Enterotoxins produce diarrhea through direct epithelial action and indirectly by activating the enteric nervous system. Calcium-sensing receptor (CaSR) inhibits both actions. The latter has been well documented in vitro but not in vivo. The hypothesis to be tested was that activating CaSR inhibits diarrhea in vivo.

To determine whether CaSR agonists ameliorate secretory diarrhea evoked by cholera toxin (CTX) in mice.

CTX was given orally to C57BL/6 mice to induce diarrhea. Calcium and calcimimetic R568 were used to activate CaSR. To maximize their local intestinal actions, calcium was administered luminally via oral rehydration solution (ORS), whereas R568 was applied serosally using an intraperitoneal route. To verify that their actions resulted from the intestine, effects were also examined on Cre-lox intestine-specific CaSR knockouts. Diarrhea outcome was measured biochemically by monitoring changes in fecal Cl- or clinically by assessing stool consistency and weight loss.

CTX induced secretory diarrhea, as evidenced by increases in fecal Cl-, stool consistency, and weight loss following CTX exposure, but did not alter CaSR, neither in content nor in function. Accordingly, calcium and R568 were each able to ameliorate diarrhea when applied to diseased intestines. Intestinal CaSR involvement is suggested by gene knockout experiments where the anti-diarrheal actions of R568 were lost in intestinal epithelial CaSR knockouts (villinCre/Casrflox/flox) and neuronal CaSR knockouts (nestinCre/Casrflox/flox).

Treatment of acute secretory diarrheas remains a global challenge. Despite advances in diarrhea research, few have been made in the realm of diarrhea therapeutics. ORS therapy has remained the standard of care, although it does not halt the losses of intestinal fluid and ions caused by pathogens. There is no cost-effective therapeutic for diarrhea. This and other studies suggest that adding calcium to ORS or using calcimimetics to activate intestinal CaSR might represent a novel approach for treating secretory diarrheal diseases.

An original method which uses in vitro anaerobic incubation at 37 degrees C followed by centrifugation, ultrafiltration, and ion exchange chromatography is described; it shows that faecal material suspended in physiological saline can destroy added creatinine. The rate of breakdown by suspensions from uraemic subjects (mean 780 mumol h-1kg-1 SEM 70) was slightly faster than in normal subjects (mean 550 mumol h-1kg-1 SEM 80). Methylamine concentration increased over eight hours as creatinine was metabolised and sarcosine appeared as an intermediate. The rates of these reactions varied within and between individuals and were inhibited by oxygen and centrifugation but not by oxytetracycline. Concentrations of free amino acids did not change significantly despite the formation of ammonia. This approach should be useful in studying the metabolic inter-relationships between intestinal contents and the host organism in health and disease.