1
|
Murphy EP, Murphy RP, McKenna D, Miller P, Doyle R, Hurson C. Improved adherence to hip fracture standards reduces mortality after hip fractures. Surgeon 2024; 22:25-30. [PMID: 37517981 DOI: 10.1016/j.surge.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/11/2023] [Accepted: 06/25/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Hip fractures are increasing in incidence due to increasing life expectancy. Mortality continues to improve but it is important to explore which factors are responsible for driving improvements. METHODS A cohort of hip fracture patients predating SARS-CoV-2 was examined to determine the predictors of adherence to the six Irish Hip Fracture Standards (IHFS) and the impact of adherence on short (30 day) and long term (1 year) mortality. Our primary aim was assess the impact of a single HFS and cumulative number of HFS on mortality after hip fracture. Our secondary aim was to determine the impact of the HFS which are intrinsically linked to specialist Geriatric care. RESULTS Across 962 patients, over 5 years, the factors which were associated with adherence to HFS were female gender, increasing ASA grade and being nursed on an orthopaedic ward. Patients with increasing ASA were more likely to have met HFS 4-6 (Geriatrician review HFS4, bone health HFS5 & specialist falls assessment HFS6), less likely to have surgery within 48 h are more likely to develop a pressure ulcer. If the patient was not nursed on an orthopaedic ward all HFS were less likely to be met. At 30 days HFS 4-6 were associated with a statistically significant odds ratio (OR) of being alive, while at one year HFS 1 (admitted to an orthopaedic ward within 4 h), 5 and 6 were associated with a statistically significant OR of being alive. As increasing numbers of hip fracture standards were met patients were more likely to be alive at 30 days and one year. CONCLUSION This study has identified that improved adherence to hip fracture standards are associated with improved mortality at 30 days and one year.
Collapse
Affiliation(s)
- E P Murphy
- Department of Trauma and Orthopaedics, St Vincents University Hospital Elm Park, Dublin 4, Ireland.
| | - R P Murphy
- Department of Geriatric and Stroke Medicine, Saolta Hospital Group, Galway University Hospital, Newcastle Road, Galway, Ireland.
| | - D McKenna
- Department of Trauma and Orthopaedics, St Vincents University Hospital Elm Park, Dublin 4, Ireland.
| | - P Miller
- Department of Trauma and Orthopaedics, St Vincents University Hospital Elm Park, Dublin 4, Ireland.
| | - R Doyle
- Department of Geriatric Medicine, St. Vincents University Hospital Elm Park, Dublin 4, Ireland.
| | - C Hurson
- Department of Trauma and Orthopaedics, St Vincents University Hospital Elm Park, Dublin 4, Ireland.
| |
Collapse
|
2
|
Murphy RP, O’Connor C, Murphy EP, O’Caoimh R. Where Are They Now? Five-Year Career Trends in a Single Graduating Medical Class. Ir Med J 2019; 112:1027. [PMID: 32083361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- R P Murphy
- Department of Geriatrics, Galway University Hospital, Galway
| | - C O’Connor
- Department of Dermatology, South Infirmary Victoria Hospital, Cork
| | - E P Murphy
- Department of Orthopedics, Galway University Hospital, Galway
| | - R O’Caoimh
- Department of Geriatrics, Mercy University Hospital, Cork
| |
Collapse
|
3
|
Murphy RP, Reddin C, Murphy EP, Waters R, Murphy CG, Canavan M. Key Service Improvements After the Introduction of an Integrated Orthogeriatric Service. Geriatr Orthop Surg Rehabil 2019; 10:2151459319893898. [PMID: 31853381 PMCID: PMC6906332 DOI: 10.1177/2151459319893898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/11/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction: Models of orthogeriatric care have been shown to improve functional outcomes for
patients after hip fractures and can improve compliance with best practice guidelines
for hip fracture care. Methods: We evaluated improvements to key performance indicators in hip fracture care after
implementation of a formal orthogeriatric service. Compliance with Irish Hip Fracture
standards of care was reviewed, and additional outcomes such as length of stay, access
to rehabilitation, and discharge destination were evaluated. Results: Improvements were observed in all of the hip fracture standards of care. Mean length of
stay decreased from 19 to 15.5 days (mean difference 3.5 days; P <
.05). A higher proportion of patients were admitted to rehabilitation (16.7% vs 7.9%,
P < .05), and this happened in a timelier fashion (17.8 vs 24.8
days, P < .05). We found that less patients required convalescence
post-hip fracture. Discussion: A standardized approach to integrated post-hip fracture care with orthogeriatrics has
improved standards of care for patients. Conclusion: Introduction of orthogeriatric services has resulted in meaningful improvements in
clinical outcomes for older people with hip fractures.
Collapse
Affiliation(s)
- R P Murphy
- Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway, Ireland
| | - C Reddin
- Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway, Ireland
| | - E P Murphy
- Department of Orthopedics and Trauma, University Hospital Galway, Galway, Ireland
| | - R Waters
- Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway, Ireland
| | - C G Murphy
- Department of Orthopedics and Trauma, University Hospital Galway, Galway, Ireland
| | - M Canavan
- Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway, Ireland
| |
Collapse
|
4
|
Fenelon C, Murphy EP, Kearns SR, Curtin W, Murphy CG. A growing challenge: The rise of femoral periprosthetic fractures - An 11-year observational study. Surgeon 2019; 18:19-23. [PMID: 31196725 DOI: 10.1016/j.surge.2019.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/23/2019] [Accepted: 05/05/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The demand for joint arthroplasty has risen as our elderly population increases and ages. With this so to has the number of patients suffering periprosthetic fractures (PPF). The aim of our study was to quantify the burden of PPF and provide an up to date reference of the epidemiology of PPF in Ireland. We also sought to assess length of stay (LOS), resource utilisation and mortality associated with this cohort of patients. METHODS An eleven-year retrospective observational study was conducted of a consecutive series of patients treated for a femoral PPF. Costs were obtained from activity based tariffs provided by the hospital inpatient enquiry system and mortality was confirmed using the national death events publication system. RESULTS Over the 11-year study period 174 procedures for a femoral PPF were performed. Mean age of patients was 77.6 years (SD 11.1 years) with 44.7% male. Median ASA grade was 3 (range 1-4) and mean LOS was 19 days. There was a 700% increase in patients undergoing surgery for a PPF over the study period. The mean cost of care was €24,413 in 2017. Thirty-day mortality was 2.9% while one-year mortality was 12.4%. CONCLUSIONS PPF occur in an elderly comorbid cohort of patients. Care of these patients now makes up a considerable part of the orthopaedic workload and consumes a significant portion of healthcare resources. Patients should be treated in tertiary referral centres with surgeons skilled in their management. Better access to rehabilitation is needed.
Collapse
Affiliation(s)
- C Fenelon
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland.
| | - E P Murphy
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland.
| | - S R Kearns
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland.
| | - W Curtin
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland.
| | - C G Murphy
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland.
| |
Collapse
|
5
|
Fenelon C, Murphy EP, O’Daly BJ, Leonard M. Where does Pelvic and Acetabular Fracture Treatment fit into the Newly Proposed Major Trauma Model in Ireland? Ir Med J 2019; 112:915. [PMID: 31243944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aim To provide the most up to date reference of referral patterns for pelvis and acetabular (PA) fractures in Ireland and discuss where services should ideally be located. Methods A retrospective review was conducted of all referrals to the national referral centre for PA fractures in Ireland for 2016 and 2017. Results Over the two-year study period 456 referrals were made. Mean age of patients was 53 years, 62.9% were male. Management was conservative in 60.7%, operative in 38.2% while 1.1% died prior to transfer. Nearly half of fractures (47.8%) were due to falls with 38.6% due to road trauma. Referrals from the proposed central trauma network accounted for 76.1% of referrals. Median length of stay was 7 days. Average cost of operative treatment was €11,774. Conclusions PA trauma is associated with significant morbidity and costs to both patients and society. Consideration needs to be given to where best to place PA services to ensure the highest quality care in this cohort of patients
Collapse
Affiliation(s)
- C Fenelon
- National Centre for Pelvic & Acetabular Surgery, Tallaght University Hospital, Dublin
| | - E P Murphy
- National Centre for Pelvic & Acetabular Surgery, Tallaght University Hospital, Dublin
| | - B J O’Daly
- National Centre for Pelvic & Acetabular Surgery, Tallaght University Hospital, Dublin
| | - M Leonard
- National Centre for Pelvic & Acetabular Surgery, Tallaght University Hospital, Dublin
| |
Collapse
|
6
|
Murphy EP, Dobson AD, Keller C, Conneely OM. Differential regulation of transcription by the NURR1/NUR77 subfamily of nuclear transcription factors. Gene Expr 2018; 5:169-79. [PMID: 8882640 PMCID: PMC6138016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
NURR1 is an orphan member of the nuclear receptor superfamily of transcription factors that shares close sequence homology to the orphan nuclear receptor and immediate early gene product NUR77(NGF1 beta). The physiological role of NURR1 has not been established in mammalian cells. However, the observation that NURR1 and NUR77 interact with at least one common enhancer element (AAAAGGTCA), together with their partly overlapping but differential expression patterns in mammalian tissues, suggests that these proteins may have both shared and independent transcription regulatory functions. To identify potential target genes that may be regulated by NURR1, we analyzed its DNA binding properties to potential cis-acting enhancer elements. Using point mutagenesis of the AAAAGGTCA motif, we have identified three additional sequences that bind specifically to both NURR1 and NUR77, one of which serves as a functional enhancer element. Comparative analysis of the transcription regulatory properties of NURR1 and NUR77 indicates that the proteins can display opposing transregulatory activities that are influenced by the specific cis-acting sequences to which they bind. Our results indicate that the transcriptional responses of specific target genes to the NURR1/NUR77 subfamily may be differentially regulated by the relative cellular levels of NURR1 and NUR77 and influenced by the specific enhancer sequences that mediate their activity. Finally, we have identified several potential target genes of neuronal and neuroendocrine origin whose promoters contain this element.
Collapse
Affiliation(s)
- E P Murphy
- Department of Cell Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | | | | | | |
Collapse
|
7
|
McGoldrick NP, Murphy EP, Kearns SR. Osteochondral lesions of the ankle: The current evidence supporting scaffold-based techniques and biological adjuncts. Foot Ankle Surg 2018; 24:86-91. [PMID: 29409225 DOI: 10.1016/j.fas.2017.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 12/20/2016] [Accepted: 01/12/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Talar osteochondral lesions are more common than has been previously recognized. Optimal treatment remains unclear and the subject of much debate in the literature. Although reparative techniques such as microfracture have produced initial good results and remain the gold standard in the management of these lesions, the literature is deficient in long-term data. Recently, techniques focused on enhancing the local biological environment have been developed which have demonstrated promising outcomes. METHODS We reviewed the available evidence concerning scaffold-based techniques and biological adjuncts in the management of talar osteochondral lesions published in the English language on PubMed. RESULTS An update is provided on the current evidence concerning the role of biological adjuncts in the management of osteochondral lesions of the talus. CONCLUSIONS There has been an explosion of interest among the orthopaedic community in the role of biologics in the management of complex talar osteochondral lesions. A number of exciting new techniques have been developed which show promise. Robust randomized control trials are required to identify the optimal surgical strategy.
Collapse
Affiliation(s)
- N P McGoldrick
- Department of Trauma & Orthopaedic Surgery, University College Hospital Galway, Galway, Ireland.
| | - E P Murphy
- Department of Trauma & Orthopaedic Surgery, University College Hospital Galway, Galway, Ireland.
| | - S R Kearns
- Department of Trauma & Orthopaedic Surgery, University College Hospital Galway, Galway, Ireland.
| |
Collapse
|
8
|
Fitzgerald DC, Meade KG, McEvoy AN, Lillis L, Murphy EP, MacHugh DE, Baird AW. Tumour necrosis factor-α (TNF-α) increases nuclear factor κB (NFκB) activity in and interleukin-8 (IL-8) release from bovine mammary epithelial cells. Vet Immunol Immunopathol 2007; 116:59-68. [PMID: 17276517 DOI: 10.1016/j.vetimm.2006.12.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 12/01/2006] [Accepted: 12/29/2006] [Indexed: 10/23/2022]
Abstract
Epithelia play important immunological roles at a variety of mucosal sites. We examined NFkappaB activity in control and TNF-alpha treated bovine mammary epithelial monolayers (BME-UV cells). A region of the bovine IL-8 (bIL-8) promoter was sequenced and a putative kappaB consensus sequence was identified bioinformatically. We used this sequence to analyse nuclear extracts for IL-8 specific NFkappaB activity. As a surrogate marker of NFkappaB activation, we investigated IL-8 release in two models. Firstly in BME-UV monolayers, IL-8 release in the presence of pro- and anti-inflammatory agents was determined by enzyme-linked immunosorbent assay (ELISA). Secondly, we measured IL-8 secretion from a novel model of intact mucosal sheets of bovine teat sinus. IL-8 release into bathing solutions was assessed following treatment with pro- and anti-inflammatory agents. TNF-alpha enhanced NFkappaB activity in bovine mammary epithelial monolayers. p65 NFkappaB homodimer was identified in both control and TNF-alpha treated cells. Novel sequencing of the bovine IL-8 promoter identified a putative kappaB consensus sequence, which specifically bound TNF-alpha inducible p50/p65 heterodimer. TNF-alpha induced primarily serosal IL-8 release in the cell culture model. Pre-treatment with anti-TNF or dexamethasone inhibited TNF-alpha induced IL-8 release. High dose interleukin-1beta (IL-1beta) induced IL-8 release, however significantly less potently than TNF-alpha. Bovine mammary mucosal tissue released high basal levels of IL-8 which were unaffected by TNF-alpha or IL-1beta but inhibited by both dexamethasone and anti-TNF. These data support a role for TNF-alpha in activation of NFkappaB and release of IL-8 from bovine mammary epithelial cells.
Collapse
Affiliation(s)
- D C Fitzgerald
- UCD School of Agriculture, Food Science & Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | | | | | | | | | | | | |
Collapse
|
9
|
McEvoy AN, Bresnihan B, FitzGerald O, Murphy EP. Corticotropin-releasing hormone signaling in synovial tissue from patients with early inflammatory arthritis is mediated by the type 1 alpha corticotropin-releasing hormone receptor. Arthritis Rheum 2001. [PMID: 11508426 DOI: 10.1002/1529-0131(200108)44:8<1761::aid-art311>3.0.co;2-d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Elevated levels of corticotropin-releasing hormone (CRH) are produced locally in inflamed human synovial tissue, and previous observations indicate a role for CRH in the pathogenesis of inflammatory joint disease. To further elucidate the biologic role of CRH at peripheral sites, we examined the expression of known CRH receptor subtypes in inflamed human synovium and compared the expression patterns in normal synovium. METHODS Immunohistochemical analysis was used to confirm enhanced expression of specific CRH receptor subtypes in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) synovium. Immunofluorescence double-labeling was used to further characterize CRH receptor-expressing cells. Reverse transcriptase-polymerase chain reaction analysis was performed to examine CRH receptor subtype messenger RNA (mRNA) expression in RA, PsA, and normal synovial tissue. In addition, CRH receptor expression was examined in isolated synovial endothelial cells and synoviocytes. RESULTS Selective up-regulation of CRH receptors in inflamed synovial tissue indicated that CRH functions locally, in an autocrine/paracrine receptor-mediated manner. Immunoreactive CRH receptor type 1 (CRH-R1) was expressed abundantly on vascular endothelial cells and discrete perivascular cell populations, identified as mast cells. In all samples of inflamed synovium studied, CRH-R1alpha mRNA was detected; however, we were unable to identify CRH-R1beta or any CRH-R2 isoforms in samples from the same cohort of, patients. CRH receptor subtype expression in separated synovial cell populations revealed a pattern of staining similar to that seen in vivo. In contrast, neither CRH receptor subtype was expressed in normal synovial tissue. CONCLUSION Our findings suggest that CRH signaling, via CRH-R1alpha, may play a role in both the vascular changes and the pathologic mechanisms associated with joint inflammation in human arthritis.
Collapse
Affiliation(s)
- A N McEvoy
- St Vincent's University Hospital, Dublin, Ireland
| | | | | | | |
Collapse
|
10
|
McEvoy AN, Bresnihan B, FitzGerald O, Murphy EP. Corticotropin-releasing hormone signaling in synovial tissue from patients with early inflammatory arthritis is mediated by the type 1 alpha corticotropin-releasing hormone receptor. Arthritis Rheum 2001; 44:1761-7. [PMID: 11508426 DOI: 10.1002/1529-0131(200108)44:8<1761::aid-art311>3.0.co;2-d] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Elevated levels of corticotropin-releasing hormone (CRH) are produced locally in inflamed human synovial tissue, and previous observations indicate a role for CRH in the pathogenesis of inflammatory joint disease. To further elucidate the biologic role of CRH at peripheral sites, we examined the expression of known CRH receptor subtypes in inflamed human synovium and compared the expression patterns in normal synovium. METHODS Immunohistochemical analysis was used to confirm enhanced expression of specific CRH receptor subtypes in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) synovium. Immunofluorescence double-labeling was used to further characterize CRH receptor-expressing cells. Reverse transcriptase-polymerase chain reaction analysis was performed to examine CRH receptor subtype messenger RNA (mRNA) expression in RA, PsA, and normal synovial tissue. In addition, CRH receptor expression was examined in isolated synovial endothelial cells and synoviocytes. RESULTS Selective up-regulation of CRH receptors in inflamed synovial tissue indicated that CRH functions locally, in an autocrine/paracrine receptor-mediated manner. Immunoreactive CRH receptor type 1 (CRH-R1) was expressed abundantly on vascular endothelial cells and discrete perivascular cell populations, identified as mast cells. In all samples of inflamed synovium studied, CRH-R1alpha mRNA was detected; however, we were unable to identify CRH-R1beta or any CRH-R2 isoforms in samples from the same cohort of, patients. CRH receptor subtype expression in separated synovial cell populations revealed a pattern of staining similar to that seen in vivo. In contrast, neither CRH receptor subtype was expressed in normal synovial tissue. CONCLUSION Our findings suggest that CRH signaling, via CRH-R1alpha, may play a role in both the vascular changes and the pathologic mechanisms associated with joint inflammation in human arthritis.
Collapse
Affiliation(s)
- A N McEvoy
- St Vincent's University Hospital, Dublin, Ireland
| | | | | | | |
Collapse
|
11
|
Murphy EP, McEvoy A, Conneely OM, Bresnihan B, FitzGerald O. Involvement of the nuclear orphan receptor NURR1 in the regulation of corticotropin-releasing hormone expression and actions in human inflammatory arthritis. Arthritis Rheum 2001; 44:782-93. [PMID: 11315917 DOI: 10.1002/1529-0131(200104)44:4<782::aid-anr134>3.0.co;2-h] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine the regulation and mode of action of peripheral corticotropin-releasing hormone (CRH) in human inflammatory arthritis. METHODS CRH messenger RNA (mRNA) levels were measured in normal and inflamed synovial tissue and in primary synoviocytes prior to and following cytokine stimulation. Primary synoviocytes were transiently transfected with CRH promoter/reporter constructs, and promoter activity in response to cytokines was assessed. Immunohistochemical staining established CRH receptor expression, and Northern blot analysis confirmed that the nuclear transcription factors NUR77 and NURR1 contributed to synovial CRH receptor-mediated signaling. Primary synoviocytes were treated with pro- and antiinflammatory mediators, and the time course of NURR1 and NUR77 modulation was examined. Nuclear extracts were analyzed by electrophoretic mobility shift assay to determine NURR1 binding to the CRH promoter/enhancer. RESULTS CRH mRNA was up-regulated in the synovial tissue in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and sarcoid arthritis, but not in normal synovium. Inflammatory cytokines, such as interleukin-1beta and tumor necrosis factor alpha, enhanced the transcriptional activity of the human CRH promoter and increased levels of CRH mRNA in primary synoviocytes. Synovial CRH functioned in a paracrine manner to induce NURR1 and NUR77. NURR1 was abundantly expressed in the inflammatory cells of both RA and PsA synovium. NURR1 and NUR77 were differentially regulated, and NURR1 was the major cytokine-regulated member of the NURR subfamily as well as the mediator of cytokine- and CRH-dependent inflammatory responses in synovium. Furthermore, glucocorticoids dramatically suppressed cytokine- and CRH-induced synovial NURR1 mRNA. CONCLUSION These data demonstrate the involvement of the transcription factor NURR1 in the regulation of CRH expression and activity in human inflammatory arthritis.
Collapse
MESH Headings
- Arthritis, Rheumatoid/metabolism
- Arthritis, Rheumatoid/pathology
- Blotting, Northern
- Cells, Cultured
- Colforsin/pharmacology
- Corticotropin-Releasing Hormone/biosynthesis
- Corticotropin-Releasing Hormone/genetics
- Culture Media, Conditioned/pharmacology
- DNA Primers/chemistry
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Dinoprostone/pharmacology
- Humans
- Immunoenzyme Techniques
- Interleukin-1/pharmacology
- Knee Joint/pathology
- Nerve Tissue Proteins/metabolism
- Nuclear Receptor Subfamily 4, Group A, Member 1
- Nuclear Receptor Subfamily 4, Group A, Member 2
- RNA, Messenger/metabolism
- Receptors, Cytoplasmic and Nuclear
- Receptors, Steroid
- Reverse Transcriptase Polymerase Chain Reaction
- Synovial Membrane/drug effects
- Synovial Membrane/metabolism
- Synovial Membrane/pathology
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Transfection
- Tumor Necrosis Factor-alpha/pharmacology
- Up-Regulation
Collapse
Affiliation(s)
- E P Murphy
- Department of Rheumatology, Education and Research Center, St. Vincent's University Hospital, Dublin, Ireland
| | | | | | | | | |
Collapse
|
12
|
Abstract
It has become clear that there is a bidirectional communication between the neuroendocrine and the immune system and that both systems influence each other and interact under physiological conditions and in response to inflammatory stimuli. The hypothalamic-pituitary axis plays an important role in regulating and controlling immune responses and dysfunction of the axis has been implicated in the pathogenesis of rheumatoid arthritis (RA). Corticotrophin-releasing hormone (CRH), one of the main hormones of the axis, is also released extra-hypothalamically, peripherally at the site of inflammation and may modulate inflammatory responses locally. In this chapter we will discuss the role of the hypothalamic-pituitary-adrenal (HPA) axis and peripheral CRH, its influences on immune function and what is known about the possible pathogenetic role of the HPA axis and peripheral CRH in RA.
Collapse
Affiliation(s)
- A M Eijsbouts
- Department of Rheumatology, University Hospital Nijmegen, The Netherlands
| | | |
Collapse
|
13
|
Murphy EP, Conneely OM. Neuroendocrine regulation of the hypothalamic pituitary adrenal axis by the nurr1/nur77 subfamily of nuclear receptors. Mol Endocrinol 1997; 11:39-47. [PMID: 8994186 DOI: 10.1210/mend.11.1.9874] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The present study was designed to examine the role of the nurr1/nur77 subfamily of nuclear receptor transcription factors in the regulation of the hypothalamic/pituitary/adrenal axis at the neuroendocrine level. We demonstrate that this nuclear receptor subfamily can regulate the expression of the CRF and POMC genes by interacting with a specific cis-acting sequence in their proximal promoter regions. To examine the physiological significance of this response, we have focused on the POMC gene. We provide evidence that nurr1 and nur77 are rapidly induced by CRF in primary pituitary cells and that this induction is mimicked by forskolin in an anterior pituitary cell line. Further, we demonstrate that both nurr1- and forskolin-dependent induction of a POMC-chloramphenicol acetyltransferase reporter gene are inhibited by mutation of the nurr1-binding site within the POMC promoter and that this site alone can confer cAMP responsiveness to a heterologous promoter. Finally, we provide evidence that the nurr1/nur77 response sequence is pivotal to both nurr1/nur77-dependent positive regulation and glucocorticoid receptor-dependent negative regulation of the POMC gene. These data strongly support the conclusion that the nurr1/nur77 subfamily plays an important coordinate neuroendocrine-regulatory role at all levels of the hypothalamic/pituitary/adrenal axis.
Collapse
MESH Headings
- Adenylyl Cyclases/metabolism
- Animals
- Binding Sites
- Colforsin/pharmacology
- Corticotropin-Releasing Hormone/biosynthesis
- Corticotropin-Releasing Hormone/genetics
- Corticotropin-Releasing Hormone/pharmacology
- DNA-Binding Proteins/physiology
- Dexamethasone/pharmacology
- Enzyme Activation/drug effects
- Gene Expression Regulation/drug effects
- Gene Expression Regulation/physiology
- Genes, Reporter
- Hypothalamo-Hypophyseal System/physiology
- Mice
- Mice, Inbred BALB C
- Multigene Family
- Nerve Tissue Proteins/physiology
- Nuclear Receptor Subfamily 4, Group A, Member 1
- Nuclear Receptor Subfamily 4, Group A, Member 2
- Pituitary Neoplasms/pathology
- Pituitary-Adrenal System/physiology
- Pro-Opiomelanocortin/biosynthesis
- Pro-Opiomelanocortin/genetics
- Promoter Regions, Genetic
- Receptors, Cytoplasmic and Nuclear
- Receptors, Steroid
- Recombinant Fusion Proteins/biosynthesis
- Recombinant Fusion Proteins/genetics
- Transcription Factors/physiology
- Tumor Cells, Cultured
Collapse
Affiliation(s)
- E P Murphy
- Department of Cell Biology, Baylor College of Medicine, Houston, Texas 77030, USA
| | | |
Collapse
|
14
|
Murphy EP, Porter JH, Heath GF. Suppression of schedule-induced drinking and food-reinforced bar pressing by tail-pinch is not reversed by naloxone. Behav Neural Biol 1985; 43:86-99. [PMID: 3994626 DOI: 10.1016/s0163-1047(85)91524-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In Experiment 1 eleven food-deprived rats were tested in a schedule-induced drinking paradigm under both tail-pinch and non-tail-pinch conditions. Tail-pinch produced a strong suppression of schedule-induced drinking, licking, licks per milliliter, bar presses, and number of reinforcers received during 30-min test sessions. Experiment 2 showed that the narcotic antagonist naloxone (2 and 4 mg/kg) did not reverse the tail-pinch suppression of schedule-induced drinking and food-reinforced bar pressing. Experiment 3 demonstrated that the suppression of schedule-induced drinking by tail-pinch could not be attributed to a suppression of drinking behavior in general, as tail-pinch had no effect on deprivation-induced drinking. The failure of naloxone to reverse this blockade suggests that endogenous opiate systems do not play a very important role in the suppression of schedule-induced polydipsia by tail-pinch. It was suggested that the combination of both the schedule-induction paradigm and the tail-pinch procedure increased arousal levels to such a high level that all behaviors were suppressed.
Collapse
|
15
|
Patton RD, Walker HB, Durel LA, McMahan EL, Murphy EP, Wilson CC. Society for Public Health Education: survey of membership. Health Educ Q 1980; 7:35-55. [PMID: 7275635 DOI: 10.1177/109019818000700104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The Society for Public Health Education, Inc. (SOPHE), through the Research and Evaluation Committee (REC) of the Tennessee chapter has surveyed its membership to determine characteristics of members, members' opinions of the organization and the benefits derived, usefulness of SOPHE publications, and the most important health education issues and goals. Survey results provide an employment profile of the membership, and indicate the membership benefits which are most valued; they also suggest that the organization's goals and its activities be expanded in scope to include, in addition to other areas, greater attention to health education practice, to planning legislation, to funding, and to cooperation with the American Public Health Association in the general promotion of health education. REC presents recommendations based on these findings.
Collapse
|