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Daniel R. Clayburgh, Mark W. Musch, Michael Leitges, Yang-Xin Fu, Jerrold R. Turner
Published in Volume 116, Issue 10
J Clin Invest. 2006; 116(10):2682–2694 doi:10.1172/JCI29218
Abstract | Full text | PDF
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Figure 9
A model of TNF-induced diarrhea.

Under normal conditions, most of the Na+ that enters the intestine is absorbed by the intestinal epithelium, producing an osmotic gradient that drives water absorption. When a small paracellular barrier defect is introduced, such as that occurring after LIGHT injection, water is still absorbed, as the osmotic gradient produced by Na+ transport remains intact; in fact, the increase in paracellular permeability may actually increase the amount of water absorbed. Alternatively, when Na+ transport alone is impaired, as occurs after NHE3 inhibition, water absorption is reduced, leading to mild malabsorptive diarrhea. When epithelial barrier dysfunction and Na+ malabsorption occur simultaneously, not only is water retained in the lumen, but additional water may egress through the paracellular spaces, contributing to a larger volume of diarrhea than occurs when a barrier defect is not present.