Peptide Absorption After Massive Proximal Small Bowel Resection: Mechanisms of Ileal Adaptation

Background Protein absorption occurs as di- and tri-peptides via H + /peptide co-transporter-1 (PepT1). Aim The aim of this study is to identify mechanisms of ileal adaptation after massive proximal enterectomy. Hypothesis Ileal adaptation in uptake of peptides is mediated through upregulation of PepT1 gene expression. Study Design Rats underwent 70% jejunoileal resection. Total mucosal cellular levels of messenger RNA (mRNA) and protein and transporter-mediated uptake per centimeter of the di-peptide glycyl-sarcosine (Gly-Sar) were compared in remnant ileum 1 and 4 weeks postoperatively to control and to 1-week sham laparotomy rats. Histomorphology, food consumption, and weights of rats were monitored. Results After 70% resection, although mRNA per cell for PepT1 decreased at 1 week ( p = 0.002), expression of mRNA at 4 weeks and protein at 1 and 4 weeks in remnant ileum were unchanged ( p > 0.1). Ileal Gly-Sar uptake ( V max —nanomoles per centimeter per minute, i.e., number of transporters per centimeter) increased at 1 and 4 weeks compared to control and 1-week sham ( p < 0.05 each); K m (i.e., transporter function) was unchanged. Villous heights (millimeters) in remnant ileum increased at 1- and 4-week time points over controls (0.45 and 0.57 vs 0.21, resp; p < 0.001). Conclusions Ileal adaptation to proximal resection for peptide absorption occurs through cellular proliferation (hyperplasia) and not through cellular upregulation of PepT1 mRNA or protein per enterocyte.