The altered tight junctions: an important gateway of bacterial translocation in cachexia patients with advanced gastric cancer.

Tight junctions (TJs) are the structural basis for the intestinal epithelium barrier. Increased intestinal permeability caused by variations in TJ proteins may result in bacterial translocation (BT). There is increasing evidence that BT might contribute to the occurrence and development of cancer cachexia, but the details are not known. Aims, we undertook further investigations into the pathway of BT in cancer cachexia. Results: BT-positive patients had a higher level of claudins-2 (CL-2, P = 0.035) and a lower level of occludin (P = 0.038) and Zonula occluden-1 (P = 0.01) than BT-negative patients. Moreover, the levels of IL-6, TNF-alpha, and IFN-gamma in BT-positive cachexia patients were higher compared with BT-negative cachexia patients (P < 0.001, P = 0.01, P < 0.001) and BT-positive noncachexia patients (P < 0.001, P = 0.025, P < 0.001). In the BT-positive cachexia patients, the local concentration of IL-6, TNF-alpha, and IFN-gamma, in the middle colic vein, was higher than in the peripheral venous (P = 0.04, P = 0.03, P = 0.038). In addition, endotoxin was detected within the small intestinal wall, and the concentration of endotoxin decreased from the mucosal side to the serosal side gradually in BT-positive patients. This study suggests that the altered TJs could be an important gateway of BT in gastric cancer cachexia and local cytokines could play a more important role than systemic cytokines in the process.