Document Detail


Pharmacogenetic trial of a cannabinoid agonist shows reduced fasting colonic motility in patients with nonconstipated irritable bowel syndrome.
MedLine Citation:
PMID:  21803011     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: Cannabinoid receptors are located on cholinergic neurons. Genetic variants that affect endocannabinoid metabolism are associated with colonic transit in patients with irritable bowel syndrome (IBS) with diarrhea. We compared the effects of dronabinol, a nonselective agonist of the cannabinoid receptor, with those of placebo on colonic motility and sensation in patients with IBS, and examined the effects of IBS subtype and specific genetic variants in cannabinoid mechanisms.
METHODS: Seventy-five individuals with IBS (35 with IBS with constipation, 35 with IBS with diarrhea, and with 5 IBS alternating) were randomly assigned to groups that were given 1 dose of placebo or 2.5 mg or 5.0 mg dronabinol. We assessed left colonic compliance, motility index (MI), tone, and sensation during fasting and after a meal. We analyzed the single nucleotide polymorphisms CNR1 rs806378, fatty acid amide hydrolase (FAAH) rs324420, and MGLL rs4881.
RESULTS: In all patients, dronabinol decreased fasting proximal left colonic MI compared with placebo (overall P = .05; for 5 mg dronabinol, P = .046), decreased fasting distal left colonic MI (overall P = .08; for 5 mg, P = .13), and increased colonic compliance (P = .058). The effects of dronabinol were greatest in patients with IBS with diarrhea or IBS alternating (proximal colonic MI, overall P = .022; compliance, overall P = .03). Dronabinol did not alter sensation or tone. CNR1 rs806378 (CC vs CT/TT) appeared to affect fasting proximal MI in all patients with IBS (P = .075). Dronabinol affected fasting distal MI in patients, regardless of FAAH rs324420 variant (CA/AA vs CC) (P = .046); the greatest effects were observed among IBS with constipation patients with the FAAH CC variant (P = .045). Dronabinol affected fasting proximal MI in patients with IBS with diarrhea or alternating with the variant FAAH CA/AA (P = .013).
CONCLUSIONS: In patients with IBS with diarrhea or alternating, dronabinol reduces fasting colonic motility; FAAH and CNR1 variants could influence the effects of this drug on colonic motility.
Authors:
Banny S Wong; Michael Camilleri; Irene Busciglio; Paula Carlson; Lawrence A Szarka; Duane Burton; Alan R Zinsmeister
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2011-07-29
Journal Detail:
Title:  Gastroenterology     Volume:  141     ISSN:  1528-0012     ISO Abbreviation:  Gastroenterology     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-10-26     Completed Date:  2012-01-20     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1638-47.e1-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT01253408
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Amidohydrolases / genetics
Aryl Hydrocarbon Hydroxylases / genetics
Cannabinoid Receptor Agonists*
Colon / drug effects,  physiopathology*
Comorbidity
Diarrhea / drug therapy,  epidemiology,  physiopathology*
Double-Blind Method
Fasting / physiology*
Female
Gastrointestinal Motility / drug effects*,  physiology
Humans
Irritable Bowel Syndrome / drug therapy,  epidemiology,  physiopathology*
Male
Middle Aged
Patient Compliance
Pharmacogenetics
Polymorphism, Single Nucleotide / genetics
Receptors, Cannabinoid / genetics
Tetrahydrocannabinol / pharmacology*,  therapeutic use
Young Adult
Grant Support
ID/Acronym/Agency:
R01 DK079866-02/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Cannabinoid Receptor Agonists; 0/Receptors, Cannabinoid; 1972-08-3/Tetrahydrocannabinol; EC 1.14.14.1/Aryl Hydrocarbon Hydroxylases; EC 1.14.14.1/CYP2C9 protein, human; EC 3.5.-/Amidohydrolases; EC 3.5.1.-/fatty-acid amide hydrolase
Comments/Corrections

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