Abstract
Gastric mucosal health is maintained in response to potentially damaging luminal factors. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) disrupt protective mechanisms leading to bleeding and ulceration. The plasminogen activator system has been implicated in fibrinolysis following gastric ulceration, and an inhibitor of this system, plasminogen activator inhibitor (PAI)-1, is expressed in gastric epithelial cells. In Helicobacter pylori-negative patients with normal gastric histology taking aspirin or NSAIDs, we found elevated gastric PAI-1 mRNA abundance compared with controls; the increase in patients on aspirin was independent of whether they were also taking proton pump inhibitors. In the same patients, aspirin tended to lower urokinase plasminogen activator mRNA. Immunohistochemistry indicated PAI-1 localization to epithelial cells. In a model system using MKN45 or AGS-GR cells transfected with a PAI-1 promoter-luciferase reporter construct, we found no evidence for upregulation of PAI-1 expression by indomethacin, and, in fact, cyclooxygenase products such as PGE2 and PGI2 weakly stimulated expression. Increased gastric PAI-1 mRNA was also found in mice following gavage with ethanol or indomethacin, but plasma PAI-1 was unaffected. In PAI-1−/− mice, gastric hemorrhagic lesions in response to ethanol or indomethacin were increased compared with C57BL/6 mice. In contrast, in PAI-1-H/Kβ mice in which PAI-1 is overexpressed in parietal cells, there were decreased lesions in response to ethanol and indomethacin. Thus, PAI-1 expression is increased in gastric epithelial cells in response to mucosal irritants such as aspirin and NSAIDs probably via an indirect mechanism, and PAI-1 acts as a local autoregulator to minimize mucosal damage.
Highlights
GASTRIC MUCOSAL HEALTH IS maintained in the presence of a hostile luminal environment consisting of acid, potentially damaging chemical and physical factors in the diet, and resident and ingested microbiota
We examined gastric plasminogen activator inhibitor (PAI)-1 mRNA abundance in a cohort of patients receiving either aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
The data suggest that aspirin usage is associated with a robust increase in gastric mucosal PAI-1 abundance independent of PPI usage or serum gastrin concentrations; for patients on NSAIDs, but not PPIs, PAI-1 mRNA is increased
Summary
GASTRIC MUCOSAL HEALTH IS maintained in the presence of a hostile luminal environment consisting of acid, potentially damaging chemical and physical factors in the diet, and resident and ingested microbiota. There is evidence, for example, for both prostaglandin-dependent and -independent components in the responses to NSAIDs [16], as well as the involvement of other signaling molecules (chemokines, cytokines, and growth factors) and interactions with systems regulating tissue architecture, including deposition of extracellular matrix proteins and their degradation by matrix metalloproteinases and other extracellular proteolytic systems. The latter, in particular, include the tissue and urokinase plasminogen activators (tPA and uPA, respectively) that convert plasminogen to plasmin, which in turn degrades fibrin.
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