No abstract

The continually renewing epithelium of the intestinal tract arises from the visceral endoderm by a series of complex developmental transitions. The mechanisms that establish and maintain the processes of cellular renewal, cell lineage allocation, and tissue restriction and spatial assignment of gene expression in this epithelium are unknown. An understanding of the regulation of intestine-specific gene regulation may provide information on the molecular mechanisms that direct these processes. In this regard, we show that intestine-specific transcription of sucrase-isomaltase, a gene that is expressed exclusively in differentiated enterocytes, is dependent on binding of a tissue-specific homeodomain protein (mouse Cdx-2) to an evolutionarily conserved promoter element in the sucrase-isomaltase gene. This protein is a member of the caudal family of homeodomain genes which appear to function in early developmental events in Drosophila melanogaster, during gastrulation in many species, and in intestinal endoderm. Unique for this homeodomain gene family, we show that mouse Cdx-2 binds as a dimer to its regulatory element and that dimerization in vitro is dependent on redox potential. These characteristics of the interaction of Cdx-2 with its regulatory element provide for a number of potential mechanisms for transcriptional regulation. Taken together, these findings suggest that members of the Cdx gene family play a fundamental role both in the establishment of the intestinal phenotype during development and in maintenance of this phenotype via transcriptional activation of differentiated intestinal genes.The epithelium of the intestinal tract arises from the visceral endoderm by progression through a series of developmental transitions (reviewed in references 33, 34, and 42). The early signals for intestinal development have been shown to be partially directed by the interaction of mesoderm with endoderm, although the mechanism of this effect has not been elucidated (reviewed in references 23 and 24). Later events include the emergence of different epithelial cell lineages, formation of crypts (proliferative compartment) and villi (differentiated compartment), and the coordinated expression of cell-specific genes. The resultant mature epithelia of the small intestine and colon have marked regional differences in architecture, cell populations, and gene expression which define distinct functional zones of the adult gut (reviewed in references 20, 21, and 50). These region-specific phenotypes are maintained throughout the life of the animal. The regulatory mechanisms that orchestrate these complex developmental transitions and maintain the well-ordered regional phenotypes along the cephalocaudal and crypt-villus axes have not been defined.

Sucrase-isomaltase (SI), an intestine-specific gene, is induced in the differentiated small intestinal villous epithelium during the suckling-weaning transition in mice. We have previously identified cis-acting elements within a short evolutionarily conserved SI promoter. However, the nature and profile of expression of the interacting proteins have not been fully characterized during this developmental transition. Herein, we show that hepatocyte nuclear factor-1 alpha (HNF-1 alpha), GATA-4, and caudal related homeodomain proteins Cdx2 and Cdx1 are the primary transcription factors from the adult mouse intestinal epithelium to interact with the SIF3, GATA, and SIF1 elements of the SI promoter. We wanted to study whether HNF-1 alpha, GATA-4, and Cdx2 can cooperate in the regulation of SI gene expression. Immunolocalization experiments revealed that HNF-1 alpha is detected in rare epithelial cells of suckling mice and becomes progressively more expressed in the villous epithelial cells during the suckling-weaning transition. GATA-4 protein is expressed exclusively in villous differentiated epithelial cells of the proximal small intestine, decreases in expression in the ileum, and becomes undetectable in the colon. HNF-1 alpha, GATA-4, and Cdx2 interact in vitro and in vivo. These factors activate SI promoter activity in cotransfection experiments where GATA-4 requires the presence of both HNF-1 alpha and Cdx2. These findings imply a combinatory role of HNF-1 alpha, Cdx2, and GATA-4 for the time- and position-dependent regulation of SI transcription during development.

Since their original identification in Drosophila, the caudal related homologues (Cdx1 and Cdx2) have been known to be evolutionarily conserved both in molecular structure and function. In a great variety of organisms they are recognized to function critically during antero-posterior patterning and the development of the intestinal epithelium. The Cdx homologues, when expressed, modulate a diverse set of processes including proliferation, apoptosis, cell-adhesion, and columnar morphology. They are also necessary for the expression of an increasing number of intestine-specific genes. By targeting these processes and genes, the Cdx homologues promote the appearance of a mature intestinal cell phenotype. In addition to these critical roles during development, accumulating evidence suggests that the Cdx homologues may play significant roles in oncogenesis in the gastrointestinal tract and other tissues. In the colon, several studies suggest the Cdx homologues may act as tumor suppressors. However, ectopic Cdx1 and Cdx2 expression is involved in the development of the precancerous intestinal metaplasia in the stomach and esophagus, and may be a transforming event in one form of acute myelogenous leukemia. This review will explore our current understanding of the roles of the caudal homologues Cdx1 and Cdx2 in intestinal development and carcinogenesis.

Becoming a culturally competent health professional is a demanding prerequisite in this multicultural society. Cultural competence is explored and abstracted as a conceptual framework through a concept analysis using the evolutionary method. Its model is constructed from a systemic, comprehensive literature review and analysis. Taking into account how cultural competence is viewed by other disciplines (medicine, psychology, education, and social work), a comprehensive definition, antecedents, and consequences of cultural competence in nursing are described and diagrammed. Additionally, two model cases and future implications are discussed. The broader American society is composed of a mosaic of discrete cultural groups existing within the context of their values and identities. Those distinct cultures affect each patient's ways of thinking and his or her perceptions on health care and health behaviors. The proposed model of cultural competence provides a theoretical guide for developing strategies to achieve culturally competent care in nursing practice and research.