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a Department of Anatomy, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates;
b Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
Key Words. Gastric stem cell • Cell dynamics • Pit cell • Zymogenic cell • Vitamin A • Stomach
Correspondence: Sherif M. Karam, M.D., Ph.D., Department of Anatomy, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, P.O.Box17666, United Arab Emirates. Telephone:971-3-703-9493; fax:971-3-767-2033; e-mail: skaram{at}uaeu.ac.ae
| ABSTRACT |
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| INTRODUCTION |
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Similar epithelial progenitors have been defined recently in the human stomach and also found to be responsible for the continuous production of all cell types in the gastric epithelium [3]. Although it is generally believed that these progenitor cells play an important role during gastric carcinogenesis [4] and, in a transgenic mouse model, their transdifferentiation into neuroendocrine gastric cancer cells has been recently demonstrated [5], little information is available regarding the factors that control the dynamic features of these epithelial progenitors.
Vitamin A or retinoic acid is known to have profound effects on cell proliferation and differentiation in other renewing epithelia. It has been shown to play an important role in epidermal keratinization [6], mammary gland formation [7], and gene expression of tracheobronchial epithelium [8]. Retinoic acid acts through specific receptors that are members of the nuclear steroid receptor superfamily of proteins. These receptors function as ligand-dependent transcription factors that are believed to control cell proliferation and differentiation [9].
In the human stomach, retinoic acid is thought to play a role in gastric cancer prevention and has long been known as a cytoprotective agent against gastric mucosal damage and ulcer formation by mechanisms that are not well understood [10]. Mozsik et al. [11] have shown that the action of retinoic acid depends on intact adrenals and vagal innervation; however, the possibility that it has direct effects on the gastric epithelium was not excluded. Recently, mRNA expression of the retinoid receptors was demonstrated in the gastric mucosa [12, 13]. However, still there is a debate whether retinoic acid can be used as a chemopreventive agent against gastric cancer. Although some investigators found that it prevents progression of atrophic gastritis to gastric cancer [14], others reported that it has no effect on cancer progression and may even increase the risk of other types of cancer, such as bronchogenic carcinoma [15].
This report examines whether retinoic acid has an effect on the proliferation of gastric epithelial progenitors. Also, it provides some insights into a possible role of retinoic acid in the control of differentiation program and turnover of the gastric epithelium.
| MATERIALS AND METHODS |
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Cell Proliferation and Migration Studies
In some experiments, retinoic acidtreated and control mice received an intraperitoneal injection of 5-bromo-2'-deoxyuridine (BrdU) (120 mg/kg body weight) 1 hour before euthanasia to label cells in S-phase. To label progeny of S-phase cells and follow their migration pathway, some mice were given, along with retinoic acid, a continuous subcutaneous infusion of BrdU (400 mg/kg body weight per day) for 1 or 3 days via the Alzet osmotic pumps.
Animals were killed by a lethal dose of the anesthetic, and the stomachs were opened, fixed in Bouins solution, and processed for paraffin embedding. Sections were incubated with goat polyclonal antibodies specific for BrdU [16]. The secondary antibody used was fluorescein isothiocyanate (FITC)- or peroxidase-conjugated rabbit anti-goat immunoglobulin G (IgG). Sections were counter-stained with tetramethylrhodamine isothiocyanate (TRITC)-conjugated Ulex europaeus agglutinin type 1 lectin (UEA-1) (Sigma) or periodic acid Schiff (PAS) to label pit cells.
In sections from mice given a single BrdU injection, cells with labeled nuclei were counted per longitudinally cut gland. For each mouse, at least fifteen glands were examined in three different sections. Counts are expressed as mean ± standard error of the mean (SE).
Because pit cells are short-lived cells and many would incorporate BrdU during a 3-day infusion, the overall labeling index of pit cells was determined after single injection and continuous infusions of BrdU. A phase-contrast microscope was used to count the number of pit cells with labeled nuclei and the total number of pit cells (with labeled and unlabeled nuclei) per gland. The labeling indices were plotted against time, and the slope of the regression line was used to estimate the turnover rate of pit cells in control and retinoic acidtreated mice, as previously reported [17].
To demonstrate cell migration in sections of BrdU-treated tissues, labeled and unlabeled cells were scored in two equal segments of the pit (low and high) and in three different gland regions (isthmus, neck, and base). Then the labeling indices were estimated in each region or segment. Data were expressed as mean of percent labeling in each region or segment ± SE. Students t test was used to compare counts or percent of BrdU-labeled cells in control versus retinoic acidtreated mice.
During cell scoring, the borders of the regions of the gastric glands were defined according to previously reported criteria [1]. Briefly, the pit-isthmus border is taken to be the lower edge of the deepest pit cell; the isthmus-neck border is defined by the upper edge of the most superficial neck cell; the upper edge of the most superficial zymogenic cell represents the beginning of the base region.
Immunofluorescence Labeling of Cell Lineages
To distinguish the different gastric cell lineages, sections were incubated with primary antibodies or lectins as previously reported [18]. The following antibodies were used: mono-clonal anti-H, K-ATPase ß-subunit for parietal cells (Cal-biochem-Novabiochem Co, La Jolla, CA), rabbit polyclonal anti-intrinsic factor antibody against baculovirus-expressed human intrinsic factor for zymogenic cells [19], polyclonal anti-gastrin antibodies (DAKO) for the antral G cells, and polyclonal anti-ghrelin antibodies for various oxyntic enteroendocrine cells [20]. Antigen-antibody complexes were detected using FITC-conjugated anti-mouse IgG. As markers for mucus-secreting pit and neck cells, TRITC-conjugated UEA-1 lectin and FITC-conjugated Grifforia simplifolica II lectin (GSII) were used, respectively. Secondary antibodies and lectins were purchased from Sigma.
Morphometric Studies
Some sections of the mouse stomachs were stained with PAS and hematoxylin and used for estimation of the surface area of different cell types by using an image analysis program (Synoptics Image Analysis, London, UK). For each section, at least three longitudinally cut pits continuous with their glands were chosen for measurements. First, the whole pit-gland unit was outlined and its area was measured in the section and expressed in square micrometers. Then, the areas of pit, parietal, and zymogenic cells were determined. Because in these paraffin sections it was sometimes difficult to differentiate between immature progenitor cells of the isthmus and mucus-secreting neck cells, both were measured together as one category referred to as isthmal-neck cells. The percentage of the area of each cell type in the pit-gland unit was determined, and data were expressed as mean ± SE. Measurements of control versus retinoic acidtreated mice were compared by the Students t test.
Terminal Deoxynucleotidyltransferase-Mediated, dUTP Nick-End Labeling Assay
To detect apoptotic cells in control and retinoic acidtreated mice, some sections were processed for terminal deoxynucleotidyltransferase labeling according to the method of Gavrieli et al. [21]. Degoxigenin-labeled UTP was used for the in situ terminal transferase reaction, and incorporation was detected using peroxidase-conjugated anti-digoxigenin and diaminobenzidine (Oncor, MD). Sections were counterstained with PAS.
Electron Microscopy
In some experiments, small pieces of the oxyntic mucosa of control and retinoic acidtreated mice were immersed, immediately after dissection, in 0.1 M sodium cacodylate buffer containing 2% paraformaldehyde and 2.5% gluter-aldehyde. After post-fixation in osmium tetroxide, tissues were dehydrated and processed for resin embedding and ultrathin sections as previously described [1]. Tissue sections were stained with uranyl-lead and examined with Philips electron microscope.
| RESULTS |
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.001). These dividing cells were found mainly in the isthmus region, with a small proportion in the low pit segment and the neck region (Fig. 2
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To visualize and confirm the difference in cell production, BrdU labeling was estimated in the isthmus, neck, and base regions, in addition to the pit segments. Counts of the 1-day BrdU-infused control mice showed an increase in the percentage of labeled cells in the isthmus and the low pit segment and neck region. In addition, very few labeled cells made their appearance in the high pit segment and the base region. Labeled cells were more numerous in retinoic acidtreated mice compared with control ones (Fig. 2
, middle panel). By 3-day BrdU infusion, counts revealed a further increase in the number of labeled cells, which was more enhanced in the high pit segment and neck and base regions of the retinoic acidtreated mice (Fig. 2
, right panel).
Retinoic Acid Expands the Area of Zymogenic Cells
Probing of normal and retinoic acidtreated tissue sections with cell markers specific for pit, neck, parietal, and enteroendocrine cells demonstrated no significant difference in the labeled area of these cell types. However, when anti-intrinsic factor was used to probe normal and treated tissues, an increase in the area of the zymogenic cells after retinoic acid treatment was observed (Figs. 3C3F
). Measurements of the areas of different cell types confirmed these observations and showed a significant increase in the area occupied by zymogenic cells in the retinoic acidtreated tissues (Fig. 4
). Zymogenic cell counts in PAS/hematoxylin-stained sections, obtained from three pairs of control and retinoic acidtreated mice, showed that the average number of zymogenic cells in control mice was approximately 11 cells per gland. In retinoic acidtreated mice, the number of zymogenic cells was significantly increased to up to 17 cells per gland.
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The TUNEL assay was used to detect apoptotic cells in the gastric mucosae of control and retinoic acidtreated mice. As previously reported, pit cells normally undergo degeneration at the luminal surface of the gastric mucosa [17]. However, more pit cells at the luminal surface of retinoic acidtreated mice underwent apoptosis compared with control mice (Fig. 5
). Counts conducted in oxyntic mucosal sections (n = four per mouse) revealed that the number of apoptotic cells was approximately one cell per five glands, whereas in retinoic acidtreated mice, it was approximately three cells per five glands.
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| DISCUSSION |
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Effects of Retinoic Acid on the Proliferation of Gastric Epithelial Progenitors
Stomach tissues probed with anti-BrdU antibodies showed that the cells that entered the S-phase of the cell cycle are located in the progenitor cell zone of the gland, which confirms earlier observation using 3H-thymidine radioautography [2]. In the present study, more BrdU-labeled cells were present in the retinoic acidtreated tissues compared with the control tissues (Figs. 1A, 1B
; Fig. 2
, left panel; Figs. 3A, 3B
).
To test whether changing the mode of retinoic acid administration would influence its effect on gastric epithelial progenitors, five mice received multiple retinoic acid injections (5 mg/kg body weight per 8 hours) for 3 consecutive days. The S-phase progenitor cells in these retinoic acidtreated mice and their control littermates were labeled by a single injection of BrdU 1 hour before euthanasia. The oxyntic and fundic mucosae of these mice showed an apparent increase in BrdU-labeled progenitor cells after retinoic acid injections, a pattern similar to that of continuous infusion experiment (Figs. 1A, 1B
; 3A, 3B
).
To follow the progeny of dividing cells in the oxyntic epithelium, mice received BrdU continuously for 1 or 3 days. All cells that entered the S-phase of the cell cycle during these infusion days incorporated and maintained the BrdU label. Therefore, the overall BrdU labeling in the gastric gland would reflect cell production pattern during this 1- or 3-day infusion period.
In control mice, the comparison of 1-hour with 1-day labeling showed that the continuous infusion of BrdU for 1 day is associated with an increase in the labeled cells in the isthmus region, low pit segment, and neck region (Fig. 2
, left and middle panels). In addition, some labeled cells make their appearance in the high pit segment and the base region, suggesting cell migration toward the luminal surface and gland bottom. By 3 days, more labeled cells appear in the isthmus and other gland regions (Fig. 2
, right panel).
Retinoic acidtreated mice showed similar pattern of BrdU labeling compared with control ones. However, retinoic acid stimulates the production of more cells, which migrate and reach the high pit segment and the base region after 1 or 3 day of infusion, compared with control mice (Figs. 1
, 2
).
Effects of Retinoic Acid on the Dynamics of Pit Cell Lineage
The present BrdU data support previous observation with 3H-thymidine radioautography that members of the pit cell lineage are produced in the progenitor cell zone and reach the surface epithelium within a few days, where they finally degenerate and are shed [17]. In the retinoic acidtreated mice, there was a stimulation of pit cell production, which rapidly reached the luminal surface. We did not observe any significant change in the area of pit cells after retinoic acid treatment (Fig. 4
). Also, the average number of pit cells was more or less similar in control and retinoic acidtreated mice (13.1 versus 13.7 cells per pit, respectively). Therefore, it is assumed that there was a steady state in pit cell population. In support of this assumption is the presence of many degenerated and exfoliated pit cells at the luminal surface (Figs. 1F
, 5B
, 6B
).
Recent studies have suggested that degeneration of pit cells depends on interplay between positive regulators of apoptosis such as proapoptotic caspases and negative regulators such as nuclear factor
B, transforming growth factor ß1, and Bcl-2 [2224]. Expressions of these factors are known to be regulated by retinoic acid, which has been shown to induce apoptosis in gastric epithelial cells both in vitro and in vivo [25, 26]. Hence, the enhancement of pit cell apoptosis observed in the present study is likely to be attributable to alteration of these factors and provides a further support for the possible role of retinoids in gastric cancer prevention.
To estimate the change in the turnover rate of pit cells after retinoic acid treatment, first, their overall labeling indices were calculated in control and retinoic acidtreated mice 1 hour after injection of BrdU and after its infusion for 1 and 3 days (Table 1
). Then the labeling indices were plotted against time, and the slope of the regression line, which reflects the increase in cell production rate, was used to calculate pit cell turnover rate (Fig. 7
). On the assumption that there was a steady state and the rate of cell production equals the rate of cell loss, and from the equation of the regression line, the turnover rate of pit cells in the control mice was 0.84% per hour or 20.2% per day. Therefore, the pit cell turnover time is approximately 5 days. Similarly, in the retinoic acidtreated mice, the turnover rate was estimated at 1.21% per hour, which is 29% per day, and the turnover time was 3.4 days (Fig. 7
). Therefore, retinoic acid has increased the turnover rate of pit cells and shortened their turnover time.
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Effects of Retinoic Acid on the Differentiation Program of Zymogenic Cell Lineage
The zymogeniccell lineage includes pre-neck, neck, and zymogenic cells [28]. The present data suggested an enhancement in the production of zymogenic cells in the retinoic acidtreated mice (Fig. 1
). The stimulation of progenitor cell proliferation was associated with an increase in the area of zymogenic cells (Figs. 3
, 4
). These results were not unexpected, because zymogenic cells are long-lived cells (~ 200 days) [28].
In mice, the acid-secreting parietal cells undergo production and maturation in the isthmus followed by a bidirectional mode of migration toward the gland bottom and the luminal surface. The overall turnover time of parietal cells is longer than 50 days [29]. Therefore, as proposed for pit cells, retinoic acid treatment might have accelerated the dynamics of parietal cell turnover by increasing rates of their production and elimination. However, by using the TUNEL assay and electron microscopy, we did not observe any change in their degeneration process. Also, parietal cells maintained a normal steady state without an apparent change in their area compared with the change observed in the immunostaining pattern of zymogenic cells, the longest-lived cells in the epithelium. So, it seems that an effect of retinoic acid on the dynamics of parietal cells of 1- to 2-month old mice is unlikely.
Whether the effects of retinoic acid on the gastric epithelial cell dynamics are attributable to direct binding to their receptors or other factors remain to be investigated. We tested the possibility that the effects observed are part of a general trophic effect, possibly by an increase in the production of gastrin-secreting G cells in the pyloric antrum. However, immunoprobing of these cells in control and retinoic acidtreated mice did not reveal any significant difference (Figs. 3C, 3D
). Insulin could be another factor, because we have recently found it to stimulate proliferation of gastric epithelial progenitors in vitro [30] and retinoic acid has been reported to stimulate insulin production [31]. Finally, because we have observed effects for retinoic acid on epithelial progenitors and two lineages, pit and zymogenic, migrating in different directions and the mRNA and protein expressions of retinoid receptors are localized in more than one cell type in the gastric glands [12, 13], it seems likely that the effects observed in this study due to retinoic acid treatment are via ligand receptor binding.
Recently, the expression of retinoic acidsynthesizing enzyme, retinaldehyde dehydrogenase 1 (RALDH1), has been demonstrated in the proliferating/differentiating gastric epithelium of developing mice [32]. Because cell proliferation and differentiation also occur in adult stomach, and because the present study demonstrates that retinoic acid alters the dynamics of the gastric epithelium of adult mice, it seems very likely that RALDH1 expression is maintained in the adult mouse stomach and retinoic acid synthesis contributes to autocrine control of gastric epithelial homeostasis.
In conclusion, our results indicate that retinoic acid plays a role in controlling cell proliferation and influencing decisions of cell commitment program in the gastric glands of the mouse stomach. These data suggest that retinoic acid is needed to maintain normal cell proliferation and differentiation in the gastric glands, which may provide a possible explanation for its cytoprotective effects against gastric mucosal ulceration and tumor development.
| ACKNOWLEDGMENTS |
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