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CHAPTER 17

Natural Products for the Prevention of Leaky Gut

DEVI BASUMATARY
1

1,3
, PRANAMIKA SARMA
1,2
, and JAGAT C. BORAH
1,4,*

2


3


4


*Corresponding author
ABSTRACT
The intestinal epithetlial layer, which acts as a protective interface between the human body and the external environment, is spread throughout the digestive system in the form of a mucosal layer providing multifold functions including nutrient uptake, absorption and regulation; mucus secretion; providing innate immunity; antigen sensitization, etc. The epithelial cells are connected by a network of multiprotein clusters, organized as tight junctions forming channels aiding in paracellular transport, allowing selective passage of essential nutrients from the gut milieu to the body. The intestine or human gut contains a diverse microbial flora which maintains the overall physiology of the gut through various signaling and metabolic pathways. Disturbance in intestinal homeostasis activates a series of signal transduction pathways causing an inflammatory cascade, a precursor in the tight junction disruption leading to a disease condition leaky gut. Natural products play an important role in the mitigation of leaky gut condition through the management of gut homeostasis. This chapter briefs the various physiological and environmental factors causing intestinal disruption and leaky gut and the development in natural product research for its prevention. Further, different physiological conditions arising due to the transloca­tion of endotoxins through the disrupted intestinal membrane have also been discussed.

17.1 INTRODUCTION

Our intestines are lined by protective physical and chemical barriers which constitute a thick mucus layer, a layer of intestinal epithelial cells known as the intestinal epithelium
426 
and lamina propria. The intestinal epithelium is a critical interface between the internal and external environment of a human body. It protects the human body system against the external environment that includes antigens from ingested food, resident bacteria of the food, pathogenic microorganisms, and so on. It is a barrier performing a defensive function in preventing the entry of potentially harmful substances into the system in addition to its basic function of transporting water, electrolytes, essential nutrients, and so on to the body. These functions are enabled by structural adaptations of epithelial cells of the intestinal epithelium, known as the intestinal epithelial cells, a single layer with diverse cell types. The intestinal epithelium is made up of cells like enterocytes, goblet cells, paneth cells, neuroendocrine cell, dendritic cell, and so on, of which the enterocytes being the major types of cells. Each cell type performs a different type of function for maintenance and balance of intestinal homeostasis (Kong et al., 2018).
Enterocytes are columnar epithelial cells playing fundamental roles in nutrient absorp­tion (e.g., ions, water, sugar, peptides, and lipids) and in immuno-surveillance activities. The selectively permeable nature of the intestinal epithelium is maintained by complex protein-protein interactions, in between the enterocytes, maintaining a sealed gate allowing only the entry of essential nutrients and macromolecules inside the system (Snoeck et al.,
2005). These complex interactions between different proteins also maintain the integrity of the intestinal epithelial barrier, keeping the barrier intact. These interactions are called the junctional complexes which include tight junctions (TJs), gap junctions, adherens junctions, and desmosomes (Ulluwishewa et al., 2011). The transmembrane proteins of adhesive junc­tional complexes link adjacent cells to the actin cytoskeleton via cytoplasmic scaffolding proteins. The adhesive junctions (AJs) and desmosomes act in the mechanical linkage of adjacent cells, whereas the TJs are the apical-most junctional complex (Groschwitz and Hogan, 2009). These junctional complexes are dynamic structures and are remodeled in response to external stimuli like pathogen encounters (Farquhar and Palade, 1963).
When the junctional complexes are compromised, the integrity of intestinal barrier gets disrupted. Under compromised conditions, the disruption of the intestinal epithelium creates a condition known as “leaky gut” where the permeability of the intestinal barrier
increases favoring the entry of pathogens, proinammatory cytokines, and antigens into the
systemic circulation. Increased intestinal permeability is associated with various chronic
diseases like inammatory bowel disease (IBD), irritable liver disease, nonalcoholic fatty
liver disease (NAFLD), cardiovascular diseases (CVDs), and so on. Figure 17.1 shows different conditions leading to leaky gut progression.
“All diseases begin in the gut”—The classical Greek physician Hippocrates claimed
more than 2000 years ago. However, modern scientic investigations have recently started validating this age-old claim as new ndings disclose that most of the chronic and inamma-
tory diseases being caused through a “leaky gut.” Natural products and herbal compositions have been playing a major role in the human health and well-being. About 25% modern medicines in practice today are of natural product origin with another bunch being inspired by natural products (Atanasov et al., 2021). Traditional medicine systems and healing practices mention many plant-based formulations and single herbs for the management
and prevention of gastrointestinal disorders, many of which have now been scientically validated and their benecial potential been explored with modern tools and techniques.
 427
This state-of-art explored the various physiological conditions leading to leaky gut condi­tion and relates the available literature for prevention of leaky gut condition with natural products. This chapter further summarizes the related pathological complications which may result from a leaky gut ranging from minor gastrointestinal complications to deadly
diseases like cancer. Further studies describing the benecial potential of natural products
in the management of various pathological ailments through the management of intestinal axis were also explored.
FIGURE 17.1 Different physiological and environmental factors affecting the progression of leaky gut.
⏎

17.2 THE PHYSICAL AND CHEMICAL BARRIERS OF THE INTESTINE

The gastrointestinal tract and its complex operations are maintained by the constitution of different dynamic layers of critical barriers. The complex physical and chemical intestinal barriers are primarily composed of an outer mucus layer, intermediate epithelial cells, inner lamina propria, antimicrobial peptides (AMPs), and secretory immunoglobulins. Figure 17.2 depicts different layers of the intestinal epithelium acting as a physical barrier.

17.2.1 THICK MUCUS LAYER

The goblet cells secrete a thick coating of mucus that covers the colon and functions as the initial “physical defense” separating the host immunity from the gut microbiota and other
428 
invaders preventing a harmful interaction (Okumura and Takeda, 2017). The mucus layer is a requisite part of the intestine’s structural makeup, working as a conduit for screening, lubrication, and translocation of the luminal contents through the epithelial layer. The main gel-forming high molecular weight glycoprotein components known as mucins are what provide mucus its viscoelastic, polymer-like qualities (Deplancke and Gaskins, 2001). These mucins can be generically categorized as either transmembrane mucins, which create the glycocalyx protecting the underlying epithelial cells, or gel-forming mucins crucial for the structural framework for the mucosal barrier (Grondin et al., 2020). Because of the host’s disproportionate immune responses to gut bacteria, impaired mucosal barriers allow gut microbes and associated toxins to easily infiltrate the mucosa and cause intestinal inflammation.
FIGURE 17.2 Cross-sectional view of the four different layers of intestinal barrier.
⏎

17.2.2 INTESTINAL EPITHELIAL CELLS (IECS)

The intestinal epithelial cells (IECs) are covered by a cell monolayer called intestinal epithelial cells. As part of its inherent defense mechanism, which prevents bacterial colonization, intestinal epithelium can renew itself every few days through a cycle of regeneration and migration made by stem cells present in crypts of the intestinal glands (Sansonetti, 2004). Enterocytes, goblet cells, paneth cells, and neuroendocrine cells are the diverse cell types present in the intestinal epithelium. The enterocyte is the most common type of cell in the intestinal epithelial monolayer. They are columnar epithelial cells essential for both the release of immunoglobulins and the absorption of essential molecules. The goblet cells, which make up about 10% of the IECs, release a coating of protective mucus that serves to lubricate and protect the intestinal wall from chemical and physical damages caused by digestive enzymes, associated microbes, and their toxins while food passes through the intestines (Gustafsson and Johansson, 2022; Kim and Ho, 2010). Paneth cells are granular-rich small intestine crypt-based epithelial cells that synthesize and release AMPs and proteins. Paneth cells use cell-autonomous MyD88 activation to identify enteric bacteria, which causes the development of several
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antimicrobial factors (Adolph et al., 2018; Vaishnava et al., 2008). In response to external stimuli, the neuroendocrine cells release intestinal hormones or peptides into the bloodstream and activate neural reactions. These intestinal hormones or peptides serve as chemoreceptors, which functions in digestive actions, identify hazardous chemicals, and provide protection.

17.2.3 INTESTINAL JUNCTIONAL COMPLEXES

Immune homeostasis depends on an intact intestinal barrier, and its disruption triggers the activation of the immune system causing chronic inflammation and diseases. A variety of protein complexes known as apical junctional complexes keep intestinal barrier intact. TJs, desmosomes, and adheren junctions are such protein complexes that maintain the integrity of the intestinal barrier (Alizadeh et al., 2022). TJs are made up of different junctional molecules like claudin, occludin, tricellulin, junctional adhesion molecule A, and zonula occludens (ZO). These junctional molecules regulate the paracellular trans­port of water, ions, and other macromolecules in neighboring cells. They also inhibit the paracellular transit of pathogens and endotoxins produced from pathogens (Suzuki,
2020). The adherens junctions initiate and sustain cell–cell adhesion and regulate intra­cellular signaling and transcription of essential factors (Hartsock and Nelson, 2008). The primary transmembrane protein of the AJ is the classical E-cadherin which has five extracellular cadherin repeat domains binding to the cadherin on the opposing cell in a calcium-dependent way. The formation, maintenance, and function of AJs are regulated by E-cadherin along with the catenin family members (Garcia et al., 2018; Hartsock and Nelson, 2008).
Desmosomes are associations between cells connecting the plasma membrane with intermediate laments. Desmogleins and desmocollins belonging to the cadherin super­family mediate adhesion at desmosomes. Desmosomes play an important role in cell–cell adhesion upholding the intestinal epithelial integrity (Delva et al., 2019).

17.2.4 LAMINA PROPRIA

The connective tissue present in the villi core is formed by the lamina propria which surrounds the crypt of the epithelium. The basal lamina supports the underlying epithelium and acts as a filter, permitting only water and tiny particles to pass through. Additionally, it prevents communication between tissue’s epithelial cells and other cell types. To act as a strong secondary line of defense, lamina propria has a large number of immune-functioning cells that protects the mucosal epithelium’s relative fragility and vulnerability which is because of the ease with which potential invading microbes can penetrate it, compared to the epidermis (Tong and Tang, 2017; Zeitz et al., 1991). The lamina propria hosts the immunological responses due to the high number of macrophages and lymphoid cells there. It is an element of the defensive mechanism that safeguards internal tissues against hazardous external microorganisms, notably those from the gastrointestinal system (Bischoff et al., 2014).
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17.2.5 INTESTINAL REGULATORY T CELLS

For the intestinal immune system to respond appropriately to self- and nonself antigens, regulatory T cells (T regs) are crucial. The inflammation brought on by a lack of Treg produc­tion, activity, or stability in the gut serves as an example of its significance in maintaining intestinal homeostasis (Figliuolo da Paz et al., 2021). Intestinal diseases like IBD, food allergies, and so on are frequently brought on by inappropriate immune responses to these harmless antigens. Immunological tolerance to these harmless foreign antigens is produced by Tregs through mucosal tolerance. Forkhead box P3 (Foxp3), expressed by Treg cells, inhibits the immune system’s reaction to harmless foreign antigens. High-affinity inter­leukin-2 (IL-2) receptor CD25 and suppressor cytokines including IL-10 and transforming growth factor 1 (TGF-1) expressed by Treg cells prevent activation of neighboring ef fector T cells (Sakaguchi et al., 2010).

17.2.6 INTESTINAL ALKALINE PHOSPHATASE

The brush border enzyme intestinal alkaline phosphatase (IAP) of alkaline phosphatase family is secreted by the IECs. It is made in the intestinal lumen and acts as a “functional barrier” to neutralize bacterial lipopolysaccharides (LPS), dephosphorylate proinflamma­tory nucleotides and pathogen-associated molecular patterns, control bicarbonate secretion and pH of the duodenal surface, absorb intestinal long-chain fatty acids, and regulate the gut microbiome (Singh et al., 2020). Systemic infections and inflammatory conditions such as IBD, metabolic syndrome, cystic fibrosis, necrotizing enterocolitis, and diabetes are linked to a reduced expression of IAP (Fawley and Gourlay, 2016).

17.2.7 ANTIMICROBIAL PEPTIDES

AMPs are diverse bioactive compounds playing critical roles in host defense and providing protection against enteric infections. AMPs are innate immune system effector chemicals that have been preserved throughout evolution. They promote innate immunity by inducing inflammatory and antibacterial responses (Gao et al., 2020). They are expressed by the paneth cells in the gastrointestinal tract (Gubatan et al., 2021). Located in tiny groups at the
base of crypts of Lieberkühn, paneth cells are secretory cells present in the small intestine’s
epithelium. The effector molecules are released by the antimicrobial-rich granules found in these cells into the crypt lumen and diffuse into the mucous layer that covers the mucosal epithelium, where they help to create the mucosal antimicrobial barrier. The antimicrobials hunt out microbes, including the small intestine’s native microbiota and invasive pathogens (Bevins and Salzman, 2011).

17.2.8 LYSOZYME

The host’s natural defensive mechanism is largely comprised of lysozyme (1,4-N-acetyl- muramidase). In the human small intestine and ascending colon, paneth cells generate this
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antimicrobial protein (Zigdon and Bel, 2020). The major source of luminal lysozyme that directly interacts with commensal bacteria comes from paneth cells, which exude lysozyme into the intestinal lumen. The intestinal lamina propria contains significant amounts of lyso­zyme produced by neutrophils and macrophages (Yu et al., 2020). It works to kill bacteria
by activating AMPs and hydrolyzing peptidoglycans. By cleaving the β-1,4 links between
N-acetylglucosamine and N-acetylmuramic acid of peptidoglycan, lysozyme selectively catalyzes the breakdown of bacterial cell walls (Ellison and Giehl, 1991). Lysozyme has a great resistance to being hydrolyzed by acids, proteases, and gastrointestinal digestion.

17.3 MECHANISTIC VIEW OF FACTORS LEADING TO A LEAKY GUT

Compromised intestinal barrier integrity results from various genetic and environmental factors. One of the main physiological concerns is the loss of barrier integrity, which has been associated with the initiation and development of several pathophysiological diseases. Studies over the years have helped us to grasp the intricate mechanisms that may increase intestinal barrier permeability and cause the barrier to lose both its structural integrity and function. Understanding the many underlying processes is crucial for creating new and effective treatment targets.

17.3.1 GUT DYSBIOSIS

Gut dysbiosis is the loss of the microbial population’s equilibrium in the gut. In this condi­tion, the population of commensal microorganisms declines while the number of pathogenic microbes increases. Dysbiosis results in immunological dysregulation and proinflammatory effects that are associated to a variety of disease states, such as autoimmune illnesses, type 2 diabetes, CVDs, and fatty liver (Martinez et al., 2021). Mucosal immunity, genetic, and environmental variables tightly control the gut microbiota’s homeostasis (Lee et al., 2011; Swidsinski et al., 2007; Yatsunenko et al., 2012). Gut dysbiosis and its associated factors, such as small intestinal bacterial overgrowth, rise in pathogen population, increase in endo­toxin levels, rise in microbial energy harvesting capacity , mucosal inflammation, and so on work together to cause a leaky gut. Commensal microorganisms can protect the integrity of the intestinal barrier by secreting antibacterial compounds like bacteriocins and creating short-chain fatty acids (SCFAs) with anti-inflammatory characteristics like butyrate from dietary fibers. Gut dysbiosis induces increased bacterial metabolites like LPS, toxins, and so on which causes mild to severe inflammations in the intestinal epithelium leading to an impaired intestinal barrier. The unfavorable synthesis of zonulin, a protein crucial for regulating TJs and eventually leading to the disintegration of gut barrier, is another way that gut dysbiosis can manifest as a leaky gut disorder (Fasano, 2020).
17.3.2

 MUCOSAL INFLAMMATION AND OXIDATIVE STRESS

Mucosal inflammation caused by a dysbiotic gut, immune response to infections, antigens, and so on is a precursor for increased intestinal permeability which starts from a low-grade
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systemic inflammation. An imbalanced immune response to the host intestinal microbiota causes idiopathic diseases like IBD, which is caused by mucosal inflammation. Loss of intestinal barrier function has been linked to mucosal inflammation in both microbiome­dependent and -independent ways. According to reports, TNF-induced decreases in ZO-1 production and oculocerebrocutaneous syndrome endocytosis offer convincing proof that inflammation reduces intestinal barrier function through the activation of myosin light chain kinase (Ma et al., 2004).
Another major cause of intestinal barrier disruption is oxidative stress. Oxidative stress is the outcome of an imbalance between the generation and clearance of reactive
oxygen species (ROS). Intestine is a signicant source of ROS due to its constant contact
to external chemicals and microbial infections (Wang et al., 2020). Intestinal and systemic
inammation are brought on by increased TJ permeability caused by oxidative damage
(Hasegawa et al., 2021).

17.3.3 TJ DISRUPTION

The tight junction proteins (TJPs) of epithelial intracellular junctions positioned in the apical region of the intestinal epithelium have a selective barrier function that permits the passage and transportation of vital solutes and compounds but restricts the transport of proteins, lipids, and peptides generated from microorganisms. Claudins, occludins, zona occludens, cingulin, and so on are a few of the proteins that make up TJs which form a framework connecting the actin cytoskeleton with the transmembrane proteins (Bhat et al.,
2019). IBD, multiple sclerosis, and cancer are all inflammation-related disorders caused by dysregulation of TJ proteins which promotes altered barrier function affecting the amounts of inflammatory cytokines like IFN-alpha, IFN-gamma, IL-6, and IL-1 (Chen et al., 2006; Kim et al., 2022; Lee et al., 2018; Li et al., 2022). Intestinal permeability may rise as a result of variables such as proinflammatory cytokines, pathogenic bacteria, LPS, and other clinical circumstances that impair TJ homeostasis (Lee et al., 2018).

17.3.4 GENETICS

Since the intestinal epithelial barrier is not fully impermeable and is not designed to be, we all have a certain amount of leaky gut, although some of us may be more susceptible to alterations in the digestive system due to a genetic predisposition. In contrast to unrelated relatives and controls, relatives of Crohn’s disease patients have higher intestinal perme­ability , according to a research by Buhner et al. The increased permeability was connected to a mutation in the caspase recruitment domain (Buhner et al., 2016). Genetic and environ­mental variables also have an influence on the makeup of the gut’s microbes, and they can either directly or indirectly lead to inflammation that compromises the epithelial barrier
et al., 2017). Another investigation found that the gut epithelium becomes more
(Mu permeable as a result of a rare mutation in the protein tyrosine phosphatase nonreceptor type 2 gene (Marchelletta et al., 2021). In persons with genetic predispositions, increased