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Zonulin levels are associated with cortisol, dopamine, and serotonin levels in irritable bowel syndrome

https://doi.org/10.31146/1682-8658-ecg-212-4-37-48

Abstract

Increase intestinal permeability is one of the main mechanisms for the development of irritable bowel syndrome (IBS). The role of stress and nutrition factors is considered as key modifiable factors contributing to the development of increase intestinal permeability. Purpose of the study: to evaluate the content of a marker of increased intestinal permeability (zonulin in feces) in relation to dietary habits, levels of anxiety and depression, levels of stress hormones (cortisol in saliva) and neurotransmitters (serotonin in blood serum, dopamine in blood plasma) in patients with IBS. Materials and methods: an open cohort prospective study was conducted with the inclusion of 263 patients with an established diagnosis of IBS. The control group consisted of 40 healthy volunteers. All individuals included in the study were assessed for diet and eating habits, the severity of anxiety and depression, including the level of specific anxiety in relation to gastrointestinal symptoms, and quality of life. In addition, the levels of cortisol in the morning and evening portions of saliva, serum serotonin, plasma dopamine and fecal zonulin were assessed. Results: in patients with IBS, the marker of increased intestinal permeability (zonulin in feces) is closely related to the nature of nutrition, anxiety levels, cortisol and serotonin secretion, and is also associated with the development of abdominal pain, diarrhea, and the severity of the disease.

About the Authors

O. V. Gaus
Omsk State Medical University
Russian Federation


M. A. Livzan
Omsk State Medical University
Russian Federation


References

1. Flacco M.E., Manzoli L., De Giorgio R, et al. Costs of irritable bowel syndrome in European countries with universal healthcare coverage: a meta-analysis. Eur Rev Med Pharmacol Sci. 2019;23(7):2986-3000. doi: 10.26355/eurrev_201904_17580.

2. Trinkley K.E., Sill B. E., Porter K., Nahata M. C. Prescribing Patterns for Outpatient Treatment of Constipation, Irritable Bowel Syndrome-Related Constipation, and Opioid-Induced Constipation: A Retrospective Cross-Sectional Study. J Manag Care Spec Pharm. 2015;21(11):1077-1087. doi: 10.18553/jmcp.2015.21.11.1077.

3. Ivashkin V.T., Maev I. V., Shelygin Yu.A., et al. Diagnosis and Treatment of Irritable Bowel Syndrome: Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia.Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2021;31(5):74-95. (In Russ.) doi: 10.22416/1382-4376-2021-31-5-74-95.@@ Ивашкин В. Т., Маев И. В., Шелыгин Ю. А. и др. Диагностика и лечение синдрома раздраженного кишечника (Клинические рекомендации Российской гастроэнтерологической ассоциации и Ассоциации колопроктологов России). Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2021;31(5):74-95. doi: 10.22416/1382-4376-2021-31-5-74-95.

4. IBS in America: Survey Summary Findings. American Gastroenterological Association. 2015. Available at: http://www.multivu.com/players/English/7634451-aga-ibs-in- america-survey/docs/survey-findings-pdf-635473172.pdf. (Accessed: 16 October 2022)

5. Abel J.L., Tayolor D. C.A. Chronic Constipation and IBS-C Treatment and Outcomes Real World Research Platform (CONTOR): A Large, Longitudinal Observational Study: 563. American Journal of Gastroenterology. 2016;111: s257. doi: 10.14309/00000434-201610001-00563.

6. Drossman D.A., Morris C. B., Schneck S., et al.International survey of patients with IBS: symptom features and their severity, health status, treatments, and risk taking to achieve clinical benefit. J Clin Gastroenterol. 2009;43(6):541-550. doi: 10.1097/MCG.0b013e318189a7f9.

7. Lacy B., Ayyagari R., Guerin A. et al. Factors associated with more frequent diagnostic tests and procedures in patients with irritable bowel syndrome. Therap Adv Gastroenterol. 2019;12:1756284818818326. doi: 10.1177/1756284818818326.

8. Alekseyenko S.A., Bagdasaryan A. A., Bakulin I. G. et al. [Brief algorithms for managing patients at the stage of providing primary health care. A guide for general practitioners]. Ed. by O. M. Drapkinа. Moscow. Vidoks. 2019. 20 р. (In Russ.)@@ Алексеенко С. А., Багдасарян А. А., Бакулин И. Г., и др. Краткие алгоритмы ведения пациентов на этапе оказания первичной медико-санитарной помощи. Пособие для врачей-терапевтов / Под ред. О. М. Драпкиной. - М.: Видокс, 2019. - 20 с.

9. Gaus O.V., Livzan M. A. IBS: what do we know about the symptoms today? Consilium Medicum. 2019;21(8):42-48. (In Russ.) doi: 10.26442/20751753.2019.8.190512.@@ Гаус О. В., Ливзан М. А. СРК: что мы знаем о симптомах сегодня? Consilium Medicum. 2019;21(8):42-48.

10. Francis C.Y., Morris J., Whorwell P. J. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther. 1997;11(2):395-402. doi: 10.1046/j.1365-2036.1997.142318000.x.

11. WHO Europe. CINDI Health Monitor: A Study of feasibility of a health behaviour monitoring survey across CINDI countries. Available at: http://www.euro.who.int/__data/assets/pdf_file/0017/240236/e79396.pdf (Accessed: 15 October 2022)

12. Erofeev Ju.V., Boldyreva M. S., Turchaninov D. V. et al. Organization and methods of conducting sociological studies of the health of the rural population for information support of the system of social and hygienic monitoring: Method. recommendations. Omsk. FGU CGSJeN Omsk region, 2004. (in Russ.)@@ Ерофеев Ю. В., Болдырева М. С., Турчанинов Д. В. и др. Организация и методика проведения социологических исследований здоровья сельского населения для информационного обеспечения системы социально-гигиенического мониторинга: Метод. рекомендации. Омск: ФГУ ЦГСЭН Омской области, 2004.

13. Zigmond A.S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-370. doi: 10.1111/j.1600-0447.1983.tb09716.x.

14. Labus J.S., Bolus R., Chang L., et al. The Visceral Sensitivity Index: development and validation of a gastrointestinal symptom-specific anxiety scale. Aliment Pharmacol Ther. 2004;20(1):89-97. doi: 10.1111/j.1365-2036.2004.02007.x.

15. Drossman D.A., Patrick D. L., Whitehead W. E. et al. Further validation of the IBS-QOL: a disease-specific quality-of-life questionnaire. Am J Gastroenterol. 2000;95(4):999-1007. doi: 10.1111/j.1572-0241.2000.01941.x.

16. Rej A., Aziz I., Tornblom H., Sanders D. S., Simrén M. The role of diet in irritable bowel syndrome: implications for dietary advice. J Intern Med. 2019;286(5):490-502. doi: 10.1111/joim.12966.

17. Lenhart A., Ferch C., Shaw M., Chey W. D. Use of Dietary Management in Irritable Bowel Syndrome: Results of a Survey of Over 1500 United States Gastroenterologists. J Neurogastroenterol Motil. 2018;24(3):437-451. doi: 10.5056/jnm17116.

18. McKenzie Y.A., Bowyer R. K., Leach H., et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet. 2016;29(5):549-575. doi: 10.1111/jhn.12385.

19. Livzan M.A., Osipenko M. F. Digestive Function Overlap Syndrome. RMJ. 2012;20(15):768-770. (In Russ.)@@ Ливзан М. А., Осипенко М. Ф. Синдром перекреста функциональных заболеваний пищеварительного тракта. РМЖ. 2012;20(15):768-770.

20. Koloski N.A., Jones M., Kalantar J., Weltman M., Zaguirre J, Talley NJ. The brain - gut pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based study. Gut. 2012;61(9):1284-1290. doi: 10.1136/gutjnl-2011-300474.

21. Eijsbouts C., Zheng T., Kennedy N. A., et al. Genome-wide analysis of 53,400 people with irritable bowel syndrome highlights shared genetic pathways with mood and anxiety disorders. Nat Genet. 2021;53(11):1543-1552. doi: 10.1038/s41588-021-00950-8.

22. Midenfjord I., Polster A., Sjövall H. et al. Anxiety and depression in irritable bowel syndrome: Exploring the interaction with other symptoms and pathophysiology using multivariate analyses. Neurogastroenterol Motil. 2019;31(8): e13619. doi: 10.1111/nmo.13619.

23. Eriksson E.M., Andrén K. I., Eriksson H. T., Kurlberg G. K. Irritable bowel syndrome subtypes differ in body awareness, psychological symptoms and biochemical stress markers. World J Gastroenterol. 2008;14(31): 4889-4896. doi: 10.3748/wjg.14.4889.

24. Sugaya N., Izawa S., Saito K. et al. Effect of prolonged stress on the adrenal hormones of individuals with irritable bowel syndrome. Biopsychosoc Med. 2015;9(1):4. Published 2015 Jan 23. doi: 10.1186/s13030-015-0031-7.

25. Videlock E.J., Shih W., Adeyemo M., et al. The effect of sex and irritable bowel syndrome on HPA axis response and peripheral glucocorticoid receptor expression. Psychoneuroendocrinology. 2016;69:67-76. doi: 10.1016/j.psyneuen.2016.03.016.

26. Barbara G., Wang B., Stanghellini V. et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology. 2007;132(1):26-37. doi: 10.1053/j.gastro.2006.11.039.

27. Buhner S., Li Q., Vignali S., et al. Activation of human enteric neurons by supernatants of colonic biopsy specimens from patients with irritable bowel syndrome. Gastroenterology. 2009;137(4):1425-1434. doi: 10.1053/j.gastro.2009.07.005.

28. Livzan M. A. Gastroenterology pain syndrome - therapy algorithm. Meditcinskiy sovet. 2010;3-4:69-71. (In Russ.)@@ Ливзан М. А. Болевой синдром в гастроэнтерологии - алгоритм терапии. Медицинский совет. 2010;3-4:69-71.

29. Harshfield G.A., Pulliam D. A., Alpert B. S. Patterns of sodium excretion during sympathetic nervous system arousal. Hypertension. 1991;17(6 Pt 2):1156-1160. doi: 10.1161/01.hyp.17.6.1156.

30. Bellono N.W., Bayrer J. R., Leitch D. B., et al. Enterochromaffin Cells Are Gut Chemosensors that Couple to Sensory Neural Pathways. Cell. 2017;170(1):185-198.e16. doi: 10.1016/j.cell.2017.05.034.

31. Sjölund K, Sandén G, Håkanson R, Sundler F. Endocrine cells in human intestine: an immunocytochemical study. Gastroenterology. 1983;85(5):1120-1130.

32. Del Colle A., Israelyan N., Gross Margolis K. Novel aspects of enteric serotonergic signaling in health and brain-gut disease. Am J Physiol Gastrointest Liver Physiol. 2020;318(1): G130-G143. doi: 10.1152/ajpgi.00173.2019.

33. Cremon C., Carini G., Wang B., et al.Intestinal serotonin release, sensory neuron activation, and abdominal pain in irritable bowel syndrome. Am J Gastroenterol. 2011;106(7):1290-1298. doi: 10.1038/ajg.2011.86.

34. Terry N., Margolis K. G. Serotonergic Mechanisms Regulating the GI Tract: Experimental Evidence and Therapeutic Relevance. Handb Exp Pharmacol. 2017;239:319-342. doi: 10.1007/164_2016_103.

35. Fu R., Chen M., Chen Y. et al. Expression and clinical significance of 5-HT and 5-HT3R in the intestinal mucosa of patient with diarrhea-type irritable bowel syndrome. Exp Ther Med. 2019;17(4):3077-3082. doi: 10.3892/etm.2019.7297.

36. Markowitz S., Friedman M. A., Arent S. M. Understanding the relation between obesity and depression: Causal mechanisms and implications for treatment. Clin Psychol Sci Pr. 2008;15:1-20. doi: 10.1111/j.1468-2850.2008.00106.x.

37. Bosi A., Banfi D., Bistoletti M. et al. Tryptophan Metabolites Along the Microbiota-Gut-Brain Axis: An Interkingdom Communication System Influencing the Gut in Health and Disease.Int J Tryptophan Res. 2020;13:1178646920928984. doi: 10.1177/1178646920928984.

38. Sun Q., Jia Q., Song L., Duan L. Alterations in fecal short-chain fatty acids in patients with irritable bowel syndrome: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(7): e14513. doi: 10.1097/MD.0000000000014513.

39. Gunn D., Garsed K., Lam C. et al. Abnormalities of mucosal serotonin metabolism and 5-HT3 receptor subunit 3C polymorphism in irritable bowel syndrome with diarrhoea predict responsiveness to ondansetron. Aliment Pharmacol Ther. 2019;50(5):538-546. doi: 10.1111/apt.15420.

40. Keshteli A.H., Madsen K. L., Mandal R., et al.Comparison of the metabolomic profiles of irritable bowel syndrome patients with ulcerative colitis patients and healthy controls: new insights into pathophysiology and potential biomarkers. Aliment Pharmacol Ther. 2019;49(6):723-732. doi: 10.1111/apt.15141.

41. Nozu T., Miyagishi S., Kumei S., et al. Metformin inhibits visceral allodynia and increased gut permeability induced by stress in rats. J Gastroenterol Hepatol. 2019;34(1):186-193. doi: 10.1111/jgh.14367.

42. Kirschstein T., Dammann F., Klostermann J. et al. Dopamine induces contraction in the proximal, but relaxation in the distal rat isolated small intestine. Neurosci Lett. 2009;465(1):21-26. doi: 10.1016/j.neulet.2009.08.080.

43. Strandwitz P. Neurotransmitter modulation by the gut microbiota. Brain Res. 2018;1693(Pt B):128-133. doi: 10.1016/j.brainres.2018.03.015.

44. Mitsi V., Zachariou V. Modulation of pain, nociception, and analgesia by the brain reward center. Neuroscience. 2016;338:81-92. doi: 10.1016/j.neuroscience.2016.05.017.

45. Curtis C., Davis C. A qualitative study of binge eating and obesity from an addiction perspective. Eat Disord. 2014;22(1):19-32. doi: 10.1080/10640266.2014.857515.

46. Blum K., Braverman E. R., Holder J. M., et al. Reward deficiency syndrome: a biogenetic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors. J Psychoactive Drugs. 2000;32 Suppl: i-112. doi: 10.1080/02791072.2000.10736099.

47. Guixà-González R., Javanainen M., Gómez-Soler M., et al. Membrane omega-3 fatty acids modulate the oligomerisation kinetics of adenosine A2A and dopamine D2 receptors. Sci Rep. 2016;6:19839. doi: 10.1038/srep19839.

48. Leech B., Schloss J., Steel A. Association between increased intestinal permeability and disease: a systematic review. Adv Integr Med. 2019;6(1):23-34 doi: 10.1016/j.aimed.2018.08.003.

49. Graziani C., Talocco C., De Sire R., et al.Intestinal permeability in physiological and pathological conditions: major determinants and assessment modalities. Eur Rev Med Pharmacol Sci. 2019;23(2):795-810. doi: 10.26355/eurrev_201901_16894.

50. Tripathi A., Lammers K. M., Goldblum S., et al. Identification of human zonulin, a physiological modulator of tight junctions, as prehaptoglobin-2. Proc Natl Acad Sci U S A. 2009;106(39):16799-16804. doi: 10.1073/pnas.0906773106.

51. Fasano A., Baudry B., Pumplin D. W., et al. Vibrio cholerae produces a second enterotoxin, which affects intestinal tight junctions. Proc Natl Acad Sci U S A. 1991;88(12):5242-5246. doi: 10.1073/pnas.88.12.5242.

52. Vanuytsel T., Tack J., Farre R. The Role of Intestinal Permeability in Gastrointestinal Disorders and Current Methods of Evaluation. Front Nutr. 2021;8:717925. Published 2021 Aug 26. doi: 10.3389/fnut.2021.717925.

53. Osipenko M.F., Livzan M. A., Skalinskaya M. I., Lyalyukova E. A. The concentration of fecal calprotectin in the differential diagnosis of intestinal diseases. Therapevticheskyi Archiv. 2015; 87 (2): 30-33. (In Russ.)@@ Осипенко М. Ф., Ливзан М. А., Скалинская М. И., Лялюкова Е. А. Концентрация фекального кальпротектина в дифференциальной диагностике заболеваний кишечника. Терапевтический архив. 2015; 87(2): 30-33.

54. Linsalata M., Riezzo G., D’Attoma B. et al. Noninvasive biomarkers of gut barrier function identify two subtypes of patients suffering from diarrhoea predominant-IBS: a case-control study. BMC Gastroenterol. 2018;18(1):167. Published 2018 Nov 6. doi: 10.1186/s12876-018-0888-6.

55. Barbaro M.R., Cremon C., Caio G. et al. Zonulin serum levels are increased in nonceliac gluten sensitivity and irritable bowel syndrome with diarrhea. Gastroenterology. 2015;11:5072-5076 doi: 10.1016/S0016-5085(15)30192-X.

56. Singh P., Silvester J., Chen X. et al. Serum zonulin is elevated in IBS and correlates with stool frequency in IBS-D. United European Gastroenterol J. 2019;7(5):709-715. doi: 10.1177/2050640619826419.

57. Livzan M.A., Gaus O. V. Fecal zonulin as a biomarker of increased intestinal permeability in patients with irritable bowel syndrome (narrative review and pilot study results).Russian Journal of Evidence-based Gastroenterology = Dokazatel’naya gastroenterologiya. 2021;10(3):47-55. (In Russ.). doi: 10.17116/dokgastro20211003147.@@ Ливзан М. А., Гаус О. В. Содержание фекального зонулина - биомаркер синдрома кишечной проницаемости у больных синдромом раздраженного кишечника (обзор и результаты пилотного исследования). Доказательная гастроэнтерология. 2021;10(3):47-55. doi: 10.17116/dokgastro20211003147.

58. Drago S., El Asmar R., Di Pierro M. et al. Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Scand J Gastroenterol. 2006;41(4):408-419. doi: 10.1080/00365520500235334.

59. Vanuytsel T., van Wanrooy S., Vanheel H. et al. Psychological stress and corticotropin-releasing hormone increase intestinal permeability in humans by a mast cell-dependent mechanism. Gut. 2014;63(8):1293-1299. doi: 10.1136/gutjnl-2013-305690.

60. Li J., Zhu W., Liu W. et al. Rifaximin for Irritable Bowel Syndrome: A Meta-Analysis of Randomized Placebo-Controlled Trials. Medicine (Baltimore). 2016;95(4): e2534. doi: 10.1097/MD.0000000000002534.


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Gaus O.V., Livzan M.A. Zonulin levels are associated with cortisol, dopamine, and serotonin levels in irritable bowel syndrome. Experimental and Clinical Gastroenterology. 2023;(4):37-48. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-212-4-37-48

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