Modulation of central endocannabinoid system results in gastric mucosal protection in the rat
Tóth, V.E.1, Fehér, Á.1, Németh, J.2, Gyertyán, I.3, Zádori, Z.S.1, Gyires K.1
1 Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Semmelweis University,
Nagyvárad tér 4., 1089 Budapest, Hungary;
2 Department of Pharmacology and Pharmacotherapy, University of Debrecen, Nagyerdei krt. 98.,
4032 Debrecen, Hungary;
3 MTA-SE NAP B Cognitive Translational Behavioural Pharmacology Group, Department of
Pharmacology and Pharmacotherapy, Semmelweis University, Nagyvárad tér 4., 1089 Budapest,
Department of Pharmacology and Pharmacotherapy, Semmelweis University, Nagyvárad tér 4., 1089,
Phone: 36-1-210-4416, Fax: 36-1-210-4412
Previous findings showed that inhibitors of fatty acid amide hydrolase (FAAH) and
monoacylglycerol lipase (MAGL), degrading enzymes of anandamide (2-AEA) and 2-
arachidonoylglycerol (2-AG), reduced the nonsteroidal anti-inflammatory drug-induced gastric lesions.
The present study aimed to investigate: i./whether central or peripheral mechanism play a major role in
the gastroprotective effect of inhibitors of FAAH, MAGL and AEA uptake, ii./ which peripheral
mechanism(s) may be responsible for mucosal protective effect of FAAH, MAGL and uptake inhibitors.
Methods: Gastric mucosal damage was induced by acidified ethanol. Gastric motility was measured in
anesthetized rats. Catalepsy and the body temperature were also evaluated. Mucosal calcitonin gene-
related peptide (CGRP), somatostatin concentrations and superoxide dismutase (SOD) activity were
measured. The compounds were injected intraperitoneally (i.p.) or intracerebroventricularly (i.c.v.).
Results: 1. URB 597, JZL184 (inhibitors of FAAH and MAGL) and AM 404 (inhibitor of AEA uptake)
decreased the mucosal lesions significantly given either i.c.v. or i.p. 2. URB 937, the peripherally
restricted FAAH inhibitor failed to exert significant action injected i.p. 3. Ethanol-induced decreased
levels of mucosal CGRP and somatostatin were reversed by URB 597, JZL 184 and AM 404, the
decreased SOD activity was elevated significantly by URB 597 and JZL 184. 4. Neither compounds
given i.c.v. influenced gastric motility, elicited catalepsy, or hypothermia. Conclusion: Elevation of
central endocannabinoid levels by blocking their degradation or uptake via stimulation of mucosal
defensive mechanisms resulted in gastroprotective action. These findings might suggest that central
endocannabinoid system may play a role in gastric mucosal defense and maintenance of mucosal
The endocannabinoid system (ECS), which comprises the cannabinoid CB1, CB2 receptors, the
endocannabinoids and their synthetic and metabolizing enzymes, is involved in the regulation of
numerous physiological processes. The two main endocannabinoids, anandamide (AEA) and 2-
arachidonoylglycerol (2-AG) may play a role in these regulatory mechanisms either as neurotransmitters
or neuromodulators (Palmer et al., 2002), and dysregulation of the ECS has been demonstrated in several
diseases (for review see: Pacher and Kunos, 2013).
Besides endocannabinoids other naturally occurring cannabinoids are the plant-derived
phytocannabinoids. Cannabis sativa plant contains more than 80 cannabinoids (Kumar et al., 2001),
among them the main active constituent of marijuana is the psychoactive ∆9-tetrahydrocannabinol (∆9-
THC), which acts at CB1 and CB2 receptors as a partial agonist. Other important natural cannabinoids
of marijuana are the non-psychoactive cannabidiol, ∆9-tetrahydrocannabivarin and cannabichromene
(Kumar et al., 2001; Russo, 2011; Turner and Elsohly, 1981). Some of these plant-derived cannabinoids
are used in the medical practice, such as ∆9-THC (dronabinol) and its synthetic analogue, nabilone
against chemotherapy-induced nausea and emesis, and as appetite stimulants (e.g. in AIDS patients).
However, as psychoactive drugs, both of them may cause psychotomimetic action. Furthermore,
combination of the non-psychoactive cannabidiol with ∆9-THC has beneficial effect in neuropathic pain,
in spasticity in multiple sclerosis, and as an adjunctive analgesic treatment in advanced cancer pain
The role of ECS in the physiology and pathophysiology of gastrointestinal (GI) tract has also
been extensively studied (Di Carlo and Izzo, 2003; Esposito et al., 2013; Kunos and Pacher, 2004; Massa
and Monory, 2006; Vigna, 2003). High levels of AEA and 2-AG, and of the enzymes responsible for
their synthesis and metabolism can be detected in the digestive tract (Marquez et al., 2009; Katayama et
al., 1997; Izzo et al., 2001; Duncan et al., 2008). Similarly, cannabinoid receptors are also widely
distributed in the GI tract. CB1 receptors have been shown by immunohistochemical studies in myenteric
and submucosal nerve plexuses along the alimentary tract (for review see: Izzo and Coutts, 2005). Co-
localization of CB1 receptors with the cholinergic marker, choline acetyltransferase in neural elements
innervating smooth muscle, mucosal and submucosal blood vessels of rat stomach fundus, corpus and
antrum has been shown (Adami et al., 2002). In the gut, in non-inflamed tissues, CB1 receptors are
mainly localized on excitatory motor neurons, interneurons and intrinsic primary afferent neurons of the
enteric nervous system. In addition, epithelial cells, smooth muscles and immune cells express CB1
receptors (Wright et al., 2005; Marquez et al., 2009; Coutts et al., 2002). CB2 receptors, on the other
hand, are mainly expressed by subepithelial immune cells (such as macrophages and plasma cells)
(Wright et al., 2005), and also by enteric neurons (Duncan et al., 2008, Wright et al., 2008), while they
are absent or weakly expressed in epithelial cells in humans (Wright et al., 2005; Wright et al., 2008).
The effect of cannabinoids on GI mucosal injury has been intensively studied (for recent review
see: Gyires and Zádori, 2016). Activation of CB receptors by endocannabinoids or synthetic derivatives
has been shown to exert mucosal protective effect against different types of experimental gastric ulcers.
For example Δ9-THC reduced mucosal damage induced by pylorus ligation in the rat (Sofia et al., 1978).
Δ9-THC also attenuated diclofenac-induced gastric mucosal lesions given either orally or
intraperitoneally (i.p.) in the mouse (Kinsey and Cole, 2013; Kinsey et al., 2011). The protective action
was mediated by CB1 receptors and the dose range of the gastroprotective effect was lower than that
producing classical cannabimimetic effects, such as locomotor immobility, antinociception,
hypothermia and catalepsy (Kinsey and Cole, 2013; Kinsey et al., 2011). These results indicate that Δ9-
THC is able to protect the gastric mucosa at doses insufficient to cause common cannabinoid side
effects. In addition, gastric lesions induced by water immersion and restraint stress in the rat were
reduced by AEA as well as by the synthetic analog WIN 55,212-2 (both are given i.p.), and their
gastroprotective action was mediated also by CB1 receptors (Dembinski et al., 2006; Germano et al.,
2001). The protective effect of AEA was associated with an increase in gastric mucosal blood flow and
mucosal DNA synthesis, and with reduced level of pro-inflammatory interleukin-1β (IL-1β) (Dembinski
et al., 2006). Involvement of CB1 receptors in gastroprotection was further supported by the results with
the selective cannabinoid CB1 receptor agonist ACEA (arachidonyl-2-chloroethylamide), which
effectively reduced the aspirin-induced gastric mucosal lesions (given i.p.) (Rutkowska and Fereniec-
While gastric acid secretion is involved in the pathomechanism of pylorus-ligation-,
nonsteroidal anti-inflammatory drug- (NSAID) or stress-induced gastric ulcer models, gastric acid does
not play a role in the development of mucosal injury induced by ethanol. This ulcer model originally
described for demonstration of the cytoprotective effect of prostaglandins by Robert et al. (Robert et al.,
1979), has been widely used method for the analysis of the mechanism of gastroprotective action. AEA,
methanandamide and WIN 55,212-2 have been found to reduce the ethanol-induced gastric lesions
following both peripheral (intravenous /i.v./) and central (intracerebroventricular, /i.c.v./)
administration, indicating that their mucosal protective effect is not likely to be related to inhibition of
gastric acid secretion, but rather to the activation of mucosal defensive processes (Shujaa et al., 2009).
Since the protective effect of methanandamide injected i.v. was reversed by the i.c.v injected CB1
receptor antagonist SR141716A, the primary site of action is likely to be central and mediated by CB1
receptors (Shujaa et al., 2009).
CB1 and CB2 receptors can be activated not only directly by the natural and synthetic ligands,
but also indirectly, by elevating the level of endocannabinoids in the vicinity of cannabinoid receptors,
either by blocking their degradation or uptake. AEA and 2-AG levels are regulated in vivo by catabolic
enzymes, like the intracellular fatty acid amide hydrolase (FAAH), which hydrolyzes AEA into
arachidonic acid and ethanolamine (Cravatt et al., 2001), and monoacylglycerol lipase (MAGL)
(Blankman et al., 2007), which is the main contributor to 2-AG hydrolysis. In addition, biological
activity of AEA is terminated by its removal from the extracellular space via cellular uptake (Fowler,
Systemic administration of 4-[Bis(1,3-benzodioxol-5-yl)hydroxymethyl]-1-
piperidinecarboxylic acid 4-nitrophenyl ester (JZL 184), a selective MAGL inhibitor, increased the level
of 2-AG in mouse whole brain without affecting the level of AEA (Long et al., 2009). Similarly, elevated
level of 2-AG, but not that of AEA was observed in the gastric mucosa of mice following i.p.
administration of JZL 184 (Kinsey and Cole, 2013; Kinsey et al., 2011; Long et al., 2009). Moreover,
the FAAH inhibitor URB 597 (N-Cyclohexylcarbamic acid 3'-(Aminocarbonyl)-[1,1'-biphenyl]-3-yl
ester) produced a profound, dose-dependent inhibition of brain FAAH activity accompanied by a
significant elevation of the brain level of AEA in rats, whereas it did not change the brain content of 2-
AG (Kathuria et al., 2003). Similarly, to FAAH inhibitor-treated mice, in FAAH (-/-) mice, elevated
levels of AEA in the central nervous system (CNS), as well as CB1-receptor mediated antinociception
could be observed (Cravatt et al., 2001; Lichtman et al., 2004).
It has been raised that increasing endocannabinoid tissue levels may provide a functionally
selective way of enhancing endocannabinoid tone only in those tissue and cells that have active synthesis
and release of endocannabinoids (Ahn et al., 2009; Di Marzo, 2008). Consequently, it has been
hypothesized that increasing endocannabinoid tissue levels would induce less psychoactive effects (such
as catalepsy, hypothermia or hyperphagia) than the direct stimulants of CB1 receptors (Kathuria et al.,
2003), while the beneficial effects due to activation of CB1 and/or CB2 receptors would be retained.
Accordingly, promising results have been obtained for FAAH inhibitors in preclinical models of acute,
inflammatory, and neuropathic pain, as well as in anxiety, depression, nausea, hypertension, pruritus,
smoking cessation, post-traumatic stress syndrome or Parkinson's disease (for reviews see: Ahn et al.,
2009; Pacher and Kunos, 2013) as well as in inflammatory bowel diseases and irritable bowel syndrome
(Salaga et al., 2014). Similarly, numerous studies demonstrated that inhibition or genetic deletion of
MAGL exerts antiemetic, antineoplastic, anxiolytic and antinociceptive effects in rodents, and protects
against brain injury, acute liver injury/inflammation and colitis (for review see: Pacher and Kunos,
Moreover, AM 404 (N-(4-hydroxyphenyl) arachidonamide), an AEA analog (Rogosch et al.,
2012), inhibits the carrier-mediated transport of AEA into presynaptic neurons from the synaptic cleft
(Beltramo et al., 1997). AM 404 is an active metabolite of paracetamol, and responsible for its analgesic
action, at least partly (Ottani et al., 2006). In addition, AM 404 was reported to exert anxiolytic effect
in the rat (given i.p.). The effect was correlated with increased level of AEA (but not that of 2-AG), in
the prefrontal cortex and was prevented by the CB1 receptor antagonist SR141716A (Bortolato et al.,
The effect of FAAH and MAGL inhibitors has also been studied against experimental gastric
mucosal lesions. It was demonstrated that the globally acting irreversible inhibitor URB 597, given i.p.,
inhibited the diclofenac-induced gastric mucosal lesions. Similarly, reduction of the mucosal lesions
was observed in transgenic, FAAH (-/-) mice. URB 597 proved to be effective also in CB2 (-/-) mice,
but was ineffective in CB1 (-/-) mice, indicating that the gastroprotective effect was mediated entirely
by CB1 receptors (Naidu et al., 2009). Another FAAH inhibitor, URB 937 (3′-carbamoyl-6-hydroxy-
[1,1′-biphenyl]-3-yl cyclohexylcarbamate]), in contrast with the globally acting URB 597, inhibits
FAAH only in peripheral tissues (Clapper et al., 2010) and proved to be also effective against gastric
lesions induced by indomethacin in the mouse (Sasso et al., 2012). Similarly, inhibition of MAGL, the
primary catabolic enzyme of 2-AG resulted in protection against gastric damage induced by diclofenac
(Kinsey et al., 2011). However, no data have been found on the effect of AM 404 on gastric mucosal
The aim of the present study was to clarify:
i./whether elevation of endocannabinoid level by inhibition of FAAH, MAGL enzymes and
anandamide uptake protects the gastric mucosa against ethanol-induced mucosal injury, an acid
independent ulcer model, appropriate for studying gastroprotective potency and efficacy,
ii./whether the primary site of gastroprotective action is central or peripheral,
iii./which peripheral mechanism may play role in centrally initiated mucosal protective effect
of endocannabinoid modulators.
Here we showed that inhibitors of FAAH, MAGL and anandamide membrane uptake, URB
597, JZL 184 and AM 404, respectively exerted mucosal protective effect against ethanol given both
i.p. and i.c.v. The primary site of action is likely to be central, since the i.c.v. injected CB1 receptor
inverse agonist AM 251 antagonized the gastroprotective effect of i.p. given URB 597, JZL 184 and
AM 404. In addition, the peripherally restricted FAAH inhibitor, URB 937 following i.p administration
failed to exert mucosal protective effect. The centrally injected URB 597, JZL 184 and AM 404 resulted
in an increase of the gastric mucosal CGRP and somatostatin levels that are involved in mucosal
defensive mechanisms. The results indicate that elevation of central endocannabinoid level may initiate
a chain of events which results in activation of gastric mucosal defensive mechanisms, consequently,
maintenance of mucosal integrity.
2. Materials and Methods
Experiments were carried out on male Wistar rats weighing 150-170 g, received from the
breeding colony of Semmelweis University. The animals were kept in a 12-hour light/dark cycle and
under condition of controlled temperature. They were maintained on standard rat laboratory chow and
tap water ad libitum.
All efforts were made to minimize animal suffering and to reduce the number of animals used
in the experiments. All procedures conformed to the Directive 2010/63/EU on European Convention for
the protection of animals used for scientific purposes. The experiments were approved by the National
Scientific Ethical Committee on Animal Experimentation and permitted by the government (Food Chain
Safety and Animal Health Directorate of the Government Office for Pest County (PEI/001/1493-
2.2. In vivo studies
2.2.1. Gastric mucosal lesions induced by absolute ethanol
After 24 h food deprivation the animals were given orally 0.5 ml acidified ethanol (98 ml
absolute ethanol + 2 ml concentrated HCl). One hour later the animals were sacrificed by inhalation of
CO2, the stomachs were excised, opened along the greater curvature, rinsed with saline and examined
for lesions. The degree of mucosal lesions was assessed in blinded manner by calculation of lesion index
based on a 0-4 scoring system described previously (Gyires, 1990). The ulcer index was calculated as
the total number of lesions multiplied by the respective severity factor. The percentual inhibition of
mucosal damage was calculated as follows:
100 – [ulcer index in treated group/ulcer index in control group x 100].
Drugs were injected either i.p. or i.c.v. to the lateral ventricle as described previously (Gyires et
al., 2000) in a volume of 5 ml/kg or 10 µl, 20 and 10 min before the ethanol challenge, respectively. To
avoid a rapid increase of intracerebroventricular pressure, the volume was injected during 1 min period
by a special apparatus. The antagonist of CB1 receptor was injected i.c.v. either together with the i.c.v.
given, or 10 min after the i.p. administered FAAH, MAGL and anandamide uptake inhibitors.
2.2.2. In vivo measurement of gastric motor activity
Gastric motility was measured in anesthetized rats with the rubber balloon method (Zádori and
Gyires, 2013; Lefebvre et al.,1992). Briefly, after 24 h food deprivation male Wistar (200-300 g) rats
were anesthetized with urethane (1.25 g/kg i.p.), a tracheal cannula was inserted to ensure a clear airway
and an intragastric balloon created from thin latex rubber connected with plastic tubing was introduced
into the stomach via mouth. The balloon was filled with 2 ml warm water (37 ◦C) to set the basal
intragastric pressure to 10 ± 0.5 cmH2O. The exact location of the balloon was verified after each
experiment. The distal end of tubing was connected to a pressure transducer and to a PowerLab
Instrument with a Chart 5 program (AdInstruments, Bella Vista, Australia) to monitor the intragastric
pressure. An equilibrium period (40-60 min) was registered before each experiment. AM 404, URB 597
and JZL 184 were given i.c.v. in a volume of 10 µl within 5 min via a CMA/100 microinjection pump.
For i.c.v injection guide cannulas were implanted with stereotaxic surgery, and the following coordinates
were used (relative to bregma): posterior 0.8 mm; lateral 1.6 mm; ventral 4.5 mm (Paxinos and Watson,
1986). The site of injection was verified after each experiment. For analysis of gastric motor activity
two parameters were determined. The gastric tone, which correlates well with fundic activity, was
calculated from the bottom points of phasic pressure wave. The mean amplitude of phasic contractions,
which correlates with the antral contractions superimposed on tonic pressure, was calculated from the
amplitude of each contraction. Both parameters were determined from 5 min segments, before and after
the injection of test compounds. Values were expressed in percentage of the basal (pre-injection) values.
2.2.3. Behavior changes
Experiments were carried out according to the methods of Tseng et al. (Tseng and Craft, 2001).
Catalepsy was evaluated using the bar test, in which the forepaws of the rats were placed on a raised
bar. Latency to withdraw both forepaws from the bar or jump onto the bar was recorded 3 times at each
animal; if the rat did not respond by 60 s, the test was terminated and 60 s was recorded. If the animal
moved away from the bar on three occasions, the test was ended. The compounds or vehicle were given
i.c.v. and 10 min later the rat’s forepaws were placed on an elevated bar. The duration of immobility
(that is catalepsy, the absence of voluntary movement) was measured for 40 min at 10 min intervals
right after the catalepsy test.
Body temperature was determined rectally by the probe inserted 2 cm into the rectum. The
temperature was recorded immediately prior to and 10 min after the i.c.v. injection of the compounds
for 40 min period at 10 min intervals.
2.3. Biochemical assays
2.3.1. Determination of gastric mucosal level of calcitonin gene-related peptide (CGRP) and
For determination of gastric mucosal level of CGRP and somatostatin following CO2 inhalation
the stomachs of the rats were removed and put in 1 ml cold distilled water, sonicated and stored at -80
°C till the determination. CGRP and somatostatin concentrations were determined by radioimmunoassay
(RIA) described previously (Németh et al., 1998). For the specific RIA the antisera (CGRP: C1012;
somatostatin: 775/7) were raised in rabbit immunized with synthetic peptide conjugated to thyroglobulin
by glutaraldehyde. The RIA tracers were mono-125l-labeled peptides prepared by Németh et al (Németh
et al., 1998; 2002). Synthetic peptides were used as RIA standards ranging from 0 to 1000 fmol/ml
(somatostatin) and from 0 to 100 fmol/ml (CGRP). Detection limits of the assays were 2 fmol/ml
(somatostatin) and 0.2 fmol/ml (CGRP). These techniques have proved to be specific, sensitive and valid
for the measurement of neuropeptides in pharmacological research. Peptide concentrations were
calculated as the measured amount of peptide per wet tissue weight, expressed as fmol/mg tissue.
2.3.2. Superoxide dismutase assay
Superoxide dismutase (SOD) activity was measured by using an assay kit (Cayman Europe,
Tallinn, Estonia) according to the manufacturer's instructions. This kit utilizes a tetrazolium salt for the
detection of superoxide radicals generated by xanthine oxidase and hypoxanthine, and measures the
activity of all three types of SOD (Cu/Zn, Mn and Fe-SOD). One unit of SOD was defined as the amount
of enzyme needed to exhibit 50% dismutation of the superoxide radical (O2−˙). SOD activity was
expressed in unit/mg tissue.
N-(4-Hydroxyphenyl)-5Z,8Z,11Z,14Z-eicosatetraenamide (AM 404) was purchased from
Tocris Bioscience (Bristol, UK), cyclohexylcarbamic acid 3'-(Aminocarbonyl)-[1,1'-biphenyl]-3-yl
ester (URB 597) and 4-[Bis(1,3-benzodioxol-5-yl)hydroxymethyl]-1-piperidinecarboxylic acid 4-
nitrophenyl ester (JZL 184) were ordered from Abcam Biochemicals (Cambridge, UK). N-(Piperidin-
1-yl)-5-(4-iodophenyl)-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole-3-carboxamide (AM 251) and
cyclohexylcarbamic acid 3′-carbamoyl-6-hydroxybiphenyl-3-yl ester (URB 937) were purchased from
Sigma Chemical Co. (St. Louis, MO, USA).
All drugs were dissolved in DMSO, and stock solutions were diluted with saline. Animals in the
control groups received the drug solvents.
2.5. Statistical analysis
All data are presented as the means S.E.M. Statistical analysis of the data was evaluated by
means of analysis of variance (ANOVA) followed by Newman-Keuls post hoc test. In the case of gastric
motility experiments the pre- and postinjection values were compared with paired Student’s t-test. Two-
way repeated measures ANOVA test was employed to evaluate the behavior (catalepsy) and body
temperature (hypothermia) changes. A probability value of less than 0.05 was considered statistically
3.1. The gastroprotective effect of URB 597, JZL 184 and AM 404 given centrally (i.c.v.)
Acidified ethanol given orally induced multiple hemorrhagic lesions on the gastric mucosa in
control (vehicle-treated) animals (lesion index: 84.4 ± 12.6, n=5). Both the globally acting FAAH
inhibitor URB 597 (2.9 - 29.5 nmol i.c.v.), the MAGL inhibitor JZL 184 (0.3 - 1.3 nmol i.c.v.) and the
membrane uptake inhibitor AM 404 (2.5 - 25 nmol i.c.v.) induced a significant inhibition of the mucosal
lesions induced by ethanol. All dose-response curves proved to be bell-shaped, the maximal protective
effects (80% or above) were achieved at the following doses: 2.9 nmol (URB 597), 1.3 nmol (JZL 184)
and 2.5 nmol (AM 404) (Fig. 1). AM 251 (3.6 nmol), a CB1 receptor inverse agonist, failed to affect the
ethanol-induced mucosal injury in a significant manner per se, however, inhibited the mucosal
protective effect of both URB 597, JZL 184 and AM 404 (Fig. 2).
3.2. The effect of URB 597, JZL 184, AM 404 and URB937 given peripherally (i.p.) on acidified ethanol-
induced gastric mucosal lesions
Both the globally acting FAAH inhibitor URB 597 and the MAGL inhibitor JZL 184 in the
doses of 2.9-8.8 and 9.6-19.2 µmol/kg i.p., respectively, inhibited in a dose-dependent manner the
mucosal lesions induced by ethanol. Similarly, the uptake inhibitor AM 404 (1.5-15 µmol/kg i.p.) also
exerted mucosal protective effect given peripherally. In contrast, injection of the peripherally restricted
FAAH-inhibitor URB 937 (in the doses of 0.8-16.92 µmol/kg i.p.) failed to result in a significant
reduction of gastric mucosal lesions induced by ethanol (Fig. 3).
3.3. The effect of the centrally (i.c.v.) given CB1 receptor inverse agonist AM 251 on the protective
action of URB 597, JZL 184 and AM 404 given peripherally (i.p.)
URB 597 (8.8 µmol/kg i.p.), JZL 184 (19.2 µmol/kg i.p.) and AM 404 (15 µmol/kg i.p.) induced
a significant inhibition of gastric mucosal injury evoked by ethanol. AM 251 (3.6 nmol) given i.c.v. 10
min after the i.p. injection of URB 597, JZL 184 and AM 404 inhibited the development of the protective
effect of the all substances (Fig. 4).
3.4. The effect of centrally given URB 597, JZL 184 and AM 404 on the mucosal levels of somatostatin
and calcitonin gene-related peptides (CGRP), and on the activity of superoxide dismutase (SOD)
Ethanol induced a profound reduction of the mucosal levels of both CGRP and somatostatin.
When the rats were pretreated with either URB 597 (2.95 nmol i.c.v.), JZL 184 (1.3 nmol i.c.v.) or AM
404 (2.5 nmol i.c.v.), a significant increase of both CGRP and somatostatin levels were observed, that
is, all the compounds prevented (or at least significantly reduced) the deleterious effect of ethanol on
mucosal mucosal protective factors (Fig. 5).
The mucosal activity of SOD also showed a significant reduction following ethanol treatment.
URB 597 and JZL 184 reversed the effect of ethanol on SOD activity parallel with the gastroprotective
effect, whereas AM 404 failed to significantly influence it (Fig. 6).
3.5. The effect of URB 597, JZL 184 and AM 404 injected i.c.v. on gastric motor activity
The effect of URB 597, JZL 184 and AM 404 on gastric motor activity was studied in
gastroprotective, as well as in 10 times higher doses. The results showed that the compounds URB 597
(2.95 - 29.5 nmol), JZL 184 (1.3 - 13 nmol) and AM 404 (2.5 - 25 nmol) injected i.c.v. influenced neither
the mean amplitude of gastric contractions nor the gastric tone in vivo by using the rubber balloon
technique (Fig. 7).
3.6. The cataleptic and hypothermic effects of i.c.v. injected URB 597, JZL 184 and AM 404
Control, saline (i.c.v.) treated rats moved away their front paws from the bar immediately. Rats
treated with URB 597 and AM 404 in gastroprotective doses (2.95 nmol and 2.5 nmol i.c.v.,
respectively) failed to show immobility in the bar test (means of latency period of paw withdrawal are
below1 sec). Similarly, neither JZL 184 (1.3 nmol) induced a significant prolongation of the latency of
paw removal (mean: 1 sec) from the bar suggesting that no cataleptic effect was elicited by the drugs in
their gastroprotective dose-range during the 40 min observation period.
Similarly, no differences could be observed in the body temperatures compared to the baseline,
pre-treatment values in control and drug-treated groups (Fig. 8).
The present results demonstrated that elevation of anandamide and 2-AG levels by blocking
their degradation or uptake resulted in gastric mucosal protective effect against ethanol-induced lesions,
given both peripherally (i.p.) and centrally (i.c.v.). Moreover, it was first shown that inhibition of AEA
cellular uptake by AM 404 (i.c.v. and i.p.) also decreased the mucosal injury induced by ethanol. Since
the peripherally acting FAAH inhibitor, URB 937, failed to inhibit the ethanol-induced lesions in a
significant manner, it may be raised that the primary site of the gastroprotective action is likely to be
central. Further evidence for the central site of mucosal protective effect was provided by the findings
that the gastroprotective action of peripherally (i.p.) injected FAAH, MAGL inhibitors and uptake
inhibitor of AEA was reversed by i.c.v. given CB1 receptor antagonist/inverse agonist AM 251,
indicating the prominent role of central CB1 receptors in gastric mucosal defense. Similarly, parallel
administration of AM 251 with either FAAH, MAGL or AEA uptake inhibitors i.c.v. prevented the
development of the mucosal protective effect suggesting the significance of central CB1 receptors in
Pharmacological blockade of the degradation of endocannabinoids is an attractive strategy for
enhancing endocannabinoid signaling. It has been supposed that elevated endocannabinoid tissue levels
would result in less psychoactive effects (such as catalepsy, hypothermia or hyperphagia) than the direct
stimulants of CB1 receptors, while the beneficial effects due to activation of CB1 and/or CB2 receptors
would be retained (Makriyannis et al., 2005; Kathuria et al., 2003).
Several data confirmed the analgesic/anti-inflammatory and mucosal protective effect of FAAH
and MAGL inhibitors. For example, inhibitors of FAAH (URB 597, OL-135) and MAGL (JZL 184)
enzymes induced analgesic effect in a wide range of antinociceptive tests in the dose range of 16-40
mg/kg i.p. (Kinsey et al., 2009). The irreversible FAAH inhibitor URB 537 exerted antinociceptive
effect both in several acute rodent model of inflammatory pain, as well as in chronic arthritis model in
mice (Kinsey et al., 2011). URB 597 combined with diclofenac resulted in synergistic analgesic
interactions and parallel significant reductions in the gastric mucosal injury induced by diclofenac. The
gastroprotective effects of URB 597 (10 mg/kg s.c.) could not be observed in CB1 (-/-) mice, whereas it
maintained its efficacy in CB2 (-/-) mice, indicating a CB1-receptor mediated mechanism of action.
Similarly, diclofenac-induced ulcer formation was less pronounced in FAAH (-/-) mice than in wild-
type animals (Naidu et al., 2009). The in vivo effect correlates with the changes of FAAH activity or
AEA level in the brain: FAAH (-/-) mice (Cravatt et al., 2001), or mice and rats treated with FAAH
inhibitor URB 597 (10 and 0.3 mg/kg i.p., respectively) (Kathuria et al., 2003; Kinsey et al., 2009)
showed either elevated levels of AEA (Cravatt et al., 2001; Kinsey et al., 2009) or decreased FAAH
activity in the CNS with a rapid onset (< 15 minutes) (Kathuria et al., 2003).
Moreover, the MAGL inhibitor JZL 184 prevented diclofenac-induced gastric hemorrhages in
the mouse (0.25-40 mg/kg i.p.) (Kinsey et al., 2011). The gastroprotective effect is in correlation with
the elevated level of 2-AG, namely, JZL 184 (4 mg/kg i.p.) was shown to increase the 2-AG levels both
in the stomach (Kinsey et al., 2011) and in the brain (Long et al., 2009). The protective effect of JZL
184 may be due to its inhibitory effect on the diclofenac-induced increases in gastric levels of
proinflammatory cytokines, such as interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and granulocyte
colony-stimulating factor. Furthermore, inhibition of acid secretion, increased gastric blood flow and
central mechanisms may also contribute to the protective action of JZL 184 (Kinsey et al., 2011).
Moreover, para-hydroxy derivative of URB 597, the compound URB 937, is a potent inhibitor
of FAAH activity in peripheral tissues, but not in the CNS, since it is extruded from the CNS and spinal
cord by the membrane transporter ATP-binding cassette (Clapper et al., 2010). URB 937 induces
elevation of AEA level in the periphery, in the liver of the mouse (ED50: 0.2 mg/kg s.c.), and 200 times
higher dose (40 mg/kg s.c.) was needed to suppress the brain FAAH activity (Clapper et al., 2010).
Similarly, orally administered URB 937 inhibited FAAH activity in liver tissue (ED50: 0.3 mg/kg)
without affecting FAAH activity in brain tissue (Clapper et al., 2010; Sasso et al., 2012). In vivo, URB
937 was found to exert antinociceptive effect against mechanical, thermal hyperalgesia, and mechanical
allodynia given orally (0.3-3 mg/kg) in the mouse, in the dose range that elevated the AEA level in
peripheral tissue (in liver) without affecting FAAH activity in brain tissue (Clapper et al., 2010). In
addition, URB 937 reduced the number and severity of gastric lesions produced by indomethacin (0.3-
1 mg/kg per os) in mice (Sasso et al., 2012).
We showed that the globally acting inhibitors of FAAH and MAGL enzymes, URB 597 and
JZL 184, respectively, injected peripherally (i.p.) exerted gastric mucosal protective action against the
acidified ethanol-induced lesions in the doses of 2.9-8.8 μmol/kg (1-3 mg/kg), and 9.6-19.2 μmol/kg (5-
10 mg/kg) respectively. However, the peripherally restricted FAAH inhibitor, URB 937 given in similar
dose-range, 0.8-16.9 μmol/kg (0.3-6 mg/kg i.p.), that was shown to inhibit the indomethacin-induced
lesions and to elevate the AEA level in the periphery (Sasso et al., 2012) in the mouse, failed to inhibit
the ethanol-induced mucosal injury.
Based on the data of the literature and our present findings it can be concluded that elevation of
endocannabinoid level in the periphery by peripherally restricted FAAH inhibitor prevents the gastric
mucosal lesions induced by NSAID in the mouse, but does not affect gastric mucosal injury elicited by
ethanol (in similar dose range) in the rat. The ethanol-induced gastric damage was inhibited, however,
by the globally acting FAAH and MAGL inhibitors, indicating that increase of central endocannabinoid
level may initiate a chain of events that result in protective action against the mucosal damaging effect
of ethanol, in a CB1 receptor-mediated fashion. The central site of gastroprotective effect of URB 597
and JZL 184 against ethanol-induced lesions was confirmed by the findings, that after peripheral (i.p.)
administration their protective effect was reversed by centrally (i.c.v.) given CB1 receptor
antagonist/inverse agonist AM 251. Moreover, both agents were highly effective and potent following
i.c.v. administration; their central gastroprotective dose range proved to be 0.3-29.5 nmol/rat (150-170
g body weight), while their effective dose range following peripheral administration was 2.9-19.5
μmol/kg (see above).
AM 404 inhibits the carrier-mediated transport of AEA into presynaptic neurons from the
synaptic cleft (Rogosch et al., 2012; Beltramo et al., 1997). However, AM 404 is not a selective uptake
inhibitor, since it also inhibits the cyclooxygenase (COX)-1 and COX-2 enzymes, as well as it is an
agonist on TRPV1 receptors, and inhibits FAAH activity (De Petrocellis et al., 2000).
Since no data have been published how inhibitors of AEA membrane uptake influence the
development of experimental mucosal lesions, we examined the effect of AM 404 given both
peripherally (i.p.) and centrally (i.c.v.) on ethanol-induced gastric lesions.
Our data showed that AM 404 given either i.p. or i.c.v. inhibited the ethanol-induced mucosal
lesions. Since the protective effect was highly reduced by the CB1 receptor antagonist AM 251, the
cannabinoid CB1 receptor plays a significant role in mediating this mucosal protective action. Moreover,
similarly to URB 593 and JZL 184, AM 251 given i.c.v. reversed the protective effect of peripherally
injected AM 404, indicating that the primary site of action is likely to be central. Further argue for the
central site of the gastroprotective is that AM 404 given i.c.v. proved to be a highly potent and effective
gastroprotective agent against ethanol-induced lesion; the effective dose range was 2.5-25 nmol/rat
(body weight 150-170 g) i.c.v., while the effective dose range of i.p. administered AM 404 was 1.5-15
Since our previous findings demonstrated that bilateral cervical vagotomy reduced the centrally-
induced gastroprotective effect of cannabinoids in a significant manner (Shujaa et al., 2009), dorsal
vagal complex (DVC) and vagal nerve may play a role in conveying the centrally initiated effect of
FAAH, MAGL and AEA uptake inhibitors to the periphery, to gastric mucosa. Similarly, vagal
dependent mechanism of gastric mucosal protection was demonstrated for several, centrally injected
neuropeptides (for reviews see: Tache et al., 1994; 2012; Gyires and Zádori, 2014) indicating the
prominent role of DVC in maintaining gastric mucosal homeostasis. Furthermore, several data indicate
that the centrally initiated gastroprotection correlates with increased gastric mucosal microcirculation
mediated by CGRP, prostaglandin and NO in a vagal-dependent mechanism (Tache et al., 1994; Tache,
2012; Gyires and Zádori, 2014).
Our present data showed that gastric mucosal CGRP level dramatically decreased following
ethanol administration, while i.c.v. injection of FAAH-, MAGL- and AEA uptake inhibitors elevated
the ethanol-induced decreased level of CGRP in a significant manner. Moreover, somatostatin may also
mediate gastric mucosal defense. Namely, it has been shown that somatostatin given i.p. exerts mucosal
protection against ethanol-induced injury. The gastroprotective dose of somatostatin prevented the
decrease of gastric mucosal blood flow caused by ethanol, which effect is likely to be dependent on NO
generation by increasing the impaired (but not the normal) mucosal blood flow and NO release (Ancha
et al., 2003). Our findings suggest, in agreement with the results of Ancha et al (Ancha et al., 2003), that
the gastric mucosal somatostatin level was also highly reduced following ethanol administration. The
decreased somatostatin level of gastric mucosa was restored by i.c.v. administration of FAAH-, MAGL-
and AEA membrane uptake inhibitors. These results indicate that both CGRP and somatostatin may
play a role in conveying the centrally initiated gastroprotective effect, most probable via restoration of
impaired mucosal microcirculation.
Furthermore, we also investigated whether the FAAH-, MAGL- and AEA membrane uptake
inhibitors given centrally may affect the activity of free radical scavenging enzyme, SOD. Namely, it
has been well documented that superoxide free radicals are involved in the development of ethanol-
induced gastric mucosal lesions, probably via an interaction with cellular membranes (Szelenyi and
Brune, 1988) and that the enzymatic antioxidant SOD reduced mucosal damage induced either by
ethanol or aspirin (Pihan et al., 1987). On the other hand, gastroprotective agents may increase the
activity of SOD in gastric mucosa, which may be responsible, at least partly, for their gastric mucosal
protective action (Kim et al., 2012). Our present findings showed that ethanol, administered orally,
resulted in a significant reduction of the activity of SOD, compared to the vehicle-treated control group.
Both FAAH- and MAGL inhibitors given i.c.v. increased the reduced SOD enzyme activity in gastric
mucosa in a significant manner, indicating that the ethanol-induced decreased free radical scavanging
capacity of gastric mucosa could be reversed by elevation of central endocannabinoid level. However,
AM 404, the AEA membrane uptake inhibitor failed to result in a significant elevation of mucosal SOD
activity, suggesting that restoration of SOD activity in gastric mucosa is not likely to play a significant
role in the mucosal protective mechanism of AM 404.
Previous data suggest that gastric mucosal protection may correlate with gastric motor activity
(Guidobono et al., 1998). Therefore, we analyzed whether of FAAH-, MAGL- and AEA membrane
uptake inhibitors given centrally at gastroprotective dose range may influence the gastric tone and
contractions. Our results showed that neither the basal tone, nor the phasic antral contractions were
influenced by the centrally injected inhibitors of the degradation or uptake of AEA or 2-AG in
Direct agonists of CB1 receptors are known to elicit multiple behavioral effects in rodents,
including analgesia, hypomotility, hypothermia and catalepsy (referred as the tetrad test for cannabinoid
activity) (Wiley and Martin, 2003; Kathuria et al., 2003). It has been raised that increasing
endocannabinoid tissue levels would be less likely to cause psychoactive effects than would the direct
stimulants of cannabinoid receptors, while the beneficial effects due to CB1/2 receptor activation, such
as analgesia, would be maintained (Makriyannis et al., 2005). For example, URB 597 and its analogue
URB 532 at doses that almost abolished FAAH activity and substantially raised brain AEA level, neither
reduced body temperature nor evoked catalepsy, key symptoms of cannabinoid intoxication in the rodent
(Kathuria et al., 2003) and marker for psychoactivity in humans. On the other hand, Long et al (Long et
al., 2009) have shown that MAGL inhibitor JZL 184 (16 mg/kg i.p.), besides antinociceptive action, in
contrast to FAAH inhibitors, induced hypothermia and hypomotility, but not catalepsy. In addition, dual
FAAH/MAGL inhibitor, JZL 195, showed broad activity in the tetrad test, such as analgesia,
hypomotility and catalepsy. In the catalepsy test, neither JZL 184 nor PF-3845 (FAAH inhibitor) had an
effect, but JZL 195 (and JZL 184 + PF-3845) showed a pronounced activity, indicating that AEA and
2-AG signaling pathways interact to regulate specific behavioral processes (Long et al., 2009).
Similarly, guineensine, a novel plant natural product was shown to inhibit the cellular uptake of
anandamide and 2-AG elicited strong catalepsy, hypothermia, reduced locomotion and analgesia in
BALB/c mice. The catalepsy and analgesia were blocked by the CB1 receptor antagonist rimonabant
indicating a cannabinoid CB1-receptor mediated effect (Nicolussi et al., 2014).
Our results showed that neither URB 597, nor JZL 184 or AM 404, given i.c.v. induced
cataleptic effects or hypothermia in gastroprotective doses.
In conclusion, the present findings indicate that pharmacological inhibition of either FAAH,
MAGL or AEA uptake (by URB 597, JZL 184 and AM 404, respectively) decreases gastric mucosal
injury induced by acidified ethanol, following central administration in a significant manner. The
mucosal protective effect may be due, at least partly, to the increase of mucosal CGRP and somatostatin
levels, as well as of SOD activity, that all were diminished by ethanol. The globally acting FAAH-,
MAGL- and AEA uptake inhibitors decreased the ethanol-induced lesions also following peripheral
administration, however, the peripherally restricted FAAH inhibitor URB 937 proved to be ineffective.
Since others (Sasso, 2012) found that URB 937 was effective against indomethacin-induced lesions in
the mouse, it might be raised that peripheral endocannabinoids are likely to play a role in mucosal
protection against NSAID-, but not ethanol-induced gastric mucosal lesions. In the later case the central
endocannabinoid system seems to play a prominent role in gastric defense.
The present results provided the first evidence for gastric mucosal protective effect of the central
inhibition of FAAH-, MAGL- and AEA uptake. These data are additional evidence for the importance
of brain-gut axis in gastric mucosal defense and gastric mucosal integrity. Endocannabinoid modulation
has become one of the exciting new areas also in the field of gastrointestinal research as a promising
way to treat different inflammatory and ulcerative disorders. Further studies are needed to clarify the
involvement of central and peripheral endocannabinoids in regulation of protective mechanisms, the
potential side effects and the potential therapeutic indications of endocannabinoid modulators in
different types of gastrointestinal mucosal inflammatory, ulcerative disorders.
The authors wish to express their thanks to Mrs. I. Szalai, Veronika Pol-Maruzs and Szilvia
László for their technical assistance. This work was supported by the grant EFOP-3.6.2-16-2017-00009.
The inhibitory effect of URB 597, JZL 184 and AM 404 on acidified ethanol-induced gastric mucosal
lesions in the rat. The compounds were injected intracerebroventricularly (i.c.v.) 10 min before the
ethanol challenge. The inhibitory effect is expressed in % compared to the control (vehicle-treated)
group. Each column represents mean ± S.E.M. (n=5/group). Statistical analysis of the data was evaluated
by means of ANOVA followed by Newman-Keuls post hoc test for multiple comparisons. **p < 0.01;
***p < 0.001 compared to the control (vehicle-treated) group.
The effect of URB 597 (2.9 nmol), JZL 184 (1.3 nmol) and AM 404 (2.5 nmol) on ethanol-induced
gastric mucosal injury given either alone or in combination with AM 251 in the rat. All the compounds
were given intracerebroventricularly (i.c.v.) 10 min before ethanol challenge. The inhibitory effect is
expressed in % compared to the respective control (vehicle- or AM 251-treated) groups. Each column
represents mean ± S.E.M. (n=5/group). Statistical analysis of the data was evaluated by means of
ANOVA followed by Newman-Keuls post hoc test for multiple comparisons. *p < 0.05; **p < 0.01;
***p < 0.001 compared to the respective control (vehicle-treated) group.
The inhibitory effect of URB 597, JZL 184, AM 404 and URB 937 on acidified ethanol-induced gastric
mucosal lesions in the rat. The compounds were injected intraperitoneally (i.p.) 20 min before the
ethanol challenge. The inhibitory effect is expressed in % compared to the control (vehicle-treated)
group. Each column represents mean ± S.E.M. (n=5/group). Statistical analysis of the data was evaluated
by means of ANOVA followed by Newman-Keuls post hoc test test for multiple comparisons. *p <
0.05; **p < 0.01; ***p < 0.001 compared to the control (vehicle-treated) group.
The effect of AM 251 (3.6 nmol, intracerebroventricularly /i.c.v./) on the mucosal protective effect of
URB 597 (8.8 μmol/kg), JZL 184 (19 μmol/kg) and AM 404 (15 μmol/kg) injected intraperitoneally
(i.p.) 20 min before the ethanol challenge in the rat. AM 251 was given 10 min after the i.p. injection.
The inhibition of gastric mucosal lesion is expressed in % compared to the respective control (vehicle-
or AM 251-treated) group. Each column represents mean ± S.E.M. (n=5/group). Statistical analysis of
the data was evaluated by means of ANOVA followed by Newman-Keuls post hoc test for multiple
comparisons. **p < 0.01; ***p < 0.001 compared to the respective control (vehicle-treated) group.
The effect of URB 597 (2.9 nmol), JZL 184 (1.3 nmol) and AM 404 (2.5 nmol) on the mucosal CGRP
(panel A) and somatostatin (panel B) concentration. The compounds were given
intracerebroventricularly (i.c.v.) 10 min before ethanol. CGRP and somatostatin concentrations were
determined by radioimmunoassay (RIA) 1 hour after ethanol challenge. Each column represents mean
± S.E.M. (n=5/group). Statistical analysis of the data was evaluated by means of ANOVA followed by
Newman-Keuls post hoc test for multiple comparisons. *p < 0.05; ***p < 0.001 compared to absolute
control group (no ethanol, no vehicle treatment, column 1), ##p < 0.01; ###p < 0.001 compared to ethanol
control group (vehicle + ethanol treatment, column 2).
The effect of URB 597 (2.9 nmol), JZL 184 (1.3 nmol) and AM 404 (2.5 nmol) on the mucosal SOD
activity. The compounds were given intracerebroventricularly (i.c.v.) 10 min before ethanol. Gastric
mucosal SOD activity was determined by using an assay kit 1 hour after ethanol challenge. Each column
represents mean ± S.E.M. (n=5/group). Statistical analysis of the data was evaluated by means of
ANOVA followed by Newman-Keuls post hoc test for multiple comparisons. **p < 0.01 compared to
absolute control group (no ethanol, or vehicle treatment, column 1), #p < 0.05 compared to ethanol
control group (vehicle + ethanol treatment, column 2).
The effect of URB 597 (2.9, 29.5 nmol), JZL 184 (1.3, 13 nmol) and AM 404 (2.5, 25 nmol) on the
amplitudes of phasic antral contractions and gastric tone in anesthetized rats using the balloon technique.
Each column represents mean ± S.E.M., n = 4–7/group. Paired Student’s t-test did not indicate
statistically significant difference between the pre- and postinjection values.
The effect of URB 597 (2.9 nmol), JZL 184 (1.3 nmol) and AM 404 (2.5 nmol) on catalepsy-test (Panel
A) and on rectal temperature (Panel B). The compounds were given intracerebroventricularly (i.c.v.)
and the duration of immobility (font paws on the bar, sec) was measured immediately prior and 10 min,
20, 30 and 40 min after the injection. The effects are expressed as means ± S.E.M. (n = 5/group). For
statistical analysis of the data two-way repeated measures ANOVA was employed, and it did not indicate
statistically significant difference compared to the control (vehicle-treated) group.
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