Pertwee R G
Department of Biomedical Sciences, Institute of Medical Sciences, University of Aberdeen Foresterhill, Aberdeen AB25 2ZD, UK.
Gut. 2001 Jun;48(6):859-67. doi: 10.1136/gut.48.6.859.
The enteric nervous system of several species, including the mouse, rat, guinea pig and humans, contains cannabinoid CB1 receptors that depress gastrointestinal motility, mainly by inhibiting ongoing contractile transmitter release. Signs of this depressant effect are, in the whole organism, delayed gastric emptying and inhibition of the transit of non-absorbable markers through the small intestine and, in isolated strips of ileal tissue, inhibition of evoked acetylcholine release, peristalsis, and cholinergic and non-adrenergic non-cholinergic (NANC) contractions of longitudinal or circular smooth muscle. These are contractions evoked electrically or by agents that are thought to stimulate contractile transmitter release either in tissue taken from morphine pretreated animals (naloxone) or in unpretreated tissue (gamma-aminobutyric acid and 5-hydroxytryptamine). The inhibitory effects of cannabinoid receptor agonists on gastric emptying and intestinal transit are mediated to some extent by CB1 receptors in the brain as well as by enteric CB1 receptors. Gastric acid secretion is also inhibited in response to CB1 receptor activation, although the detailed underlying mechanism has yet to be elucidated. Cannabinoid receptor agonists delay gastric emptying in humans as well as in rodents and probably also inhibit human gastric acid secretion. Cannabinoid pretreatment induces tolerance to the inhibitory effects of cannabinoid receptor agonists on gastrointestinal motility. Findings that the CB1 selective antagonist/inverse agonist SR141716A produces in vivo and in vitro signs of increased motility of rodent small intestine probably reflect the presence in the enteric nervous system of a population of CB1 receptors that are precoupled to their effector mechanisms. SR141716A has been reported not to behave in this manner in the myenteric plexus-longitudinal muscle preparation (MPLM) of human ileum unless this has first been rendered cannabinoid tolerant. Nor has it been found to induce "withdrawal" contractions in cannabinoid tolerant guinea pig ileal MPLM. Further research is required to investigate the role both of endogenous cannabinoid receptor agonists and of non-CB1 cannabinoid receptors in the gastrointestinal tract. The extent to which the effects on gastrointestinal function of cannabinoid receptor agonists or antagonists/inverse agonists can be exploited therapeutically has yet to be investigated as has the extent to which these drugs can provoke unwanted effects in the gastrointestinal tract when used for other therapeutic purposes.
包括小鼠、大鼠、豚鼠和人类在内的几种物种的肠神经系统含有大麻素CB1受体,这些受体主要通过抑制正在进行的收缩性递质释放来抑制胃肠蠕动。在整个生物体中,这种抑制作用的表现为胃排空延迟以及不可吸收标记物在小肠中的转运受到抑制;在离体的回肠组织条中,表现为诱发的乙酰胆碱释放、蠕动以及纵行或环行平滑肌的胆碱能和非肾上腺素能非胆碱能(NANC)收缩受到抑制。这些收缩是通过电刺激或被认为能刺激收缩性递质释放的药物诱发的,这些药物作用于取自吗啡预处理动物(纳洛酮)的组织或未预处理的组织(γ-氨基丁酸和5-羟色胺)。大麻素受体激动剂对胃排空和肠道转运的抑制作用在一定程度上是由脑中的CB1受体以及肠内的CB1受体介导的。尽管具体的潜在机制尚待阐明,但CB1受体激活也会抑制胃酸分泌。大麻素受体激动剂在人类和啮齿动物中都会延迟胃排空,并且可能也会抑制人类胃酸分泌。大麻素预处理会诱导对大麻素受体激动剂对胃肠蠕动抑制作用的耐受性。CB1选择性拮抗剂/反向激动剂SR141716A在体内和体外都能产生啮齿动物小肠运动增加的迹象,这一发现可能反映了肠神经系统中存在一群与效应器机制预先偶联的CB1受体。据报道,SR141716A在人回肠的肌间神经丛-纵行肌标本(MPLM)中不会以这种方式起作用,除非该标本首先产生大麻素耐受性。在大麻素耐受的豚鼠回肠MPLM中也未发现它会诱导“戒断”收缩。需要进一步研究来调查内源性大麻素受体激动剂和非CB1大麻素受体在胃肠道中的作用。大麻素受体激动剂或拮抗剂/反向激动剂对胃肠功能的影响在治疗上的可利用程度尚未得到研究,这些药物在用于其他治疗目的时在胃肠道中引发不良影响的程度也尚未得到研究。