Insights into the mechanisms of gastric adaptation to aspirin-induced injury: A role for regenerating protein but not trefoil peptides

The phenomenon of reduced gastric mucosal injury despite repeated doses of a damaging agent is termed adaptation. Adaptation to nonsteroidal anti-inflammatory drug-induced injury has been clearly demonstrated in both humans and experimental animals; however, the precise mechanisms remain unclear. We hypothesized that mediators of adaptation might be the regenerating protein (Regl) and the trefoil peptides TFF1 and TFF2, because these proteins play pivotal roles in gastric mucosal protection and repair. The gene expression and the protein levels of these proteins were measured and compared in normal, aspirin-injured, and aspirin-adapted rat stomachs. TFF gene and protein expression levels were similar in all three groups, whereas Regl gene expression and protein levels in adapted stomach were increased. A time course analysis of Regl expression during the onset and offset of adaptation showed that mucosal Regl increased during the development of adaptation, was maintained during subsequent aspirin dosing, and returned to baseline levels once dosing had ceased and adaptation was lost-indicative of a causal role in the adaptation process. Colocalization of increased Regl with gastric epithelial areas showing increased proliferation also suggests that Regl may be an important mediator of the resolution of mucosal injury that is characteristic of gastric adaptation to aspirin.