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- inflammatory bowel disease (2)
- intestinal barrier (2)
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Background
Accidental ingestion of fish bone is a common cause of otolaryngological emergency. Migration of the ingested bone into the thyroid gland, however, occurs very rarely. The associated clinical presentation, symptoms and duration of discomfort are also highly variable between patients and can be diagnostically challenging.
Case presentation
Here, we report the case of a 71-year-old female patient presenting with an ingested fish bone that migrated into the right thyroid lobe as a rare cause of suppurative thyroiditis with the clinical features of sepsis. We outline the diagnostic approach, peri- and intraoperative management as well as complications. It is proposed that besides endoscopy, imaging methods such as ultrasound or computed tomography may be necessary to verify the diagnosis and location of an ingested fish bone. Prompt surgical removal of the foreign body and resection of the infectious focus is recommended to minimize the risk of local inflammation, recurrent nerve lesions and septic complications arising from the spread of infection.
Conclusion
Fish bone migration into the thyroid gland is an extremely rare event, the successful detection and surgical management of which can be achieved through a careful interdisciplinary approach.
The measurement of transepithelial electrical resistance (TEER) is a common technique to determine the barrier integrity of epithelial cell monolayers. However, it is remarkable that absolute TEER values of similar cell types cultured under comparable conditions show an immense heterogeneity. Based on previous observations, we hypothesized that the heterogeneity of absolute TEER measurements can not only be explained by maturation of junctional proteins but rather by dynamics in the absolute length of cell junctions within monolayers. Therefore, we analyzed TEER in epithelial cell monolayers of Caco2 cells during their differentiation, with special emphasis on both changes in the junctional complex and overall cell morphology within monolayers. We found that in epithelial Caco2 monolayers TEER increased until confluency, then decreased for some time, which was then followed by an additional increase during junctional differentiation. In contrast, permeability of macromolecules measured at different time points as 4 kDA fluorescein isothiocyanate (FITC)-dextran flux across monolayers steadily decreased during this time. Detailed analysis suggested that this observation could be explained by alterations of junctional length along the cell borders within monolayers during differentiation. In conclusion, these observations confirmed that changes in cell numbers and consecutive increase of junctional length have a critical impact on TEER values, especially at stages of early confluency when junctions are immature.
Enteric glial cells (EGCs) of the enteric nervous system are critically involved in the maintenance of intestinal epithelial barrier function (IEB). The underlying mechanisms remain undefined. Glial cell line-derived neurotrophic factor (GDNF) contributes to IEB maturation and may therefore be the predominant mediator of this process by EGCs. Using GFAP\8^{cre}\) x Ai14\(^{floxed}\) mice to isolate EGCs by Fluorescence-activated cell sorting (FACS), we confirmed that they synthesize GDNF in vivo as well as in primary cultures demonstrating that EGCs are a rich source of GDNF in vivo and in vitro. Co-culture of EGCs with Caco2 cells resulted in IEB maturation which was abrogated when GDNF was either depleted from EGC supernatants, or knocked down in EGCs or when the GDNF receptor RET was blocked. Further, TNFα-induced loss of IEB function in Caco2 cells and in organoids was attenuated by EGC supernatants or by recombinant GDNF. These barrier-protective effects were blunted when using supernatants from GDNF-deficient EGCs or by RET receptor blockade. Together, our data show that EGCs produce GDNF to maintain IEB function in vitro through the RET receptor.
Familial gastrointestinal stromal tumors (GIST) are dominant genetic disorders that are caused by germline mutations of the type III receptor tyrosine kinase KIT. While sporadic mutations are frequently found in mastocytosis and GISTs, germline mutations of KIT have only been described in 39 families until now. We detected a novel germline mutation of KIT in exon 11 (p.Lys-558-Asn; K558N) in a patient from a kindred with several GISTs harboring different secondary somatic KIT mutations. Structural analysis suggests that the primary germline mutation alone is not sufficient to release the autoinhibitory region of KIT located in the transmembrane domain. Instead, the KIT kinase module becomes constitutively activated when K558N combines with different secondary somatic mutations. The identical germline mutation in combination with an additional somatic KIT mutation was detected in a second patient of the kindred with seminoma while a third patient within the family had a cutaneous mastocytosis. These findings suggest that the K558N mutation interferes with the juxtamembranous part of KIT, since seminoma and mastocystosis are usually not associated with exon 11 mutations.
Eine intakte Darmbarriere ist überlebensnotwendig. Bei einigen Erkrankungen kann eine Störung der Darmbarriere zur Translokation von Bakterien aus dem Lumen des Darmes in den menschlichen Körper führen, die septische Entzündungsprozesse auslösen können. In dieser Arbeit untersuchten wir zum einen die Bedeutung der desmosomalen Adhäsion für die Darmbarriere und zum anderen die Rolle der Rho-GTPasen in der Regulation der Darmbarriere. Für unsere Untersuchungen charakterisierten wir Caco2 Zellen, von denen wir nachweisen konnten, dass sie ein geeignetes Modell für die Darmbarriere sind. Wir konnten zeigen, dass Caco2 Zellen 14 Tage nach ihrer Konfluenz einen vollständigen Schlussleistenkomplex ausbilden und funktionell ähnlich Permeabilitäseigenschaften, wie die Mukosa von Ratten ex vivo aufweisen. Um die Bedeutung der desmosomalen Adhäsion zu klären, applizierten wir einen gegen die Extrazellulärdomäne von Dsg2 gerichteten Antikörper. Dieser Antikörper war spezifisch in der Lage Dsg2 vermittelte Adhäsion zu blockieren. Nach Applikation des Dsg2 ED konnten wir eine Fragmentierung der Occludensproteine, sowie eine gestörte Barrierefunktion mit erhöhter Permeabilität und erniedrigtem transepithelialen Widerstand nachweisen. Damit konnten wir zeigen, dass die Dsg2 vermittelte Adhäsion essentiell für die Aufrechterhaltung der Darmbarriere ist. Des Weiteren untersuchten wir die Rolle der Rho-GTPasen. Wir veränderten die Aktivität der Rho-GTPasen durch Applikation von bakteriellen Toxinen, wie CNF-1, CNF-y, Toxin B, C3-TF und LT sowie Mediatoren, wie Y27632 und quantifizierten die Änderung anschließend durch die Aktivitätsmessung der Rho-GTPasen mittels GLISA. In Immunfluoreszenzen konnten wir zeigen, dass sowohl eine Steigerung als auch eine Erniedrigung der Aktivität von RhoA mit einer Fragmentierung der Occludensproteine einhergeht, während die Adherens Junktionen unbeeinflusst bleiben. Diese morphologische Veränderung korreliert mit einer signifikant erhöhten Permeabilität und einem erniedrigtem transepithelialem elektrischen Widerstand. Im Gegensatz dazu, konnten wir zeigen, dass eine Erhöhung der Aktivität von Rac1 und Cdc42 in der Immunfluoreszenz zu keinen sichtbaren Veränderungen führt, die funktionellen Ergebnisse, mit einem erhöhten transepithelialen elektischen Widerstand und einer erniedrigten Permeabilität auf eine Stabilisierung der Barriere hinweisen. Eine Erniedrigung der Aktivität von Rac1 und Cdc42 führt hingegen zu einer Destabilisierung der Barriere. Morphologisch führte die Verringerung der Aktivität von Rac1 durch LT zu einer Reduzierung der Occludensproteine an den Zellgrenzen und zu einer diffuseren Färbung des Adherens Junktionsprotein E- Cadherin. Zum anderen zeigte sich in diesem Fall eine deutliche Reduzierung der Barrierefunktion mit einem erniedrigten transepithelialen elektrischen Widerstand und einer erhöhten Permeabilität. Letzlich konnte diese Arbeit durch ihre Erkenntnisse einen Teil dazu beizutragen, dass die komplexe Regulation der Darmbarriere besser verstanden wird. Dieses bessere Verständnis soll künftig zur Entwicklung neuer Therapieoptionen für Patienten dienen, die unter den septischen Folgen einer Störung der Darmbarriere leiden.
Desmoglein2 Regulates Claudin2 Expression by Sequestering PI-3-Kinase in Intestinal Epithelial Cells
(2021)
Inflammation-induced reduction of intestinal desmosomal cadherin Desmoglein 2 (Dsg2) is linked to changes of tight junctions (TJ) leading to impaired intestinal epithelial barrier (IEB) function by undefined mechanisms. We characterized the interplay between loss of Dsg2 and upregulation of pore-forming TJ protein Claudin2. Intraperitoneal application of Dsg2-stablising Tandem peptide (TP) attenuated impaired IEB function, reduction of Dsg2 and increased Claudin2 in DSS-induced colitis in C57Bl/6 mice. TP blocked loss of Dsg2-mediated adhesion and upregulation of Claudin2 in Caco2 cells challenged with TNFα. In Dsg2-deficient Caco2 cells basal expression of Claudin2 was increased which was paralleled by reduced transepithelial electrical resistance and by augmented phosphorylation of AKT\(^{Ser473}\) under basal conditions. Inhibition of phosphoinositid-3-kinase proved that PI-3-kinase/AKT-signaling is critical to upregulate Claudin2. In immunostaining PI-3-kinase dissociated from Dsg2 under inflammatory conditions. Immunoprecipitations and proximity ligation assays confirmed a direct interaction of Dsg2 and PI-3-kinase which was abrogated following TNFα application. In summary, Dsg2 regulates Claudin2 expression by sequestering PI-3-kinase to the cell borders in intestinal epithelium.