The large intestine from fetal period to adulthood and its impact on the course of colonoscopy.

The human large intestine in the living adult has a total length of about 1300 mm, ranging from 1100 to 2108 mm. The development of the gut continues after birth, up to the age 4-5. The large intestine ascends at the beginning in the right abdominal quadrant, then it traverses the abdominal cavity, and finally it descends to the anus. The left and right colic flexures are the basic flexions between the transverse, ascending and descending colon, respectively. Additionally, there are secondary bendings between intestinal segments. The angles between the neighbouring parts can vary between examined subjects. Most of the angulations can be found in the transverse (range 2-9) and sigmoid colon (range 1-9), making them the most troublesome parts to pass with a colonoscope. Colonoscopy (usually performed in the left lateral or supine position) is one of the most important examination of the large intestine mucus membrane. During this procedure the endoscope is passed through the colon into the cecum or terminal ilium. The individual anatomical features (tortuosity, supernumerary loops and elongation) may slow down or interfere with the progress of the scope. We summarize current knowledge on the human large intestine from the fetal period to adulthood and carve out some aspects that are currently less known to colonoscopists.

The role of Hes genes in intestinal development, homeostasis and tumor formation.

Notch signaling regulates intestinal development, homeostasis and tumorigenesis, but its precise downstream mechanism remains largely unknown. Here we found that inactivation of the Notch effectors Hes1, Hes3 and Hes5, but not Hes1 alone, led to reduced cell proliferation, increased secretory cell formation and altered intestinal structures in adult mice. However, in Apc mutation-induced intestinal tumors, inactivation of Hes1 alone was sufficient for reducing tumor cell proliferation and inducing differentiation of tumor cells into all types of intestinal epithelial cells, but without affecting the homeostasis of normal crypts owing to genetic redundancy. These results indicated that Hes genes cooperatively regulate intestinal development and homeostasis and raised the possibility that Hes1 is a promising target to induce the differentiation of tumor cells.

Ontogeny regulates creatine metabolism in rat small and large intestine.

The ontogeny of intestinal CRT, AGAT and GAMT was investigated in foetuses, newborn, suckling, weaning and adult rats. In the colon, CRT mediates creatine transport because it was Na(+)- and Cl(-) dependent and inhibited by creatine and GPA. In addition, Northern assays showed two CRT transcripts (2.7-kb and 4.2-kb) and the in situ hybridisation revealed that CRT mRNA is restricted to the colon epithelial cells. The immunohistochemistry revealed that CRT protein was at the apical membrane of colon epithelia. Maturation decreased colonic CRT activity to undetectable levels and increased CRT mRNA abundance. Western assays revealed 57-, 65-, 80- and 116-kDa polypeptides at the intestinal apical membrane. The abundance of the 65-, 80- and 116-kDa polypeptides decreased with age, and that of 57-kDa was only observed in adult rats. The small and large intestine express AGAT and GAMT mRNAs. Maturation decreased AGAT mRNA abundance without affecting that of GAMT. For comparison, renal AGAT mRNA levels were measured and they were increased with age. The study reports for the first time that: i) the apical membrane of rat colon have an active CRT, ii) development down-regulates CRT activity via post-transcriptional mechanism(s), iii) the intestine might synthesize creatine and iv) intestinal and renal creatine synthesis is ontogenically regulated at the level of AGAT gene expression.

Postnatal development of the mucosal plexus in the porcine small and large intestine.

Knowledge regarding the foetal and postnatal development of the enteric nervous system is crucial for the understanding of congenital disorders. While lot of information exists regarding the myenteric and submucosal plexuses, the development of the mucosal plexus has not been previously studied. The mucosal innervation seems to play an important role in the local reflex activity of the gut. In this study, we examined the development of enteric mucosal innervation in the pig at various ages of life. Small and large bowel paraffin-embedded specimens were stained with PGP 9.5 and neurofilament protein in three piglets from six age groups (60 and 90 days gestation, newborn, 4 and 12 weeks old, and adult pigs). Small and large bowel demonstrated identical innervation patterns. Myenteric and submucosal plexuses were stained with PGP 9.5 at 60 days gestation. However, the mucosal staining was first noted clearly at the newborn period. By 4 weeks, PGP 9.5 staining was noted in small amounts within the mucosa. Inner proprial and villous fibres were seen ahead in time to the subepithelial fibres. Both inner proprial and villous staining became quiet prominent by 12 weeks of age and remained unchanged into adulthood. However, the subepithelial fibres appear to increase in adulthood. This study demonstrates for the first time that enteric mucosal innervation first appears only at birth. The immaturity of the mucosa generated reflex activity, and secretory functions may have implication in the management of functional intestinal obstruction in the premature infant.

Acquisition of neuronal and glial markers by neural crest-derived cells in the mouse intestine.

Enteric neurons and glia arise from the neural crest. The phenotype of crest-derived cells was examined as they differentiated into neurons or glia in the mouse small and large intestine. Previous studies have shown that undifferentiated enteric crest-derived cells are Phox2b(+)/Ret(+)/p75(+)/Sox10(+), and at embryonic day (E) 10.5, about 10-15% of the crest-derived cells in the small intestine have started to differentiate into neurons. In the current study, by E12.5 and E14.5, about 25% and 47%, respectively, of Phox2b(+) cells in the small intestine were immunoreactive to the pan-neuronal protein, ubitquitin hydrolase (PGP9.5), and the percentage did not change dramatically from E14.5 onward. The differentiation of crest-derived cells into neurons in the colon lagged behind that in the small intestine by several days. Differentiating enteric neurons showed high Ret, low p75, and undetectable Sox10 immunostaining. Glial precursors were identified by the presence of brain-specific fatty acid binding protein (B-FABP) and detected first in the fore- and rostral midgut at E11.5. Glial precursors appeared to be B-FABP(+)/Sox10(+)/p75(+) but showed low Ret immunostaining. S100b was not detected until E14.5. Adult glial cells were B-FABP(+)/Sox10(+)/p75(+)/S100b(+). A nucleic acid stain (to identify all ganglion cells) was combined with immunostaining for PGP9.5 and S100b to detect neurons and glial cells, respectively, in the postnatal intestine. At postnatal day 0, fewer than 5% and 10% of cells in myenteric ganglia of the small and large intestine, respectively, were neither PGP9.5(+) nor S100b(+). Because some classes of neurons are not present in significant numbers until after birth, the expression of PGP9.5 by developing enteric neurons appeared to precede the expression of neuron type-specific markers.

The truncated metabolite GLP-2 (3-33) interacts with the GLP-2 receptor as a partial agonist.

The therapeutic potential of the intestinotrophic mediator glucagon-like peptide-2 (1-33) [GLP-2 (1-33)] has increased interest in the pharmacokinetics of the peptide. This study was undertaken to investigate whether the primary degradation product GLP-2 (3-33) interacts with the GLP-2 receptor. Functional (cAMP) and binding in vitro studies were carried out in cells expressing the transfected human GLP-2 receptor. Furthermore, a biologic response of GLP-2 (3-33) was tested in vivo. Mice were allocated to groups treated for 10 days (twice daily) with: (1) 5 microg GLP-2 (1-33), (2) 25 microg GLP-2 (3-33), (3) 5 microg GLP-2 (1-33)+100 microg GLP-2 (3-33), or (4) 5 microg GLP-2 (1-33)+500 microg GLP-2 (3-33). The intestine was investigated for growth changes. GLP-2 (3-33) bound to the GLP-2 receptor with a binding affinity of 7.5% of that of GLP-2 (1-33). cAMP accumulation was stimulated with an efficacy of 15% and a potency more than two orders of magnitude lower than that of GLP-2 (1-33). Increasing doses of GLP-2 (3-33) (10(-7)-10(-5) M) caused a shift to the right in the dose-response curve of GLP-2 (1-33). Treatment of mice with either GLP-2 (1-33) or (3-33) induced significant growth responses in both the small and large intestines, but the response induced by GLP-2 (3-33) was much smaller. Co-administration of 500 microg of GLP-2 (3-33) and 5 microg GLP-2 (1-33) resulted in a growth response that was smaller than that of 5 microg GLP-2 (1-33) alone. Consistent with the observed in vivo activities, our functional studies and binding data indicate that GLP-2 (3-33) acts as a partial agonist with potential competitive antagonistic properties on the GLP-2 receptor.

GLP-2 stimulates intestinal growth in premature TPN-fed pigs by suppressing proteolysis and apoptosis.

We wished to determine whether exogenous glucagon-like peptide (GLP)-2 infusion stimulates intestinal growth in parenterally fed immature pigs. Piglets (106-108 days gestation) were given parenteral nutrient infusion (TPN), TPN + human GLP-2 (25 nmol. kg(-1). day(-1)), or sow's milk enterally (ENT) for 6 days. Intestinal protein synthesis was then measured in vivo after a bolus dose of [1-(13)C]phenylalanine, and degradation was calculated from the difference between protein accretion and synthesis. Crypt cell proliferation and apoptosis were measured in situ by 5-bromodeoxyuridine (BrdU) and terminal dUTP nick-end labeling (TUNEL), respectively. Intestinal protein and DNA accretion rates and villus heights were similar in GLP-2 and ENT pigs, and both were higher (P < 0.05) than in TPN pigs. GLP-2 decreased fractional protein degradation rate, whereas ENT increased fractional protein synthesis rate compared with TPN pigs. Percentage of TUNEL-positive cells in GLP-2 and ENT groups was 48 and 64% lower, respectively, than in TPN group (P < 0.05). However, ENT, but not GLP-2, increased percentage of BrdU-positive crypt cells above that in TPN piglets. We conclude that GLP-2 increases intestinal growth in premature, TPN-fed pigs by decreasing proteolysis and apoptosis, whereas enteral nutrition acts via increased protein synthesis and cell proliferation and decreased apoptosis.

[The cytogenesis and differentiation of the epithelial endocrinocytes of the large intestine in hens and rats in ontogeny]. / Tsitogenez i differentsirovka éndokrinotsitov épiteliia tolstoi kishki kur i krys v ontogeneze.

Cytogenesis and differentiation of epithelial endocrinocytes were studied by methods of histochemistry and electron microscopy in large intestine of hen and rat in the course of their individual development. In the embryogenesis processes of cellular and organospecific differentiation occur in epithelium of these animals large intestine, which is proved by early revealing of endocrinocytes, when epithelial plast is yet undifferentiated. Growth of differentiation in hen and rats is marked on day 19-21 of postnatal embryonal development. In postnatal ontogenesis endocrine apparatus achieves definitive state by day 5 in hen and day 20 in rats. Argentaffin cells are the leading sub-population, which reflects the importance of serotonine they produce in realizing regulatory reactions of the organism. Slightly differentiated cells are the source of endocrinocyte cytogenesis.

Cell apical surface area in enterocytes from chicken small and large intestine during development.

The absorptive surface of epithelial cells from chicken small and large intestine was studied at the day of hatch (1 d group) and at 2 and 6 wk after hatch. The segments considered were duodenum, jejunum, ileum, cecum (proximal, medial, and distal regions), and rectum. The length, diameter, and density of microvilli as well as cell apical diameter were measured in tip-villous enterocytes by transmission electron microscopy. The results obtained showed that during development: 1) microvillus length remained constant in duodenum and jejunum and decreased in the other segments; 2) microvillus diameter increased only in the jejunum and the rectum; 3) microvillus density increased in duodenum, ileum, distal cecum, and rectum (especially from 1 d to 2 wk) and did not change in the other segments; 4) cell apical diameter did not change; 5) apical surface area increased both in the duodenum (2nd to 6th wk) and in the jejunum (1 d to 2 wk) but did not change in the ileum. In the proximal-medial cecum and in the rectum there was a decrease in apical surface, whereas no changes were observed in distal cecum. Results indicated that microvillus length and density are the variables that best explain the changes observed in apical surface that occurred during development.

Large bowel growth.

Developmental events in the large bowel have been studied pre- and post-natally and indicate that by birth, crypt organisation and kinetic activity are organised along adult lines. The period from birth to maturity is marked by an increase in crypt size and a massive increase in their number, with new crypts developing by a process of longitudinal fission from the base of existing ones. We know little of the fate of crypt size and number thereafter. Adaptive responses to resection or bypass of intestine are much less marked in large bowel when compared to small bowel, but in general postoperative responses have not been as extensively examined. Of the factors maintaining mass and cell turnover in large bowel mucosa simple luminal bulk seems to be most important, although a role exists for endocrine and neurovascular influences. Knowledge of growth, kinetic activity and adaptive responses in human large bowel is scanty and represents a large area for further study.

Age and intestinal retention of mercury and cadmium in rats.

The site of cadmium and mercury retention in the intestine was determined in 6-day-old sucklings and 6-week-old weaned rats 6 days after oral administration of 115mCd and 203Hg. The ileum was found to be the main site of intestinal retention of both cations in sucklings but not in weaned rats. Other age- and element-specific differences in the site of metal retention in the intestine were also found. These differences indicate that even in neonates, metal absorption might be a more specific process than previously assumed.

Alkaline phosphatase activity of the large intestinal principal cells in postnatal developing rats.

The localization of alkaline phosphatase activity in the large intestinal mucosa of postnatal developing rats was studied by means of light and electron microscopes. On the day after birth, alkaline phosphatase activity, as shown by the azo-coupling method was found on the microvilli and the tubulovacuolar system in the proximal part of the large intestine between the 1st and the 15th days, enzyme activity was localized on the microvilli, the tubulovacuolar system, and the supranuclear vacuole of the surface principal cells of the cecum and the ascending colon. After the 15th day, all the principal cells of the proximal large intestine were free of reaction products as were those in the full-grown rats. Before the 4th day of life, in the descending colon, the enzyme activity of the principal cells was observed, but only on the microvilli. After the 5th day, enzyme activity disappeared from the principal cells.