title: Moxibustion combined with acupuncture increases tight junction protein expression in Crohn's disease patients.
abstract: OBJECTIVE
  To investigate the effect of herb-partitioned moxibustion combined with acupuncture on the expression of intestinal epithelial tight junction (TJ) proteins.
  
  
  METHODS
  Sixty patients diagnosed with mild to moderate Crohn's disease (CD) were allocated into the herb-partitioned moxibustion combined with acupuncture (HMA) group (n = 30) or the mesalazine (MESA) group (n = 30) using a parallel control method. There were 2 sets of acupoints used alternately for HMA treatment. The following points were included in Set A: ST25 (Tianshu), RN6 (Qihai), and RN9 (Shuifen) for herb-partitioned moxibustion and ST36 (Zusanli), ST37 (Shangjuxu), LI11 (Quchi), and LI4 (Hegu) for acupuncture. The points for Set B included BL23 (Shenshu) and BL25 (Dachangshu) for herb-partitioned moxibustion and EX-B2 of T6-T1 (Jiajixue) for acupuncture. The patients received the same treatment 6 times a week for 12 consecutive weeks. The MESA group received 1 g of mesalazine enteric coated tablets 4 times daily for 12 consecutive weeks. Intestinal tissues were stained and examined to compare the morphological and ultrastructural changes before and after the treatment session. Immunohistochemistry and in situ hybridization assays were used to detect the expression of intestinal epithelial TJ proteins zonula occludens-1 (ZO-1), occludin, and claudin-1. The mRNA levels were also evaluated.
  
  
  RESULTS
  After the treatment, both herb-partitioned moxibustion combined with acupuncture and mesalazine improved intestinal morphology and ultrastructure of CD patients; the patients treated with HMA showed better improvement. HMA significantly increased the expression of ZO-1 (P = 0.000), occludin (P = 0.021), and claudin-1 (P = 0.016). MESA significantly increased the expression of ZO-1 (P = 0.016) and occludin (P = 0.026). However, there was no significant increase in the expression of claudin-1 (P = 0.935). There was no statistically significant difference between the two groups for the expression of occludin and claudin-1 (P > 0.05). The HMA group showed a significant improvement in ZO-1 expression compared to the MESA group (2333.34 ± 352.51 vs 2160.38 ± 307.08, P = 0.047). HMA significantly increased the expression of ZO-1 mRNA (P = 0.000), occludin mRNA (P = 0.017), and claudin-1 mRNA (P = 0.017). MESA significantly increased the expression of ZO-1 mRNA (P = 0.000), occludin mRNA (P = 0.042), and claudin-1 mRNA (P = 0.041). There was no statistically significant difference between the two groups in the expression of occludin and claudin-1 mRNA (P > 0.05). However, the HMA group showed a significant improvement in ZO-1 mRNA expression compared with the MESA group (2378.17 ± 308.77 vs 2200.56 ± 281.88, P = 0.023).
  
  
  CONCLUSIONS
  HMA can repair intestinal epithelial barrier lesions and relieve inflammation by upregulating the expression of TJ proteins and their mRNAs.
authors.affiliation: Hai-Xia Shang, An-Qi Wang, Lu-Yi Wu, Rong Ji, Ji-Meng Zhao, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
authors.forename: Hai-Xia
authors.initials: HX
authors.lastname: Shang
authors.affiliation: Hai-Xia Shang, An-Qi Wang, Lu-Yi Wu, Rong Ji, Ji-Meng Zhao, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
authors.forename: An-Qi
authors.initials: AQ
authors.lastname: Wang
authors.affiliation: Hai-Xia Shang, An-Qi Wang, Lu-Yi Wu, Rong Ji, Ji-Meng Zhao, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
authors.forename: Chun-Hui
authors.initials: CH
authors.lastname: Bao
authors.affiliation: Hai-Xia Shang, An-Qi Wang, Lu-Yi Wu, Rong Ji, Ji-Meng Zhao, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
authors.forename: Huan-Gan
authors.initials: HG
authors.lastname: Wu
authors.affiliation: Hai-Xia Shang, An-Qi Wang, Lu-Yi Wu, Rong Ji, Ji-Meng Zhao, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Chen
authors.affiliation: Hai-Xia Shang, An-Qi Wang, Lu-Yi Wu, Rong Ji, Ji-Meng Zhao, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
authors.forename: Lu-Yi
authors.initials: LY
authors.lastname: Wu
authors.affiliation: Hai-Xia Shang, An-Qi Wang, Lu-Yi Wu, Rong Ji, Ji-Meng Zhao, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Ji
authors.affiliation: Hai-Xia Shang, An-Qi Wang, Lu-Yi Wu, Rong Ji, Ji-Meng Zhao, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
authors.forename: Ji-Meng
authors.initials: JM
authors.lastname: Zhao
authors.affiliation: Hai-Xia Shang, An-Qi Wang, Lu-Yi Wu, Rong Ji, Ji-Meng Zhao, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Shi
mesh_terms: D015670:Acupuncture Therapy; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001706:Biopsy; D002681:China; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000175:diagnosis / Q000235:genetics / Q000378:metabolism / Q000628:therapy*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D007413:Intestinal Mucosa / Q000378:metabolism* / Q000648:ultrastructure; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008854:Microscopy, Electron; D008875:Middle Aged; D009071:Moxibustion; D012333:RNA, Messenger / Q000378:metabolism; D012720:Severity of Illness Index; D062725:Tight Junction Proteins / Q000235:genetics / Q000378:metabolism*; D019108:Tight Junctions / Q000378:metabolism* / Q000648:ultrastructure; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D012333:RNA, Messenger; D062725:Tight Junction Proteins; D019804:Mesalamine
keywords: Acupuncture; Crohn’s disease; Herb-partitioned moxibustion; Intestinal epithelial cells; Tight junction proteins