Abstract | BACKGROUND: Faecal urgency and incontinence with rectal hypersensitivity is a distressing, unexplained disorder that is inadequately treated. We aimed to determine whether expression of the heat and capsaicin receptor vanilloid receptor 1 (TRPV1 or VR1) was changed in rectal sensory fibres, and to correlate nerve fibre density with sensory abnormalities. METHODS: FINDINGS: In rectal hypersensitivity, nerve fibres immunoreactive to TRPV1 were increased in muscle, submucosal, and mucosal layers: in the mucosal layer, the median% area positive was 0.44 (range 0.30-0.59) in patients who were hypersensitive and 0.11 (0.00-0.21) in controls (p=0.0005). The numbers of peripherin-positive fibres also increased in the mucosal layer (hypersensitive 3.00 [1.80-6.50], controls 1.20 [0.39-2.10]: (p=0.0002). The increase in TRVP1 correlated significantly with the decrease in rectal heat (p=0.03) and the distension (p=0.02) sensory thresholds. The thresholds for heat and distension were also significantly correlated (p=0.0028). Expression of nerve fibres positive for GDNF (p=0.001) and tyrosine kinase A (p=0.002) was also increased, as were cell bodies of the submucosal ganglia immunoreactive to CGRP (p=0.0009). INTERPRETATION: Faecal urgency and rectal hypersensitivity could result from increased numbers of polymodal sensory nerve fibres expressing TRPV1. The triggering factor or factors remain uncertain, but drugs that target nerve terminals that express this receptor, such as topical resiniferatoxin, deserve consideration.
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Authors | C L H Chan, P Facer, J B Davis, G D Smith, J Egerton, C Bountra, N S Williams, P Anand |
Journal | Lancet (London, England)
(Lancet)
Vol. 361
Issue 9355
Pg. 385-91
(Feb 01 2003)
ISSN: 0140-6736 [Print] England |
PMID | 12573376
(Publication Type: Journal Article)
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Chemical References |
- Cation Transport Proteins
- GDNF protein, human
- Glial Cell Line-Derived Neurotrophic Factor
- Glial Fibrillary Acidic Protein
- Intermediate Filament Proteins
- Ion Channels
- Membrane Glycoproteins
- Nerve Growth Factors
- Nerve Tissue Proteins
- PRPH protein, human
- Peripherins
- Receptors, Calcitonin Gene-Related Peptide
- Receptors, Drug
- S100 Proteins
- TRPV Cation Channels
- TRPV1 receptor
- TRPV4 protein, human
- Substance P
- Nerve Growth Factor
- Receptor Protein-Tyrosine Kinases
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Topics |
- Adult
- Afferent Pathways
(chemistry)
- Biopsy
- Body Temperature
- Case-Control Studies
- Cation Transport Proteins
- Fecal Incontinence
(etiology, pathology)
- Female
- Glial Cell Line-Derived Neurotrophic Factor
- Glial Fibrillary Acidic Protein
(analysis)
- Humans
- Hyperesthesia
(etiology, pathology)
- Immunohistochemistry
- Intermediate Filament Proteins
(analysis)
- Ion Channels
- Male
- Membrane Glycoproteins
- Middle Aged
- Nerve Fibers, Unmyelinated
(chemistry)
- Nerve Growth Factor
(analysis)
- Nerve Growth Factors
(analysis)
- Nerve Tissue Proteins
(analysis)
- Peripherins
- Precipitating Factors
- Receptor Protein-Tyrosine Kinases
(analysis)
- Receptors, Calcitonin Gene-Related Peptide
(analysis)
- Receptors, Drug
(analysis, immunology)
- Rectal Diseases
(etiology, pathology)
- S100 Proteins
(analysis)
- Sensory Thresholds
- Substance P
(analysis)
- TRPV Cation Channels
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