Dose-response relationships within the parotid gland after radiotherapy for head and neck cancer

BACKGROUND AND PURPOSE

To determine the salivary function, after parotid-sparing radiotherapy (RT), of different regions within the parotid gland and to evaluate dose-function relationships within the parotid glands and between patients.

PATIENTS AND METHODS

Sixteen head and neck cancer patients, irradiated between September 1999 and November 2000 using a conformal parotid-sparing technique, were included in this study. Before RT and 7 months after RT (range 6-10 months), a salivary gland scintigraphy was performed in all patients combined with a single photon emission computed tomography (SPECT). The salivary excretion fraction (SEF) was measured, after stimulation, in 8-12 transverse 5mm SPECT slices of each parotid. Loss of salivary excretion fraction (dSEF %) of these slices was calculated as the proportion of SEF after RT as compared to SEF before RT. Since the planning CT-scan and the SPECT-scintigraphy were performed in the same treatment position, the dose to a transverse slice within the parotid gland could be matched to the loss of salivary excretion fraction of that respective slice. A non-linear model was fitted to the dose-loss of function data and the dose resulting in 50% loss of salivary excretion fraction (D50) was calculated.

RESULTS

Before RT, all but one patient presented with normal salivary excretion fractions (SEF) of both parotid glands. Within the same parotid gland, the SEF's of the different slices were almost equal. Seven months after RT, the reduction in SEF was statistically significant (P-value<0.0001). A significant difference in loss of salivary excretion fraction (dSEF) was also observed between both parotid glands (P<0.0001) as a result of the parotid-sparing technique. When plotting the dSEF of a slice versus the dose given to that slice, doses as low as 10-15 Gy could result in a serious loss of function (dSEF>50%). After fitting a non-linear model to these plots, the mean dose resulting in 50% loss of salivary excretion fraction (D50) 7 months after RT was 22.5 Gy. A large inter-patient variability was found in D50.

CONCLUSIONS

Salivary SPECT is a useful tool for the evaluation of the salivary function of different slices within the parotid gland. Before irradiation, the different slices within one parotid gland act as functional sub-units contributing equally to the function of the entire gland. Seven months after an average dose of 22.5 Gy (D50) the functional sub-unit has lost 50% of its excretion fraction. The high inter-patient variability in D50 and the observation that low doses (10-15 Gy) can induce serious loss of function should prompt us in the clinic to reduce the dose to the parotids even lower than the threshold of 22.5 Gy.

Biophysical and morphological properties of parasympathetic neurons controlling the parotid and von Ebner salivary glands in rats

The inferior salivatory nucleus (ISN) contains parasympathetic neurons controlling the parotid and von Ebner salivary glands. To characterize the neurophysiological and morphological properties of these neurons, intracellular recordings were made from anatomically identified ISN neurons in rat brain slices. Neurons were also filled with Lucifer yellow and morphometrically analyzed. Based on responses to membrane hyperpolarization followed by depolarization, three types of repetitive discharge patterns were defined for neurons innervating the parotid gland. The regular, repetitive discharge response to membrane depolarization was changed by hyperpolarization resulting either in a delay in the occurrence of the first spike or to an increase in the length of the first interspike interval in the action potential train. Membrane hyperpolarization had little effect on the discharge pattern of some neurons. Similar response discharge patterns were found for neurons innervating the von Ebner salivary gland, which also included a further group of neurons that responded with a short burst of action potentials. Neurons innervating the parotid salivary glands differed morphologically from the von Ebner salivary glands having significantly larger soma and more and longer dendrites than von Ebner gland neurons. In addition, the mean membrane input resistance, time constant, and spike half-width of parotid gland neurons was significantly lower than in von Ebner gland neurons. These differences in intrinsic membrane properties and morphology may relate to the functions of the von Ebner and parotid glands. von Ebner glands are involved in taste stimulus delivery and removal from posterior tongue papillae while the parotid glands contribute saliva to the entire mouth.

Distinct Ca(2+)-permeable cation currents are activated by internal Ca(2+)-store depletion in RBL-2H3 cells and human salivary gland cells, HSG and HSY

Store-operated Ca(2+) influx, suggested to be mediated via store-operated cation channel (SOC), is present in all cells. The molecular basis of SOC, and possible heterogeneity of these channels, are still a matter of controversy. Here we have compared the properties of SOC currents ( I(SOC)) in human submandibular glands cells (HSG) and human parotid gland cells (HSY) with I(CRAC) (Ca(2+) release-activated Ca(2+) current) in RBL cells. Internal Ca(2+) store-depletion with IP(3) or thapsigargin activated cation channels in all three cell types. 1 muM Gd(3+) blocked channel activity in all cells. Washout of Gd(3+) induced partial recovery in HSY and HSG but not RBL cells. 2-APB reversibly inhibited the channels in all cells. I(CRAC )in RBL cells displayed strong inward rectification with E(rev)(Ca) = >+90 mV and E(rev) (Na) = +60 mV. I(SOC) in HSG cells showed weaker rectification with E(rev)(Ca) = +25 mV and E(rev)(Na) = +10 mV. HSY cells displayed a linear current with E(rev) = +5 mV, which was similar in Ca(2+)- or Na(+)-containing medium. pCa/ pNa was >500, 40, and 4.6 while pCs / pNa was 0.1,1, and 1.3, for RBL, HSG, and HSY cells, respectively. Evidence for anomalous mole fraction behavior of Ca(2+)/Na(+) permeation was obtained with RBL and HSG cells but not HSY cells. Additionally, channel inactivation with Ca(2+) + Na(+) or Na(+) in the bath was different in the three cell types. In aggregate, these data demonstrate that distinct store-dependent cation currents are stimulated in RBL, HSG, and HSY cells. Importantly, these data suggest a molecular heterogeneity, and possibly cell-specific differences in the function, of these channels.

Proliferation and Phenotypic Preservation of Rat Parotid Acinar Cells

The purpose of this study is to develop an initial step in salivary gland tissue engineering through proliferation and phenotypic preservation of rat parotid acinar cells in vitro. By using the explant outgrowth technique and M199 medium with the addition of sialic acid, acinar cells not only survived for more than 30 days in the absence of basement membrane substrates but also proliferated to yield cells with acinar phenotypic expression. Furthermore, we tested whether chitosan can be used as a synthetic extracellular matrix to culture salivary acinar cells. Chitosan is a deacetylated product of chitin, which is a plentiful polysaccharide found in nature and is safe for the human body, but little is known about the utility of chitosan in culturing salivary acinar cells. It was found that coating fibronectin on chitosan membrane improved the attachment of acinar cells in the initial stage. However, the poor attachment of acinar cells on pure chitosan membrane did not affect cell growth after longer culture times, indicating that chitosan is potentially useful as a tissue-engineering scaffold of the salivary gland. These in vitro results are encouraging because such a culture system may serve as an artificial salivary gland for future use in the treatment of patients with salivary hypofunction.

The effects of electrostimulation on parotid saliva flow: A pilot study

OBJECTIVE

Saliva is a critical fluid necessary for oral health. Medications, radiation therapy, and systemic conditions can decrease salivary function and increase a patient's risk for caries and other oral infections. Palliative management of xerostomia includes wetting agents such as ice chips and saliva substitutes. Systemic agents stimulate salivary flow but often have unfavorable side effects. All have met with limited success. The purpose of this study is to assess the effectiveness of transcutaneous electric nerve stimulation (TENS) as a means of stimulating salivary function in healthy adult subjects.

STUDY DESIGN

Twenty-two healthy, adult subjects with no history of salivary gland disorder enrolled in the protocol. The TENS electrode pads were placed externally on the skin overlying the parotid glands. Unstimulated saliva was collected for 5 minutes via the Carlson-Crittenden cup into preweighed vials using standardized collection techniques. The TENS unit was then activated and stimulated saliva collected for an additional 5 minutes.

RESULTS

Fifteen of 22 subjects demonstrated increased parotid salivary flow when stimulated via the TENS unit. Five experienced no increase and 2 experienced a decrease. The mean unstimulated salivary flow rate was 0.02418 mL/min (SD 0.03432) and mean stimulated salivary flow rate was 0.04946 mL/min (SD 0.04328). Statistical analysis of flow rates utilizing the paired t test demonstrated the difference to be statistically significant, P < .001. In 7 subjects with 0 baseline flow, 5 continued to have no flow.

CONCLUSIONS

The TENS unit was effective in increasing parotid gland salivary flow in two-thirds of healthy adult subjects. A further study in a cohort of patients with salivary gland disorders is warranted.

Involvement of Aquaporin-5 Water Channel in Osmoregulation in Parotid Secretory Granules

Aquaporins (AQPs) are a family of channel proteins that allow water or very small solutes to pass, functioning in tissues where the rapid and regulated transport of fluid is necessary, such as the kidney, lung, and salivary glands. Aquaporin-5 (AQP5) has been demonstrated to localize on the luminal surface of the acinar cells of the salivary glands. In this paper, we investigated the expression and function of AQP5 in the secretory granules of the rat parotid gland. AQP5 was detected in the secretory granule membranes by immunoblot analysis. The immunoelectron microscopy experiments confirmed that AQP5 was to be found in the secretory granule membrane. Anti-AQP5 antibody evoked lysis of the secretory granules but anti-aquaporin-1 antibody did not and AQP1 was not detected in the secretory granule membranes by immunoblot analysis. When chloride ions were removed from the solution prepared for suspending secretory granules, the granule lysis induced by anti-AQP5 antibody was inhibited. Furthermore, 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid, an anion channel blocker, blocked the anti-AQP5 antibody-induced secretory granule lysis. These results suggest that AQP5 is, expressed in the parotid gland secretory granule membrane and is involved in osmoregulation in the secretory granules.

Functional imaging of parotid glands: diffusion-weighted echo-planar MRI before and after stimulation

PURPOSE

To investigate the feasibility of diffusion-weighted (DW) echo-planar imaging (EPI) for measuring different functional conditions of the parotid gland and to compare different measurement approaches.

MATERIALS AND METHODS

Parotid glands of 27 healthy volunteers were examined with a DW EPI sequence (TR 1,500 msec, TE 77 msec, field-of-view 250 x 250 mm, pixel size 2.10 x 1.95 mm, section thickness 5 mm) before and after oral stimulation with commercially available lemon juice. The b factors used were 0, 500, and 1,000 sec/mm (2). Apparent diffusion coefficient (ADC) maps were digitally transferred to MRIcro (Chris Rorden, University of Nottingham, Great Britain) and evaluated with a manually placed circular region of interest (ROI) containing 100 - 200 pixel. Additional ROIs including the entire parotid gland were placed on either side. The results of both measurements were compared, using the Student's t test based on the median ADC values for each person. A two-tailed p-value of less than.05 was determined to indicate statistical significance. To compare both measurement approaches, the Pearson's correlation coefficient (r) was calculated.

RESULTS

Diffusion-weighted echo-planar MR imaging successfully visualized the parotid glands of all volunteers. In a first step, the median ADC value per person was computed. Using ROIs of 100 - 200 pixels, the mean was calculated to be 1.08 x 10 (- 3) mm (2)/sec +/- 0.12 x 10 (- 3) mm (2)/sec for both parotid glands prior to stimulation. After stimulation, the mean ADC was measured at 1.15 x 10 (- 3) mm (2)/sec +/- 0.11 x 10 (- 3) mm (2)/sec for both parotid glands. Evaluating the entire parotid gland, the ADC was 1.12 x 10 (- 3) mm (2)/sec +/- 0.08 x 10 (- 3) mm (2)/sec prior to stimulation, whereas the ADC increased to 1.18 x 10 (- 3) mm (2)/sec +/- 0.09 x 10 (- 3) mm (2)/sec after stimulation with lemon juice. For both types of measurements, the increase in ADC after stimulation proved to be significant (p < 0.001). High correlations between both measurement types were found (r >.83).

CONCLUSION

Diffusion-weighted echo-planar MR imaging allows non-invasive quantification of functional changes in the parotid glands.

Intensity-modulated radiotherapy for early-stage nasopharyngeal carcinoma: a prospective study on disease control and preservation of salivary function

BACKGROUND

Xerostomia is a uniform complication after radiotherapy (RT) for nasopharyngeal carcinoma (NPC). Dosimetric studies suggested that intensity-modulated RT (IMRT) can spare part of the parotid glands from high-dose radiation. Disease control and salivary function after IMRT for early-stage NPC was studied prospectively.

METHODS

Thirty-three patients with T1,N0-N1,M0 NPC were treated with IMRT from 2000 to 2002. The prescribed dose was 68-70 grays (Gy) in 34 fractions to gross tumor volume, 64-68 Gy to the planning target volume, and 70 Gy to enlarged cervical lymph nodes. Nineteen patients had stimulated whole salivary (SWS) flow assessment and stimulated parotid salivary (SPS) flow assessment at baseline and at 2 months, 6 months, 12 months, 18 months, and 24 months after the completion of IMRT.

RESULTS

At a median follow-up of 2 years, only 1 neck failure was observed. The 2-year and 3-year local control, distant metastases-free, and overall survival rates all were 100%. The lymph node control and progression-free survival rates were 100% at 2 years and 92.3% at 3 years, respectively. The average mean dose to the parotid gland was 38.8 Gy. The SWS and SPS flow showed continuous recovery: 60% and 47.1% of patients recovered at least 25% of their baseline SPS flow and SWS flow, respectively, at 1 year after completion of IMRT, and the proportions rose to 85.7% and 71.4%, respectively, by 2 years. The pH and buffering capacity of saliva also improved with time.

CONCLUSIONS

Parotid-sparing IMRT achieved good locoregional control, and there was continuous recovery of salivary flow, pH, and buffering capacity in the first 2 years after IMRT in patients with NPC.

Mitotic proliferation of myoepithelial cells during regeneration of atrophied rat submandibular glands after duct ligation

BACKGROUND

The purpose of the present study was to elucidate whether myoepithelial cells proliferate mitotically during regeneration of rat submandibular glands after atrophy.

METHODS

The excretory duct of the right submandibular gland of rats was doubly ligated near the hilum with metal clips, which were removed after 7 days of ligation (day 0). The regenerating right submandibular glands were removed from 0 to 14 days after removal of the clips. The removed tissue was examined with immunohistochemical double staining for proliferating cell nuclear antigen (PCNA) as a marker of proliferating cells and actin as a marker of myoepithelial cells, as well as with transmission electron microscopy (TEM).

RESULTS

The PCNA-positive myoepithelial cells were observed at the periphery of transitional duct-acinar structures, ducts and acini in the regenerating glands at every time-point, and the PCNA-labeling index of myoepithelial cells increased greatly especially between day 2 and 4. The mitosis of myoepithelial cell was also identified by TEM at day 4.

CONCLUSION

These findings suggest that myoepithelial cells are able to proliferate mitotically during regeneration of rat submandibular gland.

Expressions of CCAAT-enhancer-binding proteins and c-Myc in the parotid gland of the rat: in vivo effects of isoprenaline, bethanechol, vasoactive intestinal peptide and food intake

Parotid glands of adult female rats were exposed to agonists mimicking sympathetic (isoprenaline, 1mg/kg, I.P.) or parasympathetic activity (bethanechol, 10 microg/kg/min i.v. for 30 min, and vasoactive intestinal peptide, VIP, 0.2 microg/kg/min, i.v. for 30 min) or they were reflexly activated by a meal demanding chewing. The stimulated glands were removed at varying times (15(30)-360 min) following the onset of the agonist administration or 75-300 min after the start of a 1h long feeding period, and a number of transcription factors was studied using Western blot. The protein bands were semi-quantitatively measured by densitometry. In response to isoprenaline, C/EBPalpha of 42, 38 and 30 kDa increased by 45-50% above control value, C/EBPbeta LAP (38/35 kDa) by 80% and C/EBPdelta (35 kDa) by 230%, while C/EBPbeta LIP (20 kDa) decreased by 45%. In response to VIP, C/EBPalpha of 42 kDa increased by 75% and C/EBPalpha of 30 kDa by 10%, C/EBPbeta LAP by 65% and C/EBPdelta by 410%, while C/EBPalpha of 38 kDa as well as C/EBPbeta LIP were not changed. In response to bethanechol, C/EBPalpha of 42 kDa increased by 105%, C/EBPbeta LAP by 40% and C/EBPdelta by 170%, while C/EBPalpha of 30 kDa decreased by 30% and C/EBPalpha of 38 kDa and C/EBPbeta LIP remained unchanged. c-Myc increased in response to isoprenaline and VIP by 40-55%, but not to bethanechol. In rats offered a pelleted diet, the parotid glands displayed increases in C/EBPalpha of 42 kDa by 105%, of 30 kDa by 40% and of 38 kDa, by 10%, in C/EBPbeta LAP by 65% and in C/EBPdelta by 215%, whereas C/EBPbeta LIP decreased by 25%. Thus, in parotid glands transcription factors of importance for growth and metabolism were shown to be influenced by autonomimetics as well as by nervous activity.

Intraparotid Injection of Botulinum Toxin A as a Treatment to Control Sialorrhea in Children with Cerebral Palsy

OBJECTIVE

To determine the efficacy of botulinum toxin A in the management of drooling (sialorrhea) in children and young adults with cerebral palsy.

DESIGN

Twenty-one children were enrolled in an open-label, nonblinded prospective study. Subjective and objective measures were used to determine the effect of botulinum toxin A on drooling and saliva production. Subjective measures included visual scales to document the child's severity and frequency of drooling. Objective measures included the number of bibs used per day and salivary secretion. At the initial visit, subjective and objective measures established the child's baseline drooling and saliva production. Fifteen units of botulinum toxin A was injected into each parotid glans. At each fellow-up visit of telephone survey, subjective and objective measures were recorded to monitor the child's drooling and saliva production. A postinjection questionnaire evaluated overall effect and caregiver satisfaction.

RESULTS

The visual analog scales and number of bibs used per day demonstrated statistically significant reduction in severity and frequency of drooling at 2 wks, 1 mo and 2 mos. Salivary production was significantly reduced at 1-mo fellow-up. Eighty-nine percent of the caregivers reported and improvement of their child's drooling after botulinum toxin A injection. Severity-nine percent of caregivers were satisfied with the treatment and would perform the treatment again.

CONCLUSION

Intraparotid injections of botulinum toxin A are efficacious in decreasing severity and frequency of drooling, the number of bibs used per day, and the production of saliva in children with cerebral palsy. The injections are relatively safe and adverse effects were observed in this study.

Permeant Anions Control Gating of Calcium-dependent Chloride Channels

The effects of external anions (SCN(-), NO3-, I(-), Br(-), F(-), glutamate, and aspartate) on gating of Ca(2+)-dependent Cl(-) channels from rat parotid acinar cells were studied using the whole-cell configuration of the patch-clamp technique. Shifts in the reversal potential of the current induced by replacement of external Cl(-) with foreign anions, gave the following selectivity sequence based on permeability ratios ( P(x)/ P(Cl)): SCN(-)>I(-)>NO3->Br(-)>Cl(-)>F(-)>aspartate>glutamate. Using a continuum electrostatic model we calculated that this lyotropic sequence resulted from the interaction between anions and a polarizable tunnel with an effective dielectric constant of approximately 23. Our data revealed that anions with P(x)/P(Cl) > 1 accelerated activation kinetics in a voltage-independent manner and slowed deactivation kinetics. Moreover, permeant anions enhanced whole-cell conductance ( g, an index of the apparent open probability) in a voltage-dependent manner, and shifted leftward the membrane potential- g curves. All of these effects were produced by the anions with an effectiveness that followed the selectivity sequence. To explain the effects of permeant anions on activation kinetics and g(Cl) we propose that there are 2 different anion-binding sites in the channel. One site is located outside the electrical field and controls channel activation kinetics, while a second site is located within the pore and controls whole-cell conductance. Thus, interactions of permeant anions with these two sites hinder the closing mechanism and stabilize the channel in the open state.

Subpopulation of store-operated Ca2+ channels regulate Ca2+-induced Ca2+ release in non-excitable cells

Ca2+-induced Ca2+ release (CICR) is a well characterized activity in skeletal and cardiac muscles mediated by the ryanodine receptors. The present study demonstrates CICR in the non-excitable parotid acinar cells, which resembles the mechanism described in cardiac myocytes. Partial depletion of internal Ca2+ stores leads to a minimal activation of Ca2+ influx. Ca2+ influx through this pathway results in an explosive mobilization of Ca2+ from the majority of the stores by CICR. Thus, stimulation of parotid acinar cells in Ca2+ -free medium with 0.5 microm carbachol releases approximately 5% of the Ca2+ mobilizable by 1 mm carbachol. Addition of external Ca2+ induced the same Ca2+ release observed in maximally stimulated cells. Similar results were obtained by a short treatment with 2.5-10 microm cyclopiazonic acid, an inhibitor of the sarco/endoplasmic reticulum Ca2+ ATPase pump. The Ca2+ release induced by the addition of external Ca2+ was largely independent of IP(3)Rs because it was reduced by only approximately 30% by the inhibition of the inositol 1,4,5-trisphosphate receptors with caffeine or heparin. Measurements of Ca2+ -activated outward current and [Ca2+](i) suggested that most CICR triggered by Ca2+ influx occurred away from the plasma membrane. Measurement of the response to several concentrations of cyclopiazonic acid revealed that Ca2+ influx that regulates CICR is associated with a selective portion of the internal Ca2+ pool. The minimal activation of Ca2+ influx by partial store depletion was confirmed by the measurement of Mn2+ influx. Inhibition of Ca2+ influx with SKF96365 or 2-aminoethoxydiphenyl borate prevented activation of CICR observed on addition of external Ca2+. These findings provide evidence for activation of CICR by Ca2+ influx in non-excitable cells, demonstrate a previously unrecognized role for Ca2+ influx in triggering CICR, and indicate that CICR in non-excitable cells resembles CICR in cardiac myocytes with the exception that in cardiac cells Ca2+ influx is mediated by voltage-regulated Ca2+ channels whereas in non-excitable cells Ca2+ influx is mediated by store-operated channels.

[Stenon or Stensen duct. How sholud we call the secretory duct of the parotid gland? Brief biography of its discoverer]

The duct of the parotid gland had been indiscriminately named Stenon's duct or Stensen's duct. In order to establish its origin we carried out a biographic search and a brief revision of the life of the great anatomist, geologist, palaeontologist, bishop and finally Saint Nicolaus Stensen.

Rab3D redistribution and function in rat parotid acini

Rab3D is a low molecular weight GTP-binding protein believed to be involved with regulated secretion in many cell types. In parotid, Rab3D is localized to secretory granule membranes or present in the cytosol as a complex with Rab escort protein. In the present study, we examined the redistribution of membrane-associated Rab3D during secretion in permeabilized parotid acini. When permeabilized acini were stimulated with calcium and cAMP, amylase release increased greater than twofold over basal. Quantitative immunoblotting of subcellular fractions revealed that Rab3D did not dissociate from parotid membranes during secretion. Immunohistochemical staining demonstrated that Rab3D co-localizes with amylase containing granules that are found in the apical pole of the cell. Upon stimulation with calcium and cAMP, Rab3D and amylase immunostaining of granules appeared to be more dispersed. However, Rab3D immunostaining was not observed on the plasma membrane and appeared to reside in the apical cytoplasm. To examine the role of Rab3D in amylase release, cytosolic extracts containing myc-tagged Rab3D and Rab3DQ81L, a GTP-binding mutant, were prepared and incubated with streptolysin O-permeabilized acini. Rab3D, but not Rab3DQ81L, bound to parotid membranes suggesting that Rab3D-binding to parotid membranes is guanine nucleotide-dependent. Moreover, wild-type and mutant Rab3D inhibited agonist-induced amylase release from permeabilized parotid acini. These observations indicate that in parotid acini, Rab3D does not dissociate from parotid membranes or redistribute to the plasma membrane during secretion, and may play an inhibitory role in regulated secretion. The fact that both wild-type Rab3D and the GTP-binding mutant inhibit amylase release suggests that binding of Rab3D to the membrane is not essential for secretory inhibition.

[Sialorrhea, hyperhidrosis and botulinum toxin]

OBJECTIVE

The first clinical studies indicate that Botox provides effective treatment for hyperhidrosis and sialorrhea. The aim of this work is to sum up current evaluation of this use.

METHOD

A systematic literature search was conducted on the Pub Med database, along with on chapters in other publications. The most interesting articles in relation to our own personal experience were chosen.

RESULTS

Despite recent use of BT to treat focal hyperhidrosis, there have been numerous publications since 1997. However, the injected areas have not been listed so frequently. Axillary hyperhidrosis has been studied most; it is also in this case and in the case of gustatory sweating that the best results have been obtained. Publications about palmar and especially plantar hyperhidrosis are much rarer, almost anecdotic. It has been demonstrated to a lesser extent that BT injections are effective in these cases. Literature about sialorrhea is just beginning. However, the reduction of the production of saliva following intra parenchymatic injection of toxin into the parotid and submandibular glands, thus rarifying drooling, has been demonstrated. For each of the pathological indications, both the injection techniques and the optimal doses remain to be determined.

DISCUSSION

Because BT blocks all cholinergic transmission, including the autonomous nervous system, it was plausible to expect a reduction in sweating and salivation on local injection of the product. In fact, the first publications indicated such efficiency without serious side effects. For hyperhidrosis, there has developed a consensus for making intracutaneous injections only. Of the injections in axillary areas, the palms of the hands, the plantar regions, the face or other cutaneous areas, palmoplantar hyperhidrosis is the least accessible, in any case causes the most technical problems, because of difficulty in pain management. For sialorrhea and the drooling that accompanies certain chronical neurological diseases, BT seems to have very promising effects. However, it has not been precisely determined whether to inject the parotid gland, the submandibular gland, or both. Necessary and sufficient means of targeting are still imprecise. It also remains to be determined the number of sites per gland and the doses to be injected.

Characterization of rat parotid and submandibular acinar cell apoptosis in primary culture

Apoptosis is a highly organized cellular process that is critical for maintaining glandular homeostasis. We have used primary rat salivary acinar cells from the parotid and submandibular glands to investigate the critical regulatory events involved in apoptosis. Caspase-3 activity, cleavage of caspase substrates, and deoxyribonucleic acid (DNA) fragmentation were assayed in cells treated with etoposide, a DNA-damaging agent, or brefeldin A (BFA), a Golgi toxin. Dose-response studies showed that the sensitivity of both cell types to etoposide and BFA was similar, with 150 microM etoposide or 1.5 microM BFA inducing maximal caspase activation. However, BFA induced a more robust activation of caspase and DNA fragmentation in both cell types. Similar results were observed when the caspase cleavage of poly(adenosine 5'-diphosphate ribose) polymerase and protein kinase C delta were analyzed by Western blot. Analysis of the kinetics of apoptosis showed that caspase-3 activation was maximal at 8 h of etoposide or BFA treatment in the parotid cells and at 8-18 h in the submandibular cells. A similar time course was observed when DNA fragmentation was assayed, although maximal DNA fragmentation in BFA-treated cells was two- to threefold higher than that observed in etoposide-treated cells. Despite slight kinetic differences, it would appear that the apoptotic cascade is very similar in both primary parotid and submandibular acinar cells. Although limited in their long-term stability in culture, the use of primary, nonimmortalized salivary acinar cultures will also permit the use of specific transgenic animals to further characterize the molecular events involved in the regulation of salivary gland acinar cell apoptosis.

An inwardly rectifying K+ channel in bovine parotid acinar cells: possible involvement of Kir2.1

Using electrophysiological and molecular techniques, we investigated the molecular nature of an inwardly rectifying K+ channel in bovine parotid acinar (BPA) cells and examined its role in setting resting membrane potential. In whole-cell recordings from freshly isolated BPA cells, a predominant current was a K+ current rectified strongly in the inward direction. An inward conductance of the inwardly rectifying K+ (Kir) current was proportional to [K+]o(0.57). The selectivity sequence based on permeability ratios was K+ (1.00) > Rb+ (0.63) >> Li+ (0.04) = Na+ (0.02) and the sequence based on conductance ratios was K+ (1.00) >> Rb+ (0.03) = Li+ (0.03) = Na+ (0.02). The current was blocked by extracellular Ba2+ and Cs+ in a voltage- and a concentration-dependent manner, with a Kd at 0 mV of 11.6 microM and 121 mM, respectively. Cell-attached patch measurements identified 27 pS K+ channels as being the most likely to mediate whole-cell Kir currents. Addition of Ba2+ (100 microM) to the bathing solution reversibly depolarized the resting membrane potential in intact unstimulated cells. RT-PCR of RNA from bovine parotid cells revealed transcripts of bovine Kir2.1 (bKir2.1). HEK293 cells stably expressing bKir2.1 cloned from bovine parotid exhibited whole-cell and single channel Kir currents, of which electrophysiological characteristics were quantitatively similar to those of native Kir currents. Immunohistochemical studies showed a bKir2.1 immunoreactivity in BPA cells. Collectively, these results suggest that Kir2.1 may mediate native Kir currents responsible for setting resting membrane potential in BPA cells and might be, at least in part, involved in spontaneous secretion in ruminant parotid glands.

Destruction of parotid glands affects nitrate and nitrite metabolism

The role of salivary glands in nitrate and nitrite metabolism is poorly understood. The aim of the present study was to investigate the effect of parotid gland ablation on dynamic metabolism of nitrate and nitrite in miniature pigs. The parotid glands of 5 healthy miniature pigs were bilaterally ablated by methyl violet. Concentrations of nitrate and nitrite of whole saliva, serum, and urine samples were analyzed by high-performance liquid chromatography. Results showed that bilateral ablation of the parotid glands led to a significant decrease of nitrate secretion from blood to saliva (P < 0.05) and thus low nitrite levels. Dysfunction of the parotid glands temporarily increased the systemic level of nitrate in miniature pigs after nitrate loading. This study suggests that the parotid glands play an important role in the balance of nitrate and nitrite levels in both whole saliva and the body.

Alterations of nitrate and nitrite content in saliva, serum, and urine in patients with salivary dysfunction

BACKGROUND

The role of the salivary glands in the maintenance of nitrate and nitrite in saliva is poorly understood. The aim was to study alterations of nitrate and nitrite metabolisms in patients with Sjogren's syndrome (SS) or sialosis.

METHODS

Saliva, serum, and urine samples were collected from healthy volunteers (n = 29), patients with SS (n = 31), and patients with sialosis (n = 30). Concentrations of nitrate and nitrite were determined by high-performance liquid chromatography (HPLC).

RESULTS

In the healthy group, the highest concentration of nitrate was found in parotid saliva (172 mg/l), followed by urine (160 mg/l), whole saliva (97 mg/l), and serum (33 mg/l). In the SS group, concentration of nitrate was decreased in parotid saliva and whole saliva, and increased significantly in urine. Concentration of nitrite in whole saliva was significantly decreased in the SS group and increased in the sialosis group.

CONCLUSION

Hypofunction of the salivary glands is associated with significant changes of nitrate and nitrite levels in the saliva and urine.

Autonomic control of protein production by the parotid gland of the sheep

The role of adrenoceptors in the control of parotid salivary function has been investigated in anaesthetized sheep. The enhancement of parotid protein output that occurs when the parasympathetic and sympathetic innervations to the gland are stimulated simultaneously in bursts at a low frequency (20 Hz for 1 s at 10-s intervals) was effectively abolished by pretreatment with propranolol (> or = 1.0 mg kg(-1), i.v., P < 0.001), without a comparable reduction in the flow of saliva or in the output of sodium or potassium. Secretion of protein was similarly augmented by simultaneous stimulation of the sympathetic innervation and an intracarotid infusion of acetylcholine (0.4-0.6 microg min(-1) g gland(-1)). This effect was also abolished by pretreatment with propranolol. Pretreatment with phentolamine (>1.0 mg kg(-1), i.v.) had no effect on the output of protein that occurred during combined stimulation of the parasympathetic and sympathetic innervations but increased the flow of saliva and the output of electrolytes. Stimulation of the parasympathetic innervation to the parotid gland caused a substantial fall in vascular resistance, which was reduced by the administration of atropine (0.5 mg kg(-1)). Stimulation of the sympathetic innervation caused a substantial rise in parotid vascular resistance in atropinized sheep. This effect was greater during continuous stimulation than during intermittent stimulation and enhanced by pretreatment with propranolol. It was virtually eliminated by pretreatment with phentolamine. It is concluded that the enhancement of protein output from the ovine parotid gland, that occurs during combined stimulation of the parasympathetic and sympathetic innervations at relatively low frequencies, depends upon interaction between cholinergic muscarinic and beta-adrenergic receptors. The vasoconstriction that occurs during sympathetic stimulation alone can be accounted for by activation of alpha-adrenoceptors.

SK4/IK1-like channels mediate TEA-insensitive, Ca2+-activated K+ currents in bovine parotid acinar cells

Although Ca(2+)-activated K(+) (K(Ca)) channels distinct from maxi-K(+) channels have been suggested to contribute to muscarinically stimulated K(+) currents in salivary acinar cells, the molecular nature of the channels is unclear. Using electrophysiological and RT-PCR techniques, we have now investigated the involvement of SK4/IK1-like channels in native K(Ca) currents in bovine parotid acinar (BPA) cells. Ca(2+)-dependent K(+) efflux from perfused bovine parotid tissues was not inhibited by a maxi-K(+) channel blocker, tetraethylammonium (TEA). Whole cell recordings from BPA cells showed a TEA-insensitive K(Ca) conductance, which was highly permeable to Rb(+). In inside-out macropatches, TEA-insensitive Rb(+) currents were activated by Ca(2+) with half-maximal values of 0.4 microM. 1-Ethyl-2-benzimidazolinone (1-EBIO) increased the Ca(2+) sensitivity of the currents. The calmodulin antagonists trifluoperazine, calmidazolium, and W-7 inhibited the Ca(2+)-activated Rb(+) currents. In outside-out macropatches, Ca(2+)-activated Rb(+) currents were inhibited by Ba(2+), quinine, clotrimazole, and charybdotoxin but not by d-tubocrarine or apamin. RT-PCR analysis showed transcripts of SK4/IK1 in BPA cells. These results collectively suggest that SK4/IK1-like channels mediate the native K(Ca) currents in BPA cells.

Expression and regulation of the gene for arginase I in mouse salivary glands: requirement of CCAAT/enhancer-binding protein alpha for the expression in the parotid gland

Arginase in salivary glands is potentially involved in the synthesis of proline, glutamate, and polyamines that play specific physiological roles in the glands, and also in depletion of arginine in the oral cavity to protect teeth from microorganisms. We detected protein and mRNA for the type I isoform of arginase in mouse salivary glands. Enzymes of the arginine-biosynthetic pathway were also detected. Immunohistochemical analysis revealed that arginase I was enriched in the striated duct, and was also present in the acinus, demilune and granulated duct. Mice with targeted disruption of the gene for C/EBPalpha, which is a transcription factor essential for expression of the arginase I gene in the liver, showed dramatically reduced immunoreactivity for arginase I in the parotid gland but not in the submandibular and sublingual glands. Therefore, C/EBPalpha is specifically required for expression of the arginase I gene in the parotid gland.

Visualization of ?Water Secretion? by Confocal Microscopy in Rat Salivary Glands: Possible Distinction of Para- and Transcellular Pathway

Visualization of water transport in cells, tissues and organs is an important, yet still difficult, task in morphological science. By using confocal microscopy and the fluid-phase fluorescent tracer technique, we visualized water secretion and estimated the routes of water transport across the acinar epithelia in rat parotid and submandibular glands. Confocal microscopy of whole glands perfused arterially with Lucifer yellow revealed a bright fluorescence at the basolateral space of acini. Luminal space was devoid of fluorescence, but revealed it after isoproterenol pretreatment, ductal infusion of fluorescent dextrans into the lumen, or tissue dissociation by collagenase. Under these conditions, stimulation of fluid secretion with carbachol caused a rapid decline of the luminal fluorescence intensity, indicating that the secreted water washed out the fluorescent probes in the acinar lumen. In the stimulated dissociated acini, the luminal fluorescence disappeared by 15 sec, but reappeared at 30-45 sec to maintain a low plateau level. By assuming that the tight junction was 'paralyzed' by the collagenase digestion and that the paracellular fluid transport could not influence the dilution of Lucifer yellow, we estimated that the initial water secretion by CCh occurs via the transcellular pathway, while later than 30-45 sec the additional water permeates through the paracellular pathway.

Functional analysis of human parotid gland in vivo using the (1)H MRS MT effect

Magnetization transfer (MT) was measured in the parotid gland in vivo by (1)H MR spectroscopy in 10 adult volunteers. A comparison was made of stimulated (excess saliva) and resting parotid gland (SPG and RPG, respectively). Following irradiation at an MT pulse of 150 Hz downfield from the water proton signal, signal reductions in SPG and RPG were 83.8 +/- 4.7 and 91.4 +/- 5.7%, respectively. The larger reduction for SPG indicates that an increase in the amount of water in gland cells for the production of more parotid saliva may lead to greater affinity between the protons adjacent to macromolecules and free water which contributes to the MT effect. Activity in the parotid gland correlates with the effect. This method is useful for diagnosing disorders of parotid gland secretion.