Esophageal pepsin and proton pump synthesis in barrett's esophagus and esophageal adenocarcinoma.

OBJECTIVES/HYPOTHESIS: Gastroesophageal reflux disease and associated metaplasia of the esophagus (Barrett's esophagus [BE]) are primary risk factors for esophageal adenocarcinoma (EAC). Widespread use of acid suppression medications has failed to stem the rise of EAC, suggesting that nonacid reflux may underlie its pathophysiology. Pepsin is a tumor promoter in the larynx and has been implicated in esophageal carcinogenesis. Herein, specimens from the esophageal cancer spectrum were tested for pepsin presence. Pepsin-induced carcinogenic changes were assayed in an esophageal cell culture model. STUDY DESIGN: Laboratory analysis. METHODS: Pepsin was assayed in reflux and cancer free esophagi, BE, EAC, and esophageal cancer lacking association with reflux (squamous cell carcinoma [SCC]). Refluxed or locally synthesized pepsin was assayed by Western blot. Local synthesis of pepsin and proton pumps was assayed via reverse transcription-polymerase chain reaction. The effect of pepsin on BE and EAC markers was investigated via enzyme-linked immunosorbent assay and quantitative polymerase chain reaction in human esophageal epithelial cells treated with pepsin or control diluent. RESULTS: Pepsinogen and proton pump mRNA were observed in BE (3/5) and EAC (4/4) samples, but not in normal adjacent specimens, SCC (0/2), or reflux and cancer-free esophagi. Chronic pepsin treatment (0.1-1 mg/mL, 4 weeks) of human esophageal cells in vitro induced BE and EAC markers interleukin 8 and KRT8 and depleted normal esophageal marker KRT10 (P < .05) expression. CONCLUSIONS: Local synthesis of pepsin and proton pumps in BE and EAC is not uncommon. Absence of these molecules in normal (noncancer) esophagi, SCC, and in vitro data support a role for pepsin in reflux-attributed carcinogenic changes in the esophagus. LEVEL OF EVIDENCE: NA Laryngoscope, 129:2687-2695, 2019.

Diagnóstico de reflujo gastroesofágico proximal en pacientes con trastornos respiratorios del sueño / Diagnosis of proximal gastro-oesophageal reflux in patients with rhonchopathy and sleep apnoea

Introducción: La asociación entre trastornos respiratorios del sueño y la enfermedad por reflujo gastroesofágico permite considerar el tratamiento con inhibidores de la bomba de protones como una alternativa terapéutica en pacientes con roncopatía o síndrome de apnea del sueño leve o moderado. Sin embargo, para ello se debe demostrar la presencia de reflujo gastroesofágico en el esófago proximal mediante una prueba objetiva: la pH-metría esofágica de 24 h de dos canales. Objetivo: Predecir, mediante parámetros clínicos y exploratorios, en qué pacientes con alteraciones respiratorias del sueño hay más posibilidades de reflujo ácido en el esófago proximal y, por lo tanto, sean candidatos a la realización de la pH-metría. Material y método: Se incluyó a 121 pacientes consecutivos que acuden para diagnóstico y tratamiento de alteración respiratoria durante el sueño. Se les practicó polisomnografía nocturna y pH-metría esofágica. Se analizan los datos de la anamnesis y la exploración endoscópica de la vía aérea superior y se comparan estadísticamente con los resultados de la pH-metría. Resultados: Se obtiene una buena correlación estadística entre la clínica faringolaríngea de reflujo y la exploración de la vía aérea superior para signos de reflujo esofágico proximal (p = 0,009). Las comparaciones realizadas entre estos datos clínicos y los obtenidos por pH-metría no mostraron relación positiva estadísticamente significativa. Conclusiones: En esta población de pacientes con trastornos respiratorios del sueño, los datos clínicos y endoscópicos no son útiles para sospechar la presencia de reflujo gastroesofágico esofágico proximal y, por lo tanto, iniciar tratamiento con inhibidores de la bomba de protones. Por ello es necesaria la práctica de una pH-metría esofágica de dos canales

Introduction: The close relationship between gastro-oesophageal reflux disease and sleep-related breathing disorders allows the consideration of treatment with proton pump inhibitors as a feasible alternative for patients with snoring or mild to moderate sleep apnoea syndrome. Nevertheless, the presence of gastro-oesophageal reflux in the proximal oesophagus must be identified objectively with a double channel oesophageal pH-metry. Objective: To identify clinical data allowing the selection of patients most likely to have proximal oesophageal reflux, and, therefore, candidates for oesophageal pH-metry. Material and method: Between January 2004 and September 2006, 121 patients were prospectively included. In these patients, a nocturnal polysomnography and a 24 hour double channel pH-metry were performed on the same day. We compared statistically the clinical data, endoscopic examination of the upper airway and the pH-metry results. Results: A good correlation was observed between the presence of symptoms suggesting pharyngo-laryngeal acid reflux and endoscopic examination of this area (P<.009). However, the comparison between clinical data and pH-metry results was not statistically significant. Conclusions: Clinical symptoms and endoscopic examination alone are not good tools to determine the presence of gastro-oesophageal reflux in the pharynx, in this group of patients. Its presence must be ascertained by a double channel oesophageal pH-metry

The in vitro effect of pH on osteoclasts and bone resorption in the cat: implications for the pathogenesis of FORL.

Dental disease due to osteoclast over-activity reaches epidemic proportions in older domestic cats and has also been reported in wild cats. Feline osteoclastic resorptive lesions (FORL) involve extensive resorption of the tooth leaving it liable to root fracture and subsequent tooth loss. The aetio-pathogenesis of FORL is not known. Recent work has shown that systemic acidosis causes increased osteoclast activation and that loci of infection or inflammation in cat mouth are likely to be acidotic. To investigate this, we generated osteoclasts from cat blood and found that they formed in large numbers (approximately 400) in cultures on bovine cortical bone slices. Acidosis caused an increase in the size of cells-in cultures maintained up to 14 days at basal pH 7.25, mean osteoclast area was 0.01 +/- 0.003 mm(2), whereas an 8.6-fold increase was observed in cells cultured between 11 and 14 days at pH 7.15 (0.086 +/- 0.004 mm(2)). Acidosis caused a modest increase in the number of osteoclasts. Exposure to pH 6.92 exhibited a 5-fold increase in the area of bone slices covered by resorption lacunae ( approximately 70% bone slice resorbed). In line with this finding, significant increases were observed in the expression of cathepsin K and proton pump enzymes (both approximately 3-fold) that are key enzymes reflective of resorptive activity in osteoclasts. These results demonstrate that acidosis is a major regulator of osteoclast formation and functional activation in the cat, and suggest that local pH changes may play a significant role in the pathogenesis of FORL.

Molecular and cellular regulation of the gastric proton pump.

The gastric H+, K+-ATPase is a proton pump that is responsible for gastric acid secretion and that actively transports protons and K+ ions in opposite directions to generate in excess of a million-fold gradient across the membrane under physiological conditions. This pump is also a target molecule of proton pump inhibitors which are used for the clinical treatment of hyperacidity. In this review, we wish to summarize the molecular regulation of this pump based on mutational studies, particularly those used for the identification of binding sites for cations and specific inhibitors. Recent reports by Toyoshima et al (2000, 2002) presented precise three-dimensional (3-D) structures of the sarcoplasmic reticulum (SR) Ca2+-ATPase, which belongs to the same family as the gastric H+, K+-ATPase. We have studied the structure-function relationships for the gastric H+, K+-ATPase using 3-D structures constructed by homology modeling of the related SR Ca2+-ATPase, which was used as a template molecule. We also discuss in this review, the regulation of cell surface expression and synthesis control of the gastric proton pump.

Stable expression of gastric proton pump activity at the cell surface.

Stable cell lines expressing the gastric proton pump alpha- and/or beta-subunits were constructed. The cell line co-expressing the alpha- and beta-subunits showed inward Rb(+) transport, which was activated by Rb(+) in a concentration-dependent manner. In the alpha+beta-expressing cell line, rapid recovery of intracellular pH was also observed after acid load, indicating that this cell line transported protons outward. These ion transport activities were inhibited by a proton pump inhibitor, 2-methyl-8-(phenylmethoxy)imidazo[1,2-a]pyridine-3-acetonitrile (SCH 28080). In a membrane fraction of the alpha+beta-expressing cell line, K(+)-stimulated ATPase (K(+)-ATPase) activity and the acylphosphorylation of the alpha-subunit were observed, both of which were also inhibited by SCH 28080. The specific activity and properties of the K(+)-ATPase were comparable to those found in the native gastric proton pump. In the stable cell lines, the alpha-subunit was retained in the intracellular compartment and was unstable in the absence of the beta-subunit, but it was stabilized and reached the cell surface in the presence of the beta-subunit. On the other hand, the beta-subunit was stable and able to travel to the cell surface in the absence of the alpha-subunit. These cell lines are ideal for the structure-function study of ion transport by the gastric proton pump as well as for characterization of the cellular regulation of surface expression of the functional proton pump.

Elevated expression of vacuolar proton pump genes and cellular PH in cisplatin resistance.

V-ATPases are proton-translocating enzymes, which are found not only in numerous intracellular organelles but also in the plasma membranes of many eukaryotic cells. Using differential display, we have identified one of the proton pump subunit genes, ATP6C, as a cisplatin-inducible gene. Northern blot analysis demonstrated that expression of other members of the subunit is inducible by cisplatin treatment. Proton pump gene expression is also upregulated in 3 independent cisplatin-resistant cell lines but not in vincristine- or etoposide-resistant cell lines. Cellular pH was significantly higher in cisplatin-resistant cells than in sensitive parental cells. In vitro DNA-binding activity of cisplatin was markedly increased in acidic conditions, suggesting that the cytotoxicity of cisplatin is modulated by cellular pH. Furthermore, the proton pump inhibitor bafilomycin can synergistically potentiate the cytotoxicity of cisplatin but not of etoposide or camptothecin. These results indicate that cellular pH is one of the critical parameters for effective cancer chemotherapy with cisplatin.

Electrophysiological characterization of specific interactions between bacterial sensory rhodopsins and their transducers.

The halobacterial phototaxis receptors sensory rhodopsin I and II (SRI, SRII) enable the bacteria to seek optimal light conditions for ion pumping by bacteriorhodopsin and/or halorhodopsin. The incoming signal is transferred across the plasma membrane by means of receptor-specific transducer proteins that bind tightly to their corresponding photoreceptors. To investigate the receptor/transducer interaction, advantage is taken of the observation that both SRI and SRII can function as proton pumps. SRI from Halobacterium salinarum, which triggers the positive phototaxis, the photophobic receptor SRII from Natronobacterium pharaonis (pSRII), as well as the mutant pSRII-F86D were expressed in Xenopus oocytes. Voltage-clamp studies confirm that SRI and pSRII function as light-driven, outwardly directed proton pumps with a much stronger voltage dependence than the ion pumps bacteriorhodopsin and halorhodopsin. Coexpression of SRI and pSRII-F86D with their corresponding transducers suppresses the proton transport, revealing a tight binding and specific interaction of the two proteins. These latter results may be exploited to further analyze the binding interaction of the photoreceptors with their downstream effectors.

Mutations in ATP6N1B, encoding a new kidney vacuolar proton pump 116-kD subunit, cause recessive distal renal tubular acidosis with preserved hearing.

The multi-subunit H+-ATPase pump is present at particularly high density on the apical (luminal) surface of -intercalated cells of the cortical collecting duct of the distal nephron, where vectorial proton transport is required for urinary acidification. The complete subunit composition of the apical ATPase, however, has not been fully agreed upon. Functional failure of -intercalated cells results in a group of disorders, the distal renal tubular acidoses (dRTA), whose features include metabolic acidosis accompanied by disturbances of potassium balance, urinary calcium solubility, bone physiology and growth. Mutations in the gene encoding the B-subunit of the apical pump (ATP6B1) cause dRTA accompanied by deafness. We previously localized a gene for dRTA with preserved hearing to 7q33-34 (ref. 4). We report here the identification of this gene, ATP6N1B, which encodes an 840 amino acid novel kidney-specific isoform of ATP6N1A, the 116-kD non-catalytic accessory subunit of the proton pump. Northern-blot analysis demonstrated ATP6N1B expression in kidney but not other main organs. Immunofluorescence studies in human kidney cortex revealed that ATP6N1B localizes almost exclusively to the apical surface of -intercalated cells. We screened nine dRTA kindreds with normal audiometry that linked to the ATP6N1B locus, and identified different homozygous mutations in ATP6N1B in eight. These include nonsense, deletion and splice-site changes, all of which will truncate the protein. Our findings identify a new kidney-specific proton pump 116-kD accessory subunit that is highly expressed in proton-secreting cells in the distal nephron, and illustrate its essential role in normal vectorial acid transport into the urine by the kidney.

Early steps in assembly of the yeast vacuolar H+-ATPase.

Vacuolar proton-translocating ATPases are composed of a complex of integral membrane proteins, the Vo sector, attached to a complex of peripheral membrane proteins, the V1 sector. We have examined the early steps in biosynthesis of the yeast vacuolar ATPase by biosynthetically labeling wild-type and mutant cells for varied pulse and chase times and immunoprecipitating fully and partially assembled complexes under nondenaturing conditions. In wild-type cells, several V1 subunits and the 100-kDa Vo subunit associate within 3-5 min, followed by addition of other Vo subunits with time. Deletion mutants lacking single subunits of the enzyme show a variety of partial complexes, including both complexes that resemble intermediates in the assembly pathway of wild-type cells and independent V1 and Vo sectors that form without any apparent V1Vo subunit interaction. Two yeast sec mutants that show a temperature-conditional block in export from the endoplasmic reticulum accumulate a complex containing several V1 subunits and the 100-kDa Vo subunit during incubation at elevated temperature. This complex can assemble with the 17-kDa Vo subunit when the temperature block is reversed. We propose that assembly of the yeast V-ATPase can occur by two different pathways: a concerted assembly pathway involving early interactions between V1 and Vo subunits and an independent assembly pathway requiring full assembly of V1 and Vo sectors before combination of the two sectors. The data suggest that in wild-type cells, assembly occurs predominantly by the concerted assembly pathway, and V-ATPase complexes acquire the full complement of Vo subunits during or after exit from the endoplasmic reticulum.

Biosynthesis and regulation of the yeast vacuolar H+-ATPase.

The yeast V-ATPase is highly similar to V-ATPases of higher organisms and has proved to be a biochemically and genetically accessible model for many aspects of V-ATPase function. Like other V-ATPases, the yeast enzyme consists of a complex of peripheral membrane proteins, the V1 sector, attached to a complex of integral membrane subunits, the V0 sector. Multiple pathways for biosynthetic assembly of the enzyme appear to be available to cells containing a full complement of subunits and enzyme activity may be further controlled during biosynthesis by a protease activity localized to the late Golgi apparatus. Surprisingly, the assembled V-ATPase is not a static structure. Instead, fully assembled V1V0 complexes appear to exist in a dynamic equilibrium with inactive cytosolic V1 and membrane-bound V0 complexes and this equilibrium can be rapidly shifted in response to changes in carbon source. The reversible disassembly of the yeast V-ATPase may be a novel regulatory mechanism, common to V-ATPases, that works in vivo in coordination with many other regulatory mechanisms.

Factors affecting the re-formation of vacuoles in evacuolated protoplasts and the expression of the two vacuolar proton pumps.

The re-formation of vacuoles in miniprotoplasts (evacuolated mesophyll protoplasts) of tobacco was investigated under different conditions. When a constant osmolarity was maintained, increasing the concentration of NaCl in the medium enhanced the regeneration of vacuoles compared to the control (0.5 M mannitol used as osmoticum). An enhanced growth rate of miniprotoplasts could also be observed under low-osmolarity conditions, by substitution of NaCl for KCl or NaNO3, or with different effectors (glycinebetaine and methyljasmonate). Using the polymerase chain reaction, one cDNA fragment of the B-subunit of the vacuolar ATPase and two fragments of the tonoplast-bound pyrophosphatase (PPase) of tobacco were cloned. Southern blot analyses indicates that for both proteins more than one gene is present in tobacco. During the regeneration of vacuoles the transcript level of the PPase increased earlier than that of the B-subunit of the vacuolar ATPase under all conditions tested (0.5 M mannitol, 0.3 M mannitol, and 0.25 M NaCl, respectively). Under salt-stress conditions (0.25 M NaCl used as osmoticum), the expression level of both proton pumps is enhanced compared to the control. This increase is not specifically due to salt stress but generally to an increased growth rate of the vacuole, since under low-osmolarity conditions the expression of the vacuolar pumps is enhanced, too.