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First-pass metabolism may occur in the liver (for propranolol, lidocaine, clomethiazole, and nitroglycerin) or in the gut (for benzylpenicillin and insulin). [4] The four primary systems that affect the first pass effect of a drug are the enzymes of the gastrointestinal lumen, [5] gastrointestinal wall enzymes, [6] [7] [8] bacterial enzymes [5] and hepatic enzymes.
Microfold cells (commonly referred to as M cells) sample antigens from the lumen and deliver them to the lymphoid tissue associated with the mucosa (MALT). In the small intestine, M cells are associated with Peyer's patches. Cup cells are a distinct cell type that produces vimentin. [13] Tuft cells play a part in the immune response. [13]
In the large intestines, villi are absent and a flat surface with thousands of glands is observed. Underlying the epithelium is the lamina propria, which contains myofibroblasts, blood vessels, nerves, and several different immune cells, and the muscularis mucosa which is a layer of smooth muscle that aids in the action of continued peristalsis ...
The gut-associated lymphoid tissue lies throughout the intestine, covering an area of approximately 260–300 m 2. [5] In order to increase the surface area for absorption, the intestinal mucosa is made up of finger-like projections (), covered by a monolayer of epithelial cells, which separates the GALT from the lumen intestine and its contents.
Enteroendocrine cells are specialized cells of the gastrointestinal tract and pancreas with endocrine function. They produce gastrointestinal hormones or peptides in response to various stimuli and release them into the bloodstream for systemic effect, diffuse them as local messengers, or transmit them to the enteric nervous system to activate nervous responses.
Polysaccharidases and disaccharidases in the glycocalyx break down large sugar molecules, which are then absorbed. Glucose crosses the apical membrane of the enterocyte using the sodium-glucose cotransporter. It moves through the cytosol (cytoplasm) and exits the enterocyte via the basolateral membrane (into the blood capillary) using GLUT2.
GIP is produced and secreted into the blood circulation by K cells, i.e., single cells located in the mucosa of the upper gastrointestinal tract's duodenum and upper jejunum while GLP1 is produced and secreted into the blood by L cells located in the mucosa of the lower gastrointestinal tracts small and large intestines.
For many drugs that undergo this process, lower doses of drugs can be therapeutically effective because elimination is reduced by the 'recycling' of the drug. But for a small number of drugs that are very toxic to the intestine (e.g. irinotecan ), these molecules which would not otherwise be very toxic can become so because of this process, and ...