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Hanning N, De bruyn M, Ceuleers H, Boogaerts T, Berg M, Smet A, De Schepper HU, Joossens J, van Nuijs ALN, De Man JG, Augustyns K, De Meester I, De Winter BY. Local Colonic Administration of a Serine Protease Inhibitor Improves Post-Inflammatory Visceral Hypersensitivity in Rats. Pharmaceutics 2021; 13:pharmaceutics13060811. [PMID: 34072320 PMCID: PMC8229129 DOI: 10.3390/pharmaceutics13060811] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022] Open
Abstract
Dysregulation of the protease–antiprotease balance in the gastrointestinal tract has been suggested as a mechanism underlying visceral hypersensitivity in conditions such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). We aimed to study the potential therapeutic role of an intracolonically administered serine protease inhibitor for the treatment of abdominal pain in a post-inflammatory rat model for IBS. An enema containing 2,4,6-trinitrobenzene sulfonic acid (TNBS) was used to induce colitis in male Sprague–Dawley rats, whereas controls received a saline solution. Colonoscopies were performed to confirm colitis and follow-up mucosal healing. In the post-inflammatory phase, the serine protease inhibitor UAMC-00050 (0.1–5 mg/kg) or its vehicle alone (5% DMSO in H2O) was administered in the colon. Thirty minutes later, visceral mechanosensitivity to colorectal distensions was quantified by visceromotor responses (VMRs) and local effects on colonic compliance and inflammatory parameters were assessed. Specific proteolytic activities in fecal and colonic samples were measured using fluorogenic substrates. Pharmacokinetic parameters were evaluated using bioanalytical measurements with liquid chromatography–tandem mass spectrometry. Post-inflammatory rats had increased trypsin-like activity in colonic tissue and elevated elastase-like activity in fecal samples compared to controls. Treatment with UAMC-00050 decreased trypsin-like activity in colonic tissue of post-colitis animals. Pharmacokinetic experiments revealed that UAMC-00050 acted locally, being taken up in the bloodstream only minimally after administration. Local administration of UAMC-00050 normalized visceral hypersensitivity. These results support the role of serine proteases in the pathophysiology of visceral pain and the potential of locally administered serine protease inhibitors as clinically relevant therapeutics for the treatment of IBS patients with abdominal pain.
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Affiliation(s)
- Nikita Hanning
- Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, 2610 Wilrijk, Belgium; (N.H.); (H.C.); (A.S.); (H.U.D.S.); (J.G.D.M.)
- Infla-Med, Centre of Excellence, University of Antwerp, 2610 Wilrijk, Belgium; (M.D.b.); (M.B.); (K.A.); (I.D.M.)
| | - Michelle De bruyn
- Infla-Med, Centre of Excellence, University of Antwerp, 2610 Wilrijk, Belgium; (M.D.b.); (M.B.); (K.A.); (I.D.M.)
- Laboratory of Medical Biochemistry, University of Antwerp, 2610 Wilrijk, Belgium
| | - Hannah Ceuleers
- Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, 2610 Wilrijk, Belgium; (N.H.); (H.C.); (A.S.); (H.U.D.S.); (J.G.D.M.)
- Infla-Med, Centre of Excellence, University of Antwerp, 2610 Wilrijk, Belgium; (M.D.b.); (M.B.); (K.A.); (I.D.M.)
| | - Tim Boogaerts
- Toxicological Centre, University of Antwerp, 2610 Wilrijk, Belgium; (T.B.); (A.L.N.v.N.)
| | - Maya Berg
- Infla-Med, Centre of Excellence, University of Antwerp, 2610 Wilrijk, Belgium; (M.D.b.); (M.B.); (K.A.); (I.D.M.)
| | - Annemieke Smet
- Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, 2610 Wilrijk, Belgium; (N.H.); (H.C.); (A.S.); (H.U.D.S.); (J.G.D.M.)
- Infla-Med, Centre of Excellence, University of Antwerp, 2610 Wilrijk, Belgium; (M.D.b.); (M.B.); (K.A.); (I.D.M.)
| | - Heiko U. De Schepper
- Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, 2610 Wilrijk, Belgium; (N.H.); (H.C.); (A.S.); (H.U.D.S.); (J.G.D.M.)
- Infla-Med, Centre of Excellence, University of Antwerp, 2610 Wilrijk, Belgium; (M.D.b.); (M.B.); (K.A.); (I.D.M.)
- Department of Gastroenterology and Hepatology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium
| | - Jurgen Joossens
- Laboratory of Medicinal Chemistry, University of Antwerp, 2610 Wilrijk, Belgium;
| | | | - Joris G. De Man
- Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, 2610 Wilrijk, Belgium; (N.H.); (H.C.); (A.S.); (H.U.D.S.); (J.G.D.M.)
- Infla-Med, Centre of Excellence, University of Antwerp, 2610 Wilrijk, Belgium; (M.D.b.); (M.B.); (K.A.); (I.D.M.)
| | - Koen Augustyns
- Infla-Med, Centre of Excellence, University of Antwerp, 2610 Wilrijk, Belgium; (M.D.b.); (M.B.); (K.A.); (I.D.M.)
- Laboratory of Medicinal Chemistry, University of Antwerp, 2610 Wilrijk, Belgium;
| | - Ingrid De Meester
- Infla-Med, Centre of Excellence, University of Antwerp, 2610 Wilrijk, Belgium; (M.D.b.); (M.B.); (K.A.); (I.D.M.)
- Laboratory of Medical Biochemistry, University of Antwerp, 2610 Wilrijk, Belgium
| | - Benedicte Y. De Winter
- Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, 2610 Wilrijk, Belgium; (N.H.); (H.C.); (A.S.); (H.U.D.S.); (J.G.D.M.)
- Infla-Med, Centre of Excellence, University of Antwerp, 2610 Wilrijk, Belgium; (M.D.b.); (M.B.); (K.A.); (I.D.M.)
- Department of Gastroenterology and Hepatology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium
- Correspondence: ; Tel.: +32-3-2652710
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Kumar B, Lenert P. Joint Hypermobility Syndrome: Recognizing a Commonly Overlooked Cause of Chronic Pain. Am J Med 2017; 130:640-647. [PMID: 28286166 DOI: 10.1016/j.amjmed.2017.02.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 01/24/2017] [Accepted: 02/20/2017] [Indexed: 12/11/2022]
Abstract
Joint hypermobility syndrome, also known as benign hypermobility syndrome, is a connective tissue disease characterized by joint instability, chronic pain, and minor skin changes. It shares many clinical features of Ehlers-Danlos syndrome, Hypermobility Type; enough so that many authorities consider them as one disease process. Approximately 3% of the general population is believed to have joint hypermobility syndrome, but despite this high prevalence, due to lack of awareness, heterogeneity of clinical presentation, and reliance on physical examination for diagnosis, it is largely overlooked by primary care physicians as well as by specialists. This leads to delayed or missed opportunities for diagnosis, and inappropriate interventions that frustrate both providers and patients. We review the literature regarding the pathophysiology, diagnosis, treatment options, and prognosis of joint hypermobility syndrome, and advocate for primary care physicians to consider it in the differential diagnosis of patients with chronic pain.
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Affiliation(s)
- Bharat Kumar
- Division of Immunology, University of Iowa, Iowa City.
| | - Petar Lenert
- Division of Immunology, University of Iowa, Iowa City
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Deiteren A, De Man JG, Keating C, Jiang W, De Schepper HU, Pelckmans PA, Francque SM, De Winter BY. Mechanisms contributing to visceral hypersensitivity: focus on splanchnic afferent nerve signaling. Neurogastroenterol Motil 2015; 27:1709-20. [PMID: 26337498 DOI: 10.1111/nmo.12667] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/04/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Visceral hypersensitivity is a main characteristic of functional bowel disorders and is mediated by both peripheral and central factors. We investigated whether enhanced splanchnic afferent signaling in vitro is associated with visceral hypersensitivity in vivo in an acute and postinflammatory rat model of colitis. METHODS Trinitrobenzene sulfonic acid (TNBS)-colitis was monitored individually by colonoscopy to confirm colitis and follow convalescence and endoscopic healing in each rat. Experiments were performed in controls, rats with acute colitis and in postcolitis rats. Colonic afferent mechanosensitivity was assessed in vivo by quantifying visceromotor responses (VMRs), and by making extracellular afferent recordings from splanchnic nerve bundles in vitro. Multiunit afferent activity was classified into single units identified as low threshold (LT), wide dynamic range (WDR), high threshold (HT), and mechanically insensitive afferents (MIA). KEY RESULTS During acute TNBS-colitis, VMRs were significantly increased and splanchnic nerve recordings showed proportionally less MIA and increased WDR and HT afferents. Acute colitis gave rise to an enhanced spontaneous activity of both LT and MIA and augmented afferent mechanosensitivity in LT, WDR and HT afferents. Postcolitis, VMRs remained significantly increased, whereas splanchnic nerve recordings showed that the proportion of LT, WDR, HT and MIA had normalized to control values. However, LT and MIA continued to show increased spontaneous activity and WDR and HT remained sensitized to colorectal distension. CONCLUSIONS & INFERENCES Visceral hypersensitivity in vivo is associated with sensitized splanchnic afferent responses both during acute colitis and in the postinflammatory phase. However, splanchnic afferent subpopulations are affected differentially at both time points.
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Affiliation(s)
- A Deiteren
- Laboratory of Experimental Medicine and Pediatrics, Division of Gastroenterology, University of Antwerp, Antwerp, Belgium
| | - J G De Man
- Laboratory of Experimental Medicine and Pediatrics, Division of Gastroenterology, University of Antwerp, Antwerp, Belgium
| | - C Keating
- Department of Biomedical Sciences, University of Sheffield, Sheffield, UK
| | - W Jiang
- Department of Biomedical Sciences, University of Sheffield, Sheffield, UK
| | - H U De Schepper
- Laboratory of Experimental Medicine and Pediatrics, Division of Gastroenterology, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - P A Pelckmans
- Laboratory of Experimental Medicine and Pediatrics, Division of Gastroenterology, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - S M Francque
- Laboratory of Experimental Medicine and Pediatrics, Division of Gastroenterology, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - B Y De Winter
- Laboratory of Experimental Medicine and Pediatrics, Division of Gastroenterology, University of Antwerp, Antwerp, Belgium
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Castori M, Morlino S, Celletti C, Ghibellini G, Bruschini M, Grammatico P, Blundo C, Camerota F. Re-writing the natural history of pain and related symptoms in the joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type. Am J Med Genet A 2013; 161A:2989-3004. [DOI: 10.1002/ajmg.a.36315] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 09/29/2013] [Indexed: 12/16/2022]
Affiliation(s)
- Marco Castori
- Division of Medical Genetics, Department of Molecular Medicine; Sapienza University, San Camillo-Forlanini Hospital; Rome Italy
| | - Silvia Morlino
- Division of Medical Genetics, Department of Molecular Medicine; Sapienza University, San Camillo-Forlanini Hospital; Rome Italy
| | - Claudia Celletti
- Division of Physical Therapy and Rehabilitation, Department of Orthopedic Sciences; Sapienza University, Umberto I University Hospital; Rome Italy
| | - Giulia Ghibellini
- Division of Pharmacotherapy and Experimental Therapeutics; School of Pharmacy, University of North Carolina at Chapel Hill; North Carolina
| | - Michela Bruschini
- Unit of Cognitive and Behavioral Neurology, Division of Neurology and Neurophysiopathology; San Camillo-Forlanini Hospital; Rome Italy
| | - Paola Grammatico
- Division of Medical Genetics, Department of Molecular Medicine; Sapienza University, San Camillo-Forlanini Hospital; Rome Italy
| | - Carlo Blundo
- Unit of Cognitive and Behavioral Neurology, Division of Neurology and Neurophysiopathology; San Camillo-Forlanini Hospital; Rome Italy
| | - Filippo Camerota
- Division of Physical Therapy and Rehabilitation, Department of Orthopedic Sciences; Sapienza University, Umberto I University Hospital; Rome Italy
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