Intestinal edema is the accumulation of excess interstitial fluid in the intestinal wall tissue. It can occur as a consequence of resuscitative treatment given after traumatic injury [19]. After fluid resuscitation, the lymphatic system is unable to immediately remove the extra fluid from the interstitial spaces. The excess fluid is known to cause decreased smooth muscle cell (SMC) contractility, a condition referred to as ileus [20]. However, the connection between edema and decreased SMC contractility has not been clearly established. In this study, we seek to understand the connection by testing two hypotheses with mathematical models.
Due to increased interstitial fluid in edema, neurotransmitters at the neuromuscular junction must diffuse over greater synaptic cleft distances to reach receptors on the SMC membrane [16], [6]. The first hypothesis analyzes the effect of these increased distances across the synaptic cleft on the concentrations of the neurotransmitter acetylcholine (ACH). Increased interstitial fluid also causes uncoiling of collagen fibers in the extracellular matrix, mechanically straining the cell's contractile process. The second hypothesis analyzes the effect of this increased strain of the collagen fibers on SMC contraction.
In order to test these two hypotheses, a comprehensive computational model incorporating biochemical and mechanical interactions of the SMC was developed. Many existing biochemical models were incorporated into the comprehensive model, but few mechanical models of SMC contraction have been developed. Existing mechanical SMC models only model contraction without biochemical inputs. Unique to our comprehensive model was incorporation of ACH diffusion, actin-myosin powerstroking, the cell membrane and cytoskeleton, and the extracellular collagen fibers.
Biology
The intestines play an integral role in digestion. As chyme exits the stomach, it enters the small intestines where digestion is continued and nutrients are absorbed into the blood stream through microvilli [5]. These processes occur within a central hollow region of the intestinal tract known as the lumen. Surrounding the lumen is the intestinal wall, composed of various tissue layers. Among these is the muscularis externa, which is composed of two layers of smooth muscle tissue: the circular tissue layer and the longitudinal layer [5]. Digesting material is propelled through the intestines for eventual excretion by the coordinated contraction of these two smooth muscle layers in a unidirectional squeezing motion known as peristalsis [5]. It is this process that is interrupted by edema formation [11], [15].
The tissue that composes both of the muscular tissue layers consists of interconnected SMCs [13]. A SMC is roughly ellipsoid in shape, with a length of 100 to 300 microns and a width of 5 to 10 microns [17]. Upon stimulation by nerves present in the muscularis, a SMC will contract. This contraction can vary in magnitude, with the maximum extent of contraction estimated to be approximately 70% of the cell's resting length [17]. The cytoplasm of neighboring SMCs are often connected to one another via channels known as gap junctions, allowing for the spreading activation of chemical and electrical signals [10]. Consequently, stimulation of one cell by an agonist will result in the contraction of multiple SMCs due to the flow of chemicals from the originally activated cell to adjacent cells [10], [13].
Some of the mechanical components necessary for cellular contraction are actin thin filaments, myosin-II heavy filaments, intermediate filaments, and dense bodies and plaques [2]. Actin and myosin work in tandem in the mechanochemical transduction of force. Intermediate filaments and actin filaments function as cytoskeletal elements that provide structure to the cell as well as spread the force generated by actin and myosin around the entire cell membrane [2], [13]. Intermediate filaments also function as connecting filaments that transmit force between dense bodies and dense plaques [2], [13].
Actin and myosin directly generate the force of contraction. When intracellular calcium concentrations rise, a globular protein protruding from the myosin-II heavy filament known as the myosin head becomes activated [17], [2]. This head binds to an active site located along the length of the actin filament; multiple active sites exist along a single filament [2]. When ATP phosphorylates the myosin head, the structure undergoes a series of conformational changes that replicates a rowing motion, pulling the actin filament through the cytoplasm. This action is termed the powerstroke, which is estimated to move an actin filament 10 nm by exerting a force of 3-4 pN at the actin-myosin binding site [17], [13]. Cycles of this powerstroke motion result in a continuous pattern of latching and releasing along these binding sites that pulls the actin through the cell. Actin, in turn, is attached to dense bodies or dense plaques, to which the force of contraction is applied [2], [13]. Dense bodies (plaques) are nodal structures anchored in the cytoplasm (plasma membrane) and connected to contracting actin filaments [2]. When actin and myosin generate force, it is applied to these structures such that the SMC can undergo the conformational changes necessary for cellular contraction.
Actin and myosin powerstroking is regulated by a complex network of chemical reactions, as shown in Figure 1. Intracellular calcium (
Phosphorylated myosin (
Hypothesis 1
SMC contraction can be initiated by agonist stimulation. The first hypothesis explored agonist stimulation in edematous conditions by ACH, as shown in figure 2, and its influence on the magnitude of cellular contraction. Neuron firing causes exocytosis of vesicles carrying ACH at the synaptic terminals. ACH then diffuses across the synaptic cleft to the plasma membrane of the target SMC. This distance is relatively small, with an average value of 12 - 20 nm [16]. ACH then binds to receptor proteins along the plasma membrane, which in turn leads to the formation of the secondary messenger Inositol 1,4,5-trisphosphate (
According to the first hypothesis, the chemical pathways are interrupted by intestinal edema. It was proposed that as the volume of fluid increases in the muscularis, the fluid penetrates into the interstitial spaces between SMCs and increases the distance between a target cell and the neuron that activates its contraction. As stated earlier, a typical synaptic cleft ranges from 12-20nm in length, but under edematous conditions this gap can reach anywhere from 30-60 nm [21]. Because of this larger synaptic distance, the volume through which the neurotransmitter ACH can diffuse also increases, and consequently the final concentration reaching the cell membrane receptors is lowered. The magnitude of the contractile response was expected to decrease due to decreased stimulation of secondary reaction networks. In testing hypothesis one, diffusion of ACH across the synaptic space was modeled using the two-dimensional heat equation under normal conditions and edematous conditions of varying magnitude. An explanation of this implementation is found in the discussion of the mathematical model (Section 2.1.1).
Hypothesis 2
Edema causes increased fluid in the interstitial spaces between SMCs, which overlap with the extracellular matrix. The extracellular matrix is composed of different proteins and collagen fibers. These fibers are attached to the cell membranes of the muscle cells and behave similar to coiled springs, able to stretch and compress easily, allowing the attached cells to contract and relax [12].
However due to excess fluid in the interstitial spaces in edema, the collagen fibers become stretched and uncoiled, increasing the elastic modulus for the collagen fibers. This increased elastic modulus was expected to decrease the magnitude of contraction in SMCs. In testing hypothesis two, additional mechanical tension was placed in the collagen fibers in the extracellular matrix to analyze changes in the magnitude of cellular contraction.






