Neural aspects of prostaglandin involvement in gastric mucosal defense.

In rats, central vagal stimulation by thyrotropin-releasing hormone protects against ethanol-induced gastric damage by muscarinic release of prostaglandins. In contrast, gastroprotection following capsaicin-induced stimulation of afferent neurons is prostaglandin-independent. Capsaicin-evoked protection is abolished by blockade of calcitonin gene-related peptide (CGRP) receptors and inhibition of nitric oxide (NO) synthase. Various peptides including gastrin 17, cholecystokinin octapeptide, thyrotropin-releasing hormone, bombesin, corticotropin-releasing factor, epidermal growth factor, peptide YY, neurokinin A analogs and intragastric peptone exert gastroprotection that is abolished by afferent nerve denervation, blockade of CGRP receptors and inhibition of NO synthase. Indomethacin attenuates the protection of some peptides but has no effect with others. The hyperemic response to peptides is mediated by the afferent nerve/CGRP/NO system without contribution of prostaglandins. Furthermore, it was shown that NKA analogs exert afferent nerve-, CGRP- and NO-dependent gastroprotection in the face of substantial reduction of gastric mucosal blood flow indicating that gastroprotection is not necessarily mediated by mucosal hyperemia. In the rat stomach with functioning afferent nerves neither selective inhibition of cyclooxygenase (COX)-1 nor COX-2 is ulcerogenic and only simultaneous inhibition of both COX isoenzymes induees mucosal lesions. In the face of pending injury such as intragastric acid a COX-1 inhibitor evokes dose-dependent damage whereas COX-2 inhibitors are not injurious as long as the function of afferent nerves is not impaired. After afferent nerve denervation, however, COX-2 inhibitors or dexamethasone which suppresses the acid-induced up-regulation of COX-2 are highly ulcerogenic. In conclusion, release of prostaglandins following nerve stimulation can mediate protective effects under certain conditions but is not a prerequisite for neurally mediated mucosal defense. Prostaglandins are of particular importance for the maintenance of gastric mucosal integrity when neuronal defense mechanisms are impaired.