title: Electrophysiological Studies into the Safety of the Anti-diarrheal Drug Clotrimazole during Oral Rehydration Therapy.
abstract: OBJECTIVE
  Morbidity and mortality from acute diarrheal disease remains high, particularly in developing countries and in cases of natural or man-made disasters. Previous work has shown that the small molecule clotrimazole inhibits intestinal Cl- secretion by blocking both cyclic nucleotide- and Ca(2+)-gated K(+) channels, implicating its use in the treatment of diarrhea of diverse etiologies. Clotrimazole, however, might also inhibit transporters that mediate the inwardly directed electrochemical potential for Na(+)-dependent solute absorption, which would undermine its clinical application. Here we test this possibility by examining the effects of clotrimazole on Na(+)-coupled glucose uptake.
  
  
  METHODS
  Short-circuit currents (Isc) following administration of glucose and secretagogues were studied in clotrimazole-treated jejunal sections of mouse intestine mounted in Ussing chambers.
  
  
  RESULTS
  Treatment of small intestinal tissue with clotrimazole inhibited the Cl- secretory currents that resulted from challenge with the cAMP-agonist vasoactive intestinal peptide (VIP) or Ca(2+)-agonist carbachol in a dose-dependent fashion. A dose of 30 μM was effective in significantly reducing the Isc response to VIP and carbachol by 50% and 72%, respectively. At this dose, uptake of glucose was only marginally affected (decreased by 14%, p = 0.37). There was no measurable effect on SGLT1-mediated sugar transport, as uptake of SGLT1-restricted 3-O-methyl glucose was equivalent between clotrimazole-treated and untreated tissue (98% vs. 100%, p = 0.90).
  
  
  CONCLUSIONS
  Treatment of intestinal tissue with clotrimazole significantly reduced secretory responses caused by both cAMP- and Ca(2+)-dependent agonists as expected, but did not affect Na(+)-coupled glucose absorption. Clotrimazole could thus be used in conjunction with oral rehydration solution as a low-cost, auxiliary treatment of acute secretory diarrheas.
authors.affiliation: Division of Gastroenterology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Willem S
authors.initials: WS
authors.lastname: Lexmond
authors.affiliation: Division of Gastroenterology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Rufo
authors.affiliation: Division of Gastroenterology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Edda
authors.initials: E
authors.lastname: Fiebiger
authors.affiliation: Division of Gastroenterology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Wayne I
authors.initials: WI
authors.lastname: Lencer
mesh_terms: D000818:Animals; D000930:Antidiarrheals / Q000494:pharmacology*; D001692:Biological Transport / Q000187:drug effects / Q000502:physiology; D003022:Clotrimazole / Q000494:pharmacology*; D003938:Diagnostic Techniques, Digestive System; D003967:Diarrhea / Q000188:drug therapy; D055664:Electrochemical Techniques; D055724:Electrophysiological Phenomena; D020895:Enterocytes / Q000187:drug effects* / Q000502:physiology; D005440:Fluid Therapy; D007583:Jejunum / Q000187:drug effects / Q000502:physiology; D051379:Mice; D008807:Mice, Inbred BALB C; D023421:Models, Animal; D027981:Symporters / Q000187:drug effects* / Q000502:physiology
chemical_list: D000930:Antidiarrheals; D027981:Symporters; D003022:Clotrimazole