial antigens diminished T1D incidence, which is perhaps due to the induction of immunological tolerance.
Figure 2
Rats that were fed corn protein-based diets developed T1D and demonstrated a moderate celiac-like enteropathy. Mesenteric lymph nodes, or MLNs, which drain the gut, are the substantial inductive site where dietary antigens are famous in the gut-associated connective tissue. The authors described an increase in the expression ratio of T-bet:Gata3, master transcription factors for Th1 and Th2 cytokines, respectively, in the MLN by wheat-fed BBDP rats compared to this by BBDR rats, mainly due to diminished Gata3 expression. Also, CD3+CD4+IFN?+ T cells were prevalent in the MLN of wheat-fed BBDP rats, but remained at control levels in BBDP rats fed with a diabetes-retardant wheat-free diet. BioBreeding diabetes-prone MLN cells increased quickly in response to wheat protein antigens in a particular, dose-dependent manner, and 93 percent of cells were CD3+CD4+ T cells. This proliferation was connected using a minimum proportion of CD4+CD25+ T cells and a greater proportion of dendritic cells in the MLN of BBDP rats. These results suggest that, before insulitis is established, the MLNs of wheat-fed BBDP rats contain a remarkably large proportion of Th1 cells that rapidly increased particularly in response to wheat protein antigens. Collectively, these research studies suggest a deranged mucosal immune response to gliadin in T1D and a direct connection between gliadin-induced stimulation of gut mucosal T cells and abuse of pancreatic islet cells, as seen on Figure 2.
Link between Gliadin, Zonulin & Increased Intestinal Permeability in Autoimmune Diseases
Researchers have generated enough evidence to support that gliadin can induce increased intestinal permeability by releasing preformed zonulin. Intestinal cell lines exposed to gliadin released zonulin from the cell medium with subsequent zonulin binding to the cell surface, rearrangement of the cell cytoskeleton, loss of occludin-ZO1 protein interaction, and increased monolayer permeability. Pre-treatment with all of the zonulin antagonist AT1001 blocked these alterations without affecting zonulin release. When exposed to luminal gliadin, intestinal biopsies from patients with celiac disease in remission expressed a continuous luminal zonulin discharge and increase in intestinal permeability. On the contrary, biopsies from non-CD patients showed a limited, transient zonulin release, which was paralleled by a decline in intestinal permeability that had not reached the level of permeability found in celiac disease cells. As a matter of fact, when gliadin was added to the basolateral side of cell lines or intestinal biopsies, no zonulin release was detected. The latter finding indicates that gliadin interacts using an intestinal luminal receptor, which encouraged researchers to comprehend this issue. In vitro experiments revealed specific colocalization of gliadin along with the chemokine receptor CXCR3 expressed in human and mouse intestinal epithelium and lamina propria. Gliadin vulnerability led to a tangible establishment of CXCR3 and MyD88. Ex vivo experiments revealed that gliadin exposure to intestinal segments from wild-type mice increased zonulin terminal and intestinal permeability, whereas CXCR3 intestinal segments failed to respond to gliadin. The increased intestinal permeability appeared cause a specific impact for gliadin, because the subsequent CXCR3 ligand, IP-10, did not affect intestinal barrier function. Based on these figures, researchers suggested that gliadin contrasts to CXCR3 additionally lead to stimulation of the zonulin pathway and improved intestinal permeability in a MyD88-dependent manner.
Conclusive Remarks
The classical paradigm of the pathogenesis of autoimmune diseases involving certain receptor makeup and exposure to environmental factors was contested with the addition of a third component, the decrease of intestinal barrier function. Genetic predisposition, miscommunication between innate and adaptive immunity, exposure to environmental factors and loss in intestinal barrier function secondary to the breakdown of intercellular tight junctions, or TJs, seem to be vital components in the pathogenesis of autoimmune disorders. Both in CD and T1D gliadin may play a role in inducing loss of intestinal barrier function or inducing the gastrointestinal response in genetically predisposed individuals. This new hypothesis suggests that after the digestive process is triggered, it is not auto-perpetuating, but rather, it might be balanced or reversed by preventing the continuous interaction between genes and the environment. Since TJ dysfunction allows this interaction, new treatment procedures targeted at re-establishing the intestinal barrier function supply innovative, unexplored procedures for caring for autoimmune diseases. Information referenced from the National Center for Biotechnology Information (NCBI) and the National University of Health Sciences. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
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Digestive health can be attributed to the optimal function of the gastrointestinal tract. By way of instance, however, if disease affects the structure of the gut, understanding its anatomy and function, can help healthcare specialists conclude a diagnosis outcome. The intestinal epithelium is a single layer of cells found lining the intestinal lumen, which plays the role of carrying out two essential functions in the digestive system. Its first function is to act as a barrier to prevent the passage of harmful intraluminal entities, such as foreign antigens, microorganisms and their toxins. Its second function is to act as a selective filter, allowing the translocation of important dietary nutrients, electrolytes and water from the intestinal lumen to the blood stream. The intestinal epithelium distinguishes selective permeability through two main pathways: the transepithelial/transcellular and paracellular pathways, as seen on Figure 1.
Transcellular permeability is generally related with the epithelial cells and is largely regulated by specific transporters in charge of also transferring amino acids, electrolytes, short chain fatty acids and sugars throughout the human body. Paracellular permeability is usually related to the transferring distance between epithelial cells and is greatly regulated by intercellular complexes found in the apical-lateral membrane junction and along the lateral membrane of the gastrointestinal tract, or GI tract. Interaction between the intestinal epithelial cells involves three components which can be identified at the ultrastructural level: desmosomes, adherens junctions, or AJs, and tight junctions, or TJs, as seen on Figure 2. The adhesive junctional complexes are made up of transmembrane proteins which connect adjacent cells to the actin cytoskeleton through cytoplasmic scaffolding proteins. The adherens junctions and desmosomes are believed to be more significant than the mechanical link of adjacent cells. The tight junctions, on the other hand, are the apical-most junctional complex, accountable for closing the intercellular space as well as regulating specific paracellular ionic solute transfer. The AJ and TJ complexes are also essential towards the regulation of cellular proliferation, polarization and distinction.
Structural Components of Junctional Complexes
Figure 1
Figure 2
Adherens Junctions (AJs)
The adherens junctions, also known as zonula adherens, are protein complexes located along the lateral membrane which happen in points of cell to cell contact, as seen on Figure 2. They’re shaped by interactions between transmembrane proteins, intracellular adaptor proteins and the cytoskeleton. The major AJs, or adherens junctions are formed by cadherin to catenin interactions. Epithelial (E)-cadherins, or calcium-dependent adhesion molecules, are Type-I single transmembrane spanning glycoproteins that contain an intracellular C-terminus and extracellular N-terminus. The extracellular domain creates homotypical interactions with the cadherins of neighboring cells to develop this cell to cell adhesion. The intracellular domain contains a catenin-binding domain that interacts with members of the armadillo repeat superfamily, ?-, ?- and p120-catenin. The catenins then connect the AJs into the cytoskeletal network through direct binding to the C-terminal domain of F-actin or indirectly through interactions with other adaptor proteins like afadin. Cadherin to catenin complexes are significant not only for connecting adjoining cells, but also for keeping cell polarity and for regulating epithelial migration and proliferation as well as the formation of additional adhesive complexes, such as desmosomes. In order to allow the link of adjoining cells, a decreased regulation of E-cadherin from the intestinal epithelium interrupts cell to cell adhesion which has been associated with affected intestinal epithelial proliferation and migration.
Nectin-afadin interactions create another significant AJ complex. Nectins, specificially nectin-1-4, are immunoglobulin-like proteins that withstand homophilic and heterophilic interactions with nectins on adjacent cells. Nectins can interact with the cytoskeleton through afadin, an F-actin binding protein, or rather preferably through interactions with other F- or ?-actin binding proteins including ponsin/SH3P12, vinculin and afadin dil domain-interacting proteins.
Tight Junctions (TJs)
The tight junctions are the apical-most adhesive junctional complexes in the epithelial cells of mammals which develop a continuous belt-like ring around epithelial cells at the boundary between the apical and lateral membrane regions of the gastrointestinal tract, according to Figure 2. Tight junctions, or TJs, are powerful, multi-protein complexes which serve as a selective/semipermeable paracellular barrier, that eases the passage of ions and solutes through the intercellular space, while also preventing the translocation of luminal antigens, microorganisms and their toxins. The progression of TJ biology began in the 1960’s with the development of electron microscopy. Evaluation and analysis of epithelial cells explained a series of apparent fusions, in which the space between adjacent epithelial cells had been eliminated. These so-called “kissing points” are morphologically different from AJs and desmosomes, where adjoining cell membranes stay approximately 15 to 20nm apart. Since the first observations, TJs have been found to include four families of transmembrane proteins: occludin, claudins, junctional adhesion molecules, or JAMs, and tricellulin.
The extracellular domains of transmembrane TJ proteins in adjoining cells anastomose to shape the TJ isolate. These interactions involve those proteins found in the exact same membrane as well as those including proteins in adjacent cells. Additionally, TJ proteins may form homophilic interactions, with the exact same protein, or heterophilic interactions, between non-identical TJ proteins. Like the adherens junctions, the intracellular domains interact with different scaffolding proteins, adaptor proteins and signaling complexes to moderate cytoskeletal attachment, cell polarity, cell signaling and vesicle trafficking, as seen on Figure 3. The intracellular regions of AJs possess PDZ-binding domains, which gather and come in contact with PDZ domain containing proteins. The PDZ domain (Post synaptic density-95/Drosophila disk large/Zonula occludens-1 protein) is a common structural domain of about 80 to 90 amino acids which play the role of anchoring transmembrane proteins to the cytoskeleton. The intracellular domains may also interact with non-PDZ-binding domain including proteins like cingulin, which can interact with junctional membrane proteins, the actin cytoskeleton and signaling proteins. The complex network of intracellular protein interactions can also be known as the “cytoplasmic plaque”.
Figure 3
Tight Junction Formation in the Gastrointestinal Tract
The intestinal epithelium shapes the largest and most essential barrier between our external and internal gastrointestinal tract environments. The barrier is preserved by the presence of AJs and TJs, such as cadherins, claudins, occludin and JAM proteins, which isolate groups of adjacent cells and maintains cytoskeletal anchorage, as seen on Figure 3. Expression of junctional proteins in the gut are highly regulated and dependent on both the small and/or large intestine, villus/crypt location and cell membrane specificity; apical, lateral or basolateral. The complex pattern of TJ expression from the gut is related to the particular functions of a distinct intestinal region and location. Expression of adherens junctions and tight junctions proteins can also be controlled by phosphorylation, according to Table 1. Phosphorylation can either promote TJ formation and barrier feature, or alternatively promote TJ protein redistribution and intricate destabilization.
Occludin
One of the first integral membrane proteins belonging specifically to the tight junctions to be recognized is the occludin. Occludin are predominantly found at TJs in the epithelial and endothelial cells but can also be located in astrocytes, neurons and dendritic cells. Occludin (60 to 82 kDa) is a tetraspanning integral membrane protein consisting of two extracellular loops, a short cytoplasmic N-terminus and a long cytoplasmic C-terminus. Analysis and evaluation of the function of these have demonstrated that the extracellular loops and transmembrane domains of occludin manage and maintain selective paracellular permeability. Intracellularly, the C-terminus interacts with the PDZ-domain containing protein ZO-1, which is required to connect occludin into the actin cytoskeleton, according to Figure 3.
Several occludin isoforms are characterized and believed to be the result of alternative mRNA splicing. Quite distinctly, many splice variants demonstrate altered subcellular distribution and interaction with other TJ molecules. Evaluation of these splice variants showed that the cytoplasmic C-terminal domain is funcamental for the intracellular exchange of occludin to the lateral cell membrane, which the fourth transmembrane domain name is important for targeting occludin into the TJ as well as for ZO-1 interactions.
The role of occludin is not fully outlined; nonetheless, data suggested another function for occludin from the regulation of paracellular permeability. The major allergen of the house dust mite, Der p 1, was determined to proteolyticly disrupt occludin altering this TJ complex and increasing paracellular permeability. In addition, hydrocortisone treatment of bovine retinal endothelial cells improved occludin expression two-fold and enhanced monolayer barrier properties. Though occludin is an important element of TJs, TJ formation and paracellular permeability barrier function are not dependent on occludin. Experimental investigations of occludin on mice demonstrated equivalent numbers and groups of TJs and corresponding paracellular ion passage as wild mice. Furthermore, epithelial transport and barrier function were normal in mice with occludin. Along with regulating paracellular permeability, there is evidence indicating occludin is included in cellular adhesion. Length of occludin at occludin and rat fibroblasts conferred cell to cell adhesion that has formally been interrupted by synthetic peptides associated to the first extracellular loop of occludin, underscoring the significance of the area of occludin in cell adhesion.
Evaluations indicated that occludin found along the TJ complex is regulated by phosphorylation. Several potential phosphorylation sites at tyrosine, serine, and threonine residues of occludin have been identified where the regulation of occludin phosphorylation is proposed to happen by kinases, for instance, non-receptor tyrosine kinase c-Yes and protein kinase C (PKC), and phosphatases including the serine/threonine protein phosphatase 2A, according to Figure 3. PKC?, a novel protein kinase predominantly expressed in the intestinal epithelium, was demonstrated to directly phosphorylate occludin in threonine residues (T403 and T404). Blockade of all PKC?-mediated occludin phosphorylation interrupted junctional distribution of occludin and ZO-1 and interrupted epithelial barrier function. The data suggest that occludin phosphorylation modulates occludin-ZO-1 interactions and the maintenance of intact TJ complexes and paracellular barrier function.
Claudins
Claudins are 20 to 27 kDa integral membrane proteins with four hydrophobic transmembrane domains, two extracellular loops and N- together with C-terminal cytoplasmic domains. The extracellular loops are crucial for homophilic and/or heterophilic TJ protein to protein interactions alongside the creation of ion-selective channels. The intracellular C-terminal domain is included in anchoring claudin into the cytoskeleton through connections with PDZ-binding domain names, such as ZO-1, -2 and -3, according to Figure 3. Presently, 24 distinct claudin family receptor members are identified in those who have a number of orthologues expressed in various species. They exhibit distinct cell, tissue and developmental stage-specific expression routines.
Claudin to claudin interactions between adjoining cells might be homophilic or heterophilic. Homophilic interactions have been shown for claudins 1, 2, 3, 5, 6, 9, 11, 14 and 19. On the reverse side, heterophilic interactions are more restricted and largely have been detected with claudin-3, which could interact with claudins-1, -2 and -5. Notably, there’s specificity in heterophilic trans-interactions. By way of instance, transfection of fibroblasts with claudins-1, -2 and -3 led to claudin-3 interactions with claudin-1 and -2; yet no interactions involving claudin-1 and -2 were detected. These discerning interactions are considered to describe the diversity in TJ formations and provide a molecular basis for tissue-specific heterogeneity of barrier function.
Recent study, together with claudin-deficient mice also give corroborative information supporting a role for claudins in the law of barrier function. Claudin-1 mice die within a day of birth due to significant transepidermal water loss. Furthermore, transgenic overexpression of both claudin-6 in skin disrupted tight junction formation and increased epithelial permeability. Experimental data indicates that claudins could have differential impacts on paracellular permeability. By way of instance, introduction of claudin-2 to MDCK I cells which state claudin-1 and -4 activates a decrease in transepithelial resistance, or TER; whereas transfection of claudin-3 had no effect indicating that claudin-2 markedly diminished claudin-1/claudin-4 based TJ strand regeneration. In support of the latest experimental evidence indicates that claudins can form measurements and charge-specific paracellular stations. Transfection of claudin-8 into MDCK II cells that lacks endogenous claudin-8 substantially reduced paracellular movement without impacting anion and uncharged solute movement. Experimental investigations suggest that the first extracellular loop of claudins play an essential role in deciding charge selectivity. Interchanging of the earliest or extracellular domains of claudin-4 on claudin-2 profoundly diminished the ion conductance of Na+ relative to Cl? 76. Additionally, substitution of a negatively-charged lysine into some positively charged aspartic acid (K65D) inside the loop of claudin-15 generated an increase in Na+ permeability, whereas mutation in exactly the same place of three positively charged amino acids into negatively charged aspartic acid, arginine and aspartic acid (E46K, D55R and E64K) altered the ion selectivity of claudin-15 in Na+ to Cl? channel. Pore size and density may also impact paracellular movement of non invasive and charged charged solutes.
Claudins also play an essential role in epithelial cell invasion and motility. Overexpression of claudins-3 and -4 in human ovarian epithelial cells, which lack the expression of these proteins, has been connected with enhanced epithelial cell survival and enhanced invasion and motility. Consistent with this observation, siRNA-mediated knockdown of the two claudins-3 and -4 in ovarian cancer cell lines diminished intrusion. The outcome of claudin-3 appear to get connected to altered matrix metalloprotease-2 activity, meaning claudin-induced invasion could possibly be regulated by metalloprotease proteins.
Similar to occludin, claudin localization to the TJ complex and its function are regulated by post-translational phosphorylation and through connections with PDZ-binding domains. The intracellular C-terminal domain of claudin possesses multiple regulatory sites, such as possible serine and theronine phosphorylation sites and PDZ-binding domain names. Phosphorylation of claudins-3 and -4 in prostate cancer cells is closely connected to the regulation of paracellular permeability. By way of instance, patients with pseudohypoaldosteronism type II (PHA II; or vitamin shunt syndrome) present with hyperkalemic metabolic acidosis, hypertension and dysregulated paracellular ion transport. The molecular basis is connected to some loss-of-function mutation from the serine-threonine kinases, WNK1 and WNK4, which regulate epithelial chloride cotransporters. This also contributes to an increase in the phosphorylation of both claudins-1-4 and an increase in paracellular permeability. A lot of signaling pathways are implicated in the phosphorylation of claudins like PKC, Rho GTPases, mitogen-activated protein kinases (MAPKs) and phosphatases. MAPK phosphorylation of claudin-1 is required for claudin-1-mediated barrier function. Furthermore, claudins-1, -2, -7, -8, -16 and -17 have putative PKC phosphorylation websites.
All claudins, except claudin-12, completing from the dipeptide arrangement YV, that’s been shown to interact with PDZ-binding domains comprise ZO-1, -2 and -3, multi-PDZ domain name and PALS1-associated TJ protein, according to Figure 3. Several of those scaffolding proteins contain several PDZ domains, which eases the introduction of dense localized protein complexes, also called “cytoplasmic plaques”. Also, the scaffolding proteins can interact with signaling molecules, such as heterodimeric GTP binding proteins (Rab13 and G?12), transcriptional factors and RNA-processing variables, to connect TJ complexes to the actin-cytoskeleton and modulate aspects of adrenal polarization, differentiation and barrier function.
Junctional Adhesion Molecules (JAMs)
Junctional adhesion molecules are integral membrane proteins which belong to the immunoglobulin superfamily and have two immunoglobulin folds, the VH- and C2-type, from the extracellular domain. JAMs are expressed by multiple cell types, including epithelial, endothelial and immune cells. They’re subdivided based on the expression of Type I or II PDZ-binding themes in the intracellular C-terminus, which implies that the two types interact with exceptional scaffolding and cytoplasmic proteins. JAM-A, -B and -C (or JAM1-3) have Type II binding subjects, while the atypical JAMs, such as JAM-4, coxsackie and adenovirus receptor (CAR) and endothelial selective adhesion molecule make up Type I PDZ-binding domains. Comparable to additional TJ proteins, these JAM-PDZ interactions provide anchorage to the actin cytoskeleton, according to Figure 3.
The extracellular region of JAMs adapting to multiple ligands through homophilic and heterophilic interactions, which can be proposed to regulate the mobile functions and paracellular permeability of JAMs. Homophilic JAM-A or -B interactions govern the creation of operational TJs and cell to cell border formation, while heterophilic JAM interactions play a role in leukocyte-endothelial cell adhesion.
Recent studies demonstrate the significance of JAM-A at the formation and assembly of TJs in intestinal epithelial cells. SiRNA downregulation of JAM-A at SK-C015 epithelial cells triggered an increase in permeability. Consistent with this, JAM-A mice had increased mucosal permeability as indicated by enhanced dextran flux and decreased TER. Nonetheless, these mice also had an increase in claudin-10 and -15 expression, which is believed to shape selective pores from the TJ complex, improving paracellular permeability. Interestingly, JAM-A mice have increased susceptibility to chemical-induced colitis. Dextran sodium sulfate administration to JAM-A mice induced more acute colonic injury as compared to WT control animals. These studies imply altered intestinal permeability for a susceptibility factor to autoimmune disorder.
The above information is evidence-based. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
A healthcare professional at a gastroenterology practice, such as a dietitian specializing in gastrointestinal diseases, will often care for a great deal of individuals who walk into their clinic reporting symptoms which haven’t yet been diagnosed to a specific digestive health issue. Because not many primary care physicians are in charge of diagnosing GI diseases nor are they properly aware of their wide array of symptoms, many people with gastrointestinal diseases will often go undiagnosed for years.
How can you talk to your doctor about your digestive issues?
A healthcare provider specializing in gastrointestinal diseases may look out for certain symptoms, as well as possible dietary triggers, to determine a digestive health issue. Simple lifestyle changes are generally the best treatment method to help improve GI diseases and its symptoms, however, being able to communicate accordingly with your doctor can help them diagnose your problem more accurately in order to begin treatment immediately. By following a few factors the patient can control, they can ensure their medical diagnostic procedure is fast, easy, and correct.
Arrive to your Appointment on Time
While careful planning and preparations can occasionally be sabotaged by events and situations that are out of our control, it’s essential for you to initially intend to reach your appointment on time. It’s recommended to arrive at least 15 minutes before your original appointment time, especially if you are a new patient as you will need to complete the necessary paperwork on your first visit. If you show up 15 minutes late for a 15 minute appointment, there is a great chance you’ll be hurried through your visit without ample time to go over your issues thoroughly with your doctor.
Bring Evaluation Results & Procedure Reports
It can’t be emphasized enough how common it is for patients to not know which previous diagnostic tests or even surgeries they’ve gone through for their specific disease and/or condition. If you show up to a healthcare professional’s appointment for further diagnosis and a second opinion regarding your symptoms without being aware of this information, your doctor may waste valuable time and money re-testing you for digestive health issues which may have already been ruled out by another healthcare specialist. Furthermore, without previous evaluation results and/or procedure reports, doctors can miss an obvious diagnosis based on your health history, or worse, they may perform yet another invasive procedure which you no longer needed.
If you have had an endoscopy or a colonoscopy, what were the signs? If you’ve had surgery somewhere on your gastrointestinal tract, which process was it? If you have experienced a breath test, what were they checking for and what were the results? If blood has been drawn lately, what was being checked and also what, if anything, has been discovered? Have you had any specialized tests that involved imaging of your gastrointestinal tract? These are all important questions you must know before visiting a doctor’s office.
Also, to get to a faster diagnosis, your best option is to bring copies of all relevant tests and reports you have undergone related to your digestive health issues. It may take some effort to collect these results from previous doctors or even hospitals, though medical practices offering online patient portals may make this procedure easier. If you can’t obtain the true exam results, then compiling a summarized “medical resume” may be the next best thing. Just type up a list of all of the test names or procedure reports you’ve had; who ran them (as well as where and when they were performed); and exactly what they discovered, based on those evaluations and procedures. Hand the sheet to your healthcare professional. Their office can then track down copies of any relevant results after you leave from your first appointment.
Describe your Symptoms in Detail
It can be quite embarrassing to describe your digestive symptoms to a healthcare professional and you might even feel unsure of whether you may actually have a digestive issue based on your “normal” collection of gut sounds, backed up stools and that occasional nausea you experience after eating a heavy meal. You may be tempted to use more conservative, generic phrases to describe your symptoms but healthcare specialists say you don’t have to be considerate. Your doctor has literally heard it all and it is as routine to them as speaking about the weather is to everyone else.
If you say that you “get sick to your stomach” when referring to having diarrhea, for instance, the healthcare professional may actually think you are referring to nausea. If you say “constipated” to refer to straining to have a daily bowel movement, your doctor may presume you mean you are unable to move your bowels more than once or twice per week. If you say you get a “stomachache” after eating, it could refer to sharp pain, cramps or dull pain and it doesn’t properly inform your doctor where the pain is located. Tell your doctor exactly what you mean, along with all of the extra descriptive details. What’s happening and where, what it looks like, what it smells like, what it feels like and how frequently it happens. Correctly describing your symptoms is key to a correct diagnosis.
Mention When your Symptoms Started
At times, telling your healthcare specialist when your symptoms all started can be the clue to your diagnosis. Did you notice your digestive health issues after you recovered from a bout of food poisoning in your holiday? Did things change for you in the bathroom after having your gallbladder removed? Did your digestive discomfort increase after switching to a brand new diet, such as a 30-day cleanse, Weight Watchers or a paleo-style diet? Do your symptoms coincide with starting or stopping a particular drug/medication or supplement? Have you experienced this digestive health issue since you were a child? Did your issue get better or worse during pregnancy? Putting your complaints in context will help your doctor perform a better medical diagnostic procedure.
Inform your Doctor of What you Have & Haven’t Tried
Doctors often learn just as much out of what hasn’t helped you feel better as they do from what has helped you feel better. If you have already tried a drug/medication, supplement, lifestyle changes, including diet modifications and physical activities, to address your gastrointestinal issues and it has not worked, make sure you incorporate this in your conversation with your healthcare specialist. It will help them narrow down the list of possibilities and help point to more likely gastrointestinal diseases and conditions.
Keep an Open Mind
Now that we all have access to the internet, we’ll often arrive to a doctor’s appointment with a preconceived notion about what we believe we may have. Because of this, many patients may attempt to steer the conversation toward this self-diagnosis and accidentally leave out important information that could shed light on the correct diagnosis. It is absolutely appropriate to share your own hypothesis about your digestive health issue with your healthcare provider and this can be particularly more important if you’ve got a family medical history which may accurately indicate your problem. But be sure to share all the details of your conclusion, and be open to the possibility that your doctor may see matters in a different light than all the other articles you may have read on the internet. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
In the month of October, approximately 50,000 people worldwide gathered in the World Congress of Gastroenterology to discuss different ways in which healthcare professionals could improve care for individuals with gastrointestinal, or GI, diseases, involving the gastrointestinal tract. While these attempts within the GI community are undeniably essential, it’s also fundamental that we teach the broader medical community concerning the growing challenge these gastrointestinal diseases present for the doctors.
How can you improve gastrointestinal diseases and its symptoms?
As many as 16 million individuals in the United States alone, suffer from irritable bowel syndrome, or IBS, with diarrhea, a gastrointestinal disease which mainly affects the bowel or colon and its symptoms are commonly characterized by abdominal pain and nausea. Constipation is the most common and uncomfortable gastrointestinal, or GI, issue, frequently reported by patients taking opioids. There are over 200 million opioid prescriptions written every year, each of which can lead to GI disease.
Inflammatory bowel diseases, such as ulcerative colitis and Crohn’s disease, usually involve severe nausea, abdominal pain, fatigue and weight loss. In 1999, there were 1.8 million cases of inflammatory bowel diseases, or IBD, among Americans. As of 2016, that number has substantially increased up to 3.1 million cases within the American population. When the liver is unable to efficiently eliminate toxins from the bloodstream, it can cause loss of brain function, a condition known as hepatic encephalopathy. The yearly inpatient incidence of hepatic encephalopathy increased from 20,918 from 2005 to 22,931 in 2009, making up approximately 0.33 percent of all hospitalizations from the United States.
The Significance of Proper Care for Gastrointestinal Diseases
Not only do gastrointestinal, or GI, diseases and their symptoms affect an overwhelmingly big part of our population, these have also become a burden on the federal health care system. In 2013, direct expenses of IBS, or irritable bowel syndrome, had ranged from $1,562 to $7,547 per individual, annually. The total national charges associated with HE, or hepatic encephalopathy, also increased from $4.6 billion in 2005 to $7.2 billion in 2009.
The logical question we should ask ourselves regarding the increasing cases of gastrointestinal diseases is: Are patients receiving the proper treatment they need? Let us take a closer look at IBS, as it’s one of the most frequent functional GI diseases. Research published in the American Journal of Gastroenterology in June 2017, demonstrated that there is a greater than 40 percent chance that people who visit a healthcare professional for symptoms of IBS may not receive a proper diagnosis, as it generally takes patients four years to be diagnosed with IBS. It’s no surprise that gastrointestinal healthcare specialists would appreciate it if primary care physicians and nurse practitioners would handle the most common cases. But that may not occur until the wider medical community becomes more comfortable with diagnosing gastrointestinal disorders.
Unfortunately for the population of IBS sufferers that go undiagnosed, many resort to searching the internet for the answers themselves, followed by one attempt after another of self-diagnosis and self-treatment for their specific gastrointestinal diseases. A survey by the Pew Internet & American Life Project found that 80 percent of internet users have searched for a health-related topic online, most frequently, for information about a specific disease or medical issue. A Google search for “IBS,” for example, yields approximately 50 million hits. Add direct-to-consumer advertisements into the mix, and the clutter of information may be overwhelming for patients and healthcare professionals alike. Much of the information readily available to anyone with an online connection is evidence-based, however, much is specious and unfounded. Evaluating the information in an effort to self-diagnose and self-treat may be dangerous. What we need is a strategy to help individuals and doctors cut through the clutter and make that information work for them in mutually positive ways.
Many healthcare professionals are pledging to invest multimillions to increase awareness of gastrointestinal diseases and their symptoms. Specialist groups are starting a national educational program at the primary care level which will require doctors to take an educational voyage deep within a high-definition, virtual lumen of the small intestine. Through the lens of a virtual reality tool, doctors peruse a swarm of microbiota and various bacteria drifting through the undulating, glistening layers of pinkish gut while a narrator explains how these life forms can potentially create a life of abdominal pain and discomfort. This immersive cartoon is part of a strategy to engage and educate the wider medical community on many leading theories about IBS, including the role gut microbiota can play in generating symptoms as well as that of other GI diseases.
Gastrointestinal healthcare specialists are already knowledgeable about the anatomy and function of the digestive system, however a lot of primary care physicians and the broader medical community may not be. By educating the wider medical community about these common digestive health issues, healthcare professionals can begin making a difference towards the overall treatment of gastrointestinal, or GI, diseases. If primary care physicians and nurse practitioners aren’t acutely conscious of the symptoms and possible etiologies that could point a GI� healthcare specialist to the proper treatment, their patient may continue to endure the uncomfortable symptoms for several years before finding an appropriate treatment therapy.
The greatest goal for us is to remove any obstacles which may come in between proper GI patient care, especially for the undiagnosed and untreated patient population. If healthcare professionals can diagnose patients earlier, those obstacles may soon disappear altogether. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
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