Rhinophototherapy in chronic rhinosinusitis: a double blind randomized placebo-controlled trial.

BACKGROUND: This study evaluated the efficacy of rhinophototherapy in patients with chronic rhinosinusitis (CRS) without nasal polyps. METHOD: In this randomized double-blind, placebo-controlled trial, CRS patients (n=50) received either mixed visible and ultraviolet (UVA and UVB) light source application (mUV/VIS) or visible light alone that served as placebo. Both groups were treated for 3 weeks. RESULTS: Results in the rhinophototherapy and placebo group were not significantly different and failed to reduce patient-reported outcomes measures (Rhinosinusits Disability Index, Visual Analogic Scale of symptom severity) and objective scores (rhinomanometry, olfactory thresholds, nasal Nitic Oxide concentrations), immediately and one month after treatment. CONCLUSIONS: The present data suggest that rhinophototherapy is not an efficient treatment for chronic rhinosinusitis without nasal polyps.

Taste disorders.

Taste disorders are rare compared to olfactory problems, and so the workup and understanding of taste disorders is limited. In this article, we try to update knowledge about human taste disorders with a special focus on taste disorders occurring after ENT surgery.

Future perspectives in smell and taste disorders.

Large sections of the medical community have, in the past, thought of human olfaction as a minor sense that was destined to disappear soon. This view has changed completely in the last two decades. This article will attempt to highlight the most important recent advances in our understanding of the human olfactory function and focus in particular on questions for the future and developments required in this field.

Neuroendocrine cells of nasal mucosa are a cellular source of brain-derived neurotrophic factor.

There is growing evidence for extensive interaction between sensory neurons, immune and mucosal epithelial cells during airway inflammation and hyperreactivity. This neuro-immune cross-talk (neurogenic inflammation) involves different groups of mediators, which include the neurotrophin family (nerve growth factor, brain-derived neurotrophic factor (BDNF) and neurotrophin-3 and -4). Neurotrophins modulate airway inflammation by enhancing sensory nerve excitability and production of neuropeptides, and by interaction with different immune cell types. In the present study, it was questioned whether airway epithelial cells express BDNF, and if proinflammatory cytokines (tumour necrosis factor-alpha, interleukin-1beta and interferon-gamma) and a glucocorticoid (budesonide) affect this expression. Primary cultures of nasal epithelial cells were used. It was found that BDNF was stored in chromogranin A-containing secretory granules of specialised epithelial cells, i.e. neuroendocrine cells, and was secreted in a polarised manner. Apical secretion appears to be constitutive, whereas basolateral secretion is markedly enhanced upon stimulation with cytokines. This enhanced basolateral secretion was not due to enhanced synthesis and was not affected by inhibitors of the processing enzymes, such as furin and the metalloproteinases involved in the maturation of BDNF, but was considerably diminished by budesonide. Therefore, airway mucosa might contribute to neurogenic inflammation through increased secretion of brain-derived neurotrophic factor by neuroendocrine cells under inflammatory conditions.

Implication of dipeptidylpeptidase IV activity in human bronchial inflammation and in bronchoconstriction evaluated in anesthetized rabbits.

BACKGROUND: Decreased dipeptidylpeptidase IV (DPPIV) activity within the human nasal mucosa has previously been shown to contribute to the severity of chronic inflammatory rhinosinusitis. OBJECTIVE: To investigate and correlate the role of DPPIV activity with regard to bronchial inflammation. METHODS: DPPIV/CD26 activity/concentration was investigated in the bronchial tissue of human subjects suffering from chronic bronchial inflammation. In addition, the effect of a recombinant Aspergillus fumigatus DPPIV (fuDPPIV) was investigated on histamine-induced bronchoconstriction in anesthetized rabbits. RESULTS AND CONCLUSIONS: DPPIV/CD26 was present in submucosal seromucous glands, in leukocytes and to a very low degree in endothelial cells of human bronchi. DPPIV activity was correlated with tissue CD26 content measured by immunoassay. As previously reported for the nasal mucosa, DPPIV/CD26 activity was inversely correlated with the degree of airway inflammation. Systemic pretreatment with recombinant fuDPPIV markedly reduced the increase in histamine-induced airway resistance in rabbits. In conclusion, DPPIV activity modulates lower airway tone by degrading unknown peptidic substrates released by histamine in response to an allergen. Contrasting with our observations in the nose, this modulation is apparently not mediated via a neurokinin (NK1) receptor.

Neurogenic inflammation of the upper airway mucosa.

Chronic inflammation of the upper airway mucosa is most likely caused by multiple factors, but is frequently associated with local neurogenic inflammation. This phenomenon can be induced by the inhalation of exogenous particles and chemicals present in our environment, as well as irritants produced endogenously. These irritants, i.e. histamine, H+ or bradykinin, can stimulate the abundant afferent sensory nerves endings, epithelial and neuroendocrine cells present in the upper airways mucosa. These structures can interact with our immune and neural cells by producing pro-inflammatory neuropeptides, cytokines, chemokines and neurotrophins. This short review summarizes some of our current knowledge with regard to the role of airborne chemical stimuli and their possible implications in the development of chronic inflammation of the upper airways mucosa.

Nasal lavage with sodium hypochlorite solution in Staphylococcus aureus persistent rhinosinusitis.

OBJECTIVE: To determine a selected concentration of sodium hypochlorite (NaOCl) in saline solution for nasal lavage and evaluate its clinical efficiency in the treatment of symptomatic patients with persistent, Staphylococcus aureus (SA) associated rhinosinusitis (RS). MATERIAL AND METHODS: In vitro tests for cilia and epithelial cell viability were done on reconstituted primary epithelial cells in vitro. Cells were exposed for 5 and 15 minutes twice daily for 5 consecutive days to one of the following conditions, (1) saline, (2) 0.5% NaOCl in saline, and (3) 0.05% NaOCl in saline. In order to evaluate tolerance, immunostaining was done for ezrin and F-actin network and observed with confocal microscopy. The patients (n=20) were all persistent SA symptomatic carriers, with unique patient-specific SA clonotypes, and multiple infection recurrence despite effective systemic antibiotic therapy. Each patient applied first saline alone for 3 months followed by saline + 0.05% NaOCl solution, as nasal lavage twice daily on both nostrils for 3 months. Symptom intensity and endoscopic findings were recorded with visual analogue scale (VAS). Nasal airway resistance (NAR) and nasal Nitric Oxide (NO) levels were measured before and after the saline lavage regimen, and after the saline + NaOCl treatment. RESULTS: F-actin network loss and decreased expression of ezrin were significant in cells exposed to 0.5%, but not in those exposed to 0.05% NaOCl. These changes were more obvious when exposed for 15 min. than 5 min. daily. The nasal lavage with 0.05% NaOCl in saline was well tolerated and a significant improvement in nasal obstruction (p = 0.001), posterior nasal discharge (p = 0.018), olfaction (p = 0.007) and headache (p = 0.009) was demonstrated. Significant improvement was also recorded in nasal endoscopic grading of oedema (p = 0.001), erythema (p = 0.001), purulent discharge (p = 0.002), nasal crusts (p = 0.001), and NAR (p = 0.05) as measured by rhinomanometry. There was no significant improvement in nasal NO production or subjective anterior nasal discharge. Bacteriological cultures of middle meatus secretions collected one month after the end of the treatment revealed the persistence of SA. CONCLUSION: Nasal lavage with 0.05% NaOCl solution in saline is suitable for long-term use and seems to be a good alternative to lavage with saline alone in the management of symptomatic RS associated with recurrent SA infections due to patient-specific SA clonotypes.

BDNF and DPP-IV in polyps and middle turbinates epithelial cells.

HYPOTHESIS: Neuropeptides released from sensory nerves may contribute to airway inflammation, particularly if their metabolism is impaired through defective inactivation and/or increased production. In the airways, neuropeptides are subjected to degradation by enzymes such as dipeptidyl peptidase (DPP-IV), and are upregulated by neurotrophins such as brain derived neurotrophic factor (BDNF). We therefore assessed in primary human nasal epithelial cells the expression of DPP-IV and BDNF under basal and inflammatory conditions. METHODS: Human epithelial cells were isolated from nasal polyps and middle turbinates, and grown on collagen-coated polycarbonate filters with an air liquid-interface. After three weeks of culture, constitutive cellular expression of DPP-IV and BDNF was assessed by measuring its activity and by ELISA, respectively. To mimick in vivo inflammatory conditions, cells were exposed apically and basolaterally to 50 ng/ml of TNFalpha, IL-1beta, and IFN-gamma for two days. DPP-IV activity and BDNF protein expression were measured in cell lysates and in the apical and basolateral media. RESULTS: Constitutive DPP-IV activity was similar in polyps and turbinates cells. In contrast, polyps epithelial cells expressed higher amounts of BDNF compared to turbinates derived cells. On the other hand, TNFalpha, IL-1beta, and IFN-gamma did not affect DPP-IV activity but significantly increased the cellular expression and the basolateral secretion of BDNF. CONCLUSIONS: Our data show for the first time that primary human airway epithelial cells produced DPP-IV and BDNF under basal conditions. Furthermore, the production and secretion of BDNF were markedly increased in response to pro-inflammatory cytokines, confirming the involvement of BDNF in airway inflammation.

Intracellular residency is frequently associated with recurrent Staphylococcus aureus rhinosinusitis.

AIM: The prevalence of intracellular Staphylococcus aureus organisms in the nasal mucosa of patients with recurrent infectious rhinosinusitis episodes was studied. METHOD: Twenty-seven consecutive adult patients who failed medical management of chronic rhinosinusitis (CRS) of multiple origins, associated or not with nasal polyposis, were consecutively enrolled for endonasal sinus surgery (including partial middle turbinectomy, middle antrostomy, ethmoidectomy, sphenoidotomy) and followed for a 12-month post-operative period. RESULTS: Seventeen of these patients showed the presence of intracellular S. aureus as detected by confocal laser scan immunofluorescence microscopy in epithelial cells of surgical intranasal biopsy specimens. Nine of the patients with and two without intracellular bacteria yielded S. aureus in endoscopically guided cultures of middle meatus secretions, despite the recent administration of prophylactic antibiotics. Eleven of the 17 patients with intracellular S. aureus relapsed for rhinosinusitis within the 12-month follow-up period. Molecular typing of sequential S. aureus isolates demonstrated the persistence of unique patient-specific S. aureus clonotypes in nine of the patients with intracellular bacteria during the 12-month follow-up. CONCLUSION: The presence of intracellular S. aureus in epithelial cells of the nasal mucosa is a significant risk factor for recurrent episodes of rhinosinusitis due to persistent bacterial clonotypes, which appear refractory to antimicrobial and surgical therapy.

Basic and clinical aspects of olfaction.

Disturbances of olfaction are a common occurrence in many neurological and neurosurgical patients and their correct diagnosis might be helpful in management and enhancement of quality of life. However, olfaction is seldom checked in most neurosurgical units and the "smell bottles" are often either absent or out of date. This chapter reviews systematically recent advances in our understanding of the anatomy, physiology (olfactory coding) and measurement of olfactory function in the human. The causes and symptoms of smell disorders, risk of damage to the olfactory system by various surgical procedures and, finally, the natural history of recovery and treatment of smell disorders, for example after trauma, are discussed.

[Neurogenic inflammation and chronic rhinosinusitis]. / Hlyperréactivité non spécifique et rhinosinusite chronique.

The nasal mucosa is one of the anatomical region which have the highest density of sensory innervation. The function of this sensory innervation is probably linked to the protection of the lower airways against inhalation of airborne particles and potentially harmful substances. Chronic rhinosinusitis (CRS) is associated with nasal obstruction, rhinorrhea, loss of sense of smell and facial pain or headaches. When allergy or specific hyperreactivity, infection, systemic or genetic deseases have been excluded, the diagnosis of non specific hyperreactivity or neurogenic inflammation is proposed. Sensory neuropeptides released by sensory nerves endings have powerful proinflammatory effects. The best treatment yet available include nasal lavages and the local application of topical corticosteroid spray.

Sympathetic vascular control of the pig nasal mucosa: adrenoceptor mechanisms in blood flow and volume control.

1. The adrenoceptor mechanisms influencing the total blood flow, volume and superficial blood flow in the nasal mucosa of pigs anaesthetized with pentobarbitone have been characterized by use of various agonists and antagonists. 2. Local intra-arterial bolus injection of the selective alpha 1-agonist phenylephrine, the selective alpha 2-agonist UK 14.304, the mixed alpha 1/alpha 2-agonist oxymetazoline and the mixed alpha/beta-agonists noradrenaline (NA) and adrenaline induced dosed-related reduction of nasal arterial blood flow (BF), nasal mucosal volume (V, reflecting capacitance vessel function) and the laser Doppler flowmetry signal (LDF, reflecting superficial movement of blood cells). The rank order of alpha-agonist potency regarding BF reduction was UK 14.304 greater than oxymetazoline greater than phenylephrine = adrenaline. For the volume response the potency order was UK 14.304 greater than oxymetazoline = NA = adrenaline greater than phenylephrine while for the reduction of the LDF signal the potency was UK 14.304 = NA = adrenaline greater than oxymetazoline greater than phenylephrine. The selective beta 2-agonist terbutaline caused dose-dependent increase of BF whereas only a small augmentation of the V was obtained upon the highest dose (40 nmol) while no modification of the LDF signal was observed. 3. After pretreatment with the selective alpha 1-antagonist prazosin, the response to phenylephrine was abolished while the selective alpha 2-antagonist idazoxan attenuated the effect of UK 14.304. After pretreatment with alpha-antagonists, both NA and adrenaline caused biphasic effects with constriction followed by vasodilatation for BF, but not for V or LDF. This vasodilatation was blocked by the beta-antagonist propranolol. 4. The reduction in nasal BF and V upon sympathetic nerve stimulation was attenuated both by prazosin and idazoxan. Propranolol enhanced the remaining reduction of BF but not of V in the presence of alpha-antagonists. 5. It is concluded that alpha 2-adrenoceptor mechanisms in the pig nasal mucosa are dominating for the BF, V and LDF responses to exogenous agonists. alpha 1-Adrenoceptors also seem to be involved in the sympathetic control of BF, V and LDF. Activation of beta 2-receptors increases mainly BF and does not influence the LDF signal.

Modulation by neuropeptide Y of parasympathetic nerve-evoked nasal vasodilatation via Y2 prejunctional receptor.

1. In pentobarbitone anaesthetized dogs, preganglionic stimulation of the superior cervical sympathetic nerve (15V, 1 ms, 10 Hz) induced marked reduction of nasal arterial blood flow, whereas parasympathetic nerve stimulation (5 V, 1 ms, 10-30 Hz) evoked frequency-dependent vasodilatation. 2. Sympathetic nerve stimulation for 3 min at 10 Hz evoked significant (P < 0.05) and prolonged attenuation of the vasodilator response to subsequent parasympathetic stimulation. Pretreatment with phentolamine (0.5 mg kg-1 h-1), propranolol (1 mg kg-1) and atropine (0.5 mg kg-1) reduced the vasoconstrictor effect of sympathetic stimulation by 35 +/- 4% whereas the parasympathetic nerve-evoked vasodilatation was not significantly modified. Atropine-resistant parasympathetic vasodilatation remained significantly attenuated for more than 30 min after non-adrenergic sympathetic nerve-evoked vasoconstriction. 3. Vasodilator effects of exogenous vasoactive intestinal polypeptide and peptide histidine isoleucine and vasoconstrictor effects of exogenous neuropeptide Y (NPY) and the NPY analogue [Leu31, Pro34] NPY (Y1-receptor agonist, 8 nmol kg-1), were not altered by adrenoceptor antagonists and atropine f1p4eas the effects of exogenous noradrenaline and acetylcholine were virtually abolished. Attenuation of parasympathetic-evoked vasodilatation could be mimicked by exogenous NPY (8 nmol kg-1) and the NPY analogue, N-acetyl [Leu28, Leu31] NPY 24-36 (Y2-receptor agonist, 20 nmol kg-1) but not by exogenous Y1-receptor agonist. The Y2-receptor agonist did not show significant vasoconstrictor action. 4. It is concluded that sympathetic nerve stimulation attenuates parasympathetic vasodilatation via NPY release acting on prejunctional Y2 receptors.

Intranasal administration of neuropeptide Y in man: systemic absorption and functional effects.

1. Exogenous neuropeptide Y (NPY, 10 nmol, 50 nmol and 100 nmol) and its vehicle (NaCl 0.9%) were administered in a double blind, randomized and controlled manner by intranasal spray in 7 healthy volunteers. Variations of plasma NPY concentration over time were measured during 120 min. Forty min after the administration of 50 nmol and 100 nmol of exogenous NPY, plasma NPY increased from 5.5 +/- 1.1 pM to 9.8 +/- 2.3 pM (P < 0.05) and from 9.06 +/- 5.1 pM to 20.8 +/- 6.16 pM (P < 0.001), respectively. There was no significant modification of the mean arterial blood pressure and no subjective discomfort was reported. 2. Nasal airway resistance (NAR) was measured by anterior rhinomanometry and was reduced by 25 +/- 3% and 32 +/- 5% after the spray of 50 nmol and 100 nmol, respectively, for about 90 min. 3. Double-blind, randomized, placebo-controlled and 3-way crossover design experiments were performed in 8 healthy volunteers to evaluate the influence of intranasal pretreatment with NPY (20 nmol) and the mixed alpha 1/alpha 2-adrenoceptor agonist oxymetazoline (20 nmol) on the functional effects of subsequent local irritation evoked by capsaicin (3.3 x 10(-4) mol). Subjective evaluation of NAR and local intensity of discomfort were evaluated by means of a visual analogue scale. Nasal secretions were collected and objective NAR was recorded by rhinomanometry. 4. Subjective NAR, nasal secretions and rhinomanometry recordings were not modified by intranasal application of saline, NPY or oxymetazoline. Subjective nasal obstruction, local discomfort, nasal secretions and NAR increase evoked by capsaicin were markedly reduced by NPY pretreatment (P < 0.05) when compared to saline or oxymetazoline. 5. It is concluded that intranasal application of exogenous NPY has very low systemic absorption but induced long lasting nasal vasoconstriction without cardiovascular effects. Pretreatment of the nasal mucosa with exogenous NPY reduces both secretagogue and vasodilator responses to subsequent application of capsaicin.

Influence of TASP-V, a novel neuropeptide Y (NPY) Y2 agonist, on nasal and bronchial responses evoked by histamine in anaesthetized pigs and in humans.

1. In nine anaesthetized pigs we have studied the influence of intranasal or intrabronchial pretreatment with TASP-V, a neuropeptide Y (NPY) Y2 agonist formed by the attachment of NPY 21-36 to a template-assembled synthetic peptide (TASP), on the functional responses to subsequent intranasal or intrabronchial histamine challenge. 2. In a parallel study, subjective and objective nasal airway resistance (NAR) increase following intranasal histamine challenge was evaluated in 11 healthy volunteers after TASP-V or placebo pretreatment. 3. In pigs, increase in sphenopalatine blood flow induced by histamine dihydrochloride nasal spray (0.25 mg kg(-1) in 3 ml of saline) was significantly reduced by 65% (P<0.05) following intranasal pretreatment with 10 microg kg(-1) of TASP-V. Bronchoconstriction induced by histamine dihydrochloride nebulization (0.5 mg kg(-1) in 3 ml of saline) was significantly attenuated by 25 and 55% following aerosolized pretreatment with TASP-V analogue at 10 and 20 microg kg(-1), respectively. 4. In healthy volunteers, objective increase in NAR and reduction in nasal minimal cross section area (MCSA) induced by intranasal spray of histamine dihydrochloride (15 microg kg(-1) in 200 microl of saline) were significantly attenuated by 50% following local pretreatment with 1.275 microg kg(-1) of TASP-V when compared with saline. 5. It is concluded that intranasal or intrabronchial pretreatment with TASP-V reduced nasal obstruction and bronchoconstriction evoked by histamine challenge in the pig. In healthy human volunteers, this agent attenuated NAR increase and MCSA reduction induced by intranasal application of histamine.

Prostacyclin but not phentolamine increases oxygen consumption and skin microvascular blood flow in patients with sepsis and respiratory failure.

Inadequate tissue oxygenation may occur in critically ill patients with sepsis despite an apparently adequate O2 transport (QO2), and this may contribute to the development of an O2 debt and also to multiple organ failure. It has been shown that increasing QO2 by infusing a vasodilator may reveal this O2 debt in septic patients. To investigate whether the site of action of vasodilators may be of importance in unmasking such an O2 debt, we administered prostacyclin, a prostaglandin with a preferential effect on the microcirculation, and phentolamine, an arteriolar vasodilator, in 11 patients studied during the first 48 hours after the onset of sepsis, and compared their effect on whole body oxygen consumption (VO2) and skin microvascular blood flow. The results demonstrated that increasing QO2 by prostacyclin but not by phentolamine significantly increases VO2 in critically ill patients with sepsis. The site of action of vasodilators may therefore play an important role in their ability to unmask an O2 debt.

Neuropeptide Y and sympathetic neurotransmission.

The coexistence of neuropeptide Y (NPY) with noradrenaline (NA) in perivascular nerves as well as in sympathetic nerves to muscle in the heart, spleen and vas deferens suggests a role for NPY in autonomic transmission. Sympathetic nerve stimulation or reflexogenic activation in experimental animals or man are associated with NPY release as revealed by overflow mainly upon strong activation. This difference between NPY and NA secretion may be related to the partly separate subcellular storage whereby NPY seems to be exclusively present in the large dense-cored vesicles. The NPY secretion is likely to be regulated by the local biophase concentrations of NA acting on prejunctional alpha-2-adrenoceptors since alpha-2 agonists inhibit and antagonists enhance NPY overflow, respectively. Furthermore, after NA has been depleted by reserpine, the nerve stimulation-evoked release of NPY is enhanced leading to a progressive depletion of tissue content of NPY. Exogenous NPY binds to both pre- and postjunctional receptors, inhibits NA and NPY release, enhances NA-evoked vasoconstriction and induces vasoconstriction per se. The prejunctional action of NPY which is especially noticeable in the vas deferens may serve to reduce transmitter secretion upon excessive stimulation. The long-lasting vasoconstriction evoked by sympathetic stimulation in several tissues including skeletal muscle, nasal mucosa and spleen, which remains in animals pretreated with reserpine (to deplete NA) combined with preganglionic denervation (to prevent the concomitant excessive NPY release and depletion), is mimicked by NPY and highly correlated to NPY release. Under these circumstances the NPY content in the local venous effluent reaches levels at which exogenous NPY evokes vasoconstriction.

Lung mechanics and pulmonary but not systemic vascular responses to ET-1 are Tx and infusion rate dependent.

The role of cyclooxygenase metabolites formation in the systemic and pulmonary vascular and airway responses to different intravenous infusion rates of endothelin-1 (ET-1) was investigated in eight barbiturate-anesthetized mechanically ventilated adult sheep. ET-1 (20, 200, and 400 pmol/kg) was infused into the femoral vein over either 1, 10, or 180 s before and after pretreatment with indomethacin (1.5 mg/kg i.v.). ET-1 infusion produced a dose-dependent systemic vasoconstriction that was similar with all three infusion rates. In contrast, the pulmonary vascular and airways responses to ET-1 were not only dose dependent but also infusion rate dependent so that consistent effects on the pulmonary vasculature and airways were observed only when the peptide was injected over 1 s. At the highest dosage and at the fastest rate of administration, ET-1 produced a fivefold rise in pulmonary vascular resistance, a twofold rise in airway resistance, and a 45% decrease in dynamic pulmonary compliance, whereas no changes were observed when the peptide was injected over 180 s. Plasma levels of 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha) increased 20-fold when ET-1 was administered over 1 s but only 5-fold when it was administered over 180 s. Thromboxane B2 (TxB2) increased 5-fold when ET-1 was administered over 1 s and did not increase when ET-1 was given over 180 s. Plasma TxB2 levels were linearly correlated with pulmonary vascular or airway resistance during the bolus ET-1 infusion. Pretreatment with indomethacin completely prevented the ET-1-induced rise in TxB2 and 6-keto-PGF1 alpha and blocked pulmonary vaso- and bronchoconstriction observed, whereas it enhanced systemic vasoconstriction. These results demonstrate that in adult sheep intravenous ET-1 produces pulmonary vaso- and bronchoconstriction that is infusion rate dependent and is associated with the rate-dependent production of thromboxane. In contrast, the increase in systemic vascular tone elicited by ET-1 is not affected by its rate of infusion and does not depend on the secondary generation of cyclooxygenase metabolites.

Analysis of structure-function relationships of neuropeptide Y using molecular dynamics simulations and pharmacological activity and binding measurements.

Studies on the structure-function relationship of neuropeptide Y (NPY) were undertaken using a combination of in vacuo molecular dynamics (MD) simulations and pharmacological receptor binding and biological activity measurements. Following a conformational search of NPY from which a theoretical structure was determined, a study of the structural and dynamic changes in the region of amino acids 25-36 was performed in a variety of NPY fragments and in the NPY free acid. Results revealed an increased structural change as the fragment size was decreased. Also, the mobility appears to be lowest in the full NPY vs the NPY fragments. Pharmacological measurements showed a decreased receptor binding and biological activity as fragment size decreased. Combination of the two approaches suggests a model where conformational maintenance and low configurational entropy of the 25-36 region of NPY favors both receptor binding and biological activity. Furthermore, the possibility of two receptor interaction modes is suggested. Analysis of the NPY structure suggests the direct importance of the amidated C-terminus, Gln34 and His26, an indirect importance of the Tyr1 sidechain as well as the potential importance of an apparent electric 'dipole' in NPY for receptor binding and biological activity.