Research ArticleDRUG MECHANISM

Inhibition of sodium/hydrogen exchanger 3 in the gastrointestinal tract by tenapanor reduces paracellular phosphate permeability

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Science Translational Medicine  29 Aug 2018:
Vol. 10, Issue 456, eaam6474
DOI: 10.1126/scitranslmed.aam6474

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Phosphate in flux

Kidney failure can decrease the excretion of phosphate, leading to elevated phosphate in the blood and cardiovascular complications. King et al. studied whether tenapanor, an inhibitor of the sodium/hydrogen exchanger isoform 3, could help reduce intestinal phosphate absorption. Using rodent models and human intestinal cell–derived monolayers, the authors showed that inhibition of the sodium/hydrogen exchanger isoform 3 reduced urinary sodium and phosphate excretion and cell permeability to phosphate by increasing transepithelial electrical resistance. Administering tenapanor to healthy humans increased stool phosphorus excretion. Understanding tenapanor’s mechanism of action could improve treatment options for hyperphosphatemia.