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Hydrogen-Rich Medium Ameliorates Lipopolysaccharide-Induced Barrier Dysfunction via Rhoa-Mdia1 Signaling in Caco-2 Cells

Yang, Tao; Wang, Lu; Sun, Ruiqiang; Chen, Hongguang; Zhang, Hongtao; Yu, Yang; Wang, Yanyan; Wang, Guolin; Yu, Yonghao; Xie, Keliang

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doi: 10.1097/SHK.0000000000000503
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Defined as the presence of infection together with systemic manifestations, sepsis is a deleterious host response (1). Sepsis, as well as its adverse consequences, remains to be the primary cause of death in the noncoronary intensive care unit (ICU) (1, 2). The intestine has widely been recognized as a crucial organ during the genesis and development of sepsis, as well as multiple organ dysfunction syndrome (MODS) (3). The gastrointestinal epithelium is frequently in touch with xenobiotics and various microfloras, and represents a defensive barrier between the organism and the external environment (4).

An integrated gut barrier is composed of well differentiated intestinal epithelial cells, which are tightly connected as a monolayer by the apical junctional complex (AJC). The AJC contains tight junctions (TJs) and adherens junctions (AJs), and encircles the apical ends of the lateral membranes of the epithelial cells, determining the selective paracellular permeability of the intestinal barrier (5). Both TJs and AJs are dynamically modulated in physiological and pathological conditions.

Among a number of signaling molecules that have been demonstrated to regulate the AJC, Ras homolog gene family (Rho) of small GTPases stands out (6). RhoA ranks the most studied molecule among the Rho family, regulating the assembly, maintenance, and disassembly of AJC in the intestinal epithelium (7). Mammalian diaphanous-related formin 1 (mDia1), or interchangeably called DIAPH 1, is a main RhoA effector that modulates barrier via actin polymerization, as well as microtubule organization (8, 9). Hence, the RhoA-mDia1 signaling is supposed as a potential vital target for the treatment of lipopolysaccharide (LPS)-related hyperpermeability in the intestine.

Molecular hydrogen (H2), considered as a physiological noble gas before, has currently been identified as a promising medical gas for many diseases (10, 11). Our previous studies have revealed that H2 inhalation at a concentration of 2% or 4% exerts significant curative effects on sepsis and sepsis-related multiple organ damage through reducing uncontrolled inflammation, excessive oxidative stress, irregular apoptosis, and regulating abnormally activated signal pathways (12–14). Coincidentally, H2 treatment can attenuate intestine injury (15–17). However, whether the protective effects of H2 on sepsis is via regulating intestinal barrier integrity or not is still largely unknown.

On the basis of the studies mentioned above, we utilized an in vitro model of intestinal epithelium, Caco-2 cell monolayers, to hypothesize the potential beneficial role of H2-rich medium in alleviating LPS-caused gut barrier dysfunction, likely through the RhoA-mDia1 signal pathway.


Ethical approval

This research was carried out according to the Institutional Animal Care and Use Committee Guide in General Hospital of Tianjin Medical University.


The whole cell culture reagents and supplements were from GIBCO (Grand Island, NY). Fluorescein-isothiocyanate (FITC)-labeled dextran 4 kDa (FD4) and Escherichia coli LPS 0111:B4 (Product number: L4391) were from Sigma-Aldrich (St Louis, MO). Rho inhibitor C3 exoenzyme and RhoA activator CN03 were from Cytoskeleton (Denver, CO).

Cell culture

The human colon cancer cell line Caco-2 were obtained from ATCC (Manassas, VA), and maintained in complete Dulbecco modified Eagle medium (DMEM) with 20% fetal bovine serum, 100 U/mL penicillin and 100 g/mL streptomycin, 4 mM glutamine, 10 mM (4-(2-hydroxyethyl)-1-piperazine ethanesulfonic acid), 1 mM sodium pyruvate, and 1% nonessential amino acids, and kept at 37°C in a humidified atmosphere with 5% CO2. Cells were subcultured by 0.25% trypsin solution (containing ethylene diamine tetraacetic acid [EDTA]) every 3 days. Cell culture medium was replaced everyday. Cells from passages 22 to 60 were used for experiments.

Hydrogen treatment and measurement

The preparation and storage method for H2-rich medium is in accordance with previous studies (10, 18, 19). Briefly, H2 was produced by a H2 generator, and then was dissolved into DMEM by a special catheter for 4 h under high pressure (0.4 MPa) to a supersaturated level to generate H2-rich medium. After production, H2-rich medium was filtered to remove bacteria, and then immediately used for cell culture. The concentrations of H2 in medium were detected by a needle-type Hydrogen Sensor (Unisense A/S, Aarhus, Denmark) immediately after H2-rich medium preparation was finished (0.60 ± 0.03 mM). After 24 h incubation, H2 concentration was again detected (0.23 ± 0.01 mM). For treatment, Caco-2 cells were cultured in H2-saturated medium under a humidified condition of 75% H2, 20% O2, and 5% CO2. The pH of the culture medium with or without H2 were, respectively, measured (7.31 ± 0.03 and 7.44 ± 0.01, separately).

Detection of transepithelial electrical resistance (TER) and paracellular permeability

The Caco-2 cells were plated on transwell inserts (Millipore, Billerica, MA) with polyethylene terephthalate membrane (0.33 cm2, 0.4 mm pores) at a density of 1 × 105 cells/mL cultured for about 21 days when cells reached confluence and completely differentiated. A transepithelial voltohmeter (World Precision Instruments, FL) was utilized to measure TER according to previous description (20). Both apical and basolateral sides of the transwell were thrice washed by Hank balanced salt solution (HBSS) before measurement. TER was measured until similar values were recorded for three consecutive measurements. The electrical resistance values were expressed as Ohm·cm2 (Ω·cm2). Determinations were repeatedly operated on three different sites per transwell insert, respectively.

Caco-2 monolayer permeability was measured using FD4, an established paracellular marker. After washed with HBSS, the well-grown Caco-2 monolayers were incubated with serum-free DMEM without phenol red containing 10 mg/mL FD4 in the presence or absence of different mediators as indicated below. After 2 h incubation of FD4, paracellular flux was assessed by taking 100-mL aliquots from the outer chamber. Fluorescence was measured using fluorescence spectrophotometer (Hitachi, Tokyo, Japan), with excitation and emission at 485 and 535 nm, respectively. For all experimental conditions, the permeability coefficient (PE) was calculated by the following formula: PE = [(ΔCAt) × VA]/(S × ΔCL), where PE = diffusive permeability (cm/s), ΔCA = change of FD4 concentration, Δt = change of time, VA = volume of the abluminal medium, S = surface area, and ΔCL = constant luminal concentration (7).

Measurement of cell viability

Cell Counting Kit-8 (CCK8) (Dojindo, Tokyo, Japan) assay was introduced to detect Caco-2 cell viability according to manufacturer's instructions. This assay is based on conversion of Dojindo highly water-soluble tetrazolium salt-8 (WST-8) to formazan by dehydrogenases. Water solubletetrazolium salts-8 is reduced by dehydrogenases in cells to give a yellow product (formazan), which is soluble in tissue culture medium. The amount of formazan dye generated by the activity of dehydrogenases in cells is directly proportional to the number of live cells. In brief, Caco-2 cells (1 × 105 cells) were seeded on a 96-well plate. After 24 h LPS or H2 stimulation, 10 μL cell counting kit-8 (CCK-8) solution was added to each well, and the reaction was allowed to occur in standard culture condition for 1 h. Absorbance was measured at 450 nm using a precision microplate reader (Ke Hua Biology, Shanghai, China).

Detection of intracellular reactive oxygen species (ROS)

Intracellular levels of ROS were detected by using a commercial kit (Beyotime, Shanghai, China) according to the manufacturer's instructions. In brief, after treatment, Caco-2 cells cultured in 96 well plates were stained by 2′,7′-dichlorodihydrofluorescein diacetate, a ROS-sensitive probe, for 30 min at 37°C, after which a precision microplate reader (Ke Hua Biology, Shanghai, China) was utilized to measure intracellular ROS level at 488 nm (excitation) and at 525 nm (emission). A positive control was conducted in per experiment via stimulating Caco-2 cells with H2O2 before the addition of 2′,7′-dichlorodihydrofluorescein diacetate. The results were expressed as fluorescence intensity per mg protein and compared to the relative controls.

Western blot analysis

Caco-2 cells (1 × 105 cells) were plated in 6-well plates. Once the experiment was finished, cells were rapidly rinsed with ice-cold PBS, and then were lyzed with radio immunoprecipitation assay (RIPA) lysis buffer (Solarbio, Beijing, China), and scraped. Cell lysates were centrifuged in a Centrifuge (Kubota, Osaka, Japan) to yield clear lysate, and then the supernatant was collected. The protein was quantified using a BCA Protein Assay kit (Beyotime, Shanghai, China). The equal amounts of protein samples were separated by SDS-PAGE, and then transferred to polyvinylidene fluoride (PVDF) membranes (Millipore, Billerica, MA). The membranes were incubated for 2 h in Tris-buffered saline with Tween 20 (TBST) buffer containing 5% skim milk for blocking, and then incubated overnight at 4°C with appropriate primary antibodies: a 1:500 dilution of a rabbit monoclonal anti-occludin antibody (Invitrogen, Carlsbad, CA), a 1:1,000 dilution of a rabbit monoclonal anti-E-cadherin antibody (Cell Signaling Technology, Boston, MA), a 1:1,000 dilution of a rabbit monoclonal anti-mDia1 antibody (Abcam, Cambridge, UK), and a 1:2,000 dilution of a mouse monoclonal anti-β-actin antibody (Boster, Wuhan, China). After being rinsed in TBST buffer, the membrane was incubated for 1 h at room temperature with horseradish peroxidase (HRP)-conjugated goat antirabbit or antimouse secondary antibodies (Boster, Wuhan, China). Protein bands were detected using enhanced chemiluminescence (ECL) reagent (Millipore, Billerica, MA), and then visualized and photographed using Gel quantitative Quantity One system (BIO-RAD, Tokyo, Japan). The whole western blot analyses were performed at least three times. Each protein level was normalized to β-actin, respectively.


Caco-2 cells (1 × 104 cells) were plated on coverslips and cultured. Once the experimental period was completed, cells were washed three times by cold PBS, and then were fixed (4% formaldehyde in PBS) for 15 min and permeabilized (0.5% Triton X-100 in PBS) for 10 min at room temperature. Caco-2 cells were blocked in blocking solution composed of 10% normal goat serum (Solarbio, Beijing, China) for 1 h, and then were incubated at 4°C overnight with appropriate primary antibodies: 1:250 antirabbit occludin (Invitrogen, Carlsbad, CA), 1:500 antirabbit E-cadherin (Cell Signaling Technology, Boston, MA), and 1:500 anti-mDia1 (Abcam, Cambridge, UK), followed by FITC or (tetramethyl rhodamin isothiocyanate)–TRITC conjugated secondary antibodies (Boster, Wuhan, China) incubation and DAPI (4′,6-diaminidino-2-phenylindole; Sigma-Aldrich, St Louis, Mo) counterstaining. The stained proteins were visualized and images were obtained under a confocal fluorescence microscope (Leica, Wetzlar, Germany).

RhoA activity detection

For measurement of RhoA activation, the respective G-Lisa Activity Assay Biochem Kit (Cytoskeleton, Denver, CO) was used according to manufacturer's recommendations as described previously (21). Briefly, after incubation in presence or absence of different mediators, Caco-2 cells were washed with cold PBS. Ice-cold cell lysis buffer was added, and cell lysates were harvested by centrifugation at 14,000 rpm at 4°C for 2 min. After rewarming, 50 μL lysate were added to wells of the GTPase binding plate coated with RhoA-GTP–binding domain. Other wells were added using lysis buffer or nonhydrolyzable RhoA as a negative or positive control, respectively. The plate was shook by a cold orbital shaker (Thermo Scientific, Rockford, IL) at 400 rpm at 4°C for 30 min. After the plate was washed thrice, RhoA primary antibody diluted at 1:200 was added for 45 min incubation. Then secondary HRP-labeled antibody at 1:100 dilution was added for 45 min, after which HRP detection reagent were added and incubated for 15 min at 37°C. Then HRP stop buffer was added. Finally, the signaling was immediately detected at 490 nm using a precision microplate reader (Ke Hua Biology, Shanghai, China).

RNA interference

Lentiviral vectors containing the human-specific shRNA against mDia1 sequence or the nonsilencing shRNA sequence were purchased from GeneCopoeia (Rockville, MD). Virus was produced using Lenti-Pac lentivirus packaging kit (GeneCopoeia), according to the manufacturer's instructions. Caco-2 cells were transfected 24 h after seeding, after which the infected cells were selected using puromycin (Solarbio, Beijing, China) for 48 h. Individual cells still growing in the presence of puromycin were isolated, and then were cultured and selected using puromycin to build a stable-transfected cell line.

Statistical analysis

SPSS statistical software 21.0 (IBM, Armonk, NY) was used. All data were expressed as means ± standard deviation (SD). The statistical significance of differences between groups was determined by one-factor analysis of variance (ANOVA), followed by the least significant difference (LSD) t test for multiple comparisons. A two-tailed P value of less than 0.05 was considered statistically significant.


Effects of LPS at different concentrations on Caco-2 intestinal epithelial permeability

In the following studies, the effects of different concentrations of LPS (0, 1, 10, and 100 μg/mL, and 1 mg/mL) on gut barrier permeability was determined by measuring TER and mucosal-to-serosal flux rates of FD4 in filter-grown Caco-2 intestinal monolayers for up to 48 h. Increasing concentrations above the 100 μg/mL (including 100 μg/mL) caused a dose-dependent drop in TER, whereas concentrations below 100 μg/mL produced no significant decrease (Fig. 1A). Exposure of Caco-2 monolayer to 100 μg/mL or 1 mg/mL LPS resulted in a sharp time-dependent decrease in TER between 3 and 24 h, and did not induced significant drop between 24 and 48 h (Fig. 1A). Accordingly, 100 μg/mL and 1 mg/mL LPS also, respectively, caused a time-dependent increase in the flux of FD4 (Fig. 1B). These results indicated that LPS at concentrations of 100 μg/mL or above induce Caco-2 intestinal barrier dysfunction.

Fig. 1
Fig. 1:
Effects of different concentrations of LPS (0, 1, 10, and 100 μg/mL, and 1 mg/mL) stimulation on TER and FD4 permeability of Caco-2 monolayers.A, Application of 100 μg/mL or 1 mg/mL LPS to Caco-2 monolayers resulted in time-dependent decrease in TER for 3 to 48 h and the most obvious TER drop in 24 h. LPS below 100 μg/mL (0, 1, and 10 μg/mL) led to no significant TER alterations. B, The paracellular permeability of FD4 was calculated as the permeability coefficient (P E) of FD4 flux. LPS stimulation (100 μg/mL or 1 mg/mL) led to FD4 flux increase in a time-dependent way between 3 and 48 h, and produced the highest P E in 24 h. LPS under 100 μg/mL caused few significant changes in FD4 permeability. C, Effects of LPS (100 μg/mL or 1 mg/mL) on Caco-2 cell viability. LPS (100 μg/mL) did not affect cell viability of Caco-2. However, 1 mg/mL LPS obviously caused cytotoxicity effect on Caco-2 cells. * P < 0.05 compared with 0 μg/mL LPS stimulation group. FD4, fluorescein-isothiocyanate–labeled dextran 4 kDa; H2, hydrogen gas; LPS, lipopolysaccharide; TER, transepithelial resistance.

Previous studies showed that an integrated intestinal barrier function can be destroyed either by leading to enterocyte death or simply by breaking AJC (22–24). To exclude the possibility that epithelial barrier breakdown in response to LPS resulted from major cell death instead of specific modulation of intercellular junction properties, we next investigated whether 100 μg/mL or 1 mg/mL LPS had a cytotoxic effect on Caco-2 cells. The effect of LPS on Caco-2 cell viability was determined over a 24-h experimental period by CCK8 assay. The results showed that 100 μg/mL LPS did not affect cell viability of Caco-2 cells, in contrast to which LPS at 1 mg/mL was high enough to have a cytotoxic effect on Caco-2 cells (Fig. 1C). Together, these results demonstrated that LPS at 100 μg/mL did not result in cytotoxicity and that the abnormal Caco-2 monolayer permeability is not due to cell death.

H2 prevents the TER decline and FD4 flux increase induced by LPS in Caco-2 monolayers

In consideration of the pathological effects of LPS on intestinal epithelial barrier without Caco-2 cytotoxicity, 100 μg/mL LPS was applied for the following studies. To determine the impacts of H2 on barrier-disrupting effects of LPS, Caco-2 monolayer models were incubated with both H2-rich medium and LPS simultaneously for 24 h—a time point when 100 μg/mL LPS could extremely cause barrier breakdown. As shown in Figure 2, A and B, in comparison with the group exposed to LPS alone, H2-rich medium markedly alleviated pathological TER decrease and FD4 flux increase, suggesting a definite role of H2 in Caco-2 gut barrier protection.

Fig. 2
Fig. 2:
Effects of H2 treatment on LPS-induced Caco-2 gut barrier dysfunction.A, There existed no significant difference in Caco-2 monolayer TER between control group and single H2 treatment group, and LPS-induced TER decrease was significantly counteracted by H2 cotreatment for 24 h. B, H2 incubation alone also had few effects on FD4 permeability of Caco-2 monolayers, and H2 coincubation for 24 h markedly attenuated P E increase of FD4 in response to LPS. * P < 0.05 compared with control group; # P < 0.05 compared with LPS group. FD4, fluorescein-isothiocyanate–labeled dextran 4 kDa; H2, hydrogen gas; LPS, lipopolysaccharide; P E, permeability coefficient; TER, transepithelial resistance.

Effects of H2 on oxidative stress in LPS-stimulated Caco-2 cells

Since oxidative stress acts as an important factor for barrier injury, we next investigated the levels of ROS in Caco-2 cells after the administration of LPS and H2-rich medium. Results in Figure 3 showed that 100 μg/mL LPS up-regulated the intracellular levels of ROS. H2-rich medium partly reduced intracellular ROS production (Fig. 3), suggesting the benefit of H2 for Caco-2 barrier is associated with its antioxidant effect.

Fig. 3
Fig. 3:
Impacts of LPS and H2 on oxidative stress in Caco-2 cells.LPS stimulation (100 μg/mL) significantly increased the intracellular production of ROS. H2-rich medium coincubation partly down-regulated ROS levels in Caco-2 cells stimulated by LPS. * P < 0.05 compared with control group; # P < 0.05 compared with LPS stimulation group. H2, hydrogen gas; LPS, lipopolysaccharide; ROS, reactive oxygen species.

H2 relieves expression and structure changes in epithelial apical junctions induced by LPS

The gastrointestinal paracellular barrier is achieved by intercellular junctional structures such as TJ and AJ proteins. Changes in TJ and AJ can lead to perturbations of paracellular permeability. In particular, TJ proteins such as occludin, and AJ proteins such as E-cadherin, play a major role in barrier regulation. Alterations in the expression of these proteins have been constantly discovered in gut barrier dysfunction. We therefore evaluated the effects of LPS and H2 on expression levels and structures of these junctional proteins. Well grown Caco-2 cells were incubated for three periods (6, 12, and 24 h) with LPS. Western blot revealed that, in line with the time-dependent changes in TER and FITC-dextran flux, the expression levels of occludin and E-cadherin were all down-regulated upon exposure to LPS at these three time points, and the most remarkable changes occurred at 24 h incubation (Fig. 4, A–I). Simultaneous cotreatment with H2-rich medium partly restored alterations of these TJ and AJ proteins, whereas H2 exposure alone did not affect their abundance (Fig. 4, A–I).

Fig. 4
Fig. 4:
Effects of H2 on LPS-induced pathological expressions of both occludin and E-cadherin.A–I, LPS exposure alone respectively decreased protein expression levels of occludin and E-cadherin at 6 h (A–C), 12 h (D–F), and 24 h (G–I), showing a time-dependent down-regulation. When coincubated with H2, the down-regulated expressions of occludin and E-cadherin were partly reversed. * P < 0.05 compared with control group; # P < 0.05 compared with LPS stimulation group. H2, hydrogen gas; LPS, lipopolysaccharide.

Next we investigated whether the structures of these AJCs suffered the parallel alterations or not. Immunofluorescence staining of normal Caco-2 monolayers showed that both occludin and E-cadherin were regularly distributed along the cell borders, presenting a typical “chicken wire” labeling pattern (Fig. 5). In line with the aggravated decline in expression levels, stimulation of Caco-2 with LPS for 24 h profoundly disrupted architectures of both occludin and E-cadherin by interrupting continuous band pattern and reorganizing the distribution of these proteins (Fig. 5). Concurrent administration of H2-rich medium substantially reversed these LPS-induced alterations (Fig. 5).

Fig. 5
Fig. 5:
Effects of H2 on LPS-caused structural disruptions of both occludin and E-cadherin.Normal morphology of occludin (red) and E-cadherin (green) in Caco-2 monolayers stained by immunofluorescence showed ‘chicken wire’-like pattern. LPS stimulation disrupted the localization and distribution of occludin and E-cadherin. H2 cotreatment for 24 h effectively eliminated these pathological morphological alterations of occludin and E-cadherin. Scale bar = 10 μm. H2, hydrogen gas; LPS, lipopolysaccharide.

H2 alleviates LPS-caused Caco-2 barrier dysfunction by mediating the activation of RhoA

On the basis of accumulating evidences that RhoA GTPase acted as a major regulator for the AJC formation and disassembly, impacts of both LPS and H2 on the RhoA activation were examined by G-Lisa assay (25–27). Results shown in Figure 6A revealed that LPS administration for 24 h dramatically activated GTP-binding RhoA in Caco-2 cells, whereas simultaneous addition of H2-rich medium effectively calmed down GTP-RhoA activity and kept it at a lower but still activated level, implying a potential role of RhoA in H2-mediated intestinal barrier protection.

Fig. 6
Fig. 6:
H2 regulates RhoA signaling to exert protective effects on Caco-2 barrier function.A, RhoA activity was detected by G-Lisa assay. LPS dramatically elevated levels of RhoA activation, and H2 coincubation effectively dropped RhoA activity to a moderate level. B and C, Compared with the ameliorative Caco-2 barrier protected by H2 cotreatment, CN03 pretreatment eliminated these H2-exerted gut barrier benefits. Compared with the down-regulated transepithelial/endothelial electrical resistance (TEER) and up-regulated FD4 permeability of Caco-2 monolayers caused by LPS, C3 exoenzyme pretreatment attenuated these pathological barrier functions. * P < 0.05 compared with control group; # P < 0.05 compared with LPS stimulation group; § P < 0.05 compared with H2 cotreatment (LPS + H2) group. FD4, fluorescein-isothiocyanate–labeled dextran 4 kDa; H2, hydrogen gas; LPS, lipopolysaccharide; RhoA, Ras homolog gene family member A.

To further evaluate involvements of RhoA in H2-induced barrier benefits, both RhoA activator CN03 and Rho inhibitor C3 exoenzyme were applied, respectively. Caco-2 monolayers were preincubated with 1 μg/mL CN03 for 3 h before cotreatment of LPS and H2-rich medium. Figure 6B and C demonstrated that CN03 addition remarkably counteracted the beneficial effects of H2 on TER and FD4 flux. In addition, pretreatment with 2.5 μg/mL C3 exoenzyme for 1 h before LPS stimulation mitigated the pathological permeability disrupted by LPS (Fig. 6, B and C). Thus, these observations suggested that H2 may exert protective effects on LPS-induced barrier dysfunction of Caco-2 monolayers via down-regulating RhoA activation.

H2 attenuated LPS-induced disruptions of the epithelial AJC by suppressing RhoA activity

Since RhoA was identified as playing a pivotal role in H2-induced restoration of Caco-2 barrier function, we further investigated involvements of RhoA in H2-mediated protection on TJ and AJ. Western blot analysis showed that, in agreement with functional changes in barrier permeability, robust RhoA activation by CN03 largely abrogated benefits for occludin and E-cadherin expression exerted by H2 upon LPS stimulation, and RhoA inhibition by C3 exoenzyme alleviated LPS-caused down-regulated expressions of TJ and AJ (Fig. 7, A–C). Likewise, immunofluorescence in Figure 8 revealed that CN03 preadministration observably eliminated H2-modulated reconstruction of continuous and integrated band pattern of occludin and E-cadherin, and C3 exoenzyme preaddition reversed LPS-induced abnormal alterations in structures of occludin and E-cadherin, hinting that RhoA is necessary for the AJC protection by H2. On the basis of the above discussion, a perspective was upheld that H2 down-regulates RhoA activity to a mild level, therefore providing antihyperpermeability effects in the presence of LPS.

Fig. 7
Fig. 7:
H2 lightens LPS-disrupted down-regulated expressions of both TJ and AJ via modulating RhoA activation.A–C, Compared with LPS and H2 coincubation, CN03 preaddition down-regulated occludin and E-cadherin. Compared with single LPS stimulation, C3 exoenzyme pretreatment partly up-regulated expressions of these AJC expressions. * P < 0.05 compared with control group; # P < 0.05 compared with LPS stimulation group; § P < 0.05 compared with H2 cotreatment (LPS + H2) group. AJC, apical junctional complex; H2, hydrogen gas; LPS, lipopolysaccharide.
Fig. 8
Fig. 8:
H2 alleviates LPS-induced disturbed distributions of occludin and E-cadherin by regulating RhoA activity.Distributions of occludin (red) and E-cadherin (green) cured by H2 were again disrupted by CN03 pretreatment. Pathological structures of the AJC caused by LPS were reversed by C3 exoenzyme preaddition. Scale bar = 10 μm. AJ, adherens junction; AJC, apical junctional complex; H2, hydrogen gas; LPS, lipopolysaccharide; RhoA, Ras homolog gene family member A; TJ, tight junction.

mDia1, a downstream of RhoA, is required for H2 to counteract LPS-induced barrier dysfunction and the AJC disruptions

In search for downstream effectors of H2/RhoA, we next investigated the potential role of a typical RhoA target mDia1, which assembles actin filaments and modulates microtubule dynamics to establish and maintain intercellular junctional complex (8, 9). First we noticed that LPS stimulation alone decreased mDia1 expression in Caco-2 cells (Fig. 9, A and B). The concurrent treatment with LPS and H2-rich medium, which maintained mild RhoA activation, distinctly improved the abundance of mDia1 (Fig. 9, A and B). Then we investigated whether mDia1 participated in H2-exerted interference with intestinal barrier dysfunction caused by LPS. As is shown in Figure 9D and E, knocking down of mDia1 by siRNA restored the ability of LPS to wreck the normal TER and FD4 flux of the Caco-2 monolayers, which were previously blocked by H2. Caco-2 barrier function was also impaired by mDia1 knockdown without LPS stimulation, suggesting the necessity of mDia1 for barrier maintenance. Furthermore, the down-expression of mDia1 eliminated the effects of H2-rich medium on expression levels of occludin and E-cadherin (Fig. 10, A–C). Accordingly, mDia1 knockdown counteracted the beneficial effects of H2 on structures of TJ and AJ (Fig. 11). Single mDia1 knockdown without LPS treatment destroyed both TJ and AJ (Fig. 10, A–C and Fig. 11). Together, these findings support an emerging notion that, in an in vitro Caco-2 monolayer barrier, H2 can modulate LPS-stimulated robust RhoA activation to a down-regulated but still moderately activated level, which next increases mDia1 expression level, thereby preventing the destruction of both TJ and AJ, and enhancing the intestinal epithelial barrier function.

Fig. 9
Fig. 9:
H2 protects barrier permeability of Caco-2 monolayers by up-regulating mDia1.A and B, LPS decreased mDia1 expression in Caco-2 cells, whereas H2 coincubation up-regulated mDia1 abundance. C, Expression of mDia1 in Caco-2 cells was decreased by RNA interference. D and E, Protective effects of H2 on TER and FD4 flux were eliminated by mDia1 knockdown in Caco-2 monolayers. * P < 0.05 compared with control group; # P < 0.05 compared with LPS stimulation group; § P < 0.05 compared with H2 co-treatment (LPS + H2) group. H2, hydrogen gas; FD4, fluorescein-isothiocyanate–labeled dextran 4 kDa; LPS, lipopolysaccharide; TER, transepithelial resistance.
Fig. 10
Fig. 10:
H2 attenuates pathological expressions of the AJC via mDia1 up-regulation.A, In Caco-2 cells of mDia1 knockdown, expression levels of occludin and E-cadherin were dropped, and H2-induced benefits for expressions of TJ and AJ were partly eliminated. * P < 0.05 compared with control group; # P < 0.05 compared with LPS stimulation group; § P < 0.05 compared with H2 co-treatment (LPS + H2) group. AJ, adherens junction; AJC, apical junctional complex; H2, hydrogen gas; LPS, lipopolysaccharide; TJ, tight junction.
Fig. 11
Fig. 11:
H2 ameliorates pathological structures of occludin and E-cadherin via up-regulating mDia1.The mDia1 knockdown disrupted normal structures of occludin (red) and E-cadherin (green). H2-induced protective effects on occludin and E-cadherin were impaired by mDia1 knockdown. Scale bar = 10 μm. H2, hydrogen gas.


The gut epithelium offers a crucial physical barrier against the access of hostile substances from the external environment. TJs and AJs, collectively known as the AJC, seal the paracellular gaps between adjacent enterocytes, and thereby form multifunctional structures, guarding the internal environment against luminal components (3, 5). Intestinal epithelial barrier dysfunction is widely accepted as a major origin or final pathway contributing to sepsis, septic shock, and MODS (28).

Lipopolysaccharide—a main component from cell wall of Gram-negative bacteria—is one of the most potent innate oxidative stress-activating stimuli (22). Previous experiments have discovered that, when infected by LPS,, the intestinal barrier becomes pathologically hyperpermeable (22, 23). The human intestinal Caco-2 cell line, which is originally obtained from human adenocarcinoma and expresses typical morphological and functional features of mature enterocyte after differentiation, has been widely utilized as a validated in vitro model for the gut barrier (29). Previous experiments have revealed that, different doses of LPS show distinct effects on Caco-2 monolayers (22, 28). In the present study, we reconfirmed that LPS at a concentration of 100 μg/mL observably showed its barrier-breaker role by disturbing the expressions and distributions of TJ and AJ, without affecting Caco-2 viability. Actually, the physiologically and clinically relevant concentration of LPS is about 0 to 10 ng/mL, and LPS at 1 μg/mL can markedly activate cultured cells (22). However, the present study supported that LPS at lower concentrations (0–10 μg/mL) hardly affected barrier function.

Nowadays, H2 has been recognized as a medical gas with promising potentials to prevent or cure a series of diseases, such as ischemia/reperfusion injury, neurodegeneration, metabolic syndrome, inflammation, mitochondrial diseases, and even cancers (11, 30, 31). Our researches published previously have revealed that 2% or 4% H2 inhalation effectively improves survival rates of septic animals and relieves sepsis-related organ injuries (12, 13). However, studies about the hypothesis whether these mentioned protections against sepsis induced by H2 is in relation to the intestine have seldom been reported. In fact, H2 administration with different methods has been proved definitely effective for several intestinal diseases (15, 16, 32). Consistent with these benefits for the intestine, in the present study, we proved the protective role of H2-rich medium in LPS-disrupted gut barrier model in vitro. The excessive oxidative stress has been reported to be associated with gut barrier dysfunction (33). In consideration of antioxidant effects of H2, we examined the oxidative stress, and confirmed that H2 could lower intracellular ROS production, hinting that the advantages for gut barrier by H2 may be related to antioxidation.

Hydrogen gas can also protect against sepsis by modulating many signal pathways (14, 20, 30). Therefore, experiments were conducted to elucidate mechanisms by which H2 modulated Caco-2 barrier function. Since the present results revealed involvements of RhoA-mDia1 in LPS-stimulated gut barrier breakdown, H2 effects on this signal pathway were explored. Our current results found that H2 suppressed RhoA activity. Furthermore, RhoA activator eliminated the protections of H2 on barrier integrity and AJC, and RhoA inhibitor reversed LPS-disrupted gut barrier, suggesting the protective effects of H2 against barrier dysfunction is dependent on the decrease of RhoA activity. In physiological conditions, TJ and AJ undergo dynamic regulations between assembly and disassembly, and appropriate Rho activity plays a crucial role in this dynamics, thereby maintaining the AJC at a stable state (8, 34). Instead of suppressing RhoA activity below a physiological degree, H2 kept it at a moderately activated level in LPS-stimulated Caco-2 cells, which may explain how H2 served as a rescuer for gut permeability.

Previous investigations have indicated that the complicated connections between RhoA and the AJC can be elucidated by two different downstream effectors, Rho-associated coiled-coil protein kinase (ROCK) and mDia1 (6). Under physiological circumstance, ROCK promotes actomyosin contraction and actin polymerization, whereas mDia1 facilitates actin polymerization and microtubule organization (6, 9). Sahai et al. confirmed that RhoA activation in low degree selectively transmits signals through mDia to stabilize the AJC, whereas robust RhoA activity tends to favor ROCK-dependent AJ destruction (8). Gavard et al. also found that both intensity and space distribution of active RhoA impact options of downstream signaling (35). Additionally, our previous findings have demonstrated that H2-rich medium decreases expression of ROCK to attenuate LPS-caused vascular endothelial hyperpermeability and vascular endothelial-cadherin disruption (20). Thus, in the present study, we supposed whether an alternative downstream target, mDia1, participated in mild RhoA activation-dependent protection of intestinal barrier by H2-rich medium. Results showed that, H2 could effectively increase mDia1 expression in LPS-exposed Caco-2 cells, whereas H2 treatment alone did not affect mDia1, conforming mDia1 as a downstream of H2-modulated RhoA. Further, in mDia1-interfered Caco-2 monolayers, H2 lost its protective effects on gut barrier permeability, and both expressions and structures of occludin and E-cadherin were again disrupted by endotoxin, suggesting that H2-induced advantages for intestine was mDia1-dependent.

However, there are two limitations in this study. First of all, 100 μg/mL LPS used in the present study is so high that this concentration could be unlikely achieved in vivo. In addition, the employment of immortalized cancer cell line as an in vitro gut model is another limitation in this study. On the basis of these two limitations, an in vivo model of the LPS-induced increase in mouse intestinal permeability as previously described should be introduced for further investigation (22).

To sum up, our researches illuminated that, in Caco-2 monolayers, 100 μg/mL LPS caused pathological RhoA signal activation which then damaged barrier permeability, and H2-rich medium could stabilize RhoA activity at a mild but still active level to increase mDia1 expression, therefore mitigating disruptions of cell–cell junctions and enhancing the intestinal epithelial barrier function. These findings may provide a possible mechanism for curative effects of H2 on sepsis.


1. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013; 39 2:165–228.
2. Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med 2013; 41 5:1167–1174.
3. Carrico CJ, Meakins JL, Marshall JC, Fry D, Maier RV. Multiple-organ-failure syndrome. The gastrointestinal tract: the “motor” of MOF. Arch Surg 1986; 121 2:196–208.
4. Catalioto RM, Maggi CA, Giuliani S. Intestinal epithelial barrier dysfunction in disease and possible therapeutical interventions. Curr Med Chem 2011; 18 3:398–426.
5. Laukoetter MG, Bruewer M, Nusrat A. Regulation of the intestinal epithelial barrier by the apical junctional complex. Curr Opin Gastroenterol 2006; 22 2:85–89.
6. Narumiya S, Tanji M, Ishizaki T. Rho signaling, ROCK and mDia1, in transformation, metastasis and invasion. Cancer Metastasis Rev 2009; 28 (1–2):65–76.
7. Schlegel N, Meir M, Spindler V, Germer CT, Waschke J. Differential role of Rho GTPases in intestinal epithelial barrier regulation in vitro. J Cell Physiol 2011; 226 5:1196–1203.
8. Sahai E, Marshall CJ. ROCK and Dia have opposing effects on adherens junctions downstream of Rho. Nat Cell Biol 2002; 4 6:408–415.
9. Nakano K, Takaishi K, Kodama A, Mammoto A, Shiozaki H, Monden M, Takai Y. Distinct actions and cooperative roles of ROCK and mDia in Rho small G protein-induced reorganization of the actin cytoskeleton in Madin-Darby canine kidney cells. Mol Biol Cell 1999; 10 8:2481–2491.
10. Ohsawa I, Ishikawa M, Takahashi K, Watanabe M, Nishimaki K, Yamagata K, Katsura K, Katayama Y, Asoh S, Ohta S. Hydrogen acts as a therapeutic antioxidant by selectively reducing cytotoxic oxygen radicals. Nat Med 2007; 13 6:688–694.
11. Ohta S. Molecular hydrogen as a preventive and therapeutic medical gas: initiation, development and potential of hydrogen medicine. Pharmacol Ther 2014; 144 1:1–11.
12. Xie K, Fu W, Xing W, Li A, Chen H, Han H, Yu Y, Wang G. Combination therapy with molecular hydrogen and hyperoxia in a murine model of polymicrobial sepsis. Shock 2012; 38 6:656–663.
13. Xie K, Yu Y, Pei Y, Hou L, Chen S, Xiong L, Wang G. Protective effects of hydrogen gas on murine polymicrobial sepsis via reducing oxidative stress and HMGB1 release. Shock 2010; 34 1:90–97.
14. Liu L, Xie K, Chen H, Dong X, Li Y, Yu Y, Wang G, Yu Y. Inhalation of hydrogen gas attenuates brain injury in mice with cecal ligation and puncture via inhibiting neuroinflammation, oxidative stress and neuronal apoptosis. Brain Res 2014; 1589:78–92.
15. Shigeta T, Sakamoto S, Li XK, Cai S, Liu C, Kurokawa R, Nakazawa A, Kasahara M, Uemoto S. Luminal injection of hydrogen-rich solution attenuates intestinal ischemia-reperfusion injury in rats. Transplantation 2015; 99 3:500–507.
16. Sheng Q, Lv Z, Cai W, Song H, Qian L, Wang X. Protective effects of hydrogen-rich saline on necrotizing enterocolitis in neonatal rats. J Pediatr Surg 2013; 48 8:1697–1706.
17. Buchholz BM, Kaczorowski DJ, Sugimoto R, Yang R, Wang Y, Billiar TR, McCurry KR, Bauer AJ, Nakao A. Hydrogen inhalation ameliorates oxidative stress in transplantation induced intestinal graft injury. Am J Transplant 2008; 8 10:2015–2024.
18. Chen HG, Xie KL, Han HZ, Wang WN, Liu DQ, Wang GL, Yu YH. Heme oxygenase-1 mediates the anti-inflammatory effect of molecular hydrogen in LPS-stimulated RAW 264.7 macrophages. Int J Surg 2013; 11 10:1060–1066.
19. Yu Y, Ma X, Yang T, Li B, Xie K, Liu D, Wang G, Yu Y. Protective effect of hydrogen-rich medium against high glucose-induced apoptosis of Schwann cells in vitro. Mol Med Rep 2015; 12 3:3986–3992.
20. Xie K, Wang W, Chen H, Han H, Liu D, Wang G, Yu Y. Hydrogen-rich medium attenuated lipopolysaccharide-induced monocyte-endothelial cell adhesion and vascular endothelial permeability via Rho-associated coiled-coil protein kinase. Shock 2015; 44 1:58–64.
21. Schlegel N, Burger S, Golenhofen N, Walter U, Drenckhahn D, Waschke J. The role of VASP in regulation of cAMP- and Rac 1-mediated endothelial barrier stabilization. Am J Physiol Cell Physiol 2008; 294 1:C178–C188.
22. Guo S, Al-Sadi R, Said HM, Ma TY. Lipopolysaccharide causes an increase in intestinal tight junction permeability in vitro and in vivo by inducing enterocyte membrane expression and localization of TLR-4 and CD14. Am J Pathol 2013; 182 2:375–387.
23. Lei S, Cheng T, Guo Y, Li C, Zhang W, Zhi F. Somatostatin ameliorates lipopolysaccharide-induced tight junction damage via the ERK-MAPK pathway in Caco2 cells. Eur J Cell Biol 2014; 93 7:299–307.
24. Wang X, Wang S, Li Y, Wang F, Yang X, Yao J. Sulfated Astragalus polysaccharide can regulate the inflammatory reaction induced by LPS in Caco2 cells. Int J Biol Macromol 2013; 60:248–252.
25. Elamin E, Masclee A, Dekker J, Jonkers D. Ethanol disrupts intestinal epithelial tight junction integrity through intracellular calcium-mediated Rho/ROCK activation. Am J Physiol Gastrointest Liver Physiol 2014; 306 8:G677–G685.
26. Xiaolu D, Jing P, Fang H, Lifen Y, Liwen W, Ciliu Z, Fei Y. Role of p115RhoGEF in lipopolysaccharide-induced mouse brain microvascular endothelial barrier dysfunction. Brain Res 2011; 1387:1–7.
27. Rafikov R, Dimitropoulou C, Aggarwal S, Kangath A, Gross C, Pardo D, Sharma S, Jezierska-Drutel A, Patel V, Snead C, et al. Lipopolysaccharide-induced lung injury involves the nitration-mediated activation of RhoA. J Biol Chem 2014; 289 8:4710–4722.
28. Fink MP. Intestinal epithelial hyperpermeability: update on the pathogenesis of gut mucosal barrier dysfunction in critical illness. Curr Opin Crit Care 2003; 9 2:143–151.
29. Sambuy Y, De Angelis I, Ranaldi G, Scarino ML, Stammati A, Zucco F. The Caco-2 cell line as a model of the intestinal barrier: influence of cell and culture-related factors on Caco-2 cell functional characteristics. Cell Biol Toxicol 2005; 21 1:1–26.
30. Xie K, Liu L, Yu Y, Wang G. Hydrogen gas presents a promising therapeutic strategy for sepsis. Biomed Res Int 2014; 2014:807635.
31. Ohta S. Molecular hydrogen as a novel antioxidant: overview of the advantages of hydrogen for medical applications. Methods Enzymol 2015; 555:289–317.
32. Li Y, Li Q, Chen H, Wang T, Liu L, Wang G, Xie K, Yu Y. Hydrogen gas alleviates the intestinal injury caused by severe sepsis in mice by increasing the expression of heme oxygenase-1. Shock 2015; 44 1:90–98.
33. Tian R, Tan JT, Wang RL, Xie H, Qian YB, Yu KL. The role of intestinal mucosa oxidative stress in gut barrier dysfunction of severe acute pancreatitis. Eur Rev Med Pharmacol Sci 2013; 17 3:349–355.
34. Terry S, Nie M, Matter K, Balda MS. Rho signaling and tight junction functions. Physiology (Bethesda) 2010; 25 1:16–26.
35. Gavard J, Patel V, Gutkind JS. Angiopoietin-1 prevents VEGF-induced endothelial permeability by sequestering Src through mDia. Dev Cell 2008; 14 1:25–36.

Adherens junctions; intestinal barrier dysfunction; mammalian diaphanous-related formin 1; molecular hydrogen; ras homolog gene family member A; sepsis; tight junctions; AJ; adherens junctions; AJC; apical junctional complex; FD4; FITC-labeled dextran 4 kDa; FITC; fluorescein-isothiocyanate; H2; hydrogen gas; LPS; lipopolysaccharide; mDia1; mammalian diaphanous-related formin 1; MODS; multiple organ dysfunction syndrome; Rho; Ras homolog gene family; RhoA; Ras homolog gene family member A; ROS; reactive oxygen species; SD; standard deviation; TER; transepithelial electrical resistance; TJ; tight junctions

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