Ticking off diagnoses of abdominal pain: early neuroborreliosis with radiculopathy.

Lyme disease (LD) is the most common tick-borne illness. The diagnosis of LD is difficult because of the great variation in clinical manifestations. Although abdominal pain is generally not considered a sign of LD, in this case report we describe a patient with unexplained severe abdominal pain that eventually turned out to be LD due to radiculopathy. Since the incidence of LD is rising it is important to realise that severe abdominal pain could be the first clinical manifestation of early neuroborreliosis.

Predictors of quality of life in a long-term followup study in panic disorder patients after a clinical drug trial.

In a prospective 4 year followup study, 423 panic disorder patients participated in one of two international multicenter drug trials. They were to be reinterviewed 4 years after leaving the trials; 367 (86.8%) interviews were completed. At followup, 3 of 5 patients still suffered from at least occasional panic attacks, and 2 of 5 were still agoraphobic, but only about 20 percent of the patients were still disabled. The only baseline variables that predicted disabilities at followup were the disability measures at baseline themselves. Neither panic attack frequency nor phobic avoidance at baseline predicted disability at followup. Because of the lack of association between the presence of symptoms and of social disabilities, future clinical trials and other clinical and epidemiological studies should use independent symptom measures and quality-of-life measures simultaneously.

Long-term follow-up after a drug trial for panic disorder.

BACKGROUND: This study investigates the naturalistic course of panic disorder over four years and attempts to identify predictors for outcome. METHOD: 423 DSM-III-R panic disorder patients who had taken part in an international multicentre drug trial were selected for follow-up; we were able to re-interview 367 (87%). For panic attacks, phobic avoidance and disabilities the same rating scales were administered as had been used for the clinical trials. RESULTS: While 61% of all patients experienced at least occasional panic attacks at follow-up, few suffered from serious phobic avoidance (16.7%) or serious disabilities (work 7.9%); family 8.7%; social 13.9%). Panic attack frequency at baseline, original trial medication and continuous use of psychotropic medication during follow-up are not related to outcome, whereas longer duration of illness and more severe phobic avoidance at baseline are unfavourable. CONCLUSION: The course of panic disorder is not uniform. Since long duration of illness and severe phobic avoidance at baseline are predictors for an unfavourable outcome, more rigorous efforts should be undertaken to detect and treat panic disorder at an early stage.

Renal metabolism of the beta-subunit of human choriogonadotropin in the rat.

We analyzed the immunoreactive renal metabolites of the beta-subunit moieties of unlabeled highly purified hCG, hCG beta, and desialylated hCG (as-hCG) in rats by RIA and Sephadex G-100 chromatography. Infusions of hCG beta, as-hCG, or intact hCG resulted in accumulation in the kidney of a large quantity of small mol wt peptides lacking the immunological determinants of the carboxy-terminal peptide (CTP) of the beta-subunit. In the case of as-hCG, renal accumulation of these beta-core fragments was greatly enhanced when as-hCG binding to hepatic galactose receptors was inhibited by infusion of as-fetuin. The beta-core fragments in kidney had the same immunological and G-100 chromatographic characteristics as beta-core fragments in liver, suggesting similar intracellular catabolic mechanisms in these tissues. The kinetics of beta-core fragment turnover in kidney were studied after injection of hCG beta, which is cleared from the circulation within 1 h. Loss of beta CTP immunoreactivity was the initial event in hCB beta catabolism by the kidney; most of this process occurred between 7 and 30 min after injection. This was followed by a gradual reduction of the size of accumulated hCG beta metabolites over the next 60 min. The beta-core fragments that accumulated had a Kav of approximately 0.57 and a very slow degradation rate over the next 5 h (half-life greater than 6 h). Chromatographic analysis of urine obtained 6 h after beginning a continuous infusion of hCG, hCG beta, or as-hCG displayed in each case a major peak corresponding to the infused molecule, apparently intact, and a minor peak of beta CTP immunoreactivity of small mol wt. Relative to the beta CTP fragments apparent in urine, there were few beta-core fragments. These data indicate that separate fates exist for immunoreactive fragments generated by hCG beta metabolism in the rat kidney. One appears to be intracellular and similar to the liver pathway of as-hCG degradation in that it leads to the formation of long-lived beta-core fragments. The other takes place within ready access to the urinary compartment and leads to the accumulation in urine of beta-CTP fragments.

Effect of physical conditioning on measures of thyroid hormone action.

Serum thyroid function tests (T4, T3, rT3 and TSH levels) and measures of peripheral thyroid hormone action (serum dopamine-beta-hydroxylase activity (DBH) and sex hormone binding globulin (SHBG] were determined in 6 women before and one month after initiating an aerobic physical conditioning program. The same measurements were made in a control group of 6 women who did not increase their activity during this time. In physically conditioned subjects, the resting heart rate decreased from 65.1 +/- 3.9 (mean +/- SE) at baseline to 58.0 +/- 2.9 beats per minute after one month (P less than 0.025), indicating an appreciable state of physical conditioning was achieved. However, there were no statistically significant changes in thyroid function test, serum DBH or SHBG levels in either the physically conditioned or the control group. These data indicate that being physically conditioned has a negligible effect on thyroid status.

Inheritance of adrenal phenylethanolamine N-methyltransferase activity in the rat.

Phenylethanolamine N-methyltransferase (PNMT) is the enzyme that catalyzes the S-adenosyl-L-methionine-dependent methylation of (-)norepinephrine to (-)epinephrine in the adrenal medulla. Adrenal PNMT activity is markedly different in two highly inbred rat strains; enzyme activity in the F344 strain is more than fivefold greater than that in the Buf strain. Initial characterization of the enzyme in the two inbred strains reveals evidence for catalytic and structural differences, as reflected in dissimilar Km values for the cosubstrate (S-adenosyl-L-methionine) and prominent differences in thermal inactivation curves. To assess adrenal PNMT activity in an F344 X Buf pedigree, we employed a statistical procedure to test for one- and two-locus hypotheses in the presence of within-class correlations due to cage or litter effects. The PNMT data in the pedigree are best accounted for by segregation at a simple major locus superimposed upon a polygenic background; data obtained from the biochemical studies suggest that the major locus is a structural gene locus.

Evidence that desialylation and uptake by hepatic receptors for galactose-terminated glycoproteins are immaterial to the metabolism of human choriogonadotropin in the rat.

It is widely known that removal of sialic acid from the carbohydrate chains of glycoproteins in vitro drastically reduces their survival time in the circulation; however, it is not known whether desialylation plays a significant role in the metabolism of sialylated serum glycoproteins in vivo. We have studied the metabolism of hCG and desialylated hCG (as-hCG) in rat serum and liver in vivo to assess this putative metabolic pathway for glycoprotein hormones. A single injection of as-hCG into rats was followed by its rapid removal from the circulation, principally by the liver, and its degradation into fragments of the hCG beta-subunit that lacked the carboxy-terminal peptide antigenic determinant. Continuous infusion of desialylated fetuin (as-fetuin) at a high rate along with as-hCG dramatically reduced accumulation of the beta-subunit fragments in liver and resulted in increased serum levels of as-hCG. Consequently, the MCR of as-hCG was reduced from 301 +/- 10.3 ml/h (mean +/- SE) to 13.4 +/- 1.15 ml/h by infusion of as-fetuin, which is known to compete for hepatic receptors for galactose-terminated glycoproteins. In contrast, coinfusion of as-fetuin with hCG did not influence the MCR of hCG. Furthermore, there was no serum accumulation of hCG desialylated in its hCG beta carboxy-terminal portion, with or without as-fetuin, and the quantity and pattern of immunoreactive hCG products in liver homogenate were not affected by coinfusion of as-fetuin with hCG. Thus, blockade of hepatic receptors for galactose-terminated glycoproteins did not impede hCG turnover in the circulation, impair hepatic catabolism of hCG, or lead to the accumulation of desialylated products of hCG in plasma. These data indicate that in the rat, there is negligible catabolism of glycoproteins, such as hCG, by a pathway that involves peripheral desialylation and subsequent hepatic uptake via receptors for galactose-terminated glycoproteins.

Assessment of the functional role of brain adrenergic neurons: chronic effects of phenylethanolamine N-methyltransferase inhibitors and alpha adrenergic receptor antagonists on brain norepinephrine metabolism.

The potential role of brain adrenergic neurons in regulating noradrenergic neuronal metabolism was assessed using inhibitors of phenylethanolamine N-methyltransferase (PNMT), the enzyme responsible for epinephrine production. Two centrally active PNMT inhibitors (SK&F 64139 and LY134046) were administered over a 6-day treatment period to cause prolonged reductions in epinephrine formation. In brain regions containing endogenous epinephrine (medulla-pons and hypothalamus), chronic treatment with PNMT inhibitors produced: 1) reductions of epinephrine content, 2) elevation of tyrosine hydroxylase activity and 3) elevation of alpha-1 and particularly alpha-2 adrenergic receptor radioligand binding sites; neither norepinephrine turnover nor beta adrenergic receptor binding was affected. In brain regions devoid of endogenous epinephrine (cerebellum, frontal cortex and hippocampus), chronic treatment with PNMT inhibitors produced 1) a variable increase in tyrosine hydroxylase activity (cerebellum only) and 2) a reduction in norepinephrine turnover; neither alpha or beta adrenergic receptor binding was altered. A PNMT inhibitor failing to cross the blood-brain barrier, SK&F 29661, and an alpha-1 adrenoceptor antagonist, prazosin, had no effect on brain catecholamine metabolism. High doses of an alpha-2 adrenoceptor antagonist, yohimbine, increased medulla-pons tyrosine hydroxylase activity but also resulted in prominent reductions in norepinephrine content in all brain regions. The results suggest that prolonged reductions in endogenous brain epinephrine formation produce unique effects on brain norepinephrine function; these effects are regionally distinctive and are qualitatively different from the effects seen with chronic alpha-1 or alpha-2 adrenergic receptor blockade. These data are consistent with regulation of brainstem norepinephrine-containing cell bodies by endogenous adrenergic systems, probably via medullary-pontine alpha-2 adrenergic receptors.

Binding of the imidazoline UK-14, 304, a putative full alpha 2-adrenoceptor agonist, to rat cerebral cortex membranes.

The aryl imidazoline compound UK-14, 304 (5-bromo-6-[2-imidazolin-2-yl-amino]-quinoxaline) is a potent and selective alpha 2-adrenoceptor agonist with full intrinsic activity, unlike other imidazolines. We examined the characteristics of high specific activity (84 Ci/mmol) [3H]UK-14, 304 binding to rat cerebral cortex membranes. [3H]UK-14, 304 specific binding was enhanced by Mn2+ ion, and associated and dissociated moderately rapidly at 25 degrees C. Norepinephrine-displaceable binding was saturable and monophasic, with a KD of 1.4 nM, in agreement with rate and competition experiments, and a Bmax of 200 fmol/mg protein. Competition studies revealed that binding was alpha 2-adrenoceptor-specific, with yohimbine being 12 times more potent than prazosin. [3H]UK-14, 304 appeared to label predominantly the R(H) state of the brain alpha 2-adrenoceptor, as judged by the high affinity of catecholamine and imidazoline agonists (IC50, 1-13 nM), and the relatively low affinity of yohimbine and rauwolscine (IC50, 100-300 nM), at the binding site. [3H]UK-14, 304 compares favorably with other alpha 2-adrenoceptor ligands because of its high affinity and specific activity.

Serum dopamine-beta-hydroxylase activity in depression and anxiety.

Three studies were done to determine whether serum dopamine-beta-hydroxylase (DBH) activity is affected by the symptoms of depression or anxiety. In the population-screening study, serum DBH activity was measured in a heterogeneous sample of 548 medical, surgical, and psychiatric outpatients. No association was found between serum DBH activity and scores on either the Zung Self-rating Depression Scale or the Taylor Manifest Anxiety Scale. In the longitudinal depression study, enzyme activity was measured in 14 patients with major depressive illness treated with imipramine. Serum DBH activity remained unchanged throughout treatment whether or not the patient recovered from the depressive illness. Furthermore, there was no association between enzyme activity and steady state antidepressant plasma levels. In the longitudinal anxiety study, evaluation of 45 anxious outpatients in a placebo-controlled double-blind evaluation of two benzodiazepines (diazepam and alprazolam) indicated that serum DBH activity failed to reflect either state changes in anxiety or pharmacological variables. These results are reviewed with respect to current knowledge regarding neuronal release and extraneuronal disposal of circulating DBH.

Brain epinephrine systems: detailed comparison of adrenergic and noradrenergic metabolism, receptor number and in vitro regulation, in two inbred rat strains.

Epinephrine content and PNMT activity in medulla pons and hypothalamus of F344 inbred rats is from 3- to 8-fold higher than that of Buf inbred rats. These strain-dependent differences in brain adrenergic neurons are reciprocally related to altered alpha 1- adn alpha 2-adrenergic receptor density in PNMT-containing brain regions. Radioligand binding indices related to alpha 2-receptor function reveal that receptors may be 'desensitized' as well as 'down-regulated' in the strain with high PNMT activity (F344), and may be 'supersensitive' as well as 'up-regulated' in the strain with low PNMT activity (Buf). The association between epinephrine-containing neurons and alpha-adrenergic receptor regulation appears specific, since alpha-adrenergic receptor density and regulation in brain regions devoid of PNMT and epinephrine is similar in F344 and Buf rats. While noradrenergic metabolism in F344 rats is greater than that in Buf rats, this difference is generalized throughout the brain and, thus, bears no apparent relationship to the localized alterations in alpha-adrenergic receptor density. Moreover, beta-adrenergic receptor density in the 2 strains is similar in all brain regions. These data suggest that a significant proportion of alpha-adrenergic receptors in medulla-pons and hypothalamus are intimately related to and regulated by epinephrine-containing nerve endings.

Catecholamine-synthesizing enzymes in paraganglia of aged Fischer-344 rats. Immunohistochemistry and fluorescence microscopy.

The catecholamine-synthesizing enzymes, tyrosine hydroxylase, dopamine-beta-hydroxylase and phenylethanolamine-N-methyltransferase were examined by immunohistochemistry in hypertrophied paraganglia of aged male Fischer-344 rats. All paraganglionic cells reacted with antibodies against tyrosine hydroxylase. Dopamine beta-hydroxylase was identified in most paraganglionic cells, indicating that they synthesized norepinephrine. A variable number of paraganglia were positive for phenylethanolamine-N-methyltransferase, which suggested that they synthesized epinephrine. The formaldehyde-induced fluorescence method demonstrated greenish-yellow fluorescence or yellowish-brown fluorescence. The intensity of the fluorescence was in the same range as in adrenal medullary cells. The observations indicate that paraganglia are capable of synthesizing epinephrine.

Strain differences in rat brain epinephrine synthesis: regulation of alpha-adrenergic receptor number by epinephrine.

Inbred tht strains Fischer 344 (F344) and Buffalo (BUF) differ in serveral physiological and behavioral measures. It was found that the activity of adrenomedullary and regional brain phenylethanolamine N-methyltransferase is at least four times higher in F344 rats than in BUF rats; these strain-dependent differences corresponded directly with the epinephrine content of the medulla-pons and hypothalamus. Conversely, alpha-adrenergic receptor density in brain regions containing phenylethanolamine N-methyltransferase is two to three times lower in F344 rats than in BUF rats; alpha-receptors in frontal cortex (a brain region lacking phenylethanolamine N-methyltransferase activity and epinephrine) are similar in both strains. These findings suggest that strain-dependent differences in alpha-receptors are regulated by inherited differences in presynaptic adrenergic neuronal function in different brain regions.

Phenylethanolamine N-methyltransferase: notes on its purification from bovine adrenal medulla and separation from protein carboxymethyltransferase.

Standard procedures for the purification of phenylethanolamine N-methyltransferase were modified by the addition of an affinity chromatography step utilizing immobilized S-adenosyl-L-homocysteine and by use of preparative isoelectric focusing. Enzyme derived from bovine adrenal medullae was bound to S-adenosyl-L-homocysteine agarose, and could be eluted with 0.1 M NaCl. Concentrations of S-adenosyl-L-methionine as high as 10 mM were ineffective in eluting the enzyme. Preparative isoelectric focusing of bovine phenylethanolamine N-methyltransferase showed a single peak with the pI = 4.95. The potential use of immobilized S-adenosyl-L-homocysteine in the differential separation of phenylethanolamine N-methyltransferase from other methyltransferase enzymes is discussed.

Metabolic clearance rate of dopamine beta-hydroxylase in the rat.

The metabolic clearance rate (MCR) of both bovine and rat dopamine beta-hydroxylase (DBH) preparations was measured using two complementary procedures, pulse-dose injection and constant infusion of enzyme into the rat circulation. Rats that received injections of DBH activity had plasma DBH activity levels similar to those of controls by 24 hr after a pulse dose of rat DBH. The DBH MCR computed by stochastic analysis of the disappearance curve of injected DBH activity was about 1.0 ml/hr/100 g body weight; the mean transit time of DBH was about 8 hr. The disappearance curve of heterologous enzyme (bovine DBH) was more rapid than that of the rat, yielding an MCR of about 8 ml/hr/100 g body weight. MCR values obtained with the constant-infusion technique were similar to those obtained with the pulse-dose technique. These kinetic parameters are consistent with the time frame for altered plasma DBH activity observed with pharmacological and endocrinological factors. These data support the conclusion that plasma DBH turnover time is measured in hours, not days.

Regulation and inheritance of dopamine-beta-hydroxylase.

Dopamine-beta-hydroxylase (DBH) is unique among the catecholamine biosynthetic enzymes in that release from sympathoadrenal cells during neurotransmission is an integral part of the enzyme's physiology. Because of this unique attribute, the metabolic pathways regulating DBH cannot depend solely upon intraneuronal processes. This manuscript summarizes evidence relating to the regulation of DBH metabolism in the rat. Levels of DBH in the circulation, which derive from release of sympathoadrenal cellular enzyme stores, are genetically determined; even though inherited, circulating DBH levels bear no apparent consistent relationship to cellular enzyme levels or to sympathoadrenal function. These findings suggest that processes regulating neuronal release of DBH are separate from other processes regulating disposal of the circulating enzyme. We have evaluated the circulating DBH disposal pathways by standard metabolic techniques. Our data strongly suggest that clearance of DBH from the circulatory compartment is a main, and perhaps the primary, disposal mechanism for cellular enzyme stores.

Circulating dopamine-beta-hydroxylase in the rat: importance of altered disposal pathways in experimental diabetes.

Circulatory dopamine-beta-hydroxylase (DBH) activity was increased as much as 6-fold in rats with streptozotocin-induced diabetes mellitus. The increased enzymatic activity correlated with increased DBH protein as assessed by neutralization with homologous antiserum. The high levels of circulating DBH activity induced by streptozotocin was associated with a markedly slowed disappearance of enzyme activity after the i.v. injection of exogenous bovine DBH or exogenous rat DBH. Treatment of streptozotocin-treated rats with insulin prevented the increase in circulating DBH activity and reduced the initial half-time of disappearance of bovine DBH in a dose-related manner; the correlation between the initial half-time of disappearance of the bovine enzyme and the circulating DBH activity level was strongly positive. These results indicate that a reduction in the metabolic clearance rate of circulating DBH is a major factor accounting for the increase in serum DBH activity in the streptozotocin-diabetic rat.

The inverse relationship between serum dopamine-beta-hydroxylase activity and thyroid function.

Serum dopamine-beta-hydroxylase (DBH) activity is inversely related to thyroid status in both humans and rats. The low level of serum DBH activity in hyperthyroid rats is accompanied by a rapid rate of disappearance of enzyme activity after the injection of exogenous bovine DBH. Conversely, the high level of serum DBH activity in hypothyroid rats is accompanied by a slow rate of exogenous DBH disappearance. These results suggest that the extraneuronal disposal pathway for DBH is an important factor in the regulation of the level of DBH activity in altered thyroid function in both humans and rats.