Neuro-immune interactions in inflammatory bowel disease and irritable bowel syndrome: Future therapeutic targets
ABSTRACT The gastro-intestinal tract is well known for its largest neural network outside the central nervous system and for the most extensive immune system in the body. Research in neurogastroenterology implicates the involvement of both enteric nervous system and immune system in symptoms of inflammatory bowel disease and irritable bowel syndrome. Since both disorders are associated with increased immune cell numbers, nerve growth and activation of both immune cells and nerves, we focus in this review on the involvement of immune cell-nerve interactions in inflammatory bowel disease and irritable bowel syndrome. Firstly, the possible effects of enteric nerves, especially of the nonadrenergic and noncholinergic nerves, on the intestinal immune system and their possible role in the pathogenesis of chronic intestinal inflammatory diseases are described. Secondly, the possible effects of immunological factors, from the innate (chemokines and Toll-like receptors) as well as the adaptive (cytokines and immunoglobulins) immune system, on gastro-intestinal nerves and its potential role in the development of inflammatory bowel disease and irritable bowel syndrome are reviewed. Investigations of receptor-mediated and intracellular signal pathways in neuro-immune interactions might help to develop more effective therapeutic approaches for chronic inflammatory intestinal diseases.
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ABSTRACT: Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients' lives. There are growing data suggesting that pain is variably related to the degree of active inflammation. Given the multifactorial etiologies underlying the pain, the treatment of abdominal pain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominal pain in patients with IBD, namely, inflammation, surgical complications, bacterial overgrowth, and neurobiological processes and how pain management can be addressed in each of these cases. The role of genetic factors, psychological factors, and psychosocial stress in pain perception and treatment will also be addressed. Lastly, psychosocial, pharmacological, and procedural pain management techniques will be discussed. An extensive review of the existing literature reveals a paucity of data regarding pain management specific to IBD. In addition, there is growing consensus suggesting a spectrum between IBD and irritable bowel syndrome (IBS) symptoms. Thus, this review for adult and pediatric clinicians also incorporates the literature for the treatment of functional abdominal pain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominal pain in this population.Therapeutic Advances in Gastroenterology 09/2012; 5(5):339-57. DOI:10.1177/1756283X12446158
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ABSTRACT: This paper summarizes the current knowledge on the interactions between intestinal mast cells, enteric neurons and visceral afferents which are part of the gut brain axis. The focus of this review is on the relevance of the mast cell-nerve axis in the human intestine. Similarities and important differences in the organization of the mast cell-nerve axis between human and rodents are discussed. Functionally important human mast cell mediators with neural actions in the human ENS are histamine (H1-4 receptors), proteases (PAR1 receptors), several cytokines and chemokines and probably also serotonin (5-HT(3) receptors). On the other hand, mediator release from human intestinal mast cells is modulated by neuropeptides released from enteric and visceral afferent nerves. This article is part of a Special Issue entitled: Mast Cells in Inflammation.Biochimica et Biophysica Acta 06/2011; 1822(1):85-92. DOI:10.1016/j.bbadis.2011.06.004 · 4.66 Impact Factor
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ABSTRACT: Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), which affect 5% people in the U.S. and northern European countries, result in chronic visceral pain of unknown etiology. Pharmacological treatments are thus often palliative or not very effective. This review summarizes the current knowledge on peripheral and central mechanisms of colonic pain in IBS and IBD. The role of the commensal microflora and the enteric nervous system in peripheral inflammation and sensitization of intestinal nociceptors is emphasized. Moreover, supraspinal modulatory influences (descending pathways, stress, hypervigilance) on spinal cord activity and gut physiology are presented. These data highlight the critical role of the brain–gut axis in the pathophysiology of IBS and IBD through neuro-immune and neuro-enteric interactions.Douleurs Evaluation - Diagnostic - Traitement 04/2010; 11(2):65-74. DOI:10.1016/j.douler.2010.02.006