Preservation of mucosal barrier in surgical diseases

描述（由申请人提供）：患有严重疾病（如热损伤、严重创伤、休克和脓毒症）的外科患者通常并发胃肠道粘膜损伤，可导致全身感染、脓毒性休克和多器官功能衰竭。复苏是一个重要的过程，为修复受损的肠内膜。以前的研究表明，肠上皮细胞的恢复在危重患者中延迟。我们最近的工作表明，乳脂球-EGF因子8（MFG-E8）是一种巨噬细胞源性肠上皮修复因子。MFG-E8通过PKC 5依赖性方式促进肠上皮伤口愈合。在脓毒症中，肠损伤与MFG-E8的下调相关，这有助于恢复受损。因此，在本提案中，我们将测试一个中心假设，即在生理状态下，MFG-E8通过典型的信号通路维持肠上皮细胞迁移，而在脓毒症条件下，炎症介质下调MFG-E8表达，这反过来又损害肠上皮细胞的恢复。在具体目标1中，我们将定义MFG-E8增强肠上皮恢复的分子和信号机制。我们的初步数据表明，MFG-E8激活几个PKC 5相关的细胞内信号分子。因此，我们将使用分子生物学和基因敲除方法研究这些分子在MFG-E8诱导的肠上皮细胞迁移中的作用。在具体目标2中，我们将重点了解脓毒症中肠MFG-E8基因表达下调和MFG-E8依赖性肠恢复受损的原因。我们的初步数据表明，脓毒症衍生的炎症介质模拟脓毒症对肠道MFG-E8基因表达和恢复的影响。因此，我们将测试的假设，这种介质抑制肠MFG-E8基因的表达，随后导致肠道恢复受损。在具体目标3中，我们将研究脓毒性胰岛素源性炎症刺激抑制巨噬细胞中MFG-E8表达的分子机制。我们的初步数据表明，通过炎症刺激抑制MFG-E8基因表达涉及影响MFG-E8的启动子和mRNA 3 '-非翻译区（3'-UTR）的活性。为了跟进这些发现，我们将表征MFG-E8基因启动子及其结合蛋白中的结合基序，并研究它们在炎症过程中抑制MFG-E8基因表达的作用。将应用分析基因启动子功能的标准方法。此外，我们将使用microRNA和定点突变技术来研究3 '-UTR和microRNA在炎症刺激对MFG-E8基因表达的调控中的作用。这些特定目标的实现和我们假设的证实将提供新的机制信息，使我们能够理解MFG-E8在肠道中的关键作用及其生理/病理意义。我们的研究将最终导致危重患者肠损伤管理和治疗的新策略的发展。 公共卫生相关性：急性肠损伤是重症监护病房和外科住院患者的发病率和死亡率的重要因素。然而，尽管过去几十年来医学取得了进步，但这种常见疾病的有效治疗方法仍然很少。我们最近的研究结果表明，乳脂球-EGF因子8（MFG-E8）促进脓毒症肠内膜的修复。该提案目标的实现不仅将提供新的机制信息，使我们能够了解MFG-E8在肠道中的关键作用及其生理/病理意义，而且还可能提出旨在保护危重患者肠道屏障功能的新治疗策略。

DESCRIPTION (provided by applicant): Surgical patients with critical disorders such as thermal injury, sever trauma, shock, and sepsis are commonly complicated with the gastrointestinal mucosal injury, which can lead to the development of systemic infection, septic shock, and multiple organ failure. Restitution is an important process for repair of disrupted intestinal lining. Previous studies have suggested that intestinal epithelial restitution is delayed in critically ill individuals. Our recent work has revealed that milk fat globule-EGF factor 8 (MFG-E8) is a macrophage-derived intestinal epithelial restitution factor. MFG-E8 promotes intestinal epithelial wound-healing via a PKC5 dependent manner. In sepsis, intestinal injury is associated with downregulation of MFG-E8, which contributes to the impairment of restitution. In this proposal, therefore, we will test a central hypothesis that under the physiological state, MFG-E8 maintains intestinal epithelial cell migration via a typical signal pathway, whereas under the septic condition, inflammatory mediators down-regulate MFG-E8 expression, which in turn impairs intestinal epithelial cell restitution. In Specific Aim 1, we will define the molecular and signaling mechanism through which MFG-E8 enhances intestinal epithelial restitution. Our preliminary data suggest that MFG-E8 activates several PKC5-associated intracellular signal molecules. Therefore, we will investigate the role of these molecules in MFG-E8-induced intestinal epithelial cell migration using molecular biology and gene knockdown approaches. In Specific Aim 2, we will focus on understanding the cause of down-regulation of intestinal MFG-E8 gene expression and impairment of MFG-E8-dependent intestinal restitution in sepsis. Our preliminary data suggest that a sepsis-derived inflammatory mediator mimics septic effect on intestinal MFG-E8 gene expression and restitution. Thus, we will test the hypothesis that this mediator inhibits intestinal MFG-E8 gene expression, which subsequently results in impairment of intestinal restitution. In Specific Aim 3, we will investigate the molecular mechanism underlying the inhibition of MFG-E8 expression in macrophages by septic insult-derived inflammatory stimulus. Our preliminary data show that repression of MFG-E8 gene expression by an inflammatory stimulus is involved in affecting the activities of promoter and mRNA 3'-untranslated region (3'-UTR) of MFG-E8. To follow up on these findings, we will characterize binding motifs in the MFG-E8 gene promoter and their binding proteins, and study their role in suppression of MFG-E8 gene expression during inflammation. The standard approach for analysis of the gene promoter function will be applied. In addition, we will use the microRNA and site-directed mutagenesis technologies to study the role of 3'-UTR and microRNAs in regulation of MFG-E8 gene expression by an inflammatory stimulus. Achievement of these specific aims and confirmation of our hypotheses will provide the novel mechanistic information that allows us to understand the crucial role of MFG-E8 in the gut and its physio/pathological implications. Our studies will ultimately lead to development of novel strategies for management and treatment of intestinal injury in critically ill patients. PUBLIC HEALTH RELEVANCE: Acute intestinal injury contributes to morbidity and mortality of hospitalized patients in the intensive care unit and surgical department. However, despite the medical advances of the past few decades, there remain few effective treatments for this common disorder. Our recent findings demonstrate that milk fat globule-EGF factor 8 (MFG-E8) promotes repair of intestinal lining in sepsis. Achievement of aims of this proposal will not only provide the novel mechanistic information that allows us to understand the crucial role of MFG-E8 in the gut and its physio/pathological implications, but also are likely to suggest novel therapeutic strategies aimed at preserving intestinal barrier function for critically ill patients.