Identification of pro-opiomelanocortin-derived peptides in the human adrenal medulla

Nonopioid effect of β-endorphin

This review presents the generalized literature data and the results of our own research of the nonopioid effect of β-endorphin, an opioid neuropeptide interacting not only with opioid but also with nonopioid (insensitive to the opioid antagonist naloxone) receptors. The roles of the hormone and its receptors in regulation of the immune, nervous, and endocrine systems are discussed. The effect of neuromediator on the immune system mediated by both opioid and nonopioid receptors is considered in detail. The data on distribution and function of the nonopioid β-endorphin receptor in human and animal organisms are presented. All available data on the characteristics of the nonopioid β-endorphin receptor obtained by means of radioligand analysis are given. The discussed information is supposed to extend our conceptions of the role of β-endorphin in mammals and to be of extensive use in medicine and pharmacology.

ACTH is a novel regulator of bone mass

Adrenocorticotropin (ACTH) is one of several peptide hormones derived from a larger molecule, proopiomelanocortin (POMC). ACTH is a classic endocrine hormone, processed and secreted from the pituitary to stimulate cortisol production from the fasciculata cells in the adrenal gland. However, ACTH is also produced by other cells, including macrophages, at many sites in the body. ACTH binds to a specific member of the melanocortin receptor family, the MC2R. MC2R is expressed in osteoblastic cells in vivo, as shown by in situ hybridization. MC2R expression is strongest at sites of active bone deposition, and thus ACTH response probably varies with osteoblastic activity or stage of osteoblast differentiation. In vitro ACTH stimulates proliferation of osteoblasts in a dose-dependent manner. ACTH at 10 nM increases collagen I mRNA in the osteoblastic cell line SaOs2, although at lower concentrations ACTH may oppose osteoblast differentiation. ACTH is thus, at high concentrations, anabolic for the osteoblast, and it is highly likely that the hormone has concentration-dependent effects on bone metabolism in vivo.

Tyrosine hydroxylase, chromogranin A, and steroidogenic acute regulator as markers for successful separation of human adrenal medulla

Progress in high throughput "-omic" techniques now allows the simultaneous measurement of expression levels of thousands of genes and promises the improved understanding of the molecular biology of diseases such as cancer. Detection of the dysfunction of molecular pathways in diseases requires healthy control tissue. This is difficult to obtain from pheochromocytomas (PHEOs), rare chromaffin tumors derived from adrenal medulla. The two options for obtaining adrenal tissue are: (1) whole organ removal post-mortem or during radical nephrectomy; (2) removal during PHEO surgery. Access to high quality normal adrenal tissue is limited. Removal of whole adrenals during nephrectomy is rare, because of improved surgical techniques. For adrenals removed post-mortem, the lag time to proper organ perfusion causes uncontrolled tissue degradation. Adjacent normal adrenal tissue can almost never be obtained from resected PHEOs, because they often replace the entire medulla or are well-encapsulated. If a margin of normal adrenal is attached to a resected PHEO, it seldom contains any medulla. The clean separation of medulla and cortex is further complicated, because their border is convoluted, and because adult adrenal consists of approximately 90% cortex. Thus, the quality of separation has to be evaluated with specific medullary and cortical markers. We describe the successful dissection of highly pure, medullary tissue from adrenals snap-frozen upon resection during radical nephrectomy or after brain death. Separation quality has been verified by quantitative reverse transcription with polymerase chain reaction for the medullary enzymes, tyrosine hydroxylase, and chromogranin A, and for the cortical enzyme, steroidogenic acute regulator.

The role of beta-endorphin in the pathophysiology of major depression

A role for beta-endorphin (beta-END) in the pathophysiology of major depressive disorder (MDD) is suggested by both animal research and studies examining clinical populations. The major etiological theories of depression include brain regions and neural systems that interact with opioid systems and beta-END. Recent preclinical data have demonstrated multiple roles for beta-END in the regulation of complex homeostatic and behavioural processes that are affected during a depressive episode. Additionally, beta-END inputs to regulatory pathways involving feeding behaviours, motivation, and specific types of motor activity have important implications in defining the biological foundations for specific depressive symptoms. Early research linking beta-END to MDD did so in the context of the hypothalamic-pituitary-adrenal (HPA) axis activity, where it was suggested that HPA axis dysregulation may account for depressive symptoms in some individuals. The primary aims of this paper are to use both preclinical and clinical research (a) to critically review data that explores potential roles for beta-END in the pathophysiology of MDD and (b) to highlight gaps in the literature that limit further development of etiological theories of depression and testable hypotheses. In addition to examining methodological and theoretical challenges of past clinical studies, we summarize studies that have investigated basal beta-END levels in MDD and that have used challenge tests to examine beta-END responses to a variety of experimental paradigms. A brief description of the synthesis, location in the CNS and behavioural pharmacology of this neuropeptide is also provided to frame this discussion. Given the lack of clinical improvement observed with currently available antidepressants in a significant proportion of depressed individuals, it is imperative that novel mechanisms be investigated for antidepressant potential. We conclude that the renewed interest in elucidating the role of beta-END in the pathophysiology of MDD must be paralleled by consensus building within the research community around the heterogeneity inherent in mood disorders, standardization of experimental protocols, improved discrimination of POMC products in analytical techniques and consistent attention paid to important confounds like age and gender.

A case of multiple endocrine neoplasia type II accompanied by thyroid medullary carcinoma and pheochromocytomas expressing corticotropin-releasing factor and urocortins

A 38-year-old woman with RET gene mutation presented with tumors in her thyroid and bilateral adrenal glands. I-metaiodobenzylguanidine scintigraphy revealed accumulation of the radioisotope in both adrenal glands. Both plasma adrenaline and noradrenaline levels were elevated. The circadian rhythms for plasma adrenocorticotropic hormone (ACTH) and cortisol levels were disturbed. Plasma ACTH and cortisol levels failed to be suppressed by an overnight dexamethasone test, suggesting autonomic secretion of ACTH and cortisol, although the patient had no typical Cushingoid features, hypertension, or impaired glucose tolerance. Pathological examination showed that these tumors were pheochromocytoma and thyroid medullary carcinoma, respectively, both of which highly expressed corticotropin-releasing factor, urocortin1, and urocortin3. Together with the endocrinological and pathological observations, the patient was diagnosed as multiple endocrine neoplasia type II with corticotropin-releasing factor- and urocortin-producing tumors that stimulated ACTH and glucocorticoid secretion.

Urocortin 1, urocortin 3/stresscopin, and corticotropin-releasing factor receptors in human adrenal and its disorders

CONTEXT

Urocortin 1 (Ucn1) and urocortin 3 (Ucn3)/stresscopin are new members of the corticotropin-releasing factor (CRF) neuropeptide family. Ucn1 binds to both CRF type 1 (CRF1) and type 2 receptors (CRF2), whereas Ucn3 is a specific agonist for CRF2. Recently, direct involvement of the locally synthesized CRF family in adrenocortical function has been proposed.

OBJECTIVE, DESIGN, AND SETTING

We examined in situ expression of Ucn and CRF receptors in nonpathological human adrenal gland and its disorders using immunohistochemistry and mRNA in situ hybridization.

RESULTS

Ucn immunoreactivity was localized in the cortex and medulla of nonpathological adrenal glands. Ucn1 immunoreactivity was marked in the medulla, whereas Ucn3 was immunostained mostly in the cortex. Both CRF type 1 and CRF2 were expressed in the cortex, particularly in the zonae fasciculata and reticularis but very weakly or undetectably in the medulla. Immunohistochemistry in serial tissue sections with mirror images revealed that both Ucn3 and CRF2 were colocalized in more than 85% of the adrenocortical cells. mRNA in situ hybridization confirmed these findings above. In fetal adrenals, Ucn and CRF receptors were expressed in both fetal and definitive zones of the cortex. Ucn and CRF receptors were all expressed in the tumor cells of pheochromocytomas, adrenocortical adenomas, and carcinomas, but its positivity was less than that in nonpathological adrenal glands, suggesting that Ucn1, Ucn3, and CRF receptors were down-regulated in these adrenal neoplasms.

CONCLUSIONS

Ucn1, Ucn3, and CRF receptors are all expressed in human adrenal cortex and medulla and may play important roles in physiological adrenal functions.

Evaluation of ovarian POMC mRNA through quantitative RT-PCR analysis in Rana esculenta

The evaluation of changes in the expression of specific genes requires accurate measurement of the corresponding mRNA concentration, especially when the gene is expressed at a very low level. We previously showed that the proopiomelanocortin (POMC) gene is expressed in the ovary of the frog Rana esculenta, and, to evaluate its mRNA content in frog ovary, we have now developed a sensitive quantitative RT-PCR method. This study provides evidence for the validation of this method and for the effects of captivity and hypophysectomy on POMC gene expression in the ovary of this anuran. Our data indicate that ovarian POMC gene is involved in short-term captivity stress response and seems not influenced by pituitary. These results are discussed taking into account the knowledge of the role played by opioids in stress response; moreover, a local control of POMC gene expression is also suggested.

PP/PYY cells from endocrine pancreas of the scincid lizard Eumeces inexpectatus synthesize ACTH- and alpha-MSH-like molecules

The endocrine pancreas of the scincid lizard Eumeces inexpectatus secretes four major hormones, insulin, glucagon, somatostatin, and pancreatic polypeptide (PP); in addition, other peptides and neuropeptides, often colocalized in one of the principal cell types (A, B, D, and PP), were detected by light and ultrastructural immunocytochemistry. In particular, the pancreas is rich in peptide tyrosine tyrosine (PYY), ACTH, and alpha-MSH immunoreactivity. When single- and double-immunolabeled serial sections were compared for immunostaining for PP, PYY, ACTH, and alpha-MSH, there was broad coincidence with PP, termed PP/PYY, cells in view of the extensive colocalization of these two peptides. Furthermore, ultrastructural morphometric studies revealed similar secretory granules for PP immunoreactive (ir) and ACTH ir cells, while the endocrine cells express pro-opiomelanocortin (POMC) mRNA, indicating an active, extrapituitary synthesis of the POMC-derived peptides in these cells. In conclusion, the presence of POMC-derived peptides in the endocrine pancreatic cells suggests that they may regulate insulin secretion.

Adrenomedullectomy prevents the suppression of pulsatile luteinising hormone release during fasting in female rats

Fasting inhibits the pulsatile secretion of luteinising hormone (LH) in female rats, an effect which is potentiated by the presence of oestradiol (E2). We have previously described various pharmacological or surgical treatments that can rapidly restore the pulses in a fasting animal. Nevertheless, the central and peripheral mechanisms that mediate this suppression of the pulses remain unclear. We have recently shown that adrenomedullectomy prevents the suppression of LH pulses by insulin-induced hypoglycaemia, a state which activates the sympathoadrenal axis. The present study was undertaken to establish whether this axis might contribute to the loss of the pulses that occurs in ovariectomised E2-treated rats that have been fasted for 48 h. Following sham adrenomedullectomy LH pulses were observed in animals fed ad libitum; after 48 h of fasting the animals that had received this sham procedure showed a significant suppression of LH levels and LH pulse frequency. In contrast, adrenomedullectomy prevented the inhibition of the pulses by 48 h of fasting; it had no effect on the pulses in the absence of fasting. These results suggest that adrenomedullary activity plays a significant role in the fasting-induced suppression of LH pulses in rats.

Identification and sequencing of a putative variant of proopiomelanocortin in human epidermis and epidermal cells in culture

Proopiomelanocortin (POMC) is a precursor polypeptide for various bioactive peptides, including adrenocorticotropic hormone, alpha-, beta-, and gamma-melanotropin, beta-endorphin, and beta-lipotropin. Although the classical source of POMC is the pituitary, various studies indicate the expression of POMC in several nonpituitary tissues. In this study, in situ hybridization with anti-sense cRNA riboprobe was used to show expression of POMC mRNA in human epidermis and cultured human epidermal cells (melanocytes and keratinocytes). POMC mRNA was amplified by reverse transcriptase-polymerase chain reaction using anti-sense and sense primers designed from Exons 2 and 3 of POMC gene. A approximately 300 bp product was present in normal human skin, grafted human skin, and cultured normal human melanocytes and keratinocytes. By Southern analysis this product was hybridized specifically to the POMC cDNA. Sequence analysis of the reverse transcriptase polymerase chain reaction product from tissues or cells showed 85% homology to POMC cDNA from human, bovine, pig, and monkey sources. This suggests the existence of a putative isoform or variant of POMC mRNA in human epidermis.

The effect of repeated human corticotropin-releasing hormone administration on dexamethasone-suppressed pituitary-adrenocortical activity in healthy subjects

A dexamethasone suppression test (DST) using a dosage of 1.5 mg dexamethasone was administered two times in randomized order to 10 healthy male subjects. From 2300 hours to 0700 hours subjects were injected repeatedly with either increasing dosages of human corticotropin-releasing hormone (hCRH) or 0.9% saline. In comparison to saline administration, in which cortisol levels remained suppressed, the time course of cortisol concentrations with hCRH stimulation showed a biphasic secretory pattern. According to a criterion level of a minimum of 40 ng/mL plasma for nonsuppression, the majority of the subjects changed their DST status to nonsuppression with hCRH. Adrenocorticotropic hormone secretion also differed significantly between saline and hCRH administration. During stimulation with hCRH, plasma dexamethasone levels were slightly and nonsignificantly reduced in the morning hours. Our results indicate that repeated dosages of hCRH impair the dexamethasone-induced suppression in man and support an involvement of CRH also in mediation of the DST nonsuppression during depressive illness.

Morphological and functional studies of the paracrine interaction between cortex and medulla in the adrenal gland

Within the last years it has become evident that besides the hypothalamo-pituitary-adrenal axis, extrapituitary mechanisms exist that regulate the activity of the adrenal cortex. In this context, intra-adrenal regulatory mechanisms play an important role. Several secretory products from adrenomedullary cells are able to influence adrenocortical steroidogenesis. Since the main blood flow within the adrenal is directed centripetally from the cortex to the medulla, chromatin cells should act on cortical cells in a paracrine manner. The morphological prerequisite for this regulatory pathway is seen in the close apposition of the two tissues. Within the mammalian adrenal, the two endocrine tissues are interwoven to an astonishing degree with cortical cells located within the medulla and vice versa. It is concluded from morphological and functional studies that paracrine interactions between cortex and medulla play an important role in the regulation of adrenocortical steroidogenesis.

Pro-opiomelanocortin-derived peptides, cytokines, and nitric oxide in immune responses and stress: an evolutionary approach

In vertebrates, including man, the study of stress has contributed substantially to unravelling the complex relationship between immune-neuroendocrine interactions and the systems involved. On the basis of data on the presence and distribution of the main actors (POMC products, cytokines, biogenic amines, and steroid hormones) in different species and taxa from invertebrates to vertebrates, we argue that these responses have been deeply connected and interrelated since the beginning of life. Moreover, the study of nitric oxide suggests that the inflammatory reaction is located precisely between the immune and stress responses, sharing the same fundamental evolutionary roots. The major argument in favor of this hypothesis is that the immune, stress, and inflammation responses appear to be mediated by a common pool of molecules that have been conserved throughout evolution and that from a network of adaptive mechanisms. One cell type, the macrophage, appears to emerge as that most capable of supporting this network critical for survival; it was probably a major target of selective pressure. All these data fit the unitarian hypothesis we propose, by which evolution favors what has been conserved, rather than what has changed, as far as both molecules and functions are concerned.

The hypothalamic-pituitary-adrenal axis in anorexia nervosa

Studies examining the function of the hypothalamic-pituitary-adrenal (HPA) axis in anorexia nervosa are reviewed. A principal finding is that of hypercortisolism, associated with increased central corticotropin-releasing hormone levels and normal circulating levels of adrenocorticotropic hormone. Similarities between neuroendocrine findings in anorexia nervosa and in affective disorder are reviewed. The contribution of circadian rhythm disturbances and malnutrition to observed HPA axis abnormalities in anorexia nervosa is also considered. Directions for future research are discussed.

Proopiomelanocortin, its derived peptides, and the skin

Proopiomelanocortin (POMC) is a protein synthesized predominately in the pituitary gland but also in a variety of other tissues, including the skin. Through enzyme-mediated cleavage that varies among cell types, POMC can give rise to at least eight distinct peptides whose biologic roles are incompletely delineated. Although blood-borne pituitary-derived bioactivity for the skin was first recognized 80 years ago and the responsible neuropeptides isolated 20-40 years ago, our understanding of POMC-derived peptides in skin is still rapidly evolving. In particular, recent work in cultured human and murine skin-derived cells has demonstrated POMC gene expression as well as modulation of POMC and many of its derived peptides in response to physiologic signals including ultraviolet irradiation and cytokines. Immunoreactivity for these peptides has also been detected in normal skin and hair follicles, strongly suggesting cutaneous synthesis in vivo. Candidate autocrine or paracrine functions include enhanced melanogenesis, immunomodulation, and effects on cell cycle regulation and differentiated function in both the epidermis and its appendages. This article reviews recent data concerning POMC gene expression and regulation, protein processing, signal transduction, and biologic functions relevant to cutaneous biology.

Increased expression of proopiomelanocortin (POMC) mRNA in adrenal glands of mice undergoing graft-versus-host disease (GVHD): association with persistent elevated plasma corticosterone levels

GVHD in animal models induces severe thymic atrophy as a result of prolonged secretion of high concentrations of adrenal glucocorticoids. In this study we investigated the mechanism responsible for the persistent stimulation of the adrenal glands to secrete glucocorticoids in mice undergoing GVHD. GVHD was induced across the major and multiple minor histocompatibility antigen difference in unirradiated C57Bl/6 x AF1 hybrid mice by the intravenous injection of A strain parental lymphoid cells. Our results showed plasma corticosterone (CS) levels were elevated in association with high concentrations of corticotropin (ACTH) in both the GVHD and control syngeneic (SYN) groups on day 9. By days 16 and 24, plasma CS and ACTH in the SYN mice returned to basal levels. In contrast, plasma CS levels remained elevated in the GVHD animals on days 16 and 24 despite decreasing concentrations of plasma ACTH. Reverse transcription-polymerase chain reaction (RT-PCR) showed several-fold increase in POMC mRNA in the adrenal glands of GVHD mice compared with SYN animals. In addition, high mRNA levels for murine prohormone convertase 1, the enzyme that cleaves POMC into ACTH, were also detected in GVHD adrenals. Histological analysis of GVHD adrenals failed to show any sign of adrenalitis, and RT-PCR of GVHD adrenals also failed to detect mRNA for interferon-gamma (IFN-gamma), a cytokine expressed by activated T and natural killer (NK) cells. However, mRNA for IL-12, a cytokine produced by activated macrophages, was increased in GVHD adrenals, suggesting that resident adrenal macrophages were activated during GVHD. Our findings suggest that persistent elevated levels of plasma glucocorticoids during GVHD could be mediated by intra-adrenal ACTH produced by resident adrenal macrophages activated as a consequence of GVHD.

Bacterial lipopolysaccharide (LPS) and interleukin 1 (IL-1) exert multiple physiological effects in the tilapia Oreochromis mossambicus (Teleostei)

To gain insight in immuno-endocrine communication in teleosts the physiological effects of interleukin 1 and bacterial lipopolysaccharide in teleosts were investigated. Tilapia (Oreochromis mossambicus) were treated with murine interleukin 1 and E. coli lipopolysaccharide in vivo, and lipopolysaccharide was administered to pituitary lobes and head kidneys in vitro. The integument of the fish appeared to be a sensitive target for the preparations tested, since proliferation of chloride cells and of epidermal mucous cells was observed as well as an increase in epidermal thickness. These effects may relate to an acute phase-like reaction caused by the treatments. Lipopolysaccharide administration furthermore resulted in an increase in plasma free fatty acids levels. Lipopolysaccharide, but not interleukin 1, stimulated the interrenal axis of the fish, as judged by the increase in cortisol production measured in superfusion of head kidneys. In addition to these in vivo effects, lipopolysaccharide also displayed several effects in vitro. Pituitary adrenocorticotropic hormone, as well as alpha-melanocyte stimulating hormone, release was inhibited, and the head kidney responsiveness to adrenocorticotropic hormone was inhibited after pretreatment of the tissue with the E. coli product. This latter effect coincided with the release of an unidentified alpha-melanocyte stimulating hormone immunoreactive fraction by the head kidneys which could be stimulated by lipopolysaccharide. The data strongly support the notion that the immune system is involved in adaptive regulations in teleosts, and that immunoendocrine interactions are phylogenetically old mechanisms.

A novel hypothesis: specific oncogenes and tumor suppression genes are involved in the expression of the proopiomelanocortin gene by small cell lung cancer

The endogenous opioid beta-endorphin, a derivative of proopiomelanocortin, stimulates the growth of cloned human small cell lung carcinoma. The present hypothesis states that mutations of the retinoblastoma gene (a tumor suppressor gene) associated to the malignant transformation of bronchial cells would trigger a cascade of biomolecular events leading to 'de novo' proopiomelanocortin expression in small cell lung carcinoma.

Regulation of carboxypeptidase E by membrane depolarization in PC12 pheochromocytoma cells: comparison with mRNAs encoding other peptide- and catecholamine-biosynthetic enzymes

PC12 cells, a rat pheochromocytoma cell line, have been found to express carboxypeptidase E (CPE) enzymatic activity and CPE, furin, and peptidylglycine alpha-amidating monooxygenase (PAM) mRNAs. PC12 cells secrete CPE activity in response to depolarization induced by 50 mM KCl. Short-term (1- to 3-h) treatments of PC12 cells with KCl stimulates the secretion of CPE but does not appear to stimulate the synthesis of new CPE protein, based on the measurement of CPE activity and incorporation of [35S]-Met into CPE. Also, CPE mRNA is not altered by 2-h treatments with KCl. In contrast, prolonged treatment (24-48 h) of PC12 cells with 50 mM KCl continues to stimulate the secretion of CPE activity, without altering the cellular level of CPE. Levels of CPE mRNA are significantly elevated after long-term treatment of the cells with KCl, with increases of 35% after 5 h and 55-75% after 24 to 72 h of treatment. The level of PAM mRNA is also elevated approximately 70% after 24 h of stimulation with KCl. In contrast, the mRNA levels of furin and dopamine beta-hydroxylase (DBH) do not change on treatment of PC12 cells with KCl. These findings indicate that long-term depolarization, which leads to a prolonged stimulation of PC12 cells to secrete CPE, also stimulates the synthesis of CPE and PAM but not furin or DBH.

Characteristics and kinetics of proopiomelanocortin mRNA expression by human leucocytes

Northern blot analysis of total and poly(A)+ RNA demonstrated that human leucocytes contain several proopiomelanocortin (POMC) mRNA species, including 0.8-, 1.2-, 1.5-, and 9.5-kb transcripts. Peripheral blood lymphocytes (PBL) were found to express all four species. The other cell types had either the 0.8-kb species alone or both 0.8- and 9.5-kb species. Neutrophils were the only cells to express the 9.5-kb transcript alone. In T cell clones, both interleukin (IL)-2 alone or the antigen for which the clone was specific induced POMC accumulation within 18-24 h. Cytoplasmic dot blot analysis of PBL RNA demonstrated that POMC expression could be induced by corticotrophin releasing factor, rIL-1, and phorbol ester, but not by calcium ionophore (A23187). In PBL activated in a mixed lymphocyte culture there was increased expression, particularly of the smaller species (0.8, 1.2, and 1.5 kb), within 1-3 days of activation. The intensity of the bands began to decline thereafter. The 9.5-kb POMC transcript essentially disappeared by Day 3.

Central analgesic mechanisms: a review of opioid receptor physiopharmacology and related antinociceptive systems

Clinical applications of these principles, based on the increased understanding of central analgetic mechanisms, are already being undertaken. Not only does the use of intrathecal and epidural opioids have the potential to decrease pain and related morbidity after surgical procedures, but there is at least one study that demonstrates a significant reduction in both major morbidity and mortality in high-risk surgical patients in whom epidural anesthesia and analgesia were used. These principles are also useful for the management of patients undergoing cardiac surgery. Currently, high-dose narcotic anesthesia is the technique of choice for such patients because of the greater hemodynamic stability this anesthetic technique provides. However, breakthrough hypertension and tachycardia still occur, and prolonged postoperative ventilation is a necessary consequence due to the high doses of narcotics that are required. In one study of patients undergoing coronary artery surgery, preoperative administration of clonidine, 5 micrograms/kg, orally, was demonstrated to decrease fentanyl requirements by 45% (110 to 61 micrograms/kg) while producing a similar degree of hemodynamic stability as seen with high-dose fentanyl. Extubation times were not compared, but the significantly lower dosage of fentanyl in the clonidine-treated group would be expected to lead to an earlier extubation. Whether similar potentiation of narcotic effects would be seen with dexmedetomidine, which may also prevent narcotic-induced rigidity, has not been determined, but the clinical application of such synergistic and complementary agents is another consequence of the greater understanding of central analgesic mechanisms, and augurs well for the future.

Abnormal adrenal gland metabolism in opioid addicts: implications for clinical treatment

Adrenal gland metabolism is markedly altered in heroin addicts. During daytime hours, the addict may suffer corticoid deficiency of the addisonian type, and in the evening, an excess of the cushingoid type. The high plasma levels of cortisol that are found in the evening in addicts antagonize endogenous opioids in a manner similar to naloxone. In the present study, 72% of the heroin addicts who sought treatment demonstrated reduced adrenal cortisol reserve. Effective immune and stress responses are dependent on adrenal cortisol reserve. This finding provides an explanation for the heroin addict's vulnerability to AIDS and other infectious diseases. One of methadone's greatest attributes is that it helps normalize adrenal metabolism. Clinical methods to at least partially correct adrenal metabolism may enhance current opioid addiction treatment modalities.

Reflex splanchnic nerve stimulation increases levels of carboxypeptidase E mRNA and enzymatic activity in the rat adrenal medulla

Carboxypeptidase E (CPE; EC 3.4.17.10) is a carboxypeptidase B-like enzyme involved with the biosynthesis of numerous peptide hormones and neurotransmitters, including the enkephalins. Reflex splanchnic stimulation of the rat adrenal medulla, which has previously been found to substantially increase enkephalin mRNA and enkephalin peptide levels, was examined for an influence on CPE mRNA and enzymatic activity. Several hours after insulin-induced reflex splanchnic stimulation, the levels of CPE activity in rat adrenal medulla are reduced to 40-60% of control. CPE activity returns to the control level 2 days after the treatment and then continues to increase, reaching approximately 200% of control 1 week after the treatment. The time course of the changes in CPE activity is different from those of the changes in epinephrine levels and the previously reported changes in enkephalin peptide levels. CPE mRNA is also influenced by the insulin shock, with levels increasing to 155% of the control level after 6 h and 170% after 2 days. The time course of the change in CPE mRNA levels is similar to that previously found for proenkephalin mRNA. However, the magnitude of the change is much different: Proenkephalin mRNA has been reported to increase by 1,600%. The changes in CPE mRNA and enzymatic activity are consistent with the proposal that CPE is not a rate-limiting enzyme in the biosynthesis of enkephalin.

Mapping enteroendocrine cell populations in transgenic mice reveals an unexpected degree of complexity in cellular differentiation within the gastrointestinal tract

The gastrointestinal tract is lined with a monolayer of cells that undergo perpetual and rapid renewal. Four principal, terminally differentiated cell types populate the monolayer, enterocytes, goblet cells, Paneth cells, and enteroendocrine cells. This epithelium exhibits complex patterns of regional differentiation, both from crypt-to-villus and from duodenum-to-colon. The "liver" fatty acid binding protein (L-FABP) gene represents a useful model for analyzing the molecular basis for intestinal epithelial differentiation since it exhibits cell-specific, region-specific, as well as developmental stage specific expression. We have previously linked portions of the 5' nontranscribed domain of the rat L-FABP gene to the human growth hormone (hGH) gene and analyzed expression of the fusion gene in adult transgenic mice. High levels of hGH expression were noted in enterocytes as well as cells that histologically resembled enteroendocrine cells. In the present study, we have used immunocytochemical techniques to map the distribution of enteroendocrine cells in the normal adult mouse gut and to characterize those that synthesize L-FABP. In addition, L-FABP/hGH fusion genes were used to identify subsets of enteroendocrine cells based on their ability to support hGH synthesis in several different pedigrees of transgenic mice. The results reveal remarkable differences in transgene expression between, and within, enteroendocrine cell populations previously classified only on the basis of their neuroendocrine products. In some cases, these differences are related to the position occupied by cells along the duodenal-to-colonic and crypt-to-villus axes of the gut. Thus, transgenes appear to be sensitive tools for examining the cellular and regional differentiation of this class of intestinal epithelial cells.

Adrenocortical atrophy of hypophysectomized rats can be reduced by corticotropin-releasing hormone (CRH)

The effects of high dose injections of corticotropin-releasing hormone (CRH) on the adrenal cortex of hypophysectomized rats were studied at the light- and electron-microscopical levels. Adrenocortical atrophy induced by hypophysectomy could be reduced by daily i.p. injection of 10 micrograms (3 nmol) CRH given for 3 days starting at day 5 after the operation. The cortex broadened, mostly because of hypertrophy of the zona fasciculata. Blood vessels were enlarged. Although the adrenocortical cells of hypophysectomized rats showed features of a functionally suppressed state, such as tubular mitochondria, the cells of CRH-treated animals showed characteristics of stimulated cells. The inner membrane of the mitochondria formed the typical densely packed vesicles of adrenocortical cells that are active in steroidogenesis. Lipid droplets were found to be reduced, and the cells developed filopodia at their surface. These morphological observations indicate that CRH influences the adrenal cortex via extrapituitary mechanisms.

The synthesis of ACTH and related peptides by tumours

Despite all we have learned, the reason why certain tumours and particularly non-pituitary tumours synthesize ACTH remains an enigma. There is no clear theory which links the neoplastic process with the expression of peptide hormones but it is interesting to speculate that the amplification of certain oncogenes may be linked to de-repression of hormone genes. Once the gene has been switched on, there should be some mechanism for preventing continuous expression and in the pituitary the POMC gene is normally inhibited by glucocorticoids. Therefore it is crucial to investigate the role of glucocorticoids in non-pituitary tumours and this requires an understanding of the molecular mechanisms involved in glucocorticoid inhibition of the normal POMC gene in the pituitary. The evidence presented in this chapter describing the glucocorticoid receptor binding site in the promoter region of the POMC gene in rat pituitary gives an exciting insight into the regulatory mechanisms and their potential for aberrant control. Taken with the presence of pituitary-specific regions regulating the POMC gene promoter there appear to be multiple approaches to dissecting out the differences in non-pituitary tumours. Thus in a relatively short period of time there has been a marked increase in our understanding of the molecular mechanisms underlying POMC gene expression. At the level of the peptides, progress has been slower. We are now aware that secretion of ACTH implies that a number of other peptides will be found in the circulation, even though there is limited evidence for a specific role for any of the co-secreted peptides. However, it is hard to understand the conflicting reports that N-POC is synthesized by non-small cell and small cell carcinoma of the lung when ACTH, which we assume to be co-secreted, is thought to be synthesized only by small cell carcinoma. The most likely explanation for this is the difficult nature of the radio-immunoassays for these hormones and the problems associated with studying large groups of clearly defined patients. Development of very simple methods for measuring the ACTH precursors has demonstrated that they are released into the circulation in normal subjects and that the levels are markedly elevated in non-pituitary tumours, suggesting that they are the major circulating forms in the ectopic ACTH syndrome. This implies that these tumours cannot process the precursor molecules suggesting that the processing enzymes are lacking.(ABSTRACT TRUNCATED AT 400 WORDS)

Regulatory elements of the pro-opiomelanocortin gene: pituitary specificity and glucocorticoid repression

A short 543-bp fragment o f the pro-opiomelanocortin gene is sufficient for pituitary-specific expression and, in the anterior pituitary gland, for repression of pro-opiomelanocortin transcription by glucocorticoids. Within this 5'-flanking fragment of the gene, multiple regulatory elements contribute to tissue-specific expression and a single glucocorticoid receptor binding site acts as a "negative glucocorticoid response element." The current model for glucocorticoid repression depends on the mutually exclusive binding of the glucocorticoid receptor and of a positive transcription factor, the chicken ovalbumin upstream promoter element transcription factor, to overlapping DNA sequences within the negative glucocorticoid response element.

Amidated joining peptide in the human pituitary, gut, adrenal gland and bronchial carcinoids. Immunocytochemical and immunochemical evidence

The distribution of the proopiomelanocortin-derivated amidated joining peptide (JP-N) was examined in the human pituitary gland, adrenal gland, gut and in three bronchial carcinoids. Double immunostaining showed coexistence of immunoreactive JP-N and other proopiomelanocortin derivatives, e.g., ACTH, beta-endorphin, Pro-tau-MSH, in the pituitary gland and adrenal medulla. The JP-N immunoreactive cells in the adrenal medulla were identified as a subpopulation of adrenaline-producing cells by means of an antiserum against phenylethanolamine N-methyltransferase. In the gut immunoreactive JP-N was costored with somatostatin in endocrine cells. Using radioimmunoassay, JP-N was found in higher concentrations than ACTH and alpha-MSH in the gut but not in the adrenal gland. Gel chromatography of gastric antrum and adrenal gland extracts showed three and two dominating components of immunoreactive JP-N, respectively, but under reduced conditions most of the immunoreactive material appeared as of low molecular weight in both extracts. In conclusion, immunoreactive JP-N is a major product from the processing of proopiomelanocortin in human extrapituitary tissues. The molecular forms of immunoreactive JP-N correspond to previous findings in the human pituitary gland.

Beta-endorphin and central control of arterial blood pressure during challenge of circulatory homeostasis

A variety of neurotransmitters and neuropeptides appear to participate in the central control mechanisms of arterial blood pressure. Our knowledge of these mechanisms is limited as yet. In the present study the involvement of the opioid peptide beta-endorphin in circulatory homeostasis was studied. Under conditions in which beta-endorphin does not affect basal blood pressure and heart rate this peptide had a pronounced prohypotensive influence in normotensive rats. This was found for two conditions during which circulatory homeostasis was challenged. Firstly, during blood letting in a rat model employed to test blood pressure regulation during hemorrhage, and secondly, for the central hypotensive action of alpha-methyldopa. In the first model hypotension was produced by stepwise bleeding to respectively 80, 60 and 40 mmHg mean arterial pressure. Intracerebroventricular (i.c.v.) administration of an antiserum raised against beta-endorphin or of naloxone (s.c. or i.c.v.) caused a significant increase in the required bleeding volume, whereas an opposite action was observed after the injection of morphine (s.c.) or of beta-endorphin (i.c.v.). The role of beta-endorphin in the hypotensive action of alpha-methyldopa, given intracisternally (i.c.) was evaluated in conscious rats equipped with chronic cannulas. Pretreatment with the opiate antagonist naltrexone (i.c.) caused an inhibition of the hypotension and bradycardia induced by alpha-methyldopa. This effect of the receptor antagonist was mimicked by i.c. administration of a beta-endorphin antiserum. Taken together, these data point to a hypotensive influence exerted by endogenous beta-endorphin under conditions during which circulatory homeostasis are challenged.

Immunocytochemical Localization and Biochemical Characterization of alpha-Melanocyte-Stimulating Hormon in the Brain of the Rainbow Trout, Salmo gairdneri

Abstract The distribution of alpha-melanocyte-stimulating hormone (alpha-MSH)-like immunoreactivity in the central nervous system of the rainbow trout Salmo gairdneri was investigated by indirect immunofluorescence and peroxidase-antiperoxidase techniques, using a highly specific antiserum generated in rabbits against synthetic alpha-MSH. Immunoreactive perikarya were exclusively observed in the basal hypothalamus within the pars anterioris of the nucleus lateralis tuberis. In this region, a moderate number of small stained cell bodies were observed surrounding the dorsal wall of the anterior infundibular recess. These immunoreactive cells were organized in rostro-caudal rows extending over the whole portion of the nucleus. Positive fibres originating from these perikarya were visualized in the dorsal posterior lobe and the ventral hypothalamus. A dense tract of immunoreactive fibres projected ventrally through the pituitary stalk and terminated in the neurohypophysis. The concentrations of alpha-MSH in different regions of the brain were measured by means of a sensitive and specific radioimmunoassay. The dilution curves obtained with synthetic alpha-MSH and serial dilutions of diencephalon, mesencephalon, medulla oblongata, telencephalon or pituitary extracts were strictly parallel. The highest concentration of alpha-MSH in brain was found in the diencephalon (1.31 +/- 0.07 ng/mg protein). In contrast alpha-MSH was not detectable in cerebellar extracts. Reverse-phase high-performance liquid chromatography and radioimmunoassay were used to characterize alpha-MSH-like peptides in the trout brain and pituitary. Two major forms of immunoreactive alpha-MSH were resolved by high performance liquid chromatography in hypothalamic extracts; these peptides exhibited the same retention times as des-Na-acetyl alpha-MSH and its sulfoxide derivative, respectively. Additional peaks of alpha-MSH immunoreactive material were detected in pituitary extract. These latter peptides coeluted with authentic alpha-MSH, diacetyl alpha-MSH and their sulfoxide forms. These results provide the first evidence for the presence of alpha-MSH in the brain of a teleostean fish. Our data indicate that, in the brain, the immunoreactivity corresponds to the non-acetylated form of alpha-MSH, while three different types of alpha-MSH-like molecules (namely deacetylated, monoacetylated, and diacetylated forms) coexist in the pituitary. It thus appears that, in salmonoid fish, mono- or diacetylation of the N-terminal serine residue of aL-MSH only occurs at the pituitary level.

Reduction of immunoreactive ACTH in plasma following intravenous injection of delta sleep-inducing peptide in man

Eleven healthy male volunteers, ages 25-39 years, received a single dose of synthetic delta sleep-inducing peptide (DSIP) (25 nmol/kg BW) or saline intravenously in a randomized cross-over, double-blind study. The concentrations of neuropeptides related to the hypothalamic pituitary-adrenal (HPA) axis and cortisol were examined in serial plasma samples. In addition, cortisol and monoamine metabolites were determined in urine. A significant reduction of ACTH-like immunoreactivity (ACTH-LI) in plasma was detected for at least 3 hr after the DSIP injection, compared to the control subjects, in whom a slightly elevated concentration of ACTH-LI occurred. Plasma cortisol levels were unaffected and followed the normal diurnal decline. No differences in urinary cortisol or monoamine metabolite concentrations occurred between the two groups. The results indicate an inhibitory action of DSIP on ACTH secretion in man, as previously suggested by animal experiments.

Glucocorticoid repression of pro-opiomelanocortin gene transcription

Transcription of the pro-opiomelanocortin (POMC) gene is repressed by glucocorticoids in the anterior pituitary gland. We have defined an element within the POMC promoter which is responsible for this regulatory feedback. This element, the "negative glucocorticoid response element" (nGRE), was localized in the proximal region of the POMC promoter and it contains a binding site for the glucocorticoid receptor. Receptor binding to the nGRE was correlated to hormone-dependent repression by using promoter mutagenesis. The nGRE was also shown to contain a binding site for a nuclear protein of the COUP family of transcription factors. Since the binding sites for COUP and the glucocorticoid receptor overlap, glucocorticoid-dependent repression of POMC transcription may result from mutually exclusive binding of these two nuclear transcription factors.

Proopiomelanocortin gene expression in a pheochromocytoma using upstream transcription initiation sites

The proopiomelanocortin (POMC) gene is expressed in many normal nonpituitary tissues, in addition to the pituitary. POMC-derived peptides have also been detected in many pheochromocytomas. We examined poly(A)+ RNA from 5 pheochromocytomas with a POMC exon 3 riboprobe and show that 3 tumors contained POMC-like mRNAs that were 50 to 350 bases longer than pituitary POMC mRNA. S1 nuclease analyses of tumor poly(A)+ RNA demonstrate that some of the POMC-like mRNAs contain additional segments of 238, 318 or 374 nucleotides derived from the region immediately upstream from the normal transcription initiation site. We conclude that pheochromocytomas express the POMC gene and that the long POMC-like mRNAs in these tumors and, probably, those in normal adrenal and testis arise from transcription initiating at sites upstream from the normal site used in pituitary.

Effects of naloxone on adrenal cortex regulation in patients with primary aldosteronism

Excess production of proopiomelanocortin (POMC)-derived peptides with aldosterone-stimulating activity has been suggested to play a pathogenetic role in idiopathic hyperaldosteronism (IHA). To further investigate this issue, the opiate receptor antagonist naloxone was administered to 14 patients with primary aldosteronism, 6 with an aldosterone-producing adenoma (APA) and 8 with IHA. Clinical and hormonal effects of iv administration of naloxone (10 mg as a bolus) were compared with those obtained in 8 normal subjects. In normals as well as in APA and IHA patients, naloxone caused a significant increase in plasma cortisol, and no change in ACTH, plasma renin activity (PRA) and aldosterone levels. All subjects were retested after 2 mg dexamethasone. ACTH and cortisol were reduced and PRA was unchanged in all groups, without modifications after naloxone. Baseline aldosterone showed no significant changes in all groups. While normal subjects and APA failed to show any aldosterone response to naloxone after dexamethasone, IHA patients demonstrated a significant decrease. beta-endorphin concentrations were in the normal range before and after dexamethasone. In conclusion, naloxone may have a direct action upon adrenal zona fasciculata increasing the cortisol responsiveness to physiological levels of ACTH in either normals or APA and IHA patients. The decrease of aldosterone induced by naloxone in IHA may be due to an intraadrenal opioid control of zona glomerulosa in this disorder.

Ability of corticotropin releasing hormone to stimulate cortisol secretion independent from pituitary adrenocorticotropin

Cortisol secretion by the adrenal cortex is thought to depend upon a preceding release of pituitary ACTH. This concept ignores a large number of observations suggesting important extrapituitary influences on adrenocortical function. The present study was designed to demonstrate the contribution of these extrapituitary mechanisms in the release of cortisol induced by human corticotropin releasing hormone (hCRH) in man. In patients with proven deficiency in pituitary ACTH the functional atrophy of the adrenals had been restored by pretreatment with long-acting ACTH. Fifty-eight hours after the second and last injection of ACTH a CRH test was performed (100 micrograms hCRH intravenously). Administration of hCRH induced a small but significant increase in plasma cortisol. Surprisingly, this rise was preceded by an increase in plasma ACTH similar to the ACTH response observed in the control group. It appeared that hCRH is able to stimulate cortisol release in the absence of pituitary ACTH, presumably by stimulating extrapituitary sources of ACTH.

Biological and immunological characterization of corticotropin-releasing activity in the bovine adrenal medulla

Corticotropin-releasing factor (CRF)-like activity in bovine adrenal medulla extracts were characterized by measurement of adrenocorticotropin (ACTH) release from rat anterior pituitary cells in vitro, and by a sensitive heterologous radioimmunoassay (RIA) for bovine hypothalamic CRF. Bovine adrenal medulla was boiled in 2 M acetic acid, homogenized, and submitted to acetone precipitation, followed by batch-wise treatment with C-18 resin. The partially purified adrenal medulla extract showed significant stimulation of ACTH release in vitro and CRF-like immunoreactivity (CRF-IR). After subsequent ion exchange chromatography on a SP-Sephadex column, most CRF bioactivity (CRF-BA) and CRF-IR were eluted with weakly basic materials in the SP-II fraction in which synthetic CRF is eluted. Minor CRF-BA and CRF-IR were also eluted in the SP-III fraction which contained basic peptides. Upon Sephadex G-50 gel filtration of the SP-II fraction, CRF-BA and CRF-IR coeluted, but slightly later than synthetic bovine CRF. However, rechromatography of the major CRF activity on a Sephadex G-50 column and reverse phase and ion exchange high performance liquid chromatographies (HPLC) indicated that CRF-BA and CRF-IR were eluted in the identical fraction as synthetic bovine CRF. Gel filtration in the SP-III fraction on a Sephadex G-50 column showed a few low CRF-BA peaks which lacked CRF-IR. This CRF-BA, however, contributed to less than 5% of the total CRF-BA. These results indicate that the majority of CRF-BA and CRF-IR in the bovine adrenal medulla is chromatographically indistinguishable from bovine hypothalamic CRF.(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of opioid peptides in tumors

We looked for opioid peptides and their precursors in 108 tumors of both neuroendocrine and nonneuroendocrine origin, using a monoclonal "pan-opioid" antibody, 3-E7, which recognizes the tetrapeptide Tyr-Gly-Gly-Phe (the sequence responsible for pharmacologic activity in all known opioid peptides), in conjunction with polyclonal antibodies directed against representative peptides of each of the three precursors (alpha-endorphin, [met]enkephalin-Arg-Gly-Leu, and dynorphin B). Using the avidin-biotin immunoperoxidase technique, we observed consistent cytoplasmic immunoreactivity (at least focally) in all of 15 adrenal pheochromocytomas, all of 6 thyroid medullary carcinomas, and all of 5 pituitary adenomas. Opioid staining was also observed in parathyroid adenomas (8 of 9), pancreatic islet-cell tumors (7 of 10), carcinoid tumors from various sites (18 of 26), and paragangliomas (1 of 2). There was no immunoreactivity in pulmonary small-cell carcinomas, Merkel-cell tumors of skin, neuroblastomas, or any of the non-neuroendocrine tumors examined. The expression of alpha-endorphin, [met]enkephalin-Arg-Gly-Leu, and dynorphin B varied from tumor to tumor; however, positive staining with the "pan-opioid" antibody was found in each tumor containing at least one of the three precursors. Opioid peptide immunoreactivity was also detected in non-neoplastic cells of the adrenal medulla, pancreatic islets, pituitary, intestinal and bronchial mucosa, and intestinal myenteric plexuses. We conclude that opioid expression within tumors is most likely due to enhanced expression of a normal cell product and that opioid peptides are useful markers of neuroendocrine differentiation in many tumors.