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Gastrointestinal pain: Unraveling a novel endogenous pathway through uroguanylin/guanylate cyclase-C/cGMP activation

Silos-Santiago, Inmaculadaa,*; Hannig, Gerharda; Eutamene, Heleneb; Ustinova, Elena E.c; Bernier, Sylvie G.a; Ge, Peia; Graul, Christophera; Jacobson, Saraha; Jin, Honga; Liong, Elainea; Kessler, Marco M.a; Reza, Tammia; Rivers, Samuela; Shea, Courtneya; Tchernychev, Borisa; Bryant, Alexander P.a; Kurtz, Caroline B.a; Bueno, Lionelb; Pezzone, Michael A.c; Currie, Mark G.a

doi: 10.1016/j.pain.2013.05.044
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Summary Uroguanylin activation of the guanylate cyclase-C/cyclic guanosine monophosphate pathway elicits analgesic effects in animal models of colonic hypersensitivity, unraveling a novel pathway to treat abdominal pain.

ABSTRACT The natural hormone uroguanylin regulates intestinal fluid homeostasis and bowel function through activation of guanylate cyclase-C (GC-C), resulting in increased intracellular cyclic guanosine-3′,5′-monophosphate (cGMP). We report the effects of uroguanylin-mediated activation of the GC-C/cGMP pathway in vitro on extracellular cGMP transport and in vivo in rat models of inflammation- and stress-induced visceral hypersensitivity. In vitro exposure of intestinal Caco-2 cells to uroguanylin stimulated bidirectional, active extracellular transport of cGMP into luminal and basolateral spaces. cGMP transport was significantly and concentration dependently decreased by probenecid, an inhibitor of cGMP efflux pumps. In ex vivo Ussing chamber assays, uroguanylin stimulated cGMP secretion from the basolateral side of rat colonic epithelium into the submucosal space. In a rat model of trinitrobenzene sulfonic acid (TNBS)-induced visceral hypersensitivity, orally administered uroguanylin increased colonic thresholds required to elicit abdominal contractions in response to colorectal distension (CRD). Oral administration of cGMP mimicked the antihyperalgesic effects of uroguanylin, significantly decreasing TNBS- and restraint stress–induced visceromotor response to graded CRD in rats. The antihyperalgesic effects of cGMP were not associated with increased colonic spasmolytic activity, but were linked to significantly decreased firing rates of TNBS-sensitized colonic afferents in rats in response to mechanical stimuli. In conclusion, these data suggest that the continuous activation of the GC-C/cGMP pathway along the intestinal tract by the endogenous hormones guanylin and uroguanylin results in significant reduction of gastrointestinal pain. Extracellular cGMP produced on activation of GC-C is the primary mediator in this process via modulation of sensory afferent activity.

aIronwood Pharmaceuticals, Inc., Cambridge, MA, USA

bDepartment of Neuro-Gastroenterology and Nutrition Toxalim, UMR 131 INRA/EI-Purpan, Toulouse, France

cDepartment of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

* Corresponding author. Address: Ironwood Pharmaceuticals, Inc., 301 Binney Street, Cambridge, MA 02142, USA. Tel.: +1 617 768 2609; fax: +1 617 494 0480.

E-mail address:isilos-santiago@ironwoodpharma.com

Article history:

Received 30 July 2012

Received in revised form 13 May 2013

Accepted 29 May 2013

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

© 2013 Lippincott Williams & Wilkins, Inc.
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