Division of Gastroenterology, Department of Internal Medicine, Enteric Neuromuscular Disorders and Visceral Pain Center, The University of Texas Medical Branch, Galveston, TX, USA.
Department of Neuroscience and Cell Biology, The University of Texas Medical Branch, Galveston, TX, USA.
Neurogastroenterol Motil. 2017 Sep;29(9). doi: 10.1111/nmo.13081. Epub 2017 Apr 25.
Abdominal pain is one of the major symptoms of inflammatory Bowel Disease (IBD). The inflammatory mediators released by colon inflammation are known to sensitize the afferent neurons, which is one of the contributors to abdominal pain. However, not all IBD patients have abdominal pain, and some patients report abdominal pain during remission, suggesting contributions of other pathological factors to abdominal pain in IBD. Epidemiological studies found early-life gastrointestinal infections a risk factor for IBD symptoms and adult-life gastrointestinal infections may trigger the onset of IBD. We investigated the hypothesis that neonatal colon immune challenge followed by an adult colon immune challenge upregulates spinal cord BDNF that aggravates visceral sensitivity over and above that induced by adult colon immune challenge alone.
We induced neonatal and adult colon immune challenges by intraluminal administration of trinitrobenzene sulfonic acid to the rat colon.
We found that neonatal immune challenge triggers epigenetic programming that upregulates tyrosine hydroxylase in the locus ceruleus when these rats are subjected to an adult colon immune challenge. The upregulation of locus ceruleus tyrosine hydroxylase, upregulates norepinephrine in the cerebrospinal fluid that acts on adrenergic receptors to enhance pCREB binding to the cAMP response element, which recruits histone acetylene transferase (HAT) to the BDNF gene to enhance its transcription resulting in aggravated visceromotor response to colorectal distension. HAT and adrenergic receptor antagonists block the aggravation of visceral sensitivity.
CONCLUSION & INFERENCES: HAT and adrenergic receptor inhibitors may serve as alternates to opioids and NSAIDS in suppressing abdominal pain in IBD.
腹痛是炎症性肠病(IBD)的主要症状之一。已知结肠炎症释放的炎症介质会使传入神经元敏感化,这是腹痛的原因之一。然而,并非所有 IBD 患者都有腹痛,有些患者在缓解期报告腹痛,这表明其他病理因素也会导致 IBD 患者腹痛。流行病学研究发现,生命早期的胃肠道感染是 IBD 症状的一个危险因素,而成年后的胃肠道感染可能会引发 IBD 的发作。我们假设,新生儿结肠免疫挑战后再进行成年结肠免疫挑战,会导致脊髓 BDNF 上调,从而加剧内脏敏感性,超过仅进行成年结肠免疫挑战所引起的程度。
我们通过向大鼠结肠内注入三硝基苯磺酸来诱导新生儿和成年结肠免疫挑战。
我们发现,新生儿免疫挑战会触发表观遗传编程,当这些大鼠接受成年结肠免疫挑战时,蓝斑核中的酪氨酸羟化酶上调。蓝斑核酪氨酸羟化酶的上调会增加脑脊液中的去甲肾上腺素,去甲肾上腺素作用于肾上腺素能受体,增强 pCREB 与 cAMP 反应元件的结合,募集组蛋白乙酰转移酶(HAT)到 BDNF 基因,增强其转录,从而导致结直肠扩张时内脏运动反应加剧。HAT 和肾上腺素能受体拮抗剂可阻断内脏敏感性的加剧。
HAT 和肾上腺素能受体抑制剂可能可作为 IBD 中抑制腹痛的阿片类药物和 NSAIDs 的替代品。