Hypothalamo-pituitary-adrenal manipulations and stress ulcerations in rats

The Realization of the Brain-Gut Interactions with Corticotropin-Releasing Factor and Glucocorticoids

BACKGROUND

The brain and the gut interact bi-directionally through the brain-gut axis. The interaction is mediated by the autonomic nervous system and the hypothalamic-pituitary-adrenocortical (HPA) system. The first brilliant demonstration of the brain-gut interactions was the cephalic phase of gastric and pancreatic secretion discovered by Ivan Pavlov, the first physiologist who was awarded the Nobel Prize for Physiology or Medicine in 1904. This review aims to identify the HPA system as a key hormonal branch of the brain-gut axis in stress.

METHODS

We first outlined main components of the brain-gut axis and then focused on the HPA system as a key hormonal branch of the brain-gut axis in stress. We undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question.

RESULTS

Seventy-one articles were included in the review, the eleventh of them were articles of Filaretova L. and co-authors. We will discuss in our articles how an endocrinological approach to gastroenterological field can advance our understanding of the HPA axis role in regulation of gastric mucosal integrity and uncover new findings. According to these findings activation of the HPA system is gastroprotective component of the brain-gut axis in stress but not ulcerogenic one as it was generally accepted. Corticotropin-releasing factor (CRF) and glucocorticoids are important natural players provided gastroprotection. The results suggest that an initial action of endogenous glucocorticoids, including stress- and CRF-produced ones, as well as exogenous glucocorticoids, even used at pharmacological doses, is physiological gastroprotective. Prolongation of the hormonal action may lead to the transformation of gastroprotective hormonal effect to proulcerogenic one.

CONCLUSION

The findings of this review demonstrate that corticotropin-releasing factor and glucocorticoids contribute to the realization of the brain-gut interactions and that activation of the HPA system is gastroprotective component of this interaction in stress.

The effects of palm vitamin E on stress hormone levels and gastric lesions in stress-induced rats

INTRODUCTION

This study examines the effects of palm vitamin E (PVE) or α-tocopherol (α-TF) supplementation on adrenocorticotropin hormone (ACTH), corticosterone and gastric lesions in rats exposed to water-immersion restraint stress (WIRS).

MATERIAL AND METHODS

Sixty male Sprague-Dawley rats (200-250 g) were divided into three groups. Group I: 20 rats as a control group were given a normal diet. Group II: 20 rats received oral supplementation of PVE at 60 mg/kg body weight. Group III: 20 rats received oral supplementation of α-TF at 60 mg/kg body weight. After the treatment period of 28 days, each group was further subdivided into two groups: 10 rats not exposed to stress, and the other 10 rats subjected to WIRS for 3.5 h. Blood samples were taken to measure the ACTH and corticosterone levels. The rats were then sacrificed and the stomach excised and opened along the greater curvature and examined for lesions.

RESULTS

Rats exposed to WIRS had lesions in their stomach mucosa. Our findings showed that dietary supplementation of PVE or α-TF was able to reduce gastric lesions significantly in comparison to the stressed controls. The WIRS increased plasma ACTH and corticosterone significantly. Palm vitamin E and α-TF treatments reduced these parameters significantly compared to the stressed controls.

CONCLUSIONS

Supplementation with either PVE or α-TF reduces the formation of gastric lesions, probably by inhibiting the elevation of ACTH and corticosterone levels induced by stress.

Gastroprotective role of glucocorticoid hormones

Gastric ulcer disease remains widespread; a stressful lifestyle and nonsteroidal antiinflammatory drugs (NSAIDs) make significant contributions to this pathological situation. The findings overviewed here support the idea that glucocorticoid hormones released in response to acute stress or NSAIDs act as gastroprotective substances and exert many of the same actions in the stomach as prostaglandins (PGs) and nitric oxide (NO) as well as capsaicin-sensitive afferent neurons. Glucocorticoids exert a gastroprotective effect by both maintaining local defensive factors (mucosal blood flow and mucus production) and inhibiting pathogenic elements (gastric motility and microvascular permeability). Furthermore, they exert gastroprotective actions in co-operation with PGs, NO, and the afferent neurons; and their compensatory action is observed when the protective mechanism provided by either of these factors is impaired. The gastroprotective action of glucocorticoids is also associated with maintenance of general body homeostasis, including blood glucose levels and systemic blood pressure. In conclusion, glucocorticoids released in response to acute stress or NSAIDs are naturally occurring protective factors that play an important role in maintenance of the gastric mucosal integrity. This led us to re-evaluate the traditional paradigm that glucocorticoid hormones produced during activation of the hypothalamic-pituitary-adrenocortical axis are ulcerogenic in the stomach.

Activation of the hypothalamo-hypophyseal-adrenocortical system as an important gastroprotective component of the stress reaction

This article presents an analysis of data providing evidence of the important contribution of the hypothalamo-hypophyseal-adrenocortical system (HHACS) to the processes maintaining the integrity of the gastric mucosa. According to these data, glucocorticoid hormones produced during stress-induced activation of the HHACS are gastroprotective hormones rather than ulcerogenic factors, as is widely believed. The gastroprotective influence of glucocorticoids has been demonstrated on exposure to ulcerogenic stimuli of different modalities. The gastroprotective action of glucocorticoid hormones is mediated via type II glucocorticoid receptors and may be associated with the maintenance of the blood glucose level, their calming effects on pathogenetic factors, and their favorable effects on protective factors for the gastric mucosa. Glucocorticoid hormones can compensate for the absence of the gastroprotective action of prostaglandins, nitric oxide, and capsaicin-sensitive neurons. The data lead to the conclusion that activation of the HHACS is an important gastroprotective component of the stress reaction.

Gastric ulceration and expression of prolactin receptor in the brain in Hatano high- and low-avoidance rats

Recently, prolactin was shown to inhibit the development of stress-induced ulcers. However, the mechanism for suppression of gastric ulcers by prolactin has not been clarified. Hatano high-avoidance (HAA) and low-avoidance (LAA) strains of rats were originally selected and bred from Sprague-Dawley rats based on shuttle-box tasks. The present study focused on the relationships among gastric ulceration and endocrine response with special reference to prolactin secretion and restraint stress in water of HAA and LAA rats. The restraint stress induced an elevation of plasma concentrations of ACTH, corticosterone, and prolactin. Peak levels of plasma ACTH during stressful condition were significantly higher in HAA rats than in LAA rats, while peak levels of prolactin were significantly lower in HAA rats than in LAA rats. The gastric erosion index was significantly higher in HAA rats than in LAA rats 7 h after restraint stress in water. The numbers of prolactin- receptor-positive cells determined by immunohistochemistry in the paraventricular nucleus was significantly increased in LAA rats than in HAA rats 7 h after restraint stress in water. These results indicate that HAA rats were more sensitive than LAA rats to restraint stress in water. The strain differences in gastric ulceration under stress may be involved in peripheral prolactin secretion and central prolactin receptor expression. The expression of prolactin receptor in the paraventricular nucleus may be important in suppressing gastric ulceration.

The hypothalamic-pituitary-adrenocortical system: Hormonal brain-gut interaction and gastroprotection

The hypothalamic-pituitary-adrenocortical system is a hormonal component of brain-gut axis. There are two opposite points of view regarding the influence of stress-induced activation of hypothalamic-pituitary-adrenocortical system on the stomach. According to the widely held view, glucocorticoids released during stress are ulcerogenic hormones and, therefore, stress-induced activation of hypothalamic-pituitary-adrenocortical system is harmful. The results of our investigations are, however, opposite to this traditional view. To estimate the action of glucocorticoids released during stress on the gastric mucosa, the effects of glucocorticoid deficiency or occupation of glucocorticoid receptors by the antagonist RU-38486 on the formation of stress-induced gastric erosions were estimated in rats. The reduction of stress-induced corticosterone release (induced by various experimental approaches) markedly potentiated a gastric erosion formation caused by stress and acute corticosterone replacement, mimicking stress-induced corticosterone response, prevented this erosion-potentiating effect. The administration of RU-38486 also caused a significant increase of vulnerability of gastric mucosa to stress action. Thus, an acute stress-induced increase of glucocorticoids has a gastroprotective action against stress-induced gastric injury. We also showed that various ulcerogenic stimuli, similar to stress, induce an increase in glucocorticoid production that in turn helps the gastric mucosa to resist against a harmful action of ulcerogenic stimuli. Gastroprotective action of glucocorticoids may be mediated by multiple actions, including maintenance of glucose homeostasis, gastric mucosal blood flow, mucus production and attenuation of enhanced gastric motility and microvascular permeability. For maintenance of gastric mucosal integrity glucocorticoids may cooperate with prostaglandins. In conclusion, these findings indicate that activation of hypothalamic-pituitary-adrenocortical system could be considered as a significant gastroprotective component of brain-gut axis.

Sensitization and conditioning as contributors to gastrointestinal vulnerability

Electric shocks are stressful and if signalled can result in Pavlovian conditioning of the stress response. Stress arising from such shocks or conditioned psychological "threat" influences vulnerability to gastrointestinal disorders. Reviewed are our studies with rats showing that unconditioned stress experiences sensitize the glandular portion of the stomach to later restraint-in-water induced erosions, as an animal model of ulcer disease. These stress effects are not attributable to corticoids but may be opioid/endorphin dependent. The unconditioned stress-induced sensitization is reduced by allowing the rat either control over or prediction of the shocks even though the direct experience with shocks is identical. Elicitation of the conditioned stress response by a signal during the ulcer induction or even shortly afterwards increases gastric vulnerability to erosions. We are now finding parallel unconditioned stress effects on colonic erosions and increases in intestinal permeability induced by dextran sulphate sodium, as an animal model of inflammatory bowel disease. We conclude that psychological context of past trauma and/or current threat increases vulnerability to gastrointestinal disorders.

Effect of psychogenic stress on gastrointestinal function

This review summarizes the studies published over the last twenty years on the effects of psychogenic stress on gastrointestinal function, using animal models. The effects of stress on gastric ulceration have received wide attention and the central and local mechanisms of mucosal damage have been, for the most part, clearly delineated. In comparison, relatively few studies have focused on the impact of stress on intestinal and colonic physiology, even though its influence on intestinal motility, mucosal permeability and inflammation has been established. More work is necessary in this field, especially considering the importance of irritable bowel syndrome in modern society.

Anxiety and helplessness in the face of stress predisposes, precipitates, and sustains gastric ulceration

When an organism is subjected to stress, gastric ulcers or ulcerations commonly develop but the vulnerability to and amount of pathology induced varies considerably between individuals. The role of psychological factors in determining the occurrence and severity of these ulcerations is amply demonstrated in the studies reviewed here. The present paper (a) gives a brief history of the search for the causes of gastric ulcer, (b) provides a review of our own research which reveals that vulnerability to gastric ulceration is modulated by psychologically meaningful experiences, and (c) offers a multifactorial perspective on the causes of gastric ulceration and the future of research on it.

Corticosterone increase inhibits stress-induced gastric erosions in rats

The role of glucocorticoids released in response to stress in the pathogenesis of stress-induced gastric erosions has been reevaluated. Gastric erosions elicited in male rats by 3-h cold-restraint or water-restraint stresses were studied after acute reduction of corticosterone release or occupation of glucocorticoid receptors by the antagonist RU-38486 during stress. Stress-induced corticosterone production was reduced by creating a lesion on the hypothalamic paraventricular nucleus (PVN) 4 days before stress as well as by pretreatment with a rabbit antiserum to adrenocorticotropin (ACTH) 30 min before stress. RU-38486 (10 mg/kg po) was administered 20 min before and 60 min after the onset of stress. Corticosterone for replacement was injected 15 min before the onset of stress to mimic stress-induced corticosterone response. Plasma corticosterone levels were measured by fluorometry or RIA. Gastric erosions were quantitated by measuring the area of damage. Four days after PVN lesion, stress-induced corticosterone release was decreased and gastric erosions were increased. Injecting corticosterone significantly attenuated the effect of PVN lesion on gastric erosions. The ACTH antiserum inhibited corticosteroid secretion in response to stress and markedly increased gastric erosions. The administration of the glucocorticoid/progesterone antagonist RU-38486 significantly potentiated the formation of stress-induced gastric erosions. These observations support the suggestion that glucocorticoids released during stress have a gastroprotective action rather than an ulcerogenic effect as was generally accepted.

Restraint stress in biomedical research: an update

Since the publication of our initial review of restraint stress in 1986, much work has continued with this technique, either as a tool for the investigation of other pharmacological, physiological, or pathologic phenomena or with restraint stress itself serving as the object of the study. As we noted in 1986, the major use of restraint has been for the induction of stress responses in animals and, more specifically, for the investigation of drug effects, particularly as they affect typical stress-related pathology--gastrointestinal, neuroendocrine, and immunological agents have been extensively studied. In compiling this update on restraint stress and its effects, we noted an increasing emphasis on central nervous system mechanisms in peripheral disease, especially gastrointestinal disease. In particular, many CNS-active agents have been tested for their effects on gastric and duodenal lesion formation and gastric secretion, including antidepressants, antipsychotics, anxiolytics, noradrenergic, serotonergic, dopaminergic, and peptidergic compounds. Some of these agents are especially active in the gastrointestinal tract even when administered centrally, further solidifying the concept of a brain-gut axis. The present update includes studies of: methods and procedures, pre-restraint manipulations, post-restraint/healing effects, and drug effects. In addition, a current bibliography of reports that have employed restraint is included.

Studies on the interaction between ICV effects of CRF and CNS noradrenaline depletion

The role of an intact locus coeruleus (LC) noradrenergic system for the central effects of corticotropin-releasing factor (CRF) was studied. Rats were treated with N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine hydrochloride (DSP-4), a highly selective noradrenergic neurotoxin permanently affecting mainly the LC system. This procedure did not affect the activation of the sympathetic nervous system, as measured by plasma catecholamine levels, after either intracerebroventricular (ICV) or intraperitoneal (IP) administration of 8-micrograms CRF. Neither was the increased emotionality seen in an open field test after ICV injection of CRF altered. However, the ulceroprotective effect of 8-micrograms CRF ICV during a 2-hr water restraint stress was significantly antagonized by pretreatment with DSP-4, while CRF did exhibit an ulceroprotective effect after IP administration to DSP-4-treated animals. Our data indicate that the ulceroprotective effect of CRF under restraint stress is, at least partly, dependent on an intact locus coeruleus noradrenergic system.