Tocainide and mortality after myocardial infarction: a prospective study in conscious dogs.

The production of an anterior myocardial infarction as part of an experimental animal model for sudden death was burdened by a persistently elevated mortality rate (30%) despite the use of traditional antiarrhythmic drugs. Mortality was reduced when tocainide (600 mg three times daily) was empirically administered for 4 days before and 4 days after myocardial infarction. Retrospective analysis showed that mortality at 4 days after infarction was significantly lower in the tocainide-treated dogs than in the preceding large group of dogs that had not been so treated (5 [9%] of 55, versus 64 [32%] of 199, p less than 0.01). This difference was still evident 30 days after myocardial infarction (13 [24%] of 55 versus 83 [42%] of 199; p less than 0.05). This observation led to the present prospective study in 106 dogs with a similar protocol but with a randomized sequence. At 4 days after myocardial infarction, the mortality rate was 55% lower in the tocainide group than in the control group (7 [12.5%] of 56 versus 14 [28%] of 50; p less than 0.05). During the 10 days after treatment withdrawal 9 (18%) of 49 dogs in the tocainide group died compared with only 2 (5%) of 36 in the control group. This rebound in mortality produced similar survival figures in the two groups at 14 and at 30 days after infarction when mortality was 30% (17 of 56) in the tocainide group and 34% (17 of 50) in the control group. The tocainide plasma levels were 7.4 +/- 4 micrograms/ml the day before infarction and 7.2 +/- 3 micrograms/ml 3 days after infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Monokines mediate decreased hepatic glucocorticoid binding in endotoxemia.

The purpose of this study was to determine whether endotoxin decreased hepatic glucocorticoid binding by the action of mediator(s). Steroid binding in liver cytosol, plasma glucose levels, and plasma corticosterone levels were assayed in C3HeB/FeJ LPS normoresponsive and C3H/HeJ LPS hyporesponsive mice. In C3HeB/FeJ mice, endotoxin significantly depressed the maximum number of steroid binding sites (Bmax) to 30% of control. Plasma glucose levels were decreased to 50% of control, and plasma corticosterone levels increased 4-fold. No changes in these parameters were seen in C3H/HeJ mice given endotoxin, except for decreased plasma glucose levels at the highest dose of endotoxin. Decreased steroid binding was observed in C3H/HeJ mice 4-6 hours after receiving C3HeB/FeJ peritoneal exudate cells (elicited with thioglycolate) and endotoxin. No change in steroid binding was observed in C3H/HeJ mice that received C3H/HeJ peritoneal exudate cells and endotoxin. Mediator-rich plasma was produced in CF-1 mice by infecting them with 1 X 10(7) BCG and by challenging them with endotoxin (2 micrograms) 2 weeks later for 2 h. Transfer of BCG-endotoxin plasma to C3H/HeJ mice also resulted in decreased steroid binding and plasma glucose. These results indicate that perturbation of glucocorticoid action during endotoxin shock is mediated by soluble factor(s) other than endotoxin. A likely source of mediator(s) is the mononuclear phagocyte.

Effects of aging and endotoxin on hepatic glucocorticoid action and glucose metabolism in mice.

Hepatic binding of [3H] dexamethasone, phosphoenolpyruvate carboxykinase activity, glycogen levels, and plasma glucose and corticosterone concentrations were measured in young, mature, and old mice given either endotoxin or vehicle. Endotoxin treatment differentially lowered plasma glucose concentration, hepatic glycogen content, PEPCK activity and specifically bound [3H] dexamethasone, but increased plasma corticosterone concentration by a magnitude dependent upon the age of the animal.

Uptake and binding of [3H]hydrocortisone by various pig brain regions.

The cytosol fraction of septum, hypothalamus, and hippocampus of intact and adrenalectomized pigs possessed greater concentrations of radioactivity than the cytosol fraction of amygdala, pituitary, and cortex after an intraventricular injection of [1,2-3H]hydrocortisone. Nuclear extracts from the same brain regions possessed higher concentrations of radioactivity than nuclear extracts of the other brain regions of intact pigs. Nuclear extracts of amygdala, pituitary and hypothalamus from adrenalectomized pigs exhibited the greatest increase over intact pigs in labeled hormone concentration. When adrenalectomized pigs were administered dexamethasone prior to [3H]hydrocortisone, uptake of label was most depressed in hippocampal cytosol and cuclear extract. Also sensitive to the competitive effects of dexamethasone were septal and pituitary nuclear extracts. In intact pigs, pituitary, hippocampus and cortex exhibited higher ratios of bound to total hormone in the cytososl fraction than the other brain regions. Hippocampal and amygdala cytosol possessed the greater magnitude of increase in the ratio of bound to total hormone in adrenalectomized versus intact pigs. The pituitary, septum, amygdala, and cortex of intact and adrenalectomized pigs possessed a ratio of bound to total hormone in nuclear extract 5-10 times greater than that in hippocampus and hypothalamus. However, the latter two regions exhibited a greater increase in bound: total hormone after administration of labeled hormone to adrenalectomized pigs than nuclear extracts of the other brain regions.

In vitro nuclear 3H-hydrocortisone binding in the hypothalamus of the pig.

Hypothalamic cell nuclear uptake and binding of 3H-hydrocortisone (3H-HC)-receptor complexes were studied in a cell-free system. Greater net concentrations of radioactivity were found in the 0.4 M KCl non-extractable fraction (sediment) in the first 20 min of incubation and in the 0.4 M KCl extractable fraction (supernatant) from 30 to 60 min. Incubation in low ionic strength medium favored localization of radioactivity in the supernatant, whereas high ionic strength promoted greated localization in the sediment. Specific binding in the supernatant was non-saturable, but reached a plateau in the sediment at about 5 X 10(-8)M 3H-HC. The observed value of Kd for binding in the nuclear sediment was 4.88 X 10(9)M-1 and the maximum number of binding sites was 8.8 femtomoles/mg DNA. RNA polymerase activity increased by 59% in the presence of hormone-receptors over that in the presence of free hormone in buffer.

Peripheral endocrine and metabolic responses to centrally administered interleukin-1.

It is becoming increasingly apparent that interleukin-1 (IL-1) acts systemically and centrally to play an important role in regulating the hormonal and metabolic response to stress, infection, and trauma. The aim of this study was to observe the peripheral metabolic and endocrine responses to 15, 25, and 50 ng intracerebroventricular (i.c.v.) recombinant IL-1 beta in awake, freely moving rats over a 6-hour period. The rate and duration of elevation of temperature and plasma corticosterone and glucose were dose-dependent and did not return to control levels until 6 or more hours later. Hepatic glycogen content 6 h after i.c.v. IL-1 was 58, 52 and 78% of control after 15, 25, and 50 ng, respectively. The plasma insulin response to elevated plasma glucose in rats treated with 15 ng was absent in those treated with 25 and 50 ng. Responses of plasma glucagon to each dose of IL-1 were not significantly different from control responses. PEPCK enzyme activity was diminished to 60, 66, and 81% of control after 15, 25, and 50 ng IL-1, respectively. No changes of body temperature or plasma corticosterone were observed when 25 or 50 ng IL-1 were injected intravenously. These results are strong evidence that central actions of IL-1 significantly affect peripheral glycemia via classical hepatic and endocrine adjustments.

Pressor and endocrine responses to lesions of canine rostral ventrolateral medulla.

To understand the mechanism(s) of reduction in arterial pressure (AP) after kainic acid cytotoxic lesions in the rostral ventrolateral medulla (RVLM), recordings of AP, cardiac output (CO), heart rate (HR), plasma catecholamines, and cortisol were obtained from awake relaxed dogs. Mongrels (n = 12) were instrumented with a solid-state pressure transducer in the descending aorta and a pulse transit-time ultrasonic flowmeter on the aortic arch. After the dogs recovered from thoracotomy, AP, CO, HR, and plasma levels of epinephrine, norepinephrine, and cortisol were recorded periodically or measured at rest over 2-3 wk followed by unilateral, cytotoxic lesion placement in the rostral C1 area of the RVLM. After the dogs recovered from lesion surgery, the measurements were repeated, and, compared with prelesion control values, they showed significantly decreased AP (-23.1 mmHg) and total peripheral resistance (-0.014 peripheral resistance units) but no significant changes in CO or HR. The reduction in AP may be caused partially by significant reductions in plasma epinephrine (-47%), norepinephrine (-34%), and cortisol (-66%) levels. Lesion sites corresponded to the rostral C1 area, immunocytochemically positive for phenylethanolamine-N-methyltransferase (PNMT). These observations support the concept that a discrete site in the RVLM, demarcated by a rostral subgroup of PNMT-immunoreactive cell bodies, contributes to direct sympathoexcitatory support of resting AP. The neurotransmitter responsible for vasomotor tone, however, remains unknown. This study also provides new information suggesting a role for catecholamine and cortisol regulation from this putative vasomotor center.

Effect of a single injection of reserpine on kinetics of 3H-dexamethasone binding to receptors of the cat hypothalamus and hippocampus.

Cats were injected intraperitoneally with reserpine (5 mg/kg) or saline and sacrificed 16 h later. Hypothalamic and hippocampal cytosols were assayed for the kinetics of 3H-dexamethasone (3H-DM) binding. A parallel series was performed in which saline-injected cats were infused via venocatheter with hydrocortisone (HC). Reserpine-injected cats were infused with saline. The hypothalamic cytosol of reserpinized cats showed a marked decrease in 3H-DM binding capacity relative to that from saline-treated cats. Hippocampal cytosol 3H-DM binding capacity was unaffected by reserpinization. Infusion of high levels of HC reduced the amount of 3H-DM binding in the hypothalamus, but did not account for all the reduction found after reserpine treatment. HC infusion had no effect on hippocampal binding capacity. Reserpine treatment did not change the dissociation constant differences between the two brain regions. The data suggest that depletion of neurotransmitters by reserpine treatment from the hypothalamus, but not the hippocampus, significantly reduces the number of 3H-DM binding sites and that such a reduction is due, in part, to the effects of reserpine and not to high circulating levels of HC.

General effect of endotoxin on glucocorticoid receptors in mammalian tissues.

Considering the ubiquitous nature of glucocorticoid actions and the fact that endotoxin inhibits glucocorticoid action in the liver, we proposed to examine whether endotoxin affected extrahepatic actions of glucocorticoids. Fasted C57BL/6J mice were injected intraperitoneally with endotoxin (LD50) at 0800 and were killed 6 h later. Control mice were injected with an equal volume of saline. 3H-dexamethasone binding, measured by a new cytosol exchange assay utilizing molybdate plus dithiothreitol, in liver, kidney, skeletal muscle, spleen, lung, and heart tissue was significantly lower in treated than in control mice. The equilibrium dissociation constants were not significantly different, but the number of available binding sites in each tissue was reduced by endotoxin treatment. Phosphoenolpyruvate carboxykinase activity was significantly reduced in liver but not in kidney. Endotoxin treatment lowered glycogen content in liver but not in skeletal muscle. The reduction observed in the "a" form of liver glycogen synthase due to endotoxin was not seen in skeletal muscle glycogen synthase "a." These data support the proposal that endotoxin or a mediator of its action inhibits systemic glucocorticoid action. The results also emphasize the central role of the liver in the metabolic disturbances of the endotoxin-treated mouse.

Endocrine and carbohydrate responses to interleukin-6 in vivo.

The role of interleukin-6 (IL-6) in carbohydrate metabolism beyond its inhibition of hepatic phosphoenolpyruvate carboxykinase has not been widely pursued. To describe such IL-6 effects, we examined in the rat the responses of plasma corticosterone, glucagon, insulin, and glucose levels and the hepatic glycogen content 30, 60, 90, 120, and 180 min after intravenous injection of recombinant human IL-6. The effect to increase plasma corticosterone was consonant with the well-known action of IL-6 on the hypothalamus-pituitary-adrenal cortex. IL-6 produced a transient increase in plasma glucagon that was mirrored by elevated plasma glucose and a depletion of hepatic glycogen. Plasma insulin levels were not elevated within the first hour after IL-6 injection but were significantly elevated 90 min and beyond. We suggest that the stimulus for increased circulating insulin was elevated plasma glucose, rather than a direct effect of IL-6. The results demonstrate that IL-6, acting directly on peripheral organs and/or through the central nervous system (CNS) can alter the hormonal and carbohydrate milieu. We propose that these actions of IL-6 are one aspect of its role in the acute phase response.

Myocardial contractile protein ATPase activities in adrenalectomized and thyroidectomized rats.

This report compares the effects of adrenalectomy and thyroidectomy, with and without hormone replacement, on loss of contractile protein ATPase activities. The rationale for this study was derived from the similarities in their intracellular receptors, mechanisms of action, and the large number of proteins regulated by both hormones. Rats were adrenalectomized, thyroidectomized, or both, and were subsequently treated for 6 weeks with hydrocortisone, triiodothyronine, or saline. Sham-operated rats were given saline for the same period of time. Six weeks of adrenal insufficiency resulted in diminished enzymatic activity of myofibrillar, Ca(2+)-activated myosin ATPase, and actin-activated myosin ATPase fractions. Treatment with hydrocortisone prevented the decline in enzymatic activity due to adrenalectomy. Likewise, thyroidectomy caused a loss of enzymatic activity which was prevented by treatment with triiodothyronine. The full deleterious effect of combined ablation could be partially prevented by treatment with either hydrocortisone or triiodothyronine, but the latter was most effective. The results suggest that hydrocortisone and triiodothyronine each had significant positive effects in the presence of the other, but not in its absence, on the activity of myofibrillar Ca(2+)-dependent Mg-ATPase and Ca(2+)-activated myosin ATPase. The effects of these two hormones on actin-activated myosin ATPase activity were more independent of each other. We conclude that the actions of thyroid and glucocorticoid hormones on the heart are interrelated and that optimum myocardial function results from their combined action.

Effect of central catecholamine depletion on 3H-dexamethasone binding in the dog.

Dogs were bilaterally adrenalectomized (Adx) or sham adrenalectomized 2 weeks after the administration of 6-hydroxydopamine (6-OHDA) or saline-ascorbic acid vehicle directly into the third ventricle (3V). Hypothalamic and hippocampal cytosols were assayed in vitro for high affinity binding of 3H-dexamethasone (3H-DM). 6-OHDA treatment resulted in a significant reduction of norepinephrine concentration in the hypothalamus, but not in the hippocampus, when measured 2 weeks after the second dose. Treatment with this neurotoxin also caused a decrease in 3H-DM binding in the hypothalamus that was detectable after adrenalectomy. A statistically significant reduction in bound DM was not observed in the hypothalamus after 6-OHDA treatment of dogs with intact adrenals, perhaps because of a masking effect of endogenous corticosteroids. No change was observed in the hippocampus. Saturation analysis of binding data revealed the total maximum number of available binding sites in hypothalamic cytosol was lower after 6-OHDA treatment, compared to saline-injected controls. Calculated values for dissociation constants revealed no differences between dogs treated with Adx, saline and Adx, and 6-OHDA. The data support the suggestion that catecholamines may act, in part, by altering the specific binding of a glucocorticoid to its hypothalamic receptor.

Endotoxin-induced inhibition of steroid binding by mouse liver cytosol.

Glucocorticoids have been reported to ameliorate the lethal effects of endotoxin in a wide variety of animals, including man. Restoration of hepatic gluconeogenic enzymes and nucleotides may be involved in this effect. In this study decreased binding of 3H-dexamethasone was observed in liver cytosol preparations obtained from adrenalectomized C3HeB/FeJ mice treated with 100 micrograms of Escherichia coli 0111:B4 endotoxin (Boivin). Adrenalectomy significantly reduced th endotoxin LD50 value from 4.7 mg/kg to 2.3 micrograms/kg. The amount of labeled steroid bound by endotoxin-treated mice was 13,606 +/- 2,027 dpm/mg cytosol protein compared with 17,247 +/- 2,084 dpm/mg cytosol protein in adrenalectomized controls. Results from studies on the distribution of 14C-endotoxin suggested the inhibition of steroid binding seen in liver may be a mediated event. It is likely perturbations in steroid action at the subcellular/molecular level are involved.

Failure of glucagon to induce hepatic phosphoenolpyruvate carboxykinase in endotoxic shock.

We have determined that one reason for diminished PEPCK activity during endotoxemia is the inhibition of glucocorticoid action in hepatic cells. Since glucocorticoid and glucagon hormones act cooperatively to regulate the expression of PEPCK mRNA, we examined whether endotoxin also inhibits the action of glucagon to induce this enzyme. Treated mice were injected intraperitoneally with endotoxin and glucose after a 24 hr fast and given ad libitum access to food and water. Control mice received the same amount of glucose and access to food and water. All mice were given intravenous injections of glucagon for 3 consecutive hours before euthanasia. Blood was analyzed for glucose concentrations, and the liver was assayed for PEPCK activity. Refeeding control mice after a 24 hr fast increased plasma glucose levels to 173 +/- 14 mg/dL and decreased PEPCK activity to 20.6 +/- 2.0 units/mg liver. Subsequent administration of exogenous glucagon further increased plasma glucose to 224 +/- 17 mg/dL and hepatic PEPCK to 31.4 +/- 1.4 units/mg liver. Refeeding endotoxin-treated mice after a 24 hr fast slightly increased plasma glucose levels to 75 +/- 4 mg/dL but had no effect on PEPCK activity. Subsequent glucagon administration had no effect on plasma glucose levels (75 +/- 1.0 mg/dL) or hepatic PEPCK activities (18.8 +/- 5.0 units/mg liver). Therefore, glucagon action to increase liver PEPCK activity and plasma glucose levels was inhibited in endotoxin-treated mice.

Down regulation of hepatic glucocorticoid receptors after endotoxin treatment.

The mechanism by which endotoxin administration results in hypoglycemia was evaluated by characterizing [3H]dexamethasone binding and phosphoenolpyruvate carboxykinase activity in hepatic cytosol preparations from treated and control mice. Starved mice were given Escherichia coli O111:B4 endotoxin or saline intraperitoneally on day 3 after bilateral adrenalectomy. [3H]dexamethasone binding was measured by the charcoal method after the incubation of cytosol preparations with [3H]dexamethasone in the presence or absence of unlabeled dexamethasone. Changes in [3H]dexamethasone binding were found to be time and dose dependent in treated mice. When mice given different doses of endotoxin reached the same stage of morbidity, as indicated by the average time of death, significantly lower glucocorticoid binding was measured. Scatchard analysis of binding isotherms defined a single class of binding sites. Association and dissociation rate constants and the equilibrium dissociation constant (Kd) were not altered, but the maximum number of binding sites was depressed by endotoxin. The rank order of potency of competitors for [3H]dexamethasone binding, dexamethasone greater than hydrocortisone = corticosterone greater than deoxycorticosterone greater than progesterone greater than testosterone = estradiol, was consistent with a glucocorticoid receptor, although the competition was not altered by endotoxin. Endotoxin treatment prevented the glucocorticoid-induced increase in hepatic phosphoenolpyruvate carboxykinase activity. We conclude that the hypoglycemia of endotoxin poisoning is effected, in part, by the inhibition of the glucocorticoid-mediated induction of phosphoenolpyruvate carboxykinase via the down regulation of hepatic glucocorticoid receptors.

Relative contribution of type I and II corticosterone receptors in VMH lesion-induced obesity and hyperinsulinemia.

Ventromedial hypothalamic (VMH) lesion-induced obesity is accompanied by hyperinsulinemia and hyperphagia, which are dependent upon corticosterone (Cort) for their expression. Whether Cort exerts these actions through its stimulation of type I or II Cort receptor populations is unknown. Therefore, food intake and weight gain were measured in obese adrenalectomized VMH-lesioned rats given continuous infusion of various doses of either a type I-receptor agonist (aldosterone), a type II-receptor agonist (RU-28362), or several combination doses. Similarly, the receptor population responsible for lesion-induced hyperinsulinemia was identified. Type II receptor stimulation restored the hyperphagia, weight gain, and hyperinsulinemia of adrenalectomized VMH-lesioned animals, while type I receptor stimulation blocked their weight loss.

Interleukin 1: a regulatory role in glucocorticoid-regulated hepatic metabolism.

The purpose of this study was to investigate the effect of interleukin 1 (IL 1) on glucocorticoid-regulated hepatic metabolism. Steroid binding in liver cytosol, plasma glucose, plasma corticosterone, and phosphoenolpyruvate carboxykinase (PEPCK) activity were assayed in C3H/HeJ mice after IL 1 administration. Mice received 5 pyrogenic U (PU) of rabbit IL 1 i.p. and were sacrificed 4 hr later. In adrenal-intact mice, steroid binding and plasma glucose were significantly decreased (63 and 64% of control) and plasma corticosterone was significantly elevated threefold. In adrenalectomized mice, IL 1 (5 PU) treatment produced similar results in steroid binding (66% of control) and plasma glucose (71% of control). PEPCK was measured in intact mice fasted overnight and treated with 5 PU of IL 1. PEPCK was induced in fasted control animals (23.1 +/- 1.4 U/mg) vs fed control animals (15.9 +/- 0.7 U/mg). IL 1 treatment inhibited the induction of PEPCK in fasted animals (13.4 +/- 2.0 U/mg) and caused a significant decrease in steroid binding (78% of fasted control) and plasma glucose (82% of fasted control). No difference in plasma corticosterone was seen in IL 1-treated mice and fasted control mice. These data indicate that IL 1 decreases intracellular steroid receptors, resulting in decreased induction of PEPCK and subsequent reduced gluconeogenesis and plasma glucose. We propose that IL 1 plays a regulatory role in glucocorticoid-regulated hepatic metabolism.