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Sokolowska-Mikolajczyk M, Socha M, Mikolajczyk T, Chyb J, Epler P. The effects of naltrexone, an opioid receptor antagonist, on plasma LH levels in common carp (Cyprinus carpio L.). Comp Biochem Physiol C Toxicol Pharmacol 2002; 131:417-24. [PMID: 11976056 DOI: 10.1016/s1532-0456(02)00024-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Naltrexone-an opioid receptor antagonist, was administered intraperitoneally to sexually mature male and female common carp in the prespawning period, in order to investigate its effects on spontaneous or sGnRH-A-stimulated LH secretion. Naltrexone and sGnRH-A were injected at the same time. The possible involvement of a dopaminergic system in this process was studied in males pre-treated with pimozide (a dopamine receptor antagonist) 12 h before naltrexone and/or sGnRH-A administration. Blood samples for the analysis of carp LH concentrations were taken just before the injections and then after the injections, serial sampling during 24 h was performed. In male carp, naltrexone (500 or 5000 microg kg(-1)) decreased spontaneous LH release, but there were no effects of naltrexone on sGnRH-A-stimulated LH secretion. In males pre-treated with pimozide, a similar response to naltrexone injection (500 microg kg(-1)) as in pirnozide non-treated fish, was observed. The highest dose of naltrexone, 5000 microg kg(-1), significantly stimulated LH release, in response to sGnRH-A administration in pimozide pre-treated males. In female carp, contrary to males, naltrexone at a dose of 500 microg kg(-1), caused significant stimulation of spontaneous LH release. These data indicate that endogenous opioid peptides modify LH secretion in sexually mature carp. In males, they stimulate LH secretion, acting rather on the hypothalamic GnRH system and in females, opioids inhibit LH release by the influence on the dopaminergic system.
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Affiliation(s)
- Miroslawa Sokolowska-Mikolajczyk
- Department of Ichthyobiology and Fisheries, University of Agriculture, ul. Prof. T. Spiczakowa 6, 30-199, Krakow-MydIniki, Poland.
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Phogat JB, Smith RF, Dobson H. Effect of adrenocorticotrophic hormone on gonadotrophin releasing hormone-induced luteinizing hormone secretion in vitro. Anim Reprod Sci 1997; 48:53-65. [PMID: 9412733 DOI: 10.1016/s0378-4320(97)00030-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An in vitro perifusion study investigated the effect of different forms of adrenocorticotrophic hormone (ACTH) on gonadotrophin releasing hormone (GnRH)-induced luteinizing hormone (LH) secretion, particularly GnRH self-priming, and oestradiol sensitisation of the ovine pituitary. Fragments of pituitaries were obtained from mixed-breed adult nonpregnant female sheep (without corpora lutea, unless otherwise stated). The amount of LH released by different doses of GnRH (2.5 x 10(-10) M (n = 9 chambers), 1 x 10(-10) M (n = 9), or 5 x 10(-11) M (n = 6)) was evaluated by giving two GnRH pulses (5 min each) 2 h apart. In a duplicate set of chambers, ACTH1-24 (5 x 10(-7) M) was included in the perifusate 0.5 h before the first GnRH challenge. Potassium chloride (KCl; 100 mM) was administered 2 h after the second GnRH challenge to assess the viability of the tissue and the size of the releasable LH pool. Results were expressed as percentage of LH secretion. The influence of ACTH1-24 on oestradiol sensitisation was also examined using pituitaries obtained during the luteal phase. Pituitary tissues were perifused throughout with 1 x 10(-9) M or 6 x 10(-11) M oestradiol in the medium. The LH response to the second GnRH challenge (GnRH 2) was significantly greater (p < 0.01) than after the first (GnRH 1) at the highest dose of GnRH (2.5 x 10(-10) M; 2547 +/- 804 vs. 4547 +/- 1013%), but at the lower doses (1 x 10(-10) M or 5 x 10(-11) M), the self-priming effect of GnRH was not evident (3016 +/- 550 vs. 2932 +/- 490% and 841 +/- 205 vs. 711 +/- 87%). Treatment with ACTH1-24 (5 x 10(-7) M) did not affect tonic LH secretion nor the LH response to the first or second GnRH challenge at any of the GnRH doses tested. The LH released in response to KCl was also similar from control and ACTH1-24-treated tissue at all GnRH doses. Both lower doses of GnRH (1 x 10(-10) M or 5 x 10(-11) M) produced the self-priming effect when the pituitary tissue was sensitised with the higher dose of oestradiol (1 x 10(-9) M; 1711 +/- 239 vs. 5085 +/- 1307%, and 1502 +/- 376 vs. 2619 +/- 629%). In the presence of lower concentrations of oestradiol (6 x 10(-11) M), self-priming was observed only after the higher dose of GnRH (1 x 10(-10) M; 1293 +/- 214 vs. 2865 +/- 436%), not the lower dose (5 x 10(-11) M; 985 +/- 203 vs. 1271 +/- 436%). In spite of these differences, ACTH1-24 treatment did not affect LH secretion (neither basal nor potassium-induced). The effect of ACTH1-39 (1 x 10(-8) M or 5 x 10(-7) M; n = 6 chambers per combination) on GnRH-induced LH secretion was examined using the higher (2.5 x 10(-10) M) or lower dose of GnRH (1 x 10(-10) M), with or without oestradiol sensitisation (1 x 10(-9) M). At the lower dose (1 x 10(-8) M), ACTH1-39 influenced neither tonic nor GnRH-induced LH secretion. The LH released by KCl was also similar to the control and ACTH-treated tissue. In contrast, the higher dose of ACTH1-39 (5 x 10(-7) M) increased tonic LH secretion immediately after inclusion in the medium (104 +/- 3 vs. 161 +/- 20%), but suppressed the GnRH self-priming effect after 2.5 x 10(-10) M, i.e., the LH responses to GnRH 1 and 2 were similar (1786 +/- 294 vs. 1553 +/- 373%). However, the LH response to KCl was not significantly different (p > 0.05) between the control and ACTH-treated tissues (2333 +/- 286 vs. 2638 +/- 431%). When the effect of this higher dose of ACTH1-39 on oestradiol-priming was investigated, ACTH increased tonic LH secretion but suppressed the self-priming effect of GnRH (1 x 10(-10) M GnRH; 945 +/- 274 vs. 922 +/- 323%; p > 0.05), and decreased (p < 0.05) the LH released in response to KCl compared to the controls (1803 +/- 409 vs. 4302 +/- 1017%). In summary, in vitro, ACTH1-24 did not affect either tonic LH secretion, the GnRH self-priming effect, or oestradiol sensitisation. The entire ACTH1-39 increased tonic LH secretion, but reduced GnRH self-priming and oestradiol sensitisation. (ABSTRACT TRUNCATED)
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Affiliation(s)
- J B Phogat
- Department of Veterinary Clinical Science and Animal Husbandry, University of Liverpool, Neston, South Wirral, UK
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Lal P, Rajeshwari Devi RK. Effect of chronic naloxone and morphine treatments on testicular, body weight, and plumage pigmentation cycle of lal munia, Estrilda amandava. Gen Comp Endocrinol 1997; 107:2-11. [PMID: 9208301 DOI: 10.1006/gcen.1997.6882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
At Imphal (24 degrees 44' N) testes of lal munia, Estrilda amandava, began in June/July, peaked in September/ October, and thereafter declined to a minimum in December/January. Daily im treatments of 2.5-10 mg/kg/ bird/30 days of naloxone during progressive phase suppressed testicular growth, but without effects during quiescent, peak, and regression phases. Daily morphine (5 mg/kg/bird) during progressive and peak phases stimulated testicular growth, but without effects during quiescent and regression phases. Daily morphine (10 mg/kg/bird) during progressive phase stimulated the testes, an effect reversed by daily im treatments of an equivalent dose of naloxone. Seasonal changes in body weight closely correlated with testicular size. Daily im naloxone (5 and 10 mg/kg/bird/30 days) during progressive phase inhibited the increased body weight, but had no effects during quiescent, peak, and regression phases. Morphine (5 mg/kg/bird/day) during progressive and peak phases increased body weight, but had no effects during quiescent and regression phases. Morphine (10 mg/kg/bird/day) during progressive phase increased body weight, an effect which was reversed by equivalent dose of naloxone. Plumage color increased progressively between May and August/September, was maintained during October, and thereafter declined to reach dull-brown henny feathers by December. Daily im naloxone (2.5-10 mg/kg/bird/30 days) regardless of the reproductive states did not affect plumage color cycle. Morphine (5 mg/kg/ bird/day) accelerated plumage pigmentation between June and August, but had no effect during progressive or peak phases. Postnuptial decline in plumage color was inhibited by morphine (5 and 10 mg/kg/bird/day) and naloxone failed to reverse this effect. It is concluded that in the lal munia, endogenous opioid peptides are important constituents of the neuroendocrine mechanisms that influence development of the testes and body weight.
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Affiliation(s)
- P Lal
- Department of Life Sciences, Manipur University, Canchipur, Imphal, India
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4
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Smart D. Adrenocorticotrophin (ACTH) 1–39 and corticotrophin releasing hormone (CRH) induced changes in luteinizing hormone secretion from perifused ovine pituitaries. Anim Reprod Sci 1994. [DOI: 10.1016/0378-4320(94)01317-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Evans A, Currie W, Cook S, Rawlings N. The effects of intravenous infusion of naloxone and progesterone on luteinising hormone secretion in ovariectomised ewes. Anim Reprod Sci 1994. [DOI: 10.1016/0378-4320(94)90007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
The anterior pituitary (AP) has been shown to contain a wide variety of bioactive peptides: brain-gut peptides, growth factors, hypothalamic releasing factors, posterior lobe peptides, opioids, and various other peptides. The localization of most of these peptides was first established by immunocytochemical methods and some of the peptides were localized in identified cell types. Although intracellular localization of a peptide may be the consequence of internalization from the plasma compartment, there is evidence for local synthesis of most of these peptides in the AP based on the identification of their messenger-RNA (mRNA). In several cases the release of the peptide from the AP cell has been shown and regulation of synthesis, storage and release have also been described. Because the amount of most of the AP peptides is very low (except for POMC peptides and galanin), endocrine functions are not expected. There is more evidence for paracrine, autocrine, or intracrine roles in growth, differentiation, and regeneration, or in the control of hormone release. To demonstrate such functions, in vitro AP experiments have been designed to avoid the interference of hypothalamic or peripheral hormones. The strategy is first to show a direct effect of the peptide after adding it to the in vitro system and, secondly, to explore if the endogenous AP peptide has a similar action by using blockers of peptide receptors or antisera immunoneutralizing the peptide.
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Affiliation(s)
- H Houben
- University of Leuven, School of Medicine, Department of Pharmacology, Belgium
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7
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Currie W, Bauer M, Rawlings N. The effect of naloxone on LHRH secretion from the median eminence of anestrous ewes. Anim Reprod Sci 1993. [DOI: 10.1016/0378-4320(93)90031-l] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Shacoori V, Guerin J, Girre A, Saïag B, Rault B. Effect of naloxone and beta-casomorphin on the hypothalamic-pituitary-luteinizing hormone axis in vitro. Life Sci 1992; 51:899-907. [PMID: 1518367 DOI: 10.1016/0024-3205(92)90397-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The effect of naloxone and beta-casomorphin on luteinizing hormone (LH) release from pituitary cell aggregates, obtained by three-dimensional culture, with or without mediobasal hypothalamic fragments was studied in vitro. Short-term naloxone perifusion at a concentration of 10(-5)M did not modify either basal or LHRH-stimulated LH release from the pituitary cell aggregates. In contrast, a 12-min naloxone perifusion at the same concentration caused an increase in LH release in the mediobasal hypothalamic-pituitary cell aggregate axis. This increase was rapid (12-16 min after time pulse), marked [up to 10 times (p less than 0.004) the initial base line], short (return to the base line secretion 32-40 min after the beginning of the time pulse) and dose-dependent, with a rise greater than 1000% at a concentration of 10(-4) (p less than 0.006). The same effect was observed when a second pulse was applied 48 min after the first one. LH release induced by naloxone was antagonized 56 +/- 2% (p less than 0.03) by beta-casomorphin (an exogenous opiate) at a concentration of 10(-5) M. beta-casomorphin alone did not modify LH basal secretion, but inhibited 25.1 +/- 2.4% (p less than 0.008) LH release enhanced by LHRH. These results indicate that naloxone, an opiate antagonist, markedly increases LH release via a mu-type opioid receptor mechanism at the hypothalamic level only, during short-term exposure.
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Affiliation(s)
- V Shacoori
- Laboratoire de Physiologie Pharmaceutique, Faculté de Pharmacie, Rennes, France
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Pinaud MA, Roser JF, Dybdal N. Gonadotropin releasing hormone (GnRH) induced luteinizing hormone (LH) secretion from perifused equine pituitaries. Domest Anim Endocrinol 1991; 8:353-68. [PMID: 1747998 DOI: 10.1016/0739-7240(91)90003-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In vitro responsiveness of the horse anterior pituitary (AP) gonadotropes to single and multiple GnRH challenges was examined. The pituitaries were collected from reproductively sound mares in estrus (n = 5) and diestrus (n = 5). Uniform 0.5 mm AP slices were subdivided using a 3 mm biopsy punch and then bisected for use in the perifusion chamber. Four bisected sections per chamber were perifused at 0.5 ml/min at 37 C for 560 min in Medium 199 saturated with 95% 0(2)/5% CO2. Ten minute fractions were collected after an initial 2 hr equilibration period. Four different treatment regimes of GnRH (10(-10) M) were evaluated: (A) three consecutive 10 min GnRH pulses separated by 80 and 100 min, respectively; (B) a single 120 min GnRH infusion; (C) a 10 min GnRH pulse followed 80 min later by a 120 min GnRH infusion and (D) two 10 min GnRH pulses separated by 60 min followed 80 min later by a 120 min GnRH infusion. Estimated total pituitary LH content was higher in estrous than diestrus mares (p less than 0.05). The total amount of LH released in response to GnRH tended to be greater in estrus than diestrus (p less than 0.1), whereas the percentage of LH released in estrus and diestrus was similar. An increase in the area under the LH response curve was noted with each successive 10 min pulse of GnRH during both estrus and diestrus (p less than 0.05), demonstrating a self-priming effect of GnRH. In addition, a significant increase in the peak LH amplitude (p less than 0.05) and the slope to peak amplitude (p less than 0.05) were observed for the 120 min GnRH pulse in regime C and D indicating that prior exposure to short-term pulses of GnRH increased the acute LH secretory response. These results suggest that in the cycling mare (1) the responsiveness of the pituitary (amount of LH released as percent of total LH) is similar in both estrus and diestrus, however, the magnitude of the LH response (total microgram amount of LH released) differs with the stage of the estrous cycle, being highest in estrus, and appears to be related, in part, to pituitary LH content and (2) GnRH self-priming occurs independently of the stage of the estrous cycle. Furthermore, we have demonstrated that the pulsatile mode of GnRH can act directly on the anterior pituitary to dictate the pulsatile release pattern of LH in the cycling mare.
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Affiliation(s)
- M A Pinaud
- Department of Animal Science, University of California, Davis 95616
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Barb CR, Kraeling RR, Rampacek GB. Opioid modulation of gonadotropin and prolactin secretion in domestic farm animals. Domest Anim Endocrinol 1991; 8:15-27. [PMID: 2013220 DOI: 10.1016/0739-7240(91)90036-j] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- C R Barb
- Animal Physiology Unit, Richard B. Russell Agricultural Research Center, USDA, ARS, Athens, GA 30613
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Abstract
Behavioral stress can prevent animals from achieving normal reproductive success. Stressors associated with intensive livestock management may be responsible for reduced reproductive efficiency. However, before appropriate management decisions can be made to alleviate the effects of behavioral stress on reproduction, it is necessary to identify the mechanisms by which stress disrupts normal reproduction. The neuroendocrine regulation of follicular development and ovulation requires a complex and delicate interplay between the pituitary gonadotropins and the feedback actions of the major follicular steroid, estradiol. Because of this complexity, the regulation of the follicular stage of the estrous cycle and ovulation is especially vulnerable to the effects of stress. Although the pathophysiological mechanisms by which stress disrupts reproduction are not fully understood, the stress-induced secretion of adrenal glucocorticoids seems to be of special significance because these steroids can effect both the synthesis and secretion of gonadotropins. Of additional importance may be the role of corticotropin-releasing hormone and adrenocorticotropin on the regulation of the hypothalamic-pituitary-gonadal axis.
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Affiliation(s)
- G P Moberg
- Department of Animal Science, University of California, Davis 95616
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12
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Woods JE, Honan MP, Thommes RC. Hypothalamic regulation of the adenohypophyseal-testicular axis in the male chick embryo. Gen Comp Endocrinol 1989; 74:167-72. [PMID: 2653951 DOI: 10.1016/0016-6480(89)90209-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
An antibody against luteinizing hormone-releasing hormone (LHRH) as well as naloxone, an opioid antagonist, were added to the chorioallantoic membrane (CAM) of 11.5- and 14.5-day-old male chick embryos and plasma testosterone (T) concentrations were determined. This protocol was designed to demonstrate: (1) Whether LHRH is essential in the regulation of the adenohypophyseal-testicular axis in the male embryo and (2) if LHRH is operative in this unit's function, are opiatergic pathways involved in the secretion of LHRH by the hypothalamus. Both anti-LHRH and naloxone lowered plasma T levels in 14.5-day-old embryos, but not 11.5-day-old embryos. This indicates that the hypothalamus, via LHRH, begins to regulate the pituitary-testicular unit at some time between Days 11.5 and 14.5, i.e., the hypothalamo-adenohypophyseal-testicular axis is established. The results also strongly suggest that the normal secretory pattern of LHRH is dependent upon opiatergic innervation of the hypothalamus at the same embryonic time.
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Affiliation(s)
- J E Woods
- College of Liberal Arts and Sciences, De Paul University, Chicago, Illinois 60614
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Kalra SP, Allen LG, Sahu A, Kalra PS, Crowley WR. Gonadal steroids and neuropeptide Y-opioid-LHRH axis: interactions and diversities. JOURNAL OF STEROID BIOCHEMISTRY 1988; 30:185-93. [PMID: 3290580 DOI: 10.1016/0022-4731(88)90092-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report that the two classes of regulatory neuropeptides, neuropeptide Y (NPY) and endogenous opioid peptides (EOP), modulate luteinizing hormone (LH) release in diverse fashion in gonad-intact rats. Each neuropeptide acts at two loci, the hypothalamus and pituitary, to excite (NPY) or inhibit (EOP) LH release. At the hypothalamic level, NPY stimulates luteinizing hormone releasing hormone (LHRH) release, a response mediated by alpha 2-adrenoreceptors and amplified in the presence of adrenergic agonists. At the pituitary level, NPY acts in concert with LHRH to amplify the LH response. In contrast, EOP inhibit LHRH release by decreasing the supply of excitatory adrenergic signals in the vicinity of LHRH neurons in the preoptic-tuberal pathway, and at the pituitary level, they decrease LH release in response to LHRH. Further, the gonadal steroidal milieu facilitates NPY neurosecretion and postsynaptic expression of NPY in concert with adrenergic system; a similar clear-cut facilitatory effect of gonadal steroids on EOP secretion is not yet obvious. Our additional studies imply that the EOP system has the potential to increase sensitivity towards gonadal steroids and that to induce the preovulatory LH surge the neural clock may decrease the inhibitory EOP tone prior to the critical period on proestrus. This antecedent neural event allows the excitatory adrenergic and NPY signals to evoke LHRH secretion at a higher frequency approximating that seen in ovariectomized rats. Further studies are under way to delineate the steroid-induced subcellular events that integrate the action of these regulatory peptides in the control of the episodic LHRH secretion pattern which sustains basal and cyclic gonadotropin release in the rat.
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Affiliation(s)
- S P Kalra
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville 32610
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Currie WD, Rawlings NC. Naloxone enhances LH but not FSH release during various phases of the estrous cycle in the ewe. Life Sci 1987; 41:1207-14. [PMID: 3114579 DOI: 10.1016/0024-3205(87)90198-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Suffolk x whiteface ewes were infused with 0.5 mg/kg/hr naloxone hydrochloride (NAL) for 6 hrs during the early, mid and late luteal and early follicular phases of the estrous cycle. Basal serum luteinizing hormone (LH) concentration was increased by NAL during each trial in the luteal phase and LH pulse amplitude was proportionately increased by 158%, 164% and 350% during the early luteal, mid luteal and early follicular phases, respectively. The apparent NAL induced increase (92%) in LH pulse amplitude during the late luteal phase was not significant. NAL only affected LH pulse frequency during the early follicular phase, when it was decreased. Mean serum follicle stimulating hormone (FSH) concentration was not affected by NAL. The results of this study indicate that endogenous opioid peptides (EOPs) may partially mediate the suppressive influence of estradiol-17 beta (E2) on LH pulse amplitude and also the stimulatory effect of E2 on LH pulse frequency in the early follicular phase. The data may suggest that NAL enhances the amplitude of pulses of gonadotropin releasing hormone (GnRH) by counteracting E2 inhibitory effects on LH release at the level of the pituitary. Alternately, some component of E2 feedback may be an EOP mediated component at the level of the hypothalamus.
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Kalra SP, Karla PS, Sahu A, Allen LG, Crowley WR. The steroid-neuropeptide connection in the control of LHRH secretion. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1987; 219:65-83. [PMID: 3324688 DOI: 10.1007/978-1-4684-5395-9_4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- S P Kalra
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville 32610
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