Enterocyte death and intestinal barrier maintenance in homeostasis and disease

The intestinal epithelium is the largest surface area of the body in contact with the external environment. This specialized single cell layer is constantly renewed and is a physical barrier that separates intestinal microbiota from underlying tissues, preventing bacterial infiltration and subsequent inflammation. Specialized secretory epithelial cell types such as Paneth cells and goblet cells limit bacterial adhesion and infiltration by secreting antibacterial peptides and mucins, respectively. Rapid cell renewal coincides with apical exfoliation of 'old' enterocytes without compromising epithelial barrier integrity. When the intestinal epithelium is inflamed barrier integrity can be compromised, due to uncontrolled death of enterocytes allowing bacterial infiltration. This review discusses the different mechanisms which regulate or affect intestinal barrier integrity under homeostatic and inflammatory conditions.