After incubation with P. aeruginosa PAO1, C. elegans showed a significant increase in FITC-dextran fluorescence in the worm body compared to the fluorescence shown after incubation with the other two bacterial strains (Figure 1). The fluorescence intensities of worms fed with E. coli OP50, P. aeruginosa PAO1, and E. faecalis KCTC3206 were 100.0 ± 6.6, 369.7 ± 38.9, and 105.6 ± 10.6%, respectively. The data emphasize that P. aeruginosa caused more vital damage to the epithelial gut barrier, and therefore, the worms exhibited a dramatic increase in their intestinal permeability. Based on this result, FITC-dextran can easily penetrate through the intestinal layer, so P. aeruginosa was selected as a potential candidate pathogen for screening the effects of DIM. Although E. faecalis is a gut pathogen that can produce extracellular superoxide and hydrogen peroxide, which damage colonic epithelial cell DNA15, in some cases, E. faecalis is also known as a potential probiotic bacteria due to its ability to produce bacteriocins against some pathogens25,26. The functions of a probiotic include adherence to epithelial surfaces, persistence in the human gastrointestinal tract, immune stimulation and antagonistic activity against intestinal pathogens26. Therefore, the gut permeability of worms incubated with E. faecalis remained unchanged compared with that of the vehicle control worms. This result shows that the amount of the infection can be studied by the increase in the fluorescence intensity, and P. aeruginosa causes more intestinal permeability than other strains.
Figure 2 shows the difference between live and heat-inactivated P. aeruginosa PAO1 based on the intensity of FITC-dextran fluorescence in the worm body. Both the fluorescence images and statistical data indicate that the pathogen could not trigger any toxicity to nematodes after heat inactivation. P. aeruginosa can produce exotoxin A — a potent extracellular cytotoxin that is lethal for many animals27. Exotoxin A can be rapidly abolished by heating at 45 °C to 60 °C28. Therefore, heat-inactivated P. aeruginosa was unable to damage the permeability of the worms' intestinal epithelia. The supernatant of P. aeruginosa PAO1 culture significantly damaged intestinal permeability, and therefore, the culture supernatant instead of whole P. aeruginosa cells can be used to induce intestinal permeability dysfunction19. The supernatant contains endotoxins, exotoxin A, and lipopolysaccharides29, and these components are known to induce cell toxicity30,31. Therefore, these components of the supernatant may affect the intestinal permeability, although we did not check the direct effect of exotoxins and lipopolysaccharides on the intestinal permeability in C. elegans.
DIM cotreatment for 48 h significantly decreased the FITC-dextran fluorescence intensity inside the guts of worms compared with the P. aeruginosa single treatment (Figure 3C,D). Statistical analysis by one-way ANOVA and Tukey's multiple comparison test showed that after treatment with DIM, the mean fluorescence intensity was significantly decreased in comparison with the fluorescence intensity of the P. aeruginosa-only treatment. The fluorescence intensities of the worms treated with P. aeruginosa-only and P. aeruginosa plus DIM were 486.3 ± 41.7 and 414.2 ± 25.0%, respectively (Figure 3E). Based on this result, DIM can be considered a good natural product to cure intestinal permeability dysfunction caused by bacterial infections. This result indicated that DIM can attenuate cell inflammation in gut cells, which reduces the permeability of the intestine19. This result is similar to the results obtained in a mouse model, in which DIM showed a significant reduction in inflammation in the colon32.

Figure 1: The effects of different bacteria on the intestinal permeability of C. elegans. Microscopy images of the worms including bright-field, FITC fluorescence (green channel), and merged images. Microscopy images of worms from (A) E. coli OP50 without FITC-dextran feeding, (B) E. coli with FITC-dextran feeding, (C) P. aeruginosa PAO1 with FITC-dextran feeding, and (D) E. faecalis KCTC3206 with FITC-dextran feeding. Scale bar = 1 mm (white), and 200 µm (black). Age-synchronized L4 larvae were incubated for 48 h in NGM plates seeded with E. coli (A, B), P. aeruginosa (C), and E. faecalis (D). Then, the worms were transferred to plates containing FITC-dextran (B-D), except for the vehicle control (A). (E) The FITC fluorescence intensity of the different bacterial treatments. A higher percentage of FITC fluorescence indicated a higher gut permeability. Columns and error bars indicate the mean ± SD. ***P < 0.001 for significant difference from the vehicle control.###P < 0.001 for significant difference from the FITC-dextran-treated worms fed with P. aeruginosa PAO1 (ANOVA, n = 5). This graph is representative of two independent experiments. Please click here to view a larger version of this figure.

Figure 2: The effects of live and heat-inactivated P. aeruginosa PAO1 on the intestinal permeability of C. elegans. Microscopy images of worms from (A) live E. coli OP50 without FITC-dextran feeding, (B) live E. coli with FITC-dextran feeding, (C) live P. aeruginosa PAO1 with FITC-dextran feeding, and (D) heat-inactivated P. aeruginosa with FITC-dextran feeding. Scale bar = 1 mm (white), and 200 µm (black). Age-synchronized L4 larvae were incubated for 48 h in NGM plates seeded with live E. coli (A, B), live P. aeruginosa (C), and heat-inactivated P. aeruginosa (D). Then, the worms were transferred to plates containing FITC-dextran (B-D), except for the vehicle control (A). (E) FITC fluorescence intensity comparing live and heat-inactivated P. aeruginosa PAO1. Columns and error bars indicate the mean ± SD. ***P < 0.001 and **P < 0.01 for significant difference from the vehicle control.###P < 0.001 for significant difference from the FITC-dextran-treated worms fed with live P. aeruginosa PAO1 (ANOVA, n = 5). This graph is representative of two independent experiments. Please click here to view a larger version of this figure.

Figure 3: The effect of DIM on the intestinal permeability of C. elegans fed P. aeruginosa. Microscopy images of worms from (A) E. coli OP50 without FITC-dextran feeding, (B) E. coli with FITC-dextran feeding, (C) P. aeruginosa PAO1 with FITC-dextran feeding, and (D) P. aeruginosa and DIM (100 µM) cotreatment with FITC-dextran feeding. Scale bar = 1 mm (white), and 200 µm (black). Age-synchronized L4 larvae were incubated for 48 h in NGM plates seeded with live E. coli (A, B), live P. aeruginosa (C), live P. aeruginosa and DIM (D). Then, the worms were transferred to plates containing FITC-dextran (B-D), except for the vehicle control (A). (E) The FITC fluorescence intensity indicates that the gut permeability of C. elegans was affected by DIM. Columns and error bars indicate the mean ± SD. ***P < 0.001 for significant difference from the vehicle control.###P < 0.001 and ##P < 0.01 for significant difference from the FITC-dextran-treated worms fed with P. aeruginosa PAO1 (ANOVA, n = 5). This graph is representative of two independent experiments. Please click here to view a larger version of this figure.