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Background: This study aimed at determining the turnover rate of parietal cells after inhibition of acid secretion., Methods: Rats were given omeprazole (80 mumol/kg) by gavage once daily or ranitidine (1200 mumol/kg) by osmotic minipump for 5 days. Control rats received saline only. All rats were also given 3H-thymidine by osmotic minipumps. The animals were killed, 5, 14, 28, or 56 days after the start of the 3H-thymidine infusion. After formaldehyde fixation by perfusion through the aorta, light microscopic autoradiography was carried out on plastic sections of the oxyntic mucosa to determine the labeling index of the parietal cells., Results: The average turnover rate in the control rats was calculated to be 0.61% per day, corresponding to a mean turnover time of 164 days. In the rats given inhibitors of acid secretion, the turnover rates did not differ significantly from those of the control group., Conclusion: Inhibition of gastric acid secretion did not significantly change the turnover rate of the parietal cells.

The effect of inhibition of acid secretion on parietal cell morphology and the concentration of H,K-ATPase alpha-subunit protein was determined by electron microscopy and western blotting. Omeprazole or famotidine alone or in combination were used. Control animals showed a morphological stimulation index (0 = resting, 1.0 = fully stimulated) of 0.60; omeprazole treatment (1 mg/kg, twice a day) resulted a stimulation index of 0.63, famotidine injection (20 mg/kg twice a day) an index of 0.11, famotidine infusion (0.2 mg/hr) for five days an index of 0.38, and the combination of omeprazole and famotidine injection twice a day gave an index of 0.02. No change in the frequency of degenerating or damaged parietal cells was observed in any of the groups. In control animals, the number of lysosomes was 0.9/cell, with famotidine 1.8 and with omeprazole 5.6/cell. H/K-ATPase levels fell by about 25% with omeprazole and rose by about 23% with famotidine.

Biopsy specimens from the oxyntic mucosa were obtained on 210 occasions from 76 patients with the Zollinger-Ellison syndrome (ZES) before and during omeprazole treatment. One-micrometer sections were examined by light microscopy, and in 5% linear hyperplasia of endocrine cells was observed. Morphometry was carried out in 91 of the specimens and showed a significant increase of the mean endocrine cell density in comparison with both young, healthy subjects and patients suffering from active peptic ulcer disease (PUD). No metaplasia, dysplasia, or neoplasia was detected in patients with ZES, and the mean mucosal thickness and parietal cell density remained normal. The parietal cells often displayed endosome-like structures, and occasionally there were lingulate cytoplasmic projections into the gland lumen. Electron microscopic morphometry was carried out in specimens from nine patients with ZES and did not show any significant differences in the parietal cells in comparison with healthy subjects.

Parietal cells from rabbit gastric mucosa, enriched to greater than 90% purity, were used to study the effect of the H+,K(+)-ATPase inhibitor omeprazole on DNA in vitro. In this preparation, omeprazole undergoes acid-catalyzed conversion to its active form, the sulfenamide, which subsequently binds to luminal SH groups of the H+,K(+)-ATPase and thereby inhibits acid secretion. In the parietal cell fraction the S-phase inhibitor hydroxyurea (HU) decreased [3H]thymidine uptake by 40% as measured by liquid scintillation counting (LSC), presumably due to inhibition of scheduled DNA synthesis in contaminating stem cells. In the presence of HU, irradiation with ultraviolet light (UV) or treatment with the gastric carcinogen, 1-methyl-3-nitro-1-nitrosoguanidine (MNNG) increased [3H]thymidine uptake by a factor of 5. Autoradiography of isolated, stimulated parietal cells showed that UV irradiation and MNNG treatment increased the average number of silver grains over the nuclei 18-fold and 4-fold, respectively. In contrast, treatment of histamine-stimulated parietal cells with omeprazole or ranitidine in concentrations 100 times the IC50 value for inhibition of acid secretion in the parietal cells did not increase [3H]thymidine incorporation above the control levels, measured either by LSC or by autoradiography. Extracted DNA from stimulated parietal cells treated with [3H]omeprazole or [3H]MNNG showed no binding of [3H]omeprazole but considerable binding of [3H]MNNG. It is concluded that parietal cells can undergo DNA repair, but there is no indication that omeprazole, or its acid-derived metabolites, should cause any damage to DNA, nor does it bind to DNA in its target cell, where the highest concentrations of omeprazole and its acid-derived products are found.

The parietal cell acid pump inhibitor, omeprazole, has undergone numerous genotoxicity studies, the conclusions of which have all been negative. A recent report by Burlinson described a method which is claimed to measure unscheduled DNA synthesis (UDS) in gastric mucosa, based on the incorporation of tritiated thymidine (3H-TdR) into DNA. In a subsequent letter it was concluded that omeprazole induces a significant increase in UDS, and it was suggested that 'for omeprazole, a genotoxic action cannot be discounted'. The Burlinson method of measuring UDS relies upon selective separation of non-dividing oxyntic mucosal surface cells from the stem cells located in the proliferative zone. These stem cells undergo normal cell division, subsequently migrate to the top and bottom of the gland, differentiating into the various specialized cells of the gland such as surface, parietal and chief cells. In the oxyntic mucosa the majority of stem cells are located at a level corresponding to one fifth of the mucosal thickness from the surface. The purpose of this study was to evaluate the Burlinson method, which depends upon the selective isolation of non-dividing surface cells by pronase digestion. The fraction used for measurement was investigated in terms of 3H-TdR uptake, the cellular distribution of 3H-TdR by autoradiography, the number of parietal cells and the sensitivity of 3H-TdR uptake for hydroxyurea (an inhibitor of normal, scheduled DNA synthesis). The results show that pronase digestion did not selectively isolate surface epithelial cells and that the digest contained both parietal cells (15 +/- 1.5%) and glandular fragments.(ABSTRACT TRUNCATED AT 250 WORDS)

Sixty patients with duodenal or prepyloric ulcers were given omeprazole (30 or 40 mg o.m.; average period of treatment: 2.9 weeks) or histamine H2-receptor antagonists (cimetidine 400 mg b.i.d. or ranitidine 150 mg b.i.d.; average period of treatment; 3.5 weeks) for a single period ranging between 2 and 6 weeks. At the end of the treatment period fasting plasma gastrin levels were moderately increased in both groups in comparison with the pretreatment values. Endoscopic biopsies were taken from the oxyntic mucosa at the beginning and at the end of the treatment period. Light microscopy of the biopsies was aimed particularly at determining the number of endocrine cells. In addition, the mucosal thickness and the volume densities of the parietal cells, the lamina propria and the gland lumina were measured. There were no significant differences in the endocrine or parietal cell populations, between biopsies taken from the patients before and after treatment with omeprazole or histamine H2-receptor antagonists. The mucosal thickness and the densities of the lamina propria and of the gland lumina remained unaffected by the treatment.

Acute, pharmacological inhibition of gastric acid secretion is paralleled by a return of the parietal cells to a resting morphology. However, some inhibitors acting on targets in the parietal cells distal to the receptors, may inhibit acid secretion without the return to a resting morphology. This is the case with e.g. picoprazole and thiocyanate. Long-term pharmacological or surgical inhibition of acid secretion may be followed by changes in the number and/or size of the parietal cells.

Endoscopic biopsies were taken from the oxyntic mucosa in patients with duodenal ulcer (DU) before and after 4 weeks of treatment with omeprazole. Biopsies were also obtained from Zollinger-Ellison (ZE) patients before and during treatment with omeprazole; these patients had previously failed to respond to other therapies aiming at reducing gastric acid secretion. Healthy volunteers served as controls. Light-microscopic studies of biopsy sections revealed superficial gastritis in most of the patients. Endocrine cell volume density (that is, the percentage of mucosal volume occupied by endocrine cells) was 0.3% in the DU patients and 0.7% in the ZE patients before omeprazole treatment. No significant change occurred during omeprazole treatment, which in the ZE patients continued for up to 21 months. In the controls, 0.3% of the mucosal volume was occupied by endocrine cells. Parietal cell volume density was about 15% in both the DU patients and in the controls; in the ZE patients, slightly but not significantly higher values were recorded. No significant change was observed during omeprazole treatment.

In acutely vagotomized rats, gastric acid secretion was stimulated with a combination of carbachol and pentagastrin, and/or inhibited with picoprazole, cimetidine, or l-hyoscyamine. The animals were killed 1 or 3 h later. Using stereologic electron microscopic methods, the relative area of the secretory surface in the parietal cells and the mean size of these cells were estimated. The parietal cells in the superficial quarter of the oxyntic mucosa were larger than those at deeper levels of the mucosa. Moreover, the secretory surface was proportionally larger in the superficial cells than in the deep cells. Stimulation by carbachol and pentagastrin produced an increase in the secretory surface area. Inhibition of stimulated acid secretion by l-hyoscyamine reduced the secretory surface to the level of the unstimulated controls. Cimetidine, given at doses that inhibited stimulated acid secretion, did not alter the mean size of the secretory membrane. After inhibition by picoprazole, stimulated acid secretion was abolished, but the secretory membrane became significantly larger than after cimetidine inhibition. These divergent patterns of morphologic reactions probably reflect the different mechanisms of inhibition at the cellular level.