Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Machine learning based risk stratification of patients undergoing ventricular tachycardia ablation

Background

Monomorphic ventricular tachycardia (VT) is a potentially life-threatening condition. Although radiofrequency catheter ablation represents an effective treatment method for many of these patients, significant variability is observed in postprocedural mortality, which is attributable to multiple factors, including the high burden of comorbidities. Therefore, there is a great demand for an accurate risk stratification system.

Purpose

We sought to implement a machine learning pipeline to predict 1-year all-cause mortality in patients undergoing VT ablation.

Methods

For 265 consecutive patients who underwent VT ablation at our center, we retrospectively collected demographics, medical history, cardiovascular risk factors, laboratory results, echocardiographic measurements, and VT ablation-related parameters. To predict 1-year all-cause mortality based on these features, several supervised machine learning models were trained and evaluated using 5-fold cross-validation. We applied a recursive elimination technique to identify the optimal subset of input features. The area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI) was calculated to quantify the models' performance. We also identified the most important predictors of mortality using Shapley values. As the final step, we used topological data analysis to discern and visualize patient subgroups with different mortality risk.

Results

57 (22%) patients died during the 1-year follow-up period. In predicting all-cause mortality, the best performance was achieved by a random forest model utilizing 18 input features [AUC: 0.73 (95% CI: 0.68–0.78)]. This model significantly outperformed other previously published risk scores such as the I-VT [AUC: 0.63 (95% CI: 0.55–0.70), p&lt;0.001 vs. random forest] or the PAINESD [AUC: 0.63 (95% CI: 0.55–0.71), p=0.009 vs. random forest]. The most important predictors of mortality were mitral E-wave deceleration time, cardiac resynchronization therapy, age, electrical storm, and hemoglobin concentration. In the topological network created based on the 18 input features of the best-performing random forest model, we could identify five patient subsets with different clinical characteristics and 1-year mortality rates (Figure 1).

Conclusions

Our machine learning model could efficiently predict 1-year all-cause mortality in patients undergoing VT ablation. Thus, it could facilitate the prompt identification of high-risk patients and the personalization of treatment and follow-up strategies, ultimately leading to improved outcomes.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Heart Program, as part of the National Research, Development and Innovation Fund of HungaryThematic Excellence Programme of the Ministry for Innovation and Technology in Hungary

Major vascular complications are reduced by ultrasound guided venous puncture compared to conventional technique in cardiac catheter ablation: a meta-analysis

Background

Puncture site vascular complications are relatively common during invasive electrophysiology. One of the most promising measures to minimize these adverse events is the use of vascular ultrasound during puncture.

Objective

We aimed to carry out a meta-analysis comparing conventional, anatomically guided femoral venous puncture to ultrasound-guided puncture during electrophysiology procedures, which, in contrast to, the previous meta-analyses, used a uniform endpoint and involved novel trials resulting in higher patients numbers.

Methods

We conducted a systematic search in relevant electronic databases for articles reporting the rate of vascular complications during EP procedures both with and without ultrasound guidance. We defined major vascular complications (MVCs, as defined in the 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus) as the primary endpoint. Secondary endpoints were arteriovenous fistula, pseudoanerurysm and major bleeding separately, and minor vascular complications and accidental arterial punctures. Statistical analysis was performed using a random effect model with the Mantel-Haenszel method.

Results

A total of 23605 patients were included in the 14 articles matching our selection criteria, and there were data on the primary outcome in 15160 of them (in 11 articles), with 236 (1.6%), who reached the primary endpoint of an MVC. Routine application of ultrasound guidance significantly reduced the incidence of major vascular complications (42/5645 vs. 194/9515, OR 0.36 [0.23–0.55], p&lt;0.001). Furthermore, we found significantly lower incidence in several of our secondary endpoints: for total vascular complications the OR was 0.27 [0.13–0.53] (p&lt;0.001), for major bleedings the OR was 0.42 [0.24–0.74] and for inadvertent artery puncture the OR was 0.24 [0.15–0.38] (p&lt;0.001). Data was insufficiently reported in respect of arteriovenous fistulae and of pseudoanerurysms specifically.

Conclusion

With more than double of the number of patients compared to the previous meta-analyses, and with a more consistent MVC definition, we showed that ultrasound guidance for femoral venous puncture has significant benefits, most importantly reduces the incidence of major vascular complications and total vascular complications.

Our results underscore the need for a randomized controlled trial in the question, with potentially important implications for daily clinical practice and patient safety.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Project no. NVKP_16-1–2016-0017 (“National Heart Program”) has been implemented with the support provided by the Ministry of Innovation and Technology of Hungary from the National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme. -Project no. MEC_R-141548 has been implemented with the support provided by the Ministry of Innovation and Technology of Hungary from the National Research, Development and Innovation Fund, financed under the MEC_R_21 funding scheme.

Factors predicting repeated ablation in ventricular tachycardia patients

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Heart Program

Background

Catheter ablation has emerged to be the principal treatment for recurrent ventricular tachycardia (VT). Previously, several predictors of VT recurrence have been described, such as LVESD, severe MR, incessant VT, ICD shocks and elevated LDH levels. However, factors predicting an additional ablation are unknown.

Purpose

We aimed to establish predictors of repeat ablation and compare to the predictors of ventricular arrhythmia recurrence during 1-year follow-up in structural heart disease.

Methods

Baseline medical history, laboratory results, imaging parameters, clinical properties of VTs, and procedural data were gathered in a structured database.

Results

Out of the 272 patients, 96 (35%) experienced recurrence and 36 (13%) had repeated procedures within 1 year. Independent predictors of recurrence were left ventricular end systolic diameter (HR = 1.516, p=0.015), severe mitral regurgitation (HR = 2.446, p = 0.002), incessant VT (HR = 1.64, p = 0.02), VT inducibility (HR = 3.71, p = 0.003), ICD shocks (HR = 1.95, p = 0.002) and elevated LDH levels (HR = 1.26, p = 0.003). Regarding redo ablation, elevated LDH level (HR = 1.64, p = 0.01), incessant VT (HR = 2.94, p &lt; 0.001), ICD shocks (HR = 2.38, p = 0.02), only exit point ablation (HR = 2.14, p = 0.023) were independent predictors, while hypertension (HR = 0.32, p = 0.03), longer transmitral E-wave deceleration time (HR = 0.47, p = 0.04), substrate modification (HR = 0.47, p = 0.044) were protective.

Conclusion

Predictors of repeat ablation overlap only partially with those of VT recurrence. Predictors implying higher risk VT episodes predict both recurrence and repeat ablation while factors associated with more severe left ventricular systolic dysfunction predict recurrence but not a redo procedure.

A novel machine learning based algorithm to predict 1-year mortality after ventricular tachycardia ablation

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): -Project no. NVKP_16-1–2016-0017 (’National Heart Program’) has been implemented with the support provided by the Ministry of Innovation and Technology of Hungary from the National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme.

-Project no. MEC_R-141548 has been implemented with the support provided by the Ministry of Innovation and Technology of Hungary from the National Research, Development and Innovation Fund, financed under the MEC_R_21 funding scheme.

Background

Catheter ablation constitutes an established therapeutic option in patients with monomorphic ventricular tachycardia (VT). VT patients have high comorbidity burden and high mortality, however there is big heterogenity among individual patients. Therefore, effective postprocedural risk assessment systems, prediciting the mortality of patients undergoing VT ablation are highly needed.

Purpose

We aimed to develop a risk stratification algorithm predicting the 1-year all-cause mortality of patients undergoing VT ablation, and to identify the most important input factors of the model.

Methods

Between 2005 and 2020, 272 consecutive patients underwent VT ablation due to sustained monomorphic VT at our institution. We processed their procedural, demographic and medical history data, in addition to their laboratory and echocardiographic findings. For the training of different supervised learning models, we used 63 pre-procedural and procedural variables. We performed 5-fold cross validation and calculated the area under the receiver operating characteristic (ROC) curve (AUC), to assess the performance of the models. Finally, with calculating Shapley values we determined the most important factors of the mortality prediction for the best performing model.

Results

After a follow up of one year, total all-cause mortality was 22% (59). In predicting 1-year mortality, the best performance was shown by the random forest model [AUC: 0,73 (0,68-0,78)] among the machine learning models we had trained. This model significantly outperformed the traditional score systems like I-VT [AUC: 0,63 (0,55-0,70) vs. 0,73 (0,68-0,78), p&lt;0,001] and PAINESD [AUC: 0,63 (0,55-0,71) vs. 0,73 (0,68-0,78), p=0,009] in our dataset. The predictive factors with the biggest effect on mortality were mitral E wave deceleration time, presence of cardiac resynchronization therapy, age, electric storm and hemoglobin concentration.

Conclusion

We were able to establish a supervised machine learning based system which managed to predict the 1-year mortality of VT ablation patients with high accuracy and turned out to be superior when compared to the use of existing risk scores. This enables us to identify the patients in need of a more thorough follow-up, which could reduce their mortality.

P705Step by step diagnosis and management of statin intolerance: position paper from an international lipid expert panel

Background

Statin intolerance is a clinical syndrome whereby adverse effects associated with statin therapy (most commonly muscle symptoms) result in the discontinuation of therapy. Statin discontinuation is associated with increased risk of adverse cardiac outcomes. Many patients who initially experience adverse effects are able to tolerate statin therapy to some extent. Careful stepwise diagnosis and management of individuals who experience adverse effects is essential to enable optimal reduction of cardiovascular risk.

Purpose

In this Position Paper of the International Lipid Expert Panel (ILEP), we present a step by step approach to the diagnosis and practical management of statin intolerance resulting from muscle symptoms, and other adverse effects with demonstrated statin causality.

Methods

Relevant clinical evidence and international clinical guidelines were discussed and assimilated by ILEP members. Consensus was used to formulate recommendations for the diagnosis and management of statin intolerance.

Results

Consensus resulted in the adoption of three parts to the recommendation. 1) diagnosis of Statin Intolerance; 2) advice for management of all patients with statin intolerance; 3) specific advice for patients who have partial (rather than complete) statin intolerance. Patients with partial statin intolerance are likely to make up the vast majority (even 95%) of statin-intolerant individuals. Each part of the recommendation consists of a four-step process and has an associated acronym to aid memory (see attached recommendations). We adopted the Banach and Mikhailidis four-step approach to diagnosis and we developed novel recommendations for management.

Summary of the ILEP SI recommendations.

Conclusions

We present recommendations, which will enable clinicians to distinguish between rare, severe adverse effects; true statin intolerance, and symptoms incorrectly attributed to statin therapy. In each case we summarize guidelines, clinical evidence and expert opinion pertaining to the optimal management of cardiovascular disease in these patients.

Acknowledgement/Funding

None

P4608BET-inhibition with Apabetalone in Post-ACS Patients with Diabetes: Design and Baseline Characteristics of the BETonMACE trial

Background

Diabetes (DM) is associated with increased risk of macro/microvascular disease and cognitive decline. Inflammation and vascular calcification may be contributing factors. Bromodomain and extraterminal (BET) proteins coordinate gene transcription and modify the transcriptional response to hyperglycemia, and inflammation. Apabetalone competitively and selectively inhibits binding between BET proteins and acetyl-lysine marks on histone tails: normalizing transcriptional profiles to physiological levels; reducing in vitro alkaline phosphatase (ALP) transcription and in vivo plasma ALP in a dose-dependent manner. Phase 2 trials with apabetalone show improved renal function in the chronic kidney disease (CKD) subgroups. Furthermore, treatment showed a 55% reduction in CVD events with more pronounced benefit among patients with DM, low HDL-cholesterol (HDL-C) and high sensitivity C-reactive protein (hsCRP).

Methods

The double-blind, placebo controlled phase 3 BETonMACE trial is testing the hypothesis that apabetalone 100 mg b.i.d., added to standard care, reduces major adverse cardiovascular events (MACE: CV death, non-fatal myocardial infarction or stroke) in patients with DM, acute coronary syndrome (ACS) within the preceding 7–90 days, low HDL-C (<40 mg/dL in men; <45 mg/dL in women), and estimated glomerular filtration rate (eGFR) >30 mL/min/1.7m2. The trial will continue until at least 250 MACE, providing 80% power to detect a 30% reduction. Secondary endpoints include changes in eGFR in patients with baseline eGFR 30 to <60 mL/min/1.7m2, inflammatory markers, lipids, and ALP. In addition the Montreal Cognition Assessment (MoCA) test was performed in patients ≥70 years of age at baseline and annually.

Results

Enrollment of 2425 patients across 13 countries and 195 centers is now complete. Baseline characteristics [median (IQR)] include LDL-C 65.0 (36) mg/dL, HDL-C 33.0 (7) mg/dL, HbA1c 7.3 (2.3) %, hsCRP 2.8 (4.9) mg/L, mean blood pressure 129/76 mmHg, and CKD in 266 patients (10.8%). Background care was based on guideline recommendations. Diabetes medications include metformin (79%), insulin (36%), sulfonylureas (28%), DPP4 inhibitors (11%), SGLT2 inhibitors (9.7%) and GLP1 receptor agonists (0.3%). The CKD subpopulation vs. total population differed significantly from the whole population with regard to age (71 vs. 62 y. o.), male sex (58% vs. 75%), history of hypertension (46% vs. 88%), history of stroke (1.5% vs. 7.5%), and current smokers (6.1% vs. 13%). In the 70 year and older (n=466, 19%) population 54% (n=243) showed a baseline MoCA score 25 and lower suggesting cognitive impairment.

Summary

The BETonMACE trial is testing the hypothesis that selective BET-inhibition with apabetalone, added to established, evidence-based treatment, reduces MACE in high-risk patients with DM, recent ACS, and low HDL-C. The study will also assess apabetalone's effect on renal function and cognition.

Low-dose combination therapy with colesevelam hydrochloride and lovastatin effectively decreases low-density lipoprotein cholesterol in patients with primary hypercholesterolemia

BACKGROUND

Colesevelam hydrochloride is a novel, lipid-lowering agent that binds bile acids with high affinity. A multicenter, randomized, double-blind, placebo-controlled, parallel-design study was conducted to assess the efficacy and tolerability of combination low-dose colesevelam and lovastatin treatment in patients with primary hypercholesterolemia.

HYPOTHESIS

Combination therapy with low doses of colesevelam and lovastatin decreases low density (LDL) cholesterol with minimal adverse events.

METHODS

Following a 4- to 6-week dietary lead in, 135 patients were randomized into five groups for a 4-week treatment period: placebo, colesevelam 2.3 g at dinner, lovastatin 10 mg at dinner, the combination of colesevelam and lovastatin given at dinner (dosed together), and combination treatment with colesevelam given at dinner and lovastatin administered at bedtime (dosed apart).

RESULTS

Combination colesevelam and lovastatin treatment decreased LDL cholesterol by 34% (60 mg/dl, p < 0.0001) and 32% (53 mg/dl, p < 0.0001) when colesevelam and lovastatin were dosed together or dosed apart, respectively. Both combination therapies were superior to either agent alone (p < 0.05). Decreases in LDL cholesterol exceeded the combined decreases observed for colesevelam alone (13 mg/dl, 7%) and lovastatin alone (39 mg/dl, 22%). Both combination treatments reduced total cholesterol by 21% (p < 0.0001) and apolipoprotein B by 24% (p < 0.0001). Neither combination treatment significantly altered high-density lipoprotein cholesterol or triglycerides. Adverse side effects were not significantly different among randomized groups.

CONCLUSIONS

Combination colesevelam and lovastatin was efficacious and well tolerated, resulting in additive decreases in LDL cholesterol levels whether or not both agents were administered simultaneously.

Organometric data of the reproductive tract in cycling and early pregnant Hungarian Mangalica pigs

Abstract. Since the morphology of the reproductive organs could be a wherefore of reproductive performance of Mangalica, this study was conducted to get some more information about the number of corpora lutea and the size of reproductive tract both in cycling and pregnant Mangalica pigs. Two experiments were carried out to investigate the reproductive tract of Mangalica gilts. In Experiment 1, reproductive organs of 66 gilts (12–15 month of age) were recovered immediately after slaughter to determine the number of ovarian features, the weight and diameter of the ovaries, and the weight and length of oviducts and uteri, respectively. In Experiment 2, 22 puberal Mangalica (M) gilts and 34 German Landrace (L) gilts were used following estrus synchronization and artificial insemination. Genital tracts were recovered by ovario-hysterectomy on day 1 (n = 8 M; 10 L), day 12 (n = 8 M; 22 L) and day 24 (n = 6 M; 2 L) of pregnancy and the number of corpora lutea, ovarian weight and diameter, and the weight and length of oviducts and uteri evaluated. Oviducts and uterine horns (day 1 and 12, respectively) were flushed or uterine horns were opened (day 24) for embryo recovery. In Experiment 1, 58 gilts (88 %) were cycling ones with mean number of ovulation of 10.6 ± 3.1. In first estrous gilts (n = 8) it was 11.1± 2.5. No differences were observed both between left and right ovaries, and first estrous and cycling gilts. The number of corpora lutea were correlated with ovarian weight (r = 0.35, p<0.05). Oviduct length (24.4 ± 1.4 and 24.3 ± 0.5 cm) and weight (4.3 ± 0.4 and 3.2 ± 0.2 g), and uterine horn length (143 ± 13 and 143 ± 5 cm) were not different in first estrous and cycling gilts. Uterine weight was higher in first estrous compared to cycling gilts (358 ± 32 vs. 250 ± 12 g, p < 0.05). In pregnant Mangalica (M) and Landrace (L) gilts no breed*day of pregnancy interaction regarding the number of ovulation was found. Mean number of corpora lutea was 17.2 ± 1.2 (M) and 18.6 ± 1.3 (L). Length of uterine horns was reduced in pregnant M compared to L gilts (124 ± 5 vs. 188 ± 6 cm, p < 0.01). Uterus grows in length continuously between day 1 and 24 of pregnancy in Landrace but not in Mangalica sows (p < 0.01). Uterine weight as well increased earlier (day 1 to day 12) in Landrace in comparison to Mangalica (day 12 to day 24). Results of this study support the concept that in Mangalica besides diminished ovarian and oocyte development, uterine conditions, especially growth restricted uterine development, may influence the initial process of early pregnancy and can be another reason of lower fecundity.

Clinical importance of vascular LH/hCG receptors--a review

It was believed for a long time that functional LH/hCG receptors were present only in gonads. Recent studies have demonstrated, however, that these receptors are also present in several nongonadal organs in the human body. Uterus is one of them. Besides two uterine layers, endothelial cells and smooth muscle of blood vessels in the uterus also contain these receptors. In vivo administration of hCG decreased vascular resistance in the human uterus and in vitro treatment increased vasodilatory and decreased vasoconstrictive eicosanoids in the vessels. These findings led us to investigate whether hCG administration to patients with signs of threatened abortion has any beneficial effect. Patients were treated with either magnesium or progesterone and/or hCG. The results showed that the frequency of patients reaching second trimester was higher when hCG was used, which was paralleled by a significant decrease in uterine vascular resistance. Patients who reached term after treatment had decreased incidence of preterm delivery and intrauterine growth retardation. In conclusion, we suggest that uterine vascular LH/hCG receptors play an important role in the peri-implantation period by increasing uterine blood flow through vasodilatation and also perhaps through angiogenesis and trophoblast invasion, resulting in therapeutic benefit.

Clinical data supporting the importance of vascular LH/hCG receptors of uterine blood vessels

Recent studies revealed functional extragonadal gonadotropin receptors at several sites of the human body. The human chorionic gonadotropin/luteinizing hormone (hCG/LH) receptor messenger RNA and protein were found in the endothelial and vascular smooth muscle layers of the human uterine arteries. In vivo administration of hCG decreased the blood flow resistance in the human uterus and in vitro increased vasodilating eicosanoids in the vascular wall. These findings initiated a further study investigating whether the administration of hCG to patients with signs of threatened abortion has any beneficial effect. The patients were treated with either magnesium or progesterone and/or hCG. The results showed that the rate of patients reaching second trimester was higher when hCG was included in the treatment protocol, and a parallel significant decrease in uterine blood flow resistance was also found. Analyzing the long-term results, the rate of preterm and growth-retarded deliveries was lower when hCG was administered in the first trimester. As a conclusion, the uterine vascular LH/hCG receptors play a significant role in the peri-implantation period. The hCG might also participate in angiogenesis, enhancing long-term clinical results.

Effectiveness of colesevelam hydrochloride in decreasing LDL cholesterol in patients with primary hypercholesterolemia: a 24-week randomized controlled trial

OBJECTIVE

To evaluate the efficacy, tolerability, and safety of colesevelam hydrochloride, a new nonsystemic lipid-lowering agent.

PATIENTS AND METHODS

In this double-blind, placebo-controlled trial performed in 1998, 494 patients with primary hypercholesterolemia (low-density lipoprotein [LDL] cholesterol level > or = 130 mg/dL and < or = 220 mg/dL) were randomized to receive placebo or colesevelam (2.3 g/d, 3.0 g/d, 3.8 g/d, or 4.5 g/d) for 24 weeks. Fasting serum lipid profiles were measured to assess efficacy. Adverse events were monitored, and discontinuation rates and compliance rates were analyzed. The primary outcome measure was the mean absolute change of LDL cholesterol from baseline to the end of the 24-week treatment period.

RESULTS

Colesevelam lowered mean LDL cholesterol levels 9% to 18% in a dose-dependent manner (P<.001), with a median LDL cholesterol reduction of 20% at 4.5 g/d. The reduction in LDL cholesterol levels was maximal after 2 weeks and sustained throughout the study. Mean total cholesterol levels decreased 4% to 10% (P<.001), while median high-density lipoprotein cholesterol levels increased 3% to 4% (P<.001). Median triglyceride levels increased by 5% to 10% in placebo and colesevelam treatment groups relative to baseline (P<.05), but none of these differences were significantly different from placebo. Mean apolipoprotein B levels decreased 6% to 12% in an apparent dose-dependent manner (P<.001). No significant differences occurred in adverse events or discontinuation rates between groups, and compliance rates were between 88% and 92% for all groups.

CONCLUSIONS

Colesevelam was efficacious, decreasing mean LDL cholesterol levels by up to 18%, and well tolerated without serious adverse events.

Coadministration of colesevelam hydrochloride with atorvastatin lowers LDL cholesterol additively

Colesevelam hydrochloride is a novel, potent, non-absorbed lipid-lowering agent previously shown to reduce low density lipoprotein (LDL) cholesterol. To examine the efficacy and safety of coadministration of colesevelam and atorvastatin, administration of these agents alone or in combination was examined in a double-blind study of 94 hypercholesterolemic men and women (baseline LDL cholesterol > or =160 mg/dl). After 4 weeks on the American Heart Association Step I diet, patients were randomized among five groups: placebo; colesevelam 3.8 g/day; atorvastatin 10 mg/day; coadminstered colesevelam 3.8 g/day plus atorvastatin 10 mg/day; or atorvastatin 80 mg/day. Fasting lipids were measured at screening, baseline and 2 and 4 weeks of treatment. LDL cholesterol decreased by 12-53% in all active treatment groups (P<0.01). LDL cholesterol reductions with combination therapy (48%) were statistically superior to colesevelam (12%) or low-dose atorvastatin (38%) alone (P<0.01), but similar to those achieved with atorvastatin 80 mg/day (53%). Total cholesterol decreased 6-39% in all active treatment groups (P<0.05). High density lipoprotein cholesterol increased significantly for all groups including placebo (P<0.05). Triglycerides decreased in patients taking atorvastatin alone (P<0.05), but were unaffected by colesevelam alone or in combination. The frequency of side effects did not differ among groups. At recommended starting doses of each agent, coadministration of colesevelam and atorvastatin was well tolerated, efficacious and produced additive LDL cholesterol reductions comparable to those observed with the maximum atorvastatin dose.

Chronic treatment with finasteride daily does not affect spermatogenesis or semen production in young men

PURPOSE

Finasteride, an oral type 2, 5alpha-reductase inhibitor, is used in 1 mg. daily doses for the treatment of male pattern hair loss. A dose of 5 mg. finasteride daily reduces ejaculate volume by approximately 25%, and reduces prostate volume by approximately 20% and serum prostate specific antigen (PSA) by approximately 50% in men with benign prostatic hyperplasia. To our knowledge no data exist on the effect of 1 mg. finasteride daily on ejaculate volume or other semen parameters, or on the prostate in young men. Therefore, we studied the potential effect and reversibility of effect of 1 mg. finasteride daily on spermatogenesis, semen production, the prostate and serum PSA in young men.

MATERIALS AND METHODS

In this double-blind, placebo controlled multicenter study 181 men 19 to 41 years old were randomized to receive 1 mg. finasteride or placebo for 48 weeks followed by a 60-week off-drug period. Of the 181 men 79 were included in a subset for the collection and analysis of sequential semen samples.

RESULTS

There were no significant effects of 1 mg. finasteride on sperm concentration, total sperm per ejaculate, sperm motility or morphology. Ejaculate volume in subjects on finasteride decreased 0.3 ml. (-11%) compared to a decrease of 0.2 ml. (-8%) for placebo, with a median between treatment group difference of -0.03 ml. (1%, 90% confidence interval -10.4 to 13.1, p = 0.915). There were significant but small decreases in prostate volume (-2.6%) and serum PSA (-0.2 ng./ml.) in the finasteride group, which reversed on discontinuation of the drug.

CONCLUSIONS

Treatment with 1 mg. finasteride daily for 48 weeks did not affect spermatogenesis or semen production in young men. The effects of 1 mg. finasteride daily on prostate volume and serum PSA in young men without benign prostatic hyperplasia were small and reversible on discontinuation of the drug.

Colesevelam hydrochloride (cholestagel): a new, potent bile acid sequestrant associated with a low incidence of gastrointestinal side effects

OBJECTIVES

To compare colesevelam hydrochloride (Cholestagel), a nonabsorbed hydrogel with bile acid-sequestering properties, with placebo for its lipid-lowering efficacy, its effects on laboratory and clinical safety parameters, and the incidence of adverse events.

METHODS

Following diet and placebo lead-in periods, placebo or colesevelam was administered at 4 dosages (1.5, 2.25, 3.0, or 3.75 g/d) for 6 weeks with morning and evening meals to men and women with hypercholesterolemia (low-density lipoprotein cholesterol level >4.14 mmol/L [>160 mg/dL]). Patients returned to the clinic every 2 weeks throughout the treatment period for lipid parameter measurements and adverse event assessments. Samples were collected for serum chemistry profiles, hematologic studies, coagulation studies, and vitamin level assessment at baseline and after 6 weeks of treatment.

RESULTS

Among the 149 patients randomized, 137 completed the study. Low-density lipoprotein cholesterol concentrations decreased in a dosage-dependent manner by 0.11 mmol/L (4.2 mg/dL) (1.8%) in the 1.5-g/d colesevelam treatment group and up to 1.01 mmol/L (39 mg/dL) (19.1%) in the 3.75-g/d colesevelam treatment group. Low-density lipoprotein cholesterol concentrations at the end of treatment were significantly reduced from baseline levels in the 3.0- and 3.75-g/d colesevelam treatment groups (P = .01 and P<.001, respectively). Total cholesterol levels demonstrated a similar response to colesevelam treatment, with an 8. 1% decrease from baseline in the 3.75-g/d treatment group (P<.001). High-density lipoprotein cholesterol levels rose significantly in the 3.0- and 3.75-g/d colesevelam treatment groups, by 11.2% (P=.006) and 8.1% (P=.02), respectively. Median triglyceride levels did not change from baseline, nor were there any significant differences between treatment groups. The incidence of adverse events was similar among all groups.

CONCLUSIONS

Colesevelam therapy is effective for lowering low-density lipoprotein cholesterol concentrations in persons with moderate hypercholesterolemia. It lacks the constipating effect of other bile acid sequestrants, demonstrating the potential for increased compliance.

Enhanced neurotransmitter release is associated with reduction of neuronal branching in a Drosophila mutant overexpressing frequenin

Frequenin is a Drosophila Ca2+ binding protein whose overexpression causes a chronic facilitation of transmitter release at the larval neuromuscular junction and multiple firing of action potentials. These functional abnormalities are similar to those found in other hyperexcitable mutants (Shaker, ether-a-gogo, Hyperkinetic) which, in turn, exhibit increased branching at the motor nerve endings. We report here that mutants which overexpress frequenin have motor nerve terminals with reduced number and length of branches as well as number of synaptic boutons. Similar defects are observed in transgenic flies which have additional copies of the frequenin gene indicating that the phenotype can be adscribed to the overexpression of the protein. The ultrastructure of boutons, however, appears indistinguishable from wild type. In addition, we show here that frequenin overexpression leads also to a down regulation of Shaker proteins expression. The contrast between the observations in frequenin and the other hyperexcitable mutants indicates that nerve terminal morphology and enhanced transmitter release do not have a direct causal relationship.

Expression of human chorionic gonadotropin (hCG)/luteinizing hormone receptors and regulation of the cyclooxygenase-1 gene by exogenous hCG in human fetal membranes

The present study characterized hCG/LH receptors from messenger ribonucleic acid (mRNA) to protein and whether exogenous hCG can bind and regulate the expression of the cyclooxygenase-1 (COX-1) gene in human fetal membranes from term pregnancy. Northern blotting showed that fetal membranes contain 6.0, 4.4, 2.4, and 1.4 kilobases of hCG/LH receptor mRNA transcripts. In situ hybridization revealed that amnion, chorion, and decidua contain receptor transcripts. Western immunoblotting and immunocytochemistry showed that amnion, chorion, and decidua also contain an 80-kDa receptor protein. Ligand blotting demonstrated that the 80-kDa receptor protein in fetal membranes can bind [125I]hCG, and this binding was inhibited by excess unlabeled hCG. Treatment of fetal membranes with highly purified hCG resulted in a dose- and time-dependent increase in immunoreactive COX-1 protein. The response of hCG was seen in all layers of fetal membranes. The treatment with hCG also resulted in an increase in steady state COX-1 mRNA levels. The action of hCG was prevented by cotreatment with H-89, an inhibitor of protein kinase A, but not by calphostin or lavendustin, which inhibit protein kinase C and tyrosine kinase, respectively. In summary, human fetal membranes contain hCG receptor transcripts and receptor protein that can bind hCG and up-regulate the expression of COX-1 gene.

[The immature kidney]

In humans, urine formation starts with the metanephros at the 10th week of gestation. Nephrogenesis progresses during gestation and is achieved around the 35th week. Clamping of the cord is the signal for a striking increase in renal function which reaches mature levels at the end of the first year of life. The integrity of several hormonal systems (the renin-angiotensin system, the prostaglandins) is mandatory for kidney growth and the development of renal function. The mechanisms underlying renal homeostasis are fragile and can easily be disturbed during respiratory and cardiovascular distress, or be affected by the administration of vasoactive agents. Thus, perinatal asphyxia or hypoxemia, as seen in respiratory distress syndrome or neonatal pulmonary hypertension induces intense renal vasoconstriction, with consequent oligoanuria. Congestive heart failure also results in renal hypoperfusion and sodium retention. Vasoactive agents and diuretics (indomethacin, tolazoline, furosemide) used to threat these conditions can result in renal vasoconstriction, renal hypoperfusion and failure. The pathogenesis and pathophysiology of neonatal renal disturbances being now better defined, a rational approach to the treatment of renal functional abnormalities during the neonatal period is possible.

Expression of epidermal growth factor, transforming growth factor-alpha, and their common receptor genes in human umbilical cords

Epidermal growth factor (EGF) and transforming growth factor-alpha (TGF alpha), present in amniotic fluid and/or in fetal blood, could potentially regulate cord functions. The present study investigated the possible presence of functional receptors and EGF and TGF alpha themselves in umbilical cord. The reverse transcription-polymerase chain reaction followed by Southern blotting demonstrated that human umbilical cords contain EGF, TGF alpha, and EGF/TGF alpha messenger ribonucleic acid (mRNA) transcripts. In situ hybridization revealed that these mRNA transcripts are present in vascular endothelial cells and smooth muscle, amnion, and myofibroblasts in Wharton's jelly. Western immunoblotting showed that the cords contain a 170-kilodalton EGF/TGF alpha receptor protein. Immunocytochemistry demonstrated that all of the cells that contained mRNA transcripts also contained corresponding proteins. Umbilical amnion contains more EGF, TGF alpha, and their receptors than any other part of the cord. In the cord, the fetal and middle portions contain more than the placental portion or the vessels inside the placental tissue. The cord receptors can bind [125I]EGF, stimulate receptor autophosphorylation, and increase cyclooxygenase-1 and -2 and prostaglandin E2, suggesting that the receptors are functional. In summary, our study demonstrates that human umbilical cord expresses EGF, TGF alpha, and their common receptor genes. The cord EGF/TGF alpha receptors are functional in terms of binding of EGF, activation of receptor autophosphorylation, and increasing the formation of vasoconstrictive eicosanoid. Thus, EGF, TGF alpha, and their receptors could be one of the determinants of human fetal growth and development by autocrine, paracrine, and endocrine actions in umbilical cord.

Administration of human chorionic gonadotropin affects sleep-wake phases and other associated behaviors in cycling female rats

We investigated the possible effects of human chorionic gonadotropin (hCG) on sleep-wake phases and other associated behaviors controlled by the medial preoptic area, cerebral cortex and hippocampus. Chronic epidural electroencephalographic (EEG) and temporal muscle electromyographic (EMG) electrodes were placed in cycling female rats. After a week of recovery, rats were injected intraperitoneally at 3.00 pm on the day of proestrus with either saline or highly purified hCG or indomethacin or hCG plus indomethacin. Three hours after injection, EEG, EMG and behavioral activities were recorded for 3.5 h. The administration of hCG increased high and low amplitude sleep, resting phase and decreased active awake phase, walking, sniffing and chewing as compared to the controls. While the administration of indomethacin alone had no effect, coadministration inhibited hCG effects. Medial preoptic area, cerebral cortex and hippocampus contain immunostaining for LH/hCG receptors. The administration of hCG resulted in an increase of immunoreactive PGD2 and a decrease of PGE2 in median preoptic area, cerebral cortex and hippocampus as compared to the controls. In summary, hCG administration affects sleep-wake phases and other associated behaviors in rats which can collectively be described as decreased activity. These effects are probably mediated by increasing PGD2 and decreasing PGE2 in areas of brain which control these activities. The above findings may be relevant to pregnant women who experience decreased activity when hCG is present in the circulation and cerebrospinal fluid.

Expression of functional human chorionic gonadotropin/human luteinizing hormone receptor gene in human uterine arteries

The present study investigated 1) whether extra- and intramyometrial arteries contain hCG/human LH receptor messenger ribonucleic acid (mRNA) and receptor protein, 2) whether hCG can bind to its vascular receptors and regulate the formation of vasoactive eicosanoids, and 3) whether hCG administration for ovulation induction can affect the vascular resistance in uterine arteries. The uterine arteries contain multiple hCG/LH receptor mRNA transcripts in endothelial and smooth muscle cells. The uterine arteries also contain an 80-kilodalton immunoreactive receptor protein in endothelial and smooth muscle cells. The extra- and intramyometrial arteries and an 80-kilodalton receptor protein bind [125I]hCG, which is inhibited by excess unlabeled hCG. The receptor mRNA, receptor protein, and ligand binding are higher in smaller intramyometrial arteries than in larger extramyometrial arteries. Incubation of uterine arteries with highly purified hCG resulted in a dose-dependent increase in immunoreactive cyclooxygenase-1, cyclooxygenase-2, prostacyclin synthase, and 6-keto-prostaglandin-F1 alpha and a decrease in prostaglandin-E2, thromboxane-A2 synthase, and thromboxane-B2. There was a significant decrease in the resistance index in uterine arteries, but not in common carotid arteries, by 16 h after the administration of 10,000 IU hCG for ovulation induction in women. This decrease is positively correlated with serum hCG levels, but not with progesterone or estradiol levels. In summary, these data, demonstrating the expression of functional hCG/LH receptors in human uterine arteries, are novel and may have important implications for physiological uterine blood flow regulation, reproductive failure, and obstetrical hemorrhage.

Clozapine and seizures: a review

Clozapine, a novel antipsychotic agent, is an alternative to standard neuroleptic therapy for psychotic disorders. Some advantages of clozapine over neuroleptics are that it may be a more effective antipsychotic in treatment resistant patients and has a lower incidence of extrapyramidal side effects. However, seizures associated with clozapine treatment occur at a rate of about three percent. Factors which seem to increase the likelihood of seizures include high doses of clozapine, rapid dose titration, the concurrent use of other epileptogenic agents and a previous history of neurological abnormalities. A strategy that has been proposed to reduce the occurrence of seizures is the addition of an anticonvulsant agent. At present, little rigorous scientific evidence exists to establish the effectiveness of this strategy or the choice of an anticonvulsant. However, based on what evidence there is and the side effect profiles of the various anticonvulsants, the authors propose the use of valproic acid for the prophylaxis and management of clozapine related seizures.

Novel expression of functional human chorionic gonadotropin/luteinizing hormone receptor gene in human umbilical cords

Human umbilical cord contains two arteries and a vein surrounded by Wharton's jelly with amnion covering the exterior surface. The cord blood and amniotic fluid contain human CG (hCG). Whether hCG can directly regulate cord functions is unknown. We now report that human umbilical cords contain a major 4.4-kilobase and minor 2.6- and 1.8-kilobase hCG/LH receptor messenger RNA transcripts. The cords also contain a 50-kilodalton immunoreactive receptor protein which can bind hCG and LH, but not hFSH or hTSH. Rat testis used as a positive tissue control contained the same major and minor receptor transcripts and an 80-kilodalton receptor protein which can bind [125I]hCG. Rat liver used as a negative control contained neither receptor transcripts nor receptor protein. The smooth muscle and endothelial cells of umbilical arteries and vein, umbilical amnion, and cells in Wharton's jelly contain the receptor transcripts and receptor protein which can bind [125I]hCG. The receptor expression was higher in umbilical vessels closer to the baby and decreased toward placenta, becoming barely detectable once the vessels were inside the placental tissue. In vitro treatment of umbilical cords with highly purified hCG resulted in an increase of immunoreactive cyclooxygenase-1, cyclooxygenase-2, prostacyclin synthase, and 6-keto-prostaglandin F1 alpha, little change in thromboxane A2 synthase and a decrease of prostaglandin E2 and thromboxane B2 as compared to the controls, indicating that the cord receptors are functional. In summary, these novel findings suggest that hCG present in cord blood and amniotic fluid may directly regulate the vascular tone and quite possibly other functions of human umbilical cord.

Novel coexpression of human chorionic gonadotropin (hCG)/human luteinizing hormone receptors and their ligand hCG in human fallopian tubes

The human uterus, including its blood vessels, contains hCG/human LH receptors. We now demonstrate that human fallopian tubes also contain a 4.4-kilobase hCG/LH receptor mRNA transcript and an 80-kilodalton immunoreactive protein that can bind [125I]hCG. Tubal mucosa contain more receptor transcripts, receptor protein, and [125I] hCG binding than the tubal smooth muscle or blood vessels. Human fallopian tubes also contain hCG protein and a 0.6-kilobase hCG alpha mRNA transcript. However, very little hCG is found in tubal cell layers other than mucosa. Ampullary segments contain more hCG/LH receptors and hCG than isthmus. Secretory phase tubes contain more than proliferative phase, postpartum, or postmenopause tubes. Incubation with highly purified hCG resulted in an increase in catalytically active 5-lipoxygenase, cyclooxygenase-1, and cyclooxygenase-2 enzymes in tubal tissues. In summary, human fallopian tubes, which have never previously been considered a direct target of hCG/LH action, express functional hCG/LH receptor gene as well as the gene of its ligand. These novel findings suggest numerous possibilities of both physiological and pathological importance in human fallopian tubes.

Central projections and motor nuclei of the facial, glossopharyngeal, and vagus nerves in the mormyrid fish Gnathonemus petersii

Most of the information about the anatomy of the fish's cranial nerves was collected in the first two decades of this century. Experimental analysis of the VIIth, IXth, and Xth cranial nerves by modern tract tracing techniques started about 20 years ago. Several species have been investigated to date, including one species of Agnatha (Myxinoidea), two species of elasmobranchs, and species of some orders of Teleostei like Cyprinidae, Siluriformes, Perciformes, and Gadidae. The sensory and motor nuclei of the VIIth, IXth, and Xth cranial nerves of Gnathonemus petersii were studied by anterograde and retrograde axoplasmatic transport of horseradish peroxidase and cobaltous lysine complex. The sensory nuclei form a continuous column of cells in the brain stem extending caudal to the obex. The rostral one-fourth of this column is occupied by the overlapping terminals of the VIIth and IXth nerves. The vagus nerve has 5 roots. The first 4 of these innervate the gills and the fifth supplies viscera. Afferents from the gills terminate ipsilaterally rostral to the obex in topographic order and their terminal fields overlap. Viscerosensory fibers terminate ipsilaterally in the obex region and bilaterally in the commissural nucleus of Cajal. The facial motor nucleus is located rostral to the sensory nucleus. Facial motoneurons have pear-shaped and multipolar perikarya. Their axons form a rostrally directed knee before leaving the brain. The motoneurons of the IXth and Xth nerves have a common cell column. The vagal motoneurons form a periventricular, a medial, and an intermediate cell group rostral to the obex. In the obex region and also caudal to it, a lateral and a caudal group can be distinguished. Vagal motoneurons show a topographic arrangement that is similar to that of the sensory vagal projections. The majority of motoneurons have pear-shaped perikary and ventrolaterally oriented dendrites. In the caudal nucleus the dendrites extend dorsally and overlap the terminals of sensory fibers. The axons form a dorsolaterally directed arch before joining the sensory roots. Since G. petersii uses its electrosensory system primarily for detection of food, its gustatory system is less developed than in other fishes, which possess a large number of taste buds.

The role of the gastric and hepatic vagus in voluntary alcohol intake

The present study investigated a possible role for neural signals sent from the liver and stomach to the brain in the regulation of alcohol intake. Experiment 1 showed that gastric vagotomy (GVX) reduced the intake of 3% alcohol and 6% alcohol, while water intake was increased. This effect was not due to an alteration in pharmacokinetics, although an alteration in taste function could not be ruled out. Angiotensin II reduced the intake of 6% alcohol and stimulated the intake of water similarly in both GVX and sham groups. In Experiment 2 rats were subjected to hepatic vagotomy or sham laparotomy and then offered a choice between an alcohol solution and tap water for 40 min each day. Although hepatic vagotomy (HVX) did not alter the intake of 3% alcohol or water, 6% alcohol intake was significantly reduced. Angiotensin II decreased 6% alcohol intake and increased water intake similarly in both groups. These experiments indicated that interrupting information from the liver and stomach to the brain by selective gastric and hepatic vagotomy can decrease voluntary alcohol intake. Since vagal afferent nerves are thought to participate in the control of food intake, the present findings support the hypothesis that the "food-like" qualities of alcohol, i.e., calories and taste, can contribute to the regulation of alcohol intake.

Cholecystokinin octapeptide reduces ethanol intake in food- and water-sated rats

The putative satiety peptide cholecystokinin octapeptide (CCK-8) has been shown to reduce ethanol intake induced by prior fluid deprivation. Since fluid-deprived animals tend to reduce their food intake and consequently become hungry, the ability of CCK-8 to reduce ethanol intake might be limited to conditions where the motivation for food and fluid are accentuated. The present study assessed this possibility by examining the effect of peripheral injections of CCK-8 on voluntary ethanol intake fostered by the limited access procedure which uses food- and water-sated rats. Under these conditions CCK-8 still produced a dose-dependent decrease in ethanol intake. These results demonstrate that CCK-8 reduces ethanol intake even in the absence of hunger and thirst drives.

Defining a region on tetanus toxin responsible for neuromuscular blockade

Administering high doses of tetanus toxin to animals produces neuromuscular blockade. Previous studies, in which specific F(ab) antibody fragments were used to mask the 50,000 MW COOH-terminal portion of the heavy chain (fragment c) on the toxin molecule, have shown that the paralyzing effect of the toxin was most probably located in an area comprising the light chain and the 50,000 MW NH2-terminal portion of the heavy chain (Fragment Ibc). In our study, the toxin was also complexed with F(ab) fragments directed to the light chain (alpha), heavy chain (beta), beta minus IIc, and with monoclonal antibodies to epitopes on IIc and beta minus IIc. Investigating the effect of the resulting complexes both in mice and on the sphincter pupillae muscle in rabbits permitted us to circumscribe further the tetanus toxin neuromuscular blocking activity in a region of the NH2-terminal fragment (Mr = 50,000) of the heavy chain (fragment beta minus IIc). Our results are consistent with the assumption that the beta minus IIc fragment is critical for the neuromuscular blockade activity of tetanus toxin. However, it cannot be ruled out that both the peripheral and central effects of the toxin result from the same portion of the toxin molecule, the nature of the action depending on where the toxin is carried after its introduction into the organism.

The ultrastructure and histogenesis of male germ neoplasia with emphasis on seminoma with early carcinomatous features

The range of ultrastructural morphology was studied in 107 male germ cell neoplasm to assess relationships among tumor subtypes and to consolidate diagnostic criteria. Eighty-three pure-pattern neoplasms including 47 seminomas, 26 embryonal carcinomas, 10 endodermal sinus tumors, and 24 mixed germ cell tumors were analyzed. In the seminoma category, 4 cases showing cell surface specialization in keeping with early carcinomatous transformation were noted. The finding suggested a closer link between seminoma and nonseminomatous germ cell tumors than had been traditionally recognized and was in keeping with other clinical, histologic, biochemical, and xenograft observations. Subtypes of nonseminomatous germ cell tumors also exhibited a continuum of ultrastructural morphology with some types such as embryonal carcinoma and endodermal sinus tumor often blending together. At a practical level, electron microscopy has been of value in selected differential diagnoses such as seminoma versus lymphoma.

Oculomotor system of the weakly electric fish Gnathonemus petersii

The peripheral and central aspects of the extraocular system were studied in the weakly electric fish Gnathonemus petersii. All six extraocular muscles show a similar composition of large and small fibers grouped characteristically in the proximal and distal regions respectively. The exit of the three extraocular nerves from the brain is similar to that in other vertebrates. However, the intracephalic and intracranial course of the trochlear nerve is unusual, partly because of the extraordinary hypertrophy of the cerebellum. The three nerves course rostrally on the ventral brain surface; the trochlear nerve penetrates the orbital cavity separately from the two other nerves. The fiber-diameter spectrum of each extraocular nerve is bimodal; unmyelinated fibers were not observed in any of the nerves. The location of the extraocular motor nuclei was established by retrograde axonal transport of HRP or cobaltic-lysine complex. The oculomotor nucleus is situated ventral to the posterior pole of the magnocellular mesencephalic nucleus and the trochlear nucleus is found caudal and dorsal to this. The abducens nucleus is situated at the level of the octavolateral efferent nucleus and consists of a single group of cells on each side of the ventral tegmentum. The oculomotor nucleus of G. petersii shows a somatotopic organization. The superior rectus muscle receives a contralateral innervation whereas the inferior rectus and oblique muscles and the internal rectus muscles receive an ipsilateral innervation. The superior oblique muscle is innervated by contralateral trochlear motoneurons and the external rectus by ipsilateral abducens motoneurons. The majority of extraocular motoneurons have piriform perikarya and long beaded dendrites that extend laterally in the oculomotor and abducens nuclei and rostrally in the trochlear nucleus. The terminal dendritic portions of trochlear motoneurons widely overlap with oculomotor dendrites and perikarya. In all three nuclei the axon originates opposite to the main dendrite. Collaterals of the hairpin-bend abducens axons could be identified in a few cases. The oculomotor system of G. petersii appears basically similar to that of other teleosts; the differences observed concern mainly the structure of the abducens nucleus, the intracranial and intracephalic course of the trochlear nerve, and the relatively small number of axons in each nerve.

Diagnostic electron microscopy of male genital tract tumors

As illustrated in this review, neoplasms of the male genital tract are markedly heterogenous, reflecting their complex embryologic derivation and histogenetic classification. Transmission electron microscopy has greatly increased our understanding of the structure of these tumors, and in doing so has greatly improved our light microscopy. Additionally, in a number of selected situations, TEM also provides important practical diagnostic information. Currently, light microscopy in conjunction with clinical information is the central tool of tumor taxonomy. However, TEM with histochemistry, immunohistology, analytic cytometry, and molecular biology provide practical and useful information in some situations. In all cases, the application of these techniques has greatly increased our overall understanding of tumor structure, pathobiology, and classification.