Eficacia y seguridad del uso intraocular de carbacol 0. 01 % para la inducción de miosis intraoperatoria en cirugía de catarata / Efficacy and safety of the intraocular use of 0. 01% carbacol for the induction of intraoperative miosis in cataract surgery

La catarata es definida por la Organización Mundial de la Salud (OMS) como la opacificación del lente cristalino que generalmente ocurre por el envejecimiento, trauma, o alguna enfermedad sistémica, afectando la capacidad visual de la persona. Esta disminución de la capacidad visual o incluso la ceguera, es un problema de salud pública en adultos y adultos mayores. En el Perú, aproximadamente el 0.6 % de la población tiene ceguera, cuya causa en el 47 % de los casos son por las cataratas. El tratamiento indicado para la catarata es la intervención quirúrgica, la cual consiste en reemplazar el cristalino opacificado o catarata por un lente intraocular. Hay dos formas de realizar esto, mediante la extracción extracapsular del cristalino opacificado, o mediante la facoemulsificación del cristalino, que consiste en un proceso de destrucción mediante ondas vibratorias ultrasónicas. Luego de ello, se realiza la implantación de un nuevo lente intraocular con soporte capsular, el cual reemplaza al cristalino permitiendo que el paciente vuelva tener una visión adecuada. Posterior a la implantación del lente intraocular se realiza la inducción de miosis pupilar para mantener el lente dentro de la bolsa capsular, evitar la captura del lente por el iris y el prolapso del iris por las heridas operatorias. La inducción de miosis luego de una intervención por catarata debe realizarse inmediatamente después de la implantación del lente, por lo que la vía de administración indicada es la inyección intraocular del agente miótico. De este modo, se espera que el efecto miótico se prolongue hasta por 24 horas, mientras que la aplicación tópica de un agente miótico se limita a un efecto que bordea las ocho horas, y sólo se puede realizar en el periodo postoperatorio, por lo que se genera un periodo entre la intervención quirúrgica y la aplicación del agente miótico que expone al paciente a las potenciales complicaciones anteriormente mencionadas. Aunque algunos estudios de serie de casos clínicos indican el uso de pilocarpina 2 %, el cual se encuentra disponible en el Petitorio Farmacológico de EsSalud, este medicamento no ha sido aprobado por la FDA para uso intraocular, sólo para uso tópico, dado que su uso intraocular puede ser tóxico o incrementar el riesgo de infecciones intraoculares. Así, en la actualidad EsSalud no cuenta con un medicamento miótico de uso intraocular autorizado, por lo cual, surge la necesidad de evaluar otras alternativas que pudieran ser de beneficio para dichos pacientes. OBJETIVO: objetivo del presente dictamen fue evaluar la eficacia y seguridad del uso intraocular de carbacol 0.01 % para la inducción de miosis intraoperatoria en las intervenciones quirúrgicas por catarata. Carbacol es um colinérgico o parasimpaticomimético potente, que actúa como agonista del receptor de acetilcolina, inhibiendo la acetilcolinesterasa y estimulando tanto los receptores muscarínicos como nicotínicos, produciendo miosis a través de la constricción del iris y del cuerpo ciliar, y reduciendo la presión intraocular. TECNOLOGÍA SANITARIA DE INTERÉS: CARBACOL. Carbacol, también conocido como carbamilcolina, es un colinérgico o parasimpaticomimético potente, que actúa como agonista del receptor de acetilcolina, inhibiendo la acetilcolinesterasa y estimulando tanto los receptores muscarínicos como nicotínicos, produciendo constricción del iris y del cuerpo ciliar y además reduciendo la presión intraocular. El agente colinérgico fue aprobado por la Administración de Drogas y Alimentos (FDA, por sus siglas en inglés) en el año 2002 (FDA, 2015). METODOLOGÍA: Se realizó una búsqueda sin restricción de idioma hasta mayo del 2018. La formulación de la estrategia de búsqueda incluyó los criterios de elegibilidad, los términos controlados propios de cada base y términos libres. Asimismo, se buscaron otros documentos potencialmente elegibles a través de la revisión del listado de referencias de los documentos seleccionados para lectura a texto completo. Por último, la selección de la evidencia siguió el flujograma mostrado en la subsección de resultados. RESULTADOS: Luego de la búsqueda sistemática realizada, se identificaron dos ensayos clínicos aleatorizados (ECA) Beasley, 1972 y Solomon et al., 1998; y el estudio de serie de casos de Pekel et al., 2014. Si bien estos estudios muestran algunas limitaciones que serán analizadas más adelante, es la evidencia de mayor relevancia en torno al uso de carbacol para la inducción de miosis intraoperatoria en las intervenciones quirúrgicas por catarata. Con respecto a la eficacia de carbacol en la inducción de miosis, el estudio de Beasley, 1972 muestra que el efecto miótico a los dos minutos de la inyección intraocular es significativamente mayor en carbacol, con respecto a placebo (p<0.01) y que el efecto miótico persiste por lo menos por 15 horas. Por otro lado, a la séptima semana postoperatoria, se observó una incidencia significativamente menor de sinequias anteriores periféricas (SAP) en el grupo que recibió carbacol (11 %), en comparación al grupo que recibió a placebo (35 %). Al analizar el impacto sobre la calidad de vida por parte de carbacol mediante el cuestionario modificado de SF-36, el cual mide la percepción del paciente sobre su estado de salud, el estudio de Solomon et al., 1998 muestra que carbacol incrementa la agudeza visual durante el primer día postoperatorio, con respecto a placebo, y muestra una diferencia estadísticamente significativa en el porcentaje de sujetos que pueden descender las escaleras sin ayuda durante la primera semana posterior a la intervención quirúrgica, tanto en un ambiente con luz brillante (p=0.007) o con luz tenue (p=0.037), siendo un potencial factor protector en pacientes con riesgo de presentar caídas acci Con respecto a los eventos adversos, los estudios evaluados no encontraron casos de inflamación intraocular ni de cefalea frontal. El estudio Pekel et al., 2015 muestra que sólo en el primer día postoperatorio hubo un menor volumen macular total (VMD y del grosor macular central (GMC) con respecto al volumen preoperatorio. Mientras que, durante el seguimiento (al primer día, a la primera semana y al primer mes) no se encontraron diferencias estadísticamente significativas en la presencia de edema macular, ni en el calibre de los vasos retinianos (CVR) al comparar los pacientes que recibieron carbacol con los que no lo recibieron. dentales y fractura de caderas. CONCLUSIONES: El presente dictamen preliminar muestra la evidencia disponible hasta mayo 2018 con respecto al uso intraocular de carbacol 0.01 % en comparación con placebo para la inducción de miosis intraoperatoria en pacientes operados de cataratas. No se encontraron guías de práctica clínica, revisiones sistemáticas ni evaluaciones de tecnologías sanitarias que respondan la pregunta PICO de la presente evaluación. Finalmente, se identificaron dos ECA y un estudio de serie de casos como sustento para la elaboración del presente dictamen preliminar. Al evaluar la eficacia de carbacol en la inducción de miosis, el estudio Beasley, 1972 muestra que carbacol genera miosis dentro de los dos minutos de ser aplicado y que su efecto perdura por más de 15 horas. Esto se traduce en una menor incidencia de SAP a la sétima semana postoperatorio, con respecto a placebo. Aunque no se aprecia diferencia en la conservación de la integridad de la cámara vítrea. Con respecto a los eventos adversos, los estudios evaluados no observaron casos de inflamación intraocular ni de cefalea frontal, mientras que el estudio Pekel et al., 2015 muestra que carbacol disminuye el volumen macular total (VMT) y el grosor macular central (GMT) en el primer día postoperatorio, mas no en la primera semana, ni primer mes. Por otro lado, no se ve afectado el calibre de los vasos retinianos (CVR). Estos resultados muestran una cierta protección ante el edema macular en el postoperatorio inmediato y ausencia de secuelas en la morfología macular, sin embargo, se debe tener en cuenta el posible sesgo de medición que conlleva. En resumen, carbacol es un agente miótico que inicia su acción dentro de los dos minutos de su inyección, manteniendo su efecto por más de 15 horas, generando un beneficio en el periodo postoperatorio inmediato en la agudeza visual y en el volumen macular total. Asimismo, los estudios no reportan eventos adversos como edema macular, cefalea, y, por el contrario, refieren una reducción en la incidencia de SAP, mas no hay una diferencia en la preservación de la integridad de la cámara vítrea, al ser comparado con placebo. Con respecto a la calidad de vida en el postoperatorio, se observa un inicio más temprano de la deambulación y autonomía en el uso de las escaleras, lo que podría tener un impacto positivo en el estilo de vida de los pacientes intervenidos. Por lo expuesto, el Instituto de Evaluaciones de Tecnologías en Salud e Investigación - IETSI aprueba el uso de carbacol, según lo establecido en el Anexo N.° 1. La vigencia del presente dictamen preliminar es de dos años a partir de la fecha de publicación.

Increase in sensitivity of the baroreceptor reflex following microinjection of carbachol into the posterior hypothalamic nucleus of awake rats.

In a rat model, the baroreceptor reflex can be assessed by graded infusions of either phenylephrine or sodium nitroprusside with continuous hemodynamic monitoring. Microinjection of the cholinergic agonist carbachol (CCh) into the posterior hypothalamic nucleus (PHN) evokes an increase in mean arterial pressure and a change in heart rate. Lower doses of CCh evoke only tachycardia, whereas middle and higher doses evoke a biphasic change in heart rate of tachycardia followed by bradycardia. The bradycardia following the microinjection of CCh into the PHN can be attenuated by the previous administration of the vasopressin V1 receptor antagonist [d(CH2 )5 Tyr(Me)] arginine vasopressin (AVPX). Circulating arginine vasopressin (AVP) has been shown to increase the sensitivity of the baroreceptor reflex by stimulating vasopressin V1 receptors in the area postrema. The attenuation by AVPX of the bradycardia that results following the high doses of CCh suggests that AVP is released into the circulation following stimulation of cholinergic systems within the PHN. Thus, microinjection of a high dose of CCh (11 nmol) into the PHN alters the sensitivity of the baroreceptor reflex by increasing peripheral levels of AVP.

Effects of chronic l-DOPA administration on neurogenic and endothelium-dependent relaxation responses in rabbit corpus cavernosum.

BACKGROUND: Dopamine is a crucial central neurotransmitter that plays a fundamental role in the autonomic and somatic components of penile reflexes in animals and humans. Similar to the erectile responses of dopamine, systemic administration of l-DOPA induces yawning and penile erection in some species. The possible effects of l-DOPA on nitric oxide (NO)-dependent and -independent non-adrenergic non-cholinergic (NANC) relaxation responses mediated by electrical field stimulation (EFS) and endothelium-dependent relaxation were investigated in this study. METHODS: Thirty-two adult albino male rabbits, in two- and four-week-treatment groups, were divided into three subgroups: control group (saline-injected) (n=4), 3mg/kg/day (low dose) l-DOPA-injected groups (n=6) and 12mg/kg/day (high dose) l-DOPA-injected groups (n=6). After the intraperitoneal injection treatments, the corpus cavernosum tissues were placed in organ bath chambers. The EFS-mediated responses, and the concentration-response curve to carbachol, sodium nitroprusside (SNP), sildenafil were assessed. RESULTS: The two-week treatment with high-dose l-DOPA decreased the NO-dependent NANC relaxation responses, while there was no change in the low-dose two- and four-week treatment groups. The NO-independent NANC relaxation responses in the two-week groups decreased, and the responses in the four-week groups were unchanged when compared to the controls. The relaxation responses to carbachol showed no differences among all groups except for the high-dose four-week l-DOPA group. The relaxation responses of SNP and sildenafil were increased in all of the treatment groups when compared to the controls. CONCLUSIONS: The observed increases in SNP- and sildenafil-induced responses, along with the decreased EFS-mediated responses, suggest increased sensitivity in the NO-signalling pathway following l-DOPA administration.

Long-term reproducibility of Edinger-Westphal stimulated accommodation in rhesus monkeys.

If longitudinal studies of accommodation or accommodation restoration procedures are undertaken in rhesus monkeys, the methods used to induce and measure accommodation must remain reproducible over the study period. Stimulation of the Edinger-Westphal (EW) nucleus in anesthetized rhesus monkeys is a valuable method to understand various aspects of accommodation. A prior study showed reproducibility of EW-stimulated accommodation over 14 months after chronic electrode implantation. However, reproducibility over a period longer than this has not been investigated and therefore remains unknown. To address this, accommodation stimulation experiments in four eyes of two rhesus monkeys (13.7 and 13.8 years old) were evaluated over a period of 68 months. Carbachol iontophoresis stimulated accommodation was first measured with a Hartinger coincidence refractometer (HCR) two weeks before electrode implantation to determine maximum accommodative amplitudes. EW stimulus-response curves were initially measured with the HCR one month after electrode implantation and then repeated at least six times for each eye in the following 60 months. At 64 months, carbachol iontophoresis induced accommodation was measured again. At 68 months, EW stimulus-response curves were measured with an HCR and photorefraction every week over four consecutive weeks to evaluate the short-term reproducibility over one month. In the four eyes studied, long-term EW-stimulated accommodation decreased by 7.00 D, 3.33 D, 4.63 D, and 2.03 D, whereas carbachol stimulated accommodation increased by 0.18 D-0.49 D over the same time period. The short-term reproducibility of maximum EW-stimulated accommodation (standard deviations) over a period of four weeks at 68 months after electrode implantation was 0.48 D, 0.79 D, 0.55 D and 0.39 D in the four eyes. Since the long-term decrease in EW-stimulated accommodation is not matched by similar decreases in carbachol iontophoresis stimulated accommodation, the decline in accommodation cannot be due to the progression of presbyopia but is likely to result from variability in EW electrode position. Therefore, EW-stimulated accommodation in anesthetized monkeys is not appropriate for long-term longitudinal studies of age-related loss of accommodation or accommodation restoration procedures.

Taurine supplementation restores glucose and carbachol-induced insulin secretion in islets from low-protein diet rats: involvement of Ach-M3R, Synt 1 and SNAP-25 proteins.

Isolated islets from low-protein (LP) diet rats showed decreased insulin secretion in response to glucose and carbachol (Cch). Taurine (TAU) increases insulin secretion in rodent islets with a positive effect upon the cholinergic pathway. Here, we investigated the effect of TAU administration upon glucose tolerance and insulin release in rats fed on a normal protein diet (17%) without (NP) or with 2.5% of TAU in their drinking water (NPT), and LP diet fed rats (6%) without (LP) or with TAU (LPT). Glucose tolerance was found to be higher in LP, compared to NP rats. However, plasma glucose levels, during ipGTT, in LPT rats were similar to those of controls. Isolated islets from LP rats secreted less insulin in response to increasing glucose concentrations (2.8-22.2 mmol/L) and to 100 µmol/L Cch. This lower secretion was accompanied by a reduction in Cch-induced internal Ca(2+) mobilization. TAU supplementation prevents these alterations, as judged by the higher secretion induced by glucose or Cch in LPT islets. In addition, Ach-M3R, syntaxin 1 and synaptosomal associated protein of 25 kDa protein expressions in LP were lower than in NP islets. The expressions of these proteins in LPT were normalized. Finally, the sarcoendoplasmatic reticulum Ca(2+)-ATPase 3 protein expression was higher in LPT and NPT, compared with controls. In conclusion, TAU supplementation to LP rats prevented alterations in glucose tolerance as well as in insulin secretion from isolated islets. The latter effect involves the normalization of the cholinergic pathway, associated with the preservation of exocytotic proteins.

The role of spinal orexin-1 receptors in posterior hypothalamic modulation of neuropathic pain.

The posterior hypothalamus (PH) is known to reduce nociceptive pain, but the effect of PH stimulation on neuropathic pain is not known. Because neurons containing the neurotransmitter orexin-A are located in the PH in some strains of rat and intrathecal injection of orexin-A produces antinociception in a neuropathic pain model, we hypothesized that orexin-A from neurons in the PH modifies nociception in the spinal cord dorsal horn. To test this hypothesis, the cholinergic agonist carbachol or normal saline was microinjected into the PH of lightly anesthetized female Sprague-Dawley rats with chronic constriction injury (CCI) and foot withdrawal latencies (FWL) were measured. Carbachol-induced PH stimulation produced dose dependent antinociception as shown by significantly increased FWL compared to saline controls. To investigate the role of orexin-A in PH-induced antinociception, the orexin-1 receptor antagonist SB-334867 or dimethyl sulfoxide (DMSO) for control, was given intrathecally following carbachol-induced PH stimulation. SB-334867 decreased FWL compared to DMSO controls. These data are suggestive that stimulating the PH produces antinociception in a neuropathic pain model and that the antinociceptive effect is mediated in part by orexin-1 receptors in the spinal cord dorsal horn.

GABAA receptors in the mediodorsal thalamus play a crucial role in rat shell-specific acetylcholine-mediated, but not dopamine-mediated, turning behaviour.

The role of GABA(A) receptors in the mediodorsal thalamus (mdT) in turning behaviour of rats was studied. Neither the GABA(A) receptor agonist muscimol (50 ng) nor the antagonist bicuculline (200 ng) unilaterally injected into the mdT elicited any behavioural change. Unilateral injection of the acetylcholine receptor agonist (carbachol, 5 microg) into the nucleus accumbens shell has been found to elicit contraversive circling while unilateral injection of a mixture of dopamine D(1) ((+/-)-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine-7,8-diol [SKF 38393], 5 microg) and D(2) (quinpirole, 10 microg) receptor agonists into the same site is known to elicit contraversive pivoting. The contraversive circling induced by unilateral injection of carbachol (5 microg) into the nucleus accumbens shell was dose-dependently inhibited by muscimol (25 and 50 ng) injected into the mdT. This inhibitory effect of muscimol (50 ng) was antagonised by co-administration of bicuculline (200 ng), which alone did not modify the contraversive circling induced by carbachol (5 microg). The contraversive pivoting induced by unilateral injection of a mixture of SKF 38393 (5 microg) and quinpirole (10 microg) into the nucleus accumbens shell was inhibited by muscimol (25 and 50 ng) injected into the mdT, whereas bicuculline (200 ng) injected into the mdT did not significantly modify the pivoting. The inhibitory effect of muscimol (50 ng) on the pivoting induced by a mixture of SKF 38393 (5 microg) and quinpirole (10 microg) was not dose-dependent and not antagonised by bicuculline (200 ng). The present study suggests that GABA(A) receptors in the mdT play a limited role in spontaneously occurring locomotor activity. Secondly, this study demonstrates that GABA(A) receptors in the mdT transmit accumbens-dependent cholinergic circling, but not accumbens-dependent dopaminergic pivoting, to other brain structures. Finally, the present study shows that muscimol-sensitive, non-GABA(A) receptors in the mdT influence the accumbens-dependent dopaminergic pivoting. To what extent GABA(B) receptors in the mdT mediate the muscimol-induced effects upon the dopaminergic pivoting behaviour requires additional research.

Disinhibition of perifornical hypothalamic neurones activates noradrenergic neurones and blocks pontine carbachol-induced REM sleep-like episodes in rats.

Studies in behaving animals suggest that neurones located in the perifornical (PF) region of the posterior hypothalamus promote wakefulness and suppress sleep. Among such cells are those that synthesize the excitatory peptides, orexins (ORX). Lack of ORX, or their receptors, is associated with narcolepsy/cataplexy, a disorder characterized by an increased pressure for rapid eye movement (REM) sleep. We used anaesthetized rats in which pontine microinjections of a cholinergic agonist, carbachol, can repeatedly elicit REM sleep-like episodes to test whether activation of PF cells induced by antagonism of endogenous, GABA(A) receptor-mediated, inhibition suppresses the ability of the brainstem to generate REM sleep-like state. Microinjections of the GABA(A) receptor antagonist, bicuculline (20 nl, 1 mm), into the PF region elicited cortical and hippocampal activation, increased the respiratory rate and hypoglossal nerve activity, induced c-fos expression in ORX and other PF neurones, and increased c-fos expression in pontine A7 and other noradrenergic neurones. The ability of pontine carbachol to elicit any cortical, hippocampal or brainstem component of the REM sleep-like response was abolished during the period of bicuculline-induced activation. The activating and REM sleep-suppressing effect of PF bicuculline was not attenuated by systemic administration of the ORX type 1 receptor antagonist, SB334867. Thus, activation of PF neurones that are endogenously inhibited by GABA(A) receptors is sufficient to turn off the brainstem REM sleep-generating network; the effect is, at least in part, due to activation of pontine noradrenergic neurones, but is not mediated by ORX type 1 receptors. A malfunction of the pathway that originates in GABA(A) receptor-expressing PF neurones may cause narcolepsy/cataplexy.

Embryonic stem cells as a novel cell source of cell-based biosensors.

To investigate the use of embryonic stem cells as biosensor elements, mouse embryoid bodies were cultured on the surface of the light-addressable potentiometric sensor and induce to in vitro differentiate into cardiomyocytes and neurons. Extracellular potentials of the cells were recorded by sensor, to detect stem cells potential applications in drugs screening. The experimental results show that known cardiac stimulants (isoproterenol) and relaxants (carbamylcholine) have characteristic effects on the cardiomyocytes in terms of the changes of beat frequency, amplitude and duration. Thus, the embryonic stem cells potentially represent a renewable cell source for the cell-based biosensors.

Continuous carbachol infusion promotes peripheral cell proliferation and mimics vagus hyperactivity in a rat model of hypothalamic obesity.

Lesions of the ventromedial hypothalamus (VMH) result in obesity and enhanced cellular proliferation in various organs, including the pancreas, gastrointestinal tract, and liver. Previous studies have suggested that vagal hyperactivity, rather than overeating, induces the peripheral cell proliferation in VMH-lesioned rats. The goal of the present study was to investigate the mechanism of peripheral cell proliferation in VMH-lesion-induced obesity by infusing rats with the acetylcholine agonist, carbachol, and then measuring cellular proliferation in the pancreas and duodenum using immunohistochemistry. The ventromedial hypothalamus was bilaterally lesioned in five rats. In other rats, the bilateral vagus nerves were ligated (vagotomized), and saline or carbachol was continuously administered by an osmotic minipump (n = 5 in each group). Three days later, rats were killed, and cell proliferation was assessed in the pancreas and the duodenum using immunohistochemistry for proliferating cell nuclear antigen (PCNA). Additionally, cellular proliferation in the duodenum was more precisely examined by assessing incorporation of 5-bromo-2'-deoxyuridine (BrdU). Cellular proliferation was higher in rats that received carbachol infusions and in rats with VMH-lesions when compared with control rats (P < 0.05, respectively). The pancreatic PCNA-expressing cells were predominantly identified as the B-cells of the islets of Langerhans. These data demonstrate that carbachol infusion can induce pancreatic and duodenal cell proliferation to a degree that was comparable to that in vagal hyperactivity induced by VMH lesions.

Stimulation of the lateral hypothalamus produces antinociception mediated by 5-HT1A, 5-HT1B and 5-HT3 receptors in the rat spinal cord dorsal horn.

The lateral hypothalamus is part of an efferent system that modifies pain at the spinal cord dorsal horn, but the mechanisms by which lateral hypothalamus-induced antinociception occur are not fully understood. Previous work has shown that antinociception produced from electrical stimulation of the lateral hypothalamus is mediated in part by spinally projecting 5-hydroxytryptamine (5-HT) neurons in the ventromedial medulla. To further examine the role of the lateral hypothalamus in antinociception, the cholinergic agonist carbamylcholine chloride (125 nmol) was microinjected into the lateral hypothalamus of female Sprague-Dawley rats and nociceptive responses measured on the tail-flick and foot-withdrawal tests. Intrathecal injections of the selective 5-HT1A, 5-HT1B, 5-HT3 receptor antagonists, WAY 100135, SB-224289, and tropisetron, respectively, and the non-specific antagonist methysergide, were given. Lateral hypothalamus stimulation with carbamylcholine chloride produced significant antinociception that was blocked by WAY 100135, tropisetron, and SB-224289 on both the tail-flick and foot-withdrawal tests. Methysergide was not different from controls on the tail flick test, but increased foot-withdrawal latencies compared with controls. These results suggest that the lateral hypothalamus modifies nociception in part by activating spinally projecting serotonin neurons that act at 5-HT1A, 5-HT1B, and 5-HT3 receptors in the dorsal horn.

Activation of the phasic pontine-wave generator enhances improvement of learning performance: a mechanism for sleep-dependent plasticity.

The aim of this study was to test the hypothesis that supplementary activation of the phasic pontine wave (P-wave) generator during rapid eye movement (REM) sleep enhances consolidation and integration of memories, resulting in improved learning. To test this hypothesis, two groups of rats were trained on a two-way active avoidance learning task in the morning. Immediately after training, one group of rats received a carbachol microinjection into the P-wave generator and the other group was microinjected with control saline into the same target area. After training trials and microinjections, rats were allowed a 6-h period of undisturbed sleep in the polygraphic recording chamber. At the end of 6 h of undisturbed sleep-wake recordings, rats were retested in a session of avoidance learning trials. After learning trials, the total percentage of time spent in REM sleep was significantly increased in both saline (15.36%)- and carbachol (17.70%)-microinjected rats. After learning trials, REM sleep P-wave density was significantly greater throughout the 6-h period of recordings in carbachol treated rats than in the saline treated rats. In the retrial session, the improvement in learning task performance was 22.75% higher in the carbachol-microinjected rats than in the saline-microinjected rats. These findings show that the consolidation and integration of memories create a homeostatic demand for P-waves. In addition, these findings provide experimental evidence, for the first time, that activation of the P-wave generator may enhance consolidation and integration of memories, resulting in improved performance on a recently learned task.

Arbutus unedo induces endothelium-dependent relaxation of the isolated rat aorta.

Arbutus unedo L. (Ericaceae) is used in oriental Morocco to treat arterial hypertension. We studied its vasodilator effect and mechanisms of action in vitro. The root aqueous extract of Arbutus (0.25 mg/mL) produced a relaxation of noradrenaline-precontracted ring preparations of rat aorta with intact endothelium. Relaxation by Arbutus did not occur in specimens without endothelium and was inhibited by pretreatment with 100 microM N(G)-methyl-L-arginine (L-NMA), 10 microM methylene blue or 50 microM 1H-[1,2,4] oxadiazolo [4,3-a] quinoxaline-1-one (ODQ) but not by 10 microM atropine. These results suggest that Arbutus produces an endothelium-dependent relaxation of the isolated rat aorta which may be mediated mainly by a stimulation of the endothelial nitric oxide synthase by mechanisms other than activation of muscarinic receptors.

Effects of dopaminergic and cholinergic interactions on rat behavior.

The present work studied the effects of dopaminergic and muscarinic receptor agonists and antagonists on rat locomotor activity and catalepsy. Results showed that carbachol at the highest dose used (10 mg/kg, p.o.) decreased and pimozide at the dose used abolished locomotor activity. Atropine at a low dose (1 mg/kg, p.o.) increased and at a high dose decreased this parameter. Mazindol at a high dose also increased locomotor activity. A significant and dose-dependent increase in the time on the bar was observed in animals treated with carbachol or pimozide as compared to controls. The increase observed with pimozide was greater than 60 s. Effects of carbachol on locomotor activity were observed already after the first drug exposure, but the increased time on bar produced by this drug in the test of catalepsy was observed only after repeated exposure (7th day). The effect of the highest dose (10 mg/kg, p.o.) of atropine (decreased activity) as related to the lowest one was evident at the 7th day, but the increased locomotor activity seen at the low dose was detected already at the first day. There was a predominance of the effect of pimozide on the open field as well as on catalepsy after its association with each one of the three doses of carbachol. The association of atropine and mazindol did not seem to alter locomotor activity and catalepsy as related to each drug alone. Our results indicate that interactions between dopaminergic and cholinergic systems play an important role on behavior and motor functions.

Activation of the cholinergic system of the striatum improves attention to conditioned reflex stimuli.

Chronic experiments were performed on 16 dogs using a model of an operant defensive reflex associated with maintenance of a flexion pose to study the effects of uni- and bilateral microinjections of the acetylcholine agonist carbacholine (0.05-0.4 microg) and the choline receptor blocker scopolamine (0.5 microg) into the dorsolateral part of the head of the caudate nucleus and CM-Pf intralaminar thalamic nuclei. These experiments produced data showing that the cholinergic system of the striatum has an important role in realizing the sensory and motor components of the learned movement. Activation of the cholinergic system of the dorsal striatum led to general calming of behavior and inhibition of intersignal limb elevation and the phasic components of the movement, along with ordering and stabilizing of the pose and an increase in the tonic component of the operant response. This suggests that the cholinergic system of the striatum receives an indirect efferent output via motor structures and takes part in preparing the motor apparatus needed for transferring attention to significant stimuli. Microinjections of scopolamine had the opposite effects. Use of differential signals in the same behavioral model, along with special tests for attention, showed that the cholinergic system of the striatum plays an important role in the sensory control of attention. Activation of the striatal cholinergic system led to a significant improvement in responses to differential signals and defensive signals of intensity 2-3 times slower than normal signals, and these changes were accompanied by clearer responses in special tests for attention. Scopolamine microinjections had the opposite effects. Carbacholine microinjections into the intralaminar thalamic nuclei potentiated the effects of cholinergic activation of the striatum. These data indicate that the dorsal striatum can be regarded not only as a parallel level of information processing, but also as a control system for passing this information to various levels of both sensory and motor structures. One important result of this type of control may be that of improving attention to significant stimuli.

Variability of airway responses in mice.

We examined the effect of animal strain, type of spasmogen, and mode of spasmogen administration on the pattern of lung mechanical responses in intubated and mechanically ventilated mice. We determined the response in inspiratory respiratory system resistance (R(rs)) and inspiratory static respiratory system compliance (C(rs)) to increasing doses of inhaled or intravenous carbachol or serotonin in Balb/C and C57BL/6 mice. R(rs) responsiveness was quantitated by calculating, by interpolation, the inhaled spasmogen concentration (PC(150)) and intravenous spasmogen dose (PD(150)) causing an increase in R(rs) to 150% of baseline. C(rs) responsiveness was calculated similarly for a decrease in C(rs) to 85% of baseline (PC(85) for inhaled and PD(85) for intravenous spasmogen). Baseline R(rs) and C(rs) were similar in all groups. R(rs) responsiveness to inhaled and intravenous carbachol and serotonin tended to plateau and was not different in the two strains. In contrast, C(rs) responses were variable and had a greater mean PC(85) for inhaled serotonin than carbachol in both strains and a greater fall in mean C(rs) at PC(150) for carbachol in Balb/C mice; no interstrain and interdrug differences in PD(85) were noted for intravenous spasmogens. Intravenous atropine attenuated the R(rs) response to high-dose inhaled and intravenous serotonin, suggesting the involvement of a vagal reflex. In contrast, atropine attenuated C(rs) responses only for intravenous serotonin in Balb/C mice. These results suggest that animal strain, spasmogen, and mode of administration determine the extent to which induced airflow resistance is accompanied by increases in elastic recoil.

Cholinergic modulation of the acoustic startle response in the caudal pontine reticular nucleus of the rat.

The startle response is a useful behavioural model to assess drug effects on sensorimotor information processing in the mammalian central nervous system. Prepulse inhibition of the acoustic startle response in rats is an operational measure for sensorimotor gating mechanisms which may be necessary for attention and response selection. The caudal pontine reticular nucleus is a key element of the pathway that mediates the acoustic startle response and receives an inhibitory cholinergic projection that might be important for prepulse inhibition. The present study tested whether prepulse inhibition of acoustic startle is modulated by microinfusions of the muscarinic/nicotinic acetylcholine receptor agonist carbachol and of the muscarinic acetylcholine receptor antagonist scopolamine. Carbachol (0-40 nmol/0.5 microl) dose dependently attenuated startle and enhanced prepulse inhibition. Scopolamine (0-40 nmol/0.5 microl) dose-dependently enhanced startle and reduced prepulse inhibition at a dose of 10 nmol. Scopolamine (40 nmol) also increased the spontaneous motor activity of the rats. These findings lend support to the hypothesis that muscarinic acetylcholine receptors in the caudal pontine reticular nucleus inhibit the acoustic startle response and are involved in the mediation of prepulse inhibition of startle.

Cardiovascular responses evoked by carbachol microinjection into the posterior hypothalamus involves ganglionic nicotinic and muscarinic mechanisms.

1. Microinjection of the cholinergic agonist carbachol (3.3, 5.5 and 13.2 nmol) into the posterior hypothalamic nucleus of conscious rats evokes a dose-dependent increase in blood pressure. The pressor response evoked by the lower doses of carbachol was attenuated by pretreatment with the ganglionic nicotinic receptor antagonist pentolinium (10 mg kg(-1), i.v.) while blockade of V1-vasopressin receptors with [d(CH2)5Tyr(Me)]AVP (20 microg kg(-1), i.v.) reduced the pressor response evoked by the highest dose. 2. The combination of pentolinium and the muscarinic receptor antagonist methylatropine (2 mg kg(-1), i.v.) completely blocked the response evoked by the lower doses while the addition of [d(CH2)5Tyr(Me)]AVP to these two antagonists was required for further inhibition of the pressor response to the highest dose of carbachol. Bilateral adrenal demedullation did not affect the pressor response evoked by 5.5 or 13.2 nmol of carbachol. 3. Treatment of intact and adrenal demedullated rats with pentolinium after the pressor response to 13.2 nmol of carbachol was underway reversed the pressor response, but not to the same degree as that provided by the combination of pentolinium and methylatropine, or pentolinium and [d(CH2)5Tyr(Me)]AVP. 4. Methylatropine or [d(CH2)5Tyr(Me)]AVP caused a slight reversal of the carbachol-induced pressor response once it was underway in intact rats. Methylatropine given before or after pentolinium worked with the pentolinium to completely reverse the response. Methylatropine given alone reversed the bradycardia evoked by carbachol to a tachycardia which itself was antagonized by subsequent treatment with pentolinium. 5. These results suggest that the pressor response evoked by carbachol microinjection into the posterior hypothalamic nucleus of conscious rats involves sympathoexcitation and vasopressin release. The sympathoexcitation involves nicotinic and muscarinic receptors in autonomic ganglia.

Increased sodium appetite and thirst in rat induced by the ingredients of liquorice, glycyrrhizic acid and glycyrrhetinic acid.

In the rat, blocking 11 beta-OHSD with the active ingredient of liquorice, glycyrrhizic acid (GZA) or its hydrolytic product, 18 beta-glycyrrhetinic acid (GTA), caused potassium loss, increased water intake and a primary increase in salt appetite that was specific for sodium and not secondary to sodium loss. Intracerebroventricular injection of angiotensin II enhanced the sodium appetite but carbachol did not. The stimulating effects of GZA or GTA on intakes of water and NaCl resembled those caused by the administration of excessive amounts of mineralocorticoid. The results suggest that GZA- or GTA-induced drinking behaviour is mediated by circulating glucocorticoids. After liquorice blockade of 11 beta-OHSD, the peripheral and central mineralocorticoid receptors are no longer protected from glucocorticoid action.

Aceclidine effects on outflow facility after ciliary muscle disinsertion.

Aceclidine increases outflow facility with little accommodative effect. To determine whether this dissociation resides in the ciliary muscle (CM) or trabecular meshwork (TM), we measured aceclidine effects on perfusion outflow facility in both eyes of 8 rhesus monkeys after unilateral disinsertion of the CM from the TM. Facility in the control eyes increased by approximately 250% following intravenous pilocarpine and by an additional approximately 250% following intracameral pilocarpine, relative to baseline and uncorrected for washout. In CM-disinserted eyes, the facility response to intravenous and intracameral pilocarpine averaged approximately 25% of that in contralateral controls. Cytochalasin B, which acts directly on the TM to increase facility but is not additive to maximal pilocarpine doses in normal eyes, had no additional effect beyond that of pilocarpine in control eyes but induced an additional 100% facility increase relative to baseline in CM-disinserted eyes. The accommodative response to carbachol in CM-disinserted eyes was approximately 80% of that in contralateral controls, consistent with retention of CM contractility and the gonioscopic appearance of shallow CM disinsertion. Intracameral aceclidine HCl doses of 5 and 50 micrograms increased outflow facility by approximately 80 and 250%, respectively, in control eyes, and by approximately 0 and 80% in CM-disinserted eyes. Either the low aceclidine dose affected facility via the CM, while the high dose exerted an additional effect on the TM, or aceclidine acted only via the CM, with the low dose being ineffective and the high dose modestly effective in CM-disinserted eyes because only a few CM-TM attachments remained.