Nonsteroidal anti-inflammatory drugs (NSAIDs) are a widely used class of drugs, due in part to the effective anti-inflammatory and analgesic properties they exhibit. Unfortunately, NSAIDs also exhibit substantial gastrointestinal (GI) toxicity. The mechanisms underlying the ability of NSAIDs to cause ulceration in the stomach and proximal duodenum are well understood, and this injury can largely be prevented through the suppression of gastric acid secretion by proton pump inhibitors (PPIs) or histamine H2 receptor antagonists (H2RAs). In contrast, the pathogenesis of small intestinal injury induced by NSAIDs (i.e., NSAID-enteropathy) is poorly understood, and there are no proven-effective therapies. This is a major clinical concern as NSAID-induced enteropathy and bleeding occur more frequently than NSAID-induced gastropathy, and is associated with significantly higher rates of morbidity and mortality. There is clear evidence that indicates important contributions to NSAID-enteropathy by bile, enteric bacteria, and the enterohepatic circulation of NSAIDs. However, it is not clear which of these mechanisms is/are the primary driver(s) of intestinal damage and injury. There is also evidence that hydrogen sulfide (H2S) can protect the GI mucosa from ulceration and reduce the severity of NSAID-induced GI damage, although the mechanisms of H2S-induced intestinal protection remain to be determined. Therefore, the central aim of this thesis was to evaluate the roles of bile, enteric bacteria, and the enterohepatic circulation of NSAIDs in the pathogenesis of NSAID-enteropathy, and to investigate the ability of H2S to protect the small intestine from NSAID-induced damage. Chapter 1 is an introduction to the relevant literature and Chapter 2 is an outline of the thesis scope and objectives. In Chapter 3, I demonstrated that the co-administration of an H2S-releasing agent protected rats from NSAID-induced enteropathy, in part by preventing NSAID-induced dysbiosis and bile cytotoxicity. In Chapter 4 and 5, I established that the co-administration of PPIs and H2RAs exacerbated NSAID-enteropathy in part by causing intestinal dysbiosis and enhanced bile cytotoxicity. Lastly, I demonstrated that the small intestine-sparing effects of an H2S-releasing NSAID, ATB-346, are partly attributable to the reduced enterohepatic circulation of ATB-346 or the naproxen liberated from this drug (Chapter 5). In summary, the work presented in this thesis provided novel understanding of the complicated pathogenesis of NSAID-enteropathy by confirming that the nature of the bile, the enterohepatic circulation of NSAIDs, and the nature of the intestinal microbiota are of paramount importance. In addition, the results also demonstrated that hydrogen sulfide represents an effective preventative therapy for NSAID-enteropathy and that H2S-releasing NSAIDs, such as ATB-346, have remarkable preclinical safety. / Thesis / Doctor of Philosophy (PhD)
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/16280 |
| Date | 11 1900 |
| Creators | Blackler, Rory William |
| Contributors | Wallace, John L, Bercik, Premysl, Medical Sciences |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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