Blockade of tachykinin NK1/NK2 receptors in the brain attenuates the activation of corticotrophin-releasing hormone neurones in the hypothalamic paraventricular nucleus and the sympathoadrenal and pituitary-adrenal responses to formalin-induced pain in the rat.

Evidence from pharmacological studies has implicated substance P (SP), a natural ligand of tachykinin NK(1) receptors which can also interact with NK(2) receptors, in the generation of pressor and tachycardic responses to stress. Using selective blockade of brain NK(1) and NK(2) receptors, we tested in conscious rats the hypothesis that SP initiates, within the neuronal brain circuits, the sympathoadrenal, hypothalamic-pituitary-adrenal (HPA) and behavioural responses to noxious stimuli. Formalin injected s.c. through a chronically implanted catheter in the area of the lower leg was used as a pain stimulus. Rats were pretreated i.c.v. with vehicle or the selective, nonpeptide antagonists of tachykinin NK(1) and NK(2) receptors, RP 67580 and SR 48968, respectively. Ten minutes thereafter, formalin was injected s.c. and the cardiovascular responses were recorded, plasma concentrations of catecholamines, adrenocorticotrophic hormone (ACTH) and corticosterone were determined and the expression of the inducible transcription factor c-Fos in the paraventricular (PVN) and supraoptic nuclei was detected to identify neurones which were activated during pain stimulation. Blockade of NK(1) and NK(2) receptors attenuated the formalin-induced increases in mean arterial pressure and heart rate, adrenaline and ACTH concentrations in plasma, and completely abolished the pain-induced c-Fos expression in corticotrophin-releasing hormone neurones localised in the parvocellular division of the PVN. The results obtained provide pharmacological evidence that tachykinins, most probably SP, act as mediators within the neuronal circuits linked to the initiation and control of the cardiovascular, sympathoadrenal, HPA and behavioural responses to pain stimuli and provide an excitatory input to corticotrophin-releasing hormone neurones in the PVN to activate the HPA axis. Our data demonstrating the inhibition of the complex response pattern to noxious stimuli and stress are consistent with the proposed anxiolytic and antidepressant activity of NK(1) and NK(2) receptor antagonists.

The brainstem noradrenergic systems in stress, anxiety and depression.

The locus coeruleus (LC) is regarded as a part of the central 'stress circuitry' because robust activation of the LC has been reported after stressful stimuli in experimental animals. A considerable amount of clinical evidence also suggests the relationship between the central noradrenergic (NAergic) system and fear/anxiety states or depression. However, previous animal studies have not been able to demonstrate unequivocally the involvement of the NAergic system in mediating fear or anxiety. The forebrain structures, including the hypothalamus, receive massive inputs from the medullary NAergic nuclei via the ventral NAergic bundle (VNAB). The VNAB has been implicated in the neuroendocrine stress axis mainly through its action on the corticotrophin-releasing factor neurones in the paraventricular nucleus of the hypothalamus. Novel tools were introduced that are capable of disrupting the NAergic system more selectively and/or thoroughly than the neurotoxins employed in previous studies: the anti-dopamine-beta hydroxylase (DBH)-saporin is an immunotoxin that is taken up from nerve endings and disrupt the NAergic neurones in a retrograde manner. The genetically DBH-depleted mice were also introduced, which lack endogenous noradrenaline. Owing to the rapid development of functional imaging technique, visualisation of the emotional phenomena has become possible in human subjects. Along with the advent of these technologies, endeavors have been continued to unravel the functional relevance of the central NAergic system to stress, anxiety and depression.

Participation of the prolactin-releasing peptide-containing neurones in caudal medulla in conveying haemorrhagic stress-induced signals to the paraventricular nucleus of the hypothalamus.

The prolactin-releasing peptide (PrRP) has been proposed to be a co-transmitter or modulator of noradrenaline (NA) because it colocalises with NA in the A1 (in the ventrolateral reticular formation) and A2 (in the nucleus of the solitary tract; NTS) cell groups in the caudal medulla. The baroreceptor signals, originating from the great vessels, are transmitted primarily to the NTS, and then part of the signals is conveyed to the hypothalamic neuroendocrine neurones via the ascending NA neurones. The hypotensive haemorrhagic paradigm was employed to examine whether the PrRP-containing neurones in the caudal medulla participate in conveying signals to the hypothalamic neuroendocrine neurones. Among the caudal medullary A1 or A2 neurones, the majority of the PrRP-immunoreactive (-ir) neurones became c-Fos-ir at 2 h after hypotensive haemorrhage. Hypothalamic corticotrophin-releasing hormone-ir neurones and vasopressin-ir neurones became c-Fos positive in parallel with the activation of medullary PrRP-ir neurones. After delivery of retrograde tracer fluorogold (FG) to the paraventricular nucleus of the hypothalamus (PVN), part of the PrRP/FG double-labelled neurones in the A1 and A2 became c-Fos-ir after haemorrhage, demonstrating that PrRP-ir neurones participate in conveying the haemorrhagic stress-induced signals from the medulla to the PVN. PrRP and/or NA were microinjected directly to the PVN of conscious rats, and they presented a synergistic action on arginine vasopressin release, whereas an additive action was observed for adrenocorticotrophin release. These results suggest that the PrRP-containing NA neurones in the caudal medulla may relay the haemorrhagic stress-induced medullary inputs to the hypothalamic neuroendocrine neurones.

Glucocorticoid dependency of surgical stress-induced FosB/DeltaFosB expression in the paraventricular and supraoptic nuclei of the rat hypothalamus.

FosB is a member of the Fos family transcription factors. To determine whether FosB expression is regulated by glucocorticoids (GCs) in the hypothalamus, rats underwent sham adrenalectomy (sham-ADX) or bilateral ADX, and FosB/DeltaFosB (DeltaFosB, a truncated splice variant of FosB)-immunoreactivity (ir) was determined in the paraventricular nucleus (PVN) and supraoptic nucleus (SON). In the parvocellular division of the PVN (paPVN) and SON, FosB/DeltaFosB-immunoreactivity (ir) increased significantly following sham-ADX compared to naive rats, which was suppressed with either corticosterone (CORT) or dexamethasone (DEX). Following ADX, the increase in FosB/DeltaFosB-ir was much more prominent than that in the sham-ADX group, and the ADX-induced robust increase was suppressed by CORT or DEX, but not by aldosterone. Stressless removal of CORT from drinking water did not induce FosB/DeltaFosB-ir in either the PVN or SON, and thus the up-regulation of FosB/DeltaFosB-ir following ADX was dependent on the systemic stress associated with surgery. In the paPVN, the majority of corticotrophin-releasing hormone (CRH) neurones co-expressed FosB/DeltaFosB-ir following ADX, whereas, in the magnocellular division of the PVN, vasopressin (AVP) and oxytocin (OXT) neurones did not express FosB/DeltaFosB-ir. In the SON, approximately 40% of the AVP neurones co-expressed FosB/DeltaFosB-ir following ADX, but the OXT neurones were devoid of FosB/DeltaFosB-ir. In concert with these results obtained in vivo, DEX suppressed the forskolin-induced increase in FosB gene promoter activity in a homologous hypothalamic cell line. These results suggest that GCs may be a potent regulator of FosB/DeltaFosB expression, which is induced by stress, in hypothalamic neuroendocrine neurones.

Prolactin-releasing peptide regulates the cardiovascular system via corticotrophin-releasing hormone.

Prolactin-releasing peptide (PrRP)-producing neurones are known to be localised mainly in the medulla oblongata and to act as a stress mediator in the central nervous system. In addition, central administration of PrRP elevates the arterial pressure and heart rate. However, the neuronal pathway of the cardiovascular effects of PrRP has not been revealed. In the present study, we demonstrate that PrRP-immunoreactive neurones projected to the locus coeruleus (LC) and the paraventricular nucleus (PVN) of the hypothalamus. The c-fos positive neurones among the noradrenaline cells in the LC, and the parvo- and magnocellular neurones in the PVN, were increased after central administration of PrRP. The arterial pressure and heart rate were both elevated after i.c.v. administration of PrRP. Previous studies have demonstrated that PrRP stimulated the neurones in the PVN [i.e. oxytocin-, vasopressin- and corticotrophin-releasing hormone (CRH)-producing neurones], which suggests that PrRP may induce its cardiovascular effect via arginine vasopressin (AVP) or CRH. Although the elevation of blood pressure and heart rate elicited by PrRP administration were not inhibited by an AVP antagonist, they were completely suppressed by treatment with a CRH antagonist. Thus, we conclude that PrRP stimulated CRH neurones in the PVN and that CRH might regulate the cardiovascular system via the sympathetic nervous system.

Outcomes of 23- and 25-gauge transconjunctival sutureless vitrectomies for idiopathic macular holes.

BACKGROUND/AIMS: To assess the outcomes of 23-gauge sutureless transconjunctival vitrectomies (TSV), as compared with 25-gauge TSV in macular hole surgeries. METHODS: A retrospective, consecutive, interventional case series of 47 eyes with idiopathic macular holes treated by 23- or 25-gauge TSV were analysed. RESULTS: The operative time was 37.2 (SD 8.9) min with 23-gauge TSV and 34.2 (8.7) min with 25-gauge TSV (p = 0.388). The anatomical success rate was 96% with 23-gauge TSV and 92% with 25-gauge TSV (p>0.999). The logarithm of the minimum angle of resolution of best-corrected visual acuity (BCVA) at the sixth postoperative month was 0.19 (0.16) with 23-gauge TSV and 0.19 (0.25) with 25-gauge TSV (p = 0.521). Postoperative improvement in BCVA was comparable between the two TSVs. IOP on postoperative day 1 was lower with 25-gauge TSV (12.3 (4.9) mm Hg) than with 23-gauge TSV (17.4 (5.8) mm Hg) (p = 0.036). Complications included retinal break, intraoperative bleeding and slippage of the infusion cannula with 23-gauge TSV, while retinal detachment and postoperative hypotony occurred in the 25-gauge TSV group (p = 0.570). CONCLUSION: 23-gauge TSV appears to be as safe and effective as 25-gauge TSV in macular hole surgery.

Calcium/calmodulin kinase IV pathway is involved in the transcriptional regulation of the corticotropin-releasing hormone gene promoter in neuronal cells.

Although corticotropin-releasing hormone (CRH) plays a pivotal role in the regulation of the hypothalamo-pituitary-adrenal axis, the mechanism of CRH gene expression in the neuronal cell is not completely understood. In this study, we examined the transcriptional regulation of human CRH gene 5'-promoter, using a human BE(2)C neuroblastoma cell line expressing intrinsic CRH. In particular, we focused on the involvement of calmodulin kinases (CaMKs), which are known to play an important role in excitation-induced gene expression through the rise in intracellular calcium in the central nervous system. RT-PCR analysis confirmed the expression of CaMK as well as CRH mRNA in BE(2)C cells. When we introduced approximately 1.1 kb of the 5'-promoter region of the human CRH fused with luciferase reporter gene into the cells, a substantial transcriptional activity was observed, and this was further increased by the activation of the cAMP/PKA pathway. We then examined the effect of activation of CaMKs by introducing the expression vectors of each kinase, revealing a potent stimulatory effect of CaMKIV, but no effect of CaMKII. Depolarization of the cells caused an increase in CRH promoter activity, which was completely abolished by the treatment with the CaMK antagonist K252a. Interestingly, KCREB, a dominant negative form of CREB, antagonized the effect of the CaMKIV-mediated effect. Altogether, we conclude that not only the cAMP/PKA but also the calcium/CaMKIV signaling pathway is involved in the regulation of CRH gene expression. Furthermore, CREB is thought to be involved in CaMK- as well as cAMP/PKA-mediated CRH gene expression. Since the CRH gene is expressed in the neuronal cells of the hypothalamus, the calcium/CaMKIV signaling pathway may play an important role in the excitation-mediated regulation of CRH synthesis.

Regulatory mechanisms of corticotropin-releasing hormone and vasopressin gene expression in the hypothalamus.

Tuberoinfundibular corticotropin-releasing hormone (CRH) neurones are the principal regulators of the hypothalamic-pituitary-adrenal (HPA)-axis. Vasopressin is primarily a neurohypophysial hormone, produced in magnocellular neurones of the hypothalamic paraventricular and supraoptic nuclei, but parvocellular CRH neurones also coexpress vasopressin, which acts as a second 'releasing factor' for adrenocorticotropic hormone along with CRH. All stress inputs converge on these hypothalamic neuroendocrine neurones, and the input signals are integrated to determine the output secretion of CRH and vasopressin. Aminergic, cholinergic, GABAergic, glutamatergic and a number of peptidergic inputs have all been implicated in the regulation of CRH/vasopressin neurones. Glucocorticoids inhibit the HPA-axis activity by negative feedback. Interleukin-1 stimulates CRH and vasopressin gene expression, and is implicated in immune-neuroendocrine regulation. cAMP-response element-binding protein phosphorylation may mediate transcriptional activation of both CRH and vasopressin genes, but the roles of AP-1 and other transcription factors remain controversial. Expression profiles of the CRH and vasopressin genes are not uniform after stress exposure, and the vasopressin gene appears to be more sensitive to glucocorticoid suppression.

Norepinephrine-induced CRH and AVP gene transcription within the hypothalamus: differential regulation by corticosterone.

We have previously demonstrated that microinjection of norepinephrine (NE) into the paraventricular nucleus of the hypothalamus (PVN) of conscious rats elicits a marked increase in CRH gene transcription, indicated by CRH hnRNA levels, without changing AVP hnRNA levels. We hypothesized that this differential response is due to differential sensitivity of AVP and CRH gene transcription to the inhibitory effects of the NE-induced rise in corticosterone. In the current study, we used animals that had been adrenalectomized and implanted with a subcutaneous corticosterone pellet (ADX/B) which prevented the NE-induced rise in corticosterone levels. NE (50 nmol) or artificial CSF was injected into the PVN of conscious rats, which had undergone either sham-operation (SHAM) or ADX/B 1 week earlier. CRH and AVP hnRNA levels were semi-quantitated by in situ hybridization using intron-specific riboprobes. In both SHAM and ADX/B animals, CRH hnRNA levels were significantly elevated at the 15 min time-point and returned to basal levels by 120 min. At 15 min, the magnitude of the CRH hnRNA response was only slightly greater in the ADX/B group than SHAM. In contrast, changes in medial parvocellular PVN AVP hnRNA levels in the ADX/B group were significantly greater than the changes observed in the SHAM group, at both the 15 and 120 min time-points. These results suggest that corticosterone has a greater impact on the transcriptional regulation of AVP than CRH, suggesting important differences and distinct roles of these secretagogues in the regulation of the hypothalamic-pituitary-adrenal axis.

Differential regulation of corticotropin-releasing hormone and vasopressin gene transcription in the hypothalamus by norepinephrine.

All stress-related inputs are conveyed to the hypothalamus via several brain areas and integrated in the parvocellular division of the paraventricular nucleus (PVN) where corticotropin-releasing hormone (CRH) is synthesized. Arginine vasopressin (AVP) is present in both magnocellular and parvocellular divisions of the PVN, and the latter population of AVP is colocalized with CRH. CRH and AVP are co-secreted in the face of certain stressful stimuli, and synthesis of both peptides is suppressed by glucocorticoid. CRH and AVP stimulate corticotropin (ACTH) secretion synergistically, but the physiological relevance of the dual corticotroph regulation is not understood. Norepinephrine (NE) is a well known neurotransmitter that regulates CRH neurons in the PVN. We explored the mode of action of NE on CRH and AVP gene transcription in the PVN to examine the effect of the neurotransmitter on multiple genes that are responsible for a common physiological function. After NE injection into the PVN of conscious rats, CRH heteronuclear (hn) RNA increased rapidly and markedly in the parvocellular division of the PVN. AVP hnRNA did not change significantly in either the parvocellular or magnocellular division of the PVN after NE injection. The present results show that the transcription of CRH and AVP genes is differentially regulated by NE, indicating the complexity of neurotransmitter regulation of multiple releasing hormone genes in a discrete hypothalamic neuronal population.

Regulation of nitric oxide synthase messenger RNA expression in the rat hippocampus by glucocorticoids.

Nitric oxide and glucocorticoids have been implicated in learning and memory, as well as in regulation of the stress response. By use of the in situ hybridization technique, we examined the role of glucocorticoids in the regulation of nitric oxide synthase messenger RNA in the hippocampus. In control animals, nitric oxide synthase subtype I (neuronal) messenger RNA was expressed in the CA1, CA3 and dentate gyrus of the hippocampus. Nitric oxide synthase subtype I expression was almost absent in CA2 pyramidal neurons. Neither subtype II (immunological) nor subtype III (endothelial) nitric oxide synthase messenger RNAs were observed in neurons of the hippocampal subfields. Bilateral removal of the adrenal glands resulted in a significant increase in nitric oxide synthase subtype I messenger RNA expression in the CA1 and CA3 pyramidal neurons and in granular cells of the dentate gyrus. To a lesser degree, the nitric oxide synthase subtype I messenger RNA signal was increased in CA2 pyramidal neurons. Daily administration of glucocorticoids for one week attenuated the adrenalectomy-induced increased level of expression of the messenger RNA encoding nitric oxide synthase subtype I in all areas studied. Because adrenalectomy, which suppresses the production of glucocorticoids, increases nitric oxide synthase expression, and replacement of adrenalectomized animals with glucocorticoids restores the basal levels of nitric oxide synthase subtype I expression, our results demonstrate an up-regulation of nitric oxide synthase subtype I messenger RNA in the absence of glucocorticoids in the hippocampus. The present findings suggest an involvement of the stress axis in the regulation of the synaptic plasticity process mediated by nitric oxide in the hippocampus.

Intraoral minor salivary gland tumors: a retrospective study of 129 cases.

From 1970 to 1996, 129 cases of intraoral minor salivary gland tumors were diagnosed at the Department of Pathology, Nihon University School of Dentistry. The diagnosis of each case was based on the 1991 WHO classification. Eighty benign and 49 malignant minor salivary gland tumors were found in the approximately 9,300 oral biopsies submitted during the 27-year period. Pleomorphic adenomas were the most commonly histologic type of the benign tumors identified and 51% of the malignant tumors were diagnosed as mucoepidermoid carcinoma. The most common primary location of the tumors was the palate. Sixty percent of all tumors occurred in females and the peak age for incidences of all tumors was found in the third, fourth, sixth and seventh decades. These results were compared with those of the studies in different world population groups.

Major role of 3',5'-cyclic adenosine monophosphate-dependent protein kinase A pathway in corticotropin-releasing factor gene expression in the rat hypothalamus in vivo.

To assess whether the cAMP-dependent protein kinase-A and/or the diacylglycerol-dependent protein kinase C (PKC) pathways play important roles in the activation of CRF neurons in vivo under physiological conditions, we tested the effect of microinjection of 8-bromo-cAMP (8-Br-cAMP) or 12-O-tetradecanoyl phorbol 13-acetate (TPA) into both paraventricular nuclei (PVN) of the hypothalamus in conscious rats. Both 8-Br-cAMP and TPA increased plasma ACTH concentrations and the POMC messenger RNA (mRNA) concentrations in the anterior pituitary. While injection of 8-Br-cAMP also increased CRF mRNA concentrations in hypothalamic tissue containing the PVN, TPA injection had no effect on CRF mRNA concentrations there. During insulin-induced hypoglycemia, which stimulates CRF gene expression and release, c-fos and c-jun mRNA increases in the hypothalamic tissue preceded the increase in the CRF mRNA level after insulin-induced hypoglycemia. Antisense oligodeoxyribonucleotides (oligos) directed against c-fos, c-jun, or the cAMP response element binding protein (CREB) mRNA were injected into both PVN before insulin-induced hypoglycemia to assess whether activator protein-1 or CREB mediates transcriptional activation of CRF during hypoglycemia. Only antisense oligo against CREB mRNA reduced the CRF mRNA level after insulin-induced hypoglycemia. These results suggest that protein kinase A may transduce intracellular signals in CRF neurons under physiological conditions and raises the possibility that CREB may be involved in stress-induced CRF gene expression.

Analysis of circadian variation of blood pressure and heart rate in dexamethasone-induced hypertensive rats.

We studied the effect of the chronic oral administration of dexamethasone (dexa) on arterial blood pressure (BP) in conscious rats. Special attention was paid to the effects of dexa on circadian rhythm of BP. As determined by the tail cuff-method, BP in the dexa-treated group was significantly higher than in the control group 24 h after treatment, then increased gradually, reaching a plateau on the 7th day of treatment. At that time, the difference in BP between the two groups was approximately 30 mmHg. When monitored directly and continuously on day 10, mean arterial pressure (MAP) in the dexa-treated group exceeded that of the control group by approximately 15 mmHg throughout the monitoring period. Thus, the circadian rhythm of MAP was sustained in the dexa-treated group, which was in contrast to the previously reported elimination of circadian rhythm in humans. In addition, the increase in BP may have been overestimated by tail-cuff plethysmography, possibly owing to a hightended cardiovascular reactivity to environmental stimuli in dexa-treated animals.

Effect of acetylcholine on corticotropin-releasing factor gene expression in the hypothalamic paraventricular nucleus of conscious rats.

To examine the physiological role of cholinergic input in the regulation of CRF neurons in the paraventricular nucleus (PVN) of the hypothalamus, acetylcholine (ACh) was microinjected bilaterally into the dorsolateral border of the PVN of conscious rats. Changes in the levels of POMC messenger RNA (mRNA) in the anterior pituitary, CRF mRNA in hypothalamic tissue containing the PVN, and plasma ACTH were assessed. Plasma ACTH concentrations increased in a dose-dependent manner after ACh injection (1-100 pmol/side), reaching a peak 30 min after ACh injection and returning to baseline within 120 min. The POMC mRNA level in the anterior pituitary and the hypothalamic CRF mRNA level increased in a dose-dependent manner 120 min after ACh (0.1-10 pmol/side) injection. Intracerebroventricular pretreatment with atropine completely abolished the ACh-induced increase in plasma ACTH concentrations, whereas pretreatment with hexamethonium was without significant effect. The intracerebroventricular injection of ACh also increased plasma ACTH concentrations in a dose-dependent manner in conscious rats, but not in pentobarbital-anesthetized animals. Thus, cholinergic hypothalamic input stimulates CRF gene expression in the PVN and CRF secretion into the portal circulation under physiological conditions. The use of conscious animals is essential in elucidating the physiological roles of neurotransmitters and other modulators regulating CRF neurons.

[Recurrent bronchogenic cyst--a case report].

Mediastinal bronchogenic cyst is a benign tumor and occupied about 5% of mediastinal tumor in Japan. As a benign tumor, recurrence of bronchogenic cyst is very rare, and we found only 2 cases were reported. We experienced a recurrent bronchogenic cyst found 14 years after first operation. The patient was 56-year-old male, and admitted to our hospital for further evaluation of his abnormal shadow on chest roentogenogram. He had no symptoms. He was operated an bronchogenic cyst for 14 years ago. Chest X-ray, CT, and MRI demonstrated a paratracheal cystic mass which was suspected of a recurrent bronchogenic cyst. An operation was done, and the tumor was resected. A histopathological study showed that the tumor had thin wall and had a ciliated epithelium, then it was diagnosed bronchogenic cyst. The most likely explanation for the recurrence in our patient is an incomplete resection during the initial operation. It is though that only a very small amount of epithelial tissue need remain for recurrence. For prevention of recurrence, complete resection of cyst is necessary, and long-term follow-up is indicated to detect recurrence.