Figure 2 Three distinct paracellular epithelial

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Figure 2 Three distinct paracellular epithelial permeability pathways are disrupted during disease pathogenesis Figure 2 | Three distinct paracellular epithelial permeability pathways are disrupted during disease pathogenesis. During homeostasis (left) there is little underlying mucosal immune activity and the 'leak' and 'pore' pathways, regulated by tight junctions, define intestinal permeability. In the presence of an intact epithelium, cellular membranes seal the 'unrestricted' pathway, which is independent of tight junctions. During disease pathogenesis (right), increased mucosal immune activation leads to TNF and IL-13 production, which can cause increased permeability across the leak and pore pathways, respectively. TNF enhances leak pathway permeability by both increasing myosin light chain kinase (MLCK) transcription and activity at the tight junction and causing occludin endocytosis. Pore pathway permeability is increased by IL-13-dependent claudin-2 upregulation. As inflammatory disease progresses, epithelial apoptosis occurs and permeability across the high-capacity, charge and size-nonselective unrestricted pathway dominates. Upon removal of inflammatory stimuli, the epithelium regenerates to seal the unrestricted pathway and restore permeability dependent on tight junctions. Multiple therapeutic approaches targeting the intestinal epithelial barrier have been proposed (centre). These approaches aim to either inhibit initiation and progression of disease through immunosuppression or inhibition of barrier loss dependent on tight junctions, or through restoration of epithelial barriers after disease onset by inhibiting inflammation or promoting epithelial regeneration. EGF, epidermal growth factor; IL-13R, IL-13 receptor; TNFR2, TNF receptor 2. Odenwald, M. A. & Turner, J. R. (2016) The intestinal epithelial barrier: a therapeutic target? Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2016.169