title: Sensory fibres expressing capsaicin receptor TRPV1 in patients with rectal hypersensitivity and faecal urgency.
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
  We compared full-thickness rectal biopsy samples from nine patients with physiologically characterised rectal hypersensitivity with tissue samples from 12 controls. Sensory thresholds to rectal balloon distension and heating the rectal mucosa were measured before biopsy. We assessed specimens with immunohistochemistry and image analysis using specific antibodies to TRPV1; nerve growth factor (NGF) receptor tyrosine kinase A; glial cell line-derived neurotrophic factor (GDNF); neuropeptides calcitonin gene-related peptide (CGRP) and substance P; the related vanilloid receptor-like protein (VRL) 2; glial markers S-100 and glial fibrillary acid protein (GFAP); and the nerve structural marker peripherin.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Peripheral Neuropathy Unit, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: C L H
authors.initials: CL
authors.lastname: Chan
authors.forename: P
authors.initials: P
authors.lastname: Facer
authors.forename: J B
authors.initials: JB
authors.lastname: Davis
authors.forename: G D
authors.initials: GD
authors.lastname: Smith
authors.forename: J
authors.initials: J
authors.lastname: Egerton
authors.forename: C
authors.initials: C
authors.lastname: Bountra
authors.forename: N S
authors.initials: NS
authors.lastname: Williams
authors.forename: P
authors.initials: P
authors.lastname: Anand
mesh_terms: D000328:Adult; D000344:Afferent Pathways / Q000737:chemistry*; D001706:Biopsy; D001831:Body Temperature; D016022:Case-Control Studies; D027682:Cation Transport Proteins; D005242:Fecal Incontinence / Q000209:etiology* / Q000473:pathology*; D005260:Female; D051100:Glial Cell Line-Derived Neurotrophic Factor; D005904:Glial Fibrillary Acidic Protein / Q000032:analysis; D006801:Humans; D006941:Hyperesthesia / Q000209:etiology* / Q000473:pathology*; D007150:Immunohistochemistry; D007381:Intermediate Filament Proteins / Q000032:analysis; D007473:Ion Channels; D008297:Male; D008562:Membrane Glycoproteins; D008875:Middle Aged; D036421:Nerve Fibers, Unmyelinated / Q000737:chemistry*; D020932:Nerve Growth Factor / Q000032:analysis; D009414:Nerve Growth Factors / Q000032:analysis; D009419:Nerve Tissue Proteins / Q000032:analysis; D064531:Peripherins; D015985:Precipitating Factors; D020794:Receptor Protein-Tyrosine Kinases / Q000032:analysis; D018015:Receptors, Calcitonin Gene-Related Peptide / Q000032:analysis; D011955:Receptors, Drug / Q000032:analysis* / Q000276:immunology; D012002:Rectal Diseases / Q000209:etiology* / Q000473:pathology*; D009418:S100 Proteins / Q000032:analysis; D012684:Sensory Thresholds; D013373:Substance P / Q000032:analysis; D050916:TRPV Cation Channels
chemical_list: D027682:Cation Transport Proteins; C495039:GDNF protein, human; D051100:Glial Cell Line-Derived Neurotrophic Factor; D005904:Glial Fibrillary Acidic Protein; D007381:Intermediate Filament Proteins; D007473:Ion Channels; D008562:Membrane Glycoproteins; D009414:Nerve Growth Factors; D009419:Nerve Tissue Proteins; C578994:PRPH protein, human; D064531:Peripherins; D018015:Receptors, Calcitonin Gene-Related Peptide; D011955:Receptors, Drug; D009418:S100 Proteins; D050916:TRPV Cation Channels; C494484:TRPV1 receptor; C416986:TRPV4 protein, human; D013373:Substance P; D020932:Nerve Growth Factor; D020794:Receptor Protein-Tyrosine Kinases