Ultrastructural alterations in ileal M cells of rats after chronic ethanol ingestion: reversal after cessation of ethanol.

Membranous (M) cells within the dome epithelium of ileal Peyer's patches have been shown to provide selective antigen entry for mucosa-associated lymphoid tissue. This study produced morphologic evidence of ethanol-induced disruption of the architecture in follicle-associated epithelium. The adherens type junctions of the lateral plasma membranes between M cells and columnar absorptive cells were disrupted. A 45-day exposure by ingestion of ethanol also produced marked changes in the ultrastructure of M cells. All experimental animals showed mitochondrial swelling with loss of matrix density, dilation of the endoplasmic reticulum and cytoplasmic vacuolization. The ethanol content of serum and chyme samples were 180 mg/dl and 160 mg/dl, respectively. This was well below the 4,280 mg/dl of the diet therefore a systemic mechanism was implicated for the changes observed. Membranous cells from the recovery group were normal 15 days after withdrawal from ethanol. We concluded that the ethanol-induced cytopathology in ileal M cells is reversible when ethanol exposure is discontinued.     

Microparticulate polyelectrolyte complexes for gentamicin transport across intestinal epithelia

Polysaccharide microparticles for the oral administration of gentamicin were designed in order to obtain an increased drug absorption by means of microparticle transport across the intestinal epithelia. Alginate/chitosan microparticles with a size of ～?2 μm were developed by spray-drying a water solution containing the drug complexed with the polyanionic alginate and subsequent alginate cross-linking process by calcium ions and chitosan. The pre-formulation study, performed by changing the concentration of both cross-linkers, led to the selection of the most suitable formulation which was assayed for its capacity to be translocated across intestinal epithelia, via both M cells contained in Follicle Associated Epithelium (FAE) of Peyer’s patches and enterocytes of the mucosal epithelium. An ex vivo perfusion technique of rabbit and rat intestinal tissues containing Peyer’s patches combined with an in vitro method by using Caco-2 cell monolayers demonstrated the microparticulate carrier ability to be taken up by both M cells and enterocytes. However, only the endocytosis by M cells appeared to provide the microparticle transport from the epithelium toward deeper sub-epithelial regions.     

Absorption, accumulation and biological effects of depleted uranium in Peyer's patches of rats

The digestive tract is the entry route for radionuclides following the ingestion of contaminated food and/or water wells. It was recently characterized that the small intestine was the main area of uranium absorption throughout the gastrointestinal tract. This study was designed to determine the role played by the Peyer's patches in the intestinal absorption of uranium, as well as the possible accumulation of this radionuclide in lymphoid follicles and the toxicological or pathological consequences on the Peyer's patch function subsequent to the passage and/or accumulation of uranium. Results of experiments performed in Ussing chambers indicate that the apparent permeability to uranium in the intestine was higher (10-fold) in the mucosa than in Peyer's patches ((6.21+/-1.21 to 0.55+/-0.35)x10(-6)cm/s, respectively), demonstrating that the small intestinal epithelium was the preferential pathway for the transmucosal passage of uranium. A quantitative analysis of uranium by ICP-MS following chronic contamination with depleted uranium during 3 or 9 months showed a preferential accumulation of uranium in Peyer's patches (1355% and 1266%, respectively, at 3 and 9 months) as compared with epithelium (890% and 747%, respectively, at 3 and 9 months). Uranium was also detected in the mesenteric lymph nodes ( approximately 5-fold after contamination with DU). The biological effects of this accumulation of depleted uranium after chronic contamination were investigated in Peyer's patches. There was no induction of the apoptosis pathway after chronic DU contamination in Peyer's patches. The results indicate no change in the cytokine expression (Il-10, TGF-beta, IFN-gamma, TNF-alpha, MCP-1) in Peyer's patches and in mesenteric lymph nodes, and no modification in the uptake of yeast cells by Peyer's patches. In conclusion, this study shows that the Peyer's patches were a site of retention for uranium following the chronic ingestion of this radionuclide, without any biological consequences of such accumulation on Peyer's patch functions.     

Intestinal pathway of internalisation of lactic acid bacteria and gut mucosal immunostimulation

The induction of the gut mucosal immune response is dependent on the antigen interacting with the M cells of Peyer's patches and with the immune cells associated with this lymphoid organ. In previous studies we showed that the mucosal immunostimulation by LAB varied depending upon the strain being studied. Some of them increased the inflammatory immune response and others enhanced the level of secretory antibody (S-IgA). Our aim was to determine the pathway of the internalisation of LAB strains in the intestine, to provide a basis for understing the different behaviour exhibited by them. The presence of LAB on Peyer's patches or in the immune cells associated with the villi of small intestine was determined using fluorescein-labelled bacteria and by transmission electron microscopy. Mice were dosed orally by intubation, with 10¹ cells of labelled single strains of Lactobacillus casei, Lactobacillus acidophilus, Lactobacillus delbrueckii ssp. bulgaricus and Streptococcus thermophilus. For electron microscopy studies unlabelled bacteria were used. Histological preparations of the small and large intestine were performed 1 hour after administration of the bacteria. Fluorescent bacteria of L. casei and S. thermophilus were found only in Peyer's patches while L. delbrueckii ssp. bulgaricus and L. acidophilus were observed in Peyer's patches and in the small intestine. L. acidophilus was also found in the large intestine. We confirmed these findings by electron microscopy. We determined that for L. casei the pathway of internalisation was via the M and FAE cells of Peyer's patches, while for S. thermophilus, L. acidophilus and L. delbrueckii ssp. bulgaricus the interaction with the immune cells of Peyer's patches was through the follicle associated epithelium (FAE). L. delbrueckii ssp. bulgaricus and L. acidophilus also interacted with the epithelial cells of the small intestine and L. acidophilus with epithelial cells of the large intestine. These results suggest that the different effects of LAB on the mucosal immunostimulation, are related to the different pathways of gut internalisation used to take contact with the immune cells associated with the lamina propria intestinal.     

In Vivo Phage Display to Identify M Cell-Targeting Ligands

PURPOSE: The purpose of this study was to use in vivo phage display screening technology to identify novel lead peptides that target delivery to M cells and to follicle-associated epithelium (FAE) of the intestine. METHODS: Phage display libraries were screened in vivo within the gastrointestinal tract of a rat model by successive screenings across four cycles of selection. RESULTS: Following four cycles of in vivo screening, we identified 30 unique peptide sequences that bound to Peyer's patch tissue, human Caco-2, and rat IEC-6 epithelial cells. Two of the lead targeting peptides, peptides P8 (LETTCASLCYPS) and P25 (VPPHPMTYSCQY), were shown to bind to receptors on the surface of human intestinal tissue. The L-form, D-form, retro-inverted D-form, and selective Cys-to-Ala site-directed mutants of peptides P8 and P25 were also shown to retain binding to Caco-2 cell membranes when immobilized on the surface of a model particulate. Finally, the D-peptide analog of peptide P8 (yqcsytmphppv) enhanced the delivery of polystyrene particles to M cells in vivo in a mouse model, and these particles were delivered into Peyer's patch tissue, as determined by confocal microscopy. CONCLUSIONS: In summary, we have identified novel ligands that target M cells and Peyer's patch tissue, and thus may have utility in the targeted oral delivery of vaccines and vaccine carrier systems to the mucosal immune system within the gastrointestinal tract.     

Visualization of Insulin-Loaded Nanocapsules: In Vitro and in Vivo Studies After Oral Administration to Rats

Purpose. Biodegradable poly(isobutylcyanoacrylate) nanocapsules have been recognized as a promising carrier for oral administration of peptides and proteins. In the present study, we investigate the fate of insulin-loaded nanocapsules by fluorescence and transmission electron microscopy (TEM) after intragastric force-feeding to rats. Methods. Insulin-, Texas-red^®-labeled insulin, or gold-labeled insulin-loaded nanocapsules were first characterized. Rats received a single dose of nanocapsules (diameter 60-300 nm, 57 IU insulin/kg) by intragastric force-feeding. After 90 min, ileum was isolated and prepared for fluorescence and transmission electron microscopy. Results. Nanocapsules were observed on both sides of the gut epithelium and in blood capillaries. In M-cell-free epithelium, apparently intact nanocapsules could be seen in the underlying tissue, suggesting they could cross the epithelium and carry the encapsulated peptide. In M-cell-containing epithelium, nanocapsules appeared degraded in the vicinity of macrophages. It is noteworthy that intestinal absorption of nanocapsules was observed without artifacts forcing the nanocapsules to stay in the gut. Conclusions. Based on TEM observations, this study shows the intestinal absorption of biodegradable nanocapsules leading to the transport of insulin across the epithelium mucosa. The fate of the nanocapsules appeared different depending on the presence or the absence of M cells in the intestinal epithelium.     

Aminopeptidase Activity in the Jejunal and Heal Peyer's Patches of the Albino Rabbit

The objectives of this study were (a) to compare the aminopeptidase activity in the Peyer's patches of the jejunum and ileum of the albino rabbit against that in the adjacent patch-free segments and (b) to determine the relative sensitivities of the aminopeptidase activity in the Peyer's and non-Peyer's patches to aminopeptidase inhibitors and penetration enhancers. The results indicated that the Peyer's patches were about equal in aminopeptidase activity in the jejunum and in the ileum but were only 20–30% as rich in aminopeptidase activity as their neighboring patch-free areas. Compared to non-Peyer's patches, the aminopeptidase activity in the Peyer's patches was not as sensitive to the inhibitory effect of amastatin. It was, however, much more sensitive to the inhibitory effect of puromycin and p-chloromercuribenzoate and was somewhat more sensitive to the inhibitory effect of Na deoxycholate, Na glycocholate, and poly-oxyethylene-9-lauryl ether. Therefore, based on substrate preferences and on the relative sensitivity of aminopeptidase activity to inhibition by aminopeptidase inhibitors and penetration enhancers, the relative proportions of various aminopeptidases in the Peyer's patches and in the non-Peyer's patches are likely different.     

Ex vivo and in situ PLGA microspheres uptake by pig ileal Peyer's patch segment

We investigated the ability of pig ileal Peyer's patch segments to transport intestinal poly (D,L-lactide-co-glycolide) microspheres (PLGA MS) from intestinal lumen across the mucosae using in situ and ex vivo segments with confocal laser scanning microscopy (CLSM) and transmission electronic microscopy (TEM). From a global aspect, CLSM suggested that PLGA MS were translocated by M cells labelled with a FITC-conjugated anti-cytokeratin peptide 18, and transported through the follicle-associated epithelium (FAE) in the dome area in both types of experiments. At the ultrastructural level, TEM showed the traffic of PLGA MS throughout M cells, their transport into the basolateral invaginations of the M cells and their subsequent migration into the dome area and the follicular area in contact with macrophages and lymphatic vessels. Although in situ experiments allowed following the migration of PLGA MS until mesenteric lymph nodes, an ex vivo model could be used as a useful tool to study the targeting ability of PLGA MS formulations to the gut-associated lymphoid tissue (GALT).     

Keynote review: intestinal Peyer's patch M cells and oral vaccine targeting

Specialized M cells in the follicle-associated epithelium of intestinal Peyer's patches serve as portals for diverse particulates. Following antigen handover to dome lymphocytes, a protective mucosal antibody secretion ensues. One approach to oral vaccine delivery is to mimic the entry pathways of pathogens via M cells. The paucity of human tissue for in vitro investigation has hampered the discovery of M-cell pathogen receptors; however an in vitro human M like-cell culture model displays many expected phenotypic features. Comparative studies using microarrays reveal several novel M-cell surface receptors that could be used to potentially target orally delivered antigens.     

Use of fluorescence imaging to investigate the structure and function of intestinal M cells

Fluorescence imaging technology can be applied to many aspects of cell biology ranging from the analysis of specific markers in cells and tissues to the biological actions and distribution of fluorescent proteins or particles in living cells. In this review, we examine the role of fluorescence imaging, in conjunction with other microscopical techniques, to study sites of uptake of material across the gastrointestinal epithelium. We will focus primarily on intestinal M cells, specialised antigen-sampling cells in the epithelium of the gut-associated lymphoid tissue (GALT), including Peyer's patches. In addition to their importance as sites for uptake of inert material, and hence their potential as a route of delivery of vaccines, etc., M cells are also a major site of infection by a range of microbial pathogens. The application of new fluorescence imaging technologies has expanded our knowledge on the structure, development and function of these fascinating cells.     

In vivo uptake of chitosan microparticles by murine Peyer's patches: visualization studies using confocal laser scanning microscopy and immunohistochemistry

Although oral vaccination has numerous advantages over parenteral injection, degradation of the vaccine and low uptake by the gut associated lymphoid tissue (GALT) still complicate the development of efficient oral vaccines. However, previous studies in our laboratory demonstrated that chitosan microparticles can have suitable size, charge, loading and release characteristics for oral vaccination using ovalbumin as model vaccine. In this study, two different approaches were used to investigate the in vivo uptake of chitosan microparticles by murine Peyer's patches. Firstly, a confocal laser scanning microscopy (CLSM) study was performed to visualize the uptake of fluorescent-labeled chitosan microparticles in the Peyer's patches after intragastrical feeding. Subsequently, the intestinal epithelial uptake of ovalbumin loaded chitosan microparticles was visualized using immunohistochemical staining of ovalbumin. Because the microparticles are biodegradable, this entrapped ovalbumin will be released after intracellular digestion in the Peyer's patches. CLSM visualization demonstrated that chitosan microparticles enhance the uptake of fluorescent-labeled ovalbumin by the epithelium of the Peyer's patches. No ovalbumin uptake by the intestinal epithelium was observed when the protein was administered without microparticles. Moreover, immunohistochemical visualization studies revealed that ovalbumin could only be transported into the Peyer's patches after association to chitosan microparticles. Since uptake by Peyer's patches is an essential step in oral vaccination, these in vivo experiments demonstrate that chitosan microparticles are very promising vaccine delivery systems.     

Effect of various poloxamer coatings on in vitro adhesion of isohexylcyanoacrylate nanospheres to rat ileal segments under liquid flow

This work evaluates the bioadhesive properties of isohexylcyanoacrylate nanocapsules coated with poloxamers 407, 238, 403 and poloxamine 908 compared to nanoparticles coated with poloxamer 407. Nanocapsules (oil droplets surrounded by a polymeric wall) and nanoparticles (plain polymeric spheres) were prepared, labelled with covalently linked with tetraiodinated ¹²⁵I-phthalocyanine-Zn and laid on the rat ileal segment in vitro. After 0 and 10 min following transfer of nanospheres, a liquid flow was started. In all cases studied, a fraction of the nanospheres was not adherent when perfusion was initiated and was recovered in the first fraction. The other fraction, representing approx. 45% of the nanospheres, adhered firmly and was removed very slowly by the liquid flow. In addition, when nanocapsules were coated with poloxamers 238 and 407, the percentage adhesion increased between and 10 min. Our results demonstrate that the greatest extent of mucoadhesion was achieved with poloxamers possessing a short centra polyoxypropylene (POP) chain and long polyoxyethylene (POE) side chains. The results are discussed on the basis of diffusion of the POE groups into the mucin network and creation of secondary chemical adhesive bonds (Van der Waals type) between the nanosphere coating and mucus.     

Effect of cyclophosphamide on T-lymphocyte marker expression in T-cell areas of some lymphoid organs of the rat

Surface markers on rat lymphocytes from thymus and T-cell areas of lymph node, spleen and Peyer's patches were examined in histological sections after one single dose of Cyclophosphamide (CY, 100 mg/kg body weight). A panel of monoclonal antibodies was used: W3/13, W3/25 and OX8 to investigate Pan T, TH and Ts/c marker expressions respectively. Ts/c marker expression showed a marked and significant reduction in both thymus and lymph node lymphocytes 3 days after CY treatment. This was followed by return to normal in the thymus and a significant rebound increase in the lymph node by day 7 after treatment. This Ts/c marker expression in both the spleen and Peyer's patches showed a significant increase on both day 3 and 7 after CY treatment. Mast cells were observed in large numbers in the thymus and lymph node but not in the spleen and Peyer's patches. TH marker expression was increased significantly in lymph nodes, spleen and Peyer's patches. No change was observed in Pan T marker expression in any of the tissues at any of the times examined.     

Uptake of Phosphatidylserine Liposomes by Rat Peyer's Patches Following Intraluminal Administration

Uptake of the nonabsorbable marker 6-carboxyfluorescein was investigated both free and encapsulated in liposomes as a function of their surface charge and hydrodynamic diameter in rat Peyer's patch and nonpatch tissue. Significant uptake of the marker occurred only when encapsulated in liposomes consisting of at least 25 mol% phosphatidylserine and was highest in Peyer's patches. 6-Carboxyfluorescein encapsulated in liposomes equal to or greater than 374 nm was preferentially taken up by Peyer's patches. There was a trend to higher uptake in lower intestinal segments. These findings were supported by fluorescence microscopic observations. Uptake by Peyer's patches was specific for negatively charged liposomes as judged from competition studies.     

Elevated membrane IgA+ and CD4+ (T helper) populations in murine Peyer's patch and splenic lymphocytes during dietary administration of the trichothecene vomitoxin (deoxynivalenol)

Recent investigations indicate that dietary exposure to the trichothecene vomitoxin increases total and antigen-specific serum immunoglobulin A (IgA) and glomerular IgA accumulation in mice. In this study, the effects of 25 ppm dietary vomitoxin on the histological and lymphocytic profile of component immune organs in the mucosal lymphocyte migratory pathway were evaluated in the B6C3F1 mouse. Vomitoxin administration resulted in marked stimulation of the size and frequency of germinal centres in Peyer's patches, mesenteric lymph nodes and the spleen. A slight increase in the percentage of B cells in the Peyer's patch was observed, although vomitoxin treatment had no effect on the percentage of B cells in the spleen. The percentage of IgA+ cells in Peyer's patches and spleen were approximately twice that of controls at 4, 8 and 12 wk of vomitoxin exposure whereas the percentage of IgG+ cells decreased in these two organs. Exposure to vomitoxin increased the percentage of T cells in Peyer's patches and the spleen. The percentage of CD4+ cells (T helper subset) increased slightly in Peyer's patches and more markedly (30-50%) in the spleen following vomitoxin treatment. Contrastingly, there was only a slight increase in the percentage of CD8+ cells (T cytotoxic/suppressor subset) in the spleens of vomitoxin-treated mice in comparison with controls, and no effect in Peyer's patches. The relative effects of vomitoxin on these two T cells populations was also reflected in increased CD4+: CD8+ ratios in Peyer's patches and spleen. These results are consistent with the hypothesis that dietary vomitoxin modulates normal regulation of the IgA response at the Peyer's patch level and that this is manifested in an altered lymphocyte distribution pattern in both the mucosal and systemic compartment. Notably increased levels of IgA+ and CD4+ cells are indicative of IgA-producing progenitors and T helper subsets, respectively, that in tandem could favour IgA hyperproduction and elevated IgA in serum.     

Characterization of M cell development during indomethacin-induced ileitis in rats

BACKGROUND: M cells play an important role in the intestinal immune system as they have a high capacity for transcytosis of a wide range of microorganisms and macromolecules. However, little is known about the role of M cells during intestinal inflammation. AIM: We studied M cell development during indomethacin-induced intestinal inflammation in rats. METHODS: Ileitis in rats was induced by two subcutaneous injections with indomethacin (7.5 mg/kg) given 24 h apart. Rats were sacrificed after 14 days and tissue was analysed by fluorescence microscopy and electron microscopy. M cells could be visualized by using the FITC-labelled mAb anti-cytokeratin (CK)-8 (clone 4.1.18), which was recently identified as specific M cell marker in rats. The number of cytokeratin-8 positive M cells was related to the surface of the follicle associated epithelium. For morphological studies, we used both transmission electron microscopy (T.E.M.) and scanning electron microscopy (S.E.M.). RESULTS: In non-inflamed ileum M cells were scarce. Only 4% of the follicle associated epithelium were M cells, whereas an increase of M cells up to 11% was found in inflamed follicle associated epithelium (P < 0.001). The rate of M cell induction depended on the macroscopic degree of inflammation. T.E.M./S.E.M. studies showed that in inflamed tissue most M cells underwent apoptosis with typical morphological signs. In contrast to apoptotic M cells, the neighbouring enterocytes usually appeared intact. The number of mononuclear cells below the follicle associated epithelium was significantly increased. S.E.M. studies revealed that during induced ileitis mononuclear cells migrated from the lamina propria into the gut lumen by passing through apoptotic M cells. CONCLUSIONS: During indomethacin-induced ileitis in rats the increase in M cell number in association with apoptosis of M cells may alter the intestinal barrier function. These observations may play a pivotal role in the pathogenesis of chronic intestinal inflammation, e.g. in inflammatory bowel disease.     

Stability of Liposomes in Vitro and Their Uptake by Rat Peyer's Patches Following Oral Administration

To evaluate the usefulness of liposomes as a carrier for the targeted delivery of antigens to gut-associated lymphoid tissue, liposomal stability and uptake by rat Peyer's patches were investigated. Liposomes composed of distearoylphosphatidylcholine, phosphatidylserine, and cholesterol (DSPC-liposome), or dipalmitoylphosphatidylcholine, phosphatidylserine, and cholesterol were stable in acidic solution (pH 2.0), diluted bile, and pancreatin solution. Following the oral administration of liposomes to rats, rhodamine B-PE incorporated in the lipid phase of DSPC-liposomes was preferentially taken up by Peyer's patches in the lower ileum. The uptake of rhodamine B-PE from DSPC-liposomes larger than 374 nm in mean diameter was high. Orally administered DSPC-liposomes of a large diameter thus appear to serve effectively as a vehicle for delivering antigens to Peyer's patches.     

Incorporation of the reovirus M cell attachment protein into small unilamellar vesicles: incorporation efficiency and binding capability to L929 cells in vitro

Neutral phosphatidylcholine/cholesterol (10 : 3) liposomes with the reovirus M cell attachment protein sigma 1 were made by means of detergent dialysis method. An immunological evaluation method revealed an incorporation efficiency (pg protein/microgram lipid) of 314. Binding studies with mouse fibroblasts (L929 cells) yielded a 10 fold improvement of uptake of coated liposomes compared to uncoated liposomes. Competition studies with reovirus serotype 3 demonstrated that coated liposomes were capable of binding to the reovirus receptor. In vitro incubation of rat Peyer's patches with either coated or uncoated liposomes resulted in a 10-20 fold higher uptake of the coated liposomes. These results suggest that selective adherence of a carrier system to M cells may facilitate delivery of carrier contents to mucosal underlying lymphoid tissue, thereby enhancing immune response.     

Ex-vivo evaluation of alginate microparticles for Polymyxin B oral administration

A crosslinked alginate microparticle system for the targeting to the lymphatic system by Peyer's patches (PP) uptake was designed in order to improve the oral absorption of Polymyxin B (PMB). To verify mucoadhesion and PP uptake, microparticles labelled with fluorescein isothiocyanate (FITC) were prepared by spray-drying technique and crosslinking reactions with calcium ions and chitosan (CS), in vitro characterized and assayed by an ex vivo method. Microparticles showed a size less then 3 microm, an antibiotic loading level of 11.86 +/- 0.70%, w/w, a sustained drug release behaviour in simulated gastro-intestinal (GI) fluids and a preserved biological activity throughout the manufacture. The ex vivo study was performed by a perfusion method on intestinal tracts of just sacrificed adult rats. The recovered samples were analysed by epifluorescence microscope for mucoadhesion and PP uptake and by microbiological analysis for antibiotic activity preservation, providing evidence of mucoadhesion at the level of both PP and non-PP epithelium, uptake by PP and PMB microbiological activity in PP tissue. Furthermore, the study revealed the involvement of transport pathways across villous enterocytes.     

Bioadhesion of Lectin-Latex Conjugates to Rat Intestinal Mucosa

Purpose. The specific interactions between three lectin-latex conjugates and different structures of rat intestinal mucosa have been studied ex vivo. Methods. These systems were prepared by covalent coupling of different ligands, i.e., tomato lectin (TL), asparagus pea lectin (AL), myco-plasma gallisepticum lectin (ML), and bovine serum albumin (BSA) as control, to poly(styrene) latexes. Results. Using mucosa samples without Peyer's patches (PP), the extent of interaction of all three lectin-latex conjugates with the mucosa decreased from duodenum to ileum, probably due to progressive diminution of the mucin concentration along the gastrointestinal tract. The following order of interaction of the conjugates with the mucus gel layer was observed: TL > ML = AL (p < 0.05). For each lectin, these results corresponded well to the concentration of its specific sugar in the mucus. Using intestinal samples with PP, an important increase of interaction of the conjugates with the mucosa was found for ML (about 25%) and AL (about 50%), whereas the interaction of TL decreased about 25%. Conclusions. Photomicrographs with fluorescent latexes have confirmed the specificity of the ML- and AL-latex conjugates for the PP region and of the TL-latex conjugates for the mucus gel.