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Departments of Medicine and Physiology, University of Toronto, Toronto, Ontario, Canada
Address all correspondence and requests for reprints to: Dr. G. R. Greenberg, Room 6356, Medical Sciences Building, University of Toronto, Toronto, Ontario, Canada M5S 1A8.
| Abstract |
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| Introduction |
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The aim of the present study was to examine the enterogastrone roles of PYY and GLP-1 as the principal mediators of intestinal fat-induced inhibition of stimulated gastric acid and to determine whether the mechanism of action is through activation of CCK-A receptors in conscious dogs. The influence of endogenous CCK release in duodenal fat-induced inhibition of gastric acid secretion and PYY and GLP-1 secretion was studied by iv administration of the CCK-A receptor antagonist, MK-329. The circulating GLP-1 and PYY responses to intraduodenal fat were compared with responses to exogenous infusions of CCK octapeptide (CCK-OP), as the actions of CCK-A receptors could be direct on L cells or indirect via activation of CCK receptors located within vagus nerves (12, 13). The effects on stimulated acid secretion of iv infusions of exogenous PYY and GLP-1-(736) amide to achieve plasma increments comparable to those observed after intestinal fat were studied singularly and in combination to ascertain the magnitude of acid inhibition. The results were compared with administration of the putative GLP-1 antagonist, exendin-(939) amide (14), to examine the individual role of GLP-1 in the mediation of fat-induced suppression of acid secretion. Plasma somatostatin responses to GLP-1 infusions were also undertaken, as GLP-1 is reported to stimulate this counterregulatory peptide in rats (15, 16) and somatostatin is known to inhibit acid secretion (17, 18).
| Materials and Methods |
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Experimental protocols
In the first series of experiments, after a 20-min basal period
nutrient-stimulated gastric acid secretion was investigated by
perfusing the duodenum with 8% protein (Bacto Peptone, Difco
Laboratories, Detroit, MI) at a rate of 2.4 ml/min for 180 min through
an indwelling catheter placed 10 cm distally into the duodenal cannula
that had been located opposite the entrance of the main pancreatic
duct. In the second series of experiments, intraduodenal protein
perfusions (as in experimental series 1) were studied with 10%
Intralipid (Kabi Vitrium, Baxter Pharmaceutical, Newmarket, Canada)
perfused from 90150 min at a rate of 1.7 ml/min via a second
indwelling catheter placed through the duodenal cannula. In the third
series of experiments, the CCK receptor antagonist MK-329 (a gift from
Dr. D. Veber, Merck, Sharpe, and Dohme, West Point, PA) at a dose of 75
µg/kg or its vehicle (2.0 ml 100% dimethylsulfoxide in 20 ml 0.9%
saline containing 0.1% BSA) was administered by bolus iv injection 10
min before the start of the fat perfusion (as in experimental series
2). In the fourth series of experiments, intraduodenal
protein-stimulated acid secretion was studied on separate occasions
with iv infusions from 90150 min of synthetic GLP-1-(736) amide
(Bachem, Torrance, CA) at doses of 50 and 150 pmol/kg·h alone,
synthetic PYY (Bachem) at a dose of 50 pmol/kg·h alone, GLP-1-(736)
amide in combination with PYY at 50 pmol/kg·h, and GLP-1-(736)
amide at doses of 50 and 150 pmol/kg·h with synthetic exendin-(939)
amide (Bachem) at a dose of 1500 pmol/kg·h beginning 10 min before
the start of the GLP-1-(736) infusions. In the fifth series of
experiments, CCK-stimulated release of GLP-1 and PYY was studied in the
basal state by examining iv infusions of sulfated CCK-OP (Peninsula
Laboratories, Belmont, CA) at a dose of 250 pmol/kg·h for 90 min.
Gastric acid secretion was collected continuously for 180 min and
divided into 15-min aliquots, and the volume and hydrogen ion
concentration of each aliquot were measured. Blood samples were
obtained at 20 and 10 min before, at 0 min (immediately before the
start of the infusions), and at 10-min intervals thereafter.
Laboratory methods
RIAs. Blood for GLP-1 determinations was collected in tubes
containing 1000 kallikrein inhibitor units (KIU) aprotinin (Trasylol,
Bayer, Germany) and 1.2 mg EDTA Na/ml blood. Samples were rapidly
centrifuged, and the plasma was stored at -20 C until assayed. Plasma
GLP-1 concentrations were measured by RIA using antiserum RA7168
(Peninsula). The reactivity of the antiserum was 100% for
GLP-1-(736) amide, 42% for GLP-1-(136) amide, 0.4% for
GLP-1-(737), and less than 0.2% for GLP-1-(137), GLP-2, and other
members of the glucagon-secretin group of peptides. Synthetic
GLP-1-(736) amide (Peninsula) was used for standards and for
preparation of [125I]GLP-1 labeled by the chloramine-T
method and purified as previously described (19). Before RIA, GLP-1 was
extracted from plasma with ethanol (2.5 ml 95% ethanol and 1 ml
plasma). Extracted samples of 200 µl were assayed at 4 C in duplicate
by adding 700 µl 0.05 M barbitone Na (pH 8.0) containing
0.25% (wt/vol) BSA, and 1000 KIU aprotinin and antiserum at a final
dilution of 1:24,000. The addition of 100 µl radioactive label was
delayed 24 h, and the mixture was incubated for an additional
96 h. Bound from free GLP-1 was separated by dextran-coated
charcoal. The limit of detection of the assay was 0.4 fmol/tube or 2
fmol/ml plasma, and the sensitivity of the assay (IC50) was
10.0 fmol/tube or 50.0 fmol/ml plasma. The mean intraassay variation
was 4.6%, and the mean interassay variation was 7.8%. Plasma
concentrations of gastrin (20), PYY (21), and somatostatin (22) were
determined by RIA techniques using methods described in detail
previously.
Chromatography. Gel chromatography studies for GLP-1 were undertaken on plasma samples of 2 ml each obtained 30 min after initiating the lipid perfusion. Plasma samples were collected and extracted as described above, air-dried, and reconstituted in 2.0 ml of a column buffer consisting of 0.05 M barbitone Na (pH 8.0) containing 0.25% (wt/vol) BSA and 1000 KIU aprotinin and applied to a 9 x 1000-mm Sephadex G-50 (superfine) column calibrated with synthetic GLP-1-(736) amide, GLP-1-(136) amide (both from Peninsula), dextran blue (void volume), cytochrome-c (mol wt, 12,384), and Na125I (total volume) at 4 C. Fractions were collected at a flow rate of 6 ml/h and then assayed for GLP-1 directly in the elution buffer. Elution positions are expressed as the coefficient of distribution (Kav), where Kav = (Ve - Vo)/(Vt - Vo), with Ve corresponding to the elution volume, Vo to the void volume, and Vt to the total column volume. Under these experimental conditions, the Kav for synthetic GLP-1-(136) amide was 0.56, and that for synthetic GLP-1-(736) amide was 0.63.
Hydrogen ion concentrations. The hydrogen ion concentration was determined by titration (autoburette titrator and pH meter; Radiometer, Copenhagen, Denmark) of 2-ml samples from each 15-min aliquot to pH 7.0 using 0.025 N NaOH. Gastric acid output was calculated by multiplying the hydrogen ion concentration by the volume of each 15-min aliquot.
Statistical analysis
Results are expressed as the mean ± SEM or the
mean incremental hormone response in plasma as calculated by
subtracting the mean basal concentration for each dog from the
concentration during each time period. Individual differences in
concentrations of hormones and gastric acid secretion at specific time
points within a group were detected by one-way ANOVA, and when a
significant interaction was indicated, comparisons for all given time
points were made using Students paired t test. Repeated
measures ANOVA was used to detect differences between groups, followed
by a multiple comparisons test. Data analysis was carried out using
Sigma-Stat (Jandel Scientific, San Rafael, CA). P <
0.05 or less was considered significant.
| Results |
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| Discussion |
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Although GLP-1 and PYY are colocalized in open-type endocrine L cells found in the ileum (8), circulating levels of both hormones increased rapidly after initiation of intraduodenal fat, and similar results have been reported in rats (23, 24). In accord with previous findings in humans (25), chromatographic studies showed that the predominant molecular form circulating after fat administration corresponded to GLP-1-(736) amide, the biologically active peptide. Moreover, previous studies have shown that diversion of nutrients from the ileum does not influence PYY release, whereas ileocolectomy abolishes PYY responses to intraduodenal fat (25). Together, these findings suggest that mechanisms regulating L cell secretion include either neural or hormonal pathways arising from the duodenum. Our results confirm observations that PYY responses to intraduodenal fat occur via CCK-A receptor activation (6, 26) and also indicate that the same mechanism mediates, in part, GLP-1 secretion. Further, as shown in humans (27), exogenous CCK-8 caused modest, but significant, elevations in plasma GLP-1 concentrations. However, this CCK-dependent component of L cell regulation probably occurs principally via neural, rather than hormonal, pathways because studies in vitro indicate that CCK does not stimulate either GLP-1 or PYY secretion from the isolated perfused rat ileum (28) or from intestinal cell cultures (21). Moreover, although plasma levels of CCK were not measured in the present study, the exogenous CCK-8 dose (250 pmol/kg·h) employed to maximally inhibit acid secretion (3) probably caused circulating CCK levels above values elicited by the administration of intraduodenal lipid (29). CCK receptor-binding sites have, however, been localized on vagus nerves (12, 13), and CCK stimulates the discharge of vagal afferents in the proximal duodenum (30). It, therefore, seems more likely that L cell regulation via the duodenum occurs through CCK activation of a local vago-vagal reflex, as has been reported for other digestive functions, including lower esophageal sphincter relaxation (31), exocrine pancreatic secretion (32), and gastric emptying (30).
Intravenous infusions of GLP-1 at a dose that reproduced circulating levels of GLP-1 after intraduodenal fat accounted for about 66% of the total inhibition of stimulated acid secretion. This acid inhibitory response to GLP-1 parallels results in humans (9), where infusions of GLP-1 to postprandial elevations caused about 43% inhibition of pentagastrin-stimulated acid secretion. Thus, GLP-1 mediates, in part, enterogastrone activity, but it is not the sole hormone causing the inhibitory effect by fat on acid secretion. PYY is known to suppress cephalic (33) and gastric (7, 34) phases of acid secretion, and in accord with previous studies (4), fat-mediated plasma PYY responses when simulated by exogenous infusions caused a 51% inhibition of acid secretion. Our findings further show that the inhibition achieved after coadministration of PYY and GLP-1 was additive and abolished acid secretion. Similar findings regarding the additive effect of GLP-1 and PYY on the inhibition of acid secretion have also recently been reported in humans (35). Although other hormonal inhibitors, including secretin (36) and somatostatin (4), may participate in the modulation of the acid inhibitory responses to intraduodenal fat, our results are consistent with the idea that GLP-1 and PYY, coreleased from L cells, play major roles as physiological enterogastrones.
The present findings regarding regulation of the secretion and actions of GLP-1 and PYY implicate a modulatory role on gastric acid secretion by the duodenum through a feedforward CCK-dependent neural mechanism and a feedback inhibitory hormonal pathway to parietal cells, analogous to the negative feedback loop previously proposed for the effects of GLP-1 and PYY on intestinal motor activity (37). However, the precise mechanisms by which GLP-1 and PYY inhibit acid secretion are unknown. The inhibitory response to GLP-1 was substantially more rapid, but less sustained, than that to PYY, yet the inhibitory effects of GLP-1 and PYY were additive, perhaps suggesting independent mechanisms of action. When studied in vitro, GLP-1 stimulates acid production from parietal cells (38), whereas PYY is without effect (39), indicating that the inhibitory actions of both peptides are indirect. Although GLP-1 stimulates somatostatin release in rats (15, 16), we found that GLP-1 in dogs did not alter somatostatin secretion, and similar negative responses have been reported in pigs (40) and humans (11). Further, as in previous reports (11), GLP-1 did not alter gastrin release. Putative actions by which PYY influences acid secretion include inhibition of acetylcholine release from vagus nerves innervating the stomach (41) and inhibition of gastrin-induced histamine release from ECL cells (42). Whether GLP-1 acts as a cofactor in the mediation of these effects by PYY requires further study.
Confirmation of the role of GLP-1 as a major hormonal mediator of duodenal fat inhibition of acid secretion would be facilitated by the availability of a selective antagonist. Exendin-(939) amide has been shown to interact specifically with the GLP-1 receptor on rat endocrine cells in vitro (43) and causes inhibition of GLP-1-mediated insulin secretion (44). This effect by exendin requires a dose 10-fold in excess of that of GLP-1 (43). Notwithstanding administration of this dose ratio of exendin to GLP-1, we found that exendin-(939) amide had no effect on GLP-1 inhibition of acid secretion. This finding may reflect species differences in the response to exendin or, alternatively, the GLP-1 receptor subtype mediating inhibition of acid secretion may differ from that mediating the incretin effect on ß-cells.
In summary, the present study indicates that the composite release of GLP-1 and PYY into the circulation plays a major role in the inhibition of gastric acid caused by intraduodenal fat. GLP-1 and PYY released by intraduodenal fat occurs, in part, through activation of CCK-A receptors, probably via neural rather than hormonal pathways. Mechanisms by which GLP-1 and PYY inhibit acid secretion appear to be different, but are independent of circulating concentrations of somatostatin and gastrin. The inability to show a reversal of the effects of GLP-1 after exendin implicates a distinct GLP-1 receptor subtype mediating the inhibition of acid secretion.
| Footnotes |
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Received July 7, 1997.
| References |
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