Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / A deficiÃncia de vitamina A (DVA) à considerada um importante problema de saÃde pÃblica em todo o mundo e o papel da DVA na integridade epitelial intestinal ainda nÃo està bem compreendido. O objetivo do trabalho foi investigar a associaÃÃo do retinol (vitamina A) e carotenÃides com a barreira funcional intestinal em crianÃas de uma comunidade urbana em Fortaleza, no Nordeste do Brasil. Participaram do estudo 102 crianÃas de 2 meses a 9 anos de idade. O estado nutricional das crianÃas foi avaliado atravÃs do escore âzâ de peso por altura (WHZ), mostrando que 19,6% (20/102) das crianÃas apresentaram desnutriÃÃo leve (âzâ escore de -1 a -2). Todas as crianÃas tiveram as concentraÃÃes de retinol determinadas e nenhuma estava severamente deficiente (< 0,35 ÂM); 2,9% (3/102) das crianÃas apresentaram nÃveis moderados de deficiÃncia de vitamina A (0,36 - 0,70 ÂM); 20,6% (21/102) apresentaram leve deficiÃncia (0,71 - 1,05 ÂM) e 76,5% (78/102) apresentaram concentraÃÃes suficientes de retinol no sangue (> 1,05 ÂM). A razÃo de lactulose/manitol (L/M) estava anormal em 49% (47/97) das crianÃas quando comparadas com crianÃas saudÃveis de uma mesma regiÃo geogrÃfica. Os carotenÃides, luteÃna, &#946;-criptoxantina e beta-caroteno no soro das crianÃas do Parque UniversitÃrio, apresentaram correlaÃÃes inversas significativas com a razÃo de L/M. As proteÃnas de fase aguda (proteÃna C reativa, CRP e glicoproteÃna &#945;1-Ãcida, AGP) apresentaram correlaÃÃes inversas com retinol. O retinol correlacionou-se significativamente com a proteÃna ligadora de retinol (RBP) e com a transtiretina (TTR). Esses dados sugerem que a alteraÃÃo na barreira funcional intestinal provavelmente ocorreu atravÃs do caminho paracelular com baixas concentraÃÃes de carotenÃides no soro. Os carotenÃides, precursores do retinol, poderiam assim promover um melhor marcador para a barreira funcional intestinal alterada do que as medidas de RBP ou retinol. As concentraÃÃes sanguÃneas de retinol correlacionaram-se com a RBP e TTR e correlacionaram-se inversamente com a AGP e com a CPR / Vitamin A deficiency (VAD) is considered an important public health problem worldwide and the role of VAD on intestinal epithelial integrity is not well understood. To investigate the association of retinol (vitamin A) and carotenoids with the intestinal barrier function from children in an urban community in Fortaleza, Northeastern Brazil, one hundred and two children from 2 months to 9 years old participated in the study. The nutritional status of these children, measured by weight for height z-score (WHZ), showed that 19.6% (20/102) of them had mild malnutrition (-1 to â2 z-score). All children had their serum retinol concentration measured and none were severely deficient (<= 0.35 ÂM), 2.9% (3/102) were moderately (0.36 â 0.70 ÂM), 20.6% (21/102) were mildly (0.71 â 1.05 ÂM) deficiencies; 76.5% (78/102) were vitamin A sufficient (> 1.05 ÂM). The lactulose:mannitol (L/M) ratio was abnormal in 49% (47/97) of children when compared to healthy children in the same geographic area. Serum carotenoids, lutein, beta-cryptoxanthin and beta-carotene showed significant inverse correlation with the L/M ratio. Acute phase proteins (C-reactive protein; CRP; and &#945;-acid glycoprotein; AGP) were significantly inversely correlated with retinol. Retinol was significantly correlated with retinol-binding protein (RBP), and with transthyretin (TTR). These data suggest a disruption of intestinal barrier function due to paracellular pathway with low serum concentrations of carotenoids. The retinol precursors, carotenoids, may provide a better marker for disrupted intestinal barrier function than measurements of RBP or retinol. Serum retinol concentrations correlate with RBP and TTR and inversely correlate with AGP and CRP

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / IntroduÃÃo: Apesar do reconhecimento das alteraÃÃes intestinais associadas à desnutriÃÃo e dos efeitos trÃficos da alanil-glutamina (AG) na funÃÃo de barreira intestinal, medida pela taxa de excreÃÃo urinÃria de Lactulose: Manitol, ainda sÃo escassos os estudos para determinar o efeito de suplementaÃÃo oral da AG em crianÃas desnutridas. Objetivos: Examinar o efeito de suplementaÃÃo oral de AG ou placebo glicina (G) na funÃÃo de barreira intestinal e crescimento em crianÃas sob risco nutricional residentes na comunidade do Parque UniversitÃrio do Pici. MÃtodos: Ensaio clÃnico randomizado controlado em crianÃas maiores de 6 meses e menores de 8 anos de idade, com pelo menos um dos escores z para os indicadores antropomÃtricos (IAs) (peso-para-idade, estatura-para-idade e peso-para-estatura) < -1. Cento e sete crianÃas foram randomizadas, entre julho de 2003 a novembro de 2004, para receberem AG (24g/dia) ou G (25g/dia) em quantidades isonitrogÃnicas por 10 dias. A excreÃÃo urinÃria de Lactulose:Manitol foi utilizada como medida da permeabilidade intestinal e realizada nos 1 e 10 dias do protocolo de estudo. O peso e estatura das crianÃas foram coletados nos 1Â, 10Â, 30 e 120 dias do protocolo de estudo para cÃlculo dos IAs. Resultados: O percentual da excreÃÃo urinÃria de lactulose diminuiu significantemente no grupo que recebeu AG, mas nÃo no grupo que recebeu G ( p < 0,05 teste t de Student). A melhora cumulativa nos indicadores antropomÃtricos, peso-para-estatura e peso-para-idade, no 120 dia do protocolo de estudo foi significante quando realizado a anÃlise de covariÃncia no grupo que recebeu AG versus o grupo que recebeu glicina (respectivamente, p <0,04 e <0,029). Durante o perÃodo de estudo foram observados um total de vinte (19%) Eventos Adversos (EAs) na seguinte ordem de freqÃÃncia: vÃmitos (8,4%), diarrÃia (2,8%), nÃuseas (1,9%), infecÃÃo respiratÃria (1,9%), escabiose (1,9%), asma (0,9%), epistaxe (0,9%). Os EAs nÃo foram diferentes na anÃlise estatÃstica entre os grupos estudados e somente trÃs dos EAs foram considerados como SÃrios Eventos Adversos (SEAs ), dois no grupo da alanil-glutamina (1 asma e 1 diarrÃia) e um no grupo da glicina (1 diarrÃia). ConclusÃes: A suplementaÃÃo oral de AG por 10 dias melhorou a permeabilidade intestinal e o estado nutricional em crianÃas sob risco nutricional residentes em uma comunidade de Fortaleza / Introduction: In spite of the recognition of alterations in intestinal barrier function associated with malnutrition and the trophic effects of alanyl-glutamine (AG) on intestinal barrier function, measured by the rate of urinary excretion of Lactulose:Manitol, there are still few studies determining the effect of oral supplementation of AG in malnourished children. Objectives: Examine the effect of oral AG supplementation or the placebo Glycine (G) on intestinal barrier function and growth in children who are at risk for malnutrition and are residents of the University Park of Pici community. Methods: Double blind randomized study in children between 6 months and 8 years of age, with at least one of the z scores for the anthropometrical indicators (AIs) (weight-for-age, height-for-age, and weight-for-height) less than minus one. One hundred and seven children were randomized between July 2003 and November 2004, to receive AG (24 g/day) or G (25 g/day) in iso-nitrogenic quantities for 10 days. The urinary excretion of Lactulose:Mannitol was used as a measure of intestinal permeability, and was performed on the first and tenth days of the study protocol. The weight and height of the children were collected on the 1, 10, 30, and 120 days of the study protocol to calculate the AIs. Results: The percentage of urinary excretion of Lactulose decreased significantly in the group that received AG (p < 0.05 Student T test), but not in the group that received G. The cumulative improvement in the Anthropometrical Indicators, weight-for-height and weight-for-age on the 120 day of the study protocol were significant when covariant analysis was performed in the group which received AG versus the control group G (p < 0.04 and < 0.029, respectively). During the study period a total of 20 (19%) Adverse Events (AEs) were observed in the following order of frequency: vomiting (8.4%), diarrhea (2.8%), nausea (1.9%), respiratory infection (1.9%), scabies (1.9%), asthma (0.9%), epistaxis (0.9%). The AEs were not statistical different between the study groups, and only three of the AEs were considered Serious Adverse Events (SEAs), two in the AG group (1 asthma and 1 diarrhea) and one in the G group (1 diarrhea). Conclusions: The oral supplementation of AG for 10 days improved intestinal permeability and nutritional status in children at risk for malnutrition in a Fortaleza community

Dans de nombreuses pathologies digestives dont les maladies inflammatoires chroniques intestinales (MICI), l'intégrité de la barrière épithéliale est rompue. Cette perte d'intégrité est notamment due à la réduction ou la perte d'expression des jonctions adhérentes composées du complexe E-cadhérine/caténines. Il est donc important d'identifier de nouvelles molécules capables de réguler ce complexe dans les MICI. C'est dans ce contexte que nous nous sommes intéréssés à une levure non pathogène, Saccharomyces boulardii (Sb) utilisée dans la prévention et le traitement de désordres gastro-intestinaux et qui présente des bénéfices thérapeutiques chez les patients atteints de MICI, notamment en régulant l'intégrité de la barrière intestinale. L'étude que nous avons réalisée sur des explants tissulaires provenant de patients atteints de MICI nous a permis de mettre en évidence que le surnageant de Sb (Sbs) protège la morphologie tissulaire et maintient l'expression de la E-cadhérine à la membrane. In vitro nous avons également pu montrer que Sbs accélère la ré-expression de la E-cadhérine à la membrane en régulant son recyclage par les endosomes (Rab11A), entrainant ainsi la restauration et le renforcement de la barrière épithéliale intestinale. / Some intestinal pathologies including inflammatory bowel disease (IBD) are associated with an altered barrier function. The reduction or the lost of adherens junctions composed by E-cadherin/catenins complex are linked to changes in the barrier integrity. Characterization of molecules targeting the E-cadherin/catenins complex during IBD is crucial for the development of alternative therapies. From this perspective, we focus ours studies on a non pathogenic yeast, Saccharomyces boulardii, used to prevent and treat gastro-intestinal disorders and may have beneficial effects in IBD treatment, including the regulation of barrier integrity. Ours studies on colonic explants from IBD patients showed that Sb supernatant (Sbs) protects epithelial morphology and maintains E-cadherin expression at the cell surface. In vitro study pointed out that Sbs accelerated the recovery of E-cadherin at the cell membrane. This process involved the modulation of the recycling of E-cadherin by endosomes (Rab11A), leading to restoration and strengthening of intestinal barrier function.

<p>Vitamin E is a natural lipophilic antioxidant contains eight structurally related forms, i.e., α-, β-, γ-, δ-tocopherols (αT, βT, γT, and δT) and corresponding tocotrienols. Recent research indicates that vitamin E forms are differentially metabolized to various carboxychromanols. Some these vitamin E metabolites have been shown to exhibit strong anti-inflammatory and anticancer effects, yet little is known about their bioavailability. Without this knowledge, it is impossible to assess the role of vitamin E metabolism in biological functions of vitamin E forms and their protective effects on chronic diseases. While αT and γT appear to improved gut health, the underlying mechanisms are not well understood. Furthermore, specific forms of vitamin E such as γT have been reported to have cancer-preventing effects, but their anticancer efficacy is relatively modest. For these reasons, this dissertation focused on the characterization of the pharmacokinetic formation of vitamin E metabolites after supplementation, and the investigation of the underlying mechanisms of the protective effect of vitamin E forms, αT and γT, on gut health, as well as anticancer efficacy of the combination of aspirin and γT on carcinogen-induced colon tumorigenesis.</p><p><br></p><p>The first project focuses on characterizing the pharmacokinetic formation of vitamin E metabolites after single dose supplementation of γ-tocopherol-rich mixed tocopherol (γTmT) and δ-tocotrienol (δTE). With our recently developed LC/MS/MS assay for quantifying vitamin E metabolites, we can simultaneously quantify the level of short-chain, long-chain, and sulfated carboxychromanols in plasma, urine, and fecal samples of supplemented animals. In this study, we investigated the pharmacokinetics including excretion of vitamin E forms and the formation of their metabolites after a single dose intragastric administration of tocopherols and tocotrienols in rats. We also measured vitamin E metabolites in the serum obtained from healthy humans after gT supplementation. In the plasma of rat, the pharmacokinetic profiles of γT and δTE are described as the following: γT, Cmax = 25.6 ± 9.1 μM, Tmax = 4 h; δTE, Cmax = 16.0 ± 2.3 μM, Tmax = 2 h. Sulfated CEHCs and sulfated 11’-COOHs were the predominant metabolites in the plasma of rat with Cmax of 0.4-0.5 μM (Tmax ~ 5-7 h) or ~0.3 μM (Tmax at 4.7 h), respectively. In 24-h urine, 2.7% of γT and 0.7% of dTE were excreted as conjugated CEHCs, the major identified urinary metabolites. In the feces, 17-45% of supplemented vitamers were excreted as un-metabolized forms and 4.9-9.2% as metabolites. The majority of metabolites excreted in feces were unconjugated carboxychromanols, among which 13’-COOHs constituted ~50% of total metabolites. Interestingly, 13’-COOHs derived from δTE were 2-fold higher than 13’-COOH from γT. Unlike rats, γ-CEHC is the predominant metabolites found in human plasma, although 11’-COOHs and 13’-COOHs (sulfated and unconjugated) were elevated by >20 folds responding to γT supplement. In this study, we found that tocopherols and tocotrienols, when taken as supplements, are mainly excreted as un-metabolized forms and long-chain carboxychromanols in feces. High fecal availability of 13’-COOHs may contribute to modulating effects on gut health.</p><p><br></p><p>The second project of my dissertation investigated the effect of vitamin E forms, αT and γT, on intestinal barrier function in a cellular model and a mouse colitis model. Inflammatory bowel diseases (IBD) are chronic idiopathic inflammatory conditions characterized by disruption of intestinal barrier integrity. Previous studies by others and us had demonstrated that vitamin E forms, αT and γT, can protect against chemical-induced colitis in animal models. However, the role of these vitamin E forms on intestinal barrier function has not been studied. Herein, we investigated the potential protective effects of vitamin E forms, αT and γT, on intestinal barrier function in a Caco-2 colon epithelial cell model and a dextran sodium sulfate (DSS)-induced colitis mouse model. In Caco-2 cells, pretreatment with 25mM αT and γT attenuated Caco-2 monolayer barrier dysfunction induced by 10 ng/mL TNF-α/IFN-γ, suggesting that these vitamin E forms protect intestinal barrier integrity in this cellular model. In male BALB/c mice, the supplementation of αT (0.05%) or γTmT (0.05%) when given 3 weeks before DSS treatment or at the same time as DSS treatment alleviated DSS-induced fecal bleeding and diarrhea symptoms in mice, and attenuated colon inflammation and colitis-associated damages. Additionally, αT and γTmT supplementation attenuated DSS-induced intestinal barrier dysfunction, as indicated by improving the level of occludin, a tight junction protein, in the colon and reducing lipopolysaccharide-binding protein (LBP) in the plasma. Furthermore, gut microbiota analysis demonstrated that αT and γTmT supplementation could modulate intestinal microbiome composition in mice with DSS treatment. DSS treatment reduced the relative abundance of Lachnospiraceae compared to healthy mice, and supplementation of αT and γT partially reversed this effect. Interestingly, the family Lachnospiraceae has been reported to decrease in IBD patients. Our study demonstrated the protective effects of vitamin E forms on intestinal barrier integrity in a cell-based model and a colitis model in mice. Furthermore, we demonstrated that these vitamin E forms caused favorable changes in the intestinal microbial population under colitis condition.</p><p><br></p><p>The third project of my dissertation evaluated the anticancer efficacy of the combination of aspirin and γT using an azoxymethane (AOM)-induced and colitis-promoted colon tumorigenesis mouse model. Extensive inflammation in the colon promotes the development of colorectal cancer (CRC). Eicosanoid production by pro-inflammatory enzymes, cyclooxygenases (COX-1 and COX-2) and 5-lipoxygenase (5-LOX) play a critical role in the initiation, progression, and invasion of CRC. Thus, nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, have been recommended for chemoprevention of CRC. However, long-term use of aspirin can cause many side effects, and the anticancer activity of aspirin is very modest. Previously, we have demonstrated that the combination of γT with aspirin prolonged the anti-inflammatory activity of aspirin and alleviated aspirin-associated adverse effects in a carrageenan-induced inflammation model in rats. Additionally, we found that the combination of γT and aspirin has stronger anticancer activity than aspirin or γT alone against HCT-116 human colorectal carcinoma cells. Therefore, we examined the anticancer effect of the combination of 0.025% aspirin and 0.05% γT against AOM-induced and DSS-promoted tumorigenesis in mice. In this study, we have found that the combination of aspirin and γT, but not aspirin or γT alone, suppressed colon tumorigenesis in mice, as indicated by 40% and 50% reduction in the multiplicity of total polyps (P < 0.05) and large adenomatous polyps (>2mm2, P < 0.05), respectively. More strikingly, the combination of aspirin and γT reduced the overall tumor area by 60% (P < 0.05). Noteworthy, the supplementation of γT also alleviated aspirin-induced stomach lesion and appeared to modulate intestinal microbial composition. Our study demonstrated that the combination of aspirin and γT has stronger anticancer activity than aspirin or γT alone while alleviates aspirin-associated adverse effect, suggesting that the combination of γT and aspirin is a more effective and safer chemopreventive agent for CRC than aspirin alone.</p>