Name: ileectomy-induced bile overaccumulation in mouse intestine
Uploaded: 2017-08-21T13:00:00
Description: Watch this Scientific Journal Video about Ileectomy-induced Bile Overaccumulation in Mouse Intestine at JoVE.com

This research is supported by Tom Peterson Foundation and NIH grant R01-HL119780 (Jain, MK).

Animal protocol was reviewed and approved by the Institutional Animal Care and Use Committee at Case Western Reserve University School of Medicine and was conducted in accordance with the National Institutes of Health (NIH) Guide for the Care and Use of Laboratory Animals (8th Edition, 2011). Mice were euthanized by methods compliant with the American Veterinary Medical Association (AVMA) Guidelines for Euthanasia of Animals (2013 Edition). C57BL/6J, male, 8 - 16 week old mice were used in this protocol. Mice were housed...

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In order to perform a successful ileectomy, the superior mesenteric artery must be ligated in advance to block the blood supply to the resecting segment. The ischemic ileal segment will turn dark purple after ligation. The ileal segment must then be completely resected. A normal blood supply must be ensured for the retained ends. This is essential to avoid bleeding and improper removal, which can easily cause surgical failure due to ischemic necrosis after suturing. During the anastomosis, it is important to join the ile...

In modern biomedical research, genetically manipulated animal models are widely utilized to glean insights into human diseases. In particular, tissue or cell-specific gain-and-loss functions of genes have been used to study molecular regulation as well as induced biological effects. Despite the advancements in manipulating target genes in vivo, there are lingering limitations. First, many cell or tissue specific deletions will affect multiple organs. For example, epithelial gene deletion will eliminate expression in epithelia of multiple tissues. Further, even if deletion is restricted to a specific tissue, spatial control is rarely feasible. For example, in a tissue like the intestine, distinct segments carry out very specific functions that cannot be manipulated with precision in vivo. In these situations, resection of the gene-containing tissues is considered to be a more efficient studying approach to determine the mechanistic and functional significance of tissue communication.
Ileectomy is mostly used in patients with Crohn&#39;s and inflammatory diseases involving the distal ileum 1,2,3. The ileum typically produces several energy storage hormones like fibroblast growth factor 15/19 (FGF15/19), peptide YY (PYY), and glucagon-like peptide 1/2 (GLP1/2); these hormones play important local and endocrine roles in many biological functions4,5,6. Among these hormones, FGF15 has been identified as a robust endocrine inhibitor of bile acid synthesis in the liver. Once reabsorbed into ileal enterocytes, bile acids activate the nuclear receptor farnesoid X receptor (FXR) to stimulate Fgf15 expression, which subsequently leads to feedback inhibition of hepatic bile acid synthesis 7. In a recent study, we introduced the mouse ileectomy model in order to study the ileal kruppel-like factor 15 (KLF15)-Fgf15 signaling axis that regulates circadian bile acid production in the liver 8. Most importantly, we introduced a novel family, the kruppel-like factors, particularly KLF15, into bile acid biology. Based on functional studies including ileectomy surgery, we determined that KLF15 upregulates bile acid synthesis via an indirect non-hepatic mechanism. Finally, ileal KLF15 is also identified as the first endogenous negative regulator of Fgf15.
The intestinal segments descending from proximal to distal regions are responsible for absorption of different nutrients. The ileum is the major segment responsible for bile acid and vitamin B12 (VB12) absorption 9. An earlier study employed a mouse model of proximal gut resection to study short bowel syndrome; various resection lengths, diets, and suture types were proposed to maintain an optimal post-surgery survival rate 10. Furthermore, a more recent review indicates that ileal resection typically results in more severe disease than other gastrointestinal (GI) segment resections because of the decreased adaptive capacity of the remaining tract 11. This topic has gained intensive interests of basic and clinical research groups, whereas the understanding of recovery and the effective therapeutic approaches are still limited.
Bile acid diarrhea results from imbalances in bile acid homeostasis in the enterohepatic circulation 12,13. It can be a consequence of ileal resection, gastrointestinal disease, or a result of idiopathic bile acid malabsorption. More than 80% of patients have been found to present with diarrhea after undergoing ileal resection 14. Ileectomy has the potential to be an important surgery model for the investigation of bile acid diarrhea. In this study, a series of ileal resections provide a gradient assessment of FGF15 deficiency as well as intestinal bile salt malabsorption, overaccumulation, and toxic damages.

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			<td height="21" style="width:248px;height:21px;">Dissection microscope</td>
			<td style="width:195px;">Olympus</td>
			<td style="width:97px;">SZ61</td>
			<td style="width:183px;">For surgery&#160;</td>
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			<td height="21" style="width:248px;height:21px;">Animal temperature controller</td>
			<td style="width:195px;">Physitemp Instruments, Inc.</td>
			<td style="width:97px;">TCAT-2LV</td>
			<td style="width:183px;">For body temperature control</td>
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			<td height="21" style="width:248px;height:21px;">Isoflurane anesthetic vaporizer</td>
			<td style="width:195px;">VetEquip</td>
			<td style="width:97px;">&#160;911104</td>
			<td style="width:183px;">For anesthesia</td>
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			<td height="21" style="width:248px;height:21px;">Dissection forceps</td>
			<td style="width:195px;">&#160;Fine Science Tools, Inc.</td>
			<td style="width:97px;">11274-20</td>
			<td style="width:183px;">For surgery&#160;</td>
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			<td height="21" style="width:248px;height:21px;">Scissors</td>
			<td style="width:195px;">&#160;Fine Science Tools, Inc.</td>
			<td style="width:97px;">14084-08</td>
			<td style="width:183px;">For surgery&#160;</td>
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			<td height="21" style="width:248px;height:21px;">Needle holder</td>
			<td style="width:195px;">&#160;Roboz Surgical Instrument Co.</td>
			<td style="width:97px;">RS-7882</td>
			<td style="width:183px;">For surgery&#160;</td>
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			<td height="21" style="width:248px;height:21px;">Micro knives-needle blade</td>
			<td style="width:195px;">Fisher Scientific</td>
			<td style="width:97px;">10318-14</td>
			<td style="width:183px;">For surgery&#160;</td>
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		<tr height="21">
			<td height="21" style="width:248px;height:21px;">6-0 monofilament suture</td>
			<td style="width:195px;">Ethicon</td>
			<td style="width:97px;">1698G</td>
			<td style="width:183px;">For abdominal skin closure</td>
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		<tr height="21">
			<td height="21" style="width:248px;height:21px;">7-0 silk suture</td>
			<td style="width:195px;">Ethicon</td>
			<td style="width:97px;">766G</td>
			<td style="width:183px;">For ligation</td>
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		<tr height="21">
			<td height="21" style="width:248px;height:21px;">8-0 monofilament suture</td>
			<td style="width:195px;">Ethicon</td>
			<td style="width:97px;">1714G</td>
			<td style="width:183px;">For anastomosis</td>
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			<td height="21" style="width:248px;height:21px;">Surgical sponges</td>
			<td style="width:195px;">Dynarex Corp.</td>
			<td style="width:97px;">3333</td>
			<td style="width:183px;">For surgery&#160;</td>
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			<td height="21" style="width:248px;height:21px;">Small cotton-tipped applicators&#160;</td>
			<td style="width:195px;">Fisher Scientific</td>
			<td style="width:97px;">23-400-118</td>
			<td style="width:183px;">For surgery&#160;</td>
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			<td height="21" style="width:248px;height:21px;">Isoflurane</td>
			<td style="width:195px;">Piramal Healthcare Limited</td>
			<td style="width:97px;">66794-013-25</td>
			<td style="width:183px;">For anasthesia</td>
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			<td height="21" style="width:248px;height:21px;">Buprenorphine hydrochloride</td>
			<td style="width:195px;">Reckitt-Benckiser Pharmaceuticals</td>
			<td style="width:97px;">12496-0757-1</td>
			<td style="width:183px;">For analgesia</td>
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			<td style="width:195px;">B. Braun Medical Inc.</td>
			<td style="width:97px;">0264-7800-10</td>
			<td style="width:183px;">For washing/injection</td>
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			<td height="21" style="width:248px;height:21px;">Povidone iodine prep solution</td>
			<td style="width:195px;">Dynarex Corp.</td>
			<td style="width:97px;">1413</td>
			<td style="width:183px;">For skin preparation</td>
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			<td height="21" style="width:248px;height:21px;">Puralube vet ointment</td>
			<td style="width:195px;">Dechra Veterinary Products</td>
			<td style="width:97px;">17033-211-38</td>
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			<td height="21" style="width:248px;height:21px;">Hair remover lotion</td>
			<td style="width:195px;">Church &#38; Dwight Co., Inc.</td>
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			<td style="width:183px;">For skin preparation</td>
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			<td height="21" style="width:248px;height:21px;">Intensive care unit</td>
			<td style="width:195px;">ThermoCare</td>
			<td style="width:97px;">FW-1</td>
			<td style="width:183px;">For post-surgery recovery</td>
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			<td height="21" style="width:248px;height:21px;">DietGel recovery</td>
			<td style="width:195px;">ClearH2O</td>
			<td style="width:97px;">72-06-5022</td>
			<td style="width:183px;">For post-surgery recovery</td>
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			<td height="21" style="width:248px;height:21px;">Aurum total RNA fatty and fibrous tissue kit</td>
			<td style="width:195px;">Bio-Rad</td>
			<td style="width:97px;">7326830</td>
			<td style="width:183px;">For RNA isolation</td>
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			<td height="31" style="width:248px;height:31px;">iScript reverse transcription supermix for RT-qPCR</td>
			<td style="width:195px;">Bio-Rad</td>
			<td style="width:97px;">1708841</td>
			<td style="width:183px;">For reverse transcription assay</td>
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			<td height="21" style="width:248px;height:21px;">TaqMan fast advanced master mix</td>
			<td style="width:195px;">Applied Biosystems/Life Technologies</td>
			<td style="width:97px;">4444965</td>
			<td style="width:183px;">For QPCR analysis</td>
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			<td height="21" style="width:248px;height:21px;">Total bile acid assay kit</td>
			<td style="width:195px;">Genzyme Diagnostic</td>
			<td style="width:97px;">DZ042A-K01</td>
			<td style="width:183px;">For bile acid assay</td>
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			<td height="21" style="width:248px;height:21px;">C57BL/6J&#160;</td>
			<td style="width:195px;">The Jackson Laboratory</td>
			<td style="width:97px;"></td>
			<td style="width:183px;"></td>
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ileectomy-induced bile overaccumulation in mouse intestine

Intestinal resection is a common therapeutic approach for human diseases such as obesity, inflammatory bowel disease, Crohn's disease, and colon cancer that often results in severe short bowel syndrome-like adverse effects including bile acid diarrhea, dehydration, electrolyte disturbances, and nutrient malabsorption. Here we introduce a murine ileal resection model, termed ileectomy, to evaluate tissue communication and the maintenance of systemic homeostasis. After ileal resection, circulating blood is permanently devoid of the ileum-specific endocrine hormone fibroblast growth factor 15 (FGF15), which releases its endocrinal inhibition of bile acid synthesis in the liver. In combination with the increased production and abolished reabsorption of bile acids after removing the ileum, mice that underwent surgery suffer from bile salt overaccumulation in the intestine and associated diarrhea, morbidity, and mortality. Novel usage of the surgery model introduced in this study may provide mechanistic and functional insights into ileal control of systemic metabolic regulation in physiology and disease.

The procedures for ileectomy are shown in Figure 1. The first step includes preparing mouse abdominal skin, making an abdominal incision, and using retractors to fully expose the intestine (Figure 1A-C). Next, the mouse cecum was located (Figure 1D); given that its size and shape make it an easily identifiable landmark. The cecum, ileum, and part of the distal jejunu...

Watch this Scientific Journal Video about Ileectomy-induced Bile Overaccumulation in Mouse Intestine at JoVE.com

Ileectomy-induced Bile Overaccumulation in Mouse Intestine

Small intestine-dependent bile acid reabsorption and feedback inhibition of hepatic bile acid synthesis is important for systemic homeostasis and health. In this study, we describe a mouse model for ileal resection to evaluate ileectomy-induced bile malabsorption, overaccumulation, and toxicity in mouse intestine.

Intestinal resection is a common therapeutic approach for human diseases such as obesity, inflammatory bowel disease, Crohn's disease, and colon cancer ...

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