Zhong Weixia, Picca Andrew J, Lee Albert S, Darmani Nissar A
Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA.
Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA.
Auton Neurosci. 2017 Jan;202:18-27. doi: 10.1016/j.autneu.2016.07.006. Epub 2016 Jul 26.
Cisplatin-like chemotherapeutics cause vomiting via calcium (Ca)-dependent release of multiple neurotransmitters (dopamine, serotonin, substance P, etc.) from the gastrointestinal enterochromaffin cells and/or the brainstem. Intracellular Ca signaling is triggered by activation of diverse emetic receptors (including tachykininergic NK, serotonergic 5-HT, dopaminergic D, cholinergic M, or histaminergic H) whose activation in vomit-competent species can evoke emesis. Other emetogens such as cisplatin, rotavirus NSP4 protein and bacterial toxins can also induce intracellular Ca elevation. Netupitant is a highly selective neurokinin NK receptor (NKR) antagonist and palonosetron is a selective second-generation serotonin 5-HT receptor (5-HTR) antagonist with a distinct pharmacological profile. An oral fixed combination of netupitant/palonosetron (NEPA; Akynzeo(®)) with >85% antiemetic efficacy is available for use in the prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV). Cannabinoid CB receptor agonists possess broad-spectrum antiemetic activity since they prevent vomiting caused by a variety of emetic stimuli including the chemotherapeutic agent cisplatin, 5-HTR agonists, and DR agonists. Our findings demonstrate that application of the L-type Ca channel (LTCC) agonist FPL 64176 and the intracellular Ca mobilizing agent thapsigargin (a sarco/endoplasmic reticulum Ca-ATPase inhibitor) cause vomiting in the least shrew. On the other hand, blockade of LTCCs by corresponding antagonists (nifedipine or amlodipine) not only provide broad-spectrum antiemetic efficacy against diverse agents that specifically activate emetogenic receptors such as 5-HT, NK, D, and M receptors, but can also potentiate the antiemetic efficacy of palonosetron against the non-specific emetogen, cisplatin. In this review, we will provide an overview of Ca involvement in the emetic process; discuss the relationship between Ca signaling and the prevailing therapeutics in control of vomiting; highlight the evidence for Ca-signaling blockers/inhibitors in suppressing emetic behavior in the least shrew model of emesis as well as in the clinical setting; and also draw attention to the clinical benefits of Ca-signaling blockers/inhibitors in the treatment of nausea and vomiting.
顺铂类化疗药物通过胃肠道肠嗜铬细胞和/或脑干中钙(Ca)依赖性释放多种神经递质(多巴胺、5-羟色胺、P物质等)来引发呕吐。细胞内Ca信号传导由多种催吐受体(包括速激肽能NK、5-羟色胺能5-HT、多巴胺能D、胆碱能M或组胺能H)的激活所触发,这些受体在有呕吐反应的物种中被激活时可引发呕吐。其他催吐剂,如顺铂、轮状病毒NSP4蛋白和细菌毒素,也可诱导细胞内Ca升高。奈妥匹坦是一种高度选择性的神经激肽NK受体(NKR)拮抗剂,帕洛诺司琼是一种具有独特药理学特征的选择性第二代5-羟色胺5-HT受体(5-HTR)拮抗剂。奈妥匹坦/帕洛诺司琼(NEPA;Akynzeo®)的口服固定组合具有超过85%的止吐疗效,可用于预防急性和迟发性化疗引起的恶心和呕吐(CINV)。大麻素CB受体激动剂具有广谱止吐活性,因为它们可预防由多种催吐刺激引起的呕吐,包括化疗药物顺铂、5-HTR激动剂和多巴胺受体激动剂。我们的研究结果表明,应用L型钙通道(LTCC)激动剂FPL 64176和细胞内Ca动员剂毒胡萝卜素(一种肌浆网/内质网Ca-ATP酶抑制剂)可使最小的鼩鼱发生呕吐。另一方面,相应拮抗剂(硝苯地平或氨氯地平)对LTCC的阻断不仅对特异性激活催吐受体(如5-HT、NK、D和M受体)的多种药物具有广谱止吐疗效,而且还可增强帕洛诺司琼对非特异性催吐剂顺铂的止吐疗效。在本综述中,我们将概述Ca在呕吐过程中的作用;讨论Ca信号传导与控制呕吐的现有治疗方法之间的关系;强调Ca信号传导阻滞剂/抑制剂在最小鼩鼱呕吐模型以及临床环境中抑制呕吐行为的证据;并提请注意Ca信号传导阻滞剂/抑制剂在治疗恶心和呕吐方面的临床益处。