cholecystokinin and Intestinal-Pseudo-Obstruction

Severe congenital diarrhea occurs in approximately half of patients with Aristaless-Related Homeobox (ARX) null mutations. The cause of this diarrhea is unknown. In a mouse model of intestinal Arx deficiency, the prevalence of a subset of enteroendocrine cells is altered, leading to diarrhea. Because polyalanine expansions within the ARX protein are the most common mutations found in ARX-related disorders, we sought to characterize the enteroendocrine population in human tissue of an ARX mutation and in a mouse model of the corresponding polyalanine expansion (Arx).. Immunohistochemistry and quantitative real-time polymerase chain reaction were the primary modalities used to characterize the enteroendocrine populations. Daily weights were determined for the growth curves, and Oil-Red-O staining on stool and tissue identified neutral fats.. An expansion of 7 alanines in the first polyalanine tract of both human ARX and mouse Arx altered enteroendocrine differentiation. In human tissue, cholecystokinin, glucagon-like peptide 1, and somatostatin populations were reduced, whereas the chromogranin A population was unchanged. In the mouse model, cholecystokinin and glucagon-like peptide 1 populations were also lost, although the somatostatin-expressing population was increased. The ARX protein was present in human tissue, whereas the Arx protein was degraded in the mouse intestine.. ARX/Arx is required for the specification of a subset of enteroendocrine cells in both humans and mice. Owing to protein degradation, the Arx mouse recapitulates findings of the intestinal Arx null model, but is not able to further the study of the differential effects of the ARX protein on its transcriptional targets in the intestine.

Topics: Adolescent; Animals; Cell Differentiation; Cholecystokinin; Chromogranin A; Diarrhea; Disease Models, Animal; Duodenal Diseases; Duodenum; Enteroendocrine Cells; Failure to Thrive; Female; Glucagon-Like Peptide 1; Homeodomain Proteins; Humans; Intestinal Pseudo-Obstruction; Male; Mice; Mice, Inbred C57BL; Mutagenesis, Insertional; Peptides; Somatostatin; Steatorrhea; Transcription Factors

The study explores, by the use of manometry, the frequency and severity of small intestinal involvement in patients with systemic sclerosis, and relates the manometric findings to clinical symptoms, radiology, and some intestinal regulatory peptides.. Stationary antroduodeno-jejunal manometry was used to study small bowel involvement in 10 patients with systemic sclerosis and dysmotility of the oesophagus or signs of malabsorption. Measurements were made during fasting, after a meal, and after octreotide administration and were then compared with a sex-matched control group of healthy individuals. Plasma samples were taken in order to analyse levels of motilin, peptide YY, cholecystokinin, and somatostatin.. Manometry was abnormal, with signs of intestinal pseudo-obstruction in eight out of 10 patients. In the control group, one individual had an abnormal manometry, as a result of burst activity. The mean contractile amplitudes during fasting and periods after food, spontaneous phase III periods, and octreotide-induced activity complexes were significantly reduced in the systemic sclerosis group when compared with controls. None of the patients, including two with advanced manometric intestinal disturbances, had small intestinal dilatation when examined by radiography. The plasma peptide levels did not differ significantly between the two groups.. In eight out of 10 patients the manometric criteria for intestinal pseudo-obstruction were fulfilled, with a motility pattern consistent with both neuropathy and myopathy. The release of motility-regulating peptides was unaffected.

Topics: Adult; Aged; Cholecystokinin; Colon; Esophageal Motility Disorders; Female; Gastrointestinal Motility; Gastrointestinal Transit; Humans; Intestinal Pseudo-Obstruction; Intestine, Small; Male; Manometry; Middle Aged; Motilin; Octreotide; Peptide YY; Radiography; Radioimmunoassay; Scleroderma, Systemic; Severity of Illness Index; Somatostatin

Topics: Cholecystokinin; Chronic Disease; Humans; Intestinal Pseudo-Obstruction; Male; Neostigmine; Parasympathomimetics

Topics: Adult; Aged; Cholecystokinin; Female; Gastrointestinal Motility; Humans; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Male; Middle Aged