Release of histamine by the liver

Gleb Anrep, 1891-1955

Gleb (Vassilievitch von) Anrep was descended from a famous Westphalian family with a proud history of high military distinction which can be traced back to the tenth century. Field Marshal von Anrep was leader of the Livonian Order of Knights who built an outpost of Christianity on the shores of the Baltic. General von Anrep came to St Petersburg at the invitation of Peter the Great and founded the Russian branch of the family in the eighteenth century. Professor Vassili (Basil) von Anrep (1854-1925) was the first member of this family to prefer science to arms. He was born in St Petersburg and studied law in the university there for a year, but he soon tired of academic legal arguments and entered the Medical Academy where he was a brilliant student. He spent two years studying pharmacology in Leipzig, where he described the local anaesthetic action of cocaine and recommended its use in medicine four years before its introduction by Roller. He returned to Russia to be professor of pharmacology, first in Kharkov and then in the Medical Academy in St Petersburg. At the invitation of Prince Oldenburgski he founded the Institute of Experimental Medicine and directed it for several years. At the command of the Emperor he then founded a medical institute for women doctors, which was needed because Moslem women refused to be treated by men. His public duties interfered with his researches and eventually he devoted himself entirely to the reform of education. He held high administrative posts in connexion not only with medicine but also with education in general, and nearly succeeded in introducing compulsory education for all Russians. In the first world war he was at the head of the Russian Red Cross. At the outbreak of the revolution he was thrown into prison, but was released after six months and since the family had come from the Baltic he managed to obtain a Latvian passport. He arrived in London in 1919, stayed with his younger son Gleb for a few years and then left for Paris, where he died in 1925.

The intestinal phase hormone

The existence of a stimulatory intestinal phase of gastric acid secretion has been suspected, but largely ignored, for many years. Recently, however, it has become clear that the intestinal phase plays an important role in acid production during digestion. The intestinal phase is of additional interest in relation to the profound gastric acid hypersecretion associated with portacaval shunt (PCS). Substantial evidence indicates that PCS-related gastric hypersecretion is due to unmasking of the intestinal phase by hepatic bypass of a humoral stimulant in portal blood that is normally degraded to a considerable extent by the liver. Studies in our laboratory during the past 12 years have provided strong physiologic evidence for humoral mediation of both the intestinal phase of gastric secretion and of PCS-related hypersecretion by a hormone that arises in the small intestine, particularly in the jejunum. Furthermore, our studies have demonstrated that this intestinal phase hormone (IPH) exists in humans as well as in dogs, rats, and pigs. Additionally, recent work by a number of investigators, as well as by our group, has provided convincing evidence that IPH is different from any of the known gastric stimulatory hormones. With these physiologic observations as a background, we have used a classical method for extracting acidic peptides to prepare a hog intestinal mucosa extract (HIME) that has all of the known physiologic properties of an IPH. Specifically, HIME contains a potent stimulant of gastric acid secretion that acts according to a linear dose-response relationship; that is not gastrin in any of its immunoassayable forms; that significantly augments the maximal acid secretory responses to pentagastrin, gastrin, CCK, and histamine; and that is substantially degraded by the liver, in contrast to gastrin and CCK. Efforts at isolating the gastric stimulatory substance in HIME suggest that it is a peptide of low molecular weight. Work directed at isolating IPH in pure form and identifying it is in progress.

[Studies on the pre- and posthepatic plasma histamine concentrations and their possible pathophysiological effects in liver cirrhosis (author's transl)]

Fluorometric estimations of plasma histamine in the peripheral venous blood were performed in a control group of 16 subjects with normal liver values and normal liver biopsy specimen. Two further groups with liver changes were studied: Ten patients with fatty liver (stage I-II) and 22 cases suffering from liver cirrhosis, including 7 patients with portocaval shunt. Additionally, plasma histamine concentrations were determined in the blood of the portal vein, hepatic vein, cubital vein and in the femoral artery of another 11 normal subjects and 8 cirrhotic patients, some of them with portocaval shunt. The elimination of histamine by the liver was calculated. In healthy humans about two thirds (67.8 plus or minus 11.4 per cent; n=11) of the histamine content in the portal vein is eliminated by liver passage. This is due mainly to liver uptake and catabolism of histamine. It could be shown, that the elimination rate (41.0 plus or minus 15.1 per cent, n=8) is diminished in cirrhotic livers. Therefore, the plasma histamine content measured in the peripheral venous blood is significantly higher (p less than 0.001) in cirrhotic patients (1.2 +/- 0.3 ng/ml; n=22) than in healthy subjects (0.7 +/0 0.2 ng/ml; n=16). The expected pathophysiological effects of the elevated plasma histamine levels in liver cirrhosis are discussed with respect to circulatory changes ("hyperdynamic circulation") and their possible role in the development of "hepatogenic" ulcers of the stomach.

Gastric secretion after massive small bowel resection

This paper confirms that gastric hypersecretion can occur in man and dogs after massive intestinal resection. The assumption, made by others, that hypersecretion in the clinical situation is similar to that observed in dogs is challenged. An acute hypersecretory state occurred in eight of 19 patients after massive intestinal resection. This was apparent as an increased rate of basal secretion. It was usually transient and unrelated to the length of intestine resected. A correlation was noticed between hypersecretion and jaundice in the immediate postoperative period. Histamine release after acute hepatic injury was postulated as the cause of the hypersecretion. By contrast a chronic gastric hypersecretory state was demonstrated in dogs after massive intestinal resection. The rate of basal secretion was not significantly altered. The increased daily acid output was shown to be due to prolonged and enhanced response to food. The cause was thought to be loss of inhibitory agents, such as enterogastrone, normally released by the small intestine when in contact with food. The rationale of performing vagotomy and pyloroplasty at the same time as the intestinal resection is questioned.

Histamine metabolism in diseases of the liver

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