Opiate receptor-mediated inhibition of rat jejunal fluid secretion

Insights into opioid action in the intestinal tract

Opioids have been used for centuries as antidiarrhoeal drugs. In recent years, their mechanism and sites of action in exerting their antidiarrhoeal effect have been studied intensely. Attempts have been made to propose their general mode of action. Whilst there are numerous similarities in their general effects on motility, fluid secretion, and neuroeffector transmission, the differences between species, in some cases, can be remarkable. We highlight and contrast the similarities and differences in the commonly examined species and compare them to humans. Insights into mechanisms of opioid antidiarrhoeal action now also provide some new perspectives of opioid action in the intestine.

The effect of acute and chronic administration of morphine and morphine withdrawal on intestinal transit time in the rat

The effects of acute and chronic morphine administration and of morphine-withdrawal on intestinal transit time of a liquid meal were investigated using rats. Many experiments have assessed the effects of acute morphine administration on intestinal transit, but the intestinal effects of chronic morphine administration have been neglected. Our results showed no significant differences between morphine-dependent and control animals when assessing the leading edge of the liquid meal infusion, its distribution and geometric centre (G.C.). However, during naloxone-precipitated withdrawal from morphine, the leading edge of the infusion and its G.C. were significantly distal to values obtained from other groups. Acute morphine administration caused delayed intestinal transit of a meal infusion, an effect partly caused by significant retention of the infusion in the stomach and duodenum. The leading edge of the meal infusion and G.C. were significantly proximal to values obtained from other groups of animals. The results show that morphine-dependent rats develop complete tolerance to the delayed intestinal transit of a meal observed after acute morphine administration and that withdrawal from morphine accelerates intestinal transit of a liquid meal.

The response of the intestinal mucosa to prostaglandin E2 during withdrawal from morphine

Experiments were designed to determine whether the diarrhoea characteristic of morphine withdrawal results from an enhanced sensitivity of the intestinal mucosa to PGE2. Rats (250-300 g) were made morphine-dependent by subcutaneous injection of an emulsion releasing 300 mg morphine HCl over 48 h. In-vivo, the transintestinal potential difference (PD) responses to PGE2 (4.6-46 micrograms kg-1 i.v.), which reflect increased Cl secretion, were significantly larger in withdrawn (morphine emulsion, 10 mg kg-1 naloxone s.c.) compared with non-dependent animals (emulsion only, naloxone s.c., P less than 0.05). Muscle-stripped intestinal sheets from dependent animals incubated with naloxone (10(-5) mol L-1) in-vitro did not demonstrate a greater electrical response (PD, short circuit current) to PGE2 (1.4 x 10(-6) mol L-1) than sheets taken from non-dependent animals. In-vitro preparations from animals withdrawn in-vivo did not respond differently from tissue taken from non-dependent animals (naloxone 10 mg kg-1 s.c., 10(-4) mol L-1 in medium, in both groups). This occurred in whole sheets of intestine as well as sheets without attached muscle. Jejunal fluid absorption in-vivo was lower in withdrawn animals than in non-dependent animals. However, the responses to intra-arterial infusion of PGE2 were similar in both groups with 2 micrograms min-1 inhibiting absorption and 4 micrograms min-1 inducing secretion. In-vivo, PGE2-induced Cl secretion appears to be enhanced during withdrawal although net fluid transport is not altered, suggesting different effects of the withdrawal process on the electrogenic Cl secretory and neutral NaCl absorptive mechanisms.

Meal-stimulated release of methionine-enkephalin into the canine jejunal lumen

Application of enkephalins to the luminal surface of the bowel augments intestinal absorption. However, to date, endogenous enkephalins have not been demonstrated within intestinal luminal fluid. To determine whether enkephalins are present in the intestinal lumen, five adult dogs had 25-cm chronic jejunal Thiry-Vella loops constructed. Dogs were studied in the awake, fasted state. Jejunal loops were perfused with isoosmotic, neutral Krebs buffer containing protease inhibitors. After basal sampling, the dogs received a high fat meat meal. Collections were made during the meal and for 60 min postprandially. Luminal met-enkephalin levels were determined by radioimmunoassay and confirmed by HPLC. HPLC separation of luminal samples demonstrated two immunoreactive peaks which co-eluted with pure met-enkephalin and met-enkephalin-sulfoxide. Basal met-enkephalin outputs averaged 52 +/- 13 ng/min. The meal significantly increased mean luminal met-enkephalin output to 137 +/- 71 ng/min. During the initial 20-min postprandial period, output remained elevated (180 +/- 73 ng/min), after which it returned to basal levels. We conclude that met-enkephalin is present in the jejunal lumen, and that luminal release of this opioid is augmented by a meal.

Naloxone-reversible antidiarrheal effects of enkephalinase inhibitors

Thiorphan and acetorphan, two potent inhibitors of enkephalinase (EC 3.4.24.11 membrane-metalloendopeptidase) significantly reduced the castor oil-induced diarrhea in rats when administered intravenously (or orally, for acetorphan) but not when administered intracerebroventricularly. These effects were more marked during the 90 min period following the castor oil challenge but were still significant up to 4-8 h after the latter. Acetorphan was about 6 times more potent than thiorphan. The antidiarrheal activity of both compounds was completely prevented in rats receiving naloxone subcutaneously but not intracerebroventricularly (in the case of thiorphan). In contrast to loperamide, a peripherally acting opiate receptor agonist, the enkephalinase inhibitors did not significantly reduce gastrointestinal transit as measured in the charcoal meal test. The antidiarrheal activity of enkephalinase inhibitors therefore seems attributable to protection of endogenous opioids, presumably outside the brain, and to reduction of intestinal secretion rather than transit.

Opioid action of the intestine: the importance of the intestinal mucosa

Drug effects on the intestine are traditionally explained in terms of action on the muscle layers and the nerves that control them. This is particularly true in the case of the opioids but research starting two decades ago has identified the intestinal mucosa as the site of action of the antidiarrhoeal opioids. Continued research using the intestinal mucosa offers a fresh approach to solving some old problems. For example it could lead to more confident predictions to be made about the wanted and unwanted effects of opioid drugs on the intestine and may help to find better drug treatments for alleviating withdrawal diarrhoea in addicts. Eventually it may help to explain how the general process of opioid dependence occurs at a cellular level.

Pathogenesis and pharmacology of diarrhea

The etiological factors involved in diarrhea are multiple. Also the mechanisms and mediators involved are multiple: intracellular mediators (Ca, cAMP, cGMP, calmodulin, phospholipids), extracellular mediators (hormones, neurotransmitters, prostaglandins, enterotoxins...), intramural blood flow and oxygen, intestinal motility (local- and peristaltic motility). Till now, antidiarrheals are not so versatile that they provide a solution to all types of diarrhea. The mechanisms of action of fluid replacement therapy, loperamide, alpha 2 agonist and some nonsteroidal anti-inflammatory substances are reviewed.

Choice of anesthetic for intestinal absorption and secretion experiments using rats

The net rates of glucose and water absorption from, and secretion of water into, the lumen of the rat small intestine were compared using alpha-chloralose, halothane, pentobarbitone, and urethane as anesthetics. Water and glucose transport were determined by recirculation of perfusion fluid through the lumen of the jejunum. Net fluid secretion was stimulated by intraarterial (i.a.) infusion of prostaglandin E1 (PGE1) and vasoactive intestinal peptide (VIP). The results show that the anesthetics used exert only minimal influence on the physiological rates of glucose and water absorption and there is no correlation between the small differences in glucose and water absorption among the anesthetics. However, when the fluid secretory mechanism of the mucosa is stimulated with either PGE1 or VIP, pentobarbitone allows the greatest rates of secretion, but halothane prevents secretion. It is suggested that of the anesthetics used, pentobarbitone is the most appropriate for intestinal secretion experiments.

Antipropulsive effects of central and peripheral morphine in the rat gastrointestinal tract

The antipropulsive effects of centrally or peripherally administered morphine have been examined at three levels of the rat gastrointestinal tract. Adult male rats were anaesthetized with pentobarbitone (50 mg kg-1 i.p.) and were implanted with an intraluminal catheter in either the proximal duodenum or mid-jejunum. Other animals were also implanted with a cannula in the right lateral cerebral ventricle. Gastric emptying and transit were determined selectively by measuring the progression of a radioactive chromium (CR-51) solution, given intragastrically for tests of gastric emptying or instilled into the proximal or distal intestinal catheter for determination of intestinal transit, 30 min after administration of morphine or saline given either subcutaneously (s.c.) or intracerebroventricularly (i.c.v.). Morphine given either s.c. (5 mg kg-1) or i.c.v. (30 micrograms, total dose) significantly inhibited gastric emptying and transit through bulk portions of the small intestine indicating that by either route it inhibits propulsion at all three levels of the gastrointestinal tract.

Characterization of the opiate receptor population mediating inhibition of VIP-induced secretion from the small intestine of the rat

Net water transport was measured from the jejunum of anaesthetized rats by a re-circulation technique. Several narcotic analgesics were administered intravenously and assessed for activity in reversing net fluid secretion induced by intra-arterial infusion of vasoactive intestinal peptide (VIP). The mu-opiate agonists, morphine, RX 783006 and FK 33-824 produced full reversal of the secretory phase of the VIP response, but failed to restore totally fluid transport to the control level of net absorption. The kappa-agonist, ethylketocyclazocine, caused only partial reversal of VIP-induced secretion while the more selective kappa-agonist, MR 2034, produced a small though non-significant antisecretory effect at high doses. The delta-agonist, D-Ala2-D-Leu5-enkephalin also had negligible antisecretory activity. Naloxone caused a parallel displacement to the right of the antisecretory dose-response line to morphine. The 'in vivo pA2' value of naloxone was 7.14. The results are compared with previously published antinociceptive activities of the opiate agonists and in vivo pA2 values of naloxone. It is concluded that stimulation of mu-opiate receptors mediates inhibition of VIP-induced fluid secretion from the rat jejunal mucosa.

Effects of morphine on net water absorption, mucosal adenylate cyclase activity and PGE2 metabolism in rat intestine

Morphine (10 mg/kg s.c.) was shown to increase net basal water and electrolyte absorption in rat ileum and colon perfused in vivo. These effects were significantly greater in the ileum. Under the same conditions of dosage and time course of administration the activities of relevant mucosal enzymes were studied. Ileal mucosal adenylate cyclase stimulated by prostaglandin E2 (PGE2) in vitro was inhibited by morphine pretreatment. Colonic stimulated cyclase activity was unaffected as were basal activities in both regions. Morphine did not alter the activities of enzymes involved in PGE2 metabolism and is unlikely to act by modulating endogenous PG levels. Transport ATPase activities, were also unchanged in morphine treated animals. These results are discussed in relation to the mechanism of action of morphine on intestinal mucosa.