Model of interstitial pressure as a result of cyclical changes in the capillary wall fluid transport.

Reported interstitial pressures range from -8 to +6 mm Hg in different tissues and from <-20 mm Hg in burned tissue or more than +30 mm Hg in tumors. We have tried to link interstitial pressure to the here proposed cyclical changes in the fluid transport across the capillary wall. In the presented model interstitial pressure is considered as an average of pressures in numerous pericapillary spaces. A single pericapillary pressure is a dynamic difference between the net outward (hydraulic pressure+interstitial colloid osmotic pressure) and inward (plasma colloid oncotic pressure) forces. Hence, dominating net outward forces would result in a positive pericapillary interstitial pressure, while stronger inward forces would produce negative pressures in the pericapillary space. All interruptions of blood flow leave some blood in capillaries with a normal oncotic pressure and no hydrostatic pressure that might act as a strong absorber of interstitial fluid until the blood flow is reestablished. Model assumptions for the systemic circulation capillaries include (a) precapillary sphincters can almost entirely stop the capillary flow, (b) only a minority of sphincters are normally open in the tissue, and (c) hydrostatic pressures in unperfused capillaries are similar to the pressures at their venous ends. The key proposal is that capillaries with closed precapillary sphincters along their entire length have low hydrostatic pressure of 10 to 15 mm Hg. This pressure cannot force filtration, so these capillaries reabsorb interstitial fluid from the pericapillary space along their entire length. In the open capillaries, hydrostatic pressure filtrates fluid to the pericapillary space along most of their length. Fluid enters, moves some 20 or 30 micrometers away and back to be reabsorbed at the same point. Closed periods are periods of intense fluid reabsorption, while the short open periods refill the space with fresh fluid. It can be calculated that subcutaneous tissue interstitial pressure values might develop if the closed periods are 1.14 to 2.66 times longer than the open periods. Positive interstitial pressures observed in some organs might develop if open periods are longer than the closed periods. High interstitial colloid pressure in lungs makes both perfused and unperfused capillaries absorptive, resulting in more negative values of lung interstitial pressure. The same model is used to explain interstitial pressure values in tumors, burned tissue and intestinal villi.

A model of hydraulic interactions in liver parenchyma as forces behind the intrahepatic bile flow.

The small diameters of bile canaliculi and interlobular bile ducts make it hard to attribute the bile flow solely to the process of secretion. In the model liver within its capsule is considered a limited space in which volume expansions of one part are possible only through the shrinking of other parts. The liver capsule allows only very slow volume changes. The rate of blood flow through the sinusoides is governed by the Poisseuill-Hagen law. The model is based on a concept of circulatory liver units. A unit would contain a group of acini sharing the same conditions of arterial flow. We can imagine them as an acinar group behind the last pressure reducer on one arterial branch. Acini from neighboring units compose liver lobules and drain through the same central venule. One lobule can contain acini from several neighboring circulatory units. The perfusion cycle in one unit begins with a transient tide in the arterial flow, governed by local mediators. Corresponding acini expand, grabbing the space by compressing their neighbors in the same lobules. Vascular resistance is reduced in dilated and increased in compressed acini. Portal blood flows through the dilated acini, bypassing the compressed neighbors. The cycle ends when the portal tide slowly diminishes and acinar volume is back on the interphase value until the new perfusion cycle is started in another circulatory unit. Each cycle probably takes minutes to complete. Increased pressures both in dilated and in compressed acini force the bile to move from acinar canalicules. Both up and down changes in acinar volume might force the acinar biliary flow. In cases of arterial vasoconstriction, increased activity of vasoactive substances would keep most of the circulatory units in the interphase and increased liver resistance can be expected. Liver fibrosis makes all acini to be of fixed volume and result in increased resistance. Because of that, low pressure portal flow would be more compromised, as reported. In livers without arterial blood flow, although some slow changes in the portal flows can be expected, acinar volume changes should be reduced. In acute liver injury, enlarged hepatocytes would diminish sinusoidal diameter and increase acinar resistance. In liver tumors, areas of neovascularization with reduced resistance would divert the arterial flow from the normal tissue, while in the compressed perifocal areas, increased vascular resistance should diminish mainly the portal flow.

A model of the gastric gland ejection cycle: low ejection fractions require reduction of the glandular dead space.

This paper was inspired by the reported results of authors from Uppsala and Lund that gastric glands in rats rhythmically contract 3-7 cycles per minute and develop luminal pressures more than 10 mmHg. To ensure that pepsinogen is not retained in the acid-rich section of the gland, ejection fractions would need to be more than 50% of the gland volume. We have tried to calculate the ejection fraction of such contractions. Dimensions of human gastric glands were measured on the fresh frozen samples of macroscopically and histologically normal gastric mucosa. In total, 18 specimens (from nine persons) were measured under the microscope. The density of glands was 135 +/- 11 (mean +/- S.D.) glands per mm( 2) of gastric mucosa. A typical gastric gland is a tubular structure 1.2 +/- 0.22 mm long and 0.03-0.05 mm wide. We have used 1 mm for length and 0.03 mm for the gland diameter to calculate that each gland approximates a volume of 707 pl, suggesting that the total glandular volume for 15 million glands reaches 10.6 ml. Further calculations based on one to five contractions per minute on an average and on the total volume of gastric glands of 10 ml showed that only ejection fractions less than 10% deliver daily volumes less than 3 l. The presented model of the gastric gland activity is based on the idea that the low ejection fractions require a reduction of the glandular dead space. The reduced luminal pressure during the gland relaxation might cause backflux of hydrophobic viscoelastic mucus through the gland aperture. Repeated glandular contractions and relaxations would move the mucus all the way to the gland bottom, filling the gland cavity below the neck with an axial semisolid mucous cylinder. This filling would reduce the gland dead space. During contractions, the gland would eject mainly the peripheral, the more liquid part of its content. The decreasing luminal pressure in the relaxing gland would pull the outlet mucus inside, protecting gland apertures from the gastric juice.

Endothelin-secreting tumors and the idea of the pseudoectopic hormone secretion in tumors.

Ectopic hormone secretion in tumor cells is here described as an amplification of hormone production already present in normal, nonendocrine tumor-originated tissue. This idea is tested on the available data regarding endothelin-1 (ET-1) secreting tumors. The endothelins are ubiquitous regulatory peptides produced by various tissues. The precursor cells of many tumor types secrete endothelins. ET-1 protein expression was detected in situ in all tested prostate cancers as well as in normal prostate tissue. The majority of hepatocellular carcinomas produce ET-1, while ET-1 is secreted by the normal hepatic stellate cells. Human breast cancer cells produce immunoreactive ET-1. Similar data exist for pancreatic tissue, the thyroid and large bowel. We can conclude that tumor cells might sustain endothelin secretions already present in the normal tumor-originated tissue. The model that is presented of the pseudoectopic hormone secretion consists of relations between a few parameters. The proportion of hormone-secreting tumors (Th) among all tumors (T) of that organ depends on the amount of the hormone-secreting cells (Ch) among all cells (C) susceptible to malignant transformation. The corrective factor (k) was introduced in the expression Th/T=Ch/C*k, to represent specific conditions altering the malignant transformation probability for a certain normal hormone-secreting cell. In prostate, breast and colon, the kvalue is predicted to be approximately 1, suggesting that ET-1-secreting normal cells are not more prone to the malignant transformation than their neighbours. In liver and pancreas, the incidence of ET-1-secreting tumors outnumbers the proportions of normal ET-1-secreting cells (k values >1). In these organs, normal ET-1-secreting cells seem more likely to turn malignant in comparison to their neighbours, perhaps due to their function, position and exposition to oncogenic factors, or even due to their ET-1 secretion. There are similar data for thyroid and adrenal glands. No ET-1 secretion was reported in kidney neoplasms. Normal renal ET-1 secreting cells might be less prone to turn malignant than other renal cells. Unlse the normal lung tissue, small cell lung cancers often secrete adrenocorticotrophic hormone (ACTH). The pancreatic islet cells do not secrete gastrin, but their tumors often do. Constant k would exceed 1 in both cases. We speculate that these tumors might originate from a small subset of cells with the described feature. Tumor cells sometimes lack features of the normal tissue, as in the cases of the steroid receptor-negative breast cancer. These tumors might originate from the hypothetical subset of receptor-free breast cells. Benign breast epithelial cells lacking oestrogen receptors have been described in cases of megalomastia. These cells might be constituents of normal breasts or, perhaps, present only in cases of increased breast cancer risk.

Minoxidil and male-pattern alopecia: a potential role for a local regulator of sebum secretion with vasoconstrictive effects?

Regulation of the hair cycle takes place at the pilo-sebaceous unit with the sebaceous gland as a sex hormone-dependent part. Although minoxidil stimulates proliferation of follicular cells and activation of prostaglandin endoperoxide synthase-1, it was suggested that other mechanisms, such as an increase in the local blood flow, might mediate the drug effect on hair growth. If that is the case, it is possible that minoxidil counteracts some vasoconstrictive mediator of male-pattern alopecia. This hypothetical vasoconstrictive mediator X would have to meet some criteria: (I) vasoconstriction both in the general circulation and in the hair-growing skin; (II) local vasoconstrictive activity in the hair growing skin should be related to the circulating testosterone level; (III) only an increase in the local mediator X activity causes male-pattern alopecia, since hypertensive patients are not balder than expected. The sebaceous gland is a possible place of the mediator X secretion since it is a sex-hormone-dependent part of the pilo-sebaceous unit. ET-1 might be a suitable candidate for the mediator X, since male hormones raise ET-1 plasma levels and female hormones lower them. The speculation presented here is that ET-1, beside vasoconstriction in the general circulation, might also regulate the sebum secretion, by triggering contractions of the myoepithelial cells. This hypothetical mechanism would normally remain confined to the sebaceous gland. During puberty, sex hormones stimulate growth of sebaceous glands in both sexes. In women hypertrophied sebaceous glands under estrogen control would not increase its ET-1 content, while in men, testosterone would increase ET-1 secretion that might affect the neighboring arterioles. Induced vasoconstriction might reduce the hair growth and promote hair loss. If ET-1 plays the described role, then an ET-1 antagonist, i.e. bosentane, should also have some hair-growing properties.

Simulation model of defective insulin receptors as byproducts of receptor recycling.

Our simulation model assumes that the defective insulin-binding receptors in non-insulin-dependent diabetes (NIDDM) patients result from functional receptor recycling. The model is a short program written in MS DOS 5.0 Qbasic. MODEL DESIGN: Receptors with intracellular portions damaged in the process of recycling are considered defective since they bind insulin but do mediate insulin effects, or recycle. Their occurrence depends on the average activation rate of functional receptors. The insulin-binding receptors (defective and functional) are objects of slow and time-dependent turnover defined by the turnover rate. Recycled receptors rejoin functional receptors or enter the pool of defective receptors. The waste in the functional receptors' pool is covered by a limited amount of newly synthesized receptors. The defective receptors often accumulate in cases of increased activation of functional receptors. SIMULATION RESULTS: The insulin-binding receptor quantity is determined, in the model, only by the number of newly synthesized receptors, reflecting the intensity of insulin stimulation. Synthesis is increased following variable insulin stimulations and decreased after sustained, intensive insulin stimulation. The number of functional receptors inversely reflects the average activation rate of functional receptors compared with the insulin-binding receptors turnover rate. High activation rates can diminish the proportion of functional receptors to less than 5% of that of all insulin-binding receptors. The model predicts that cells bearing only functional receptors show progressively shortened half-lives of receptors, reflecting the receptor activation intensity. On the other hand, cells bearing both defective and functional receptors show stable receptors' half-lives (20-36% of the defective receptors' half-life). Simulation results suggest that reduced functional receptor proportions in NIDDM patients might reflect the imbalance between the activation of functional receptors and the slow catabolism of defective receptors.

Computer simulation of factors involved in the down-regulation of hormonal effects.

Down-regulation of hormonal effects is in the presented simulation related to the number of functional receptors and quantity of available hormonal stimulation. The former is in the model substituted with the quantity of stimulation able to produce a full down-regulation (Hs100) of target cells. The halftime (t1/2) of the hormonal effect recovery means the interval before the second hormonal stimulation can elicit half of the initial hormonal effect. Recovered hormonal effects are calculated after periods of two, three, four and five t1/2. The interval among hormonal stimulations varied from 1/2 to 5/2 of t1/2. Shorter than t1/2 intervals showed profound down-regulation even at weak hormonal stimulations (> 20% of Hs100). Stable levels of hormonal effects after frequent hormonal stimulations are found only in cases of very weak stimulations (< 10% of Hs100). Intervals equalling t1/2 among weak stimulations (< 20% Hs100) produced stable hormonal effects. Further prolongation among repeated stimulations improved stability of hormonal effects and even strong stimulations (> 60% of Hs100) were followed with only temporary profound down-regulation. Hormone-binding receptors unable to activate target cells are in the model described as defective. Probability for the target cell to be stimulated is in the model defined as P. Relative quantity of hormonal stimulation per target cell needed to achieve certain P is calculated for cells bearing different proportions of defective receptors. Activation following weak hormone stimulations is highly probable (> 90%) for cells bearing less than 30% of defective receptors. With the proportion of defective receptors over 60%, the activation probability after weak hormone stimulations is reduced (< 66%). Down-regulation can be considered as a modulator of hormonal effects. In prediabetic patients, intense stimulation of pancreatic insulin secretion by frequent or increased ingestion of carbohydrates might lead to sustained hyperinsulinemia. A substantial portion of the target tissue would become down-regulated with increased number of defective insulin receptors. Poor glucose utilization in the down-regulated tissue with resultant hyperglycemia would further stimulate insulin secretion until failure. Reduced tissue transportability of large hormone molecules, such as hGH, or proinsulin, can make their effects more pronounced in the perivascular space. Circulating hormone binding proteins or the basal membrane thickening in small vessels can further decrease the hormonal effects on more remote cells. Physical activity in IDDM patients increases insulin effect. Possible explanation is that increased muscle perfusion is making more insulin available to the less down-regulated skeletal muscle cells.

The role of gastric mast cells, enterochromaffin-like cells and parietal cells in the regulation of acid secretion.

The idea presented here is that, in gastric mucosa, two independent regulatory systems use the same transmitter: histamine molecules. The IgE/mast cell system is dispersed throughout the body, while the other regulates the gastric acid secretion. IgE molecules in gastric mucosa are attached to the mast cells. Mast cells release histamine molecules after the antigen has been recognized by IgE. These molecules normally act on vascular H1 receptors to promote extravasation and chemotaxy. Gastrin molecules are released from antral G cells to stimulate gastric acid secretion. Their influence on parietal cells is indirectly augmented by gastrin governed release of histamine molecules from enterochromaffin-like cells. These histamine molecules normally act on H2 receptors of parietal cells to promote gastric acid secretion. Chronic infection of gastric mucosa (i.e. with Helicobacter pylori), autoimmune disorders or repetitive mucosal exposure to the same antigen, can develop chronic inflammation of gastric mucosa. Gastric acid secretion is diminished with secondary hypergastrinemia and increased release of histamine from enterochromaffin-like cells in an attempt to stimulate the few remaining parietal cells. Hypothetically, increased concentrations of released histamine in gastric mucosa might activate the vascular H1 receptors with extravasation and aggravated inflammation. This can further decrease the number of active parietal cells, reduce gastric acid secretion and potentiate hypergastrinemia. In this hypothetical setting, H1 blockers might reduce the damage by abolishing the vascular reactions. The prolonged antigen load on gastric mucosa can promote production of specific IgE antibodies. Further exposures to the same antigen degranulate sensitized mucosal mast cells. Liberated histamine can produce extravasation through the vascular H1 receptor and, hypothetically, local hyperacidity through the parietal cell H2 receptors. The result would be hyperacidity and hypogastrinemia with possible ulcer disease. Some individuals are more predisposed to IgE production or have increased numbers of mast cells that might explain why only some people develop ulcer disease after H. pylori infection.

Mechanisms of prion diseases described as long-lasting disorders of the blood-brain barrier system.

Prison diseases can be described as disorders wherein circulating prion molecules of external origin intervene with the normal synthesis of similar molecules in the central nervous system. The hypothesis is that the endogenous prion-like molecules denote the blood-brain barrier discontinuity. In the case of barrier discontinuity, small numbers of hypothetical signal molecules enter circulation and attach to the receptor sites in the neighbouring blood vessels. The specific receptors of the cells in the blood vessels stimulated by endogenous prion-like molecules might initiate the repairing processes of the blood-brain barrier. In prion diseases, prion molecules from external sources are similar to endogenous prion-like molecules or to the hypothetical signal molecules described here. Large numbers of prion molecules enter circulation and initiate repairing processes in large brain areas causing the tissue damage. This damage leads to new barrier discontinuities that would provoke pathological process even when the exogenous prion molecules are no longer present in the circulation.