Anaphylactoid reactions activate hypothalamo-pituitary-adrenocortical axis: comparison with endotoxic reactions

Mast cells in the autonomic nervous system and potential role in disorders with dysautonomia and neuroinflammation

Mast cells (MC) are ubiquitous in the body, and they are critical for not only in allergic diseases but also in immunity and inflammation, including having potential involvement in the pathophysiology of dysautonomias and neuroinflammatory disorders. MC are located perivascularly close to nerve endings and sites such as the carotid bodies, heart, hypothalamus, the pineal gland, and the adrenal gland that would allow them not only to regulate but also to be affected by the autonomic nervous system (ANS). MC are stimulated not only by allergens but also many other triggers including some from the ANS that can affect MC release of neurosensitizing, proinflammatory, and vasoactive mediators. Hence, MC may be able to regulate homeostatic functions that seem to be dysfunctional in many conditions, such as postural orthostatic tachycardia syndrome, autism spectrum disorder, myalgic encephalomyelitis/chronic fatigue syndrome, and Long-COVID syndrome. The evidence indicates that there is a possible association between these conditions and diseases associated with MC activation. There is no effective treatment for any form of these conditions other than minimizing symptoms. Given the many ways MC could be activated and the numerous mediators released, it would be important to develop ways to inhibit stimulation of MC and the release of ANS-relevant mediators.

Anaphylactic hypotension causes renal and adrenal sympathoexcitaion and induces c-fos in the hypothalamus and medulla oblongata

NEW FINDINGS

What is the central question of this study? Whether anaphylaxis affects sympathetic outflows to the brown adipose tissue (BAT) and adrenal gland and whether anaphylaxis affects some brain areas in association with sympathetic regulation. What is the main finding and its importance? Sympathoexcitatory responses to anaphylaxis occurred regionally in the kidney and adrenal gland, but not in the thermogenesis-related BAT. Further, anaphylactic hypotension also caused increase in c-fos immunoreactivity in the hypothalamic and medullary areas. Moreover, catecholaminergic neurons of the brainstem cause adrenal sympathoexcitation in a baroreceptor-independent manner.

ABSTRACT

We previously reported that sympathetic nerve activity (SNA) to the kidney and the hindlimb increases during anaphylactic hypotension in anaesthetized rats. Based on this evidence, we examined effects of anaphylactic hypotension on SNA to the brown adipose tissue (BAT), and the adrenal gland and kidney in anaesthetized rats. We demonstrated that adrenal and renal SNA, but not BAT-SNA, were stimulated. In addition, the effects of anaphylaxis on neural activities of the hypothalamic and medullary nuclei, which are candidates for relaying efferent SNA to the peripheral organs, were investigated via immunohistochemical staining of c-fos. Anaphylaxis increased c-fos expression in the neurons of the paraventricular nucleus (PVN) of the hypothalamus and in those of the nucleus tractus solitarii (NTS) and rostral ventrolateral medulla (RVLM) of the medulla oblongata; c-fos was expressed in γ-aminobutyric acid (GABA)-ergic neurons of the NTS and in the catecholaminergic neurons of the RVLM. In addition, c-fos expression in the rostral NTS and mid NTS during anaphylaxis was reduced by sinoaortic baroreceptor denervation; however, increased c-fos expression in the caudal NTS and RVLM or adrenal sympathoexcitation were not affected by sinoaortic baroreceptor denervation. These results indicated that anaphylactic hypotension activates the hypothalamic PVN and the medullary NTS and RVLM independently of the baroreflex pathway. Further, it stimulated efferent SNA to the adrenal gland and kidney to restore blood pressure.

Blunted HPA axis response in lactating, vasopressin-deficient Brattleboro rats

Adaptation to stress is a basic phenomenon in mammalian life that is mandatorily associated with the activity of the hypothalamic-pituitary-adrenal (HPA) axis. An increased resting activity of the HPA axis can be measured during pregnancy and lactation, suggesting that these reproductive states lead to chronic load in females. In this study, we examined the consequences of the congenital lack of vasopressin on the activity of the HPA axis during lactation using vasopressin-deficient Brattleboro rats. Virgin and lactating, homozygous vasopressin-deficient rats were compared with control, heterozygous rats. In control dams compared with virgins, physiological changes similar to those observed in a chronic stress state (thymus involution, adrenal gland hyperplasia, elevation of proopiomelanocortin mRNA levels in the adenohypophysis, and resting plasma corticosterone levels) were observed. In vasopressin-deficient dams, adrenal gland hyperplasia and resting corticosterone level elevations were not observed. Corticotropin-releasing hormone (Crh) mRNA levels in the hypothalamic paraventricular nucleus were elevated in only the control dams, while oxytocin (OT) mRNA levels were higher in vasopressin-deficient virgins and lactation induced a further increase in both the genotypes. Suckling-induced ACTH and corticosterone level elevations were blunted in vasopressin-deficient dams. Anaphylactoid reaction (i.v. egg white) and insulin-induced hypoglycemia stimulated the HPA axis, which were blunted in lactating rats compared with the virgins and in vasopressin-deficient rats compared with the controls without interaction of the two factors. Vasopressin seems to contribute to the physiological changes observed during lactation mimicking a chronic stress state, but its role in acute HPA axis regulation during lactation seems to be similar to that observed in virgins. If vasopressin is congenitally absent, OT, but not the CRH, compensates for the missing vasopressin; however, the functional restitution remains incomplete.

Methylene blue administration in the compound 48/80-induced anaphylactic shock: hemodynamic study in pigs

PURPOSE

To verify if the methylene blue (MB) administration prevents and/or reverses the compound 48/80 (C48/80)-induced anaphylactic shock in pigs.

METHODS

Female Dalland pigs were anesthetized and had the hemodynamic parameters recorded during the necessary time to administer some drugs and observe their effect. The animals were randomly assigned to one of the five groups: 1) control; 2) MB: the animals received a bolus injection of MB (2 mg/kg) followed by continuous infusion of MB (2.66 mg/Kg/h delivered by syringe infusion pump); 3) C48/80: the animals received a bolus injection of C48/80 (4 mg/kg); 4) C48/80+MB: the animals received a bolus injection of C48/80 (4 mg/kg) and 10 minutes after the C48/80 administration the animals received a bolus injection of MB (2 mg/kg) followed by continuous infusion of MB (2.66 mg/Kg/h delivered by syringe infusion pump); 5) MB+C48/80: the animals received a bolus injection of MB (2 mg/kg) and 3 minutes later they received a bolus injection of C48/80 (4 mg/kg).

RESULTS

The intravenous infusion of MB alone caused no changes in the mean arterial pressure (MAP) showing that the administered MB dose was safe in this experimental model. The C48/80 was effective in producing experimental anaphylactic shock since it was observed a decrease in both MAP and cardiac output (CO) after its administration. The MB did not prevent or reverse the C48/80-induced anaphylactic shock in this model. In fact, the MAP of the animals with anaphylactic shock treated with MB decreased even more than the MAP of the animals from the C48/80 group. On the other hand, the C48/80-induced epidermal alterations disappeared after the MB infusion.

CONCLUSION

Despite our data, the clinical manifestations improvement brings some optimism and does not allow excluding the MB as a possible therapeutic option in the anaphylactic shock.

Nitric oxide has a role in attenuating the neuroendocrine response to anaphylactoid stress during lactation

Stress increases nitric oxide (NO) production in the paraventricular nucleus of the hypothalamus (PVH). Lactation diminishes the response to stress and increases basal NO production markers in the PVH of the dam. This study investigated whether lactation modified the anaphylactic reaction to egg white (EW) injection, and if nitric oxide regulates the neuroendocrine response to this stressor. The activational response of PVH to EW was assessed by c-Fos immunohistochemistry, and NO production was determined by histological staining of NADPH-diaphorase and neuronal nitric oxide synthase (nNOS) and by measuring the concentration of total nitrates and nitrites (NOx) in the hypothalamus of lactating and diestrus rats. EW injection significantly increased the number of Fos-positive neurons in the parvocellular subdivision of the PVH in diestrus, but not in lactating rats. Similarly, EW injection increased the number of NADPH-diaphorase- and nNOS-positive cells in the PVH of diestrus rats, but it did not alter the already increased basal number of NO-positive cells in lactating rats. Furthermore, the total concentration of NOx in the hypothalamus, the circulating level of corticosterone and interleukin-6 increased significantly after EW in diestrus, but not in lactating rats, compared to their corresponding controls. Intracerebral administration of L-NAME, a general NOS inhibitor, reversed the attenuation of the activational response to EW in the PVH of lactating rats. The present results show that lactation diminishes the anaphylactoid reaction to EW compared to that in diestrus rats. This attenuation was absent after L-NAME treatment, suggesting that sustained NO production in the PVH during lactation may limit the neuroendocrine response to stress.

Compound 48/80 causes oxidative stress in the adrenal gland of rats through mast cell degranulation

Rats were intraperitoneally treated once with compound 48/80 (C48/80), a mast cell degranulator, (0.75 mg/kg). Serum serotonin, histamine and corticosterone levels increased 0.5 h after C48/80 treatment, but their increases were reduced thereafter. Adrenal total ascorbic acid (ascorbic acid plus dehydroascorbic acid), ascorbic acid and dehydroascorbic acid levels decreased 0.5, 3 or 6 h after C48/80 treatment, adrenal lipid peroxide level increased at 3 and 6 h, adrenal non-protein-SH level decreased at 3 and 6 h and adrenal beta-tocopherol level decreased at 3 h. Ketotifen, a mast cell stabilizer (1 mg/kg) administered intraperitoneally at 0.5 h before C48/80 treatment, attenuated all these changes found in the serum and adrenal at 3 h after treatment, while beta-tocopherol (250 mg/kg), administered orally at 0.5 h after C48/80 treatment, attenuated all these changes in the adrenal tissue. These results indicate that C48/80 causes oxidative stress in rat adrenal gland through mast cell degranulation.

Changes in c-Fos and NOS expression in the PVH of lactating rats in response to excitotoxicity and stress

This study investigated how lactation modified the expression patterns of Fos and nitric oxide synthase in the hypothalamic paraventricular nucleus (PVH) induced by excitotoxicity and stress. Kainic acid or egg white treatment weakly activated Fos expression in the PVH of lactating in comparison to diestrus or ovariectomized (OVX) rats. Labels for NADPH-diaphorase and nNOS revealed a different distribution pattern in the PVH depending on the physiological condition and challenge. The present results confirm that lactation attenuates the PVH activational response to stress and excitotoxicity, and both stimuli induced nitric oxide expression in the PVH of diestrus, lactating, and OVX rats.

Nasal provocation of patients with allergic rhinitis and the hypothalamic-pituitary-adrenal axis

BACKGROUND

Allergic rhinitis is a common problem involving activation of nasal mast cells and irritability. The hypothalamic-pituitary-adrenal (HPA) axis is stimulated in cases of emotional or environmental stress, and mast cells have been implicated in stress-induced immune responses.

OBJECTIVE

To investigate whether intranasal challenge of patients allergic to a single antigen would stimulate the HPA axis.

METHODS

Plasma corticotropin and cortisol levels were measured 20, 40, 60, 80, 100, and 120 minutes after intranasal antigen administration in healthy volunteers (n=3) and in patients with rhinitis who are allergic to Parietaria (n=10).

RESULTS

Mean +/- SD corticotropin levels were 24.43 +/- 14.38 pg/mL in patients compared with 8.83 + 5.02 pg/mL in controls, and this increase was statistically significant (P = .049). Patient cortisol levels also increased to a mean +/- SD of 8.87 +/- 4.90 pg/mL (at 40 minutes) compared with 4.36 +/- 1.72 pg/mL in controls (P = .11 due to 1 outlier). Compared with individual patient prechallenge levels, corticotropin levels increased in 7 patients and cortisol levels increased in 5 at 40 minutes.

CONCLUSION

These results suggest that allergic rhinitis may activate the HPA axis. A larger study with additional controls is required for definitive conclusions.

Functional heterogeneity of the responses of histaminergic neuron subpopulations to various stress challenges

In rats, the cell bodies of the histaminergic neuronal system are clustered in five distinct cell groups (E1-E5) within the posterior hypothalamus. On the basis of tract tracing studies, these histaminergic subgroups have been regarded as one functional unit. In addition to its well-characterized role in arousal, locomotor activity, metabolism, feeding, drinking and behaviour, as well as in coordination of autonomic functions, histamine has been implicated in regulation of the hypothalamo-pituitary-adrenocortical axis during stress. To address the capacity of different histaminergic subgroups to respond to various challenges, we revealed c-Fos, the immediate early gene marker of activated neurons, in histamine synthesizing neurons by combining c-Fos immunocytochemistry with in situ hybridization of histidine decarboxylase (HDC) mRNA. Compared to the negligible colocalization of these markers in control rats, restraint, insulin-induced hypoglycaemia and foot shock resulted in specific activation of histamine synthesizing neurons of the E4 and E5 subgroup in the tuberomammillary region. Up to 36% of HDC mRNA-expressing cells show c-Fos immunoreactivity in the E5 region. In addition, some neurons of the E1, E2 and E3 histaminergic groups were activated after restraint stress. Many less c-Fos-positive histaminergic neurons were detected after immobilization and dehydration. Ether stress, acute hyperosmotic stimulus or injection of bacterial lipopolysaccharide did not activate hypothalamic HDC-positive neurons. These results suggest, for the first time, the functional heterogeneity of histaminergic neuron population, the components of which are recruited in a stressor- and subgroup-specific manner.

Endogenous glucocorticoids inhibit scratching behavior induced by the administration of compound 48/80 in mice

In this study, we investigated the effects of endogenous glucocorticoids on the compound 48/80 (a condensation product of N-methyl-p-methoxyphenethylamine with formaldehyde)-induced mouse scratching behavior using either RU-486 (mifepristone), a glucocorticoid receptor antagonist, or a surgical resection of the adrenal glands. Subcutaneous injection of compound 48/80 induced not only a corticosterone elevation in the plasma but also an enhanced expression of corticotropin releasing hormone (CRH) mRNA in the paraventricular nucleus, which thus suggests that hypothalamic-pituitary-adrenal axis is activated by the compound 48/80-induced cutaneous reaction. Inhibition of such an endogenous glucocorticoid activity by RU-486 significantly increased the degree of scratching behavior at not only the early-phase (<60 min) but also the late-phase (>60 min) time course after the injection of compound 48/80. Since the elevation of the histamine levels in the plasma in the RU-486-treated mice was no longer found in late-phase scratching behavior, these results thus indicate that histamine is a dominant mediator responsible for early-phase scratching behavior, while different mediators other than histamine may be also involved in the induction of late-phase scratching behavior. Moreover, surgical removal of adrenal glands also significantly increased the compound 48/80-induced scratching behavior without affecting anxiety and locomotor parameters, indicating that endogenous glucocorticoids exert their anti-pururitogenic effects independently of changes in behavioral performance. In conclusion, endogenous glucocorticoid activity was found to suppress the compound 48/80-induced scratching behavior in mice.