词条 | Intestinal permeability |
释义 |
PhysiologyThe barrier formed by the intestinal epithelium separates the external environment (the contents of the intestinal lumen) from the body[4] and is the most extensive and important mucosal surface
ModulationOne way in which intestinal permeability is modulated is via CXCR3 receptors in cells in the intestinal epithelium, which respond to zonulin.[8] Gliadin (a glycoprotein present in wheat) activates zonulin signaling in all people who eat gluten, irrespective of the genetic expression of autoimmunity. This lead to increased intestinal permeability to macromolecules.[8][15][9] Bacterial pathogens such as cholera, select enteric viruses, and parasites modulate intestinal tight junction structure and function, and these effects may contribute to the development of chronic intestinal disorders.[8][10] Stress and infections also seem to cause perturbations in intestinal permeability.[15]Clinical significanceMost people do not experience adverse effects, but the opening of intercellular tight junctions (increased intestinal permeability) can act as a trigger for diseases that can affect any organ or tissue depending on genetic predisposition.[8][9][11] It can allow passage of microbes, microbial products, and foreign antigens into the mucosa and the body proper. This can result in activation of the immune system and secretion of inflammatory mediators.[12] Increased intestinal permeability is a factor in several diseases, such as Crohn's disease, celiac disease,[13] type 1 diabetes,[14] type 2 diabetes,[13] rheumatoid arthritis, spondyloarthropathies,[15] inflammatory bowel disease,[8][31] irritable bowel syndrome,[16] schizophrenia,[17][18] certain types of cancer,[8] obesity,[19] fatty liver,[20] atopy and allergic diseases,[14] among others. In the majority of cases, increased permeability develops prior to disease,[8] but the cause–effect relationship between increased intestinal permeability in most of these diseases is not clear.[31][21] A relationship with autism has been hypothesized but the data supporting this theory are limited and contradictory, since both increased intestinal permeability and normal permeability have been documented in people with autism. Studies with mice provide some support to this hypothesis.[22] A well studied model is celiac disease, in which increased intestinal permeability appears secondary to the abnormal immune reaction induced by gluten and allows fragments of gliadin protein to get past the intestinal epithelium, triggering an immune response at the intestinal submucosa level that leads to diverse gastrointestinal or extra-gastrointestinal symptoms.[23][24] Other environmental triggers may contribute to alter permeability in celiac disease, as intestinal infections and iron deficiency.[23] Once established, this increase of permeability might self-sustain the inflammatory immune responses and perpetuate a vicious circle.[23] Eliminating gluten from the diet leads to normalization of intestinal permeability and the autoimmune process shuts off.[25] Research directionsIn normal physiology, glutamine plays a key role in signalling in enterocytes that are part of the intestinal barrier, but it is not clear if supplementing the diet with glutamine is helpful in conditions where there is increased intestinal permeability.[26] Prebiotics and certain probiotics such as Escherichia coli Nissle 1917 have been found to reduce increased intestinal permeability.[16] Lactobacillus rhamnosus,[27] Lactobacillus reuteri,[27] and Faecalibacterium prausnitzii[28] have also been shown to significantly reduce increased intestinal permeability. Larazotide acetate (previously known as AT-1001) is a zonulin receptor antagonist that has been probed in clinical trials. It seems to be a drug candidate for use in conjunction with a gluten-free diet in people with celiac disease, with the aim to reduce the intestinal permeability caused by gluten and its passage through the epithelium, and therefore mitigating the resulting cascade of immune reactions.[24][29]Leaky gut syndromeA proposed medical condition called leaky gut syndrome has been popularized by some health practitioners, mainly of alternative medicine and nutritionists, with claims that restoring normal functioning of the gut wall can cure many systemic health conditions. There is little evidence to support this claim and that so-called "treatments" for "leaky gut syndrome"—such as nutritional supplements, as those containing probiotics.;[16] herbal remedies; gluten-free foods; and low FODMAP, low sugar, or antifungal diets—have any beneficial effect for most of the conditions they are claimed to help.[30] See also
References1. ^{{cite book|author1=M. Campieri|author2=C. Fiocchi|author3=S.B. 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This permeating effect is secondary to the binding of specific undigestible gliadin fragments to the CXCR3 chemokine receptor with subsequent release of zonulin, a modulator of intercellular tight junctions. This process takes place in all individuals who ingest gluten. For the majority, these events do not lead to abnormal consequences. 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quiz 31, 92|journal=Alternative Therapies in Health and Medicine}} 22. ^{{cite journal|vauthors=Rao M, Gershon MD |title= The bowel and beyond: the enteric nervous system in neurological disorders |journal= Nature Reviews Gastroenterology & Hepatology|volume= 13|issue= 9|pages= 517–28|date=September 2016 |pmid=27435372 |pmc=5005185 |doi= 10.1038/nrgastro.2016.107|url= |type=Review}} 23. ^1 2 {{cite journal |vauthors=Heyman M, etal | date = Sep 2012 | title = Intestinal permeability in coeliac disease: insight into mechanisms and relevance to pathogenesis | journal = Gut| volume = 61 | issue = 9| pages = 1355–64 | doi = 10.1136/gutjnl-2011-300327 | pmid = 21890812 | type = Review | quote= Changes in intestinal paracellular and transcellular permeability appear secondary to the abnormal immune reaction induced by gluten. Gliadin was suggested to increase junction permeability to small molecules through the release of prehaptoglobin-2. Environmental triggers of CD other than gliadin may also promote changes in permeability. Intestinal infection and iron deficiency can stimulate the expression of the transferrin receptor (TfR) CD71 in enterocytes. ... Once established, the alterations in intestinal permeability, notably the retro-transport of IgA-gliadin peptides, might self-sustain the inflammatory immune responses and perpetuate a vicious circle.}} 24. ^1 {{Cite journal|last=Khaleghi|first=Shahryar|last2=Ju|first2=Josephine M.|last3=Lamba|first3=Abhinav|last4=Murray|first4=Joseph A.|date= Jan 2016 |title=The potential utility of tight junction regulation in celiac disease: focus on larazotide acetate|journal=Therapeutic Advances in Gastroenterology|volume=9|issue=1|pages=37–49|doi=10.1177/1756283X15616576|pmc=4699279|pmid=26770266 | type=Review. Research Support, N.I.H., Extramural}} 25. ^{{cite journal| author=Fasano A| title=Intestinal permeability and its regulation by zonulin: diagnostic and therapeutic implications | journal=Clinical Gastroenterology and Hepatology| year= 2012 | volume= 10 | issue= 10 | pages= 1096–100 | pmid=22902773 | doi=10.1016/j.cgh.2012.08.012 | pmc=3458511 | type=Review }} 26. ^{{cite journal|last1=Akobeng|first1=AK|last2=Elawad|first2=M|last3=Gordon|first3=M|title=Glutamine for induction of remission in Crohn's disease.|journal=Cochrane Database of Systematic Reviews|date=8 February 2016|volume=2|pages=CD007348|pmid=26853855|doi=10.1002/14651858.CD007348.pub2|url=http://clok.uclan.ac.uk/13855/1/__lha-022_pers-I_00068E5E_My%20Documents_Akobeng_et_al-2016-The_Cochrane_library.pdf}} 27. ^1 {{cite journal | vauthors=Lopetuso LR, Scaldaferri F, Bruno G, Petito V, Franceschi F, Gasbarrini A | title=The therapeutic management of gut barrier leaking: the emerging role for mucosal barrier protectors | journal= European Review for Medical and Pharmacological Sciences| volume=19 | issue=6 | pages=1068–1076 | year=2015 | url=https://www.europeanreview.org/article/8706 | pmid = 25855934 }} 28. ^{{cite journal | vauthors=Ganesan K, Chung SK, Vanamala J, Xu B | title=Causal Relationship between Diet-Induced Gut Microbiota Changes and Diabetes: A Novel Strategy to Transplant Faecalibacterium prausnitzii in Preventing Diabetes | journal= International Journal of Molecular Sciences| volume=19 | issue=12 | pages=E3720 | year=2018 | doi=10.3390/ijms19123720 | pmc=6320976 | pmid = 30467295 }} 29. ^{{cite journal |vauthors=Crespo Pérez L, etal | date = Jan 2012 | title = Non-dietary therapeutic clinical trials in coeliac disease | url = | journal = European Journal of Internal Medicine| volume = 23 | issue = 1| pages = 9–14 | doi = 10.1016/j.ejim.2011.08.030 | pmid = 22153524 | type = Review}} 30. ^1 2 {{cite web|url=http://www.nhs.uk/conditions/leaky-gut-syndrome/|title=Leaky gut syndrome|date=26 February 2015|publisher=NHS Choices|accessdate=15 August 2016}} 1 : Digestive system |
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