title: Increased faecal serine protease activity in diarrhoeic IBS patients: a colonic lumenal factor impairing colonic permeability and sensitivity.
abstract: OBJECTIVE
  Diarrhoea-predominant irritable bowel syndrome (IBS-D) is characterised by elevated colonic lumenal serine protease activity. The aims of this study were (1) to investigate the origin of this elevated serine protease activity, (2) to evaluate if it may be sufficient to trigger alterations in colonic paracellular permeability (CPP) and sensitivity, and (3) to examine the role of the proteinase-activated receptor-2 (PAR-2) activation and signalling cascade in this process.
  
  
  METHODS
  Faecal enzymatic activities were assayed in healthy subjects and patients with IBS, ulcerative colitis and acute infectious diarrhoea. Following mucosal exposure to supernatants from control subjects and IBS-D patients, electromyographic response to colorectal balloon distension was recorded in wild-type and PAR-2(-/-) mice, and CPP was evaluated on colonic strips in Ussing chambers. Zonula occludens-1 (ZO-1) and phosphorylated myosin light chain were detected by immunohistochemistry.
  
  
  RESULTS
  The threefold increase in faecal serine protease activity seen in IBS-D patients compared with constipation-predominant IBS (IBS-C) or infectious diarrhoea is of neither epithelial nor inflammatory cell origin, nor is it coupled with antiprotease activity of endogenous origin. Mucosal application of faecal supernatants from IBS-D patients in mice evoked allodynia and increased CPP by 92%, both of which effects were prevented by serine protease inhibitors and dependent on PAR-2 expression. In mice, colonic exposure to supernatants from IBS-D patients resulted in a rapid increase in the phosphorylation of myosin light chain and delayed redistribution of ZO-1 in colonocytes.
  
  
  CONCLUSIONS
  Elevated colonic lumenal serine protease activity of IBS-D patients evokes a PAR-2-mediated colonic epithelial barrier dysfunction and subsequent allodynia in mice, suggesting a novel organic background in the pathogenesis of IBS.
authors.affiliation: Neuro-Gastroenterology and Nutrition Unit, Institut National de la Recherche Agronomique, 180 Chemin de Tournefeuille, BP 3, 31931 Toulouse Cedex 9, France.
authors.forename: K
authors.initials: K
authors.lastname: Gecse
authors.forename: R
authors.initials: R
authors.lastname: Róka
authors.forename: L
authors.initials: L
authors.lastname: Ferrier
authors.forename: M
authors.initials: M
authors.lastname: Leveque
authors.forename: H
authors.initials: H
authors.lastname: Eutamene
authors.forename: C
authors.initials: C
authors.lastname: Cartier
authors.forename: A
authors.initials: A
authors.lastname: Ait-Belgnaoui
authors.forename: A
authors.initials: A
authors.lastname: Rosztóczy
authors.forename: F
authors.initials: F
authors.lastname: Izbéki
authors.forename: J
authors.initials: J
authors.lastname: Fioramonti
authors.forename: T
authors.initials: T
authors.lastname: Wittmann
authors.forename: L
authors.initials: L
authors.lastname: Bueno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D003106:Colon / Q000201:enzymology*; D003967:Diarrhea / Q000201:enzymology*; D005243:Feces / Q000201:enzymology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000201:enzymology; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000201:enzymology*; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D008875:Middle Aged; D010539:Permeability; D044464:Receptor, PAR-2 / Q000378:metabolism; D012697:Serine Endopeptidases / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D044464:Receptor, PAR-2; D012697:Serine Endopeptidases