Eicosanoids and their role in the pathogenesis of diarrhoeal diseases.

Eicosanoids are unsaturated fatty acid compounds derived from 20-carbon 'essential' fatty acids, the most important being arachidonate. Both cyclooxygenase and lipoxygenase products of arachidonate are abundant in the human gut and their biological effects include modulation of fluid and electrolyte secretion, motor activity, mucosal blood flow, and cytoprotection, in addition to chemotaxis and immune response in inflammation. In health, these lipid mediators reinforce or synergize normal homeostatic mechanisms that could proceed in their absence. Receptors for control of intestinal secretion can be divided into two major classes, one of which triggers the production of cyclic AMP and another, which initiates phospholipid breakdown and arachidonate release. An intimate connection appears to exist between phospholipid metabolism, cytosolic Ca2+ levels, electrogenic anion secretion, Na+ pump rate, electroneutral Na+/H+ exchange activity, and intracellular pH. Ca2+-dependent secretagogues affect fluid and electrolyte transport in the small and the large bowel by increasing Ca2+ entry and Ca2+ mobilization through stimulation of eicosanoid formation, prostaglandins of the E type being the most important. Secretory diarrhoea may be thought of, therefore, as cellular Ca2+ intoxication. Uncontrolled formation of eicosanoids, perhaps with a changed spectrum of arachidonate metabolites, may not only be the source of diarrhoea associated with mucosal inflammation, but may also be critical for cell proliferation resulting in abnormal cell differentiation, which seems to be the link between long-standing inflammatory bowel disease and the increased risk of colonic neoplasia. A better understanding of the pathophysiological role of eicosanoids in diarrhoeal disease has allowed reinterpretation of the rationale behind current therapy.