Very high dose cyclophosphamide with imidazole carboximide and vincristine sulfate in the treatment of stage IV neuroblastoma

To address the problem of drug dosage as a limiting factor for successful chemotherapy, seven patients with Stage IV neuroblastoma were treated with very high dose cyclophosphamide with imidazole carboximide (DTIC) and vincristine sulfate in conjunction with intensive supportive care. None of the patients experienced a complete response. The major toxicity was myelosuppression, complicated by significant infections. Toxicity was significantly more severe in this study than in similar regimens using these three drugs at conventional doses. Although the number of patients in this study was small and most had received prior therapy, our data do not support the efficacy of very high dose cyclophosphamide in the treatment of Stage IV neuroblastoma.

Peptides as central regulators of feeding

During the past decade there has been an increased awareness of the role peptides play as neuromodulators. In this article we review the available data on peptides as central regulators of food ingestion. We stress the possible problems of non-specific effects. We stress that whereas many peptides decrease feeding after central injection, only two families of peptides have been shown to increase feeding after central injection. These are the opioid family and the pancreatic polypeptide-neuropeptide Y family. The putative role of corticotropin releasing factor as the mediator of norepinephrine and serotonin effects on feeding is discussed.

The kappa opioid receptor and food intake

Many studies have suggested a role of opioid receptors in the modulation of food intake. Several distinct classes of opioid receptors have been postulated. In an attempt to establish which opioid receptor(s) modulate feeding we studied the effect of the kappa agonist, bremazocine, on feeding and compared its effects to the preferential mu agonist, morphine, and the mixed kappa-sigma agonist, butorphanol and the kappa agonist, ethylketocyclazocine. Bremazocine increased feeding to the same extent as morphine and was less potent than the mixed agonist/antagonists. The bremazocine effect demonstrated a bell-shaped dose response curve. Daily administration of bremazocine or morphine enhances the effect on increasing food intake. However, this effect of daily injections on enhancing food intake is not present when animals receiving morphine are crossed over to bremazocine and vice versa. The bremazocine effect is enhanced by diprenorphine and not inhibited by naloxone. Low doses of the dopamine antagonist, haloperidol, enhance the bremazocine effect and higher doses inhibit it. Finally, using another kappa agonist, tifluadom, we showed that the effect on food intake is stereospecific. Our studies provided further evidence for a role for the kappa opioid receptor in feeding. However, they also suggest that more than one subpopulation of opioid receptors is involved in feeding modulation.

Naloxone induced suppression of feeding in tigers

Naloxone suppresses, but does not eliminate feeding in Siberian tigers. Naloxone administration paired with novel foods appeared to induce emesis.

Do calories, osmolality, or calcium determine gastric emptying?

To determine whether calories, osmolality, or calcium mediate gastric emptying we employed a standardized radioactive meal in 10 normal human volunteers. A variety of simple and complex sugars, medium-chain fatty acid (MCFA), pectin, and gluten were dissolved in water and ingested with the test meal. The studies were also performed with calcium chloride, EDTA, and an equimolar combination of these chemicals. Results of gastric emptying showed that incremental glucose produced an increase in emptying time with a tendency for emptying time to show a proportionally greater delay with increasing glucose concentrations. Fructose and polyhexose had similar effects to glucose. Pentoses (xylose and arabanose) markedly prolonged gastric emptying when compared with the same amount of glucose. The effect of sucrose and gluten on gastric emptying did not significantly differ from controls. Twenty-five grams MCFA had an effect similar to 50 g glucose. Pectin, a complex carbohydrate, produced a varied effect in different individuals. There was no obvious relationship between osmolality and gastric emptying. Calcium chloride and EDTA prolonged gastric emptying, but the equimolar combination gave values similar to controls. Our findings suggest 1) calories nor osmolality alone determine gastric emptying, 2) both calcium and calcium chelation with EDTA prolong gastric emptying, and 3) a specific food does not necessarily produce the same effect on gastric emptying in different individuals.

Environment modulates naloxone's suppressive effect on feeding in diabetic and non-diabetic rats

We evaluated the effect of environment on naloxone-induced suppression of feeding in streptozotocin rats and sham injected controls. Naloxone was administered to animals fasted for 24 hours and food intake was measured at 30, 60 and 120 minutes. Diabetic rats, in their home cages, were insensitive to naloxone's suppressive effect for the first 30 minutes and the 5 mg/kg dose suppressed feeding only at 120 minutes. In control rats, feeding was suppressed at 1 and 5 mg/kg naloxone during the first 30 minutes. In contrast, when animals were placed in novel plastic cages, control animals were insensitive to naloxone at all time points at doses as high as 5 mg/kg. In novel cages, diabetic rats responded to doses of 1 and 5 mg/kg during the first 30 minute period by lowering food intake. It should also be noted that basal food intake was suppressed (40-53%) when animals were placed in novel cages. These data suggest that stress of a novel environment alters the neuroregulatory system involved in inducing feeding. Lack of response of normal rats to naloxone's suppressive effect in a novel environment suggests that (1) a non-opioid feeding system operates under these conditions, or (2) opioid receptors are occupied as a result of the release of endogenous opioids due to stress. The opposite result observed in the diabetics indicates that glucose has a modulating effect on opioid effects.

Opioid modulation of ingestive behaviors in woodchucks and racoons

We have examined the effect on feeding of opioid blockade with naloxone in two species which demonstrate a marked seasonality in their feeding patterns, the racoon (Procyon lotor) and the woodchuck (Marmota monax). Naloxone suppressed food intake in the woodchuck which is a true hibernator. Naloxone failed to suppress food intake in the racoon and, in fact, enhanced intake of a preferred sucrose solution. In the racoon, ir-dynorphine concentrations were extremely high in the hypothalamus compared to the values obtained in rats and woodchucks. We suggest that possible explanations for the lack of responsiveness to opiates in racoons may be their extremely high daily food intake relatively to body mass when compared to woodchucks and rats and the high levels of ir-dynorphin may be sufficient to overcome the inhibitory effect of naloxone. These studies stress the occurrence of species diversity in the response to opioid antagonism.

The pineal gland and opiate-induced feeding

Opiate systems in the brain are thought to play a major, though not exclusive, role in the regulation of intake. The rough correspondence of feeding and pineal activity rhythms in the rat offers the possibility that the pineal may also modulate ingestive behavior. In these studies we measured the possibility that pineal manipulations would influence feeding responses to opiate agonists and the antagonist naloxone. Male rats received one of four treatments (or a corresponding control treatment): pinealectomy, removal of the superior cervical ganglia (SCG), transection of the optic nerves or chronic melatonin treatment (1 mg/kg daily). Pinealectomy and melatonin treatment reduced intake during the first half of the dark period, and removal of the SCG reduced intake during the second half of the light period. The most striking effect was seen after optic nerve transection, which reduced nocturnal and increased diurnal intake. Pinealectomy, but no other manipulation, caused a slight decrease in sensitivity to the inhibitory effects of naloxone on intake. None of the treatments affected daytime feeding responses to morphine, ketocyclazocine, or butorphanol. These results suggest that the pineal gland has a minimal role in modulating the opioid regulation of food intake.

Peptides and feeding

This report reviews the hypothesis that peptides play a role in appetite modulation, stressing that the available evidence is predominantly pharmacological and thus caution needs to be taken in assigning physiological significance at this time. Two peptide systems have been postulated--a peripheral satiety system, typified by the gastrointestinal hormone cholecystokinin and a central feeding system driven by the opioid peptides and neuropeptide Y. This review also discusses the putative role of peptides in the anorexia of aging, drinking elicited by feeding and as mediators of the autonomic effects seen in association with ventromedial hypothalamic lesions.

Neuropeptides and appetite: contribution of neuropharmacological modeling

It is now clear that a variety of neuropeptides interact with the more classically defined neurotransmitters to stimulate or inhibit feeding. An extensive peripheral peptide satiety system has been identified. Peptides involved in this system include cholecystokinin, bombesin, gastrin-releasing peptide, glucagon, somatostatin, and possibly thyrotropin-releasing hormone and calcitonin. Some of these peptides appear to inhibit feeding by activating ascending fibers in the vagus, whereas others exert their actions independent of the vagus. In addition, neuropeptides appear to play a role in producing the neuromodulatory effects of taste on appetite, and hormones from the endocrine system modulate neuropeptide effects on feeding. The central appetite regulatory system appears to be arranged in a cascade, with an interaction between dynorphin and dopamine producing a part of the feeding drive. This drive is held in check by a variety of neuropeptides including calcitonin, corticotropin-releasing factor, and bombesin. In turn, these peptides are modulated by a norepinephrine-alpha-aminobutyric acid (GABA) system. Neurotensin, serotonin, cyclohistidyl proline diketopiperazine, and the peripheral satiety system appear to modulate the norepinephrine-GABA disinhibitory system. By the judicious use of neuropharmacological modeling we have developed a model of the neurotransmitter interactions involved in appetite regulation that can act as a springboard for the design of future experiments to unravel the mysteries of appetite regulation.

Neuropeptide Y: a potent inducer of consummatory behavior in rats

Neuropeptide Y (NPY) is a 36 amino acid peptide with potent cardiovascular effects. In the present study, intraventricular injection of NPY was shown to markedly stimulate feeding and drinking during the illuminated period of the light/dark cycle, a time when rats ingest small amounts of food. It also enhanced nocturnal food and water intake following a 24 hour period of food deprivation and during nocturnal feeding. The NPY induction of food intake was suppressed by the opiate antagonist, naloxone, and by the dopamine antagonist, haloperidol. Phentolamine, an alpha adrenergic antagonist, failed to suppress NPY-induced feeding. Based on the maximum quantity of food which was ingested following central administration of NPY, this peptide appears to represent one of the most potent stimulators of feeding yet to be described.

Lesions of the globus pallidus and striatum attenuate ketocyclazocine-induced feeding

A large body of evidence suggests that endogenous opioids are involved in the regulation of feeding. As the striatum and globus pallidus have relatively high concentrations of opioid receptors, these areas are possible sites of action for the stimulatory effects of opiates on feeding. To test these possibilities, male rats were lesioned bilaterally in the globus pallidus or striatum. Nocturnal food intake was then measured after the subcutaneous administration of the opiate antagonist, naloxone (0-10 mg/kg). Spontaneous daytime intake was measured after the subcutaneous administration of the kappa opiate agonist ketocyclazocine (0-10 mg/kg). Neither pallidal nor striatal lesions affected the sensitivity of naloxone in reducing food intake. On the other hand, both lesioned groups were 10-100 times less sensitive to the stimulatory effects of ketocyclazocine. These results suggest that the globus pallidus and striatum may be target areas for the stimulatory effects of exogenous opiates on food intake. Additionally, the relationship of these areas to the dopaminergic nigrostriatal tract suggests that feeding regulation may involve an interaction between dopaminergic and opioid systems.

Effects of calcitonin gene-related peptide on food intake

Recently, calcitonin gene-related peptide (CGRP), a product of alternative processing of RNA transcripts from the calcitonin gene, has been characterized. CGRP is present in a number of areas of the brain involved in modulating ingestive behaviors. We tested the effect of centrally administered CGRP on ingestive behaviors. ICV CGRP over a dose range of 1 to 10 micrograms suppressed food intake in 24 hr deprived rats and 20 and 10 micrograms decreased spontaneous nocturnal food intake. CGRP was less effective than calcitonin at suppressing food intake. Peripheral CGRP was less effective than centrally administered CGRP. Behaviorally, CGRP treated animals rested more, groomed less and ate less. Central CGRP (10 micrograms) did not alter circulating glucose levels. These results suggest that CGRP in high doses may be centrally active in regulating consummatory behaviors.

Feeding systems in Chinese hamsters

Modulation of feeding by opiates, putative satiety peptides, and dopamine was explored in the Chinese hamster, an animal that develops diabetes mellitus in certain inbred strains. Diabetic hamsters were hyperphagic relative to their nondiabetic controls, but both groups exhibited natural circadian variation in feeding. Starvation provoked hyperphagia of about 1-h duration in both groups. Naloxone and butorphanol had no effects on Chinese hamster feeding. Opiate receptor binding on Chinese hamster brains demonstrated no specific binding of naloxone or ethylketocyclazocine, but IR-dynorphin concentrations were comparable with that in rats. N-allylnormetazocine, a sigma-opiate receptor agonist, appeared to stimulate diabetic hamster feeding. Peptides reputed to have satiety effects in rats were without effect in Chinese hamsters: cholecystokinin, bombesin, somatostatin, and pancreatic polypeptide. Calcitonin limited feeding in both groups but may be nonspecific. Dopaminergic blockade by haloperidol also limited feeding, and diabetic hamsters were more sensitive to this. Although Chinese hamsters clearly can modulate their food intake when diabetic, we conclude that the opiatergic and peptidergic influences on feeding are very different from those in rats and may be of little importance.

The effect of ovariectomy, estradiol and progesterone on opioid modulation of feeding

A number of lines of evidence have suggested that alterations in gonadal steroids may modulate opioid function. We report here the effects of manipulation of female gonadal steroids on the opioid feeding system. Naloxone produced a depression of feeding in all groups. Although the group X dosage interaction was not significant, an internally consistent tendency effect of naloxone among the different treatment groups was observed. Estradiol treated rats were 20 times less sensitive to naloxone's suppressive effects of feeding than ovariectomized animals. Sham operated controls and animals treated with estradiol and progesterone had sensitivities to naloxone which were intermediate to those seen in estradiol treated and ovariectomized animals. A significant drug X dosage interaction was present for the ketocyclazocine effects at 4 hours. Overall, ovariectomized animals were resistant to feeding induced by ketocyclazocine compared to the other groups. Ovariectomy significantly decreased ir-dynorphin levels in the cortex and these values were restored towards normal by a combination of estrogen and progesterone treatment. These studies add to the growing literature suggesting a role for the peripheral endocrine system in the modulation of opioid feeding system.

Variables affecting measurement of human red cell Na+,K+ATPase activity: technical factors, feeding, aging

Because it has been suggested that decreased activity at the erythrocyte sodium pump might be the cause of age-related decreases in basal oxygen consumption, we have examined age-associated changes in Na+,K+-ATPase activity in red cell membranes. The initial portion of this study was directed toward elucidating possible methodological pitfalls in membrane preparation which might account for some of the variable results reported in prior erythrocyte Na+,K+-ATPase studies. We found that two of four red cell membrane fractions have substantial Mg2+-ATPase activity and contribute a significant portion of total membrane protein. As these two fractions contain little Na+,K+-ATPase activity their contamination of the other two fractions could cause significant variation in measured Na+,K+-ATPase activity. Additionally, we found that meal feeding raised Na+,K+-ATPase activity necessitating that measurements be made in the fasting state. With these methodological variables controlled, we found only a 10.8% coefficient of variation between fasting samples obtained on separate days in eight subjects. Using this methodology, we observed no correlation of Na+,K+-ATPase specific activity with age in males, and only a weak correlation in females who showed decreasing Na+,K+-ATPase specific activity occurring with advancing age. These observations suggest that changes in erythrocyte Na+,K+-ATPase activity do not cause the age-related fall in basal oxygen consumption.

Mechanism of pain in diabetic peripheral neuropathy. Effect of glucose on pain perception in humans

Animal studies have suggested an altered response to opiate agonists and antagonists as well as an altered pain threshold in diabetic animals. In the studies reported herein, a 50 g glucose infusion in normal subjects resulted in a significant decrease in both the threshold level of pain and the maximal level of pain tolerated, as measured by responses to electrical pain induced by a Grass stimulator. In addition, patients with diabetes mellitus were hyperalgesic when compared with normal subjects. It is concluded that elevated glucose levels and/or rapid fluxes in glucose levels result in a decrease in pain tolerance. These findings have potential clinical implications in the pathophysiology and management of painful diabetic neuropathy and the use of narcotic agents in diabetes mellitus.

Separate influences of insulin and hyperglycemia on hepatic drug metabolism in mice with genetic and chemically induced diabetes mellitus

Numerous investigators have reported abnormalities of hepatic drug metabolism in hypoinsulinemic animal models with chemically induced diabetes mellitus, but there has been little assessment of hepatic drug metabolism in recently described animal models with genetic diabetes mellitus characterized by hyperinsulinemia and insulin resistance rather than insulin deficiency. Hepatic microsomal cytochrome P-450 content and drug metabolizing activity in obese, diabetic C57BL/KsJ mice homozygous for the diabetes gene mutation (db/db) have been compared with levels found in livers of 1) lean, nondiabetic control mice with the same C57BL/KsJ genetic background and 2) lean C57BL/6J animals made diabetic by streptozotocin treatment. No changes in specific enzyme content or activity were seen in young db/db mice, but microsomal protein and total hepatic cytochrome P-450 content and meperidine demethylation and pentobarbital hydroxylation activity were markedly increased compared to controls. In hyperglycemic, hypoinsulinemic mice with streptozotocin-induced diabetes mellitus, the amount of microsomal protein did not change, but hepatic cytochrome P-450 content and enzyme activity were significantly increased whether expressed per milligram of microsomal protein or as totals per liver. In old db/db animals, hyperglycemia persisted but plasma insulin levels fell into the normal range so that the insulin-glucose profile of these animals resembled that seen in the streptozotocin treatment group. In association with these changes, hepatic enzyme specific activities in the old db/db mice approximated values found in the streptozotocin group rather than in the young db/db animals. These differences in hepatic microsomal enzymes between hyperinsulinemic and hypoinsulinemic mice with diabetes mellitus suggest that both hyperglycemia and insulin separately and significantly influence cytochrome P-450 turnover and mixed function oxidase activity.

Food intake: opioid/purine interactions

The exogenous opioids butorphanol tartrate (BT) and ethylketocyclazocine (EKC) have been reported to stimulate feeding in rats. In this study we evaluated the effects of purines (known to suppress feeding) and the adenosine antagonist, caffeine, on opioid induced feeding. Adenosine and inosine significantly suppressed BT and EKC induced feeding at various doses and time points. Caffeine enhanced food consumption was suppressed by various doses of naloxone, but was not suppressed by adenosine or inosine. Although caffeine itself induced further feeding, it did not enhance BT induced food consumption. Adenosine and inosine failed to suppress BT induced feeding when 12.5 mg/kg of caffeine was administered to the rats suggesting blockade of the adenosine receptor by caffeine. In contrast to 12.5 mg/kg caffeine, high dose caffeine (50 mg/kg) suppressed BT induced feeding over a 4 hour time period. Adenosine (50 mg/kg) and inosine (50 mg/kg) injected one hour after injection of BT and caffeine (50 mg/kg) reversed the suppressive effect of high dose caffeine in BT induced feeding. These studies indicate that opioid induced feeding can be suppressed by adenosine and inosine. Also, caffeine can reverse the suppressive effect of adenosine and inosine on feeding and vice versa. Naloxone's suppression of caffeine enhanced food consumption indicate that at least part of caffeine's effect on food intake may be mediated through an opioid mechanism.