Taurine amplifies renal kallikrein and prevents salt-induced hypertension in Dahl rats

OBJECTIVE

To determine whether taurine reduces blood pressure by stimulating the renal kallikrein-kinin system.

METHODS

The effects of taurine on blood pressure, urinary kallikrein activity and renal kallikrein gene expression were investigated in Dahl salt-sensitive (Dahl-S) rats. The specificity of the action of taurine was verified by comparison with the action of beta-alanine, a carboxylic analogue of taurine. The effect of co-administration of the specific bradykinin B2 receptor antagonist Hoe 140 was also examined.

RESULTS

Administration of taurine (3% in drinking water) for 4 weeks retarded the development of salt (4% sodium chloride diet)-induced hypertension. Systolic blood pressure at the end of the experiment was significantly higher in control rats than in taurine-treated rats. Urinary sodium excretion was not decreased by the reduction in blood pressure. The heart weight:body weight ratio was significantly lower, and urinary volume and kallikrein excretion were significantly higher, in taurine-treated rats. Renal kallikrein gene expression at weeks 1 and 4 was higher in taurine-treated rats. Systolic blood pressure 3 and 4 weeks after the administration of beta-alanine was slightly, but not significantly, lower than that of untreated rats on a high-salt diet, and was accompanied by a significantly lower body weight. Urinary kallikrein excretion decreased with a high-salt diet regardless of beta-alanine administration. Continuous systemic administration of Hoe 140 did not cause any significant alteration in blood pressure in Dahl-S rats that received taurine with a high-salt diet. Taurine also showed a renoprotective effect, as judged by a reduction in proteinuria.

CONCLUSION

These results suggest that taurine is an effective antihypertensive agent for salt-induced hypertension. Although taurine activated renal kallikrein, further studies are required to confirm the participation of activated kallikrein in the antihypertensive, cardioprotective and renoprotective effects of taurine.

Central squamous cell carcinoma of the mandible. Computed tomographic findings

Five cases of central squamous cell carcinoma of the mandible were investigated with the use of computed tomography. Bucco-lingual extent and spread along the mandibular division of the trigeminal nerve were evaluated. Three patients with trismus showed involvement of the masseter or medial pterygoid muscle on computed tomography. Involvement of more than two landmarks along the trigeminal nerve were observed in cases with both paresthesia of the lower lip and severe pain that resembled neuralgia. Perineural invasion was confirmed histologically in four cases, and all of these patients had both severe pain and mandibular canal involvement that could be demonstrated with computed tomography. When localized soft tissue changes are evident along the course of the trigeminal nerve in the region between the mandibular foramen and foramen ovale, ascending perineural spread should be suspected. Computed tomography findings correlated well with clinical symptoms but added information about the spread of the lesion within the surrounding soft tissue.

Mandibular reconstruction using hydroxylapatite granules, autogenous bone, and a cervical island skin flap

Ten patients with gingival carcinoma who were treated by marginal mandibulectomy were reconstructed using hydroxylapatite granules, autogenous bone chips, and a cervical island skin flap. The cervical flap was used to produce a cover and partition, designed to prevent the displacement of the mixture of hydroxylapatite and bone. Reconstruction was successfully achieved in all patients. Loss of height of the reconstructed mandible over an average 18-month follow-up ranged from 8% to 22%. One patient has worn a full denture and five patients wear partial dentures.

Crossover comparison between the depressor effects of low and high work-rate exercise in mild hypertension

1. The relationship between work-rate and the antihypertensive effect of exercise in hypertensives, and the mechanism of that effect, were investigated by a crossover clinical trial. 2. Ten mild hypertensives were randomly divided into two groups. One group performed low work-rate exercise (LWE) on a cycle ergometer for 10 weeks (blood lactate threshold; approximately 50% of maximum oxygen consumption [Vo2max]). After a 10 week interval without exercise training, these subjects were then switched to a high work-rate exercise (HWE) regimen (4 mmol/L of blood lactate; approximately 75% of Vo2max) for another 10 weeks. In the other group, the order of exercise training was reversed. Since two patients withdrew from the protocol during HWE periods, statistical analysis was performed on the data from the remaining eight patients. There were no order effects observed in any of the data from the two groups. 3. During both LWE and HWE, resting blood pressure (BP) fell significantly after the initiation of exercise therapy (P < 0.05). Furthermore, the overall effects of 10 weeks of LWE and HWE on BP were not significantly different. 4. The work-rate at the lactate threshold, which reflects physical fitness, had increased significantly by 16 W (P < 0.01) after the LWE period and by 11 W (P < 0.01) after the HWE. 5. During the LWE period, changes in haemodynamic and humoral variables were not significant, except for a reduction in plasma norepinephrine at week 10 (P < 0.05). In the HWE period, changes in haemodynamic and humoral variables were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Beneficial effects of a serine protease inhibitor in peripheral vascular disease

Kallikrein, a serine protease known to generate bradykinin (a vasodilating peptide) in alkaline conditions, also generates angiotensin II (a vasoconstricting peptide) in weak acidic conditions. Based on this previous observation, the present study was performed to determine whether ischemic muscle tissue, in which the regional pH must decrease, produces angiotensin II by kallikrein or a similar enzyme, and whether nafamostat (NAF), a serine protease inhibitor, improves local hemodynamics under ischemic conditions caused by exercise in patients with ischemic peripheral vascular disease. NAF was administered intravenously to 20 patients with peripheral vascular disease. Lower-limb thermograms and blood flow were measured before and after exercise. Femoral venous blood of affected limbs was obtained to measure viscosity and humoral variables (i.e., pH, lactate, angiotensin II and bradykinin). Walking distance and subjective symptoms were also recorded. As a control, the same patients repeated this test with saline infusion on a separate day. NAF significantly increased maximal walking distance, improved subjective symptoms during exercise, and attenuated exercise-induced venous lactate and blood viscosity increases, and pH reduction. The blood viscosity increase correlated with the lactate increase. Pretreatment with NAF also resulted in a higher lower-limb skin temperature, and a greater increase of blood flow in the lower limbs after exercise than did pretreatment with saline. The results suggest that kallikrein-like serine protease may exacerbate ischemic symptoms. Changes in plasma bradykinin and angiotensin II in the femoral vein were not detectable, probably because of the lower levels of these peptides in the peripheral circulation.

[A case of idiopathic hyperaldosteronism diagnosed by adrenal imaging]

We report a case of idiopathic hyperaldosteronism (IHA) which was differentiated from an aldosterone producing adenoma by the adrenal imaging techniques with computed tomography (CT) and scintigraphy. In this patient, the high basal aldosterone level with the suppressed plasma renin activity typically indicated the diagnosis of primary aldosteronism. However, the differentiation from an aldosterone producing adenoma by responses of plasma aldosterone levels to upright posture, captopril or adrenocorticotropic hormone (ACTH) administration was not definitive. Abdominal CT revealed bilateral adrenal swelling. Adrenal scintillation scanning with 131I-iodocholesterol showed bilateral uptake even after the administration of dexamethasone. Blood sampling from the right adrenal vein was unsuccessful. Blood pressure and serum potassium levels remained unchanged during dexamethasone administration (2 mg/day) over ten days. After the administration of spironolactone and nisoldipine blood pressure and serum potassium levels were normalized. Adrenal imaging is considered to be very useful for the diagnosis of IHA.

Role of locally formed angiotensin II and bradykinin in the reduction of myocardial infarct size in dogs

OBJECTIVE

The aim was to investigate the role of local formation of angiotensin II and bradykinin in the reduction of myocardial infarct size.

METHODS

Bilaterally nephrectomised male mongrel dogs were used. Effects were compared of pretreatment with three inhibitors of angiotensin II forming enzyme-captopril (an angiotensin converting enzyme inhibitor), nafamostat (a serine protease inhibitor), and chymostatin (a cysteine protease inhibitor)--on left anterior descending coronary artery occlusion. Haemodynamic variables were monitored and blood was collected from the anterior interventricular vein and the aorta. Angiotensin I, angiotensin II, and bradykinin were measured by radioimmunoassay. After 90 min of occlusion, infarct sizes were determined by a macroscopic enzyme technique.

RESULTS

Angiotensin II release into the anterior interventricular vein increased from 0.03(SEM 1.19) pg.min-1 (before coronary occlusion) to 4.64(1.37) pg.min-1 (n = 14, p < 0.05), while angiotensin I release and plasma renin activity remained unchanged. The increase in angiotensin II release was inhibited by nafamostat and chymostatin, but not by captopril. Bradykinin release increased from -3.18(2.72) (before coronary occlusion) to 34.7(12.3) pg.min-1 (n = 14 p < 0.05) by 30 min after occlusion. This increase was augmented by captopril, from 4.10(2.86) before occlusion to 97.8(39.6) pg.min-1 at 5 min after occlusion (n = 12, p < 0.05), but not by nafamostat or chymostatin. Infarct size was smaller (p < 0.05) in the captopril group than in the control group.

CONCLUSIONS

Angiotensin II is locally produced in the ischaemic heart by both serine protease(s) and chymostatin inhibitable protease(s), but not by angiotensin converting enzyme. From the reduction in myocardial infarct size produced by angiotensin converting enzyme inhibition, it seems that bradykinin accumulation may play a more important role than the suppression of angiotensin II formation.

Clinical symptoms of open lock position of the condyle. Relation to anterior dislocation of the temporomandibular joint

Nine cases of open lock position of the condyle of the temporomandibular joint (TMJ) are reported. In two patients recurrent dislocation of the TMJ was diagnosed clinically, and four had previous episodes of anterior dislocation. An arthrotomographic examination revealed that the condyles of the affected TMJs were located anterior to the anterior bands of the disks at an open-mouth position. An arthrographic fluoroscopic examination showed that the anterior bands mechanically obstructed the anteriorly displaced condyles from posterior movement into the articular fossae to various degrees at open-mouth position. One cause of anterior dislocation of the TMJ is thought to be fixation of the condyle in the open lock position resulting from a disturbance of a neuromuscular mechanism. In the two patients with dislocation, occlusal treatment eliminated muscular symptoms and the dislocations completely disappeared.

Active and inactive renin after exercise

The effects of graded exercise on plasma concentrations of active and inactive renin were studied in seven healthy men. Exercise was performed on a cycle ergometer at four different exercise intensities (corresponding to 30%, 50%, 80% and 87% of VO2max) for 10 min each. Concentrations of active renin and total renin after activation by trypsin were measured by direct immunoradiometric assay. Non-trypsin-activated renin concentration (inactive) was obtained by subtraction. Active renin concentrations at 30%, 50%, 80% and 87% of VO2max were 1.2, 1.9, 3.1 and 4.6 times higher than the control concentration, respectively. Similar increases in plasma renin concentration, determined by conventional enzymatic assay, were observed at every stage. In contrast, changes in inactive renin concentration were not significant at any stage. Significant increases in noradrenaline concentration were found at every exercise stage, but adrenaline, aldosterone and lactate concentrations were significantly elevated only after exercise at 50%, 80% and 87% of VO2max. The similarity between the changes in concentration of active renin and noradrenaline would suggest that sympathetic nerve activity may have been responsible either for the release of active renin or for the conversion of inactive renin to its active form in the kidney.

Human renin activation by protease from the renin granule fraction of the dog kidney cortex

To clarify the possible conversion of prorenin in renin granules where conversion reportedly occurred, we investigated whether the renin granule fraction of the kidney could activate prorenin to the active form. Renin granules were isolated from the dog kidney cortex by discontinuous sucrose density gradient centrifugation. Human active renin was quantified by immunoradiometric assay which could detect only the human active renin but not the inactive human renin or dog renin. Inactive renin from human amniotic fluid was incubated with the subcellular fraction of the dog kidney cortex. The renin granule fraction that showed the highest renin activity stimulated the inactive renin to become the active form. The membrane preparation obtained from the renin granule fraction by freezing and thawing the fraction in low osmolarity retained the activity of renin activation. Other subcellular fractions showed less renin activation. The optimal pH for renin activation by the membrane was pH 5.0 to 6.0. The activation depended on the time of incubation and concentration. The activation was inhibited by N-ethylmaleimide but not by EDTA or serine protease inhibitors. These results suggest that renin is processed by a membrane bound protease in renin granules.

[A rare adult case of double-outlet right ventricle without pulmonary stenosis: an autopsy case]

Double outlet right ventricle (DORV) is a rare cardiac malformation especially in adulthood. We report a woman with DORV who survived to the age of 33 years. She had not been seriously limited, before she visited our hospital for cardiac evaluation at the age of 25 years. She was cyanotic, and had clubbing of fingers and toes and facial edema. Holosystolic murmur and diastolic regurgitant murmur were audible along the left sternal border. Chest X-ray showed cardiomegaly and enlarged pulmonary trunks. Electrocardiography showed right axis deviation and biventricular hypertrophy. Laboratory examination revealed polycythemia (Hb: 22.4 g/dl), increased levels of hepatic enzymes due to congestive liver and marked hypoxemia (Pao2: 40 mmHg), Diagnosis of DORV was made with cardioangiography. Surgical repair was not indicated. Thereafter, she experienced recurrent heart failure which progressed gradually. She died probably of ventricular arrhythmia at the age of 33 years. At autopsy, the heart showed dilatation of the right atrium and ventricle, and hypertrophy of the bilateral ventricles. Both the pulmonary artery without stenosis and the aorta originated completely from the right ventricle, which were almost normally positioned with bilateral conus. Large ventricule septal defect was found at the subaortic portion. Patent ductus arteriosus and preductal aortic coarctation co-existed. To our knowledge, few cases with DORV who survived over 30 years have been reported, and they all manifested pulmonary stenosis. The present case is a very rare DORV that survived over 30 years without the complication of pulmonary stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Inhibitory effects of kinins on angiotensin I conversion in the local circulation

The inhibition of angiotensin converting enzyme (ACE) by kinins was studied using bradykinin (BK), lysyl-bradykinin (Lys-BK), [Hydroxyproline3]-bradykinin ([Hyp3]-BK) and [Hydroxyproline3]-lysyl-bradykinin ([Hyp3]-Lys-BK). The latter two are novel kinins recently identified in our laboratory. All the four kinins displayed competitive inhibition on the conversion of angiotensin I to angiotensin II by purified canine lung ACE. Inhibition constants (Ki) for the four kinins were estimated from Dixon's plot as follows-BK: 0.27 microM, Lys-BK: 0.57 microM, [Hyp3]-BK: 0.34 microM, and [Hyp3]-Lys-BK: 0.27 microM. In the rat hindlimb perfusion system, the kinins were demonstrated to partially inhibit angiotensin I conversion to angiotensin II by the vascular ACE. Taken together, these results suggest that angiotensin II formation by ACE in the vascular tissue is possibly inhibited by local kinins, especially after ACE inhibitor administration. This indirect action of kinins, coupled with its direct vasodilatory action, might indicate a cooperative participation in vasodilation.

Substrate-dependent angiotensin II formation in the peripheral circulation

An alternative angiotensin II-forming system distinct from the vascular renin-angiotensin system was demonstrated using a rat hindlimb perfusion system and synthetic substrates. This pathway was resistant to captopril and aprotinin, but was highly sensitive to chymostatin. Moreover, angiotensin II formation was substrate-dependent, i.e. angiotensin II formation from tridecapeptide human renin substrate in the presence of captopril was more than twice than that from an equimolar amount of angiotensin I. Both pathways may play a role in regulating the peripheral circulation.

A case of a clinically "silent" pheochromocytoma

A case of a clinically "silent" pheochromocytoma is presented. The adrenal mass was incidentally discovered by abdominal ultrasonography and computed tomography. In the course of hospitalization, the patient was normotensive and asymptomatic. Plasma catecholamine levels were nearly normal, whereas urinary levels of catecholamine metabolites were slightly elevated. A glucagon provocative test and 131I-metaiodobenzylguanidine scintigram were useful for diagnosing such an atypical pheochromocytoma. A discussion of clinically-unsuspected pheochromocytoma is also presented.

Angiotensin-converting activity of tissue kallikrein

This study examined the ability of tissue kallikreins, purified from both rat submandibular gland (SMG) and human urine, to form angiotensin II from synthetic angiotensin I. Both kallikreins converted angiotensin I to angiotensin II at neutral pH with the following kinetic constants: SMG kallikrein, Km = 9.43 x 10(-5) mol/l, Kcat = 1.58 mumols/mg protein/min; human urinary kallikrein, Km = 1.71 x 10(-4) mol/l, Kcat = 0.06 mumol/mg protein/min. These activities were not affected by angiotensin-converting enzyme (ACE) inhibitor. These results suggest that tissue kallikrein might participate in the formation of angiotensin II during administration of an ACE inhibitor.

High-renin malignant hypertension secondary to an aldosterone-producing adenoma

Malignant hypertension and high plasma renin activity was found in a 39-year-old woman with an aldosterone-producing adenoma. Only 3 similar cases have been previously reported, and all patients died before or after identification of the adenoma. The present paper documents the first reported case of a successfully managed high-renin malignant hypertension secondary to an aldosterone-producing adenoma. Regardless of its sporadic occurrence and common presence with low plasma renin activity, primary aldosteronism should be considered as a possible underlying cause of high-renin malignant hypertension.

Effects of the angiotensin converting enzyme inhibitors captopril, rentiapril, and alacepril in patients with essential and renovascular hypertension

The effects of captopril, rentiapril, and alacepril were compared in five patients with renovascular hypertension (RVH) and five with essential hypertension (EH). The dose of each drug was equivalent to 50 mg of captopril. Rentiapril inhibited angiotensin converting enzyme activity more strongly and for longer periods than did the other two drugs. In the patients with RVH, blood pressure was significantly reduced more quickly and for longer periods by rentiapril than by captopril or alacepril; in the patients with EH, alacepril was the most potent antihypertensive agent. The results indicate that rentiapril is as effective as the other two drugs in patients with hypertension and that alacepril is more effective in patients with low-renin hypertension or renin-independent hypertension than captopril or rentiapril.

Abdominal aortic aneurysm of unknown origin and renovascular hypertension in a 25 year old male

A 25 year old male had an abdominal aortic aneurysm involving bilateral renal arteries. Aortography revealed no irregularity in the aortic wall but a slight kinking at the tenth thoracic level followed by a fusiform aneurysm. Computed tomography (CT) showed an enlarged aortic lumen with an intraluminal thrombus. Plasma renin activity (PRA) was markedly increased (11 ng/ml/h), and the administration of captopril caused a further increase in PRA with a significant reduction in blood pressure, indicating the presence of renovascular hypertension. Abdominal aneurysm in a young adult is very rare. The etiology of the aneurysm appears to be idiopathic.

[Prolapse of the buccal fat pad in infant]

Two infant cases with traumatic prolapse of the buccal fat pad were presented. They suffered injuries from objects held in the mouth, such as a spoon and a tooth brush. Both received surgical treatment under local anesthesia, including closure of the wound with sutures. As the prolapsed tissue was fresh in the first case, it was repositioned. However, since the second case had passed 3 days after the accident and had a sign of infection, the prolapsed tissue was totally removed. Postoperative course was uneventful and there was no recurrence in both cases.

Isolation of [hydroxyproline3]Lysyl-bradykinin formed by kallikrein from human plasma protein

[Hydroxyproline3]Lysyl-bradykinin ([Hyp3]Lys-BK), a new kinin was isolated, besides Lysyl-bradykinin (Lys-BK), from the reaction mixture of human plasma protein Cohn's fraction IV-4 with hog pancreatic kallikrein. The liberated kinins were isolated by procedures including ethanol extraction, Sephadex G-15, CM cellulose and reverse-phase high performance liquid chromatography and quantitated by radioimmunoassay. On HPLC, two peaks of immunoreactive kinins emerged. Peak 1, an unknown kinin proceeded to peak 2 which had an identical retention time to that of Lys-BK. The amino acid sequence of the unknown peak 1 proved to be Lys-Arg-Pro-Hyp-Gly-Phe-Ser-Pro-Phe-Arg, or [Hydroxyproline3]Lys-BK, and peak 2 Lys-BK. The ratio of the amounts of two kinins thus formed were [Hyp3]Lys-BK 25 +/- 4% and Lys-BK 75 +/- 4%. The existence of [Hyp3]Lys-BK suggests a presence of a new kininogen containing [Hyp3]Lys-BK in human plasma protein.

Identification of [hydroxyproline3]-bradykinin released from human plasma and plasma protein Cohn's fraction IV-4 by trypsin

Aside from bradykinin (BK), a novel kinin, [Hydroxyproline3]-bradykinin ( [Hyp3]-BK), was isolated from the reaction mixture of human plasma and plasma protein Cohn's fraction IV-4 with trypsin. The liberated kinins were isolated based on procedures which we previously described for the isolation of [Hyp3]-lysyl-bradykinin ( [Hyp3]-Lys-BK) formed by kallikrein. The ratio of the amounts of two kinins thus formed from human plasma protein Cohn's fraction IV-4 were [Hyp3]-BK 25 +/- 4% and BK 75 +/- 4%, similarly to that of [Hyp3]-Lys-BK and Lys-BK, formed by kallikrein, but it varied by persons. The isolation of [Hyp3]-BK and [Hyp3]-Lys-BK suggests that a novel kininogen containing hydroxyproline in the third position of the bradykinin sequence in human plasma protein, possibly undergone post-translational modifications.

[Pulmonary tuberculosis in patients with oral cancer]

During an 11 year period, from 1976 to 1986, 33 (10.1%) out of 328 patients with oral cancer treated at our clinic had either a scarred pulmonary tuberculosis (TB) or active TB. Four of these 33 patients developed active TB. In two of these cases TB occurred before the therapy of oral cancer commenced and in the other two, after the operation for oral cancer. In one of the 4 cases, a recrudescence of the TB was suspected. Five cases that were suspected of having TB on analysis of their chest X-rays were administered prophylactic anti-tuberculous chemotherapy, after which no recrudescence or onset of TB.

Identification of [hydroxyproline3]-lysyl-bradykinin released from human plasma protein by kallikrein

[Hydroxyproline3]-lysyl-bradykinin [( Hyp3]-Lys-BK), a new kinin was isolated, besides lysyl-bradykinin (Lys-BK), from the reaction mixture of human plasma protein Cohn's fraction IV-4 with hog pancreatic kallikrein. The liberated kinins were isolated by procedures including ethanol extraction, Sephadex G-15, CM cellulose and reverse-phase high performance liquid chromatography (HPLC) and quantitated by radioimmunoassay. On HPLC, two peaks of immunoreactive kinins emerged. Peak 1, an unknown kinin proceeded to Peak 2 which had an identical retention time to that of Lys-BK. The amino acid sequence of the unknown Peak 1 proved to be Lys-Arg-Pro-Hyp-Gly-Phe-Ser-Pro-Phe-Arg, or [Hyp3]-Lys-BK, and Peak 2 Lys-BK. The ratio of the amounts of two kinins thus formed were [Hyp3]-Lys-BK 25 +/- 4% and Lys-BK 75 +/- 4%. The existence of [Hyp3]-Lys-BK suggests a presence of a new kininogen, containing [Hyp3]-Lys-BK in human plasma protein, possibly undergone post-translational modifications.

Formation of angiotensin II by tonin-inhibitor complex

Enzymatic activity of tonin-alpha 1-macroglobulin complex was studied in vitro and in vivo, using an immunoimmobilization technique. Tonin-alpha 1-macroglobulin complex, which was immunologically immobilized by anti-alpha 1-macroglobulin antibody covalently coupled to agarose gels, could quantitatively hydrolyze angiotensin I and synthetic tridecapeptide renin substrate to form angiotensin II. However, the solid-phase antibody-bound tonin-alpha 1-macroglobulin complex could not hydrolyze the plasma protein renin substrate. Phenylmethylsulfonyl fluoride, a serine protease inhibitor, inhibited both free tonin and the solid-phase antibody-bound tonin-alpha 1-macroglobulin complex. The hydrolytic activity of the solid-phase antibody-bound tonin-alpha 1-macroglobulin complex against angiotensin I was not inhibited by soybean trypsin inhibitor (molecular weight, 23,000), a potent inhibitor of free tonin. Taken together, these results suggest that tonin bound to alpha 1-macroglobulin keeps the active site intact and that inhibition of the enzyme activity is due to a steric hindrance. When 500 microliter of tonin was administered intravenously to rats, the immunoimmobilization method was used to show that the tonin-alpha 1-macroglobulin complex in the plasma formed angiotensin II. Thus, the tonin-alpha 1-macroglobulin complex in the plasma may be linked to some forms of hypertension through angiotensin II formation.