Involvement of cannabinoid receptors in gut motility and visceral perception

• Published in: British journal of pharmacology 2004-04, Vol.141 (8), p.1335-1345
• Main Authors: Hornby, Pamela J, Prouty, Stephen M
• Format: Article
• Language: English
• Subjects: anandamide; Animals; Biological and medical sciences; Cannabinoid Receptor Agonists; Cannabinoid Receptor Modulators - pharmacology; Cannabinoid Receptor Modulators - therapeutic use; delta9‐tetrahydrocannabinol; emesis; endocannabinoid; Gastroesophageal reflux disease; Gastrointestinal Motility - physiology; Humans; ileitis; intestine; lower oesophageal sphincter; Medical sciences; Pain Threshold - drug effects; Pain Threshold - physiology; Pharmacology. Drug treatments; Receptors, Cannabinoid - physiology; Reviews; stomach; Visceral Afferents - drug effects; Visceral Afferents - metabolism; Visceral Afferents - physiology
• ISSN: 0007-1188; 1476-5381
• DOI: 10.1038/sj.bjp.0705783

From a historical perspective to the present day, all the evidence suggests that activation of cannabinoid receptors (CBRs) is beneficial for gut discomfort and pain, which are symptoms related to dysmotility and visceral perception. CBRs comprise G‐protein coupled receptors that are predominantly in enteric and central neurones (CB1R) and immune cells (CB2R). In the last decade, evidence obtained from the use of selective agonists and inverse agonists/antagonists indicates that manipulation of CB1R can alter (1) sensory processing from the gut, (2) brain integration of brain‐gut axis, (3) extrinsic control of the gut and (4) intrinsic control by the enteric nervous system. The extent to which activation of CB1R is most critical at these different levels is related to the region of the GI tract. The upper GI tract is strongly influenced by CB1R activation on central vagal pathways, whereas intestinal peristalsis can be modified by CB1R activation in the absence of extrinsic input. Actions at multiple levels make the CB1R a target for the treatment of functional bowel disorders, such as IBS. Since low‐grade inflammation may act as a trigger for occurrence of IBS, CB2R modulation could be beneficial, but there is little supporting evidence for this yet. The challenge is to accomplish CBR activation while minimizing adverse effects and abuse liabilities. Potential therapeutic strategies involve increasing signaling by endocannabinoids (EC). The pathways involved in the biosynthesis, uptake and degradation of EC provide opportunities for modulation of CB1R and some recent evidence with inhibitors of EC uptake and metabolism suggest that these could be exploited for therapeutic gain. British Journal of Pharmacology (2004) 141, 1335–1345. doi:10.1038/sj.bjp.0705783