Inclusion of patients
All participants provided written informed consent after fully understanding the research content. The Ethics Committee of Shanghai Pudong New Area People's Hospital has reviewed and approved this research protocol (No. 2024k007). Sample size was calculated using G*Power: the selected test was a t-test, and the statistical test was designed to detect differences between two independent samples. With an effect size of d = 0.5, α = 0.05, and power = 0.9, the calculation indicated that a minimum of 86 subjects should be enrolled in each group. To account for potential unforeseen circumstances during the trial, 116 patients were enrolled in each group. A total of 116 patients with IBS-D who visited Shanghai Pudong New Area People's Hospital between July 2024 and July 2025 were included in this study as the experimental group. The inclusion criteria were: (1) IBS-D meeting the Rome IV diagnostic criteria; (2) colonoscopy indicating no organic lesions in the mucosa. Exclusion criteria: (1) Patients with inflammatory bowel disease (IBD), colorectal cancer, etc.; (2) diabetic patients; (3) patients with a recent history of abdominal surgery; and (4) patients with severe heart, liver, or kidney insufficiency. Meanwhile, 116 healthy volunteers who matched the patients' demographic characteristics, such as age and sex, were recruited as the control group. Healthy controls were confirmed to have no history of chronic gastrointestinal diseases or corresponding clinical symptoms. Five milliliters of peripheral venous blood were drawn from all subjects. The supernatant was then transferred to an ultra-low-temperature refrigerator at -80 °C for cryopreservation prior to subsequent RNA extraction.
A 10-day questionnaire was completed by each participant to record the following clinical manifestations: (a) assessment of abdominal pain severity using a 10-point visual analog scale; (b) frequency of abdominal pain during the survey period (number of painful days); (c) bowel movement frequency (maximum number of bowel movements per day); (d) Bristol Faecal Traits Scale to assess faecal traits. The subjects' emotional state was evaluated using the Hospital Anxiety and Depression Scale (HADS).
Cell culture and modeling
Caco-2 cells were routinely cultured in Dulbecco's Modified Eagle Medium (DMEM) medium containing 10% fetal bovine serum (FBS) and 1% penicillin–streptomycin, in an incubator at 37 °C and 5% CO₂. The Caco-2 cell line spontaneously differentiates into a polarized monolayer of cells with tight junctions and microvilli, exhibiting morphological and functional characteristics similar to those of mature intestinal epithelial cells. LPS triggers an inflammatory response and disrupts tight junctions in the intestinal epithelium, increasing intestinal permeability—a process highly similar to the pathological features of IBS-D. Furthermore, given that LPS-treated Caco-2 cells have been widely used in previous studies19,20,21 to model IBS-related barrier dysfunction and inflammation, lipopolysaccharide (LPS) treatment of Caco-2 cells was selected in this study to establish an in vitro model of IBS-D. Once the cells had grown to approximately 80% confluence, the culture medium was replaced with complete medium containing 5 µg/ml LPS22, and the cells were stimulated for 24 h. Conventionally cultured cells without LPS were used as the control group.
Cell transfection
To investigate the roles of NEAT1 and miR-29b-3p in Caco-2 cells, Caco-2 cells were transfected. The cells were divided into six groups as follows: 1. control group (no treatment); 2. LPS group; 3. LPS + si-NC group; 4. LPS + si-NEAT1 group; 5. LPS + si-NEAT1 + inhibitor NC group; and 6. LPS + si-NEAT1 + miR-29b-3p inhibitor group. Two small interfering RNAs (si-NEAT1) targeting NEAT1 were designed and synthesized: si-NEAT1_1 (5′-GCCTTGTAGATGGAGCTTGC-3′) and si-NEAT1_2 (5′-GUGAGAAGUUGCUUAGAAAUU-3′). A non-targeting random sequence siRNA (si-NC) was used as a negative control. Meanwhile, the miR-29b-3p inhibitor and its negative control were also synthesized. miR-29b-3p inhibitor: 5’-AACACUGAUUUCAAAUGGUGCUA-3’. Negative control: 5’-CAGUACUUUUGUGUAGUACAA-3’.
Caco-2 cells were plated in 24-well plates and transfected once cultures reached 60–70% confluence, following the manufacturer’s protocol. Briefly, 1.25 µL of siRNA was diluted in 25 µL of reduced-serum medium to achieve a final siRNA concentration of 50 nM. For miRNA inhibition, 2 µL of the miR-29b-3p inhibitor or its negative control was diluted in 25 µL of reduced-serum medium to a final concentration of 100 nM. Separately, 1.5 µL of the transfection reagent was mixed with 25 µL of reduced-serum medium. The diluted siRNA (or inhibitor/negative control) was then mixed with the diluted transfection reagent to form the transfection complex, which was added dropwise to the cells. Six hours after transfection, the transfection mixture was replaced with fresh complete medium, and the cells were maintained for another 48 h before downstream functional assays. Knockdown or inhibition efficiency was confirmed by RT-qPCR before further experiments.
Real-time quantitative reverse transcription PCR (RT-qPCR)
Total RNA was isolated from serum samples and Caco-2 cells subjected to the indicated treatments. Briefly, each sample was lysed with 1 mL of RNA extraction reagent and combined with 200 µL of chloroform. After centrifugation at 12,000 × g for 15 min at 4 °C, the upper aqueous phase was transferred to a fresh tube, mixed with 500 µL of isopropanol, and kept at −20 °C for 30 min. The samples were then centrifuged at 12,000 × g for 10 min at 4 °C. The resulting RNA pellet was washed twice with 75% ethanol, air-dried, and resuspended in 20 µL of RNase-free water. RNA yield and purity were measured with a micro-spectrophotometer, and only samples with A260/A280 values of 1.8–2.0 were used. The RNA was reverse transcribed into cDNA following the manufacturer’s protocol. For detection of NEAT1, ZO-1, occludin, claudin-2, and GAPDH, 1 µg of total RNA was used for each 20 µL reverse-transcription reaction containing 1× RT buffer, 0.5 mM dNTPs, 0.5 µM oligo(dT) primer, 200 U reverse transcriptase, and RNase-free water. The reaction was carried out at 37 °C for 15 min, followed by enzyme inactivation at 85 °C for 5 s.
Quantitative PCR was performed with cDNA as the template using a SYBR Green-based real-time PCR system. NEAT1, miR-29b-3p, ZO-1, occludin, and claudin-2 expression levels were measured with gene-specific primers. U6 served as the reference gene for miR-29b-3p, whereas GAPDH was used to normalize NEAT1 and tight junction-related genes. Relative expression was calculated using the 2−ΔΔCt method. The primer sequences are listed in Table 1.
Cell viability assay
Log-phase Caco-2 cells were plated in 96-well plates at 1 × 104 cells per well. A blank control group (containing only the culture medium), a control group (untreated cells), and an experimental group (Caco-2 cells under different treatment conditions) were set up, with 5–6 duplicate wells in each group. Cells were assigned to four time points: 0, 24, 48, and 72 h. A separate culture plate was prepared for each time point to avoid repeatedly opening the incubator during measurements. After the culture period, 10 µL of CCK-8 solution was added to each well, avoiding bubble formation. Subsequently, the culture plate was returned to a 37 °C, 5% CO₂ incubator and incubated in the dark for 2 h. The absorbance of each well was measured immediately at 450 nm using a microplate reader. Ultimately, cell viability was expressed as a percentage.
Cell apoptosis assay
Apoptosis was quantified by flow cytometry after Annexin V-FITC/PI staining. Caco-2 cells from each treatment group were harvested and rinsed twice with ice-cold PBS. Centrifugation was carried out at 300 × g for 5 min at 4 °C. The cell pellet was then resuspended in 100 µL of 1× binding buffer, followed by sequential addition of 5 µL Annexin V-FITC and 5 µL PI. After gentle mixing, the samples were incubated for 15 min at room temperature in the dark. Next, 300 µL of 1× binding buffer was added, and the suspension was mixed carefully before transfer to a 5 mL flow cytometry tube. Samples were analyzed by flow cytometry within 1 h.
Trans-epithelial electrical resistance (TEER)
Permeability was assessed by measuring the TEER values of Caco-2 cells23. Caco-2 cells were inoculated in Transwell chambers and cultured for 21 days to form a dense monolayer. Six independent biological replicates were performed under each experimental condition, and five technical replicates were also performed under each condition. Before and after the experimental treatment, the TEER values of each group were measured by a transmembrane resistance meter using electrodes sterilized with ethanol and balanced with PBS. In brief, the long rod of the electrode was immersed in the basolateral culture medium, and the short rod in the apical culture medium, to avoid contact with the filter membrane. After stabilization, the resistance value (Ω) was read, and measurements were repeated until three consistent readings were obtained. The resistance of blank Transwell filters (without cells) was measured under the same conditions, and this value was subtracted from all experimental readings. TEER (Ω·cm2) = (sample resistance – blank resistance) × effective membrane area. Data are presented as: (experimental group/control group) × 100%.
Enzyme-linked immunosorbent assay (ELISA)
The supernatants of Caco-2 cells from different treatment groups were collected after 24 h of culture. The levels of pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-1β (IL-1β), were measured using commercial ELISA reagents according to the manufacturer's instructions. The assay was performed strictly in accordance with the instructions. The samples and standards were added to the wells precoated with antibodies, then incubated and washed. Then, the biotinylated detection antibody was added. After another incubation and washing, streptavidin labeled with horseradish peroxidase was added. Finally, the substrate TMB was added for color development, and the reaction was terminated with the stop solution. The absorbance of each well was measured immediately at 450 nm using a microplate reader.
Western blot
Proteins were isolated from Caco-2 cells after the indicated treatments using RIPA buffer containing protease inhibitors. Protein levels were measured with a bicinchoninic acid (BCA) assay. For each sample, 30 µg of protein was loaded per lane, resolved on 10% SDS-PAGE gels, and transferred to PVDF membranes. The membranes were blocked in 5% non-fat milk for 1 h at room temperature and then incubated overnight at 4 °C with antibodies against ZO-1 (1:1,000), occludin (1:500), claudin-2 (1:1,000), and GAPDH (1:5,000). After washing, the membranes were incubated with HRP-conjugated secondary antibodies for 1 h at room temperature. Bands were detected by enhanced chemiluminescence (ECL), and band intensity was analyzed using ImageJ. GAPDH served as the loading control.
Dual-luciferase reporter (DLR) assay
The potential binding sites of miR-29b-3p to the NEAT1 sequence were predicted through the ENCORI database (https://rnasysu.com/encori/). Subsequently, NEAT1 fragments containing wild-type (WT) or mutant (MUT) binding sites were cloned into the pmirGLO reporter vector. The constructed recombinant plasmid was co-transfected into the cells with miR-29b-3p mimics (Sense: 5’-UAGCACCAUUUGAAAUCAGUGUU-3’; Antisense: 5’-CACUGAUUUCAAAUGGUGCUAUU-3’) or inhibitors and their respective negative controls (mimic NC, Sense: 5’-UUCUCCGAACGUGUCACGUTT-3’; Antisense: 5’-ACGUGACACGUUCGGAGAATT-3’). Forty-eight hours after transfection, the cells were collected, and the activities of firefly luciferase and renilla luciferase were determined using a dual luciferase detection reagent. Renilla luciferase activity was used as an internal reference for standardization.
RNA Immunoprecipitation (RIP) assay
For the RIP assay, Caco-2 cells were harvested, rinsed with PBS, and incubated on ice for 15 min in 200 µL of RIP lysis buffer supplemented with protease and RNase inhibitors. Cell lysates were centrifuged at 16,000 × g for 10 min at 4 °C, and 10 µL of each supernatant was retained as the input control. For immunoprecipitation, 40 µL of Protein A/G magnetic beads were rotated with 5 µg of anti-Ago2 antibody or normal IgG in 200 µL of RIP wash buffer for 30 min at room temperature. After three washes with 500 µL of RIP wash buffer, 100 µL of the bead suspension was combined with 100 µL of lysate, adjusted to a final volume of 1 mL with RIP wash buffer, and incubated overnight at 4 °C with rotation. The beads were then washed five times with 500 µL of RIP wash buffer and resuspended in 150 µL of the same buffer. Protein digestion was performed by adding 15 µL of proteinase K (20 mg/mL) and 15 µL of 10% SDS, followed by incubation at 55 °C for 30 min with shaking. The supernatant was collected, and RNA was isolated with the extraction reagent and precipitated overnight. Enrichment of NEAT1 and miR-29b-3p was then assessed by RT-qPCR.
Subcellular localization analysis
Caco-2 cells were separated into nuclear and cytoplasmic fractions using the referenced commercially available nuclear-cytoplasmic separation reagent, following the manufacturer’s instructions. Total RNA was extracted from these two components, and the distribution of NEAT1 in the nucleus and cytoplasm was detected by RT-qPCR. Calibration was performed using U6 (predominantly nuclear) and GAPDH mRNA (predominantly cytoplasmic) as indicators of separation efficiency.
Statistical analysis
For clinical serum samples, a power analysis (t-test, d = 0.5, α = 0.05, power = 0.9) indicated that a minimum of 86 subjects per group was required. To account for potential unforeseen circumstances during the trial, 116 patients were enrolled in each group to detect clinically significant differences. Data normality for continuous variables was evaluated using the Shapiro-Wilk test. Because all continuous data were normally distributed (P > 0.05), parametric analyses were applied. Categorical variables were analyzed using the chi-square test. Cell-based experiments included six independent biological replicates, with five technical replicates for each biological replicate. Data are presented as mean ± SD. Comparisons between two continuous-variable groups were performed using Student’s t-test, whereas comparisons among multiple groups were analyzed by one-way ANOVA followed by Tukey’s post hoc test. Statistical significance was defined as P < 0.05.