Role of nitric oxide in mediating non-adrenergic non-cholinergic relaxation of the cat ileocecal sphincter

Ileocecal junction: anatomic, histologic, radiologic and endoscopic studies with special reference to its antireflux mechanism

AIM

The aim of the study was to perform histomorphologic, endoscopic, and radiologic studies of the ileocecal junction (ICJ). A clearer understanding of the anatomical structure of the ICJ may shed some light on its function.

METHODS

Histomorphologic studies were performed in 18 cadavers and radiologic in 22 and endoscopic in 10 healthy volunteers. Morphologic studies were done with the help of a magnifying loupe: histologic sections were stained with hematoxylin and eosin and Masson's trichrome. The ICJ was studied radiologically using the method of small bowel meal. Endoscopic study was done under controlled air inflation using a video endoscope.

RESULTS

A nipple (1.5-2 cm long) with transversely lying stoma protruded from the medial wall of the cecum. A fornix was found on each side. The nipple stoma was surrounded by two lips: upper and lower. A mucosal fold started at both angles of the stoma and extended along the cecal circumference. It was marked on the outer cecal aspect by a groove.

CONCLUSION

The ileocecal nipple is a muscular tube with a transversely lying stoma and is suspended to the cecal wall by a "suspensory ligament". The morphologic structure of the ileocecal nipple was confirmed endoscopically and radiologically. The ileocecal nipple was closed at rest and opened upon terminal ileal contraction to deliver ileal contents to the cecum. It evacuated the barium periodically into the cecum. The ileocecal nipple structure seems to be adapted to serve the function of cecoileal antireflux.

Gastrointestinal Function Regulation by Nitrergic Efferent Nerves

Gastrointestinal (GI) smooth muscle responses to stimulation of the nonadrenergic noncholinergic inhibitory nerves have been suggested to be mediated by polypeptides, ATP, or another unidentified neurotransmitter. The discovery of nitric-oxide (NO) synthase inhibitors greatly contributed to our understanding of mechanisms involved in these responses, leading to the novel hypothesis that NO, an inorganic, gaseous molecule, acts as an inhibitory neurotransmitter. The nerves whose transmitter function depends on the NO release are called "nitrergic", and such nerves are recognized to play major roles in the control of smooth muscle tone and motility and of fluid secretion in the GI tract. Endothelium-derived relaxing factor, discovered by Furchgott and Zawadzki, has been identified to be NO that is biosynthesized from l-arginine by the constitutive NO synthase in endothelial cells and neurons. NO as a mediator or transmitter activates soluble guanylyl cyclase and produces cyclic GMP in smooth muscle cells, resulting in relaxation of the vasculature. On the other hand, NO-induced GI smooth muscle relaxation is mediated, not only by cyclic GMP directly or indirectly via hyperpolarization, but also by cyclic GMP-independent mechanisms. Numerous cotransmitters and cross talk of autonomic efferent nerves make the neural control of GI functions complicated. However, the findingsrelated to the nitrergic innervation may provide us a new way of understanding GI tract physiology and pathophysiology and might result in the development of new therapies of GI diseases. This review article covers the discovery of nitrergic nerves, their functional roles, and pathological implications in the GI tract.

Muscarinic modulation of nitrergic neurotransmission in guinea-pig gastric fundus

Muscarinic receptor activation by (4-Hydroxy-2-butynyl)-1-trimethylammonium-m-chlorocarbanilate chloride (McN-A-343) was investigated both on NADPH-d staining and on electrically induced responses in guinea-pig gastric fundus. McN-A-343 (10 micromol L(-1)) significantly increased the optical density of NADPH-d positive neurones, while blockade of nitric oxide synthase with N(omega)-nitro-L-arginine (L-NA) decreased it, suggesting facilitation of nitric oxide (NO) production. Electrical field stimulation (EFS; 2 Hz, 0.2 ms, supramaximal current intensity, 10 s train duration) elicited on-contraction followed by off-relaxation in the circular muscle strips. McN-A-343 (10 micromol L(-1)) transformed the EFS-evoked response from on-contraction into on-relaxation, which was neurogenic, tetrodotoxin-sensitive and hexamethonium-resistant. L-NA partly reduced the EFS-evoked relaxation, revealing two components: a nitrergic and a non-nitrergic one. The effect of McN-A-343 on the amplitude of the EFS-evoked relaxation was not changed by the M(3) receptor antagonist para-fluoro-hexahydro-sila-difenidol hydrochloride, but was significantly enhanced by M(1) receptor blockade with telenzepine. In the presence of telenzepine, the L-NA-dependent nitrergic component of the EFS-induced relaxation predominates. We suggest that cholinergic receptor activation has a dual effect on nitrergic neurotransmission: (i) stimulation of NOS by muscarinic receptor(s) different from M(1) and M(3) subtype, (ii) prejunctional inhibition of NO-mediated relaxation via M(1) receptors. In addition, M(1) receptors may facilitate the non-nitrergic relaxation.

Neurogenic pathways mediating ascending and descending reflexes at the porcine ileocolonic junction

We studied the pharmacology of the neural pathways mediating the responses of ileo- and coloileo-colonic junction (ICJ) to regional distension in ten anaesthetized pigs. Using manometric pullthroughs and a sleeve sensor, we found the ICJ demonstrated sustained tone that was resistant to tetrodotoxin. Ileal distension decreased ICJ pressure by 22.2 ¿ 10.1% (11.9 ¿ 2.7-10.1 ¿ 2.6 mmHg; P=0.002) and colonic distension augmented ICJ pressure by 23.5 ¿ 8.6% (12.8 ¿ 1.5-15.6 ¿ 2.1 mmHg; P=0.02). Bethanecol and Nw-nitro-L-arginine methyl ester (L-NAME) increased ICJ pressure (P=0.002, P=0.01, respectively). Sodium nitroprusside and isoproterenol reduced ICJ pressure (P=0.004, P=0.02, respectively). In the presence of L-NAME, the early inhibitory ileo-ICJ response was abolished, while early and late inhibitory responses were abolished by further addition of propranolol but not by the addition of hexamethonium, atropine, prazosin or yohimbine. The excitatory colo-ICJ response was replaced by inhibition in the presence of L-NAME. We concluded that: (1) the porcine ICJ displays myogenic tone which is influenced by excitatory muscarinic and inhibitory nitrergic and beta adrenergic pathways (2) an inhibitory ileo-sphincteric reflex mediated by nitrergic and beta adrenergic postganglionic neural pathways (3) both excitatory and inhibitory neurogenic colo-sphincteric reflexes exist, and the excitatory pathway involves nitrergic neurotransmission.

Nitric oxide modulates release of noradrenaline in guinea-pig gastric fundus

The interaction between nitric oxide (NO) and the release of [(3)H]noradrenaline ([(3)H]NA) in conditions of non-activated and activated nicotinic receptors in guinea-pig gastric fundus preincubated with [(3)H]NA was studied. Nicotinic receptor agonist, 1,1-dimethyl-4-phenyl-piperazinium iodide (DMPP) (100 microM) significantly increased the resting release of [(3)H]NA. NO-synthase inhibitor, N(omega)-nitro-L-arginine (L-NNA) (100 microM) significantly decreased DMPP-induced release of [(3)H]NA. Field electrical stimulation (FES) (2Hz; 1 ms; 360 st) significantly increased the release of [(3)H]NA above the basal levels. L-NNA significantly decreased the stimulation-evoked release of [(3)H]NA. DMPP increased the stimulation-evoked release of [(3)H]NA, effect which was significantly decreased by L-NNA. The data suggests that endogenous NO increases the release of [(3)H]NA, evoked either by activation of the nicotinic receptors or by electrical stimulation in guinea-pig gastric fundus.

Nitric oxide (NO) increases acetylcholine release from and inhibits smooth muscle contraction of guinea-pig gastric fundus

Experiments were carried out to investigate the interaction between nitric oxide (NO) and cholinergic neurotransmission in smooth muscle strips of guinea-pig gastric fundus. Electrical field stimulation (2 Hz, 1 ms, 360 shocks) evoked atropine-sensitive contractions. Dimethylphenylpiperazinium (DMPP) (100 microM), a nicotinic receptor agonist, reversed the stimulation-evoked contraction and resulted in relaxation. Nomega-nitro-L-arginine (L-NNA) (100 microM), an NO synthase inhibitor, significantly increased the amplitude of stimulation-evoked contraction and abolished the effect of DMPP. Electrical stimulation increased the release of [3H]acetylcholine ([3H]ACh) from the tissue strips above the basal levels. Neither L-NNA (100 microM) nor DMPP (100 microM) alone influenced the basal release of [3H]ACh. Nomega-nitro-L-arginine (100 microM) decreased the electrical stimulation-evoked release of [3H]ACh. Dimethylphenylpiperazinium increased the stimulation-evoked release of [3H]ACh but had no effect in the presence of L-NNA. It is suggested that in guinea-pig gastric fundus, endogenous NO released in response to field stimulation has an opposite effect at the pre- and postsynaptic sites: it increases the release of ACh from cholinergic nerve terminals but reduces smooth muscle responses to ACh.

In vitro and in vivo effects of nitric oxide synthase inhibitors and nitric oxide inactivators on the South American opossum ileocolonic junction

The potential role of nitrergic nerves in the regulation of the South American (SA) opossum ileocolonic junction (ICJ) function was investigated. In vitro, the effects of nitric oxide (NO) synthase inhibitors and NO inactivators on the non-adrenergic non-cholinergic (NANC) nerve-mediated relaxations of the circular muscle of the SA opossum ICJ were determined by employing isolated strips. Electrical field stimulation (0.2-8.0 Hz) caused frequency-dependent NANC relaxations. Nicotine and ATP also induced concentration dependent NANC relaxations that were abolished by tetrodotoxin (TTX). The relaxation response induced by NANC nerve activation was reduced in a dose dependent manner by NO synthase inhibitors while vasoactive intestinal peptide (VIP) and sodium nitroprusside (SNP) induced relaxations were uninfluenced by these drugs. In vivo, the NO synthase inhibitor, L-NAME, administered into the local artery caused a raise in intraluminal pressure of the ICJ in anaesthetized SA opossums in a L-arginine-preventable manner. Hydroquinone and pyrogallol, while being able to reduce, in a superoxide dimutase (SOD) reversible manner, the relaxations induced by exogenous NO failed to affect the NANC nerve-induced relaxations. Finally, neurones and nerve fibres in the myenteric plexus as well as varicose nerve fibres on the circular smooth layer were positive for NADPH-diaphorase activity. These findings indicate that nitrergic nerves inhibit ICJ circular smooth muscle in vitro and in vivo but cast doubts on the neuromediator being the NO radical.

Modulation of electrically evoked responses in rat duodenum by activation of nicotinic cholinoceptors

1. The effect of activation of nicotinic cholinoceptors in rat duodenal segments following electrical field stimulation (EFS) was investigated. 2. Electrical field stimulation elicited a two-component response: transient relaxation followed by contraction. The EFS-evoked response was tetrodotoxin (TTX; 1 mumol/L) sensitive. The relaxation component was NG-nitro-L-arginine (L-NNA; 100 mumol/L) sensitive, while the contractile response was atropine (1 mumol/L) sensitive. 3. 1,1-Dimethyl-4-phenyl-piperazinium iodide (DMPP; 20 mumol/L) induced relaxation of spontaneously active preparations that was L-NNA sensitive. L-Arginine (1 mmol/L) reversed the effects of L-NNA on DMPP-induced relaxation. 4. When EFS was applied, DMPP increased the amplitude of the relaxation component of the response and reduced the contractile component. 5. In the presence of L-NNA, the effect of DMPP on the relaxation component of the response to EFS was reduced, but the contractile response was not affected. L-Arginine partly reduced this effect of L-NNA. 6. Neither propranolol (1 mumol/L) nor yohimbine (1 mumol/L) had any effect on the actions of DMPP on EFS-evoked responses, but prazosin (1 mumol/L) strongly reduced the effect of DMPP on the contractile component of the response to EFS and slightly reduced the effect of DMPP on the relaxation response. 7. Histochemical studies demonstrated that, in the myenteric plexus of the rat duodenum, there are many reduced nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d)-positive neurons and that their number decreased after treatment with L-NNA. In the presence of L-arginine and L-NNA, the number of NADPH-d-positive neurons was similar to that found in control samples. 8. The data suggest that activation of nicotinic cholinoceptors modulates EFS-evoked responses in the rat duodenum as a result of the potentiation of nitrergic and adrenergic neurotransmission.

Pattern of nonadrenergic, noncholinergic responses during short- or long-lasting electrical stimulation in guinea-pig ileum

1. The pattern of responses of longitudinally oriented guinea pig ileum organ bath preparations was studied during short- (1-5 sec) or long-lasting (20 sec) electrical field stimulation (EFS, 0.8 msec, 40 V, 1-20 Hz). 2. In the presence of phentolamine (5 microM), propranolol (5 microM), and atropine (3 microM), the EFS elicited nonadrenergic, noncholinergic (NANC), tetrodotoxin (0.3 microM)-sensitive responses. 3. The 1-sec EFS evoked relaxation. The response to 5-sec EFS consisted of relaxation followed by twitch, whereas relaxation, twitch and tonic contraction characterized the NANC response to 20-sec EFS. The maximum relaxation was observed at 10-Hz short- or long-lasting EFS. 4. Both N-G-nitro-L-arginine (L-NNA, 0.1-0.5 mM) and apamin (1-5 microM) concentration dependently inhibited the relaxation of the NANC response to 10-Hz 20-sec EFS. During L-NNA treatment, the twitch and the tonic contractions were increased. The inhibitory effect of L-NNA was reversed by L-arginine (0.1-0.5 mM) but not by D-arginine. Sodium nitroprusside (1-10 microM) was without effect. 5. AP 13.2 ACOH (0.1 microM), a blocker of Substance P receptors, inhibited the twitch and the tonic contractions. The contractions were decreased after desensitization of purinoceptors by ATP and in the presence of the GABA(A) receptor antagonist bicuculline (30 microM). 6. Depending on the EFS duration, a subsequent occurrence of relaxation and contractions characterized the NANC responses. It seems that relaxation is mediated by nitric oxide whereas Substance P and ATP are involved in the maintenance of the twitch and the tonic contractions. Nitric oxide appears to exert an inhibitory effect on the excitatory transmitters, whereas purinergic mechanism(s) could modulate the nitric oxide-dependent relaxation.