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Carbon monoxide plays role in orchestrating digestive tract function

Tuesday, June 17, 2003

By Michael Woods, Post-Gazette National Bureau

WASHINGTON -- The deadly gas carbon monoxide, which kills hundreds of people annually, has a secret life inside the body as a chemical messenger that is essential for good health, a study reported yesterday.

Only one other gas, nitric oxide, which also is toxic in the outside world, is known to pass along the innermost biochemical whispers that signal structures in the body to work properly.

Nitric oxide's emergence as a chemical messenger created an international medical sensation. The discoverers won the 1998 Nobel Prize in Medicine. Knowledge about nitric oxide led to the impotence drug, Viagra, and is being used or studied in the diagnosis and treatment of other diseases, including hardening of the arteries, cancer, infections, asthma, intestinal diseases and memory problems.

"Carbon monoxide could possibly become another nitric oxide," Dr. Gianrico Farrugia of the Mayo Clinic in Rochester, Minn., said in an interview. "Only time and more experiments will tell."

Farrugia and an associate, Dr. Joseph Szurszewski, headed the study, which focused on carbon monoxide's role in orchestrating movements of muscles in the digestive system. The results were published in the prestigious journal of the National Academy of Sciences, which is based in Washington and advises the federal government on science and technology.

They showed that cells in the digestive system manufacture tiny amounts of carbon monoxide, which then regulates muscle contractions. The contractions occur with great precision to properly move food ahead through the stomach and intestines.

One area of intestine, for instance, contracts to squeeze its contents a few inches forward. It then relaxes and refills while the neighboring area contracts and passes the material down the line to the next section of intestine. Without carbon monoxide's cues, the entire intestine might contract at the same time.

Farrugia pointed out that carbon monoxide probably orchestrates other body processes, since the biochemical apparatus for making it also exists in brain, heart, liver, kidney and other cells.

Carbon monoxide works as a so-called neurotransmitter, a chemical that carries signals from one nerve cell to another. It joins nitric oxide as an oddball in that genre. Other neurotransmitters are proteins -- huge, complicated molecules built from many atoms.

Carbon monoxide and nitric oxide, however, work perfectly with only two atoms. There's one carbon and one oxygen in carbon monoxide and a single nitrogen and single oxygen in nitric oxide.

"The Farrugia research is important, as it provides powerful new data establishing carbon monoxide as a neurotransmitter," Dr. Solomon H. Snyder of Johns Hopkins University in Baltimore, the reputed "godfather" of research on chemical messengers, said in an interview. "Evidence from multiple sources is now accumulating indicating that carbon monoxide is as important a neurotransmitter as nitric oxide," Snyder added, noting that it also seems to regulate the relaxation of blood vessels.

Viagra, the popular impotence drug, works by triggering the release of nitric oxide in the penis. It relaxes blood vessels and allows blood to flow in.

Farrugia predicted that one of the first uses of low doses of carbon monoxide, or drugs that trigger its release, would be in treating a shutdown in intestine function that often follows abdominal surgery. Patients must stay hospitalized until the intestines go back online, increasing the length of hospital stays.

Michael Woods can be reached at mwoods@nationalpress.com or 1-202-662-7072.

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