[Vasoconstrictive Therapies for Bleeding Esophageal Varices and their Mechanisms of Action]. / Wirkmechanismen der vasokonstriktiven Therapie der Osophagusvarizenblutung.

Variceal bleeding is one of the most dramatic complications in gastroenterology and has a high mortality rate. Early treatment with vasoactive drugs can save lives when skilled endoscopists are not immediately available. Vasoactive drugs like terlipressin, somatostatin or octreotide are not only indicated as first-choice emergency treatment, but they also increase the success rate of endoscopic treatments. Whereas the efficacy and mechanisms of action of terlipressin to arrest haemorrhage and to improve the disturbed cardiovascular situation of cirrhotic patients, including those with hepatorenal syndrome, are well documented, the efficacy and mechanisms of action of somatostatin and octreotide remain unclear and uncertain. On account of its vasoconstrictive effects on the dilated splanchnic blood vessels, terlipressin reduces blood flow into the portal vein and, thus, reduces portal venous pressure and blood flow through porto-systemic shunts. As a consequence, variceal bleeding is arrested, central and arterial hypovolaemia is corrected, and activation of the renin-angiotensin-aldosterone system as well as the sympathetic nervous system is reduced, leading to lower intrahepatic and intrarenal resistance. The result is an improvement of organ perfusion - including perfusion of the kidneys and the liver - as well as an improvement of the hyperdynamic cardiovascular situation and a better survival rate. Whereas terlipressin has been shown to stimulate kidney function and to prolong survival time in patients with bleeding esophageal varices as well as those with hepatorenal syndrome, no such promising effects were observed with somatostatin or octreotide.

Influence of the corticotropin releasing hormone (CRH) on the brain-blood barrier permeability in cerebral ischemia in rats.

The increase in the blood-brain barrier (BBB) permeability and a developing cerebral oedema due to the ischemic infarction appear a few hours, and intensify during a few days, after closing the carotid arteries. It fails to be clear, however, what causes the increase in the microvessels damage, and whether the damage is a secondary result of the vasoactive substances released by the neurones and glia cells damaged by the ischemia. CRH, which plays an essential role in integrative the nervous, endocrine, and immunological systems, has a positive effect on the decrease in the permeability of the BBB damaged by various physical and chemical factors. Therefore, the examination of the CRH role in the cerebral ischemia may prove useful for explaining the processes taking place in the foci of the cerebral infarction and their environment. The experiment was carried out on rats which, 20 minutes before closing of both internal carotid arteries, was administered 10 microg CRH to cerebrospinal fluid via cisterna magna of the brain. The BBB permeability was measured 30 minutes, 3 hours, 3 days, and 7 days after closing the arteries. The experiment has shown the CRH protective effect on the BBB and its consequent effect on the decrease in the BBB permeability which appears in the 3 hours after closing the arteries (p<0.05), and is high significant during the chronic phase of the cerebral ischemia (p<0.03). It can be thus concluded that CRH, by affecting directly the endothelium of the cerebral vessels, decreases the endothelial damage in the acute phase of the ischemia. The decrease is noted to be more significant in the chronic phase of the ischemia; such an effect can be attributed to CRH stimulating the hypothalamic-adrenal axis, and to the secondary activation of the mechanisms decreasing the BBB permeability.

Corticotropin releasing hormone (CRH) increases beta-endorphin (beta-end like) concentration in cerebrospinal fluid of rats with vasospasm following subarachnoid hemorrhage.

The chronic stage of vasospasm occurring several days after subarachnoid hemorrhage (SAH) is characterized by the development of histopathologic changes in cerebral arteries causing cerebral ischemia. Numerous experimental data indicate the involvement of immune mechanisms in the angiopathy caused by SAH. Endogenous opioids play also an important role in the ischemic lesions of the brain. Corticotropin releasing hormone (CRH) induces the release of beta-endorphin (beta-END) from hypothalamic neurons and also from mononuclear white blood cells. The function of CRH and beta-END in vasospasm following SAH and the interrelationship between neuroendocrine and immune changes requires further elucidation. In the present study we investigated the influence of CRH injected into cerebral cisterna magna (CM) of rats on beta-END-like level in cerebrospinal fluid (CSF) in acute and chronic phase of cerebral vasospasm following artificial SAH. Acutely CRH induced a significant rise of beta-END-like in CSF both in SAH and sham SAH rats. However, in rats subjected to SAH, a single injection of CRH caused a prolonged rise of 5-END in CSF, which was also seen 2 days after SAH, during the chronic phase of vasospasm. The obtained results indicate that CRH increases neuroendocrine changes induced by SAH, probably by an activation of immune cells involved in the patomechanism of chronic vasospasm.

Influence of hormones and hormone antagonists on sexual differentiation of the brain.

In summary, a number of studies have shown that not only estrogenic and androgenic steroids and their antagonists influence sexual differentiation of the mammalian brain but also drugs which stimulate or inhibit the adrenergic, the serotoninergic, or the cholinergic system in the developing brain. The present knowledge on the possible participation of neurotransmitter systems in sexual differentiation of the brain and their mode of interaction in this process perinatally with gonadal steroids is still rather limited. Sexual differentiation of the central nervous system is a complex integrated process, which relies on proper chronological and quantitative interactions of various endocrine and neuroendocrine mediators. Any disturbance of this delicate endogenous hormonal balance during ontogenetic development, e.g. by means of environmental influences, can result in permanent manifestation of anatomic and functional sexual deviations. A large number of man-made chemicals that have been released into the environment have the potential to disrupt the endocrine system of animals and humans. They do so because they mimick the effects of natural hormones or neurotransmitters by recognizing their binding sites, or they antagonize the effects of endogenous hormones or neurotransmitters by blocking their interaction with their physiological binding sites. Interaction of environmental endocrine disruptors with animals or humans during ontogeny may have deleterious effects on the differentiation of reproductive structures and functions, rendering the individuals in question permanently incapable to reproduce and, thus, endangering survival of the species.

Stimulation of rat pituitary tumoral cell proliferation in vitro by tetra- and pentagastrin.

The effects of the active gastrin fragments, penta- and tetragastrin on the incorporation of tritiated thymidine into the rat pituitary tumoral cells were investigated in vitro. The significant stimulation of 3H-thymidine incorporation was observed as an effect of the investigated substances. The putative role of gastrin as an autocrine growth factor active in pituitary tumorigenesis was discussed.

Influence of neurotransmitters on sexual differentiation of brain structure and function.

Newborn rats received daily subcutaneous treatment with compounds which influence serotoninergic, cholinergic, alpha-adrenergic and beta-adrenergic activity. In adulthood luteinizing hormone (LH) secretion pattern, female sexual behavior, and the volume of the sexually dimorphic nucleus of the preoptic are (SDN-POA) were determined. Postnatal administration of l-tryptophan increased the volume of the SDN-POA significantly when given alone or when given simultaneously with testosterone propionate (TP). Para-chlorophenyl-alanine (pCPA) also increased SDN-POA volume, but did not potentiate the stimulating influence of TP. Clonidine had no effect per se on SDN-POA development, but it significantly potentiated the effect of TP in females. Salbutamol increased SDN-POA volume in females and in males. Postnatal treatment of female rats with the alpha-adrenergic receptor antagonists prazosine and yohimbine or with the nicotin receptor antagonist mecamylamine had permanent potentiating effects on the pattern of LH secretion, whereas postnatal treatment with beta-adrenergic compounds reduced the LH-release response to gonadal steroids in adulthood. Postnatal treatment with clonidin or l-tryptophane inhibited differentiation of the capacity for lordosis behavior. Beta-receptor agonists postnatally had a potentiating effect on the capacity for lordosis behavior in female and male rats. Cholinergic stimulation postnatally inhibited differentiation of the capacity for lordosis behavior in female rats, but prevented the inhibitory effect of postnatal androgenization. There was no correlation between SDN-POA volume and any of the two functional parameters.

The pre- and postnatal influence of hormones and neurotransmitters on sexual differentiation of the mammalian hypothalamus.

A number of brain structures and a great number of brain functions have been shown to be sexually dimorphic. It has also been shown that development and differentiation of these structures and functions proceeds during a critical pre- and postnatal period of increased susceptibility, and is controlled by gonadal steroids and neurotransmitter substances. The brain of male and female mammals seems to be still undifferentiated before the period of increased susceptibility to gonadal steroids and neurotransmitters starts. Feminization of brain structure and functions, e.g., establishment of the cyclic LH-surge mechanism and the expression of lordosis behavior, seems to depend on the moderate interaction of estrogens with the developing nervous system. Defeminization and masculinization of brain functions seem to be established during interaction of the developing nervous system with androgens, which have to be converted, at least in part, into estrogens. Structural differentiation of the male brain, e.g., the sexually dimorphic nucleus of the preoptic area (SDN-POA), seems to be exclusively estrogen-dependent, during differentiation of male brain functions, however, estrogens may be supportive, rather than directive, to the primary action of androgens. The molecular mechanisms of sexual differentiation of the brain are not yet fully understood. It seems, however, that the priming action of gonadal steroids during the period of increased susceptibility is either mediated by neurotransmitters, or neurotransmitters modulate the priming action of gonadal steroids. In particular, the adrenergic, the serotoninergic, the cholinergic, and possibly the dopaminergic system were shown to have strong influences on sexual differentiation of brain structure and functions. In contrast to the great number of available studies on the influence of gonadal steroids on sexual differentiation of the brain, there are rather few studies available concerning the influence of neurotransmitter systems. The available results are partly contradictory, so that an interpretation must be done with caution and will leave plenty of room for speculation. Postnatal application of compounds which stimulate or inhibit adrenergic activity mainly affected the neural control of gonadotropin secretion, and had only minor influences on differentiation of behavior patterns. It seems, however, that adrenergic participation in the differentiation of the center for cyclic gonadotropin release is very complex and stimulatory and inhibitory components may operate simultaneously. Activation or inhibition of beta-adrenergic receptors during postnatal development was shown to impair the responsiveness of the center for cyclic gonadotropin release to gonadal steroids, and impairs the expression of ejaculatory behavior in male rats.(ABSTRACT TRUNCATED AT 400 WORDS)

Postnatal treatment of rats with the beta 2-adrenergic agonist salbutamol influences the volume of the sexually dimorphic nucleus in the preoptic area.

Sexual differentiation of the brain seems to be influenced by postnatal interaction of gonadal steroids with neurotransmitter systems, in particular the adrenergic system. Stimulation or inhibition of adrenergic receptors during early postnatal development had previously been shown to influence steroid-induced sexual differentiation of rat brain function. In the present study newborn male and female rats were treated daily for 5 days with salbutamol, a specific beta 2-receptor agonist, or with alprenolol, a beta-receptor antagonist and the volume of the sexually dimorphic nucleus of the preoptic area (SDN-POA) was examined in adulthood. This nucleus, one of the most striking sex differences in brain anatomy, is several-fold larger in male than in female rats. Postnatal treatment with salbutamol increased SDN-POA volume in female and in male rats. The effect was particularly striking in males, because any previous pre- and/or postnatal treatment of male rats with large amounts of gonadal steroids had been unable to increase the volume of the SDN-POA above normal. The beta-receptor antagonist alprenolol had no effect on SDN-POA differentiation. The results indicate that beta 2-adrenergic stimulation influences development and differentiation of the SDN-POA.

Postnatal treatment of rats with beta-adrenergic agonists or antagonists influences differentiation of sexual brain functions.

Sexual differentiation of the brain seems to be influenced by postnatal interaction of gonadal steroids with neurotransmitter systems, in particular the adrenergic system. Stimulation or inhibition of alpha-adrenergic receptors during early postnatal development had previously been shown to influence steroid-induced sexual differentiation of brain functions. In the present study newborn male and female rats were treated either with salbutamol, a selective beta 2-adrenergic receptor agonist, isoprenaline, a general beta-adrenergic receptor agonist, or with alprenolol, a general beta-adrenergic receptor antagonist. In adulthood the female animals were ovariectomized and were tested for the capacity to show an LH-surge response and female sexual behaviour after priming with estradiol benzoate (EB) and progesterone (P). Male animals were tested for expression of male sexual behavior and, after gonadectomy and priming with EB + P, for the capacity to show female lordosis behavior. In summary, our results suggest that activation or inhibition of beta-adrenergic receptors during postnatal development permanently impairs the responsiveness of the center for cyclic gonadotropin release to gonadal steroids in female rats and impairs the expression of ejaculatory behavior in male rats. A slight stimulatory effect on the expression of female lordosis behavior was observed in male and female rats after postnatal activation of beta-adrenergic receptors.

Effect of growth hormone-releasing hormone on human peripheral blood leukocyte chemotaxis and migration in normal subjects.

The effect of synthetic human growth hormone-releasing hormone (GHRH) on chemotactic response and migration inhibition of human peripheral blood leukocytes has been studied. In the assay performed by using modified Nelson methods, significant inhibition of chemotactic response was observed at 10(-6)M-10(-8) M concentrations of GHRH. There is a strong negative correlation (r = -0.519; p less than 0.001) between the chemotactic response of peripheral blood leukocytes and the concentration of GHRH. In contrast, GHRH tested at the same concentration range was not active in the migration inhibition assay. This finding provides additional evidence for the neuroimmunomodulatory action of GHRH.

Some blood vessels in the rat median eminence are surrounded by a dense plexus of vasoactive intestinal polypeptide/peptide histidine isoleucine (VIP/PHI) immunoreactive nerves.

Using immunohistochemistry at the light and electron microscopic level some blood vessels along the median eminence were shown to be surrounded by dense networks of vasoactive intestinal polypeptide/peptide histidine isoleucine (VIP/PHI)-positive fibers. VIP and PHI released from these fibers may contribute to the elevated levels of these two peptides measured in portal blood as compared to peripheral blood by radioimmunoassay. VIP and PHI may also be important in the control of blood flow through the median eminence.

Postnatal treatment of rats with adrenergic receptor agonists or antagonists influences differentiation of sexual behavior.

The aim of the study was to investigate the possible role of the adrenergic system in development and differentiation of neural centers controlling sexual behavior in adulthood. For this purpose normal and androgenized female rats were treated with the alpha 1-receptor antagonist prazosin, the alpha 2-receptor agonist clonidine, or the alpha 2-receptor antagonist yohimbine-HCl throughout the first week of life. In adulthood all animals were ovariectomized and, after appropriate hormone-priming, they were tested for the capacity to display female and male sexual behavior patterns. Alteration of adrenergic transmission during the critical postnatal period for sexual differentiation of neural centers resulted in significant changes in the capacity to express female lordosis behavior in adulthood. In nonandrogenized animals clonidine significantly reduced the capacity for lordosis behavior. In androgenized animals clonidine had the opposite effect; it attenuated the inhibitory effect of testosterone propionate (TP) on differentiation of lordosis behavior. Prazosin, which was without effect in nonandrogenized animals, also attenuated the inhibitory effect of TP on differentiation of lordosis behavior. Yohimbine was without effect in androgenized and nonandrogenized animals. There was no influence of any of the adrenergic drugs on differentiation of male sexual behavior. In conclusion, differentiation of lordosis behavior seems to be mediated or modulated via adrenergic transmission. The defeminizing effect of testosterone postnatally on the differentiation of lordosis behavior seems to be expressed via alpha 1-adrenergic transmission, and diminished adrenergic activity during the postnatal period seems to protect the developing brain against this effect of testosterone.

Release of dynorphin-like immunoreactivity from rat adenohypophysis in vitro during inhibition of anterior pituitary hormone secretion from individual cell types.

LHRH has previously been found to be the only known hypothalamic releasing factor which can specifically stimulate the release of the opioid dynorphin and other proenkephalin B-derived peptides from the rat adenohypophysis in vitro. In the present study the mechanisms that regulate dynorphin release were further characterized. It was examined whether or not dynorphin release from the adenohypophysis in vitro is altered during inhibition of the secretion of various anterior pituitary hormones. Rat anterior pituitary quarters were incubated in vitro and hormone release into the incubation medium was measured by RIAs. Somatostatin, dopamine, T3, dexamethasone, and 5 alpha-dihydrotestosterone were used to inhibit the secretion of GH, PRL, TSH, ACTH/beta-endorphin, or LH/FSH, respectively. GH, PRL, or beta-endorphin release was inhibited without affecting the simultaneous release of dynorphin A-(1-13)-like immunoreactivity (Dyn A1-13-IR). Concentrations of T3, somatostatin, or dopamine which were effective in suppressing the evoked and/or basal release of TSH, GH, or PRL, respectively, produced no effect on Dyn A1-13-IR release caused by high potassium concentration (40 mM) or LHRH (500 pM). The LHRH-induced release of LH and FSH was inhibited by the glucocorticoid dexamethasone or the androgen 5 alpha-dihydrotestosterone. Under these conditions, Dyn A1-13-IR release was also reduced. However, whereas LH release was completely blocked by 5 alpha-dihydrotestosterone, FSH and Dyn A1-13-IR release was reduced only by 50%. The release of FSH and Dyn A1-13-IR in vitro from anterior pituitary glands taken from rats, castrated 3 weeks before, was enhanced to a similar extent (about 2.5-fold); the simultaneous enhancement of LH release was significantly (P less than 0.005) greater (about 5-fold). We conclude that the mechanisms which regulate the release and/or biosynthesis of dynorphin and other proenkephalin B-derived peptides of the adenohypophysis are similar to those of the gonadotropins but different from those of any other anterior pituitary hormone, and may be more closely related with FSH release than LH release. These data support the view that dynorphin of the normal rat adenohypophysis may be localized in at least a subpopulation of gonadotrophs.

Neonatal sex reversal of the brain and the urinary excretion of sex dependent proteins (SDP) in the rat.

In contrast to females adult male rats excrete a variety of low molecular weight sex dependent urinary proteins (SDP). Electrophoretic separation of these proteins yields at least 8 protein bands which are arranged in typical patterns. The present study was performed to investigate the effect of sexual differentiation, which can be influenced by neonatal hormone treatment, on production and excretion of the individual SDP-bands (I-VIII). Two major groups of rats were studied: one group was neonatally treated with testosterone propionate (TP, females) or cyproterone acetate (males). Another group of rats with or without neonatal TP-treatment were gonadectomized in adulthood and subsequently implanted with TP. The results demonstrated that SDP excretion is mainly related to the circulating plasma testosterone levels. The sexual differentiation of the brain, however, influences the quantity of SDP excreted which is especially evident for bands I and II. Neonatal cyproterone had influence on these two bands only. The results demonstrate that the hormonal mechanisms regulating the excretion of SDP varies in respect to the different protein bands. The functional role of sexual brain differentiation on the excretion of SDP and the detailed mechanisms by which the brain may control this excretion remain to be determined.

Effect of human growth hormone-releasing hormone on the release of dynorphin-like immunoreactivity, luteinizing hormone, and follicle-stimulating hormone from rat adenohypophysis in vitro.

The effect of GH-releasing hormone (GHRH) on the release of the endogenous opioid dynorphin from rat adenohypophysis was investigated in vitro. Rat anterior pituitary quarters were incubated in vitro, and hormone release into the incubation medium was measured by RIAs. Human pancreatic GHRH [hpGHRH-(1-44)] as well as human Leu27,Gly45-GHRH [GHRH-(1-45)] enhanced the secretion of dynorphin A1-13-like immunoreactivity (Dyn A1-13-IR) in a concentration-dependent manner. The concentrations of hpGHRH-(1-44) that stimulated the release of Dyn A1-13-IR were about 100-fold higher than those that enhanced GH secretion. GH release induced by hpGHRH-(1-44) was blocked by somatostatin (IC50, approximately 10 nM) without affecting hpGHRH-(1-44)-induced release of Dyn A1-13-IR. GH release was elicited by prostaglandin E2, while Dyn A1-13-IR secretion remained unchanged. At concentrations that enhanced Dyn A1-13-IR release, hpGHRH-(1-44) also elicited LH and FSH secretion. The LHRH antagonist D-pGlu1, D-Phe2,D-Trp3,6-LHRH blocked the secretion of Dyn A1-13-IR, LH, and FSH induced by hpGHRH-(1-44), whereas the LHRH antagonist did not influence the simultaneous GH release elicited by hpGHRH-(1-44). A possible direct effect of GHRH on the LHRH receptor was examined in radioligand binding studies using iodinated D-Ala6, des-Gly10-LHRH ethylamide (LHRH-A). The binding of [125I]iodo-LHRH-A to rat anterior pituitary membranes was completely displaced by hpGHRH-(1-44) and GHRH-(1-45). The deduced apparent dissociation constants were about 3 orders of magnitude higher than that of LHRH-A, but were close to those concentrations that enhanced Dyn A1-13-IR release. We conclude that GHRH-induced release of Dyn A1-13-IR is unrelated to GH release. High concentrations of GHRH may interact directly with LHRH receptors on gonadotrophs and thereby enhance the release of LH, FSH, and Dyn A1-13-IR.

Pre- and postnatal influence of an estrogen antagonist and an androgen antagonist on differentiation of the sexually dimorphic nucleus of the preoptic area in male and female rats.

The volume of the sexually dimorphic nucleus in the preoptic area (SDN-POA) of the rat brain is severalfold larger in adult male rats than in adult females. This sex difference in brain structure was previously shown to develop under the influence of androgenic and estrogenic hormones during the perinatal period. We tried to clarify the differential role played by androgens and estrogens during development and differentiation of the SDN-POA by treating male and female rats during an extended pre- and postnatal period either with the estrogen antagonist tamoxifen or with the androgen antagonist cyproterone acetate. Treatment with tamoxifen did not alter serum levels of testosterone in male rats during the perinatal period, but it inhibited development and differentiation of the SDN-POA. Pre- and postnatal treatment of male rats with cyproterone acetate resulted in female phenotypic appearance, but it had no influence on differentiation of the SDN-POA. Perinatal treatment of female rats with tamoxifen resulted in permanent anovulatory sterility, but did not influence SDN-POA differentiation. Treatment of female rats with cyproterone acetate had no influence on SDN-POA differentiation or on the capacity to ovulate. Since pre- and postnatal treatment of male rats with cyproterone acetate is known from previous studies to femenize sexual behavior patterns and to retain the mode for cyclic gonadotropin release, and since the same treatment did not influence differentiation of the SDN-POA in the present study, it may be concluded that the SDN-POA is not directly involved in the control of female sexual behavior and in the control of the gonadotropic hormone release pattern.(ABSTRACT TRUNCATED AT 250 WORDS)