MAOA expression predicts vulnerability for alcohol use.

The role of the monoamines dopamine (DA) and serotonin (5HT) and the monoamine-metabolizing enzyme monoamine oxidase A (MAOA) have been repeatedly implicated in studies of alcohol use and dependence. Genetic investigations of MAOA have yielded conflicting associations between a common polymorphism (MAOA-LPR) and risk for alcohol abuse. The present study provides direct comparison of tissue-specific MAOA expression and the level of alcohol consumption. We analyzed rhesus macaque MAOA (rhMAOA) expression in blood from males before and after 12 months of alcohol self-administration. In addition, nucleus accumbens core (NAc core) and cerebrospinal fluid (CSF) were collected from alcohol access and control (no alcohol access) subjects at the 12-month time point for comparison. The rhMAOA expression level in the blood of alcohol-naive subjects was negatively correlated with subsequent alcohol consumption level. The mRNA expression was independent of rhMAOA-LPR genotype and global promoter methylation. After 12 months of alcohol use, blood rhMAOA expression had decreased in an alcohol dose-dependent manner. Also after 12 months, rhMAOA expression in the NAc core was significantly lower in the heavy drinkers, as compared with control subjects. The CSF measured higher levels of DA and lower DOPAC/DA ratios among the heavy drinkers at the same time point. These results provide novel evidence that blood MAOA expression predicts alcohol consumption and that heavy alcohol use is linked to low MAOA expression in both the blood and NAc core. Together, the findings suggest a mechanistic link between dampened MAOA expression, elevated DA and alcohol abuse.

Developmental etiology for neuroanatomical and cognitive deficits in mice overexpressing Galphas, a G-protein subunit genetically linked to schizophrenia.

Schizophrenia is a widespread psychiatric disorder, affecting 1% of people. Despite this high prevalence, schizophrenia is not well treated because of its enigmatic developmental origin. We explore here the developmental etiology of endophenotypes associated with schizophrenia using a regulated transgenic approach in mice. Recently, a polymorphism that increases mRNA levels of the G-protein subunit Galphas was genetically linked to schizophrenia. Here we show that regulated overexpression of Galphas mRNA in forebrain neurons of mice is sufficient to cause a number of schizophrenia-related phenotypes, as measured in adult mice, including sensorimotor gating deficits (prepulse inhibition of acoustic startle, PPI) that are reversed by haloperidol or the phosphodiesterase inhibitor rolipram, psychomotor agitation (hyperlocomotion), hippocampus-dependent learning and memory retrieval impairments (hidden water maze, contextual fear conditioning), and enlarged ventricles. Interestingly, overexpression of Galphas during development plays a significant role in some (PPI, spatial learning and memory and neuroanatomical deficits) but not all of these adulthood phenotypes. Pharmacological and biochemical studies suggest the Galphas-induced behavioral deficits correlate with compensatory decreases in hippocampal and cortical cyclic AMP (cAMP) levels. These decreases in cAMP may lead to reduced activation of the guanine exchange factor Epac (also known as RapGEF 3/4) as stimulation of Epac with the select agonist 8-pCPT-2'-O-Me-cAMP increases PPI and improves memory in C57BL/6J mice. Thus, we suggest that the developmental impact of a given biochemical insult, such as increased Galphas expression, is phenotype specific and that Epac may prove to be a novel therapeutic target for the treatment of both developmentally regulated and non-developmentally regulated symptoms associated with schizophrenia.

Differential expression of guanine nucleotide-binding proteins enhances cAMP synthesis in regenerating rat liver.

Events leading to cAMP accumulation after partial hepatectomy (PH) and effects of cAMP on hormonal induction of DNA synthesis in hepatocytes were characterized. Hepatic cAMP peaked biphasically post-PH and paralleled changes in adenylyl cyclase activity. Fluctuations in cyclase activity were not explained by variations in glucagon receptor kinetics, but reflected altered G-protein expression. Membrane levels of the stimulatory G-protein, Gs alpha, increased early after PH and were sustained. Levels of the inhibitory G-protein, Gi2 alpha, increased more slowly, peaked later, and quickly fell. Levels of both G-proteins correlated poorly with levels of their mRNAs, suggesting posttranscriptional factors modify their membrane concentrations. When growth factor-induced DNA synthesis was compared in hepatocyte cultures grown with or without agents that increase intracellular cAMP, DNA synthesis was inhibited by sustained high levels of cAMP but was enhanced when high cAMP levels fell. In both regenerating liver and hepatocyte cultures, the expression of a "differentiated" hepatocyte gene, phosphoenolpyruvate carboxykinase, correlated with elevated cAMP levels. These data suggest that the differential expression of G-proteins integrates signals initiated by several growth factors so that the accumulation of cAMP is tightly regulated post-PH. The ensuing variations in cAMP levels modulate both growth and differentiated functions during liver regeneration.

Differential expression of guanosine triphosphate binding proteins in men at high and low risk for the future development of alcoholism.

We evaluated G-proteins that are components of adenylyl cyclase (AC) signal transduction in erythrocyte and lymphocyte membranes from 26 family history positive (FHP) non-alcoholic and 26 family history negative (FHN) nonalcoholic subjects. Subjects were classified as FHP if their father met criteria for alcohol dependence; as FHN, if there was no history of alcoholism in any first or second degree relatives. Immunoblot analysis indicated that levels of erythrocyte membrane Gs alpha from FHP subjects were greater than levels in FHN subjects (171 +/- 11 vs 100 +/- 6, P < 0.001). To confirm the results of the immunoblot analysis, Gs alpha was quantitated by cholera toxin-dependent [32P]ADP-ribosylation. Levels of erythrocyte [32P]ADP-ribose-Gs alpha from FHP subjects were greater than levels in FHN subjects (236 +/- 28 vs 100 +/- 14, P < 0.001). Gs alpha levels did not correlate with age or alcohol consumption. By contrast to differences in Gs alpha, immunoblot analysis showed similar levels of Gi(2)alpha and Gi(3)alpha in erythrocyte membranes of FHP and FHN subjects. Pertussis toxin-catalyzed [32P]ADP-ribosylation of Gi-like G-proteins confirmed the immunoblot observations. Lastly, compared to FHN subjects, FHP subjects had enhanced Gs alpha expression in lymphocyte membranes as well (138 +/- 11 vs 100 +/- 5.5; P < 0.02). In summary, compared to FHN nonalcoholic men, FHP nonalcoholic men had greater levels of the stimulatory G-protein, Gs alpha, in erythrocyte and lymphocyte membranes. Enhanced expression of Gs alpha may be a marker of increased risk for the future development of alcoholism.

Signal-transducing G proteins: basic and clinical implications.

The pivotal role that G proteins play in transmembrane signal transduction is highlighted by the rapidly expanding list of receptors and effector molecules that are coupled through G proteins. G proteins are poised to allow discrimination and diversification of cellular signals into the cytosolic milieu. The utilization of an evolutionarily conserved "GTPase clock" by G proteins, offers insight into the fundamental role these proteins play in biology. Knowledge of the implication of altered expression or function of G proteins in human disease is now emerging. It is not surprising that deficiency or expression of altered forms of these important proteins can lead to global or restricted metabolic disturbances, depending upon the distribution and role of the G protein. Human disorders, including heart failure, alcoholism, endocrine abnormalities, and neoplasia, are now recognized as due in part to altered expression or function of G proteins.

The cAMP-protein kinase A signal transduction pathway modulates ethanol consumption and sedative effects of ethanol.

Ethanol and other drugs of abuse modulate cAMP-PKA signaling within the mesolimbic reward pathway. To understand the role of the cAMP-PKA signal transduction in mediating the effects of ethanol, we have studied ethanol consumption and the sedative effects of ethanol in three lines of genetically modified mice. We report that mice with the targeted disruption of one Gsalpha allele as well as mice with reduced neuronal PKA activity have decreased alcohol consumption compared with their wild-type littermates. Genetic reduction of cAMP-PKA signaling also makes mice more sensitive to the sedative effects of ethanol, although plasma ethanol concentrations are unaffected. In contrast, mice with increased adenylyl cyclase activity resulting from the transgenic expression of a constitutively active form of Gsalpha in neurons within the forebrain are less sensitive to the sedative effects of ethanol. Thus, the cAMP-PKA signal transduction pathway is critical in modulating sensitivity to the sedative effects of ethanol as well as influencing alcohol consumption.

Family history of alcoholism and hypothalamic opioidergic activity.

BACKGROUND: This study was designed to assess whether nonalcoholic offspring from families with a high density of alcohol-dependent individuals have altered endogenous central nervous system opioid activity. Naloxone hydrochloride stimulates plasma cortisol by blocking opioidergic input on the corticotropin-releasing factor neuron, thereby providing a noninvasive method for measuring hypothalamic opioid tone. METHODS: Forty-eight nonalcoholic subjects aged 18 to 25 years were enrolled in a protocol to measure endogenous opioid activity by inducing opioid receptor blockade with the receptor antagonist, naloxone. Twenty-six subjects were offspring from families with a high density of alcohol dependence and were designated as family history-positive subjects. Twenty-two subjects were biological offspring of nonalcohol-dependent parents and designated as family history-negative subjects. Subjects received naloxone hydrochloride (0, 125, and 375 microg/kg) in double-blind, randomized order. Serum cortisol levels were monitored. RESULTS: Family history-negative subjects had a graded cortisol response to each dose of naloxone. In contrast, family history-positive subjects achieved a maximal cortisol response to the 125-microg/kg dose of naloxone hydrochloride with no further increase in cortisol levels observed following the 375-microg/kg dose. Family history-negative subjects had a diminished cortisol response to the 125-microg/kg dose compared with the family history-positive subjects. Plasma naloxone concentrations did not differ between family history groups. CONCLUSIONS: Individuals from families with a high density of alcohol dependence are more sensitive to naloxone compared with offspring of nonalcohol-dependent parents. This implies that individuals with a family history of alcohol dependence have diminished endogenous hypothalamic opioid activity.

Increased expression of Gs(alpha) enhances activation of the adenylyl cyclase signal transduction cascade.

Expression of the stimulatory G protein, G(S)alpha, can vary over a 3-fold range in human tissues and in rodent central nervous system. In fact, the offspring of alcoholics have higher levels of G(S)alpha expression in certain tissues compared with the offspring of nonalcoholics. The aim of this research was to test the hypothesis that a causal relationship exists between the level of expression of G(S)alpha and induction of the adenylyl cyclase (AC) cascade. The methodology employed transient transfection of HEK 293 cells with a cDNA for the 52-kDa form of G(S)alpha under regulation by inducible metallothionein promoters. Transfectants were exposed to varying concentrations (0-125 microM) of zinc sulfate that produced a 3-fold range of membrane G(S)alpha expression. The range of G(S)alpha expression produced was found to mimic a physiologically relevant spectrum of G(S)alpha expression in membranes derived from human tissues and rat brain. It was observed that induction of G(S)alpha expression increased constitutive as well as stimulated cAMP accumulation. Moreover, induction of G(S)alpha expression increased events distal to the accumulation of cAMP including the phosphorylation of the transcription factor, cAMP response element binding protein and transcriptional activation of cAMP-dependent reporter genes. In summary, these studies show that the amount of G(S)alpha expression has a marked impact on the level of activity of the AC cascade from the membrane through to the nucleus. It is hypothesized that individuals who differ in G(S)alpha expression may also differ in the expression of certain cAMP-dependent genes.

Ethanol differentially regulates proadrenocorticotropin/endorphin production and corticosterone secretion in LS and SS lines of mice.

The stimulatory effects of ethanol administration on the hypothalamic-pituitary-adrenal (HPA) axis were investigated in the long sleep (LS) and short sleep (SS) lines of mice, selectively bred for differences in sensitivity to ethanol. To characterize the effects of ethanol exposure on levels of anterior pituitary pro-ACTH/endorphin mRNA, animals were treated with ethanol for either 4 or 7 days. Northern analyses of total RNA extracted from anterior pituitary indicated that ethanol-treated SS mice had 1.5-fold higher pro-ACTH/endorphin mRNA levels on day 4 and 2.5-fold higher mRNA levels on day 7 than SS control mice. Although ethanol-treated LS mice had 4-fold higher pro-ACTH/endorphin mRNA levels on day 4 compared to those in control LS mice, by day 7 pro-ACTH/endorphin mRNA levels in ethanol-treated LS mice were 40% less than LS control levels. Quantitation of pro-ACTH/endorphin-related peptide biosynthesis was determined by immunoprecipitation and sodium dodecyl sulfate-polyacrylamide gel electrophoresis of extracts from [35S]methionine-labeled anterior pituitary explants. Ethanol treatment for 7 days increased pro-ACTH/endorphin biosynthesis in SS mice, but decreased pro-ACTH/endorphin biosynthesis in LS mice. These results parallel the effect of ethanol on pro-ACTH/endorphin mRNA levels. Serum corticosterone levels also paralleled pro-ACTH/endorphin production in both lines of mice. In summary, ethanol acutely activates the HPA axis in SS mice, and this activation is sustained after repeated ethanol administration. In contrast, LS mice have initial activation of the HPA axis, which attenuates after repeated ethanol exposure. LS and SS mice may be appropriate models for understanding the mechanism(s) responsible for the differential activation of the HPA axis by ethanol and the development of pseudo-Cushing's syndrome in man.

Effect of chronic secretagogue exposure on pro-adrenocorticotropin/endorphin production and secretion in primary cultures of rat anterior pituitary.

The effects of rat CRF, arginine vasopressin (VP), oxytocin (OXY), and isoproterenol (ISO) on the biosynthesis and release of pro-ACTH/endorphin-derived peptides by monolayer cultures of rat anterior pituitary cells in complete serum-free medium (CSFM) were studied. When cells were exposed to hormone for 3 h, CRF, VP, OXY, and ISO were each able to stimulate secretion of immunoactive hormone into culture medium. To determine the effects of chronic secretagogue exposure on corticotrope function, cultures were exposed to hormone for 14 days, and total hormone production was measured by immunoassay (cumulative hormone secreted plus cell hormone content). In the absence of CRF, total hormone production increased 3.6 +/- 0.2-fold (mean +/- SEM) over the period from 2-14 days; chronic CRF treatment brought about a 7.9 +/- 0.7-fold increase in total hormone production over the same period (P less than 0.0025) or a 2.2-fold increase over control cells. Total hormone production was not affected by chronic treatment with VP (100 nM), OXY (100 nM), or ISO (100 nM); the response of the cells to chronic CRF treatment was unaltered by chronic inclusion of VP, OXY, or ISO. To examine the chronic effects of secretagogues more directly, anterior pituitary cells were grown in control CSFM or in CSFM containing CRF or VP for 7 days and then incubated in medium containing radiolabeled amino acid for 15 min. The newly synthesized pro-ACTH/endorphin was quantified by immunoprecipitation and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Cells grown in CSFM containing CRF synthesized 1.9 times more labeled pro-ACTH/endorphin that cells grown in control CSFM or in CSFM containing VP. Chronic exposure of anterior pituitary cultures to 8-bromo-cAMP stimulated both synthesis and release of pro-ACTH/endorphin-derived peptides, suggesting that a secretagogue capable of producing a sustained elevation in intracellular cAMP levels will stimulate prohormone synthesis.

Comparison of acute and chronic secretagogue regulation of proadrenocorticotropin/endorphin synthesis, secretion, and messenger ribonucleic acid production in primary cultures of rat anterior pituitary.

The acute and chronic effects of secretagogues activating cAMP-dependent pathways (CRH and cAMP) and activating cAMP-independent pathways [phenylephrine and phorbol 12-myristate 13-acetate (PMA)] on anterior pituitary function were examined in serum-free cultures. Applied acutely, PMA produced a greater stimulation of ACTH/endorphin secretion than CRH or cAMP. However, the effects of CRH and cAMP on secretion were maintained for up to 12 days, while those of PMA and phenylephrine diminished rapidly. Secretagogue effects on pro-ACTH/endorphin biosynthesis were determined by immunoprecipitation of biosynthetically labeled beta-endorphin-related peptides. Cultures exposed to CRH or cAMP and [3H]tyrosine for 12 h produced 1.7 +/- 0.2- and 1.6 +/- 0.1-fold more newly synthesized beta-endorphin-related material than control cells. Cultures exposed to phenylephrine or PMA synthesized 1.3 +/- 0.1- and 1.4 +/- 0.1-fold more peptide than control cells. Exposure of cells to CRH or cAMP for 12 days increased pro-ACTH/endorphin biosynthesis to a greater extent than the 12-h treatment (3.0 +/- 0.1- and 2.5 +/- 0.3-fold over control value, respectively). Exposure to phenylephrine or PMA for 12 days had the same effect on pro-ACTH/endorphin biosynthesis as exposure for 12 h. After acute or chronic secretagogue exposure, the cells secreted relatively more newly synthesized beta-lipotropin than beta-endorphin. Levels of pro-ACTH/endorphin mRNA in cultures treated acutely (12 h) or chronically (12 days) with CRH, cAMP, or phenylephrine changed in parallel with rates of pro-ACTH/endorphin biosynthesis. In contrast, chronic exposure to PMA stimulated biosynthesis while reducing pro-ACTH/endorphin mRNA levels. In summary, these results suggest that factors that activate cAMP-dependent pathways are more powerful stimulators of pro-ACTH/endorphin biosynthesis than factors that activate cAMP-independent pathways; the cAMP-dependent pathway may be primarily responsible for regenerating depleted hormone reserves.

A proposed role for chromogranin A as a glucocorticoid-responsive autocrine inhibitor of proopiomelanocortin secretion.

Chromogranin A (CgA) is a 50 kilodalton (kDa) acidic glycoprotein that is costored and cosecreted from secretory granules with endogenous hormone from diverse endocrine cell types. The physiological role(s) of CgA is yet to be defined. In this study we used the AtT-20 mouse corticotropic cell line, which produces both CgA and POMC-derived peptides, to study 1) the regulation of CgA and POMC synthesis and secretion, and 2) the influence of CgA on POMC secretion. To study regulation of CgA and POMC biosynthesis and secretion, cells were treated with dexamethasone (DEX) or CRF for 48 h and CgA and POMC messenger RNAs and proteins were analyzed. Exposure to DEX for 48 h (10 nM) inhibited secretion of the 16 K fragment of POMC by 60% while stimulating CgA secretion 500% of control value. Consonant with these changes in protein, POMC mRNA levels fell to 40% of control levels while CgA mRNA levels increased to 250% of control values with DEX treatment. DEX treatment had no effect on the sizes of the CgA [2.1 kilobase (kb)] and POMC (1.0 kb) mRNAs. CRF (100 nM) stimulated secretion of both CgA (4-fold) and ACTH (2.5-fold) above basal values. By contrast, CRF increased POMC mRNA levels but had no effect on levels of CgA mRNA. Changes in total peptide production paralleled the changes in mRNA levels. Because DEX differentially regulated CgA and POMC synthesis and secretion, we questioned whether CgA could function as an autocrine inhibitor of hormone secretion. CgA inhibited CRF-stimulated secretion of 16 K fragment in a concentration-dependent manner (100% at 100 nM) without affecting basal 16 K fragment secretion. Moreover, anti-CgA antiserum, but not nonimmune serum, increased basal 16 K fragment secretion 2-fold and CRF-stimulated 16 K fragment secretion 1.5-fold. These results suggest that CgA plays an autocrine role as a glucocorticoid responsive inhibitor of POMC-derived peptide secretion.

Relationship between plasma adrenocorticotropin, hypothalamic opioid tone, and plasma leptin.

The purpose of the present study was to further the understanding of the relationship between plasma leptin concentrations, hypothalamic opioid tone, and plasma ACTH secretory dynamics. ACTH(1-24) challenges (250 micrograms) produced the expected increase in plasma cortisol levels but did not alter plasma leptin levels. Activation of the entire hypothalamic-pituitary-adrenal (HPA) axis was induced by employing the opioid receptor antagonist, naloxone. By blocking opioidergic inhibitory input to hypothalamic CRH neurons, naloxone induced the expected increase in plasma ACTH and cortisol. Plasma ACTH levels peaked 30 min after naloxone administration, whereas plasma cortisol levels peaked 60 min after opioid receptor blockade. Once again, plasma leptin concentrations were not altered by this manipulation. However, there was a positive correlation between fasting, integrated plasma leptin concentrations, and plasma ACTH responses to naloxone (peak r = 0.822, P < 0.0001; and area under curve r = 0.832, P < 0.0001). The correlation was stronger when leptin was normalized to body mass index and expressed as the leptin/body mass index ratio (peak r = 0.878, P < 0.00001; and area under curve r = 0.882, P < 0.00001). In summary, these findings indicate that activation of the HPA axis does not acutely alter plasma leptin concentrations. However, plasma leptin levels may influence hypothalamic opioidergic tone and thus modulate the magnitude of CRH release. The acute interaction of the HPA axis and leptin is unidirectional.

Alterations in the hypothalamic-pituitary-adrenal axis in actively drinking alcoholics.

The impact of chronic alcohol abuse on the hypothalamic-pituitary-adrenal (HPA) axis was investigated in actively drinking, nondepressed alcoholics with no evidence of liver disease. Fourteen male alcoholics and 13 matched nonalcoholics were studied. Although alcoholics and controls had similar decrements in cortisol levels after metyrapone blockade, plasma ACTH and 11-deoxycortisol levels in alcoholics were 60% (P less than 0.05) and 40% (P less than 0.05), respectively, of control values. To further clarify defects in the HPA axis of the alcoholic group, each subject underwent a CRH stimulation test. Compared to control subjects, alcoholics had a significantly blunted plasma ACTH response to CRH stimulation (P less than 0.05). Timing of the peak plasma ACTH response was altered in alcoholics. Whereas all control subjects had a peak plasma ACTH response 30 min after CRH administration, 50% of alcoholics demonstrated a peak plasma ACTH response 60 min after CRH administration, and 50% demonstrated a peak plasma ACTH response 30 min after CRH. To determine if adrenal function was also impaired, alcoholics and controls underwent a standard (250 micrograms) and a submaximal (0.250 micrograms) Cortrosyn stimulation test. Controls demonstrated a significant cortisol response to both standard and low dose Cortrosyn. Although alcoholics had a cortisol response similar to that of controls after the standard dose of Cortrosyn, they did not have a statistically significant rise in cortisol after the submaximal dose of Cortrosyn. Twenty-four-hour urinary free cortisol levels were 2-fold higher in alcoholics compared to controls. In summary, although a subset of alcoholics demonstrated enhanced basal production of cortisol, most alcoholics had a blunted response to acute intervening stress, including CRH, low dose ACTH-(1-24), and metyrapone blockade. These data suggest that alcoholics have ethanol-induced HPA axis injury, resulting in an inappropriately reduced response to nonethanol-induced stress.

Adrenocorticotropin responses to naloxone in sons of alcohol-dependent men.

The endogenous opioid system is part of a neural circuitry functionally related to alcohol-seeking behaviors. A family history of alcoholism is the strongest predictor of future development of alcohol dependence. This study was designed to evaluate ACTH responses to opioid receptor blockade as a function of family history for alcohol dependence. The nonselective opioid antagonist naloxone stimulates ACTH secretion by blocking opioidergic input on paraventricular corticotropin-releasing factor neurons, thereby providing a methodology for comparing hypothalamic opioid tone between study groups. Sixty nonalcoholic subjects, aged 18-25 yr, were enrolled in a protocol to measure the ACTH response to naloxone. Thirty-two subjects were offspring from families with a high density of alcohol dependence and were designated as family history-positive subjects. Twenty-eight subjects were offspring of nonalcohol-dependent parents and were designated family history-negative subjects. Subjects received naloxone (125 microg/kg) or placebo (0.9% saline) in double blind, randomized order. Plasma ACTH was monitored. Family history-positive men had increased ACTH response to naloxone compared to 1) family history-positive women, 2) family history-negative men, and 3) family history-negative women. Despite differences in plasma ACTH levels after naloxone administration, plasma naloxone concentrations did not differ between study groups. This finding suggests that nonalcoholic male offspring of alcohol-dependent men have altered endogenous opioid activity directed at hypothalamic corticotropin-releasing factor neurons.

The effects of mild ethanol intoxication on the hypothalamic-pituitary-adrenal axis in nonalcoholic men.

Historically, ethanol exposure has been thought to stimulate the hypothalamic-pituitary-adrenal (HPA) axis. However, recent studies have demonstrated decreased responsiveness to metyrapone and insulin-induced hypoglycemia in alcoholic subjects. The present study investigated in more detail the effect of acute ethanol ingestion (0.75 g/kg) on the HPA axis in healthy nonalcoholic men (n = 14). In study 1, plasma ACTH/cortisol levels were determined basally and every 30 min over a 180-min period after the ingestion of placebo or ethanol (n = 8). When the subjects were analyzed as a group, ethanol did not alter ACTH or cortisol levels. However, in two of eight subjects, ethanol ingestion was accompanied by a rise in plasma ACTH. In study 2, ethanol or placebo was ingested over 15 min, and 1 microgram/kg ovine (o) CRH was administered (n = 9). Hormone levels were determined at 20 min before and 0, 15, 30, 60, and 90 min after iv oCRH. Compared to responses to placebo, plasma ACTH responses to oCRH were blunted during the ethanol session [peak ACTH, 14.2 +/- 1.4 vs. 20.3 +/- 3.1 pmol/L (P = 0.036); peak value minus baseline (delta), 7.3 +/- 1.4 vs. 13.4 +/- 2.6 pmol/L (P = 0.017); delta divided by baseline x 100, 131 +/- 28 vs. 197 +/- 29% (P = 0.041); area under the ACTH curve, 1082 +/- 116 vs. 1529 +/- 232 pmol/min.L (P = 0.024)]. Ethanol ingestion also significantly blunted plasma cortisol levels after oCRH compared to placebo treatment. In study 3, ethanol or placebo was ingested over 15 min, and 0.25 microgram ACTH-(1-24) was administered (n = 5). Cortisol levels, determined 20 min before and 0, 30, 60, and 90 min after ACTH treatment, were not altered by ethanol administration. In summary, mildly intoxicating doses of ethanol did not stimulate the HPA axis in six of eight subjects. However, mild intoxication significantly impaired oCRH-stimulated ACTH/cortisol secretion. We speculate that mild intoxication with ethanol may impair the ability of the HPA axis to respond to physiological stressors.

Corticotropin-independent Cushing's syndrome caused by an ectopic adrenal adenoma.

Although nonsecreting suprarenal embryonic remnants are frequently found in the urogenital tract, adenomatous transformation resulting in glucocorticoid excess is a rare phenomenon. We report a case of a 63-yr-old woman that presented with new-onset hirsutism, facial plethora, hypertension, centripetal obesity, and a proximal myopathy. The 24-h urinary free cortisol excretion rate was elevated, and the serum ACTH level was suppressed. The patient failed an overnight and low dose dexamethasone suppression test and did not respond to CRH stimulation. In light of the undetectable baseline morning ACTH levels and the blunt response to CRH, the diagnosis of corticotropin-independent Cushing's syndrome was made. Imaging studies revealed normal adrenal glands and enlargement of a left pararenal nodule incidentally observed 4 yr before the onset of symptoms. Dramatic resolution of symptoms was observed after surgical removal of the 3.5-cm mass. Pathological exam confirmed adrenocortical adenoma in ectopic adrenal tissue. The case reported here represents the unusual circumstance in which the development of adenomatous transformation of ectopic adrenal tissue has been prospectively observed with imaging studies. It illustrates the importance of considering ectopic corticosteroid-secreting tumors in the context of corticotropin-independent Cushing's syndrome.

Association of IGF-I levels with muscle strength and mobility in older women.

The functional consequences of the age-associated decline in IGF-I are unknown. We hypothesized that low IGF-I levels in older women would be associated with poor muscle strength and mobility. We assessed this question in a population representative of the full spectrum of health in the community, obtaining serum IGF-I levels from women aged 70-79 yr, enrolled in the Women's Health and Aging Study I or II. Cross-sectional analyses were performed using 617 women with IGF-I levels drawn within 90 d of measurement of outcomes. After adjustment for age, there was an association between IGF-I and knee extensor strength (P = 0.004), but not anthropometry or other strength measures. We found a positive relationship between IGF-I levels and walking speed for IGF-I levels below 50 microg/liter (P < 0.001), but no relationship above this threshold. A decline in IGF-I level was associated with self-reported difficulty in mobility tasks. All findings were attenuated after multivariate adjustment. In summary, in a study population including frail and healthy older women, low IGF-I levels were associated with poor knee extensor muscle strength, slow walking speed, and self-reported difficulty with mobility tasks. These findings suggest a role for IGF-I in disability as well as a potential target population for interventions to raise IGF-I levels.

Plasma adrenocorticotropin responses to opioid blockade with naloxone: generating a dose-response curve in a single session.

We examined two methods of generating a dose-response curve to the opioid receptor antagonist naloxone. In 15 healthy male subjects (18-25 years) plasma adrenocorticotropin (ACTH) responses to five doses of naloxone studied over 5 separate days were compared to plasma ACTH responses to five incremental doses of naloxone studied within a single session. There was a statistically significant positive correlation in ACTH responses (area under the curve and peak) between dosing methods. Furthermore, the doses of naloxone that produced half-maximal and maximal ACTH response were similar. The comparability of ACTH responses between the two naloxone dosing techniques, combined with the safety and ease associated with the single-session methodology, underscores the usefulness of the single-session technique for future investigations.

Alzheimer's disease: low levels of peptide alpha-amidation activity in brain and CSF.

Carboxyl terminal alpha-amidation confers biologic activity to many neuropeptides. Levels of alpha-amidating activity, peptidyl-glycine alpha-amidating monooxygenase (PAM), were reduced in the CSF of patients with dementia of the Alzheimer type (DAT) compared with healthy, age-matched controls. Repeat lumbar puncture data revealed a decline in CSF PAM activity of approximately 16% per year in DAT patients. Of the cerebral cortical regions examined, only the temporal pole showed reduced PAM activity in patients with Alzheimer's disease (AD) compared with controls. These studies may indicate selective dysfunction of neurons which normally synthesize biologically active, alpha-amidated peptides in the CNS of AD patients.