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Lawrence S, Scofield RH. Post traumatic stress disorder associated hypothalamic-pituitary-adrenal axis dysregulation and physical illness. Brain Behav Immun Health 2024; 41:100849. [PMID: 39280087 PMCID: PMC11401111 DOI: 10.1016/j.bbih.2024.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 08/11/2024] [Accepted: 08/17/2024] [Indexed: 09/18/2024] Open
Abstract
Conventional human stress responses are mediated by the sympathetic adrenal medullar (SAM) axis and the hypothalamic pituitary adrenal (HPA) axis. The SAM axis mediates the immediate response to stress through norepinephrine and epinephrine while the HPA axis mediates the slow response through corticosteroids, primarily cortisol, to effect systemic changes. Post Traumatic Stress Disorder (PTSD), a psychiatric disorder that develops in a small subset of people exposed to a traumatic event, may dysregulate these systems and result in increased risk of various clinical conditions. These conditions include but are not limited to cardiovascular disease, metabolic conditions, autoimmune diseases, neurocognitive disorders, and women's health complications such as preterm birth, polycystic ovarian syndrome, and endometriosis to name a few. This review focuses on how PTSD dysregulates the HPA axis, and further, how these alterations affect the immune system and physical health outcomes.
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Affiliation(s)
- Stephanie Lawrence
- Department of Veterans Affairs Medical Center, Oklahoma City, OK, 73104, USA
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - R Hal Scofield
- Department of Veterans Affairs Medical Center, Oklahoma City, OK, 73104, USA
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
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2
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Bosse M, Bayart JL. Crioplast ® is a reliable device to ensure pre-analytical stability of adrenocorticotrophin (ACTH). Clin Chem Lab Med 2024; 62:e123-e125. [PMID: 38366955 DOI: 10.1515/cclm-2024-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Maxime Bosse
- Department of Laboratory Medicine, 82408 Clinique Saint-Pierre , Ottignies, Belgium
| | - Jean-Louis Bayart
- Department of Laboratory Medicine, 82408 Clinique Saint-Pierre , Ottignies, Belgium
- Department of Laboratory Medicine, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
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3
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Tsuang FY, Shih SR, Tseng HM, Wang HC. Perioperative growth hormone levels as an early predictor of new-onset secondary adrenal insufficiency following transsphenoidal pituitary tumor resection. Asian J Surg 2024; 47:1746-1755. [PMID: 38148260 DOI: 10.1016/j.asjsur.2023.12.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVE This study aims to predict new-onset secondary adrenal insufficiency (NOSAI) after transsphenoidal pituitary tumor resection surgery using perioperative growth hormone (GH) and prolactin (PRL) levels, among other factors. METHODS A cohort of 124 adult patients who underwent transsphenoidal resection for non-functioning pituitary adenoma, with routine perioperative glucocorticoid use, was used to develop the predictive regression model. An additional 46 patients served as the validation cohort. Generalized additive models were used to identify optimal cut-off points for the variables. RESULTS The GH level on postoperative day one (POD1) can be a simple predictor by implementing a cut-off point of 0.41 ng/ml. A value ≤ 0.41 ng/mL predicted NOSAI with 0.6316 sensitivity and 0.7810 specificity for the original cohort and 1.0000 sensitivity and 0.7143 specificity for the validation cohort. The multiple logistic regression model included perioperative PRL level difference, perioperative GH level difference, intraoperative cerebrospinal fluid (CSF) leakage, tumor size, and the combined effect of diabetes insipidus (DI) and relative perioperative GH level difference. The areas under the receiver operating characteristic curves were 0.9410 (original cohort) and 0.9494 (validation cohort) for the regression model. CONCLUSION Early morning GH level on POD1 can predict NOSAI with fair accuracy when perioperative stress dose glucocorticoid is administered. Prediction accuracy can be improved by considering CSF leakage, DI, and perioperative changes in GH and PRL in the final regression model.
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Affiliation(s)
- Fon-Yih Tsuang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Shyang-Rong Shih
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ham-Min Tseng
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Huan-Chih Wang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan.
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4
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Jaschke NP, Breining D, Hofmann M, Pählig S, Baschant U, Oertel R, Traikov S, Grinenko T, Saettini F, Biondi A, Stylianou M, Bringmann H, Zhang C, Yoshida TM, Weidner H, Poller WC, Swirski FK, Göbel A, Hofbauer LC, Rauner M, Scheiermann C, Wang A, Rachner TD. Small-molecule CBP/p300 histone acetyltransferase inhibition mobilizes leukocytes from the bone marrow via the endocrine stress response. Immunity 2024; 57:364-378.e9. [PMID: 38301651 PMCID: PMC10923082 DOI: 10.1016/j.immuni.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/01/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
Mutations of the CBP/p300 histone acetyltransferase (HAT) domain can be linked to leukemic transformation in humans, suggestive of a checkpoint of leukocyte compartment sizes. Here, we examined the impact of reversible inhibition of this domain by the small-molecule A485. We found that A485 triggered acute and transient mobilization of leukocytes from the bone marrow into the blood. Leukocyte mobilization by A485 was equally potent as, but mechanistically distinct from, granulocyte colony-stimulating factor (G-CSF), which allowed for additive neutrophil mobilization when both compounds were combined. These effects were maintained in models of leukopenia and conferred augmented host defenses. Mechanistically, activation of the hypothalamus-pituitary-adrenal gland (HPA) axis by A485 relayed shifts in leukocyte distribution through corticotropin-releasing hormone receptor 1 (CRHR1) and adrenocorticotropic hormone (ACTH), but independently of glucocorticoids. Our findings identify a strategy for rapid expansion of the blood leukocyte compartment via a neuroendocrine loop, with implications for the treatment of human pathologies.
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Affiliation(s)
- Nikolai P Jaschke
- Division of Endocrinology, Department of Medicine III, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Department of Internal Medicine (Rheumatology, Allergy & Immunology) and Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA.
| | - Dorit Breining
- Division of Endocrinology, Department of Medicine III, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Maura Hofmann
- Division of Endocrinology, Department of Medicine III, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Sophie Pählig
- Division of Endocrinology, Department of Medicine III, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Ulrike Baschant
- Division of Endocrinology, Department of Medicine III, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Reinhard Oertel
- Institute of Clinical Pharmacology, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Sofia Traikov
- Max-Planck Institute of Molecular Cell Biology, Dresden, Germany
| | - Tatyana Grinenko
- Institute of Clinical Chemistry and Laboratory Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Jiao Tong University School of Medicine, Shanghai, China
| | - Francesco Saettini
- Tettamanti Research Center, University of Milano-Bicocca, University of Milano Bicocca, Monza, Italy
| | - Andrea Biondi
- Centro Tettamanti, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Pediatria, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Dipartimento di Medicina e Chirurgia, Università degli Studi Milano-Bicocca, Monza, Italy
| | - Myrto Stylianou
- Biotechnology Center (Biotec) Technische Universität Dresden, Dresden, Germany
| | - Henrik Bringmann
- Biotechnology Center (Biotec) Technische Universität Dresden, Dresden, Germany
| | - Cuiling Zhang
- Department of Internal Medicine (Rheumatology, Allergy & Immunology) and Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Tomomi M Yoshida
- Department of Internal Medicine (Rheumatology, Allergy & Immunology) and Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Heike Weidner
- Division of Endocrinology, Department of Medicine III, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Wolfram C Poller
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Filip K Swirski
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andy Göbel
- Division of Endocrinology, Department of Medicine III, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Lorenz C Hofbauer
- Division of Endocrinology, Department of Medicine III, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Martina Rauner
- Division of Endocrinology, Department of Medicine III, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Christoph Scheiermann
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Biomedical Center (BMC), Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel-Center for Experimental Medicine (WBex), Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Planegg-Martinsried, Germany
| | - Andrew Wang
- Department of Internal Medicine (Rheumatology, Allergy & Immunology) and Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Tilman D Rachner
- Division of Endocrinology, Department of Medicine III, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Leite JA, Orellana AM, Andreotti DZ, Matumoto AM, de Souza Ports NM, de Sá Lima L, Kawamoto EM, Munhoz CD, Scavone C. Ouabain Reverts CUS-Induced Disruption of the HPA Axis and Avoids Long-Term Spatial Memory Deficits. Biomedicines 2023; 11:biomedicines11041177. [PMID: 37189795 DOI: 10.3390/biomedicines11041177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 05/17/2023] Open
Abstract
Ouabain (OUA) is a cardiotonic steroid that modulates Na+, K+ -ATPase activity. OUA has been identified as an endogenous substance that is present in human plasma, and it has been shown to be associated with the response to acute stress in both animals and humans. Chronic stress is a major aggravating factor in psychiatric disorders, including depression and anxiety. The present work investigates the effects of the intermittent administration of OUA (1.8 μg/kg) during the chronic unpredictable stress (CUS) protocol in a rat's central nervous system (CNS). The results suggest that the intermittent OUA treatment reversed CUS-induced HPA axis hyperactivity through a reduction in (i) glucocorticoids levels, (ii) CRH-CRHR1 expression, and by decreasing neuroinflammation with a reduction in iNOS activity, without interfering with the expression of antioxidant enzymes. These changes in both the hypothalamus and hippocampus may reflect in the rapid extinction of aversive memory. The present data demonstrate the ability of OUA to modulate the HPA axis, as well as to revert CUS-induced long-term spatial memory deficits.
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Affiliation(s)
- Jacqueline Alves Leite
- Departament of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
- Department of Pharmacology, Institute of Biological Sciences, Universidade Federal de Goiás, Goiânia 74690-900, Brazil
| | - Ana Maria Orellana
- Departament of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Diana Zukas Andreotti
- Departament of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Amanda Midori Matumoto
- Departament of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | | | - Larissa de Sá Lima
- Departament of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Elisa Mitiko Kawamoto
- Departament of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Carolina Demarchi Munhoz
- Departament of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Cristoforo Scavone
- Departament of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
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Zachariah MA, Cua S, Muhlestein WE, Otto BA, Carrau RL, Kirschner LS, Ghalib LM, Lonser RR, Hardesty DA, Prevedello DM. Intraoperative Predictor of Remission in Cushing Disease. Oper Neurosurg (Hagerstown) 2023; 24:460-467. [PMID: 36701661 DOI: 10.1227/ons.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Cushing disease represents a challenge for neurosurgeons, with high recurrence rates reported. Characteristics associated with remission are incompletely understood; thus, an intraoperative predictor for outcome would be valuable for assessing resection of adrenocorticotropic hormone (ACTH) secreting tissue. OBJECTIVE To evaluate whether intraoperative ACTH measurement could predict outcome after surgery for Cushing disease. METHODS Retrospective cohort study of 55 consecutive encounters with Cushing disease who had peripheral plasma ACTH levels measured intraoperatively before, during, and after tumor resection. The primary outcome measure was remission, defined by either 2 negative 24-hour urine free cortisol or 2 negative midnight salivary cortisol measurements. A logistic regression machine learning model was generated using recursive feature elimination. RESULTS Fifty-five operative encounters, comprising 49 unique patients, had a mean follow-up of 2.73 years (±2.11 years) and a median follow-up of 2.07 years. Remission was achieved in 69.1% (n = 38) of all operations and in 78.0% (n = 32) of those without cavernous sinus invasion. The final ACTH level measured intraoperatively correctly predicted outcome (area under the curve = 0.766; P value = .002). The odds ratio of remission in patients with the lowest quartile vs highest quartile final intraoperative ACTH was 23.4 ( P value = .002). Logistic regression machine learning model resulted in incorporating postoperative day 1 morning cortisol, final intraoperative ACTH that predicted outcome with an average area under the curve of 0.80 ( P = .0027). CONCLUSION Intraoperative ACTH may predict outcome after surgery in Cushing disease; furthermore, investigation is warranted.
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Affiliation(s)
- Marcus A Zachariah
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Santino Cua
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Whitney E Muhlestein
- Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Bradley A Otto
- Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Lawrence S Kirschner
- Department of Endocrinology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Luma M Ghalib
- Department of Endocrinology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Russell R Lonser
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Douglas A Hardesty
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
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Asuzu DT, Bhatt S, Nwokoye D, Hayes C, Cortes M, McGlotten R, Keil M, Tatsi C, Nieman L, Chittiboina P. Cortisol and ACTH Measurements at Extubation From Pituitary Surgery Predicts Hypothalamic-Pituitary-Adrenal Axis Function. J Endocr Soc 2023; 7:bvad025. [PMID: 36846212 PMCID: PMC9954986 DOI: 10.1210/jendso/bvad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Indexed: 02/09/2023] Open
Abstract
Context Early prediction of hypothalamic-pituitary-adrenal (HPA) axis function following transsphenoidal surgery (TSS) can improve patient safety and reduce costs. Objective Systematic measurement of ACTH and cortisol at extubation following anesthesia to predict remission from Cushing's disease (CD) and HPA axis preservation following non-CD surgery. Design Retrospective analysis of clinical data between August 2015 and May 2022. Setting Referral center. Patients Consecutive patients (n = 129) undergoing TSS who had perioperative ACTH and cortisol measurements. Interventions ACTH and cortisol measurement at extubation. Further serial 6-hourly measurements in CD patients. Main outcome measures Prediction of future HPA axis status based on ACTH/cortisol at extubation. Results ACTH and cortisol increased sharply in all patients at extubation. CD patients (n = 101) had lower ACTH values than non-CD patients (110.1 vs 293.1 pg/mL; P < 0.01). In non-CD patients, lower plasma ACTH at extubation predicted the need for eventual corticosteroid replacement (105.8 vs 449.1 pg/mL, P < 0.01). In CD patients, the peak post-extubation cortisol at 6 hours was a robust predictor for nonremission (60.7 vs 219.2 µg/dL, P = 0.03). However, normalized early postoperative value (NEPV; the post-extubation values minus the peak preoperative CRH or desmopressin test values) of cortisol reliably distinguished nonremission earlier, at the time of extubation (-6.1 vs 5.9, P = 0.01), and later. Conclusions We found that at extubation following TSS, ACTH can predict the need for eventual steroid replacement in non-Cushing's patients. In patients with CD, we found a robust prediction of nonremission with NEPV cortisol at extubation and later.
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Affiliation(s)
- David T Asuzu
- Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, MD, USA,Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda, MD, USA,Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Shyama Bhatt
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda, MD, USA
| | - Diana Nwokoye
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda, MD, USA
| | - Christina Hayes
- Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, MD, USA
| | - Michaela Cortes
- Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, MD, USA
| | - Raven McGlotten
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Meg Keil
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Christina Tatsi
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Lynnette Nieman
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Prashant Chittiboina
- Correspondence: Prashant Chittiboina, MD, MPH. Tenure Track Investigator, Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, National Institutes of Health. 10 Center Dr, Rm 3D20, Bethesda, MD 20892-1414, USA.
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Brandner S, Schroeter S, Çalışkan G, Salar S, Kobow K, Coras R, Blümcke I, Hamer H, Schwarz M, Buchfelder M, Maslarova A. Glucocorticoid modulation of synaptic plasticity in the human temporal cortex of epilepsy patients: Does chronic stress contribute to memory impairment? Epilepsia 2021; 63:209-221. [PMID: 34687218 DOI: 10.1111/epi.17107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Memory impairment is common in patients with temporal lobe epilepsy and seriously affects life quality. Chronic stress is a recognized cofactor in epilepsy and can also impair memory function. Furthermore, increased cortisol levels have been reported in epilepsy patients. Animal models have suggested that aggravating effects of stress on memory and synaptic plasticity were mediated via glucocorticoids. The aim of this study was, therefore, to investigate the effect of glucocorticoid receptor (GR) modulation on synaptic plasticity in the human cortex of epilepsy patients. METHODS We performed field potential recordings in acute slices from the temporal neocortex of patients who underwent surgery for drug-resistant temporal lobe epilepsy. Synaptic plasticity was investigated by a theta-burst stimulation (TBS) protocol for induction of long-term potentiation (LTP) in the presence of GR modulators. RESULTS LTP was impaired in temporal cortex from epilepsy patients. Pretreatment of the slices with the GR antagonist mifepristone (RU486) improved LTP induction, suggesting that LTP impairment was due to baseline GR activation in the human cortex. The highly potent GR agonist dexamethasone additionally weakened synaptic strength in an activity-dependent manner when applied after TBS. SIGNIFICANCE Our results show a direct negative glucocorticoid effect on synaptic potentiation in the human cortex and imply chronic activation of GRs. Chronic stress may therefore contribute to memory impairment in patients with temporal lobe epilepsy. Furthermore, the activity-dependent acute inhibitory effect of dexamethasone suggests a mechanism of synaptic downscaling by which postictally increased cortisol levels may prevent pathologic plasticity upon seizures.
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Affiliation(s)
- Sebastian Brandner
- Department of Neurosurgery, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sarah Schroeter
- Department of Neurosurgery, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Orthopedic, Trauma, and Hand Surgery, Osnabrück Clinic, Osnabrück, Germany
| | - Gürsel Çalışkan
- Department of Genetics and Molecular Neurobiology, Institute of Biology, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Seda Salar
- Department of Psychiatry and Psychotherapy, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Katja Kobow
- Department of Neuropathology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Roland Coras
- Department of Neuropathology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ingmar Blümcke
- Department of Neuropathology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Hajo Hamer
- Department of Neurology, Epilepsy Center, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Schwarz
- Department of Neurology, Epilepsy Center, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Anna Maslarova
- Department of Neurosurgery, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Martínez-Díaz IC, Carrasco L. Neurophysiological Stress Response and Mood Changes Induced by High-Intensity Interval Training: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147320. [PMID: 34299775 PMCID: PMC8304833 DOI: 10.3390/ijerph18147320] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/17/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Abstract
This pilot study, conducted in advance of a future definitive randomized controlled trial, aimed to investigate the feasibility of using a HIIT-based intervention to induce neurophysiological stress responses that could be associated with possible changes in mood. Twenty-five active male college students with an average age of 21.7 ± 2.1 years, weight 72.6 ± 8.4 kg, height 177 ± 6.1 cm, and BMI: 23.1 ± 1.4 kg/m2 took part in this quasi-experimental pilot study in which they were evaluated in two different sessions. In the first session, subjects performed a graded exercise test to determine the cycling power output corresponding to VO2peak. The second session consisted of (a) pre-intervention assessment (collection of blood samples for measuring plasma corticotropin and cortisol levels, and application of POMS questionnaire to evaluate mood states); (b) exercise intervention (10 × 1-min of cycling at VO2peak power output); (c) post-intervention assessment, and (d) 30-min post-intervention evaluation. Significant post-exercise increases in corticotropin and cortisol plasma levels were observed whereas mood states decreased significantly at this assessment time-point. However, a significant increase in mood was found 30-min after exercise. Finally, significant relationships between increases in stress hormones concentrations and changes in mood states after intense exercise were observed. In conclusion, our HIIT-based intervention was feasible to deliver and acceptable to participants. A single bout of HIIT induced acute changes in mood states that seems to be associated with hypothalamic-pituitary-adrenal axis activation.
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10
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Dose Escalation of Naltrexone to Reduce Stress Responses Associated With Opioid Antagonist Induction: A Double-blind Randomized Trial. J Addict Med 2021; 14:253-260. [PMID: 31609865 DOI: 10.1097/adm.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT To describe the role of opioid antagonist induction in reducing stress response and withdrawal symptoms. OBJECTIVE Complexity of naltrexone induction is limiting broader applicability of opioid antagonist-assisted abstinence. The aim of this clinical trial was to assess the stress response to 2 low-dose naltrexone induction protocols under minimal oral sedation. DESIGN Double-blind randomized controlled trial. SETTING Open setting in-patient unit. PARTICIPANTS Adults with opioid use disorder, and at least a year-long history of opioid use. INTERVENTION PROTOCOL Patients received either a single 12.5 mg naltrexone oral dose (SI group) or escalating dosage regimen starting from 50 μg up to a cumulative dose of 12.5 mg (ED group). MAIN OUTCOME MEASURE Differences in cortisol and adrenocorticotropic hormone (ACTH) concentrations 1 hour after the start of naltrexone induction. RESULTS In all, 124 patients were enrolled and 68 remained in the trial at the point of randomization-33 in SI and 35 in ED group. Eight patients were excluded from final analysis. Plasma cortisol and ACTH concentrations were significantly higher in SI group; mean difference between groups 313 nmol/L (95% confidence interval [CI] 182-444, P < 0.001) and 36.9 pg/mL (95% CI 12.3-61.4, P = 0.004), respectively. SECONDARY OUTCOMES SI patients experienced significant increases in plasma cortisol and ACTH concentrations, and withdrawal scores. In ED group these measures remained at or below baseline throughout the 24-hour period from start of naltrexone induction. CONCLUSIONS Contrary to a single 12.5-mg dose, the escalating naltrexone dosing regimen produced no significant increase in stress response and withdrawal scores during antagonist induction.
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Siebold L, Krueger AC, Abdala JA, Figueroa JD, Bartnik-Olson B, Holshouser B, Wilson CG, Ashwal S. Cosyntropin Attenuates Neuroinflammation in a Mouse Model of Traumatic Brain Injury. Front Mol Neurosci 2020; 13:109. [PMID: 32670020 PMCID: PMC7332854 DOI: 10.3389/fnmol.2020.00109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/22/2020] [Indexed: 12/21/2022] Open
Abstract
Aim: Traumatic brain injury (TBI) is a leading cause of mortality/morbidity and is associated with chronic neuroinflammation. Melanocortin receptor agonists including adrenocorticotropic hormone (ACTH) ameliorate inflammation and provide a novel therapeutic approach. We examined the effect of long-acting cosyntropin (CoSyn), a synthetic ACTH analog, on the early inflammatory response and functional outcome following experimental TBI. Methods: The controlled cortical impact model was used to induce TBI in mice. Mice were assigned to injury and treatment protocols resulting in four experimental groups including sham + saline, sham + CoSyn, TBI + saline, and TBI + CoSyn. Treatment was administered subcutaneously 3 h post-injury and daily injections were given for up to 7 days post-injury. The early inflammatory response was evaluated at 3 days post-injury through the evaluation of cytokine expression (IL1β and TNFα) and immune cell response. Quantification of immune cell response included cell counts of microglia/macrophages (Iba1+ cells) and neutrophils (MPO+ cells) in the cortex and hippocampus. Behavioral testing (n = 10–14 animals/group) included open field (OF) and novel object recognition (NOR) during the first week following injury and Morris water maze (MWM) at 10–15 days post-injury. Results: Immune cell quantification showed decreased accumulation of Iba1+ cells in the perilesional cortex and CA1 region of the hippocampus for CoSyn-treated TBI animals compared to saline-treated. Reduced numbers of MPO+ cells were also found in the perilesional cortex and hippocampus in CoSyn treated TBI mice compared to their saline-treated counterparts. Furthermore, CoSyn treatment reduced IL1β expression in the cortex of TBI mice. Behavioral testing showed a treatment effect of CoSyn for NOR with CoSyn increasing the discrimination ratio in both TBI and Sham groups, indicating increased memory performance. CoSyn also decreased latency to find platform during the early training period of the MWM when comparing CoSyn to saline-treated TBI mice suggesting moderate improvements in spatial memory following CoSyn treatment. Conclusion: Reduced microglia/macrophage accumulation and neutrophil infiltration in conjunction with moderate improvements in spatial learning in our CoSyn treated TBI mice suggests a beneficial anti-inflammatory effect of CoSyn following TBI.
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Affiliation(s)
- Lorraine Siebold
- Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, United States.,The Lawrence D. Longo MD Center for Perinatal Biology, Loma Linda University, Loma Linda, CA, United States
| | - Amy C Krueger
- Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Jonathan A Abdala
- The Lawrence D. Longo MD Center for Perinatal Biology, Loma Linda University, Loma Linda, CA, United States
| | - Johnny D Figueroa
- Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, United States.,Center for Health Disparities and Molecular Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Brenda Bartnik-Olson
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Barbara Holshouser
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Christopher G Wilson
- Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, United States.,The Lawrence D. Longo MD Center for Perinatal Biology, Loma Linda University, Loma Linda, CA, United States.,Department of Pediatrics, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Stephen Ashwal
- Department of Pediatrics, Loma Linda University Medical Center, Loma Linda, CA, United States
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Hazell G, Horn G, Lightman SL, Spiga F. Dynamics of ACTH-Mediated Regulation of Gene Transcription in ATC1 and ATC7 Adrenal Zona Fasciculata Cell Lines. Endocrinology 2019; 160:587-604. [PMID: 30768667 PMCID: PMC6380881 DOI: 10.1210/en.2018-00840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 01/26/2019] [Indexed: 02/07/2023]
Abstract
We tested the hypothesis that mouse ATC1 and ATC7 cells, the first adrenocortical cell lines to exhibit a complete zona fasciculata (ZF) cell phenotype, respond to dynamic ACTH stimulation in a similar manner as the adrenal gland in vivo. Exploiting our previous in vivo observations that gene transcription within the steroidogenic pathway is dynamically regulated in response to a pulse of ACTH, we exposed ATC1 and ATC7 cells to various patterns of ACTH, including pulsatile and constant, and measured the transcriptional activation of this pathway. We show that pulses of ACTH administered to ATC7 cells can reliably stimulate a pulsatile pattern of transcriptional activity that is comparable to that observed in adrenal ZF cells in vivo. Hourly pulses of ACTH stimulate dynamic increases in CREB phosphorylation (pCREB) and transcription of genes involved in critical steps of steroidogenesis including signal transduction (e.g., MRAP), cholesterol delivery (e.g., StAR), and steroid biosynthesis (e.g., CYP11A1), as well as those relating to transcriptional regulation of steroidogenic factors (e.g., SF-1 and Nur-77). In contrast, constant ACTH stimulation results in a prolonged and exaggerated pCREB and steroidogenic gene transcriptional response. We also show that when a large dose of ACTH (100 nM) is applied after these treatment regimens, a significant increase in steroidogenic transcriptional responsiveness is achieved only in cells that have been exposed to pulsatile, rather than constant, ACTH. Our data support our in vivo observations that pulsatile ACTH is important for the optimal transcriptional responsiveness of the adrenal. Importantly, our data suggest that ATC7 cells respond to dynamic ACTH stimulation.
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Affiliation(s)
- Georgina Hazell
- Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - George Horn
- Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Stafford L Lightman
- Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Francesca Spiga
- Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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Roelfsema F, Pereira AM, Veldhuis JD. Impact of Adiposity and Fat Distribution on the Dynamics of Adrenocorticotropin and Cortisol Rhythms. Curr Obes Rep 2014; 3:387-95. [PMID: 26626915 DOI: 10.1007/s13679-014-0118-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Obesity impacts many hormonal systems, including pituitary hormones, as well as insulin and leptin. In this review we discuss articles which investigate the influence of obesity on the hypothalamic-pituitary-adrenal (HPA) axis. Different techniques have been used to assess the function of the HPA-axis in obesity, including measuring fasting and/or late evening levels of adrenocorticotropic hormone (ACTH) and (free) cortisol in plasma and saliva, studying feedback with dexamethasone or cortisol, and evaluating responsiveness of the system to corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP) or ACTH 1-29. In addition, more elaborate studies investigated 24-h secretion patterns, analyzed with deconvolution techniques to quantitate pulsatile secretion rates of cortisol and less often ACTH. Other investigators used timed infusions of labeled cortisol for the estimation of the 24-h secretion rate, clearance rate and distribution volume. Many studies relied on the 24-h urinary excretion of free cortisol, but for quantitation of the 24-h secretion, measurement of all cortisol-derived metabolites is required. Several studies have applied modern liquid chromatography-tandem-mass spectrometry techniques to measure these metabolites. The picture emerging from all these studies is that, first, ACTH secretion is amplified, likely via enhanced forward drive; and, second, serum cortisol levels are normal or even low, associated with a normal 24-h cortisol secretion per liter distribution volume determined by deconvolution, but enhanced when based on the increased total distribution volume associated with obesity. Increased cortisol secretion was also established by isotope dilution studies and reports based on the measurement of all urinary cortisol metabolites. The responsiveness of the adrenal gland to ACTH is diminished. The studies do not address quantitative aspects of cortisol-cortisone metabolism on individual organs, including liver, central and peripheral fat, intestine, skin, and muscle.
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Affiliation(s)
- Ferdinand Roelfsema
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands.
| | - Alberto M Pereira
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Johannes D Veldhuis
- Endocrine Research Unit, Mayo Medical and Graduate Schools, Clinical Translational Research Center, Mayo Clinic, Rochester, MN, 55901, USA
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Animesh S, Paul Aoun DO, Jean Wigham RN, Sue Weist RN, Johannes D. V. Gender determines ACTH recovery from hypercortisolemia in healthy older humans. Metabolism 2013; 62:1819-29. [PMID: 24074810 PMCID: PMC3860097 DOI: 10.1016/j.metabol.2013.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/21/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Available clinical data raise the possibility that stress-adaptive mechanisms differ by gender. However, this notion has not been rigorously tested in relation to cortisol-mediated negative feedback. MATERIALS/METHODS Degree of ACTH inhibition during and recovery from an experimental cortisol clamp was tested in 20 healthy older subjects (age 60±2.2 y). Volunteers received oral placebo or ketoconazole (KTCZ) to inhibit adrenal steroidogenesis along with i.v. infusions of saline or a low vs high physiological dose of cortisol in a prospectively randomized double-blind, placebo-controlled design. ACTH and cortisol concentrations were measured every 10 min during the feedback-clamp phase and thereafter (recovery or escape phase). Corticosteroid-binding globulin (CBG) was measured, and free cortisol concentrations were calculated. RESULTS Gender did not determine mean ACTH concentrations during the saline or cortisol feedback-clamp phases per se. However, women had markedly impaired ACTH recovery after stopping both low- and high-dose cortisol infusions compared with men (P=0.005, KTCZ/low-dose cortisol arm; and P=0.006, KTCZ/high-dose cortisol arm). Decreased ACTH recovery in women was accompanied by lower total and free cortisol concentrations, pointing to heightened feedback inhibition of hypothalamo-pituitary drive of ACTH secretion as the main mechanism. CONCLUSIONS In summary, gender or a factor related to gender, such as sex steroids or body composition, determines recovery of ACTH secretion from cortisol-enforced negative feedback. Attenuated ACTH recovery in post-menopausal women may have relevance to sex differences in stress-related adaptations.
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Affiliation(s)
| | | | | | | | - Veldhuis Johannes D.
- Corresponding author. Tel.: + 1 507 255 0902; fax: + 1 507 255 0901. (J.D. Veldhuis)
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Ribeiro-Oliveira A, Abrantes MM, Barkan AL. Complex rhythmicity and age dependence of growth hormone secretion are preserved in patients with acromegaly: further evidence for a present hypothalamic control of pituitary somatotropinomas. J Clin Endocrinol Metab 2013; 98:2959-66. [PMID: 23640965 PMCID: PMC3701276 DOI: 10.1210/jc.2013-1581] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
CONTEXT Traditionally, acromegaly is viewed as a disease resulting from GH hypersecretion from an autonomous pituitary somatotropinoma. OBJECTIVE To test the hypothesis that GH secretion in acromegaly is still subjected to normal hypothalamic control, we studied the daily rhythmicity of GH secretion in normal controls and patients with newly diagnosed, untreated acromegaly. DESIGN AND SETTING This was an observational inpatient study in the General Clinical Research Center at the University of Michigan. PATIENTS OR OTHER PARTICIPANTS One hundred four normal controls and 67 acromegalic patients were included in the study. INTERVENTION The intervention consisted of frequent blood sampling over 24 hours. MAIN OUTCOME MEASURE(S) We hypothesized that acromegalic patients would show rhythmicity, sexual dimorphism, and age-related decline of GH secretion similar to normal controls. RESULTS Both normal controls and the patients exhibited 3 major GH waves with the highest values at 12:00 pm, 5:00 pm, and 1:00 am (P < .001 for all). Both controls and patients exhibited a clear appearance of the nocturnal GH waves, irrespective of the gender (P < .001 for all). The amplitude of the maximal (nocturnal) GH secretory wave (1:00 am) as compared with the nadir GH secretion (9:00 am) was clearly different between the 2 groups, with a significantly smaller magnitude in acromegaly (P < .001). A subsequent subanalysis of both groups was performed separately for both genders. Similar to the entire groups, both controls and patients exhibited a clear appearance of the nocturnal GH waves, irrespective of the gender (P < .001 for all). Patients with clearly elevated GH values have shown an age-related decline of GH secretion (r = -0.35, P < .001), similar to controls. CONCLUSIONS The analysis of GH profiles in multiple patients with untreated acromegaly discloses the persistence of the hallmarks of the central control of GH regulation, ie, nictohemeral rhythmicity, sexual dimorphism, and an age-related decline of GH output.
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Veldhuis JD, Sharma A, Roelfsema F. Age-dependent and gender-dependent regulation of hypothalamic-adrenocorticotropic-adrenal axis. Endocrinol Metab Clin North Am 2013; 42:201-25. [PMID: 23702398 PMCID: PMC3675779 DOI: 10.1016/j.ecl.2013.02.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Tightly regulated output of glucocorticoids is critical to maintaining immune competence, the structure of neurons, muscle, and bone, blood pressure, glucose homeostasis, work capacity, and vitality in the human and experimental animal. Age, sex steroids, gender, stress, body composition, and disease govern glucocorticoid availability through incompletely understood mechanisms. According to an ensemble concept of neuroendocrine regulation, successful stress adaptations require repeated incremental signaling adjustments among hypothalamic corticotropin-releasing hormone and arginine vasopressin, pituitary adrenocorticotropic hormone, and adrenal corticosteroids. Signals are transduced via (positive) feedforward and (negative) feedback effects. Age and gonadal steroids strongly modulate stress-adaptive glucocorticoid secretion by such interlinked pathways.
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Affiliation(s)
- Johannes D Veldhuis
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, MN 55905, USA.
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Carroll BJ, Iranmanesh A, Keenan DM, Cassidy F, Wilson WH, Veldhuis JD. Pathophysiology of hypercortisolism in depression: pituitary and adrenal responses to low glucocorticoid feedback. Acta Psychiatr Scand 2012; 125:478-91. [PMID: 22211368 PMCID: PMC3893569 DOI: 10.1111/j.1600-0447.2011.01821.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To test three theories of hypercortisolemia in depression-hypothalamic overdrive, impaired glucocorticoid feedback, or autonomous cortisol production. METHOD We applied an overnight low-cortisol feedback strategy by administering metyrapone to hypercortisolemic depressed in-patients and control subjects. RESULTS Under metyrapone, the increases of plasma adrenocorticotropic hormone (ACTH) concentrations and of basal and pulsatile ACTH secretion were not exaggerated in hypercortisolemic depressed patients compared with control subjects. ACTH approximate entropy (ApEn) did not differ at baseline or under metyrapone. Thus, neither hypothalamic overdrive nor irregular ACTH secretion was seen. We did not detect impaired cortisol feedback: the ACTH response was not reduced, and ApEn measures that are sensitive to feedback changes were comparable in both groups. Metyrapone disrupted cortisol secretory regularity in depressed and control subjects. On the baseline day, basal cortisol secretion was significantly increased and was highly irregular (high ApEn), and ACTH-cortisol cross-ApEn was markedly elevated in high-cortisol patients. CONCLUSION Classical feed-forward overdrive and impaired feedback theories of hypercortisolemia in depression were not supported. Depressive hypercortisolemia may result from alternative pathophysiological mechanisms involving irregular basal hypersecretion of cortisol, associated with adrenal enlargement, possibly through splanchnic sympathetic activation of the adrenal cortex.
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Affiliation(s)
| | - Ali Iranmanesh
- Endocrine Service, Medical Section, Salem Veterans Affairs Medical Center, Salem, VA 24153
| | - Daniel M. Keenan
- Department of Statistics, University of Virginia, Charlottesville, VA 22904
| | - Frederick Cassidy
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710
| | - William H. Wilson
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710
| | - Johannes D. Veldhuis
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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Scheff JD, Calvano SE, Lowry SF, Androulakis IP. Transcriptional implications of ultradian glucocorticoid secretion in homeostasis and in the acute stress response. Physiol Genomics 2011; 44:121-9. [PMID: 22128089 DOI: 10.1152/physiolgenomics.00128.2011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Endogenous glucocorticoids are secreted by the hypothalamic-pituitary-adrenal (HPA) axis in response to a wide range of stressors. Glucocorticoids exert significant downstream effects, including the regulation of many inflammatory genes. The HPA axis functions such that glucocorticoids are released in a pulsatile manner, producing ultradian rhythms in plasma glucocorticoid levels. It is becoming increasingly evident that this ultradian pulsatility is important in maintaining proper homeostatic regulation and responsiveness to stress. This is particularly interesting from a clinical perspective given that pathological dysfunctions of the HPA axis produce altered ultradian patterns. Modeling this system facilitates the understanding of how glucocorticoid pulsatility arises, how it can be lost, and the transcriptional implications of ultradian rhythms. To approach these questions, we developed a mathematical model that integrates the cyclic production of glucocorticoids by the HPA axis and their downstream effects by integrating existing models of the HPA axis and glucocorticoid pharmacodynamics. This combined model allowed us to evaluate the implications of pulsatility in homeostasis as well as in response to acute stress. The presence of ultradian rhythms allows the system to maintain a lower response to homeostatic levels of glucocorticoids, but diminished feedback within the HPA axis leads to a loss of glucocorticoid rhythmicity. Furthermore, the loss of HPA pulsatility in homeostasis correlates with a decrease in the peak output in response to an acute stressor. These results are important in understanding how cyclic glucocorticoid secretion helps maintain the responsiveness of the HPA axis.
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Affiliation(s)
- Jeremy D Scheff
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey 08854, USA
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Iranmanesh A, Keenan DM, Aoun P, Veldhuis JD. Overnight ACTH-cortisol dose responsiveness: comparison with 24-h data, metyrapone administration and insulin-tolerance test in healthy adults. Clin Endocrinol (Oxf) 2011; 75:596-601. [PMID: 21609353 PMCID: PMC3287347 DOI: 10.1111/j.1365-2265.2011.04125.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To estimate the dose dependence of endogenous ACTH stimulation of adrenal cortisol secretion overnight. DESIGN Ten-minute sampling for ACTH and cortisol over 8 and 24 h (n = 17), after metyrapone administration (n = 6), during an insulin-tolerance test (n = 7). SUBJECTS Healthy adults. MEASUREMENTS ACTH dose-responsive estimates. RESULTS Twenty-four hour ACTH-cortisol concentration pairs yielded an estimated EC(50) (one-half maximally stimulatory ACTH concentration) of 5·1 (2·2-9·5) pmol/l [median (range)]. This did not differ from EC(50) s based on 8- or 6-h data [5·9 (3·5-11) and 7·5 (3·7-41) pmol/l] in the same individuals. ACTH efficacy (maximally stimulatable cortisol secretion rate) was 8·4 (3·1-20), 11 (5·9-24) and 15 (5·9-22) nmol/l/min, when calculated over 24, 8 and 6 h, respectively (P = NS). Adrenal sensitivity (slope term) was also consistent across sampling durations, viz. 14 (1·3-95), 18 (1·3-64) and 20 (1·3-64) slope units. Compared with placebo, metyrapone reduced ACTH efficacy from 11 (6·2-62) to 2·8 (1·5-4·5) nmol/l/min for cortisol (n = 9, P < 0·001), while increasing ACTH efficacy for 11-desoxycortisol from 2·3 (0·9-2·9) to 99 (70-218) nmol/l/min (n = 6, P < 0·01), thus affirming face validity. Combined ACTH and cortisol responses to hypoglycaemia allowed an estimate of ACTH efficacy of 28 (22-81) nmol/l/min, compared with the control value of 8·7 (5·6-26), suggesting enhanced adrenal responsiveness. CONCLUSIONS The results suggest that endogenous ACTH-adrenal drive can be approximated from overnight 8-h sampling of paired ACTH and cortisol concentrations. This strategy may have merit in clinical research in childhood, pregnancy, anxiety states and frail elderly individuals, when ACTH injections are not desired.
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Affiliation(s)
- Ali Iranmanesh
- Endocrine Section, Department of Medicine, Salem Veterans Affairs Medical Center, Salem, VA 24153
| | - Daniel M. Keenan
- Department of Statistics, University of Virginia, Charlottesville, VA 22904
| | - Paul Aoun
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, MN 55905
| | - Johannes D. Veldhuis
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, MN 55905
- Corresponding author: Tel: (507) 255-0902, Tel: (507) 255-0901,
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Iranmanesh A, Rochester DF, Liu J, Veldhuis JD. Impaired adrenergic- and corticotropic-axis outflow during exercise in chronic obstructive pulmonary disease. Metabolism 2011; 60:1521-9. [PMID: 21632072 PMCID: PMC3181386 DOI: 10.1016/j.metabol.2011.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 03/21/2011] [Accepted: 03/26/2011] [Indexed: 10/18/2022]
Abstract
Exercise stimulates coordinated release of the sympathoadrenal hormones adrenocorticotropic hormone (ACTH), cortisol, norepinephrine (NE), and epinephrine (Epi). The study hypothesis was that chronic obstructive pulmonary disease (COPD) is marked by heightened sympathoadrenal outflow at comparable relative workloads. The location of the study was at a clinical research unit. Eight healthy men and 9 men with stable COPD (forced expiratory volume at 1 second <75% predicted) were studied. Volunteers rested (baseline) or exercised at individual submaximal (35% ± 5%) or maximal oxygen consumption. Blood was sampled every 2 minutes for 40 minutes concurrently. Two-way analysis of covariance was applied to examine group (healthy/COPD) and exercise (3 levels) effects on ACTH, cortisol, NE, and Epi release and regularity (estimable by approximate entropy). The timing of peak hormone concentrations was Epi, 14 minutes; NE, 16 minutes; ACTH, 22 minutes; and cortisol, 34 minutes in both cohorts. Type of exercise regimen influenced all 4 hormones (each P < .001), and subject group (control vs COPD) affected cortisol (P < .001) and Epi (P = .048) responses. Exercise regimen and group together controlled ACTH, cortisol, and Epi (each P < .001), but not NE, responses. In particular, endocrine responses were attenuated in COPD compared with control subjects. Approximate entropy analysis also identified loss of maximal exercise-induced ACTH-secretory regularity in COPD patients (P = .042). These outcomes demonstrate impaired rather than augmented exercise-associated sympathocorticotropic-axis outflow in patients with COPD even when outcomes are normalized to maximal oxygen consumption, suggesting that factors other than fitness are at work.
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Affiliation(s)
- Ali Iranmanesh
- Endocrine Service, Medical Section, Salem Veterans Affairs Medical Center, Salem, VA 24153
| | - Dudley F. Rochester
- Division of Pulmonary and Critical Medicine, University of Virginia Health Sciences Center, Charlottesville, VA 22901
| | - Jing Liu
- Division of Pulmonary and Critical Medicine, University of Virginia Health Sciences Center, Charlottesville, VA 22901
| | - Johannes D. Veldhuis
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, MN 55905
- Corresponding author: Tel: (507) 255-0906, Fax: (507) 255-0901,
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Veldhuis JD, Iranmanesh A, Roelfsema F, Aoun P, Takahashi P, Miles JM, Keenan DM. Tripartite control of dynamic ACTH-cortisol dose responsiveness by age, body mass index, and gender in 111 healthy adults. J Clin Endocrinol Metab 2011; 96:2874-81. [PMID: 21752885 PMCID: PMC3167672 DOI: 10.1210/jc.2011-0084] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recent analyses in small cohorts suggest that pituitary hormones exert time-varying (viz., initial and delayed) dynamic dose-responsive effects on target glands, wherein down-regulating dynamics are inferable on a time scale of single pulses. HYPOTHESIS Age, body mass index (BMI), and sex modulate the rapid potency-down-regulating dynamics of pulsatile pituitary ACTH-adrenal cortisol coupling overnight. LOCATION The study was conducted at a clinical translational research unit. SUBJECTS Subjects included healthy adults (48 women, 63 men; aged 18-77 yr; BMI 18-42 kg/m(2)). OUTCOMES Outcomes included analytical dose-response estimates of endogenous ACTH efficacy, dynamic ACTH potency, and adrenal sensitivity from overnight 10-min ACTH-cortisol profiles. RESULTS Stepwise backward-elimination, multivariate-regression analysis revealed that in the combined cohorts (n = 111), age was associated with enhanced initial ACTH potency (R = 0.265, P = 0.005). Moreover, age and BMI jointly attenuated adrenal sensitivity (R = 0.334, P = 0.0017) and augmented down-regulated ACTH potency (R = 0.321 and P = 0.0028). Exploratory gender-segmented analyses showed that these outcomes might be explained by: (1) a negative effect of age in men on adrenal sensitivity (R = 0.270, P = 0.034) and (2) positive effects of age in men (R = 0.332, P = 0.0019) and BMI in women (R = 0.331, P = 0.024) on initial ACTH potency. CONCLUSIONS In healthy adults, adrenal sensitivity to endogenous ACTH pulses, ACTH efficacy, and ACTH potency is associated with age, BMI, and gender. These findings may explain conflicting data in earlier literature and introduce the need to control all three of age, BMI, and sex in future studies of the stress-adaptive axis.
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Affiliation(s)
- Johannes D Veldhuis
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, Minnesota 55905, USA.
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22
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Veldhuis JD, Roelfsema F, Iranmanesh A, Carroll BJ, Keenan DM, Pincus SM. Basal, pulsatile, entropic (patterned), and spiky (staccato-like) properties of ACTH secretion: impact of age, gender, and body mass index. J Clin Endocrinol Metab 2009; 94:4045-52. [PMID: 19755477 PMCID: PMC2758736 DOI: 10.1210/jc.2009-1143] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Age, gender, and BMI determine ultradian modes of LH and GH secretion, viz., pulsatile, basal, pattern-defined regularity [approximate entropy (ApEn)] and spikiness (sharp, brief excursions). Whether the same determinants apply to ACTH secretion is not known. SETTING The study was conducted at a tertiary medical center. SUBJECTS We studied normal women (n = 22) and men (n = 26) [ages, 23-77 yr; body mass index (BMI), 21-32 kg/m(2)]. METHODS Volunteers underwent 10-min blood sampling to create 24-h ACTH concentration profiles. OUTCOMES Dynamic measures of ACTH secretion were studied. RESULTS Mean ACTH concentrations (R(2) = 0.15; P = 0.006) and both pulsatile (R(2) = 0.12; P = 0.018) and basal (nonpulsatile) (R(2) = 0.16; P = 0.005) ACTH secretion correlated directly with BMI (n = 48). Men had greater basal (P = 0.047), pulsatile (P = 0.031), and total (P = 0.010) 24-h ACTH secretion than women, including when total secretion was normalized for BMI (P = 0.019). In men, both ACTH-cortisol feedforward and cortisol-ACTH feedback asynchrony (cross-ApEn) increased with age (R(2) = 0.20 and 0.22; P = 0.021 and 0.018). ACTH spikiness rose with age (P = 0.046), principally in women. Irregularity of cortisol secretion (ApEn) increased with age (n = 48; P = 0.010), especially in men. In both sexes, percentage pulsatile ACTH secretion predicted 24-h mean cortisol concentrations (R(2) = 0.14; P = 0.009). CONCLUSION Valid comparisons of ultradian ACTH dynamics will require cohorts matched for age, gender, and BMI, conditions hitherto not satisfied in most physiological studies of this axis.
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Affiliation(s)
- Johannes D Veldhuis
- Endocrine Research Unit, Mayo Medical School, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, Minnesota 55905, USA.
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23
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Modeling the hypothalamus-pituitary-adrenal system: homeostasis by interacting positive and negative feedback. J Biol Phys 2009; 35:149-62. [PMID: 19669558 DOI: 10.1007/s10867-009-9134-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 01/06/2009] [Indexed: 10/21/2022] Open
Abstract
The hypothalamus-pituitary-adrenal (HPA) system is closely related to stress and the restoration of homeostasis. This system is stimulated in the second half of the night, decreases its activity in the daytime, and reaches the homeostatic level during the late evening. In this paper, we derive and discuss a novel model for the HPA system. It is based on three simple rules that constitute a principle of homeostasis and include only the most substantive physiological elements. In contrast to other models, its main components include, apart from the conventional negative feedback ingredient, a positive feedback loop. To validate the model, we present a parameter estimation procedure that enables one to adapt the model to clinical observations. Using this methodology, we are able to show that the novel model is capable of simulating clinical trials. Furthermore, the stationary state of the system is investigated. We show that, under mild conditions, the system always has a well-defined set-point, which reflects the clinical situation to be modeled. Finally, the computed parameters may be interpreted from a physiological point of view, thereby leading to insights about diseases like depression, obesity, or diabetes.
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24
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Veldhuis JD, Keenan DM, Pincus SM. Motivations and methods for analyzing pulsatile hormone secretion. Endocr Rev 2008; 29:823-64. [PMID: 18940916 PMCID: PMC2647703 DOI: 10.1210/er.2008-0005] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 09/16/2008] [Indexed: 01/05/2023]
Abstract
Endocrine glands communicate with remote target cells via a mixture of continuous and intermittent signal exchange. Continuous signaling allows slowly varying control, whereas intermittency permits large rapid adjustments. The control systems that mediate such homeostatic corrections operate in a species-, gender-, age-, and context-selective fashion. Significant progress has been made in understanding mechanisms of adaptive interglandular signaling in vivo. Principal goals are to understand the physiological origins, significance, and mechanisms of pulsatile hormone secretion. Key analytical issues are: 1) to quantify the number, size, shape, and uniformity of pulses, nonpulsatile (basal) secretion, and elimination kinetics; 2) to evaluate regulation of the axis as a whole; and 3) to reconstruct dose-response interactions without disrupting hormone connections. This review will focus on the motivations driving and the methodologies used for such analyses.
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Affiliation(s)
- Johannes D Veldhuis
- Endocrine Research Unit, Department of Internal Medicine, Mayo Medical School, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, Minnesota 55905, USA.
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25
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Iranmanesh A, Veldhuis JD. Hypocortisolemic clamp unmasks jointly feedforward- and feedback-dependent control of overnight ACTH secretion. Eur J Endocrinol 2008; 159:561-8. [PMID: 18713842 PMCID: PMC2693721 DOI: 10.1530/eje-08-0417] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND ACTH secretion is under hypothalamic stimulatory (feedforward) and adrenal inhibitory (feedback) control. HYPOTHESIS Assessment of overnight ACTH secretion during a hypocortisolemic clamp will permit the estimation of changing feedforward and feedback. SUBJECTS Seven healthy men. INTERVENTIONS An oral dose of placebo (PLAC), metyrapone (METY, 3 g), or ketoconazole (KTCZ, 1.2 g) was given at midnight (MN) to block glucocorticoid synthesis. Plasma ACTH was sampled every 10 min (MN to 0800 h). ANALYSIS Variable-waveform deconvolution analysis of ACTH secretion and approximate entropy (ApEn) analysis of pattern regularity. RESULTS Compared with PLAC, administration of METY and KTCZ reduced morning cortisol concentrations by >or=77 and 54% respectively (P<0.001). Hypocortisolemia elevated pulsatile ACTH secretion by 8.2- (METY) and 5.3-fold (KTCZ; both P<0.001). Basal ACTH secretion rose by 3.4-fold under METY-induced cortisol depletion (P=0.020). ACTH secretory-burst shape and half-life were stable. ApEn of ACTH release declined overnight (P=0.021) and with the drug (P=0.001), denoting enhanced feedforward coordination. CONCLUSION The combined data predict overnight amplification and coordination of hypothalamic feedforward drive onto ACTH release. Therefore, disruption of either mechanism might contribute to clinical pathophysiology, such as late-day elevations of cortisol output in fasting, alcoholism, depression, or aging.
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Affiliation(s)
- Ali Iranmanesh
- Department of Medicine, Salem Veterans Affairs Medical Center, Salem, Virginia 24153, USA
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26
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Reti IM, Miskimon M, Dickson M, Petralia RS, Takamiya K, Bland R, Saini J, During MJ, Huganir RL, Baraban JM. Activity-dependent secretion of neuronal activity regulated pentraxin from vasopressin neurons into the systemic circulation. Neuroscience 2007; 151:352-60. [PMID: 18082971 DOI: 10.1016/j.neuroscience.2007.10.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 10/15/2007] [Accepted: 11/10/2007] [Indexed: 11/18/2022]
Abstract
Neuronal activity regulated pentraxin (Narp) is a secreted, synaptic protein that has been implicated in modulating synaptic transmission. However, it is unclear how Narp secretion is regulated. Since we noted prominent Narp immunostaining in vasopressin neurons of the hypothalamus and in the posterior pituitary, we assessed whether it, like vasopressin, is released into the systemic circulation in an activity-dependent fashion. Consistent with this hypothesis, electron microscopic studies of the posterior pituitary demonstrated that Narp is located in secretory vesicles containing vasopressin. Using affinity chromatography, we detected Narp in plasma and found that these levels are markedly decreased by hypophysectomy. In addition, we confirmed that injection of a viral Narp construct into the hypothalamus restores plasma Narp levels in Narp knockout mice. In checking for activity-dependent secretion of Narp from the posterior pituitary, we found that several stimuli known to trigger vasopressin release, i.e. hypovolemia, dehydration and endotoxin, elevate plasma Narp levels. Taken together, these findings provide compelling evidence that Narp is secreted from vasopressin neurons in an activity-dependent fashion.
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MESH Headings
- Adenoviridae/genetics
- Animals
- C-Reactive Protein/metabolism
- Chromatography, Affinity
- DNA, Complementary/biosynthesis
- DNA, Complementary/genetics
- Dehydration/physiopathology
- Genetic Vectors
- Humans
- Hypovolemia/physiopathology
- Immunohistochemistry
- Lipopolysaccharides/toxicity
- Mice
- Mice, Knockout
- Microscopy, Electron
- Microscopy, Immunoelectron
- Motor Activity/physiology
- Nerve Tissue Proteins/blood
- Nerve Tissue Proteins/metabolism
- Neurons/metabolism
- Neurons/physiology
- Pituitary Gland/metabolism
- Rats
- Rats, Sprague-Dawley
- Restraint, Physical
- Stress, Psychological/metabolism
- Stress, Psychological/physiopathology
- Vasopressins/physiology
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Affiliation(s)
- I M Reti
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21205, USA.
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27
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Peters A, Conrad M, Hubold C, Schweiger U, Fischer B, Fehm HL. The principle of homeostasis in the hypothalamus-pituitary-adrenal system: new insight from positive feedback. Am J Physiol Regul Integr Comp Physiol 2007; 293:R83-98. [PMID: 17459911 DOI: 10.1152/ajpregu.00907.2006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Feedback control, both negative and positive, is a fundamental feature of biological systems. Some of these systems strive to achieve a state of equilibrium or “homeostasis”. The major endocrine systems are regulated by negative feedback, a process believed to maintain hormonal levels within a relatively narrow range. Positive feedback is often thought to have a destabilizing effect. Here, we present a “principle of homeostasis,” which makes use of both positive and negative feedback loops. To test the hypothesis that this homeostatic concept is valid for the regulation of cortisol, we assessed experimental data in humans with different conditions (gender, obesity, endocrine disorders, medication) and analyzed these data by a novel computational approach. We showed that all obtained data sets were in agreement with the presented concept of homeostasis in the hypothalamus-pituitary-adrenal axis. According to this concept, a homeostatic system can stabilize itself with the help of a positive feedback loop. The brain mineralocorticoid and glucocorticoid receptors—with their known characteristics—fulfill the key functions in the homeostatic concept: binding cortisol with high and low affinities, acting in opposing manners, and mediating feedback effects on cortisol. This study supports the interaction between positive and negative feedback loops in the hypothalamus-pituitary-adrenal system and in this way sheds new light on the function of dual receptor regulation. Current knowledge suggests that this principle of homeostasis could also apply to other biological systems.
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Affiliation(s)
- A Peters
- Department of Internal Medicine I, Endocrinology, University of Luebeck, 23538 Luebeck, Germany.
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28
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Young EA, Ribeiro SC, Ye W. Sex differences in ACTH pulsatility following metyrapone blockade in patients with major depression. Psychoneuroendocrinology 2007; 32:503-7. [PMID: 17462829 PMCID: PMC1975691 DOI: 10.1016/j.psyneuen.2007.03.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 03/12/2007] [Accepted: 03/13/2007] [Indexed: 11/27/2022]
Abstract
Numerous studies suggest that increased central drive to the hypothalamic-pituitary adrenal (HPA) axis occurs in patients with major depression. To determine if increased central drive occurs throughout the 24 h, we evaluated ACTH secretion under metyrapone blockade of cortisol production. We collected blood every 10 min for measurement of ACTH and data were analyzed for ACTH pulsatility using the pulse detection algorithm deconvolution. We studied 28 patients with major depression and 28 age and sex-matched control subjects, of which 9 pairs were men and 19 pairs were women. We found a significant group x sex interaction with number of ACTH pulses (p=0.04); depressed men showed more ACTH pulses over 24h than matched control men (p=0.02). There was also a significant sex difference in AUC pulses with men showing a smaller AUC ACTH than women. Previous analyses of these data with RM-ANOVA showed a smaller ACTH response in depressed men compared to control men. These data suggest that pulsatility and mean ACTH levels are examining different aspects of HPA axis function, and that the types of HPA axis dysregulation in depression may differ between men and women.
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Affiliation(s)
- Elizabeth A Young
- Department of Psychiatry, The University of Michigan, Ann Arbor, MI 48109, USA.
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29
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Young EA, Ribeiro SC. Sex differences in the ACTH response to 24H metyrapone in depression. Brain Res 2006; 1126:148-55. [PMID: 16824495 DOI: 10.1016/j.brainres.2006.05.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Accepted: 05/14/2006] [Indexed: 11/18/2022]
Abstract
Increased hypothalamic-pituitary-adrenal (HPA) axis activation has been observed in major depression. Increased corticotropin-releasing hormone (CRH) is hypothesized to drive corticotropin (ACTH) secretion leading to increased ACTH and cortisol secretion throughout 24H. Contradicting data exist as to whether the increased drive is present throughout the day or is restricted to the late afternoon and evening. To determine if increased HPA axis activation occurs during a specific circadian phase or is found throughout the 24H, we studied 26 healthy drug-free depressed patients and 26 healthy age- and sex-matched control subjects under metyrapone inhibition of cortisol synthesis for 24H beginning at 4 PM. Blood was drawn every 10 min for 24H and assayed for ACTH and cortisol. Gender differences in response to metyrapone were seen in both patients and controls. Depressed women demonstrated increased ACTH concentrations between 4 PM and 10 PM compared to control women. Maximal ACTH response over time was identical between depressed and control women. Depressed men demonstrated significantly decreased ACTH secretion between 4 and 10 PM as well as decreased maximal ACTH response compared to control men or depressed women. These data support an increased evening CRH drive in depressed women, but overall decreased CRH drive in depressed men.
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Affiliation(s)
- Elizabeth A Young
- Department of Psychiatry, The University of Michigan, MI 48109-0720, USA.
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30
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Klemcke HG, Vallet JL, Christenson RK. Lack of effect of metyrapone and exogenous cortisol on early porcine conceptus development. Exp Physiol 2006; 91:521-30. [PMID: 16431931 DOI: 10.1113/expphysiol.2005.033134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A study was conducted to evaluate the influence of maternal cortisol on early conceptus development in pigs (Sus scrofa). The corticosteroid synthesis inhibitor metyrapone was injected daily during days 14-19 of pregnancy, without (n = 6) and with commensurate administration of cortisol (n = 6). Blood samples were taken via an indwelling jugular catheter on days 14 and 18, and conceptuses were harvested during surgery on day 20. Compared with vehicle-injected control dams (n = 7) plasma cortisol and aldosterone concentrations were decreased (P < 0.01) by 52 and 29%, respectively, by metyrapone treatment. Cortisol administration reversed decreases in plasma cortisol by day 18. There were no treatment-associated effects on conceptus survival or size. Nor were there treatment-associated effects on allantoic fluid volume or content. Trophodermal glucocorticoid receptor (GR) mRNA expression decreased by 34% (P < 0.05) in metyrapone-treated pigs, and was not further influenced by concomitant administration of cortisol, thereby suggesting an influence of aldosterone on GR mRNA expression. Also, when all pigs were considered, there were treatment-independent second-order polynomial regressions (P < 0.05) between maternal plasma cortisol concentrations and embryonic weight, allantoic size and allantoic glucose concentrations, and between plasma aldosterone concentrations and trophodermal GR mRNA expression. Such biphasic corticosteroid concentration versus tissue parameter curves are noteworthy, but difficult to interpret validly. They may suggest that an appropriate corticosteroid environment is necessary for optimal porcine embryonic development during this stage of gestation, but cannot overshadow the absence of treatment effects on the porcine embryonic measures evaluated.
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Affiliation(s)
- H G Klemcke
- USDA-ARS, Roman L. Hruska US Meat Animal Research Center, Clay Center, NE 68933, USA.
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31
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Evans JF, Shen CL, Pollack S, Aloia JF, Yeh JK. Adrenocorticotropin evokes transient elevations in intracellular free calcium ([Ca2+]i) and increases basal [Ca2+]i in resting chondrocytes through a phospholipase C-dependent mechanism. Endocrinology 2005; 146:3123-32. [PMID: 15802497 DOI: 10.1210/en.2004-1612] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Both clinical and in vitro evidence points to the involvement of the melanocortin peptide, ACTH, in the terminal differentiation of chondrocytes. Terminal differentiation along the endochondral pathway is responsible for linear growth, but also plays a role in osteoarthritic cartilage degeneration. Chondrocyte terminal differentiation is associated with an incremental increase in chondrocyte basal intracellular free calcium ([Ca(2+)](i)), and ACTH agonism of melanocortin receptors is known to mobilize [Ca(2+)](i.) Using differentiated resting chondrocytes highly expressing type II collagen and aggrecan, we examined the influence of both ACTH and dexamethasone treatment on matrix gene transcription and [Ca(2+)](i). Resting chondrocytes treated concurrently with dexamethasone and ACTH expressed matrix gene transcripts in a pattern consistent with that of rapid terminal differentiation. Using the fluorescent Ca(2+) indicator, fura-2, we determined that ACTH evokes transient increases in [Ca(2+)](i) and elevates basal Ca(2+) levels in resting chondrocytes. The transient increases were initiated intracellularly, were abrogated by the phospholipase C-specific inhibitor, U73122, and were partly attenuated by myo-inositol 1,4,5-triphosphate receptor inhibition via 10 mm caffeine. The initial intracellular release also resulted in store-operated calcium entry, presumably through store-operated channels. Dexamethasone priming increased both the initial ACTH-evoked [Ca(2+)](i) release and the subsequent store-operated calcium entry. These data demonstrate roles for ACTH and glucocorticoid in the regulation of chondrocyte terminal differentiation. Because the actions of ACTH are mediated through known G protein-coupled receptors, the melanocortin receptors, these data may provide a new therapeutic target in the treatment of growth deficiencies and cartilage degeneration.
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Affiliation(s)
- Jodi F Evans
- Department of Medicine, Winthrop University Hospital, Mineola, New York 11501, USA.
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32
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Evans SB, Wilkinson CW, Gronbeck P, Bennett JL, Zavosh A, Taborsky GJ, Figlewicz DP. Inactivation of the DMH selectively inhibits the ACTH and corticosterone responses to hypoglycemia. Am J Physiol Regul Integr Comp Physiol 2004; 286:R123-8. [PMID: 14660476 DOI: 10.1152/ajpregu.00328.2003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We have previously reported that repeated bouts of insulin-induced hypoglycemia (IIH) in the rat result in blunted activation of the paraventricular, arcuate, and dorsomedial hypothalamic (DMH) nuclei. Because DMH activation has been implicated in the sympathoadrenal and hypothalamic-pituitary-adrenal (HPA) responses to stressors, we hypothesized that its blunted activation may play a role in the impaired counterregulatory response that is also observed with repeated bouts of IIH. In the present study, we evaluated the role of normal DMH activation in the counterregulatory response to a single bout of IIH. Local infusion of lidocaine (n = 8) to inactivate the DMH during a 2-h bout of IIH resulted in a significant overall decrease of the ACTH response and a delay of onset of the corticosterone response compared with vehicle-infused controls (n = 9). We observed suppression of the ACTH response at time (t) = 90 and 120 min (50 +/- 12 and 63 +/- 6%, respectively, of control levels) and early suppression of the corticosterone response at t = 30 min (59 +/- 13% of the control level). The epinephrine, norepinephrine, and glucagon responses were not altered by DMH inactivation. Our finding suggests that DMH inactivation may play a specific role in decreasing the HPA axis response after repeated bouts of IIH.
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Affiliation(s)
- Scott B Evans
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195-6560, USA
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33
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Gliddon CM, Smith PF, Darlington CL. Interaction between the hypothalamic-pituitary-adrenal axis and behavioural compensation following unilateral vestibular deafferentation. Acta Otolaryngol 2003; 123:1013-21. [PMID: 14710901 DOI: 10.1080/00016480310000520] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Vestibular compensation is defined as the process of behavioural recovery that occurs following the loss of sensory input from one or both vestibular labyrinths. The visual and postural instability resulting from the vestibular damage must alter the homeostasis of the subject; however, very little research has been conducted that investigates the interaction between vestibular compensation and the adaptive stress response of the body, i.e. the hypothalamic-pituitary-adrenal (HPA) axis. The aim of this review is to describe and evaluate the experimental evidence indicating a link between vestibular compensation and the body's response to stress, via the HPA axis.
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Affiliation(s)
- Catherine M Gliddon
- Vestibular Research Group, Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago Medical School, Dunedin, New Zealand
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34
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Keenan DM, Veldhuis JD. Cortisol feedback state governs adrenocorticotropin secretory-burst shape, frequency, and mass in a dual-waveform construct: time of day-dependent regulation. Am J Physiol Regul Integr Comp Physiol 2003; 285:R950-61. [PMID: 12842865 DOI: 10.1152/ajpregu.00299.2003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Quantification of in vivo pituitary hormone secretion requires simultaneous appraisal of implicit 1) secretory-burst waveform, mass, and stochastic pulse timing; 2) basal secretion; 3) biexponential elimination kinetics; and 4) random experimental error (Keenan DM, Licinio J, and Veldhuis JD. Proc Natl Acad Sci USA 98: 4028-4033, 2001). The present study extends this analytic formalism to allow for time of day-dependent waveform adaptation (burst-shape change) at statistically determinable boundary times. Thereby, we test the hypothesis that diurnal mechanisms and glucocorticoid negative feedback jointly govern distinctive facets of the burstlike secretion of ACTH. To this end, we reanalyzed intensively (10 min) sampled 24-h plasma ACTH concentration profiles collected previously under feedback-intact and drug-induced cortisol depletion in nine healthy adults. Akaiki information criterion-based model comparison favored dual (rather than single) secretory-burst representation of 24-h ACTH release in both the intact and low-cortisol setting in eight of nine subjects. Under feedback-intact conditions, analytically predicted waveform changepoints (median clock times 0611 and 1739) flanked an interval of elevated ACTH secretory-burst mass (P < 10-3). Experimental hypocortisolemia did not alter day/night boundaries, but 1) stimulated day ACTH secretory-burst mass (P < 10-3); 2) accelerated day ACTH secretory-burst frequency (P < 10-3); and 3) forced skewness of day ACTH secretory bursts toward more rapid initial release (P < 0.05). In contrast, the basal ACTH secretion rate and regularity of interpulse-interval lengths were invariant of day/night segmentation and cortisol availability. In conclusion, unknown diurnal factors and systemic cortisol concentrations codetermine ACTH secretory-burst waveform, frequency, and mass, whereas neither mechanism regulates basal ACTH release or regularity of the burst-renewal process.
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Affiliation(s)
- Daniel M Keenan
- Division of Endocrinology and Metabolism, Dept. of Internal Medicine, Mayo Medical and Graduate Schools of Medicine, General Clinical Research Center, Mayo Clinic, Rochester, MN 55905, USA
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35
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Keenan DM, Roelfsema F, Biermasz N, Veldhuis JD. Physiological control of pituitary hormone secretory-burst mass, frequency, and waveform: a statistical formulation and analysis. Am J Physiol Regul Integr Comp Physiol 2003; 285:R664-73. [PMID: 12738612 DOI: 10.1152/ajpregu.00195.2003] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present study investigates the time-varying control of pituitary hormone secretion over the day and night (D/N). To this end, we implemented an analytical platform designed to reconstruct simultaneously 1) basal (nonpulsatile) secretion, 2) single or dual secretory-burst waveforms, 3) random effects on burst amplitude, 4) stochastic pulse-renewal properties, 5) biexponential elimination kinetics, and 6) experimental uncertainty. The statistical solution is conditioned on a priori pulse-onset times, which are estimated in the first stage. Primary data composed of thyrotropin (TSH) concentrations were monitored over 24 h in 27 healthy adults. According to statistical criteria, 21/27 profiles favored a dual compared with single secretory-burst waveform. An objectively defined waveform change point (D/N boundary) emerged at 2046 (+/-23 min), after which 1) the mass of TSH released per burst increases by 2.1-fold (P < 0.001), 2) TSH secretory-burst frequency rises by 1.2-fold (P < 0.001), 3) the latency to maximal TSH secretion within a burst decreases by 67% (P < 0.001), 4) variability in secretory-burst shape diminishes by 50% (P < 0.001), and 5) basal TSH secretion declines by 17% (P < 0.002). In contrast, the regularity of successive burst times and the slow-phase half-life are stable. In conclusion, nycthemeral mechanisms govern TSH secretory-burst mass, frequency, waveform, and variability but not evidently TSH elimination kinetics or the pulse-timing process. Further studies will be required to assess the generality of the foregoing distinctive control mechanisms in other hypothalamo-pituitary axes.
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Affiliation(s)
- Daniel M Keenan
- Division of Endocrinology and Metabolism, Dept. of Internal Medicine, Mayo Medical School and Graduate School of Medicine, General Clinical Research Center, Mayo Clinic, Rochester, MN 55905, USA.
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36
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Abstract
Age and gender impact the full repertoire of neurohormone systems, including most prominently the somatotropic, gonadotropic and lactotropic axes. For example, daily GH production is approximately 2-fold higher in young women than men and varies by 20-fold by sexual developmental status and age. Deconvolution estimates of 24-h GH secretion rates exceed 1200 microg/m2 in adolescents and fall below 60 microg/m2 in aged individuals. The present overview highlights plausible factors driving such lifetime variations in GH availability, i.e., estrogen, aromatizable androgen, hypothalamic peptides and negative feedback by GH and IGF-I. In view of the daunting complexity of potential neuromodulatory signals, we underline the utility of conceptualizing a simplified three-peptide regulatory ensemble of GHRH, GHRP (ghrelin) and somatostatin. The foregoing signals act as individual and conjoint mediators of adaptive GH control. Regulation is enforced at 3-fold complementary time scales, which embrace pulsatile (burst-like), entropic (orderly) and 24-h rhythmic (nycthemeral) modes of GH release. This unifying platform offers a convergent perspective of multivalent control of GH outflow.
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Affiliation(s)
- J D Veldhuis
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mayo Medical School of Medicine, General Clinical Research Center, Mayo Clinic, Rochester, MN 55905, USA.
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Evans SB, Wilkinson CW, Gronbeck P, Bennett JL, Taborsky GJ, Figlewicz DP. Inactivation of the PVN during hypoglycemia partially simulates hypoglycemia-associated autonomic failure. Am J Physiol Regul Integr Comp Physiol 2003; 284:R57-65. [PMID: 12388440 DOI: 10.1152/ajpregu.00439.2002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The anatomic connections of the paraventricular nucleus of the hypothalamus (PVN) are such that it is ideally situated to modulate and/or control autonomic responses to a variety of stressors, including hypoglycemia. In our experimental model of hypoglycemia-associated autonomic failure (HAAF), a syndrome in which the counterregulatory response to hypoglycemia is partially compromised via unknown mechanisms, activation of the PVN is blunted (15). We hypothesized that this blunted PVN activation during HAAF may be sufficient to cause the impaired counterregulatory response. To test this hypothesis, we anesthetized the PVN with lidocaine during insulin-induced hypoglycemia in rats and measured counterregulatory hormone levels. PVN inactivation decreased indexes of the sympathoadrenal response (plasma epinephrine and norepinephrine) and the hypothalamic-pituitary axis response (ACTH). Inactivation decreased the peak epinephrine response to hypoglycemia by almost half (-42 +/- 6% from control; P = 0.04) and the peak norepinephrine response by 34 +/- 5% (P = 0.01). The peak plasma ACTH levels attained were suppressed by 35 +/- 6% (P = 0.02). Adrenal corticosterone and pancreatic glucagon responses were not impaired. This pattern of neuroendocrine response is unlike that previously seen with our HAAF model. Control infusions of lidocaine >or=1 mm anterior or posterior to the PVN did not simulate this neuroendocrine pattern. Thus it appears that decreased PVN activation, as occurs with HAAF, may be involved in specific components of HAAF (i.e., blunting the sympathoadrenal and hypothalamic-pituitary-adrenocortical axis response), but not in others (i.e., blunting the glucagon response).
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Affiliation(s)
- Scott B Evans
- Departments of Psychology and of Medicine, University of Washington, Seattle 98195, USA.
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Boone AN, Vijayan MM. Glucocorticoid-mediated attenuation of the hsp70 response in trout hepatocytes involves the proteasome. Am J Physiol Regul Integr Comp Physiol 2002; 283:R680-7. [PMID: 12185003 DOI: 10.1152/ajpregu.00125.2002] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The physiological implication of elevated cortisol levels on cellular heat-shock protein 70 (hsp70) response was examined using primary cultures of rainbow trout (Oncorhynchus mykiss) hepatocytes. Trout hepatocytes treated with cortisol, the predominant glucocorticoid in teleosts, responded to the heat shock (+15 degrees C for 1 h) with a significant drop in hsp70 accumulation over a 24-h recovery period. [(35)S]methionine incorporation and pulse-chase studies confirmed that this cortisol impact was due to decreased hsp70 synthesis and not enhanced protein breakdown. Cortisol also significantly decreased glucocorticoid receptor (GR) expression in trout hepatocytes. This receptor downregulation was inhibited by the proteasomal inhibitors, lactacystin and MG-132, implying a role for the proteasome in GR downregulation by cortisol. Inhibiting the proteasome did not significantly modify heat-induced hsp70 accumulation in the absence of cortisol but significantly elevated hsp70 expression in the presence of cortisol in heat-shocked trout hepatocytes. Taken together, our results suggest proteasome-mediated GR degradation as a mechanism for the attenuation of hsp70 response by cortisol in heat-shocked hepatocytes.
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Affiliation(s)
- Adrienne N Boone
- Department of Biology, University of Waterloo, Waterloo, Ontario, N2L 3G1 Canada
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