title: Linaclotide, through activation of guanylate cyclase C, acts locally in the gastrointestinal tract to elicit enhanced intestinal secretion and transit.
abstract: Linaclotide is a first-in-class, orally administered 14-amino acid peptide that is in development for the treatment of irritable bowel syndrome with constipation and chronic constipation. We have characterized the solution structure of linaclotide, the in vitro binding and agonist activity to guanylate cyclase C receptors, the stability of linaclotide under conditions mimicking the gastric environment, oral bioavailability, and the pharmacodynamic effects in rat models of gastrointestinal transit and intestinal secretion. Nuclear magnetic resonance spectroscopy analysis determined that the molecular structure of linaclotide is stabilized by three intramolecular disulfide bridges. Linaclotide exhibited high affinity and pH-independent binding (K(i): 1.23-1.64 nM) to guanylate cyclase C receptors on human colon carcinoma T84 cells and concomitantly, linaclotide binding resulted in a significant, concentration-dependent accumulation of intracellular cyclic guanosine-3', 5'-monophosphate (cGMP) (EC₅₀:99 nM). Linaclotide was stable after 3 h incubation in simulated gastric fluid (pH 1) and similarly, was completely resistant to hydrolysis by pepsin. Pharmacokinetic analysis of linaclotide showed very low oral bioavailability (0.1%). Orally administered linaclotide elicited a significant, dose-dependent increase in gastrointestinal transit rates in rats at doses of ≥5 μg/kg. Exposure of surgically ligated small intestinal loops to linaclotide induced a significant increase in fluid secretion, accompanied by a significant increase in intraluminal cGMP levels. These results suggest that the guanylate cyclase C agonist linaclotide elicits potent pharmacological responses locally in the gastrointestinal tract, and that orally administered guanylate cyclase C agonists may be capable of improving bowel habits in patients suffering from irritable bowel syndrome with constipation and chronic constipation.
authors.affiliation: Ironwood Pharmaceuticals Inc., 301 Binney Street, Cambridge, MA, 02142, USA. rbusby@ironwoodpharma.com
authors.forename: Robert W
authors.initials: RW
authors.lastname: Busby
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Bryant
authors.forename: Wilmin P
authors.initials: WP
authors.lastname: Bartolini
authors.forename: Etchell A
authors.initials: EA
authors.lastname: Cordero
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hannig
authors.forename: Marco M
authors.initials: MM
authors.lastname: Kessler
authors.forename: Shalina
authors.initials: S
authors.lastname: Mahajan-Miklos
authors.forename: Christine M
authors.initials: CM
authors.lastname: Pierce
authors.forename: Robert M
authors.initials: RM
authors.lastname: Solinga
authors.forename: Li Jing
authors.initials: LJ
authors.lastname: Sun
authors.forename: Jenny V
authors.initials: JV
authors.lastname: Tobin
authors.forename: Caroline B
authors.initials: CB
authors.lastname: Kurtz
authors.forename: Mark G
authors.initials: MG
authors.lastname: Currie
mesh_terms: D000818:Animals; D001667:Binding, Competitive; D001682:Biological Availability; D002460:Cell Line; D002478:Cells, Cultured; D003248:Constipation / Q000188:drug therapy; D006152:Cyclic GMP / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004789:Enzyme Activation / Q000187:drug effects; D005260:Female; D005772:Gastrointestinal Transit / Q000187:drug effects*; D006801:Humans; D007413:Intestinal Mucosa / Q000166:cytology / Q000187:drug effects* / Q000378:metabolism*; D007419:Intestinal Secretions / Q000378:metabolism; D043183:Irritable Bowel Syndrome / Q000188:drug therapy; D054368:Laxatives / Q000737:chemistry / Q000378:metabolism / Q000493:pharmacokinetics / Q000494:pharmacology*; D008297:Male; D010455:Peptides / Q000737:chemistry / Q000378:metabolism / Q000493:pharmacokinetics / Q000494:pharmacology*; D011487:Protein Conformation; D055550:Protein Stability; D051381:Rats; D000074261:Receptors, Enterotoxin; D050705:Receptors, Guanylate Cyclase-Coupled / Q000819:agonists*; D018000:Receptors, Peptide / Q000819:agonists*
chemical_list: D054368:Laxatives; D010455:Peptides; D018000:Receptors, Peptide; D000074261:Receptors, Enterotoxin; D050705:Receptors, Guanylate Cyclase-Coupled; D006152:Cyclic GMP; C523483:linaclotide