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Intestinal Epithelial Secretory Function: Role of Proteinase-Activated Receptors Michelle C

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Intestinal Epithelial Secretory Function: Role of Proteinase-Activated Receptors Michelle C DRUG DEVELOPMENT RESEARCH 59:386–394 (2003) DDR Intestinal Epithelial Secretory Function: Role of Proteinase-Activated Receptors Michelle C. Buresi and Wallace K. MacNaughtonn Mucosal Inflammation Research Group, University of Calgary, Calgary, Canada Strategy, Management and Health Policy Preclinical Development Clinical Development Venture Capital Preclinical Toxicology, Formulation Phases I-III Postmarketing Enabling Research Drug Delivery, Regulatory, Quality, Phase IV Technology Pharmacokinetics Manufacturing ABSTRACT The ability of enterocytes to secrete electrolytes and water into the intestinal lumen represents a critical feature of mucosal defense. During disease, this function may be altered and may initiate or exacerbate pathological conditions. Although many of the intracellular mechanisms linking stimulation to secretion have been elucidated, novel pathways continue to be revealed. These pathways provide potential for therapeutic manipulation of cellular function. In addition, the importance of the microenvironment surrounding enterocytes is increasingly being acknowledged, and the interactions between epithelial cells and their milieu are proving to be essential to the regulation of secretory function, both in health and disease. In this way, epithelial ion transport functions can be modulated by mediators released from neighboring nerves, inflammatory cells, and pathogens, or by endocrine factors. Much interest has recently been elicited by the discovery that proteinases can regulate cellular functions through the activation of proteinase-activated receptors (PARs). Because of the abundance of proteases within the gastrointestinal tract, particularly in the setting of development, inflammation, and healing, it is likely that PARs have an important role to play in these processes. PARs have been localized to a variety of cell types in the gastrointestinal tract, and have been shown to influence epithelial secretory function on several levels. In this review, we discuss the mechanisms by which proteases and PARs regulate intestinal secretory function, and the manner in which these modulations might contribute to inflammatory processes. Drug Dev. Res. 59:386–394, 2003. c 2003 Wiley-Liss, Inc. Key words: epithelium; secretion; chloride; MAP kinase THE ROLE OF THE INTESTINAL EPITHELIUM IN conditions. Excessive secretion due to a hyperrespon- HOST DEFENSE siveness to secretagogues, as exemplified by the The gastrointestinal epithelium represents the response to cholera toxin, can result in diarrhea leading first line of defense against ingested bacteria, antigens, to excess water and electrolyte loss. Conversely, the drugs, and toxins. An important aspect of intestinal inability to secrete chloride and water due to a barrier function is the ability of a subpopulation of hyporesponsiveness to secretagogues, exemplified by enterocytes to secrete electrolytes such as chloride in a basolateral to apical direction, promoting the move- Grant sponsor: Canadian Institutes of Health Research ment of water into the lumen. The movement of (CIHR); Grant number: MOP 53311. chloride and water into the lumen of the intestinal n crypts prevents their colonization by bacteria and slows Correspondence to: Wallace MacNaughton, PhD, Muco- sal Inflammation Research Group, University of Calgary, the translocation of antigens into the lamina propria 3330 Hospital Dr. NW, Calgary, AB, Canada T2N 1N4. [Cirino et al., 1996; Asfaha et al., 2001]. E-mail: [email protected] Responsiveness of the epithelium to secretago- Published online in Wiley InterScience (www.interscience.wiley. gues can be significantly altered during pathological com) DOI: 10.1002/ddr.10308 c 2003 Wiley-Liss, Inc. PARs AND INTESTINAL ION TRANSPORT 387 models of intestinal inflammation [MacNaughton et al., [Keast et al., 1986; Cooke, 1992; MacNaughton et al., 1998; Asfaha et al., 2001; Freeman and MacNaughton, 1996, 1997; Green et al., 2000]. Thus, substances that 2000] and as observed in human inflammatory bowel affect enteric neural function also have the potential to disease [Archampong et al., 1972; Hubel and Renquist, alter epithelial secretion of chloride and water. 1990; Sandle et al., 1990], may allow the translocation of bacteria, antigens, or toxins across the epithelium PROTEINASES AND EPITHELIAL FUNCTION: and into the lamina propria where they may then MICROENVIRONMENT AND NEUROIMMUNE trigger, exacerbate, or prolong inflammation. Further- CONTROL SYSTEMS more, defective chloride secretion in the gut, such as How can the secretory function of enterocytes be that which occurs in congenital deficiencies such as regulated by serine proteinases and PARs? Serine cystic fibrosis, leads to intestinal obstruction and proteinases often have activities related to inflamma- malabsorption [O’Loughlin et al., 1991; Grubb and tion, tissue remodeling, and healing [reviewed in Gabriel, 1997]. Macfarlane et al., 2001]. The PARs in different tissues might thus respond selectively to site-targeted protei- REGULATION OF CHLORIDE SECRETION nases, either in the setting of tissue injury or in the Many of the intracellular mechanisms regulating course of development [Werb, 1997]. The gastrointest- chloride secretion by intestinal epithelial cells have inal (GI) tract is exposed to a particularly large array of been characterized. While the details are beyond the proteinases, whether in physiological or pathological scope of this review, of relevance are the second settings, due to its proximity to digestive enzymes, messenger systems that regulate apical chloride secre- proteinases from pathogens and proteinases derived tion. Typically, chloride secretion in the gut is mediated from inflammatory cells or the microvasculature. by intracellular signaling pathways involving either an Proteinases such as thrombin and mast cell tryptase increase in intracellular calcium levels through the are abundant in the gastrointestinal mucosa and action of phospholipase C and inositol triphosphate, or submucosa during inflammatory conditions where an increase in cyclic AMP (cAMP) through the action hemorrhage, vascular disruption, and immune cell of adenylyl cyclase. These signaling systems can be infiltration are evident [reviewed in Vergnolle, 2000]. modified by mediators originating from nerves, im- Luminal trypsin may also act on enterocytes via PAR2 mune cells, myofibroblasts, or other neighboring cells, localized to the apical surface [Kong et al., 1997] or and responsiveness to these mediators may be altered may access the basolateral surface of the epithelium, as during disease states [reviewed in Barrett and Keely, well as other cell types, as a result of increased 2000]. For example, various reactive oxygen species, epithelial permeability. Other proteinases, such as platelet activating factor, lipoxygenase metabolites of plasmin, granzyme A, and cathepsin G have also been arachidonic acid, and certain cytokines including IL-1, shown to cleave and activate PARs, albeit less potently all induce chloride secretion. Interestingly, the secre- [Suidan et al., 1994, 1996; Molino et al., 1995; Vouret- tion elicited by each of these factors is sensitive to Craviari et al., 1995]. In addition, it has been shown inhibition by cyclooxygenase inhibitors such as non- that allergenic house dust mite proteinases are capable steroidal anti-inflammatory drugs (NSAIDs). This of cleaving and activating PARs to affect epithelial observation suggests that arachidonic acid metabolites, function in the respiratory tract [Sun et al., 2001; such as the prostaglandins, may act as final common Asokananthan et al., 2002b]. Some bacterial protei- mediators of many stimulants of intestinal ion transport nases have also been demonstrated to activate PARs [Hinterleitner and Powell, 1991; Montrose et al., 1999]. situated on oral epithelial cells, and to affect secretion This has implications for the mediation of epithelial of inflammatory mediators [Lourbakos et al., 2001]. secretory function by PARs as discussed below. Regulation of epithelial function by PAR1 may Regulation of epithelial chloride secretion is also furthermore be influenced by proteinases, such as under tight neural control, especially through the neutrophil elastase, proteinase 3, and cathepsin G, that action of submucosal secretomotor neurons of the are able to cleave PAR1 downstream of the thrombin enteric nervous system. Specifically, release of vasoac- cleavage site, resulting in the deactivation of the tive intestinal polypeptide or acetylcholine stimulates receptor, and rendering it unresponsive to further chloride secretion through activation of cAMP- and activation by thrombin. Caþþ-dependent pathways respectively. In addition, Thus, a variety of proteinases may be in a position the rate of chloride secretion can be influenced by a to act on PARs and to influence enterocyte secretory variety of neurally derived mediators including opiates, function on several levels, either by direct interaction gamma-aminobutyric acid (GABA), calcitonin gene with the epithelium, or by altering the release of related peptide (CGRP), substance P, and serotonin secretagogues from other cell types. Although PAR 388 BURESI AND MACNAUGHTON activation by a protease is an irreversible event, and stimulus-secretion coupling pathway, wherein EGF resensitization is dependent on mobilization of intra- receptor transactivation and Src activation precede a cellular stores and on synthesis of new receptors, the MEK-ERK1/2 dependent activation of cytosolic PLA2 turnover of PARs in native tissue
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