Protective effect of rebamipide against celecoxib-induced gastric mucosal cell apoptosis

A major clinical problem encountered with the use of non-steroidal anti-inflammatory drugs (NSAIDs) is gastrointestinal complications. We have previously suggested that both decreases in prostaglandin E₂ (PGE₂) levels and mucosal apoptosis are involved in the development of NSAID-produced gastric lesions and that this apoptosis is mediated by an increase in the intracellular Ca²⁺ concentration and the resulting endoplasmic reticulum (ER) stress response and mitochondrial dysfunction. Celecoxib and rebamipide are being used clinically as a safer NSAID and an anti-ulcer drug, respectively. In this study, we have examined the effect of rebamipide on celecoxib-induced production of gastric lesions. In mice pre-administered with a low dose of indomethacin, orally administered rebamipide suppressed celecoxib-induced mucosal apoptosis and lesion production but did not decrease in PGE₂ levels in the stomach. Rebamipide also suppressed celecoxib-induced increases in intracellular Ca²⁺ concentration, the ER stress response, mitochondrial dysfunction and apoptosis in vitro. We also found that rebamipide suppresses the increases in intracellular Ca²⁺ concentration induced by an activator of voltage-dependent L-type Ca²⁺ channels and that another blocker of this channel suppresses celecoxib-induced increases in intracellular Ca²⁺ concentration. These results suggest that celecoxib activates voltage-dependent L-type Ca²⁺ channels and that rebamipide blocks this activation, resulting in suppression of celecoxib-induced apoptosis. We believe that this novel activity of rebamipide may play an important role in the protection of gastric mucosa against the formation of celecoxib-induced lesions.