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促肾上腺皮质激素释放因子1受体作为肠易激综合征的治疗靶点

CRF1 receptors as a therapeutic target for irritable bowel syndrome.

作者信息

Martinez V, Taché Y

机构信息

Integrative Pharmacology--Gastrointestinal Biology, AstraZeneca R&D, Mölndal, Sweden.

出版信息

Curr Pharm Des. 2006;12(31):4071-88. doi: 10.2174/138161206778743637.

Abstract

The characterization of the corticotropin-releasing factor (CRF) family of neuroendocrine regulatory peptides, the cloning and pharmacological characterization of two CRF receptor subtypes (CRF(1) and CRF(2)), and the development of selective CRF receptor antagonists provided new insight to unravel the mechanisms of stress and the potential involvement of the CRF system in different pathophysiological conditions, including functional gastrointestinal disorders, mainly irritable bowel syndrome (IBS), and psychopathologies such as anxiety/depression. Compelling pre-clinical data showed that brain CRF administration mimics acute stress-induced colonic responses and enhances colorectal distension-induced visceral pain in rats through CRF(1) receptors. Similarly, peripheral CRF reduced the pain threshold to colonic distension and increased colonic motility in humans and rodents. These observations mimic the manifestations of IBS, characterized by abdominal bloating/discomfort and altered bowel habits. Moreover, CRF-CRF(1) pathways have been implicated in the development of anxiety/depression. These psychopathologies, together with stressful life events, have high comorbidity with IBS, and are considered significant components of the disease. From these observations, CRF(1) receptors have been suggested as a target to treat IBS. Peripherally acting CRF(1) antagonists might directly improve IBS symptoms, as related to motility, secretion and immune response. On the other hand, central actions will be beneficial as to prevent the psychopathologies that co-exist with IBS and as a way to modulate the central processing of stress- and visceral pain-related signals. Here, we review the pre-clinical and clinical data supporting these assumptions, and address the efforts done at a pharmaceutical level to develop effective therapies targeting CRF(1) receptors for functional gastrointestinal disorders.

摘要

神经内分泌调节肽促肾上腺皮质激素释放因子(CRF)家族的特性、两种CRF受体亚型(CRF(1)和CRF(2))的克隆及药理学特性,以及选择性CRF受体拮抗剂的研发,为揭示应激机制以及CRF系统在不同病理生理状况(包括功能性胃肠疾病,主要是肠易激综合征(IBS),以及焦虑/抑郁等精神病理学)中的潜在作用提供了新的见解。令人信服的临床前数据表明,在大鼠中脑内给予CRF可模拟急性应激诱导的结肠反应,并通过CRF(1)受体增强结直肠扩张诱导的内脏疼痛。同样,外周给予CRF可降低人类和啮齿动物对结肠扩张的疼痛阈值,并增加结肠动力。这些观察结果模拟了以腹胀/不适和排便习惯改变为特征的IBS的表现。此外,CRF - CRF(1)通路与焦虑/抑郁的发生有关。这些精神病理学状况与应激性生活事件一起,与IBS的共病率很高,被认为是该疾病的重要组成部分。基于这些观察结果,CRF(1)受体已被建议作为治疗IBS的靶点。外周作用的CRF(1)拮抗剂可能直接改善与动力、分泌和免疫反应相关的IBS症状。另一方面,中枢作用将有助于预防与IBS共存的精神病理学状况,并作为调节与应激和内脏疼痛相关信号的中枢处理的一种方式。在此,我们综述支持这些假设的临床前和临床数据,并探讨在药物层面为开发针对功能性胃肠疾病的CRF(1)受体有效疗法所做的努力。

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