Platelet alpha 2-adrenoceptor binding and function during the menstrual cycle

[Strategies for perioperative sympatho-modulation]

Despite the growing evidence for the efficacy of different sympatho-modulatory therapies to lower perioperative cardiac morbidity and mortality, such therapeutic strategies are rather infrequently used in daily clinical practice. Most physicians involved in perioperative medicine are aware of the increasing literature related to this topic, but only few comply with current clinical practice guidelines even in the absence of contraindications. This review discusses possible explanations for this reluctance and again summarizes the basic and clinical principles of current sympatho-modulatory therapies including alpha(2)-agonism, beta-adrenergic antagonism, and regional anesthetic techniques in modern anesthetic practice. In addition, the emerging perioperative concept of a patient-tailored individualized pharmacotherapy based on "gene profiling", particularly the adrenergic polymorphisms, is discussed.

Imidazoline and alpha(2a)-adrenoceptor binding sites in postmenopausal women before and after estrogen replacement therapy

BACKGROUND

Platelet alpha(2A)-adrenoceptors (alpha(2A)AR) and imidazoline binding sites (subtype I(1)) have been proposed as peripheral markers of brain stem receptors that mediate sympathetic outflow and are reported to be elevated in major depression.

METHODS

In our study, p[(125)I]-iodoclonidine was used to assess platelet alpha(2A)AR and I(1) binding sites in healthy postmenopausal women (n = 34) compared with healthy women of reproductive age (n = 26). Receptor determinations were repeated in 19 postmenopausal women following 59-60 days of estrogen replacement therapy (ERT; 0.1 mg estradiol transdermal patches).

RESULTS

I(1) binding sites were twofold higher in platelets of postmenopausal women compared with women of reproduction age but were down-regulated (normalized) after 59-60 days of ERT. All other binding parameters, including platelet alpha(2A)AR density, were not different between groups nor were they changed after ERT. Platelet I(1) densities after 59-60 days of ERT were positively correlated with plasma luteinizing hormone concentrations.

CONCLUSIONS

It is suggested that increased imidazoline binding sites might be associated with mood and behavioral changes in postmenopausal women.

Adrenergic receptors in premenstrual dysphoric disorder: I. Platelet alpha 2 receptors: Gi protein coupling, phase of menstrual cycle, and prediction of luteal phase symptom severity

BACKGROUND

Abnormal alpha 2-adrenergic receptor (AR) function is implicated in anxiety and depressive disorders. Premenstrual dysphoric disorder (PMDD) is characterized by anxiety and depressive symptoms, which may be associated with changes in alpha 2AR function. Previous studies on alpha 2AR function during phases of the menstrual cycle in controls and PMDD patients are inconsistent.

METHODS

alpha 2AR function was examined in 16 PMDD patients and 15 controls during the follicular phase, and in 10 PMDD patients during late luteal phase. Antagonist-measured maximum binding capacity, agonist-measured receptor density in high- and low-conformational states, and agonist affinity to both states were measured. Coupling efficiency to Gi protein was estimated.

RESULTS

There were no significant differences in coupling efficiency. PMDD patients had significantly low antagonist affinity; there were no differences in other binding parameters. There were no changes in alpha 2AR binding parameters between phases of menstrual cycle in PMDD women. alpha 2AR density and symptom severity were inversely related during the follicular phase in controls and patients. During luteal phase, alpha 2AR density correlated positively with symptom severity in patients. High follicular alpha 2AR density predicted more severe luteal symptoms in PMDD patients.

CONCLUSIONS

These findings are discussed in view of the molecular biology of alpha 2AR, and their role in PMDD, anxiety, and depressive disorders.

Alpha 2-adrenoceptors and I1-imidazoline binding sites: relationship with catecholamines in women of reproductive age

A comparison is presented between plasma catecholamine concentrations and platelet [125I]-p-iodoclonidine binding sites in 16 healthy women. Blood samples were obtained at six regularly spaced intervals over two consecutive menstrual cycles from healthy women with regular menstrual periods. Although no cycle-related changes were observed per se, there were significant correlations between the platelet binding sites and plasma norepinephrine and epinephrine concentrations. The densities of platelet alpha 2-adrenoceptors were negatively correlated in an exponential fashion (r2 = 0.694, P = 0.009) with plasma epinephrine concentrations, implying agonist-induced downregulation. On the other hand, platelet I1-imidazoline binding sites were positively correlated with plasma concentrations of norepinephrine in a linear fashion (r2 = 0.326, P = 0.021). This is the first indication that I1 binding sites might be upregulated by a physiological factor. Furthermore, the data suggest that elevations in plasma norepinephrine might explain reports of upregulated I1 binding sites in depressed patients.

Platelet alpha 2-adrenoreceptors, catecholamines, hemodynamic variables, and anxiety in panic patients and their asymptomatic relatives

The objectives of this study were to a) replicate our prior finding of a decreased number (Bmax) of platelet alpha 2-adrenoreceptors in panic disorder, b) determine if binding is also decreased in asymptomatic first-degree relatives of panic patients (known to be at increased risk for developing panic), and c) evaluate the effect of treatment on the presumptive decrease in binding (i.e., is the decrease a state or a trait marker for panic?). Panic patients had clonidine and yohimbine platelet-binding assays, symptom ratings, and measurement of lying and standing plasma epinephrine, norepinephrine, systolic and diastolic blood pressure, and heart rate before treatment, after approximately 2 months of medication (fluoxetine, tricyclics, or alprazolam) and/or cognitive behavioral treatment, and after symptom remission while drug free; normal subjects had determinations of the same measures at approximately the same time intervals. Relatives of both groups had one determination only of all measures. Tritiated clonidine binding was decreased and lying heart rate was increased in patients before treatment. Magnitude of binding decrease was correlated with symptom severity and standing norepinephrine. No binding abnormality was seen in first-degree relatives of patients. Treatment increased clonidine binding in patients. Both patients and relatives of patients showed significantly increased standing plasma norepinephrine in comparison to controls. There is a state-related decrease in binding, associated with symptom severity and norepinephrine, in panic disorder. Abnormal reactivity of norepinephrine to standing might be a marker for increased likelihood of panic development in individuals at risk.

The effects of the menstrual cycle, race, and gender on adrenergic receptors and agonists

OBJECTIVE

To examine possible effects of race, sex, and the menstrual cycle on adrenergic receptors (beta 2 and alpha 2) and agonists.

METHODS

Sixty-three normotensive black men and women and white men and women were studied twice, approximately 6 weeks apart. Women were studied once during the follicular phase and once during the luteal phase of the menstrual cycle. beta 2-Adrenergic receptors and adenylate cyclase activity were examined on lymphocytes, and alpha 2-adrenergic receptors were examined on platelets. Norepinephrine and epinephrine were determined in plasma.

RESULTS

Women showed greater lymphocyte beta 2-receptor sensitivity (isoproterenol-stimulated cyclic adenosine monophosphate; p = 0.009). Women also showed greater postreceptor adenylate cycle activity independent of the beta-receptor (forskolin stimulation; p = 0.006). When these differences were controlled for, the gender-related differences in beta 2-receptor sensitivity were no longer evident. Black women had a reduced beta 2-receptor sensitivity in the luteal phase compared with the follicular phase, whereas white women showed no significant change (p = 0.018). Black subjects had lower lymphocyte beta 2-receptor density (Bmax) values than white subjects (p = 0.047). There were no significant effects on alpha 2-adrenergic receptors.

CONCLUSION

The findings suggest that although there is no generalized effect of the menstrual cycle on adrenergic receptors in white women, such an effect may occur in black women. The findings also suggest that previously reported gender-related differences in beta 2-receptor sensitivity may be due to gender-related differences in postreceptor activity and not the beta 2-receptor per se.

Increased imidazoline and alpha 2 adrenergic binding in platelets of women with dysphoric premenstrual syndromes

An association between dysphoric premenstrual syndromes (PMS) and a lifetime history of major depressive disorders has previously been documented. Other studies have demonstrated an increase in the binding of radiolabeled imidazoline compounds to platelets of depressed patients. Clonidine and related imidazoline compounds interact with alpha 2 adrenoceptors to inhibit neuronal noradrenergic activity and in higher concentrations, they stimulate noradrenergic activity through their interaction with imidazoline receptors. Here we report increased 3H para-aminoclonidine binding to high affinity alpha 2 adrenoceptor sites as well as to nonadrenergic imidazoline binding sites in platelets of women with dysphoric PMS. This higher binding was most pronounced during the late-luteal-symptomatic phase of the menstrual cycle and, to a lesser degree, during the non-symptomatic mid-follicular phase. Binding to the imidazoline site distinguished women with dysphoric PMS from women with no such symptoms, was highly positively correlated with the severity of symptoms, and was negatively correlated with plasma levels of progesterone. These findings suggest that platelet imidazoline binding sites might be a biological marker for dysphoric states in PMS or for the vulnerability to develop them. These findings also point to a possible biological link between dysphoric PMS and major depressive disorders.

Dose-response aggregometry--contribution to the precise platelet function evaluation

A method for the determination of blood platelet aggregability as the function of ADP concentration is described. Individual platelet aggregability was characterised by means of parameters of the sigmoidal relationship between the dose of the aggregating reagent and the aggregation curve amplitude. The method was applied to establish ADP-induced aggregability of various mammalian species. The aggregation curves of rabbit and rat platelets reached significantly lower maximum amplitudes than those of human and dog platelets. The eman concentration of ADP was significantly higher in dog platelets and the slope of the dose-response curve was significantly steeper in rat platelets compared to the other species studied. Some of the causes of individual intra-species ADP-induced aggregation variability revealed by means of dose-response aggregometry are discussed.

Effect of estradiol implant on noradrenergic function and mood in menopausal subjects

The effect of the alpha 2-adrenoceptor agonist, clonidine, on plasma growth hormone (GH), plasma 3-methoxy-4-hydroxyphenylethylenegylcol (MHPG), blood pressure and sedation were studied in 16 menopausal subjects before and 6 wk after a 100-mg implant of estradiol. The specific binding of tritiated yohimbine to intact platelets also was studied. Estradiol implants increased basal GH output and reduced baseline MHPG and sedation scores. However, none of the subsequent responses to clonidine were altered. Platelet yohimbine binding also was unchanged following the implant. Both observer- and self-rating scales showed a marked reduction in anxiety and depression scores. The results suggest that estradiol may alter some indices of noradrenergic function, but that the mechanism does not involve alterations in alpha 2-adrenoceptor sensitivity.

Binding of tritiated yohimbine to platelets in women with maternity blues

Platelet alpha 2-adrenoceptor binding was measured in 108 women in the 36th week of pregnancy, at ten and twenty days and at three and six months post-partum. An age matched non-pregnant control group of women (N = 25) was also studied. The number (Bmax) of alpha 2-adrenoceptors was elevated antepartum but fell to control values on the tenth post-partum day. At three and six months post-partum, however, alpha 2-adrenoceptor Bmax was again increased. Women who developed maternity blues (N = 59) had significantly more platelet alpha 2-adrenoceptors than those who did not (N = 49) at both ten and twenty days post-partum. In addition their alpha 2-adrenoceptor Bmax was greater than controls at all time points measured except the tenth post-partum day. In contrast, the alpha 2-adrenoceptor Bmax of women without the blues did not differ from controls at any stage. It is suggested that women who develop maternity blues may have a relatively enduring abnormality in alpha 2-adrenoceptor sensitivity which is associated with psychological symptoms when concentrations of circulating sex-steroids suddenly change.

Adrenoceptor and imipramine receptor binding during the menstrual cycle

The binding characteristics of platelet alpha 2-adrenoceptors, lymphocyte beta 2-adrenoceptors and platelet imipramine receptors were studied in five women during their menstrual cycle. A significant cyclic variation in the number of beta 2-adrenoceptor sites on intact lymphocytes was found during the menstrual cycle, while binding to alpha 2-adrenoceptors and imipramine receptors remained unchanged.