Dissociation of the end-plate potential run-down and the tetanic fade from the postsynaptic inhibition of acetylcholine receptor by alpha-neurotoxins

The effects of so-called postsynaptic snake alpha-neurotoxins (alpha-bungarotoxin, cobratoxin, erabutoxin b) on the wanings of tetanic contraction (tetanic fade) and the run-down of end-plate potentials during stimulation at 100 Hz were studied, respectively, in intact and cut mouse phrenic nerve-diaphragm preparations. No tetanic fade was evident with high concentrations of toxins until the complete failure of contractile response whereas the tetanic fade was evident after prolonged incubation with lower concentrations of toxins. The proportion of junctions exhibiting end-plate potential run-down increased progressively during toxin incubation. However, depression of end-plate potential amplitude by the toxins was not necessarily accompanied by run-down. The tetanic fade and the run-down became more pronounced for a time shortly after washout of toxins despite the restoration of single twitches and end-plate potential amplitudes, indicating the presynaptic origin of these effects induced by alpha-neurotoxins. We demonstrated that the functions of the pre- and postsynaptic acetylcholine receptors can be dissociated by using the different kinetics of toxin-receptor interactions. The results also implicate that a positive feedback enhancement of transmitter release operates via the presynaptic acetylcholine receptor in the neuromuscular junction in normal physiological conditions during repetitive pulses.

The frequency distribution of cardiovascular diseases in 13 hospital admitted patients in Korea. Korean Society of Circulation

The frequency distribution of cardiovascular disease are changing recently due to the development of living environment. Unfortunately there are few epidemiological studies of cardiovascular diseases in general population, we tried to estimate the recent trend of cardiovascular diseases studying hospitalized patients in nationwide 13 large hospitals during a year of 1985. The hypertensive disease (24.1%) was the most common cardiovascular disease and the next were cerebrovascular disease (15.8%), arrhythmias (12.2%), ischemic heart disease (9.7%), congenital heart disease (9.1%), and rheumatic heart disease (5.4%) in order. This results showed that hypertensive disease and cerebrovascular disease are still the major cardiovascular disease and ischemic heart disease and arrhythmias are increased. But chronic rheumatic heart disease is declined compared with previous studies in hospitalized patients.

Does endogenous adenosine modulate the release of acetylcholine from motor nerve during single and repetitive stimulations in the mouse diaphragm?

In order to elucidate the physiological role of endogenous adenosine in regulating the release of acetylcholine, the effects of 8-phenyltheophylline, an antagonist of adenosine receptors and dipyridamole, an uptake inhibitor of adenosine, on the contractile response and quantal release of acetylcholine during single and repetitive stimulations of isolated mouse phrenic nerve-diaphragm preparations were studied. The curves relating the concentration vs. inhibition of contractile response to added adenosine and ATP were shifted parallel to the left by dipyridamole, but were shifted to the right by 8-phenyltheophylline at concentrations with little Ca2+-mobilization or phosphodiesterase inhibition. In the absence of exogenously added adenosine, 8-phenyltheophylline increased the quantal content of end-plate potentials (1 Hz), whereas dipyridamole decreased the quantal content. Successive decrease of the amplitude of end-plate potentials (e.p.p. run-down) evoked at 50 Hz was not changed either by 8-phenyltheophylline or by dipyridamole, suggesting that adenosine or ATP released from the motor nerve does not accumulate to an effective concentration even after repetitive stimulation for a feed-back regulation of the transmitter release. It is concluded that endogenous adenosine does inhibit the release of acetylcholine from motor nerve. However, the source of adenosine may be mostly from the muscle and is probably not involved in the feedback autoregulation.

Pre- and postsynaptic effects of nicotine on the mouse phrenic nerve-diaphragm preparation

Nicotine at less than or equal to 33 microM enhanced the single twitch response to indirect stimulation but potentiated the blocking effect of tubocurarine. Failure of tetanic contraction (tetanic fade) occurred on stimulation at 100 Hz. At 76 microM, nicotine induced a first phase rapid (10 min) inhibition of twitch response followed later (60-90 min) by a second phase complete block. Neostigmine partially restored the response at either phase of block whereas diaminopyridine completely antagonized the blockade. The end-plate was depolarized maximally by only 10-15 mV within 30 min with 43 microM nicotine. The depolarization was maintained but was antagonized by tubocurarine. The twitch response induced by direct stimulation was unchanged indicating no depolarization block ensued. The amplitudes of both EPP (0.7 Hz) and MEPP were markedly depressed in parallel indicating a curare-like postsynaptic inhibition without an effect on the release of transmitter. It is concluded that nicotine blocks the neuromuscular transmission by a dual mechanism by its partial agonist action. At higher frequencies of transmission, nicotine (greater than or equal to 22 microM) also produced a remarkable run-down of EPP just like other receptor antagonists suggesting that the nerve terminal acetylcholine receptors are not particularly sensitive to nicotine as those on the autonomic ganglia.

A regenerating release of acetylcholine from mouse motor nerve terminals treated with anticholinesterase agents

It was found by intracellular recording with glass microelectrodes that train stimulation (50-200 Hz) of the phrenic nerve of intact or cut mouse diaphragm induced an accumulative depolarization of the endplate and triggered after a few pulses an 'all-or-none' regenerative depolarization lasting for 300-900 ms when acetylcholinesterase was inhibited by neostigmine or diisopropylfluorophosphate. This depolarization was associated with a noise of the membrane potential and a failure of the end plate potential. Low Ca2+ prolonged whereas high Ca2+ shortened the duration of regenerative depolarization which needed no further stimulation once triggered. d-Tubocurarine abolished the depolarization while restoring the end plate potential. A regenerative release of acetylcholine due to an activation of presynaptic cholinoceptors is speculated.

Mechanisms of the inhibition by neostigmine of tetanic contraction in the mouse diaphragm

Neostigmine (0.5-2 microM) caused fade of tetanic contractions (Wedensky inhibition) evoked by repetitive nerve stimulation. The mechanism underlying this action was studied in intact and cut isolated phrenic nerve-diaphragm preparations of mice. The fade was brought about by failure to elicit muscle action potentials. During fade, the muscle was unable to conduct directly evoked action potentials across the central endplate zone. Recovery of excitability occurred in 5 s with continued stimulation. In the presence of neostigmine, the resting membrane potential at endplate areas during repetitive stimulation decreased from -80 mV to less than -50 mV within the first 10 pulses at 75-200 Hz and thereafter recovered gradually to about -60 mV in the following 5 s during continuous stimulation. The quantal content of endplate potentials evoked by single stimulation was not reduced by neostigmine whereas that evoked by high frequency stimuli (75 Hz) was reduced to about 1/3 in 10 pulses. It is concluded that the fade of tetanic contraction caused by inhibition of acetylcholinesterase is induced by the inactivation of sodium channels in the area surrounding the endplates and that the sustained fade is due to a decrease of transmitter release. Both effects are the result of acetylcholine accumulation.

A comparison of the antagonisms by neostigmine and diaminopyridine against the neuromuscular block caused by cobrotoxin and (+)-tubocurarine

Cobrotoxin was about 11-fold more potent than (+)-tubocurarine on a weight basis in blocking neuromuscular transmission in mouse isolated phrenic nerve-diaphragm preparations. Neostigmine and diaminopyridine increased the concentrations of cobrotoxin for 70% inhibition of indirect contraction by 290 and 320%, and increased those of (+)-tubocurarine by 180 and 230%, respectively. More than additive increases were obtained when neostigmine and diaminopyridine were used simultaneously. Cobrotoxin, however, was only 6-fold more toxic than (+)-tubocurarine after intraperitoneal injection in mice. The lethal dose of (+)-tubocurarine was increased by 80% when both antidotes were used together, but only by 15-20% when used alone. In contrast, the lethality of cobrotoxin was not decreased by these drugs. Unexpectedly, the time to death after treatment with cobrotoxin was shortened when mice were pretreated with these antidotes.

Pharmacological identification of saxitoxin-like toxins in the cultured purple clam, Hiatula diphos

An outbreak of poisoning from ingestion of purple clam (Hiatula diphos), obtained from a brackish fish-culture pond, occurred in southern Taiwan in early January 1986. The extract blocked the twitch responses and generation of the action potential of the mouse diaphragm without an effect on the resting membrane potential or the miniature endplate potential. The depolarizations and spontaneous firings of the diaphragm induced by veratridine and crotamine were effectively antagonized by the toxic clam extract, indicating the presence of saxitoxin-like substances, which may have amounted to 0.013% tetrodotoxin equivalent.

Electrophysiological studies of myotoxin a, isolated from prairie rattlesnake (Crotalus viridis viridis) venom, on murine skeletal muscles

Myotoxin a reduced the resting membrane potential of mouse and rat diaphragms from about -80 mV to -60 mV, induced spontaneous repetitive firing and enhanced the contractile force in response to single stimulations. The depolarizing effect was reversed noncompetitively by tetrodotoxin, local anesthetics or low Na+ solution, but was augmented by ouabain or low Cl-solution while being unaffected by high K+ solution or electrical stimulation of the muscle. The duration of muscle action potential was prolonged by only 20-30%, whereas the rate of rise (dV/dt) was unaffected. About a 40% increase of membrane conductance was observed, be abolished by the Na+-channel blocker tetrodotoxin. By contrast, K+ conductance was unaffected. Effects on caffeine-induced contracture, quantal release of neurotransmitter and the amplitude of miniature endplate potential were not appreciably affected. These effects of myotoxin a indicate that the toxin affects the muscle, but not the nerve, by acting specifically on the Na+-channel of the sarcolemma or T-tubule, like crotamine, rather than on the sarcoplasmic reticulum. The effects of sea anemone toxin II on the Na+-channel (marked depolarization and prolongation of action potential) could not be prevented by saturating the muscle with myotoxin a. On the other hand, the effect of veratridine, a member of another group of toxins acting on the Na+-channel, was enhanced. These results suggest that myotoxin a acts on the Na+-channel at a site which is discrete from those of tetrodotoxin, veratridine and sea anemone toxin II.

Potentiation between neostigmine and 3,4-diaminopyridine in antagonizing the neuromuscular block induced by D-tubocurarine

The antagonisms to the d-tubocurarine-induced neuromuscular blockade by neostigmine and 3,4-diaminopyridine (DAP) were studied quantitatively in the isolated phrenic nerve-diaphragm preparation of mice in vitro and in lethality of mice in vivo by assaying concentrations of d-tubocurarine needed to produce 70% block of indirect muscle contraction and LD50, respectively. The "antagonist efficacies", defined as the ratio of d-tubocurarine concentration (dose) after pretreatment with antagonistic agents over that of control, were 1.87, 2.24 and 14.7, respectively, for neostigmine, DAP and both agents combined when the stimulus pulses were at 0.1 Hz. Under 50 Hz train stimulation, the antagonist efficacies were lower, being 1.85, 1.64 and 5.33, respectively. For the lethality to d-tubocurarine, the values were still lower, being only 1.21, 1.33 and 1.84, respectively. The synergism between neostigmine and DAP, as evident from the marked increase of antagonist efficacy in vitro, is more than expected from the possible interaction of the major pharmacological actions of these two agents.

A study on the membrane depolarization of skeletal muscles caused by a scorpion toxin, sea anemone toxin II and crotamine and the interaction between toxins

Quinquestriatus toxin (QTX) isolated from the venom of a scorpion (Leiurus quinquestriatus) and sea anemone (Anemonia sulcata) toxin II enhanced the twitch response of the rat and mouse diaphragms and like crotamine (isolated from the venom of Crotalus durissus terrificus) caused spontaneous fasciculation of the muscle. Trains of action potentials in muscles at 70-250 Hz, which could not be antagonized by (+)-tubocurarine, were triggered by single stimulation or occurred spontaneously after treatment with these toxins. QTX and toxin II prolonged the rat muscle action potential 3 to 4 fold whereas crotamine prolonged the action potential by only 30%. The membrane potential was depolarized from about -82 mV to -55 mV by crotamine 2 micrograms ml-1, -41 mV by toxin II 5 micrograms ml-1 and to -50 mV by QTX 1 microgram ml-1. The concentrations to induce 50% maximal depolarization (K0.5) were 0.07, 0.15 and greater than 0.4 microgram ml-1, respectively, for QTX, crotamine and toxin II, whereas the rates of depolarization were in the order toxin II greater than or equal to crotamine greater than QTX. The depolarizing effects of crotamine and QTX, but not of toxin II, were saturable. The depolarizing effects of all three toxins were irreversible whereas the membrane potential could be restored by tetrodotoxin non-competitively. Simultaneous treatment with crotamine and QTX or crotamine and toxin II at concentrations below K0.5 caused only additive effects on depolarization. When the muscle was depolarized by pretreating with a saturating concentration of crotamine, the onset of depolarization by QTX was greatly retarded whereas that by toxin II was unaffected. Action potentials were further prolonged in both cases. 8 It is inferred that all three peptide toxins act at sites on the sodium channel and the binding sites for QTX and crotamine overlap to a considerable extent. On the other hand, the site for toxin II appears not to overlap with that of crotamine but may overlap with that of QTX.

Potentiation by crotamine of the depolarizing effects of batrachotoxin, protoveratrine A and grayanotoxin I on the rat diaphragm

The interactions between crotamine and tetrodotoxin and group II sodium channel toxins, including batrachotoxin, protoveratrine A and grayanotoxin I, were studied on the rat diaphragm muscle. When the diaphragm was pretreated with 0.1 micrograms crotamine/ml for 45 min (a condition known to depolarize the muscle by less than 3 mV, which is only 20% of the maximal depolarization induced by a saturating concentration of crotamine), the rate of depolarization by group II toxins was markedly enhanced and the time to reach the steady state depolarization was greatly shortened. The maximal depolarizations induced by each of the group II toxins, however, were not increased. Pretreatment with saturating concentrations of crotamine also caused no change of the steady state depolarization induced by batrachotoxin or grayanotoxin I. Moreover, pretreatment of the diaphragm with a high concentration of grayanotoxin I, whose effect is reversible, did not impede the depolarizing effect of crotamine. Tetrodotoxin restored the membrane potential, depolarized by crotamine, with 50% restoration at a concentration of 16 ng/ml, no matter whether a high (20 micrograms/ml) or a low (2 micrograms/ml) concentration of crotamine were used. The above results indicate that there is no competition between crotamine and group II toxins or between crotamine and tetrodotoxin. However, crotamine may affect the binding of group II toxins allosterically, increasing their affinity although the intrinsic activity may not be changed.

Cystadenocarcinoma of the ovary in a 4-year-old: benign transformation during therapy

Ovarian tumors comprise only 1% of all tumors in females below the age of 17 years. Of these, the epithelial tumors are the least common, being particularly rare before puberty and then increasing in frequency with advancing age after puberty. The youngest girl previously reported in the literature with an epithelial ovarian tumor was a 9-year-old child with an ovarian papillary cystadenocarcinoma. This is the only case thus far reported of a malignant ovarian epithelial tumor occurring before puberty. Only histologically benign appearing glands were detected in the resected tumor masses, on a second-look laparotomy following the use of multiagent chemotherapy.