Gut homeostasis, injury, and healing: New therapeutic targets

Abstract

The integrity of the gastrointestinal mucosa plays a crucial role in gut homeostasis, which depends upon the balance between mucosal injury by destructive factors and healing via protective factors. The persistence of noxious agents such as acid, pepsin, nonsteroidal anti-inflammatory drugs, or Helicobacter pylori breaks down the mucosal barrier and injury occurs. Depending upon the size and site of the wound, it is healed by complex and overlapping processes involving membrane resealing, cell spreading, purse-string contraction, restitution, differentiation, angiogenesis, and vasculogenesis, each modulated by extracellular regulators. Unfortunately, the gut does not always heal, leading to such pathology as peptic ulcers or inflammatory bowel disease. Currently available therapeutics such as proton pump inhibitors, histamine-2 receptor antagonists, sucralfate, 5-aminosalicylate, antibiotics, corticosteroids, and immunosuppressants all attempt to minimize or reduce injury to the gastrointestinal tract. More recent studies have focused on improving mucosal defense or directly promoting mucosal repair. Many investigations have sought to enhance mucosal defense by stimulating mucus secretion, mucosal blood flow, or tight junction function. Conversely, new attempts to directly promote mucosal repair target proteins that modulate cytoskeleton dynamics such as tubulin, talin, Ehm², filamin-a, gelsolin, and flightless I or that proteins regulate focal adhesions dynamics such as focal adhesion kinase. This article summarizes the pathobiology of gastrointestinal mucosal healing and reviews potential new therapeutic targets.

Keywords: Intestine; Mucosa; Repair; Restitution; Sheet migration; Stomach ulcer

Core Tip: The integrity of the gastrointestinal mucosa is crucial in gut homeostasis, which depends upon the balance between mucosal injury by destructive factors and healing via protective factors. An excess of destructive agents breaks down the mucosal barrier. Upon injury, under physiological conditions, gastrointestinal mucosa heals itself by complex processes. However, the gut may not heal under pathological conditions. Currently available drugs attempt to minimize or reduce injury to the gastrointestinal tract. Recent studies have focused on improving mucosal defense or directly promoting mucosal repair. This article summarizes the pathobiology of gastrointestinal mucosal healing and reviews potential new therapeutic targets.