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Open Access Research article

A possible involvement of Nrf2-mediated heme oxygenase-1 up-regulation in protective effect of the proton pump inhibitor pantoprazole against indomethacin-induced gastric damage in rats

Ho-Jae Lee1, Young-Min Han2, Eun-Hee Kim2, Yoon-Jae Kim3 and Ki-Baik Hahm4*

Author Affiliations

1 Lab of Chemoprevention, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, 406-840, Korea

2 Lab of Translational Medicine, College of Pharmacy, CHA University, 605 Yeoksam 1-dong, Gangnam-gu, Seoul, 135-081, Korea

3 Department of gastroenterology, Gachon University Gil Medical Center, Incheon, 405-760, Korea

4 Lab of Translational Medicine, Department of Gastroenterology, CHA University Bundang Hospital, Seongnam, 463-838, Korea

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BMC Gastroenterology 2012, 12:143  doi:10.1186/1471-230X-12-143

Published: 16 October 2012



Proton pump is an integral membrane protein that is ubiquitous ATP binding cassette (ABC) involved in many transport processes in all living organisms, among which a specialized form of pump, so called p-type proton pump, exists in the parietal cells of stomach. Though proton pump inhibitors (PPIs) are frequently prescribed to prevent nonsteroidal anti-inflammatory drugs (NSAIDs)-induced gastric damage, the acid suppressive actions do not suffice to explain.


In order to document the effects of pantoprazole, one of PPIs, on the NSAIDs-induced gastric damage, in vitro and in vivo studies were performed. Immunocytochemistry, Western blot analysis, electrophoretic mobility shift assay and RT-PCR were conducted to evaluate the induction of heme oxygenase-1 (HO-1) through Nrf2 activation in normal gastric mucosal RGM-1 cells or in vivo stomach tissues from rats treated with indomethacin and/or pantoprazole.


Pantoprazole activated Nrf2 through inactivation of Keap1, after which the expression of HO-1 was significantly increased in a dose-dependent manner in RGM-1 cells. Increased ARE-DNA binding activity was observed maximally at 1 h with 300 μM of pantoprazole. The expression of HO-1 induced by pantoprazole was significantly associated with the increased in vitro tube formation (P < 0.05) and angiogenic factors including VEGF, bFGF, and HIF-1α. Indomethacin markedly increased the expressions of TNF-α, IL-1ß, IL-8, NOX-1, ICAM-1 and VCAM, whereas pantoprazole significantly decreased the expressions of indomethacin-induced these inflammatory mediators in accord with pantoprazole-induced HO-1 (P < 0.05) as documented with HO-1 inhibitor. In vivo model of indomethacin-induced gastric damage could validate in vitro-drawn results that pantoprazole remarkably protected against indomethacin-induced gastric damage, in which zinc protoporphyrin (5 mg/kg, ip) significantly abolished the protective efficacy of pantoprazole.


These results demonstrate that Nrf2-mediated HO-1 induction of PPIs afforded a significant protective effect against NSAIDs-induced gastric damage beyond acid suppressive actions.

Heme oxygenase-1; Proton pump inhibitor; NSAIDs-induced gastropathy; Nrf2