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Serotonin Augments Gut Pacemaker Activity via 5-HT3 Receptors

  • Hong-Nian Liu,

    Affiliation Department of Cell Physiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

  • Susumu Ohya,

    Affiliation Department of Molecular and Cellular Pharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan

  • Yuji Nishizawa,

    Affiliation Department of Anatomy and Cell Biology, Nagoya University Graduate School of Medicine, Nagoya, Japan

  • Kenta Sawamura,

    Affiliation Department of Cell Physiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

  • Satoshi Iino,

    Affiliation Department of Anatomy, Faculty of Medical Sciences, University of Fukui, Fukui, Japan

  • Mohsin Md Syed,

    Current address: Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America

    Affiliation Department of Cell Physiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

  • Kazunori Goto,

    Affiliation Department of Cell Physiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

  • Yuji Imaizumi,

    Affiliation Department of Molecular and Cellular Pharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan

  • Shinsuke Nakayama

    Affiliation Department of Cell Physiology, Nagoya University Graduate School of Medicine, Nagoya, Japan


Serotonin (5-hydroxytryptamine: 5-HT) affects numerous functions in the gut, such as secretion, muscle contraction, and enteric nervous activity, and therefore to clarify details of 5-HT's actions leads to good therapeutic strategies for gut functional disorders. The role of interstitial cells of Cajal (ICC), as pacemaker cells, has been recognised relatively recently. We thus investigated 5-HT actions on ICC pacemaker activity. Muscle preparations with myenteric plexus were isolated from the murine ileum. Spatio-temporal measurements of intracellular Ca2+ and electric activities in ICC were performed by employing fluorescent Ca2+ imaging and microelectrode array (MEA) systems, respectively. Dihydropyridine (DHP) Ca2+ antagonists and tetrodotoxin (TTX) were applied to suppress smooth muscle and nerve activities, respectively. 5-HT significantly enhanced spontaneous Ca2+ oscillations that are considered to underlie electric pacemaker activity in ICC. LY-278584, a 5-HT3 receptor antagonist suppressed spontaneous Ca2+ activity in ICC, while 2-methylserotonin (2-Me-5-HT), a 5-HT3 receptor agonist, restored it. GR113808, a selective antagonist for 5-HT4, and O-methyl-5-HT (O-Me-5-HT), a non-selective 5-HT receptor agonist lacking affinity for 5-HT3 receptors, had little effect on ICC Ca2+ activity. In MEA measurements of ICC electric activity, 5-HT and 2-Me-5-HT caused excitatory effects. RT-PCR and immunostaining confirmed expression of 5-HT3 receptors in ICC. The results indicate that 5-HT augments ICC pacemaker activity via 5-HT3 receptors. ICC appear to be a promising target for treatment of functional motility disorders of the gut, for example, irritable bowel syndrome.


Special interstitial cells with abundant c-Kit receptors on their surface are distributed throughout the gastrointestinal tract. These cells are referred to as interstitial cells of Cajal (ICC) due to the histological features of the network [1][3]. It is now considered that ICC in the myenteric region act as pacemaker cells, and produce gut movements in concert with enteric neurones and smooth muscle cells [4][6]. Numerous neurotransmitters and hormones are likely to affect ICC activity, and thereby modulate gut motility.

Serotonin (5-hydroxytryptamine: 5-HT), well known for mood control in the brain, also plays a crucial role in cellular signalling in the gut. Indeed, enterochromaffin cells release the majority (>90%) of 5-HT in the human body in response to the pressure of intraluminal content and other noxious stimuli [7]. Some enteric neurones in the descending peristaltic reflex pathway also release 5-HT as a neurotransmitter [8][10]. Since enteric neurones and smooth muscle cells express various 5-HT receptors depending upon cell type and location of the cell, and their functions are critically affected by this signalling molecule [11], [12], 5-HT receptors are key targets in pharmacological interventions of gut functional disorders, as well as psychiatric disorders of the brain.

It is thought that oscillations of the intracellular (cytosolic) Ca2+ concentration ([Ca2+]i) in ICC cells underlie gut pacemaker activity. Namely, periodic activation of Ca2+-sensitive ion channels in the plasma membrane generates pacemaker potentials [13], [14]. Previously, we demonstrated that spontaneous electrical activity occurs in synchrony with [Ca2+]i oscillations in ICC, and that coordinated actions of intracellular Ca2+ release channels and transmembrane Ca2+ influx pathways underlie ICC [Ca2+]i oscillations [15][17].

In the present study, we provide evidence that 5-HT regulates ICC pacemaker activity. We performed Ca2+ imaging and potential mapping of ICC pacemaker activity using fluorescent Ca2+ probes and microelectrode array (MEA), respectively, and found that 5-HT enhances both Ca2+ and electric activities of ICC via 5-HT3 receptors, which are nonselective cation channels permeable to Ca2+. We also carried out RT-PCR and immunostaining to confirm the expression of 5-HT3 receptors in ICC. Our findings suggest that 5-HT modulation of ICC activity should also be considered for gut motility disorders, for example, irritable bowel syndrome with a prevalence of around 10% [18]. Interestingly, this disease is known to be frequently complicated by psychiatric illness and mood disorders.

Materials and Methods


Animals used in the present study were treated ethically. All procedures were approved by the Institutional Animal Care and Use Committee. BALB/c (wild-type) and W/Wv mice (3–6 weeks after birth) were killed by cervical dislocation, after being anaesthetized with diethyl ether. Unless otherwise stated, BALB/c mice were used in all experiments.

Ca2+ imaging

Cell cluster preparations were used in Ca2+ imaging [16], [19]. Although we detected 5-HT-augmentation of ICC Ca2+ activity in isolated ileal musculature segments containing the myenteric plexus (Figure S1; Video S1 and Video S2), we used cell cluster preparations in Ca2+ imaging to examine numerous drugs related to 5-HT, because it was difficult to stably load Ca2+ indicators in many intact muscle segments.

The musculature along with the myenteric plexus were carefully dissected from the ileum, and incubated in Ca2+-free Hanks' solution containing collagenase (1 mg/ml, Wako Chemical, Osaka, Japan), trypsin inhibitor (2 mg/ml, type I-S, Sigma, St Louis, MO, USA), ATP (0.3 mg/ml, Seikagakukogyo, Tokyo, Japan), and bovine serum albumin (2 mg/ml, Sigma) for 40 min at 37°C. The musculature preparation was then triturated with fire-blunted glass pipettes. The resultant cell clusters were plated onto a lab-made culture dish, and kept in Dulbecco's modified Eagle's medium (Sigma) supplemented with 10% foetal bovine serum (Sigma) and antibiotics (30 µg/ml streptomycin and 30 units/ml penicillin; Sigma) at 37°C for 2–3 days.

The cultured cell cluster preparations were incubated in ‘normal’ solution containing approximately 8 µM Fluo3-AM (acetoxymethly ester of Fluo-3: Dojindo, Kumamoto, Japan) and detergents (0.02% Pluronic F-127: Dojindo; 0.02% cremophor EL, Sigma) for 3–4 h at room temperature. A CCD camera system (Argus HiSCA, Hamamatsu Photonics, Hamamatsu, Japan) was used to continuously monitor digital images of Fluo-3 emission light. The cell clusters were illuminated at 488 nm and emission light of 515–565 nm was detected. The temperature of the recording chamber was kept at 35°C using a micro-warm plate system (MP10DM, Kitazato Supply, Fujinomiya, Japan). Digital images (0.963 µm/pixel) were normally collected at 300 ms intervals. Changes in fluorescence emission intensity (F) were expressed as Ft/F0, where F0 is the basal fluorescence intensity. Ratio-images were constructed by dividing each Ca2+ image with a Ca2+ image acquired at a basal [Ca2+]i time after subtracting background fluorescence. The frequency of spontaneous [Ca2+]i oscillations in the presence of nifeipine (and TTX) did not differ from that of spontaneous oscillatory inward currents previously measured by the patch clamp technique [20]. We thus judged that the procedure for loading fluo-3 was appropriate, and the spontaneous [Ca2+]i activity reflected pacemaker activity in ICC. This notion also agrees well with previous reports in which dihydropyridine (DHP) Ca2+ antagonists selectively suppress [Ca2+]i activity in smooth muscle by blocking L-type Ca2+ channels [13], [19].

In preliminary experiments, we checked the effects of several concentrations of 5-HT receptor agonists and antagonists in order to assess which subtypes of 5-HT receptors are responsible for the augmentation of [Ca2+]i oscillations in ICC. First, 5-HT was examined at 1, 3, 10 and 50 µM (n = 3–4). The active area of [Ca2+]i oscillations was nearly the same (102% of the control) at 1–3 µM, and increased to ∼145% at 10 µM and to ∼149% at 50 µM. We thus compared the effects of 5-HT and other 5-HT receptor agonists at 10 µM (Fig. 1 and 2). LY-278584, a 5-HT3 antagonist, did not significantly suppress [Ca2+]i oscillations below 10 µM in 10 min. In order to minimize the deterioration of fluo-3 fluorescence during illumination, 10 µM of LY-278584 was normally applied (Fig. 2A–B). Also, according to previous experiments in enteric neurones and ICC, 10 µM GR113808 [21] and 40 µM SK&F96365 [17] were used to inhibit 5-HT4 receptors and Ca2+-permeable transmembrane channels, respectively (Fig. 2C–D).

Figure 1. 5-HT potentiates ICC pacemaker [Ca2+]i activity.

A) Ca2+ images acquired from a cell cluster preparation in control (a-b) and 5 min after 5-HT (10 µM) application (c-d). B) Time course of pacemaker [Ca2+]i activity recorded in the three squares (x, y and z) indicated in Ba. Dotted lines correspond to the times when images (Ba-d) were acquired. Changes in fluorescence emission intensity (F) are expressed as Ft/F0, where F0 is the basal fluorescence intensity. C-E) Bars show changes in the peak amplitude (C), frequency (D), and active area of spontaneous pacemaker [Ca2+]i activity (E) (Mean ± s.d., n = 22). Asterisks, P<0.05 compared to control. F-G) Immunohistochemistry of the ileal myentric plexus (MyP) layer in wild-type (F) and W/Wv mice (G) lacking ICC in this region of the small intestine. Red and green represent neurones (PGP9.5) and ICC (c-Kit), respectively. H) The lack of effect of 5-HT (10 µM) in a cell cluster preparation from W/Wv mice.

Figure 2. Evidence that endogenous 5-HT generates basal pacemaker [Ca2+]i activity via 5-HT3.

A-D) Examples of effects of drugs relating to 5-HT. Each time course of changes in [Ca2+]i activity was acquired 3–5 min after application of drugs. All measurements were carried out in the presence of 1 µM nifedipine. LY-278584, 2-Me-5-HT, GR113808 and O-Me-5-HT were applied at 10 µM, and SK&F96365 was applied at 40 µM. E) Graphs summarizing the effects of drugs relating to 5-HT on the amplitude of pacemaker [Ca2+]i oscillations. Blue bar represents the control. Blue and red bars in the left graph include both experiments (n = 10) for control and subsequent application of LY-278584 shown in A (n = 5) and B (n = 5). Statistical significance of the effects of 2-Me-5-HT and O-Me-5-HT were evaluated by comparing with each control observed in the presence of LY-278584 (n = 5, each). Middle and right graphs represent experiments shown in C (n = 5) and D (n = 5), respectively. Asterisks (P<0.05). n.d. (No [Ca2+]i activity detected.).

Electrical recording

An 8×8 planar microelectrode array (150 µm in polar distance) connected to a 64-channel amplifier (MED 64 System: Alpha Med Science, Osaka, Japan) was used to simultaneously record electrical field potentials of ∼1 mm2 square [22], [23]. Ileal musculature segments (∼5 mm×20 mm) containing the myenteric plexus were fixed using a brain slice anchor (SDH series, Harvard Apparatus Japan, Tokyo, Japan) in the recording chamber kept at 35°C on a heater, and were superfused with ‘normal’ extracellular solution at a constant rate of 2 ml/min. The extracellular solution contained nifedipine (Sigma) and TTX (LKT Laboratories: St Paul, MN, USA) in order to isolate ICC pacemaker activity by suppressing smooth muscle and neural activities. Slow electrical potentials were recorded by applying a high-pass filter of 0.1 Hz to stabilize the baseline drift [24]. A sampling rate of 20 kHz was applied.

In field potential data processing, the digital resolution was reduced to 50 ms (20 Hz) by thinning out the recording points at 1∶1000, and an FFT-based digital band-pass filter (0.04–0.5 Hz) was additionally applied. The effects of 5-HT and 2-Me-5-HT on ICC pacemaker electrical activity were evaluated using a power spectrum (9.4–27.0 cpm). Two-dimensional field potential images were constructed by calculating the values at the desired location via spline interpolation (with 50 points between each electrode), using the MATLAB software package (Mathworks: Natick, MA, USA) [25].


A longer (50 min) enzymatic incubation and more complete trituration with glass pipettes were performed to obtain isolated cells. The digestive enzymes used were the same as described for cell cluster preparations. The resultant cell suspension was incubated in a ‘normal’ extracellular solution containing phycoerythrin-conjugated anti-mouse CD117 (c-Kit) antibody (PE-ACK2, eBioscience, San Diego, CA, USA) in 1/100 v/v for 10 min, and then centrifuged and rinsed with ‘normal’ solution three times. About 5–10 isolated smooth muscle cells and c-Kit-immunopositive cells were separately collected into sterile tubes, using patch pipettes (GC150-15, Harvard Apparatus, Kent, U.K.) with 10–20 µm tip diameter under a fluorescent microscope. The samples were kept at −80°C until use. The procedures for subsequent RT-PCR were the essentially the same as previously described [26].

The following PCR primers were used: 5-HT2B (NM_008311, 1340-1443, amplicon  = 104 bp): 5′-GATCAACCCTGCCATGTACCA-3′ (+) and 5′-CGCCATCGTTTTCAGTGAGA-3′ (-); 5-HT3A (NM_013561, 363-463, amplicon  = 101 bp): 5′-GACTCCTGAGGACTTCGACAATG-3′ (+) and 5′-ACTTCCCCACGTCCACAAACT-3′ (-); 5-HT3B (NM_020274, 607-728, amplicon  = 122 bp): 5′-ACTCTTCTGGCACCATTAGAACC-3′ (+) and 5′-GAGGCTGCAGTTCTGGATATCA-3′ (-); 5-HT4 (NM_008313, 1100-1222, amplicon  = 123 bp): 5′-CTTTCCTCTGGCTTGGCTATATCA-3′ (+) and 5′-GTCTTTTGTAGCGCTCATCATCAC-3′ (-); c-Kit (Y00864, 2156-2256, amplicon  = 101 bp): 5′-GAGCCTTCCTGTGACAGTTCAAAT-3′ (+) and 5′-TCTATTCTTGCGGATCTCCTCTTG-3′ (-); glyceraldehyde-3-phosphate-dehydrogenase (GAPDH) (M32599, 730–833, amplicon  = 104 bp): 5′-CATGGCCTTCCGTGTTCCT-3′ (+) and 5′-CCTGCTTCACCACCTTCTTGA-3′ (-); CD68 (a marker for mast cells) (NM_009853, 574-830, amplicon  = 257 bp): 5′-CACCTGTCTCTCTCATTTCC-3′(+) and 5′-CTTAGAGAGAGCAGGTGAAG-3′ (-); Cma1 (a marker for macrophages) (NM_010780, 332–668, amplicon  = 337 bp): 5′-CGGGAAGGTCTATAACAGTCCTCC-3′ (+) and 5′-CTGGTGAAGTGTTTGCAGGCT-3′(-). The pair of primers for 5-HT4 was also designed to cover 5-HT4A, 5-HT4B, 5-HT4E, and 5-HT4F.


Small segments (10 mm×20 mm) of smooth muscle layers (including the myenteric plexus) isolated from the mouse ileum, were fixed with 4% paraformaldehyde (4°C) for 30 min, and permeabilized with 0.1% triton X-100 and 5% BSA (bovine serum albumin, fraction V: Sigma) for 1 h. The tissue was double stained sequentially with anti-5-HT3 antibody [SR-3 (H-138) sc-28958: Santa Cruz Biotechnology, Santa Cruz, CA, USA] and anti-mouse CD117 (c-Kit) antibody (ACK4: Acris antibodies, Germany) in 100 mM PBS (phosphate buffered-saline solution) overnight. The PBS contained 1% BSA in order to block non-specific reactions. This was followed by incubation with secondary antibodies, Alexa Fluor 488-conjugated anti-rabbit IgG and Alexa Fluor 555-conjugated anti-rat IgG (Molecular Probes, Eugene, OR, USA) at a concentration of 15 µg/ml for 1 h. Double-stained small segments were mounted on a slide glass with an anti-fading agent (ProLong: Molecular Probes) and scanned using a confocal microscope (TCS-SP2: Leica Microsystems, Tokyo, Japan). Controls were prepared by omitting the primary antibodies. The reactivity was negligible in network-forming cells in the myenteric plexus (i.e. ICC). The antibody used for staining the 5-HT3 receptor (sc-28958: Santa Cruz Biotechnology) is a rabbit polyclonal antibody raised against amino acids 341–478 mapping at the C-terminus of 5-HT3A of human origin, and is used in human, mouse and rat specimens.

Solutions and drugs

The composition of the ‘normal’ extracellular solution used in [Ca2+]i imaging and electrical recording was (in mM): NaCl, 125; KCl, 5.9; MgCl2 1.2; CaCl2 2.4; glucose 11; Tris-HEPES 11.8 (pH 7.4). Nifedipine, LY-278584, 2-methyl-5-HT (maleate salt), GR113808 and O-methyl-5-HT (hydrochloride) were purchased from Sigma. SK&F96365 was from Calbiochem (San Diego, CA, U.S.A.). Stock solutions of nifedipine were prepared by dissolving the drug in ethanol, while other drugs were dissolved in dimethyl sulfoxide (DMSO). The working concentrations of the solvents were less than 1%. In preliminary experiments, we observed that applications of this concentration of either solvent alone had little effect on [Ca2+]i oscillation in cell cluster preparations. DMEM and other reagents for cell culture were purchased from Sigma.


Numerical data are expressed as mean±SD. Differences between means were evaluated by paired t-tests. The probability (P)<0.05 was taken as a statistically significant difference.


5-HT augments [Ca2+]i activity in ICC

ICC generate pacemaker activity employing [Ca2+]i oscillations [13], [14]. To examine the effect of 5-HT on [Ca2+]i activity in ICC, we used cell cluster preparations (100–200 µm in diameter) obtained from the mouse ileum. This preparation contains ICC, smooth muscle cells and enteric neurons, and is considered to be an integrated model system to investigate gut pacemaker activity. Dihydropyridine (DHP) Ca2+ antagonists can selectively suppress [Ca2+]i and contractile activities of smooth muscle cells by blocking L-type Ca2+ channels, while pacemaking [Ca2+]i oscillations in ICC persist [19]. We therefore carried out [Ca2+]i imaging in the presence of nifedipine.

A typical effect of 5-HT is shown in Fig. 1A. In the continuous presence of nifedipine (1 µM), spontaneous [Ca2+]i oscillations were observed in a small limited area (near (x)) [control: Panels (a–b) in Fig. 1A]. Application of 5-HT (10 µM) enlarged the region showing spontaneous [Ca2+]i oscillations [Panels (c–d)]. The time course of changes in [Ca2+]i (Ft/F0) is plotted in Fig. 1B. In control conditions (a), only the region of interest (ROI) (x) shows [Ca2+]i oscillations with an amplitude of more than 1.2 (Ft/F0), while such activity was negligible in ROI (y) and (z). After application of 5-HT, the area yielding spontaneous [Ca2+]i oscillations enlarged, covering all three regions (x–z) synchronously. The peak amplitude in ROI (y) reached 80–90% of that in (x). On average, the area yielding [Ca2+]i oscillations increased from 11.5±6.0 to 42.5±18.3% (n = 22), while the frequency was little affected (19.4±1.2 in normal vs. 19.5±1.7 cycles/min in the presence of 5-HT, n = 22) (Fig. 1C–E). Essentially similar effects of 5-HT were observed even in the presence of TTX as well as nifedipine (n = 5), suggesting that 5-HT augmented ICC pacemaker activity, but not through neural activity.

An interesting response was observed in preparations showing intermittent [Ca2+]i oscillations. 5-HT (10 µM) caused the activity towards a continuous oscillation pattern, with a significant enlargement of the oscillation active area (n = 6) (Figure S2).

When [Ca2+]i imaging was carried out in ileal cell cluster preparations from W/Wv mice, which have few pacemaking interstitial cells in this part of the small intestine (Fig. 1F–G) [27][29], no [Ca2+]i oscillation was observed irrespective of 5-HT application (in the presence of 1 µM nifedipine, n = 4) (Fig. 1H). This result confirms that ICC are responsible for 5-HT-mediated enhancement in normal mice.

5-HT receptor agonists and antagonists

Next, we assessed which receptors are responsible for 5-HT-mediated pacemaker [Ca2+]i activity. In these experiments, we used preparations showing synchronous [Ca2+]i oscillations (like the preparation shown in Fig. 1). Application of LY-278584 (10 µM), an antagonist for type 3 5-HT receptors (5-HT3) significantly decreased the amplitude of the oscillations, and the intervals between them often became irregular (middle traces in Fig. 2A–B). Almost complete recovery was achieved by additional application of 10 µM 2-methyl-5-HT (2-Me-5-HT), a selective agonist for 5-HT3 receptors (Fpeak/F0: 1.27±0.06 in control vs 1.25±0.06 with 2-Me-5-HT, n = 5) (the right trace in Fig. 2A). Also, in order to confirm the target cells, 2-Me-5-HT (10 µM) was applied in cell cluster preparations from W/Wv mice, but no [Ca2+]i oscillation was induced (n = 5).

O-methyl-5-HT (O-Me-5-HT) is a known non-selective 5-HT receptor agonist, but lacking affinity for 5-HT3 receptors. Application of O-Me-5-HT (10 µM) caused no recovery of spontaneous [Ca2+]i activity in the presence of LY-278584 (10 µM)(n = 4, Fig. 2B). Essentially the same results as shown in Fig 2A–B were obtained in the presence of TTX (250 nM), indicating that there is no contribution of neural activity: Namely these drugs work through action potential-independent mechanisms.

In contrast to the effects of 5-HT3 antagonists, application of 10 µM GR113808, a selective antagonist for 5-HT4, had little effect on spontaneous [Ca2+]i oscillations in ICC (Fpeak/F0: 1.25±0.06 in control vs 1.22±0.02, n = 5)(middle trace in Fig. 2C). Additional application of 10 µM LY-278584 again suppressed [Ca2+]i activity (right trace in Fig. 2C). These pharmacological examinations, together suggest that pacemaker [Ca2+]i activity in ICC is generated by endogenous 5-HT via 5-HT3 receptors.

Ca2+ influx sensitive to SK&F96365 plays an essential role in generating ICC pacemaker [Ca2+]i activity, presumably co-ordinating with intracellular Ca2+ release channels [16], [17]. In order to assess whether this Ca2+ influx pathway contributes to the pacemaker activity mediated via 5-HT3 receptors, the effect of 2-Me-5-HT was examined in the presence of SK&F96365. Application of 40 µM SK&F96365 suppressed pacemaker [Ca2+]i activity in ICC as observed previously [17], but subsequent application of 2-Me-5-HT caused no recovery (n = 5) (Fig. 2D). The responses of pacemaker [Ca2+]i activity to the drugs relating to 5-HT receptors and Ca2+ influx are summarized in Fig. 2E.

5-HT3 receptors in ICC

To confirm expression of 5-HT receptors in ileal ICC, we performed RT-PCR. After enzymatic dispersion, c-Kit immunopositive interstitial cells (equivalent to ICC) and smooth muscle cells were individually collected. A transcript for 5-HT3A was detected only in ICC, while 5-HT2B was detected in both ICC and smooth muscle cells (Fig. 3A). We also confirmed that neither CD68 nor Cma1 (mast cell markers) was detected in c-Kit-immunopositive interstitial cells (n = 4), unlike in spleen samples (n = 4) (Fig. 3B). In addition, transcripts for 5-HT3B and 5-HT4 were detected in ICC, but not in smooth muscle cells (not shown).

Figure 3. RT-PCR examinations for 5-HT receptors.

A) RNA samples were obtained from isolated c-KIT-immunopositive cells (ICCs) or smooth muscle cells (SMC). NTC represents ‘no template control’. RT-PCR was performed for 5-HT2B, 5-HT3A, c-kit and GAPDH (an index of proper amplification). Numbers on the right of each gel indicate the size marker (bp). B) Examples of RT-PCR detection of mast cell markers (CD68 and Cma1) in spleen (35 cycles) and c-kit-immuopositive cells (50 cycles).

Immunohistochemistry was also performed. Double-labelled immunostaining with anti-c-Kit and anti-5-HT3 antibodies (Fig. 4) revealed that network-forming interstitial cells expressing both 5-HT3 and c-Kit (orange cells in left panel) exist near the myenteric plexus, which contains neurons with only 5-HT3 immunoreactivity (green). In addition, these network-forming cells have large nuclei (a single cell is shown expanded in the right panels). The network-like structure and large nuclei are known features of ICC [2], [6].

Figure 4. Immunohistochemistry for c-KIT and 5-HT3.

Smooth muscle layer of the ileum including the myenteric plexus was double-labelled with anti-c-KIT antibody (ACK4, red) and anti-5-HT3 antibody (sc-28958, green). Left panel (A: merged image) shows myenteric neurons (plexus) (green) surrounded by network-forming cells expressing both c-KIT and 5-HT3. Bar, 50 µm. An ICC-like cell is shown expanded in right panels (B: merged image; C: c-KIT; D: 5-HT3). Bar, 10 µm. The network-like structure and large nucleus are known histological features of ICCs.

Augmentation of electrical activity

In order to confirm the excitatory effect of 5-HT on ICC pacemaker activity, we next measured electrical activity. Isolated musclature of the mouse ileum was placed on an 8×8 microelectrode array (MEA) with a polar distance of 150 µm, and field potentials of a ∼1 mm2 area were simultaneously monitored through a multi-channel amplifier and recording system (See Materials and Methods). To suppress smooth muscle and neural activities, extracellular solution contained nifedipine (1 µM)) and TTX (250 nM), respectively.

A potential map was constructed by using the simultaneous recordings at 64 channels and spline interpolation (Fig. 5A–B). In this preparation, ICC electrical activity propagated from the left bottom to the right top in normal solution (A), and application of 5-HT (10 µM) potentiated ICC electrical activity (B). Representative field potentials of three channels (Fig. 5C–D) show ICC electrical activities for a long duration. 5-HT significantly increased the amplitude of the field potentials, but did not alter the frequency (Video S3 and Video S4). Also, power spectra over the recording area were constructed from field potentials of all 64 channels for approximately 40 s. This analysis shows a marked increase in the spectral power without shifting the peak frequency.

Figure 5. MEA measurements of ICC electrical activity in the presence of nifedipine (1 µM) and TTX (250 nM).

A-B) Field potential images constructed at 200 ms. The top and bottom of the images correspond to the oral and anal ends of the preparation, respectively. C-D) Representative field potential recordings at three channels in the same preparation. The dotted lines indicate the period of the potential images (PI) acquired. E-F) Power spectra constructed from field potential recordings at all 64 channels. A, C and E: control; B, D and F: during application of 5-HT.

The effect of 2-Me-5-HT (10 µM), a 5-HT3 receptor agonist (Figure S3), on ICC electrical activity was also examined. Essentially similar enhancement was observed. Graphs in Fig. 6 summarise the enhancement of 5-HT and 2-Me-5-HT on ICC electrical activity. The spectral power between 9.4-27.0 cpm (Pw9.4-27.0cpm) was used to evaluate the ICC electrical activity, based on a comparison between wild-type and W/Wv mice [23]. In the control of normal ileum, Pw9.4–27.0cpm (from 64 channels) ranged from 1.0 to 19.0×10−3 µV2 (n = 24). Application of 5-HT increased Pw9.4–27.0cpm to 168±45% (P<0.01, n = 12), and 2-Me-5-HT increased it to 153±35% (P<0.01, n = 12).

Figure 6. Potentiation of ICC electrical activity with 5-HT (10 µM) and 2-Me-5-HT (10 µM).

All measurements were carried out in the presence of nifedipine (1 µM) and TTX (250 nM).


ICC act as gut pacemaker cells. Moreover, fairly recent studies suggest that these cells also coordinate peristaltic movements through their network-forming structure [30]. In the light of the important roles of ICC, any hormones and neurotransmitters that modulate ICC activity are considered to have a significant influence upon gut motility. The present finding that 5-HT augments ICC activity implies that this signalling molecule in particular plays a crucial role in regulating gut motility, because the gut contains a majority of 5-HT in the body [8], [11].

The fact that 2-Me-5-HT causes similar effects to 5-HT implies that 5-HT3 receptors are responsible for the 5-HT-mediated enhancement of ICC Ca2+ activity. Lines of studies have suggested that the primary pacemaking activity is the spontaneous [Ca2+]i oscillations in ICC [13], [15], [31]. Namely, [Ca2+]i oscillations in ICC periodically activate plasmalemmal Ca2+-activated ion channels: Ca2+-activated Cl channels [32][35], and/or Ca2+-activated non-selective cation channels [36][38]. Ca2+ release from the intracellular Ca2+ stores, presumably endoplasmic reticulum (ER), appears to be the major Ca2+ source of [Ca2+]i oscillations in ICC, while Ca2+ influx from the extracellular space is required to maintain this [Ca2+]i activity (periodic Ca2+ release) [13], although co-ordinating mechanisms for these Ca2+ pathways are not yet understood. Since 5-HT3 receptors are ligand-gated non-selective cation channels, permeable to Ca2+ [39], [40], this channel is likely to act as a Ca2+ influx pathway to enhance pacemaker activity in ICC (Figure S4). This notion is supported by the fact that SK&F96365, which is known to block a broad range of Ca2+-permeable non-selective cation channels [41][43], terminates ICC pacemaker Ca2+ activity even in the presence of 2-Me-5-HT (Fig. 2D). Also, ICC is known to express DHP-insensitive voltage-gated Ca2+-permeable channels [44], [45]. This transmembrane Ca2+ pathway may simultaneously contribute to the enhancement of ICC [Ca2+]i activity.

Five subunits (i.e. 5-HT3A–E) are known to form the 5-HT3 receptor complex, and changes in the composition alter Ca2+-permeability of this channel [46]. In future studies, it would be of interest to elucidate the composition of 5-HT3A-E receptor subtypes and how 5-HT3 receptors are coupled to Ca2+ release channels in intracellular Ca2+ stores to generate pacemaker [Ca2+]i activity. Polymorphism of these 5-HT3 receptor subunit genes seems likely to affect gut motility by modulating ICC as well as neuronal activities [12], and underlies some functional disorders [47]. Furthermore, RT-PCR examinations detected transcripts of other 5-HT receptor genes in ICC i.e. 5-HT2 and 5-HT4 receptor genes [48], [49]. Recent studies have shown that 5-HT2B receptor antagonists reduced proliferation of cultured ICC, and that the small intestine of mice lacking 5-HT2B receptors contains less ICC in the myenteric and deep muscular plexuses, although intestinal transit is not significantly slowed [50], [51]. On the other hand, 5-HT4 receptor antagonists impair the regeneration of enteric neurons after surgical operation and their development in gut-like organs derived from mouse embryonic stem cells, with indistinguishable changes in the ICC network [21], [52]. It is likely that 5-HT causes numerous effects via these different 5-HT receptors, depending on cell type, location of the gut, and the stage of development and aging.

The scenario for 5-HT augmentation of ICC activity is possibly modified by the roles of adjacent cells in the actual gut. In the present study, we applied nifedipine and TTX to clearly demonstrate the effect of 5-HT on ICC; however, smooth muscle cells and enteric neurones suppressed by these inhibitors may also be involved, because coordinated actions of these cells produce gut motility [4]. For example, as seen in Fig. 5, ICC pacemaker activity propagates on the luminal plane. Indeed, electric conduction of gut pacemaker activity along the musculature can be detected magnetically [53]. It is thought that ICC and smooth muscle cells are electrically connected [54]. Therefore, under normal conditions (without DHP Ca2+ antagonists), in addition to network-forming processes in ICC, the smooth muscle bundle conducts a part of electric current generated by a group of ICC, and amplifies pacemaker activity in adjacent ICC, because it is thought that ICC possess a mechanism to transform depolarisation in the plasma membrane into activation of [Ca2+]i oscillations for pacemaking [55], [56]. Also, some populations of enteric neurones may release activators for ICC pacemaker activity in response to 5-HT. In the myenteric plexus, serotonergic neurones are involved in descending contraction [9], [10], and it is known that ICC express numerous receptors for excitatory neurotransmission, e.g. purinoceptors, neurokinin and acetylcholine receptors [57][60]. These molecules may access ICC to activate in parallel.

The present finding on augmentation of ICC activity via 5-HT3 receptors implies pharmacological interventions on gut motility disorders. For example, irritable bowel syndrome, classified into two types, i.e. diarrhoea- and constipation-dominant IBS (d-IBS and c-IBS), is known to involve 5-HT-related mechanisms along with infectious and inflammatory changes. Excess 5-HT due to impairment of reuptake transport is ascribed to some populations of d-IBS [61][63]. Also, antineoplastic drugs, e.g. cisplatinum, stimulate 5-HT release [64][66]. In such cases, it is rational to suppress ICC pacemaker activity in addition to nervous activities by blocking 5-HT3 receptors. It is speculated that stimulation of 5-HT3 receptors in enteric neurons and ICC synergically facilitates gut contractility and afferent neural activity toward the brain. Thereby, 5-HT3 receptors in the gut may contribute to the gut-brain axis. As seen in murine ileal ICC, we have also observed that 5-HT3 receptor agonists potentiate, while antagonists suppress both Ca2+ and electric pacemaker activities in the murine stomach in preliminary experiments. Although extensive studies are required in model animals and humans, 5-HT is likely to enhance ICC pacemaker activity throughout the gastrointestinal tract.

Similar regulatory mechanisms may underlie other peripheral spontaneous activities. Evidence is being accumulated that ICC-like interstitial cells ubiquitously exist in many organs and tissues that are effectors of the autonomic nervous system, such as the ureter, urinary bladder, urethra, uterus, lymph ducts, veins, etc, suggesting their possible contribution to spontaneous activity [67][71]. Also, in some ICC-like cells, spontaneous [Ca2+]i and electric activities have already been demonstrated. In the light of regulatory mechanisms of ICC and ICC-like cells, investigating functional disorders related to a wide range of peripheral spontaneous rhythmicity, e.g. irritable bladder, is merited.

In summary, the present study has shown 5-HT augmentation of ICC pacemaker activity via 5-HT3 receptors. Since 5-HT3 receptors are Ca2+-permeable nonselective cation channels, this effect on ICC activity is presumably through enhancement of Ca2+ influx from the extracellular space, through itself and simultaneous activation of voltage-gated Ca2+-permeable channels. ICC appear to be a promising target in functional motility disorders in the gut.

Supporting Information

Figure S1.

An example of 5-HT-augmentation of ICC pacemaker [Ca2+]i oscillations in an ileal musculature preparation. Ileal musculature segments (∼5 mm×20 mm) containing the myenteric plexus, the same preparation used in 8×8 MEA measurements, were loaded with Fluo-3AM. Fluo-3 emission light images were continuously monitored the same as cell cluster experiments. The extracellular solution contained 1 µM nifedipine and 250 nM TTX. A) A control fluorescent image. B and C) Series of ratio images of a [Ca2+]i oscillation cycle in control and in the presence of 5-HT (10 µM), respectively. Each image was acquired at 300 ms intervals. Video S1 and Video S2 correspond to ratio images shown in B and C, respectively. Note that green represents the Ft/F0 ratio of ∼1 in cell cluster preparations (Fig. 1A) to display the size of the preparation, while black represents the ratio of ∼1 in musculature preparations, because the size of preparations were larger than the frame of the image. After 5-HT application the active area markedly increased.


Figure S2.

Regular occurrence of pacemaker [Ca2+]i oscillations after application of 5-HT. A) Ca2+ images acquired from a cell cluster preparation in control (a–c) and 5 min after 5-HT (10 µM) application (d, e). This preparation showed intermittent [Ca2+]i oscillations in control condition. B) Time course of pacemaker [Ca2+]i activity recorded in the square (x) indicated in A: control (left) and 5 min after application of 10 µM 5-HT (right). Dotted lines correspond to the times when images (a–e) were acquired. C–E) Bar graphs showing changes in the peak amplitude (C), frequency (D), and active area (E) of spontaneous pacemaker [Ca2+]i activity (Mean ± S.D., n = 6).


Figure S3.

An example of the effect of 2-Me-5-HT (10 µM) on field potentials. Field potential images in control (A) and during application of 2-Me-5-HT (B) are displayed at 200 ms intervals. Note, 2-Me-5-HT-enhanced ICC electrical activity, as seen during 5-HT application.


Figure S4.

Possible underlying mechanisms for 5-HT-enhancement of gut pacemaker activity and contractility. It is thought that intracellular Ca2+ release channels, i.e. ryanodine receptors (RyR) and InsP3 receptors (IP3R) in ICC are periodically activated by the support of a Ca2+ influx pathway across the plasma membrane, although mechanisms underlying the coordinated actions of intracellular and plasma membrane ion channels are not yet known. 5-HT augments ICC [Ca2+]i oscillations presumably (1) by facilitating Ca2+ influx via 5-HT3 receptors, and (2) simultaneous activation of voltage-gated Ca2+-permeable insensitive to DHP Ca2+ antagonists (DHP(-)VGCC). In ICC, [Ca2+]i oscillations periodically activate Ca2+-activated ion channels in the plasmamembrane, i.e. Ca2+-activated Cl channels (ClCa) and/or Ca2+-activated nonselective cation channels (NSCCCa), and thereby generate electric pacemaker activity. In smooth muscle (SM) cells, conducted pacemaker activity via gap junction (GJ) channels activates DHP-sensitive voltage-gated Ca2+ channels (DHP(+)VGCC), i.e. L-type Ca2+ channels, causing periodic contraction. In the present study, to differentiate ICC activity, all experiments were carried out in the presence of a DHP Ca2+ antagonist, nifedipine.


Video S1.

[Ca2+]i oscillations measured in a musculature preparation in normal condition, corresponding to Figure S1B.


Video S2.

[Ca2+]i oscillations measured in a musculature preparation in the presence of 5-HT (10 µM), corresponding to Figure S1C.


Video S3.

Field potential oscillations acquired under a control condition, corresponding to Figure 5A. An 8×8 microelectrode array with a polar distance of 150 µm was used. The recording area was ∼1 mm2.


Video S4.

Field potential oscillations acquired 5 min after application of 10 µM 5-HT corresponding to Figure 5B.



The authors are grateful to Professor Miyako Takaki (Nara Medical University, Japan) for valuable discussion.

Author Contributions

Conceived and designed the experiments: SN. Performed the experiments: H-NL MMdS KG SO YN KS SI YI SN. Analyzed the data: YI SN. Wrote the paper: SN.


  1. 1. Maeda H, Yamagata A, Nishikawa S, Yoshinaga K, Kobayashi S, et al. (1992) Rrequirement of c-kit for development of intestinal pacemaker system. Development 116: 369–375.
  2. 2. Faussone-Pellegrini MS, Thuneberg L (1999) Guide to the identification of interstitial cells of Cajal. Microsc Res Tech 47: 248–266.
  3. 3. Sanders KM, Ördög T, Koh SD, Torihashi S, Ward SM (1999) Development and plasticity of interstitial cells of Cajal. Neurogastroenterol Motil 11: 311–338.
  4. 4. Huizinga JD (1999) Gastrointestinal peristalsis: joint action of enteric nerves, smooth muscle, and interstitial cells of Cajal. Microsc Res Tech 47: 239–247.
  5. 5. Camilleri M (2001) Enteric nervous system disorders: genetic and molecular insights for the neurogastroenterologist. Neurogastroenterol Motil 13: 277–295.
  6. 6. Takaki M (2003) Gut pacemaker cells: The interstitial cells of Cajal. J Smooth Muscle Res 39: 137–161.
  7. 7. Bülbring E, Lin RC (1958) The effect of intraluminal application of 5-hydroxytryptamine and 5-hydroxytryptophan on peristalsis; the local production of 5-HT and its release in relation to intraluminal pressure and propulsive activity. J Physiol (Lond) 140: 381–407.
  8. 8. Gershon MD (1981) The enteric nervous system: multiplicity of neurotransmitters outside of the brain. In: Bülbring E, Brading AF, Jones AW, Tomita T editors. Smooth Muscle: An Assessment of Current Knowledge. 263-284. Edward Arnold.
  9. 9. Furness J (2006) The enteric nervous system. First Edition. Wiley-Blackwell. pp. 1–288.
  10. 10. Wood JD (2006) Integrative function of enteric nervous system. In: Barrett KE, Ghishan FK, Merchant JL, Said HM, Wood JD, Johnson LR editors. Physiology of the Gastrointestinal Tract. Fourth Edition, Vol 2. Academic Press 665–684.
  11. 11. Crowell MD, Wessinger SB (2007) 5-HT and the brain-gut axis: opportunities for pharmacologic intervention. Expert Opin Investig Drugs 16: 761–765.
  12. 12. De Ponti F (2004) Pharmacology of serotonin: what a clinician should know. Gut 53: 1520–1535.
  13. 13. Nakayama S, Kajioka S, Goto K, Takaki M, Liu H-N (2007) Calcium-associated mechanisms in gut pacemaker activity. J Cell Mol Med 11: 958–968.
  14. 14. Berridge MJ (2008) Smooth muscle cell calcium activation mechanisms. J Physiol (Lond) 586: 5047–5061.
  15. 15. Torihashi S, Fujimoto T, Trost C, Nakayama S (2002) Calcium oscillation linked to pacemaking of interstitial cells of Cajal. J Biol Chem 277: 19191–19197.
  16. 16. Aoyama M, Yamada A, Wang J, Ohya S, Furuzono S, et al. (2004) Requirement of ryanodine receptors for pacemaker Ca2+ activity in ICC and HEK293 cells. J Cell Sci 117: 2813–2825.
  17. 17. Liu HN, Ohya S, Furuzono S, Wang J, Imaizumi Y, et al. (2005) Co-contribution of IP3R and Ca2+ influx pathways to pacemaker Ca2+ activity in stomach ICC. J Biol Rhythm 20: 15–26.
  18. 18. Spiller R (2007) Recent advances in understanding the role of serotonin in gastrointestinal motility in functional bowel disorders: alterations in 5-HT signalling and metabolism in human disease. Neurogastroenterol Motil 19: Suppl 225–31.
  19. 19. Nakayama S, Ohya S, Liu HN, Watanabe T, Furuzono S, et al. (2005) Sulphonylurea receptors differently modulate ICC pacemaker Ca2+ activity and smooth muscle contractility. J Cell Sci 118: 4163–4173.
  20. 20. Nakayama S, Torihashi S (2002) Spontaneous rhythmicity in cultured cell clusters isolated from mouse small intestine. Jpn J Physiol 52: 217–227.
  21. 21. Matsuyoshi H, Kuniyasu H, Okumura M, Misawa H, Katsui R, et al. (2010) A 5-HT4-receptor activation-induced neural plasticity enhances in vivo reconstructs of enteric nerve circuit insult. Neurogastroenterol Motil 22: 806–813.
  22. 22. Nakayama S, Shimono K, Liu H-N, Jiko H, Katayama N, et al. (2006) Pacemaker phase shift in the absence of neural activity in guinea-pig stomach: a microelectrode array study. J Physiol (Lond) 576: 727–738.
  23. 23. Nakayama S, Ohishi R, Sawamura K, Watanabe K, Hirose K (2009) Microelectrode array evaluation of gut pacemaker activity in wild-type and W/Wv mice. Biosens Bioelectron 25: 61–67.
  24. 24. Brock JA, Cunnane TC (1987) Relationship between the nerve action potential and transmitter release from sympathetic postganglionic nerve terminals. Nature 326: 605–607.
  25. 25. Shimono K, Brucher F, Granger R, Lynch G, Taketani M (2000) Origins and distribution of cholinergically induced β rhythms in hippocampal slices. J Neurosci 20: 8462–8473.
  26. 26. Ohya S, Asakura K, Muraki K, Watanabe M, Imaizumi Y (2002) Molecular and functional characterization of ERG, KCNQ, and KCNE subtypes in rat stomach smooth muscle. Am J Physiol 282: G277–287.
  27. 27. Reith AD, Rottapel R, Giddens E, Brady C, Forrester L, et al. (1990) W mutant mice with mild or severe developmental defects contain distinct point mutations in the kinase domain of the c-kit receptor. Genes Dev 4: 390–400.
  28. 28. Ward SM, Burns AJ, Torihashi S, Sanders KM (1994) Mutation of c-kit blocks development of interstitial cells and electrical rhythmicity in the murine intestine. J Physiol (Lond) 480: 91–97.
  29. 29. Iino S, Horiguchi S, Horiguchi K, Nojyo Y (2007) Interstitial cells of Cajal in the gastrointestinal musculature of W mutant mice. Arch Histol Cytol 70: 163–173.
  30. 30. Nakagawa T, Ueshima S, Fujii H, Nakajima Y, Takaki M (2005) Different modulation of spontaneous activities by nitrergic inhibitory nerves between ileum and jejunum in W/Wv mutant mice. Auton Neurosci 119: 25–35.
  31. 31. Yamazawa T, Iino M (2002) Simultaneous imaging of Ca2+ signals in interstitial cells of Cajal and longitudinal smooth muscle cells during rhythmic activity in mouse ileum. J Physiol (Lond) 538: 823–835.
  32. 32. Tokutomi N, Maeda H, Tokutomi Y, Sato D, Sugita M, et al. (1995) Rhythmic Cl- current and physiological roles of the intestinal c-kit-positive cells. Pflügers Arch 431: 169–177.
  33. 33. Huizinga JD, Zhu Y, Ye J, Molleman A (2002) High conductance chloride channels generate pacemaker currents in interstitial cells of Cajal. Gastroenterol 123: 1627–1636.
  34. 34. Gomez-Pinilla PJ, Gibbons SJ, Bardsley MR, Lorincz A, Pozo MJ, et al. (2009) Ano1 is a selective marker of interstitial cells of Cajal in the human and mouse gastrointestinal tract. Am J Physiol Gastrointest Liver Physiol 296: G1370–1381.
  35. 35. Hwang SJ, Blair PJ, Britton FC, Odriscoll KE, Hennig G, et al. (2009) Expression of anoctamin 1Tmem16a by interstitial cells of Cajal is fundamental for slow wave activity in gastointestinal muscles. J Physiol (Lond) 587: 4887–4904.
  36. 36. Walker RL, Koh SD, Sergeant GP, Sanders KM, Horowitz B (2002) TRPC4 currents have properties similar to the pacemaker current in interstitial cells of Cajal. Am J Physiol Cell Physiol 283: C1637–1645.
  37. 37. Goto K, Matsuoka S, Noma A (2004) Two types of spontaneous depolarizations in the interstitial cells freshly prepared from the murine small intestine. J Physiol (Lond) 559: 411–422.
  38. 38. Faville RA, Pullan AJ, Sanders KM, Smith NP (2008) A biophysically based mathematical model of unitary potential activity in interstitial cells of Cajal. Biophys J 95: 88–104.
  39. 39. Davies PA, Pistis M, Hanna MC, Peters JA, Lambert JJ, et al. (1999) The 5-HT3B subunit is a major determinant of serotonin-receptor function. Nature 397: 359–363.
  40. 40. Nichols DE, Nichols CD (2008) Serotonin receptors. Chem Rev 108: 1614–1641.
  41. 41. Roe MR, Worley JF III, Qian F, Tamarina N, Mittal AA, et al. (1998) Characterization of a Ca2+ release-activated nonselective cation current regulation membrane potential and [Ca2+]i oscillations in transgenically derived β-cells. J Biol Chem 273: 10402–10410.
  42. 42. Zhu X, Jiang M, Birnbaumer L (1998) Receptor-activated Ca2+ influx via human trp3 stably expressed in human embryonic kidney (HEK)293 cells. J Biol Chem 273: 133–142.
  43. 43. Kajioka S, Nakayama S, Asano H, Brading AF (2005) Involvement of ryanodine receptors in muscarinic-receptor-mediated membrane current oscillation in urinary bladder smooth muscle. Am J Physiol Cell Physiol 288: C100–108.
  44. 44. Kim YC, Koh SD, Sanders KM (2002) Voltage-dependent inward currents of interstitial cells of Cajal from murine colon and small intestine. J Physiol 541: 797–810.
  45. 45. Boddy G, Willis A, Galante G, Daniel EE (2006) Sodium-, chloride-, and mibefradil- sensitive calcium channels in intestinal pacing in wild-type and W/WV mice. Can J Physiol Pharmacol 84: 589–599.
  46. 46. Niesler B, Walstab J, Combrink S, Möller D, Kapeller J, et al. (2007) Characterization of the novel human serotonin receptor subunits 5-HT3C, 5-HT3D, and 5-HT3E. Mol Pharmacol 72: 8–17.
  47. 47. Fasching PA, Kollmannsberger B, Strissel PL (2008) Polymorphisms in the novel serotonin receptor subunit gene HTR3C show different risks for acute chemotherapy-induced vomiting after anthracycline chemotherapy. J Cancer Res Clin Oncol 134: 1079–1086.
  48. 48. Wouters MM, Gibbons SJ, Roeder JL, Distad M, Ou Y, et al. (2007) Exogenous serotonin regulates proliferation of interstitial cells of Cajal in mouse jejunum through 5-HT2B receptors. Gastroenterol 133: 897–906.
  49. 49. Liu M, Geddis MS, Wen Y, Setlik W, Gershon MD (2005) Expression and function of 5-HT4 receptors in the mouse enteric nervous system. Am J Physiol Gastrointest Liver Physiol 289: G1148–1163.
  50. 50. Tharayil VS, Wouters MM, Stanich JE, Roeder JL, Lei S, et al. (2010) Lack of serotonin 5-HT2B receptor alters proliferation and network volume of interstitial cells of Cajal in vivo. Neurogastroenterol Motil 22: 462–469.
  51. 51. Du P, O'Grady G, Gibbons SJ, Yassi R, Lees-Green R, et al. (2010) Tissue-specific mathematical models of slow wave entrainment in wild-type and 5-HT2B knockout mice with altered interstitial cells of Cajal networks. Biophys J 98: 1772–1781.
  52. 52. Takaki M, Misawa H, Matsuyoshi H, Kawahara I, Goto K, et al. (2011) In vitro enhanced differentiation of neural networks in ES gut-like organ from mouse ES cells by a 5-HT4-receptor activation. Biochem Biophys Res Commun 406: 529–533.
  53. 53. Nakayama S, Atsuta S, Shinmi T, Uchiyama T (2011) Pulse-driven magnetoimpedance sensor detection of biomagnetic fields in musculatures with spontaneous electric activity. Biosens Bioelectron 27: 34–39.
  54. 54. Sperelakis N, Daniel EE (2004) Activation of intestinal smooth muscle cells by interstitial cells of Cajal in simulation studies. Am J Physiol Gastrointest Liver Physiol 286: G234–243.
  55. 55. van Helden DF, Imtiaz MS (2003) Ca2+ phase waves: a basis for cellular pacemaking and long-range synchronicity in the guinea-pig gastric pylorus. J Physiol (Lond) 548: 271–296.
  56. 56. van Helden DF, Laver DR, Holdsworth J, Imtiaz MS (2010) Generation and propagation of gastric slow waves. Clin Exp Pharmacol Physiol 37: 516–524.
  57. 57. Iino S, Ward SM, Sanders KM (2004) Interstitial cells of Cajal are functionally innervated by excitatory motor neurones in the murine intestine. J Physiol (Lond) 556: 521–530.
  58. 58. Furuzono S, Nakayama S, Imaizumi Y (2005) Purinergic modulation of pacemaker Ca2+ activity in interstitial cells of Cajal. Neuropharmacol 48: 264–273.
  59. 59. Takaki M, Suzuki H, Nakayama S (2010) Recent advances in studies of spontaneous activity in smooth muscle: ubiquitous pacemaker cells. Prog Biophys Mol Biol 102: 129–135.
  60. 60. Tsuchida Y, Hatao F, Fujisawa M, Murata T, Kaminishi M, et al. (2011) Neuronal stimulation with 5-hydroxytryptamine 4 receptor induces anti-inflammatory actions via {alpha}7nACh receptors on muscularis macrophages associated with postoperative ileus. Gut 60: 638–647.
  61. 61. Atkinson W, Lockhart S, Whorwell PJ, Keevil B, Houghton LA (2006) Altered 5-hydroxytryptamine signaling in patients with constipation- and diarrhea-predominant irritable bowel syndrome. Gastroenterol 130: 34–43.
  62. 62. Camilleri M, Andrews CN, Bharucha AE, Carlson PJ, Ferber I, et al. (2007) Alterations in expression of p11 and SERT in mucosal biopsy specimens of patients with irritable bowel syndrome. Gastroenterol 132: 17–25.
  63. 63. Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, et al. (2007) Clinical Services Committee of The British Society of Gastroenterology. Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut 56: 1770–1798.
  64. 64. Johanson JF (2004) Options for patients with irritable bowel syndrome: contrasting traditional and novel serotonergic therapies. Neurogastroenterol Motil 16: 701–711.
  65. 65. Jordan K, Kasper C, Schmoll HJ (2005) Chemotherapy-induced nausea and vomiting: current and new standards in the antiemetic prophylaxis and treatment. Eur J Cancer 41: 199–205.
  66. 66. Gan TJ (2005) Selective serotonin 5-HT3 receptor antagonists for postoperative nausea and vomiting: are they all the same? CNS Drugs 19: 225–238.
  67. 67. Huizinga JD, Faussone-Pellegrini MS (2005) About the presence of interstitial cells of Cajal outside the musculature of the gastrointestinal tract. J Cell Mol Med 9: 468–473.
  68. 68. Brading AF, McCloskey KD (2005) Mechanisms of disease: specialized interstitial cells of the urinary tract-an assessment of current knowledge. Nat Clin Pract Urol 2: 546–554.
  69. 69. McCloskey KD, Hollywood MA, Thornbury KD, Ward SM, McHale NG (2002) Kit-like immunopositive cells in sheep mesenteric lymphatic vessels. Cell Tissue Res 310: 77–84.
  70. 70. Lavoie B, Balemba OB, Nelson MT, Ward SM, Mawe GM (2007) Morphological and physiological evidence for interstitial cell of Cajal-like cells in the guinea pig gallbladder. J Physiol (Lond) 579: 487–501.
  71. 71. Lang RJ, Hashitani H, Tonta MA, Parkington HC, Suzuki H (2007) Spontaneous electrical and Ca2+ signals in typical and atypical smooth muscle cells and interstitial cell of Cajal-like cells of mouse renal pelvis. J Physiol (Lond) 583: 1049–1068.