Exendin-4 differentially modulates essential functions of human dermal fibroblasts under normoglycemic and hyperglycemic conditions.

Evidence that exendin-4, a glucagon-like peptide-1 analog, might be used to treat poorly healing wounds under diabetic and nondiabetic conditions has gained increasing interest. Little is known, however, about the effects of the drug on the production by dermal fibroblasts of key extracellular matrix and regulatory compounds. Therefore, we used human skin fibroblasts cultured in normo- (1 g/l = 5.6 mmol/l glucose) or hyperglycemic (4.5 g/l = 25 mmol/l glucose) culture medium to test the effects of exendin-4 (0 - 100 nmol/l) on fibroblast functions crucial for the wound healing process. Exendin-4 increased the proliferative and metabolic activities, as measured by the BrdU (bromodeoxyuridine) and MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assays, respectively, of fibroblasts cultured in normoglycemic medium. Under hyperglycemic conditions, the drug had no effect on proliferation and reduced metabolic fibroblast activity. Exendin-4 decreased metalloproteinase-9 (MMP-9) secretion in the normoglycemic milieu only and increased tissue inhibitor of metalloproteinase-1 (TIMP-1) concentration in fibroblast colonies under both normo- and hyperglycemic experimental conditions. Exendin-4 increased the fibroblast growth factor-1 (FGF-1) concentration in cell colonies maintained in the normoglycemic milieu but decreased FGF-1 release when fibroblasts were grown in hyperglycemic medium. High glucose caused lactic dehydrogenase (LDH) leakage when compared with normoglycemic conditions, and exendin-4 was not able to prevent this effect, although it reduced LDH release from fibroblasts cultured in normoglycemic medium. Finally, exendin-4 increased glycosaminoglycan (GAG) content under both experimental conditions. Our results indicate that exendin-4 effects on the production of the extracellular matrix and regulatory proteins differ in human skin fibroblasts exposed to either normal or high glucose. In general, the beneficial effects of the drug, which may be important for the improvement of wound healing, are more pronounced under normoglycemic conditions, thus indicating that hyperglycemia attenuates the positive effects of exendin-4 on fibroblasts.

The inhibitory effect of combination treatment with leptin and cannabinoid CB1 receptor agonist on food intake and body weight gain is mediated by serotonin 1B and 2C receptors.

Previous studies reported that the co-injection of leptin and cannabinoid CB1 receptor antagonists reduces food intake and body weight in rats, and this effect is more profound than that induced by these compounds individually. Additionally, serotonin mediates the effects of numerous anorectic drugs. To investigate whether serotonin interacts with leptin and endocannabinoids to affect food intake and body weight, we administered 5-hydroxytryptamine(HT)1B and 5-hydroxytryptamine(HT)2C serotonin receptor antagonists (3 mg/kg GR 127935 and 0.5 mg/kg SB 242084, respectively) to male Wistar rats treated simultaneously with leptin (100 µg/kg) and the CB1 receptor inverse agonist AM 251 (1 mg/kg) for 3 days. In accordance with previous findings, the co-injection of leptin and AM 251, but not the individual injection of each drug, resulted in a significant decrease in food intake and body weight gain. Blockade of the 5-HT1B and 5-HT2C receptors completely abolished the leptin- and AM 251-induced anorectic and body-weight-reducing effects. These results suggest that serotonin mediates the leptin- and AM 251-dependent regulation of feeding behavior in rats via the 5-HT1B and 5-HT2C receptors.

The effects of leptin in combination with a cannabinoid receptor 1 antagonist, AM 251, or cannabidiol on food intake and body weight in rats fed a high-fat or a free-choice high sugar diet.

High intake of fats and sugars has prompted a rapid growth in the number of obese individuals worldwide. To further investigate whether simultaneous pharmacological intervention in the leptin and cannabinoid system might change food and water intake, preferences for palatable foods, and body weight, we have examined the effects of concomitant intraperitoneal administration of leptin and AM 251, a cannabinoid 1 (CB1) receptor antagonist, or cannabidiol (CBD), a plant cannabinoid, in rats maintained on either a high-fat (HF) diet (45% energy from fat) or free-choice (FC) diet consisting of high-sucrose and normal rat chow (83% and 61% energy from carbohydrates, respectively). Leptin at a dose of 100 µg/kg injected individually for 3 subsequent days to rats fed a HF diet reduced significantly the daily caloric intake and inhibited body weight gain. The hormone had no significant effects, however, on either caloric intake, body weight or food preferences in rats fed an FC diet. Co-injection of leptin and 1 mg/kg AM 251 resulted in a further significant decrease in HF diet intake and a profound reduction in body weight gain both in HF diet- and FC diet-fed rats. This drug combination, however, had no effect on the consumption of high-sucrose chow. In contrast, 3mg/kg of CBD co-injected with leptin did not modify leptin effects on food intake in rats maintained on an FC or HF diet. None of the drug combinations affected water consumption. It is concluded that the concomitant treatment with leptin and AM 251 attenuated markedly body weight gain in rats maintained on high-calorie diets rich in fat and carbohydrates but did not affect preferences for sweet food.

Combined stimulation of glucagon-like peptide-1 receptor and inhibition of cannabinoid CB1 receptor act synergistically to reduce food intake and body weight in the rat.

Pharmacological activation of the glucagon-like peptide-1 (GLP-1) receptor and inhibition of the cannabinoid CB1 receptor were found to reduce food intake and body weight in humans and animals. Since earlier studies revealed that endocannabinoids may interact with other neurotransmitters to affect feeding behavior, we have examined whether a stable GLP-1 agonist, exendin-4 and a CB1 receptor antagonist, AM 251, may reciprocally enhance their inhibitory effects on food consumption in the rat. Additionally, we have tested whether the blockade of the GLP-1 receptor by exendin (9-39) modifies AM 251-dependent effects on energy balance. In a dose-response study, male Wistar rats were injected intraperitoneally with either 1.5-6.0 µg/kg exendin-4, 0.5-2 mg/kg AM 251, 80-320 µg/kg exendin (9-39) or their vehicle and the daily food and water intake as well as body weight changes were monitored two days before and two days after the injection. Exendin-4 at a dose of 3.0 and 6.0 µg/kg and AM 251 at a dose 2 mg/kg decreased significantly 24-hour food intake and body weight. Therefore, in the next study, the effects of lower doses of exendin-4 (1.5 µg/kg) and AM 251 (1.0 mg/kg) administered alone or together on food consumption were compared. As opposed to being injected alone, the co-administration of the two resulted in a marked decrease in both daily food intake and body weight. Exendin (9-39) did not modify the suppressory effect of the highest AM 251 dose on food consumption. Apparently, the effect of AM 251 on the appetite is not mediated by GLP-1. The concomitant stimulation of GLP-1 receptor and blockade of CB1 receptor, however, may act synergistically to inhibit appetite in the rat.

Effects of peripheral or central GLP-1 receptor blockade on leptin-induced suppression of appetite.

Leptin and glucagon-like peptide-1 (GLP-1) were proved to act in concert to control the activity of feeding centres. Since leptin receptor was identified in the gut endocrine L cells and neurons producing GLP-1, we have checked whether GLP-1 mediates the effects of leptin on feeding and drinking behaviour. To this aim, an intraperitoneal or intracerebroventricular injection of exendin (9 - 39), a GLP-1 antagonist, (50 or 10 microg per rat, respectively) followed by leptin (100 or 5 microg per rat, respectively) was made and 24-hour food intake and body weight changes were measured. Previous injection of exendin (9-39) completely abolished the supressory effect of peripheral leptin on food intake and body weight gain. Moreover, exendin (9-39) significantly attenuated the effect of intracerebroventricular leptin on food but not water consumption. It is concluded that intact GLP-1 signalling is necessary to mediate the effect of leptin on food intake in the rat. Conversely, leptin seems to affect the thirst center function independently of GLP-1. Also, these findings produce further evidence for close interactions between long- and short-term factors regulating the activity of feeding centres.

Interactions between leptin and exendin-4, a glucagon-like peptide-1 agonist, in the regulation of food intake in the rat.

Leptin interplays with other peptides to control feeding behaviour in humans and animals. Using exendin-4, an agonist of glucagon-like peptide-1, we investigated whether leptin modifies its effect on food intake in the rat. In the first series, exendin-4 alone (0.1, 2 or 10 microg per rat), leptin alone (0.1, 2, 10 or 100 microg per rat) or exendin-4 and leptin together (0.1 + 0.1, 2 + 2, 10 + 10, or 2 + 100 microg per rat, respectively) were injected once intraperitoneally. In the second series animals were injected either with exendin-4 (2 microg) alone, leptin (10 microg) alone, or leptin (10 microg) + exendin-4 (2 microg) daily for 5 subsequent days. At the lowest dose used, leptin and exendin-4 injected once together, but not separately, reduced significantly a 24-hour food intake. When used in higher doses, however, leptin did not change the exendin-4-dependent suppressory effect on food consumption. No significant differences in food intake were seen between rats treated repeatedly with exendin-4 only and animals injected with both drugs. Hence, leptin and exendin-4 may act additively to inhibit appetite when present in low concentrations while, at high leptin doses, this effect is abolished. The lack of synergistic effects of exendin-4 and high leptin concentrations on food intake may explain, at least in part, mechanisms responsible for leptin resistance in subjects with hyperleptinaemia.

Effects of glucagon-like peptide-1 (7-36) amide on neurohypophysial hormone secretion induced by acute hyperosmotic challenge.

This study was designed to investigate possible effects of glucagon-like peptide-1 (7-36) amide on the vasopressin and oxytocin release induced by acute peripheral or central osmotic stimulation. In the first series of experiments, rats were injected intraperitoneally with the isotonic (0.15 M) or hypertonic (1.5 M) NaCl solution and then, intracerebroventricularly, with either 1 microg glucagon-like peptide-1 (7-36) amide dissolved in 5 microl of isotonic saline or with the vehicle only. In the second study, 1 microg glucagon-like peptide-1 (7-36) amide, dissolved in isotonic or hypertonic (0.6 M) saline, was injected into the cerebroventricular system. Control rats were treated with isotonic or hypertonic saline only. All the animals were decapitated 10 min after the intracerebroventricular injection. Glucagon-like peptide-1 (7-36) amide enhanced significantly the basal secretion of vasopressin and oxytocin. Moreover, this peptide increased additionally the release of both neurohypophysial hormones stimulated previously by peripheral osmotic challenge. On the other hand, the peptide increased the oxytocin but not vasopressin secretion brought about by an intracerebroventricular injection of hypertonic saline thus suggesting that the central osmotic stimulation decreases the sensitivity of vasopressin neurons to glucagon-like peptide-1 (7-36) amide. It is concluded that glucagon-like peptide-1 (7-36) amide may affect the secretory activity of the hypothalamo-neurohypophysial system under acute osmotic challenge.

Effects of glucagon-like peptide-1(7-36) amide on neurohypophysial and cardiovascular functions under hypo- or normotensive hypovolaemia in the rat.

To date, glucagon-like peptide 1(7-36) amide (tGLP-1) has been found to affect the neurohypophysial and cardiovascular functions in normotensive and normovolaemic rats. The aim of the present study was to investigate possible effects of tGLP-1 on the mean arterial blood pressure and the release of vasopressin and oxytocin under conditions of blood volume depletion in the rat. In the first series of experiments, the animals were injected i.p. with either 0.15 M saline or 30% polyethylene glycol (PEG). PEG caused an 18% reduction of blood volume 1 h after injection. No significant changes in the mean arterial blood pressure were found in either normo- or hypovolaemic rats during the experiment. tGLP-1 injected i.c.v. at a dose of 1 microg/5 microl 1 h after the i.p. injection increased similarly the arterial blood pressure in normo- and hypovolaemic rats. The plasma vasopressin/oxytocin concentrations were markedly elevated in hypovolaemic animals and tGLP-1 further augmented the release of both hormones. In the second study, hypovolaemia was induced by double blood withdrawal. The haemorrhage resulted in a marked decrease of the mean arterial blood pressure and in the elevated plasma vasopressin/oxytocin concentrations. tGLP-1 injected immediately after the second blood withdrawal increased the arterial blood pressure. In parallel, tGLP-1 enhanced significantly vasopressin and oxytocin secretion when compared with haemorrhaged, saline-injected rats. The results of this study indicate that tGLP-1 may affect the arterial blood pressure and the secretion of neurohypophysial hormones under pathological conditions brought about by blood volume depletion.

tGLP-1 and release of vasopressin and oxytocin from the isolated rat hypothalamo-neurohypophysial system: effects of a tGLP-1 receptor agonist and antagonist.

To date, glucagon-like peptide-1 (7-36) amide (tGLP-1) has been found to enhance the vasopressin and oxytocin secretion in vivo but not in vitro (i.e., when the isolated neurointermediate lobe of the pituitary was used for experiments). The goal of this study was to investigate whether tGLP-1 can influence the function of the hypothalamo-neurohypophysial complex in vitro. Also, the effect of a tGLP-1 agonist, exendin-4, and antagonist, exendin-(9-39), on the release of vasopressin/oxytocin from the isolated rat hypothalamo-neurohypophysial complex was tested. tGLP-1 enhanced the basal but not the potassium-stimulated release of vasopressin and oxytocin from the hypothalamo-neurohypophysial complex. On the other hand, tGLP-1 failed to affect the release of both hormones from the isolated neurointermediate lobe. The tGLP-1 agonist increased the secretion of oxytocin and vasopressin from the hypothalamo-neurohypophysial system whilst the tGLP-1 antagonist completely abolished the stimulatory effect of tGLP-1 on the secretion of both hormones. It is concluded that tGLP-1 affects the function of vasopressin- and oxytocinergic neurones through specific hypothalamic receptors.

Melatonin and the synthesis of vasopressin in pinealectomized male rats.

The pineal hormone, melatonin, is known to modify, under different experimental conditions, neurohypophysial hormone secretion in the rat. The aim of this study was to investigate the effect of melatonin on the vasopressin biosynthesis rate in the hypothalamus of either pinealectomized or sham-operated rats, using the colchicine method. To estimate whether colchicine affects the function of the neurohypophysis in these animals, the neurohypophysial and plasma vasopressin levels were also measured. The vasopressin synthesis rate was increased after pineal removal, when compared with sham-operated animals, and melatonin strongly inhibited the rise in the hormone synthesis due to pinealectomy. After pineal removal plasma vasopressin concentration was significantly elevated, and melatonin attenuated this effect. On the contrary, the neurohypophysial vasopressin content was significantly decreased after pinealectomy, but it was not further modified by melatonin.Thus, melatonin suppresses the synthesis and secretion of vasopressin in pinealectomized rats. The present results confirm our previous reports as to the inhibitory impact of the pineal on both vasopressin synthesis and release and suggest that melatonin may mediate the effect of the pineal gland on vasopressinergic neuron activity.

Effects of centrally or systemically injected glucagon-like peptide-1 (7-36) amide on release of neurohypophysial hormones and blood pressure in the rat.

The present study was designed to compare the effects of glucagon-like peptide-1 (7-36) amide (GLP-1) injected centrally or systemically in a dose range of 10-10000 ng on the vasopressin and oxytocin release as well as the blood pressure in the rat. The urethane-anaesthetised Wistar male and female rats were fitted with venous as well as arterial catheters and, in the second study, additionally with the intracerebroventricular cannula. The arterial blood pressure was monitored throughout the experiment. The plasma vasopressin/oxytocin concentrations were measured in blood samples taken 15 min before and 5, 15 and 30 min after the intravenous or intracerebroventricular GLP-1 injection. No gender-dependent differences were seen as to the GLP-1 effect on the blood pressure or the hormone release. GLP-1 administered centrally or systemically at low doses (10 or 100 ng) either showed a hypertensive or biphasic (an increase followed by a decrease in the blood pressure) effect. On the other hand, 1000 or 10000 ng GLP-1 caused a clear increase of the blood pressure regarding the way of injection. When injected systemically, GLP-1 increased the release of both neurohypophysial hormones. When injected centrally, however, GLP-1 either enhanced or, at low doses, significantly reduced the plasma vasopressin/oxytocin levels. The effect on the blood pressure seems to be independent of the possible pressor effect of endogenous vasopressin. It is concluded that GLP-1 may modulate the function of the hypothalamo-neurohypophysial system as well as the cardiovascular system through both the central and systemic mechanisms.

Luteinizing hormone-releasing hormone and oxytocin response to hyperosmotic stimulation: in vitro study.

It was shown previously that luteinizing hormone-releasing hormone (LHRH) affects the neurohypophysial oxytocin release in water-deprived rats. However, the detailed mechanisms by which LHRH modifies the oxytocin response to hyperosmotic stimulation have not been explained so far. Using the isolated hypothalamo-neurohypophysial explants obtained from euhydrated rats, the effect of LHRH on the oxytocin secretion was studied under conditions of direct osmotic (i.e., Na(+)- evoked) as well as nonosmotic (i.e., K(+)-evoked) stimulation. Additionally, the oxytocin response to LHRH was investigated using the explants obtained from animals drinking 2% saline for eight days (systemic, i. e., both direct and indirect, osmotic stimulation). LHRH significantly enhanced Na(+)- and K(+)-evoked oxytocin release from explants taken from rats drinking tap water, indicating that LHRH could affect the Na(+)/K(+)-dependent depolarization of perikarya of oxytocin neurones. In contrast, LHRH significantly diminished the K(+)-stimulated hormone release when the neurohypophysial complex was obtained from previously salt-loaded rats, suggesting that peripheral osmotic stimulation somehow modifies the sensitivity of oxytocinergic neurones to LHRH (possible mechanisms are discussed). It is concluded that LHRH may participate in the regulation of oxytocin secretion via both direct and indirect impact on magnocellular oxytocinergic neurones depending on the current functional status of the hypothalamo-neurohypophysial complex.

The pineal and oxytocin synthesis.

The aim of this study was to investigate the effect of pineal removal on oxytocin synthesis in the hypothalamus using the colchicine method. To this end, rats were injected intracerebroventricularly (i.c.v.) with colchicine solution (5 microg/5 microl) or normal saline and decapitated 20 h later. The animals were either pinealectomized or sham-operated two or eight weeks before i.c.v. injection. The oxytocin content in the hypothalamus was significantly higher in colchicine-treated rats whereas no significant differences were seen in the neurohypophysial hormone level between saline- or colchicine-injected animals. Thus, colchicine inhibited the hormonal transport but probably did not affect the function of the neurohypophysis. Two weeks after pinealectomy neither the oxytocin synthesis rate nor its neurohypophysial content were significantly different from control values. The oxytocin synthesis rate was increased markedly eight weeks after pineal removal. At that time, the neurohypophysial oxytocin content was reduced suggesting the increased secretion of the hormone. It is concluded that the pineal has an inhibitory impact on both oxytocin synthesis and release.

The effect of melatonin on vasopressin release under stress conditions in pinealectomized male rats.

The findings here reported showed that the response of vasopressinergic neurons to immobilization stress is augmented by melatonin. The effectiveness of melatonin in functional modification of these neurons' activity under conditions of stress changes after pineal removal.

Luteinizing hormone-releasing hormone and function of the magnocellular vasopressinergic system.

Mechanisms by which luteinizing hormone-releasing hormone (LHRH) affects vasopressin secretion were investigated using the isolated rat hypothalamo-neurohypophysial explants. LHRH in a concentration of 4 x 10(-7)M inhibited both the basal and K(+)-stimulated vasopressin release from explants isolated from euhydrated rats. When, however, the tissue was obtained from animals previously salt-loaded, the inhibitory effect of LHRH was completely abolished, thus implying a decrease in the sensitivity to LHRH. LHRH did not affect vasopressin secretion under conditions of generalized blockade of synaptic inputs by 15 mM MgSO(4), suggesting the indirect action of this neurohormone on the hypothalamic magnocellular system. It is concluded that LHRH may play the role of a neuromodulator of vasopressinergic neurones in the rat.

Effects of methylphenidate on oxytocin and vasopressin levels in pinealectomized rats during light-dark cycle.

Although previous reports have shown that methylphenidate (MPH), in addition to its known behavioral effect, can influence the hypothalamo-pituitary-adrenal axis by increasing the plasma ACTH, the pineal gland seems to be involved in neuroendocrinological processes too, e.g., in hypothalamic synthesis and release of oxytocin (OXY) and vasopressin (AVP). Therefore, a study was performed to measure the OXY and AVP content of the hypothalamus, neurohypophysis, and plasma after application of MPH in the morning and evening in pinealectomized (PE) as well as sham-operated control (SO) rats. Pinealectomy influenced both the daily pattern (reversed in the neurohypophysis) and the levels of OXY and AVP. Starting from this different situation, application of MPH produced diverse effects. Hypothalamus: PE, increase in both hormones in the morning and evening; SO, decrease in morning OXY level. Neurohypophysis: PE, increase in morning OXY level; SO, decrease in both hormones even though in the morning only. Plasma: PE, decrease in morning OXY concentration; SO, increase in both hormones in the morning and decrease in the evening. The present results indicate that MPH application influences the hypothalamo-neurohypophysial system. Furthermore, the hypothesis has been supported that this influence may be dependent on the circadian activity of the pineal gland as well.

The effects of melatonin on vasopressin secretion in vivo: interactions with acetylcholine and prostaglandins.

The pineal hormone melatonin influences the neurohypophysial hormone release from the isolated hypothalamus in vitro through the effect on the cholinergic pathways as well as the biosynthesis of prostaglandins. The aim of the present study was, therefore, to investigate the effects of melatonin (0.5, 1, or 5 ng) administered in vivo on the vasopressin and oxytocin release as well as to examine whether similar interactions between melatonin and acetylcholine or prostaglandins occur in vivo. In the initial study on the effect of melatonin male Sprague-Dawley rats were implanted under anaesthesia with an arterial and venous cannula. Melatonin in a dose of 0.5 ng injected intravenously had no effect on plasma vasopressin concentration. The higher dose of 1 ng caused a significant decrease in vasopressin release 10 min after injection, whereas 5 ng melatonin caused an increase in plasma hormone concentrations, the difference being significant 20 min after injection. No significant effects of melatonin on the oxytocin release was found. In the second study in which an I.C.V. cannula was additionally implanted, the cholinergic muscarinic receptor antagonist atropine (10 microg) injected I.C.V. abolished the melatonin-induced effects on plasma vasopressin level. On the other hand, a cyclo-oxygenase inhibitor ibuprofen (75 microg) injected I.C.V. blocked the vasopressin release induced by 5 ng melatonin and reversed the inhibitory effect of 1 ng melatonin. These results demonstrate that melatonin affects the neurosecretory function of the hypothalamo-neurohypophysial complex in vivo possibly via mechanisms involving cholinergic transmission and/or prostaglandin biosynthesis.

Luliberin inhibits the release of Oxytocin from hypothalamo-neurohypophysial system in dehydrated but not in euhydrated or haemorrhaged rats.

Rats euhydrated, dehydrated for two days or haemorrhaged were given intracerebroventricularly (i.c.v.) luteinizing hormone releasing hormone (LH-RH) in a daily dose of 100 ng dissolved in 10 microl of 0.9 % sodium chloride. In euhydrated rats, a single i.c.v. dose of LH-RH as well as the daily i.c.v. treatment with LH-RH for two days did not affect significantly either the plasma oxytocin concentrations or the hypothalamo-neurohypophysial oxytocin content. In animals dehydrated for two days and treated with LH-RH the increase in plasma oxytocin was almost suppressed and the depletion of neurohypophysial hormone content was significantly less marked. Luliberin treatment had no effect on the hypothalamo-neurohypophysial content of oxytocin as well as on plasma oxytocin concentration in haemorrhaged rats. We suggest that LH-RH may have a regulatory role in the hypothalamo-neurohypophysial oxytocinergic system, especially under hyperosmotic dehydration.

Inhibition of prostaglandin synthesis and the release of vasopressin and oxytocin from the rat neurohypophysis: in vitro studies.

The basal and K(+)-evoked release of vasopressin (VP) and oxytocin (OT) from the neurointermediate lobes in vitro was determined under conditions of indomethacin-induced inhibition of prostaglandin (PG) synthesis. The in vivo treatment with indomethacin (IM), administered to donor animals, did not modify the release of VP during resting conditions as well as during the potassium stimulation; on the contrary, both base-line and K(+)-evoked release of OT was significantly inhibited under such conditions. Incubation of neurointermediate lobes in a solution containing indomethacin resulted in an inhibition of VP and OT release both during resting conditions and during depolarization due to excess potassium.

Effect of a prostacyclin analogue on the vasopressin and oxytocin secretion in vitro.

Iloprost (ZK 36374; a stable prostacyclin analogue) increases basal as well as potassium-evoked vasopressin and oxytocin secretion from rat neurointermediate lobes in vitro. This finding suggests a possible regulatory role of endogenous prostacyclin in the release of neurohypophysial hormones.