Guanylin: a peptide regulator of epithelial transport.

Regulation of intestinal salt and water transport is critical to the maintenance of fluid volume. Control of this life-sustaining activity is mediated by the concerted actions of hormones, neurotransmitters, and locally acting factors. The intestinal peptide guanylin is ideally suited to play a pivotal role in this regulation. Guanylin is produced by the epithelium and appears to be secreted mucosally to act locally on an apical receptor. The guanylin receptor is a member of the guanylate cyclase (GC-C) family of proteins. Elevation of intracellular cyclic GMP by guanylin mediates the stimulation of Cl- secretion, which results in the increased intestinal fluid secretion. Proguanylin is found in the circulation and GC-C occurs in other epithelia, suggesting that guanylin plays an endocrine role by regulating the function of tissues such as the kidney and liver. Uroguanylin is a structurally related peptide that is abundant in urine, has biological activity similar to guanylin, and appears to be made by the intestine. This peptide may link the intestine and kidney in an endocrine pathway for control of renal salt excretion. Overproduction of guanylin/uroguanylin would be expected to elicit secretory diarrhea similar to that caused by the bacteria that produce peptide analogs of these endogenous peptide hormones. This unique molecular mimicry has provided clues leading to the discovery of guanylin and insight into the mechanism of action of these intestinal peptides. The discoveries of guanylin and uroguanylin have provided exciting opportunities for further enhancing our understanding of epithelial transport and function.