The Peptidergic Brain-Gut Axis: Influence on Gastric Ulcer Formation

The existence of a relationship between the brain and the formation of gastric ulcers has been suspected since the last century. The advancement of stereotaxic procedures and the use of electrical lesion or stimulation have allowed localization within the limbic system, hypothalamus and brain stem, of discrete nuclei that influence the formation of gastric ulceration in experimental animals. Recently, further progress in the understanding of how the brain may influence gastric pathogenesis has been made by the demonstration that specific peptides act in the central nervous system to induce or prevent the formation of gastric ulcers and to markedly alter gastric secretory and motor function. Peptides established to have a centrally mediated protective effect are bombesin, calcitonin, corticotropin-releasing factor, neurotensin and opioid peptides. Growing evidence suggests a possible role for endogenous thyroptropin-releasing hormone in mediating cold-restraint stress induced gastric lesions. Circadian variations of the content and release of these peptides have been demonstrated in specific brain structures. To what extent such rhythms of peptide secretion are potentially linked to the circadian changes in the susceptibility to ulcer formation is worth investigating.     

Prevention of stress-induced gastric ulcers by dopamine agonists in the rat

Dopamine (DA) and DA agonists have been shown to exert a protective role against the formation of duodenal ulcers. The effect of stimulation of DA receptors on the development of stress-induced gastric ulcers is currently unknown. Accordingly, we evaluated the effect of several DA agonists on the development of gastric ulcers induced by 3 h of cold + restraint stress (CRS) in rats. Apomorphine, d-amphetamine, methylphenidate, and threo-dl-p-hydroxymethylphenidate (an hydroxylated analog of methylphenidate), significantly reduced both the incidence and severity of CRS-induced gastric ulcers. The gastric cytoprotection afforded by these agents was dose-related, and completely antagonized by pretreatment with the peripheally acting DA antagonist domperidone. Because domperidone blocks peripheral, but not central, DA receptors, and since the entry of threo-dl-p-hydroxymethylphenidate across the blood-brain barrier into the brain is restricted to a great extent, we conclude that stimulation of peripheral DA receptors is primarily involved in the gastric cytoprotection induced by dopamimetics.The pathogenesis of stress-induced gastric ulcers remains largely unknown, and significant efforts have been made over the last decade to functionally characterize some of the factors involved in the etiology of this disease. Considerable attention has been focused on gastric acid secretion, but its primary role in stress-induced gastric ulcer disease remains uncertain. In fact, agents which effectively inhibit or neutralize gastric acid secretion such as cimetidine or antacids do not necessarily exert protection against stress-induced gastric ulcers (1,2). Moreover, in our original studies with neurotensin, a brain and gastrointestinal peptide, we have found that central administration of this neuropeptide, which completely prevents the development of cold + restraint stress (CRS)-induced gastric ulcers, does not appreciably alter gastric acid secretion (2). These findings support the contention that gastric acid secretion may not be an important factor in the development of this type of gastric ulcer.There is, however, considerable evidence that the automatic nervous system plays an intermediary role in the development of these ulcers (3,4). In this regard, surgical or pharmacological blockade of the vagal (cholinergic) division of the autonomic nervous system prevents the appearance of stress-associated gastric ulcers (5,6). Direct stimulation of catecholamine receptors, or indirect activation via increased sympathetic outflow to the periphery (7,4,8–11) appears to produce a salutary effect of stress-induced gastric ulcers.Szabo and his associates (12, 13, 14) have extensively studied the anti ulcer effects of dopamine (DA) in duodenal ulcer formation. Whether DA also modifies the development of stress-induced gastric ulcers is currently unknown.We have therefore evaluated the effect of selected DA receptor agonists and antagonists on CRS-induced gastric ulcer formation in rats.     

Vegetative nervous system's contribution to the development of stress induced gastric ulcers]

A vegetative nervous system contribution to the development of stress-induced gastric ulcers has been investigated. The experiments involved male Wistar rats. Vegetative nervous system activity has been assessed with acetylcholine brain and stomach tissue levels and synthesis as well as adrenaline and noradrenaline levels in adrenals and gastric wall. The results have shown, that ulcerogenic effect of stress is accompanied by the increase in both cholinergic and adrenergic activities. Moreover, it has been shown, that markedly strong stimulation of the adrenergic system in some rats, together with pharmacologic activation of alpha-adrenergic receptors, inhibits the development of stress-induced gastric ulcers.     

Central basic fibroblast growth factor inhibits gastric ulcer formation in rats

We have recently reported that basic fibroblast growth factor (bFGF) acts in the brain to inhibit the secretion of gastric acid and pepsin, two major aggressive factors in the pathogenesis of gastric ulcer formation. In the present study, we determined whether or not bFGF has an anti-ulcer action via the central nervous system, using male Wistar rats. The intracisternal injection of bFGF dose-dependently (0.1-1.0 microgram(s)/rat) inhibited the severity of gastric ulcers induced by water-immersion restraint stress or central thyrotropin-releasing hormone. The same doses of peripherally injected bFGF failed to protect the gastric mucosa from these ulcerogenic procedures. These results suggest for the first time that bFGF has a mucosal protective effect through a mechanism involving the central nervous system. It is speculated that this anti-ulcer action of bFGF is, at least in part, dependent upon its gastric antisecretory effect.     

Potent CNS action of calcitonin to inhibit cysteamine-induced duodenal ulcers in rat

Intracisternal injection of calcitonin (0.01-5 micrograms) dose dependently prevented the development of duodenal ulcers induced by cysteamine in female rats. By contrast, intravenous infusion of the peptide at a dose 50 times higher than an effective intracisternal dose, had no effect. Intracisternal injection of calcitonin increased by three fold the generation of 6-keto-PGF1 alpha, the stable hydrolysis product of PGI2, in the duodenal mucosa. These studies demonstrated that calcitonin acts within the brain to potently suppress duodenal ulcers induced by cysteamine. The mechanisms of the antiulcer effect may involve changes in prostaglandin generation along with alterations of gastrointestinal secretion and motility associated the central injection of calcitonin. Growing evidence suggests that salmon calcitonin may act as a neuromodulator or neurotransmitter in the central nervous system. Specific binding sites have been demonstrated for calcitonin in the hypothalamus, brain stem and dorsal horn of the spinal cord using homogenate and membrane preparations or in vitro autoradiography methods. The peptide injected into the cerebrospinal fluid (CSF) produces a wide spectrum of biological effects including analgesia, hyperthermia, changes in pituitary hormone release, decrease in food and water intake, locomotor activity, and blood pressure. Numerous studies also demonstrated that calcitonin acts within the brain to markedly influence gastrointestinal secretory and motor function in rats and dogs and gastric ulceration in rats. In particular, intracisternal injection of salmon calcitonin was found very potent to selectively inhibit gastric ulcers elicited by stress, aspirin and central thyrotropin-releasing factor but not by necrotizing agents. In the present study, we further investigated the antiulcer effect of salmon calcitonin using the well established cysteamine experimental model to induce duodenal ulcers in rats. Part of this work has been reported in abstract form.     

Peptidergic control of food intake in food-producing animals

Roles of brain and intestinal peptides in the control of food intake may vary among species for specific peptides depending on the degree of complexity of the gastrointestinal tract. Cholecystokinin (CCK) in the brain and intestine is the most widely studied of the peptides involved in the control of feeding. Although CCK released from the intestine may act on peripheral receptors in producing satiety in the pig, a monogastric animal, it has little effect on feeding after peripheral administration in sheep. CCK injected peripherally in chickens decreases food intake, but because of the delay in gastric emptying related to the crop and gizzard, it may be of minor importance. Possible roles for brain CCK have been suggested because CCK injected into the cerebrospinal fluid (CSF) decreases feeding in all three species. In sheep, food intake was stimulated by sequestration of endogenous CCK in CSF with specific CCK antibodies, which suggests a physiological role for brain CCK controlling food intake in this species. Opioid peptides increased feeding in sheep after i.v. and CSF injections. Only peripheral, and not CSF, injections of naloxone, a specific opiate antagonist, decreased feeding and blocked both peripheral and central opioid peptide-stimulated feeding. The balance of CCK and the opioid peptide activity in either the central nervous system or the periphery appears important in the control of feeding, but specific peptide functions and sites of action probably vary among species.     

Deficiency of glucocorticoid production delays the healing of acute gastric mucosal erosion and chronic ulcers in rats

Effects of glucocorticoid deficiency followed by corticosterone replacement on the healing of gastric erosions and chronic gastric ulcers have been investigated in rats. Glucocorticoid deficiency was induced by adrenalectomy performed after the formation of gastric erosions or ulcers. Gastric erosions were produced by indomethacin (35 mg/kg, i.p.) or by 6 h immobilization at temperature 8 degrees C, chronic gastric ulcers were induced by 60% acetic acid. All ulcerogenic stimuli caused an increase in corticosterone production. Adrenalectomy created corticosterone deficiency and delayed the healing of gastric erosions and chronic gastric ulcers. The effect of adrenalectomy was more evident in the indomethacin ulcerogenic model. Replacement by corticosterone prompted the healing of gastric erosions and ulcers in adrenalectomized animals. These data suggest a participation of endogenous glucocorticoids in a restoration of gastric mucosal integrity.     

Hypothalamic peptides: central nervous system control of visceral functions

Thyrotropin-releasing factor (TRF), somatostatin, and bombesin-like peptide are present in the brain and may be involved in central nervous system (CNS) control of visceral functions. All three peptides exert potent actions to modify animal thermoregulation. TRF and somatostatin or somatostatin analogs act within the brain to influence parasympathetic and sympathetic outflow resulting in changes of adrenal epinephrine secretion, gastric acid secretion, heart rate, and blood pressure. Bombesin acts within the brain to increase adrenal epinephrine secretion and to inhibit gastric acid secretion without influencing other sympathetic or parasympathetic activities. These peptides and others may be important physiological regulators of CNS information processing related to a variety of visceral systems.     

Molecular aspects of restitution: functions of trefoil peptides.

Healing of mucosal damage takes place in two phases: restitution of mucosal integrity and remodeling towards recreating the original glandular arrangements. These processes can be observed in several experimental rodent models: e.g., cryoprobe or NSAID-generated ulcers in the gastric or duodenal mucosa and following surgical resection of the small or large bowel. In some studies, it has been possible to detect changes in the expression of peptides, either in the reparative epithelium or adjacent to the damage, that may contribute to the healing processes. Trefoil peptides are expressed constitutively by epithelial cells in specific regions of the gastrointestinal tract, in association with mucins. Several studies have shown that trefoil peptide expression is enhanced at sites of damage in man and rat, and experimental evidence supports their active participation in the healing process. Recombinant trefoil peptides are able to enhance the rate of epithelial cell migration in vitro and are able to protect against indomethacin-induced damage in vivo, yet they do not depend upon TGF-beta for enhancing cell migration and do not appear to affect acid secretion. The mode of action of trefoil peptides appears to be receptor-mediated but is not simple. There is good evidence that there are interactions between members of the trefoil family and the EGF family that are beneficial for mucosal defense and repair. This raises the possibility that combining trefoil peptides with other growth factors or small molecules may be advantageous for treatment of ulceration.     

Lysosomal enzyme activity of the gastric mucosa in rats during experimental ulcer formation

Lysosomal membrane stability has been studied in the gastric mucosa in response to mechanical damage caused by lysosomal fractionation and release of lysosomal enzymes from mucous cells into the gastric cavity of alive animals during induction of acetic ulcer or erosive damage of the gastric mucosa resulting from intraperitoneal introduction of histamine and serotonin. It has been found that all types of ulcerogenesis in the gastric mucosa led to the decrease in lysosomal membrane stability to mechanical stress in the course of lysosomal fractionation. In addition there was a substantial release of lysosomal enzymes into the gastric cavity in different types of ulcerogenesis. The decrease in lysosomal membrane stability combined with a subsequent development of ulcers and erosions in the gastric mucosa seems indicative of the fact that lysosomal enzymes take part in the initial formation of ulcers in the gastric mucosa.     

Analogs of neurokinin A(4-10) afford protection against gastroduodenal ulcers in rats

We have developed a novel series of peptides, related to the NKA(4-10) sequence, in which substitution of selected amino acids determined variations in the affinity for the TK receptor subtypes. Subcutaneous pretreatment of rats with some peptides of this series reduced gastric ulcers induced by ethanol, indomethacin or acetylsalicylic acid (ASA) as well as duodenal ulcers induced by dulcerozine. In particular [Ala5]NKA(4-10) and [Ala5,beta Ala8]NKA(4-10) possess a broad spectrum of antiulcer activity which is long lasting and stronger than the precursor NKA(4-10). The observation that the prevention of ethanol-induced gastric lesions could be reversed by pretreatment with indomethacin favors the possible involvement of prostaglandins in the observed gastroprotection by TK analogs.     

Brain-gut relationships: gastric mucosal defense is also important.

Growing recognition that there exists a functionally important brain-gut axis has prompted several research groups to examine more closely the role of central nervous system factors in gastric mucosal injury. Less attention has been directed toward brain regulation of defensive factors in the gut. Toward that end, we have been characterizing a growing role for dopamine as an important mediator of gastric defense. New data suggest that dopamine, and other substances including many peptides as well as interleukin, act not only to reduce aggressive elements which promote gastric mucosal injury (gastric acid, pepsin, gastrin, leukotrienes) but also to augment defensive factors which retard ulcerogenesis (mucus, bicarbonate, prostaglandins, free radical scavenging enzymes, vasodilators/relaxers). Increasing attention should be directed toward the often-neglected defensive aspect of gastric mucosal ulcerogenesis and protection.     

Protein distribution of the orexin-2 receptor in the rat central nervous system

Orexin-A and -B are neuropeptides mainly expressed in the lateral hypothalamic area (LHA). A role for orexins was first demonstrated in the regulation of feeding behaviour. Subsequently, the peptides have been implicated in the control of arousal. To date, two receptors for orexins have been characterised: orexin-1 and -2 receptors (OX-R1 and OX-R2). Both receptor genes are widely expressed within the rat brain. Particularly high expression of both receptor genes in certain hypothalamic and pons nuclei could be responsible for the orexigenic and arousal properties of the peptides. It is, however, presently unclear if one given receptor subtype or both subtypes may mediate a specific biological effect of orexins such as an increase in food intake. We have recently reported the distribution of the OX-R1 protein in the rat nervous system. In this study, we report the distribution of the OX-R2 protein in the rat brain and spinal cord using specific anti-peptide antisera raised against the OX-R2 protein. We also assess the expression profile of the OX-R2 gene in different brain regions. Immunolabelling for the OX-R2 protein was observed in brain regions that exhibited OX-R1-like immunoreactivity (cerebral neocortex, basal ganglia, hippocampal formation, and many other regions in the hypothalamus, thalamus, midbrain and reticular formation). Differences in the OX-R1 and OX-R2 distribution were, however, noticed in the hippocampus, hypothalamus and dorso-lateral pons.     

Is caerulein amphibian CCK?

The amphibian skin decapeptide caerulein is structurally related to the mammalian peptides gastrin and CCK, suggesting that the peptides might share a common evolutionary history. It has been suggested that caerulein is the amphibian counterpart of gastrin and CCK, and that the Amphibia do not possess authentic gastric and CCK. High Performance Liquid Chromatography (HPLC) in conjunction with radioimmunoassay using a caerulein-specific antiserum and C-terminal CCK antisera, was used to characterize CCK-and caerulein-like peptides in amphibian brain and gut. In the brain of Xenopus laevis, two CCK-like peptides were present, one of which was indistinguishable by HPLC from mammalian CCK8. No decapeptide caerulein was detected in the brain of Xenopus laevis or Rana temporaria. In the stomach of Xenopus and in the intestine of both species studied, CCK-like and caerulein-like peptides were present. The results indicate therefore that the Amphibia possess CCK8-like rather than caerulein-like peptides in brain. In contrast, stomach and intestine contain both CCK-like and caerulein-like peptides, but the latter are however distinguishable from the decapeptide found in skin.     

Role of cyclooxygenase isoforms in gastric mucosal defence.

A complex system of interacting mediators exists in the gastric mucosa to strengthen its resistance against injury. In this system prostaglandins play an important role. Prostaglandin biosynthesis is catalysed by the enzyme cyclooxygenase (COX), which exists in two isoforms, COX-1 and COX-2. Initially the concept was developed that COX-1 functions as housekeeping enzyme, whereas COX-2 yields prostaglandins involved in pathophysiological reactions such as inflammation. In the gastrointestinal tract, the maintenance of mucosal integrity was attributed exclusively to COX-1 without a contribution of COX-2 and ulcerogenic effects of non-steroidal anti-inflammatory drugs (NSAIDs) were believed to be the consequence of inhibition of COX-1. Recent findings, however, indicate that both COX-1 and COX-2 either alone or in concert contribute to gastric mucosal defence. Thus, in normal rat gastric mucosa specific inhibition of COX-1 does not elicit mucosal lesions despite near-maximal suppression of gastric prostaglandin formation. When a selective COX-2 inhibitor which is not ulcerogenic when given alone is added to the COX-1 inhibitor, severe gastric damage develops. In contrast to normal gastric mucosa which requires simultaneous inhibition of COX-1 and COX-2 for breakdown of mucosal resistance, in the acid-challenged rat stomach inhibition of COX-1 alone results in dose-dependent injury which is further increased by additional inhibition of COX-2 enzyme activity or prevention of acid-induced up-regulation of COX-2 expression by dexamethasone. COX-2 inhibitors do not damage the normal or acid-challenged gastric mucosa when given alone. However, when nitric oxide formation is suppressed or afferent nerves are defunctionalized, specific inhibition of COX-2 induces severe gastric damage. Ischemia-reperfusion of the gastric artery is associated with up-regulation of COX-2 but not COX-1 mRNA. COX-2 inhibitors or dexamethasone augment ischemia-reperfusion-induced gastric damage up to four-fold, an effect abolished by concurrent administration of 16,16-dimethyl-PGE(2). Selective inhibition of COX-1 is less effective. Furthermore, COX-2 inhibitors antagonize the protective effect of a mild irritant or intragastric peptone perfusion in the rat stomach, whereas the protection induced by chronic administration of endotoxin is mediated by COX-1. Finally, an important function of COX-2 is the acceleration of ulcer healing. COX-2 is up-regulated in chronic gastric ulcers and inhibitors of COX-2 impair the healing of ulcers to the same extent as non-selective NSAIDs. Taken together, these observations show that both COX isoenzymes are essential factors in mucosal defence with specific contributions in various physiological and pathophysiological situations.     

Regulation of pituitary peptides by the immune system

It has long been thought that the central nervous system is able to influence the progression of disease. Furthermore, there is now overwhelming evidence that the communication pathways are bidirectional. A variety of immune system peptides are now known to be capable of transmitting information from the immune system to the central nervous system. These immunotransmitters include interleukins, interferons and thymosine peptides which have the capability of modulating slow-wave sleep as well as the release of neuro- and pituitary peptides. In some instances, release of these peptides during early development may have long lasting, if not permanent effects upon the normal development of neuroendocrine circuits. Collectively these various brain mediated events appear to contribute in various and diverse ways to defense against pathogens. It is becoming more and more apparent that certain abnormalities within the immune system may be the consequence of a neurological abnormality. The converse is also true.     

Distribution of beta-endorphin-related peptides in rat pituitary and brain.

beta-Endorphin, the most potent known naturally occurring analgesic agent, is found in pituitary and brain in company with a series of structurally and biosynthetically related peptides that are essentially devoid of opiate activity. In studies of beta-endorphin it is important to discriminate between the active and inactive forms of the peptide. This review describes the use of chemical and immunological methods for localizing the peptides in the tissues, extracting and resolving the peptides by chromatography, and determining the concentrations of the peptides by radioimmunoassay. These approaches have allowed the distribution of beta-endorphin and its related peptides to be assigned unequivocally in regions of rat pituitary and brain. It has been found that the multifunctional corticotropin-endorphin prohormone can undergo processing by different mechanisms in different tissues, permitting the intrinsic activities of its fragments to be expressed selectively. The different processing patterns can be attributed to the existence of highly specific enzymes, characteristic of individual cells, which regulate the formation of this potent opiate.     

Prostaglandins: effects on the gastrointestinal tract

Several prostaglandins have been shown to exert five major gastrointestinal actions. Inhibition of gastric acid secretion, orally and parenterally. Antiulcer activity (they prevent gastric and duodenal ulcers produced experimentally in animals, and they accelerate the rate of healing of duodenal ulcers in humans). Cytoprotection for the stomach, the small and the large intestine. Cytoprotection is defined as the property of many prostaglandins to protect the mucosa of the stomach and intestine from becoming inflamed and necrotic when this mucosa is exposed to noxious agents. Cytoprotection is separate from, and unrelated to, inhibition of gastric secretion. In humans, certain prostaglandins of the E type given at very low doses prevent gastric bleeding produced by aspirin and indomethacin. Stimulation of intestinal secretion, through increase of cyclic AMP formation. Stimulation of smooth muscle contraction. Certain prostaglandins are likely to be beneficial in the treatment of gastric ulcers, stress ulcers, duodenal ulcers, and perhaps gastritis and certain forms of inflammatory bowel disease.     

Inhibition of leukocyte migration after concanavalin A and phytohemagglutinin in patients with ulcers]

An attempt of the assessment of T-cells function in patients with gastric or duodenal ulcer has been undertaken. The studies involved 60 patients with gastric or duodenal ulcers and 47 individuals of the control group. Lymphocyte reactivity to different concentrations of concanavalin A and phytohemagglutinin has been assessed with leukocyte migration inhibition test. Lymphocyte T function has been examined also in patients with gastric or duodenal ulcers in reference to the theophylline-dependent and theophylline-sensitive subpopulation of T-cells. Leukocyte migration index values after phytohemagglutinin and concanavalin A did not differ significantly in patients with gastric or duodenal ulcers and theophylline-sensitive T-cells. Differences have been noted in the migration inhibition deficits. This phenomenon has been least frequent in case of phytohemagglutinin in the control group (5.8%) and most frequent in patients with gastric ulcer (62%). Percentage of patients responding to higher concanavalin A concentration (40 micrograms/ml) with leukocyte migration inhibition has been the highest in patients with duodenal ulcer. This index value has been significantly lower (p < 0.05) only in patients with duodenal ulcer and increased number of theophylline-dependent lymphocytes T. Increased reactivity of T-cells to higher concanavalin A concentration in patients with duodenal ulcer with theophylline-dependent T-cells in peripheral blood probably indicates increased the suppressor lymphocytes activity.