The role of tyrosine metabolism in the pathogenesis of chronic migraine.

OBJECTIVE: The pathogenesis of chronic migraine (CM) remains largely unknown. We hypothesized that anomalies of tyrosine metabolism, found in migraine without aura (MwwA) patients, play an important role in the transformation of MwwA into CM, since the increase in the number of MwwA attacks is the most predisposing factor for the occurrence of CM. METHODS: To test our hypothesis we measured the plasma levels of dopamine (DA), noradrenaline (NE) and trace amines, including tyramine (TYR) and octopamine (OCT), in a group of 73 patients with CM, 13 patients with chronic tension-type headache (CTTH) and 37 controls followed in the Headache Centers of the Neurology Departments of Asti, Milan and Vicenza hospitals in Italy. RESULTS: The plasma levels of DA and NE were several-fold higher in CM patients compared with control subjects ( P > 0.001). The plasma levels of TYR were also extremely elevated ( P > 0.001); furthermore, these levels progressively increased with the duration of the CM. CONCLUSIONS: Our data support the hypothesis that altered tyrosine metabolism plays an important role in the pathogenesis of CM. The high plasma levels of TYR, a potent agonist of the trace amine associated receptors type 1 (TAAR1), may ultimately down-regulate this receptor because of loss of inhibitory presynaptic regulation, therein resulting in uncontrolled neurotransmitter release. This may produce functional metabolic consequences in the synaptic clefts of the pain matrix implicated in CM.

Is migraine a risk factor for the occurrence of eating disorders? Prevalence and biochemical evidences.

The eating disorders (ED), anorexia nervosa (AN) and bulimia nervosa (BN), are severe psychiatric and somatic conditions occurring mainly in young woman. Although the aetiology is largely unknown, same evidences suggest that biological and psychological factors play a relevant role in the pathogenesis, along with monoamine, indole and same hypothalamic hormonal dysfunctions. Migraine is characterized by similar metabolic and psychological anomalies suggesting that a possible relationship exists between the two pathological conditions. To understand the possible relationship between migraine and ED, we have investigated the prevalence of migraine and the other primary headaches in a large group of AN and BN patients. In addition, we have studied the role of tyrosine metabolism in the same group of AN and BN young woman sufferers. In particular, we measured plasma levels of elusive amines: tyramine (Tyr) and octopamine (Oct) and catecholamines: noradrenalin (NE), dopamine (DA). The results of this study show that the prevalence of migraine in the woman affected by ED is very high (<75 %). The levels of Tyr and DA were higher and levels of NE were lower in the ED patients in respect to the control subjects. These biochemical findings suggest that abnormalities of limbic and hypothalamic circuitries play a role in the pathogenesis of ED. The very high prevalence of migraine in our group of ED sufferers and the biochemical profile of migraine, similar to that of ED patients shown in this study, suggest that migraine may constitute a risk factor for the occurrence of ED in young females. This hypothesis is supported by the onset of migraine attacks that initiated, in the majority of the patients, before the occurrence of ED symptoms.

Conserved features of chronic stress across phyla: the effects of long-term stress on behavior and the concentration of the neurohormone octopamine in the cricket, Gryllus texensis.

Many of the deleterious effects of chronic stress in vertebrates are caused by the long-term elevation of stress hormones. These negative effects are thought to be unavoidable by-products of sustained activation of the stress response, but the details remain unclear. A comparative perspective may help in understanding chronic stress. We exposed crickets (Gryllus texensis) to a mock predator. A single exposure to a mock predator induced a transient increase in the hemolymph (blood) concentration of the insect stress neurohormone, octopamine. Repeated exposure to the mock predator increased basal levels of octopamine, similar to the effects of chronic stress on the basal levels of vertebrate stress hormones. This study is the first to report an increase in the basal levels of an invertebrate stress hormone in response to repeated flight-or-fight stress. Chronic stress reduced weight gain, and decreased feeding and enhanced weight loss after food deprivation in adult female crickets. However, chronic stress also increased the tendency of crickets to produce sustained flight. Therefore, this study supports the hypothesis that increasing basal levels of stress hormones may be a phylogenetically common response to chronically stressful conditions. It also demonstrates that chronic stress has both positive and negative effects in insects.

Migraine prevalence in eating disorders and pathophysiological correlations.

The eating disorders (ED): anorexia nervosa (AN) and Bulimia nervosa (BN) are severe psychiatric and somatic conditions occurring mainly in young woman. Although the etiology is largely unknown, same evidences suggest that biological and psychological factors play a relevant role in the pathogenesis, along with monoamine, indole and same hypothalamic hormonal dysfunctions. Migraine is characterized by similar metabolic and psychological anomalies suggesting that a possible relationship exists between the two pathological conditions. In order to understand the possible relationship between migraine and ED, we have investigated the prevalence of migraine and the other primary headaches in a large group of AN and BN patients. In addition, we have studied the role of tyrosine metabolism in the same group of AN and BN young woman sufferers. In particular, we measured plasma levels of elusive amines: tyramine (Tyr) and octopamine (Oct) and catecholamines: noradrenalin (NE), dopamine (DA). The results of this study show that the prevalence of migraine in the woman affected be EA is very high (>75%). The levels of Tyr and DA were higher and levels of NE were lower in the ED patients with respect to the control subject. These biochemical findings suggest that abnormalities of limbic and hypothalamic circuitries play a role in the pathogenesis of ED. The very high prevalence of migraine in our group of ED sufferers and the biochemical profile of migraine, similar to that ED patients have shown in this study, suggest that migraine may constitute a risk factor for the occurrence of ED in the young females. This hypothesis is supported by the onset of migraine attacks that initiated, in the majority of the patients, before the occurrence of ED symptoms.

Supplementation with a low-dose of octopamine does not influence endurance cycling performance in recreationally active men.

OBJECTIVES: The aim of this study was to examine the influence of octopamine supplementation on endurance performance and exercise metabolism. DESIGN: Double-blind cross-over study. METHODS: Ten healthy, recreationally active men (Mean±SD; age: 24±2 years; body mass: 78.4±8.7kg; VO2peak: 50.5±6.8 mLkg-1min-1) completed one VO2peak test, one familiarisation trial and two experimental trials. After an overnight fast, participants ingested either a placebo or 150mg of octopamine 60min prior to exercise. Trials consisted of 30min of cycle exercise at 55% peak power output, followed by a 30min performance task whereby participants completed as much work (kJ) as possible. RESULTS: Performance was similar between the experimental trials (placebo: 352.8±39kJ; octopamine: 350.9±38.3kJ; Cohen's d effect size=0.05; p=0.380). Substrate oxidation and circulating concentrations of free fatty acids, prolactin and cortisol were similar between trial conditions (all p>0.05). There were also no differences across trials for heart rate or perceived exertion during exercise (both p>0.05). CONCLUSIONS: Acute supplementation with a low dose of octopamine did not influence endurance cycle performance, substrate oxidation or circulating hormonal concentrations, which could be due to the low serum octopamine concentrations observed. Future studies should investigate the influence of larger doses of octopamine in recreationally active and well-trained individuals during prolonged exercise in temperate and high ambient conditions.

Occurrence, transport, and storage of octopamine in human thrombocytes.

3H-octopamine was found to be accumulated in human platelets, achieving a maximum concentration gradient of 30:1. Its accumulation was partially inhibited by reserpine, imipramine, serotonin, ouabain, dinitrophenol, and iodoacetate. When octopamine was added to platelet preparations, it led to a decrease of both endogenous and 14C-serotonin. To determine whether octopamine accumulates in human platelets in vivo, preparations from 6 patients receiving monoamine oxidase inhibitors and 17 control subjects were assayed enzymatically for octopamine. Octopamine was detectable in all of the drug-treated patients, averaging 0.45 +/- 0.06 ng/mg protein, while only 4 of the 17 control subjects had detectable (greater than 0.05 ng/mg protein) platelet octopamine. Although much lower than platelet serotonin levels, these octopamine levels are in the range of those reported for platelet norepinephrine and epinephrine.

Hepatic encephalopathy EEG and octopamine.

In a group of 30 patients with and without hepatic encephalopathy octopamine values were determined and EEG recorded. The data reported show no relationship between octopamine values and presence or seriousness of hepatic encephalopathy but showed a clear correlation between hepatic encophalopathy and electroencephologram disturbance.

The effect of normalization of plasma amino acids on hepatic encephalopathy in man.

Previous work from this laboratory has suggested that the plasma amino acid pattern, known to be deranged in hepatic encephalopathy, may be related causally. In order to test this hypothesis, 23% dextrose and a special amino acid solution whose components were calculated to normalize the plasma amino acid pattern were infused in 11 patients, eight with chronic cirrhosis and acute exacerbation (Group 1) and three patients with fulminant hepatitis (Group 2), in amounts of up to 120 Gm. of protein equivalent per 24 hours. Plasma amino acids were abnormal but different in both groups. In Group 1 (cirrhosis) changes in plasma amino acid pattern including elevated phenylalanine, tyrosine, glutamate, aspartate, and methionine and decreased valine, leucine, and isoleucine. In Group 2 all amino acids were elevated, with the exception of the branched chains which were normal. Hepatic encephalopathy improved in all patients in Group 1 and in one of three patients in Group 2 following the infusion. The ratio (see article) showed an excellent correlation with a grade of encephalopathy. When this ratio, previously 1.0 in the presence of encephalopathy, returned to the normal value near 3.0 to 3.5, encephalopathy improved. An excellent correlation was obtained between the ratio and the grade of encephalopathy and was dose related as well. The results suggest that different amino acid patterns in hepatic encephalopathy of differing etiologies require treatment modalities which may differ for the two types of encephalopathy. Whereas amino acid infusion appears to be a valuable, efficacious way of providing nutrition in treating hepatic encephalopathy in patients with cirrhosis and acute deterioration and coma, other means of therapy such as plasms "laundering" appear to be necessary in patients with fulminant hepatitis.

Pathogenesis of hepatic encephalopathy and hyperdynamic syndrome in cirrhosis. Role of false neurotransmitters.

We sought to determine whether false neurotransmitters (FNTs) play an important role as determinants not only of hepatic encephalopathy but also of hyperdynamic syndrome in cirrhosis. A combined biochemical and hemodynamics study of 55 bleeding cirrhotic patients was made. We evaluated the aromatic and aliphatic branched-chain amino acids and octopamine serum levels as well as the hemodynamic measurements. The results show that there is a correlation between levels of serum octopamine and aromatic amino acids and hepatic coma: the higher the octopamine level, the deeper the hepatic coma. There is also a correlation between aromatic amino acids and cardiac index and total peripheral resistance. Furthermore, when a narrowing of arteriovenous difference in oxygen occurs and oxygen consumption decreases, there is an increase not only in the level of aromatic amino acids, but also in octopamine level, suggesting an important linkage between hemodynamic and metabolic impairment.

Simultaneous radioenzymatic determination of phenylethylamine, phenylethanolamine, tyramine and octopamine in plasma of patients with hepatic encephalopathy.

A sensitive radioenzymatic assay for the simultaneous determination of phenylethylamine, phenylethanolamine, tyramine and octopamine in plasma samples is reported. After extraction with ethanol, the amines are subjected to enzymatic N-methylation with labelled S-adenosylmethionine, preceded in the case of phenylethylamine and of tyramine, by an enzyme-catalyzed beta-hydroxylation step. The procedure is completed by extraction with toluene containing different amounts of isoamylalcohol, followed by controlled evaporation of the solvent. A generalized and highly significant increase in the concentration of all the four amines was found in plasma samples from patients suffering from hepatic encephalopathy.

Determination of plasma octopamine and its level in renal disease.

A radioenzymatic assay method for the estimation of octopamine levels in plasma was developed. Preparation of the enzyme, phenylethanolamine-N-methyl transferase, dilution of the plasma sample, preparation of a suitable blank, and the assay conditions were found to have a significant effect on the sensitivity of the assay. Plasma octopamine levels were measured in a population of 33 normal individuals ranging in age from 19 to 94 years. Significantly higher plasma octopamine levels were found in the age group 70-90 years. Excluding those individuals over the age of 70 years, no significant differences in plasma octopamine levels were found for males or females, the range of values was 0 to 0.68 ng per ml, with a mean value of 0.23 ng per ml (n = 25). Examination of plasma octopamine levels in patients with severe renal disease requiring hemoperfusion dialysis, revealed a significantly higher level of plasma octopamine in renal disease (1.9 ng per ml), and an increase in plasma octopamine during dialysis; the mean level post dialysis being 2.7 ng per ml.

Octopamine and ammonia plasma levels in hepatic encephalopathy.

It has been recently proposed that hepatic encephalopathy could be due to the accumulation of octopamine acting as a false neurotransmitter, and the increase of ammonia might reflect this accumulation. The simultaneous determination of octopamine and ammonia was performed in 88 cases with or without encephalopathy. The correlation between the two substances appeared to be good (P less than 0.01; r = 0.5), except in shunted patients. All the cases with low octopamine and high ammonia were patients who had been submitted to surgical portal-systemic anastomosis. This finding does not seem to be coincidental; in this type of patients, the mechanism of hepatic encephalopathy could involve other beta-hydroxyphenylethanolamines in addition to octopamine. The presence of the inhibition of the reaction of transmethylation constantly observed during octopamine plasma assay is in favour of this hypothesis.

Octopamine plasma levels and hepatic encephalopathy: a re-appraisal of the problem.

An investigation on the blood levels of octopamine was carried out on 70 adult individuals. There was a statistically significant correlation between the levels of octopamine and hepatic encephalopathy. Normal subjects had values below 1 ng/ml, while patients with grade 3 or grade 4 encephalopathy constantly showed values above 3.2 ng/ml. In these two groups the distribution was fairly homogeneous. Through the differences between cirrhotics without neurologic involvement and those with grade 1 or 2 hepatic encephalopathy displayed statistical significance, distribution of values in these groups was rather non-homogeneous. Octopamine levels paralleled variations in mental state in 3 out 4 cases. No difference was found between venous and arterial values. The reaction of transmethylation used in the assay of octopamine was constantly found to be inhibited by the presence of plasma. This inhibition is probably due to the presence of one or more beta-hydroxyphenylethanolamines other than octopamine.

Influence of phenylethanolamine on octopamine plasma determination in hepatic encephalopathy.

Octopamine and phenylethanolamine levels were measured by a radioenzymatic procedure in 30 cirrhotic patients with and without hepatic coma and in 15 normal controls. Octopamine data were obtained either by direct extraction with 40% isoamyl alcohol in toluene according to Molinoff et al. (Molinoff, P.B., Landsberg, L. and Axelrod, J. (1969) J. Pharm. Exp. Ther. 170, 253), or after pre-extraction of phenylethanolamine with 3% isoamyl alcohol in toluene. Phenylethanolamine was statistically correlated with the grade of hepatic encephalopathy. Octopamine levels also appeared to parallel the grade of coma, although the values obtained after pre-extraction were lower and less significant than those obtained with 40% isoamyl alcohol in toluene extraction. The higher values of directly extracted octopamine are due to contamination of other beta-hydroxylated phenylethylamines, among which is phenylethanolamine.

Encephalopathy, oxygen consumption, visceral amino acid clearance, and mortality in cirrhotic surgical patients.

To assess the relationship of the high mortality of coma in cirrhotic surgical patients to defects in energy metabolism, reduced utilization of amino acids by the liver and other visceral tissues, oxygen consumption, central plasma clearance rate of amino acids (CPCR of amino acids), and the plasma concentrations of plasma inducing factors were measured in a series of 59 cirrhotic patients. They were classed as alert, encephalopathic, and comatose (Groups A, E, and C, respectively). The comatose group was set apart from the other two by a significantly higher mortality of 83 percent (p less than 0.005) combined with a lower whole body oxygen consumption of 103 +/- 6.8 ml/min per m2 compared with 135 +/- 10 ml/min per m2 in alert patients and 159 +/- 12 ml/min per m2 in the encephalopathic patients (p less than 0.01) and CPCR of amino acids of only 120 +/- 20 ml of plasma/min per m2 compared with 240 +/- 30 ml of plasma/min per m2 in the alert patients and 300 +/- 50 in the encephalopathic patients (p less than 0.01). An inverse correlation of tyrosine and phenylalanine concentrations existed with both whole body oxygen consumption (r = -0.56, p less than 0.01) and also with total amino acid clearance (r = -0.61, p less than 0.01). Tyrosine and phenylalanine concentrations also correlated directly with the octopamine concentration (r = 0.64, p less than 0.01). Thus, we conclude that coma is a symptom of hyperaminoacidemia, but that death is the result of impaired oxidative energy production and a deficiency of amino acid clearance for synthesis of proteins required for survival.

Serum polyamine and octopamine changes following partial hepatectomy and portacaval shunt.

Factors influencing hepatic regeneration following major hepatic resection are poorly understood and often may be modified by associated surgical procedures. Experimental and clinical evidence would suggest that hepatic regeneration may be impaired following hepatectomy performed in conjunction with portacaval shunting. A patient is described who offered a clinical situation in which it was possible to evaluate the effects of complete portal-venous diversion on hepatic regeneration following massive hepatic resection. The usefulness of biogenic amines as a monitor of the course of hepatic regeneration is demonstrated. The potential development of hepatic encephalopathy was evaluated by serial determinations of serum ammonia and the biogenic amine, octopamine, which correlated well with the patient's clinical state.

Visual evoked potential recordings in hepatic encephalopathy and their variations during branched chain amino-acid treatment.

In fourteen subjects with various stages of hepatic encephalopathy (HE), Visual Evoked Potential (VEP) recording and blood ammonia (NH3), octopamine (OCT) and phenylethanolamine (PEA) determinations were performed before and during a four-day treatment with branched chain amino acid (BCAA) i.v. infusion. All the subjects with HE showed significant basal VEP alterations, namely an increased latency and a lowered amplitude of the P100 wave, in comparison with a control group of 26 normal subjects. A significant improvement in P100 wave amplitude occurred just about 60' after the beginning of BCAA infusion, while P100 latency was still unaffected, as were OCT, PEA and NH3 levels. After the fourth day of BCAA treatment, both P100 wave amplitudes and latencies were strongly improved, together with OCT, PEA and NH3 levels. VEP improvements seemed to be well correlated with HE clinical evolution, and were able to detect modifications of central nervous system reactivity earlier than serum parameters.

A selective radioenzymatic assay for the determination of octopamine and phenylethanolamine in plasma and cerebrospinal fluid. Preliminary results in human and experimental hepatic encephalopathy.

A sensitive radioenzymatic assay for the simultaneous determination of phenylethanolamine and octopamine in biological fluids is described. It is derived from the radioenzymatic assay originally described by Molinoff et al. (1969) and subsequently modified by Saavedra (1974). The enzymatic reaction is based upon the methylation of phenylethanolamine and octopamine by phenylethanolamine-N-methyl transferase using 14C-S-adenosylmethionine as the methyl donor. The N-methyl derivatives of the two amines are separately extracted and estimated. Selectivity is increased by optimization of extraction and evaporation and by subsequent extraction of the two compounds. Phenylethanolamine and octopamine levels were determined in plasma of human subjects and in plasma and CSF of dogs. The levels were found significantly elevated both in human and experimental hepatic encephalopathy.

In vitro adsorption of possible aetiological factors of hepatic encephalopathy.

Four different adsorbents (activated charcoal, XAD-4, a strong base anion and a strong acid cation-exchange resin) were tested in vitro for their capacity to remove substances that may be important in the development of hepatic encephalopathy. Separate columns packed with one of these adsorbents were perfused for three hours with a reconstituted plasma solution containing simultaneously high concentrations of amino-acids, ammoniumchloride, short-chain fatty acids, octopamine and bile salts. Effective removal of all these substances was only obtained when either activated charcoal, or XAD-4, were combined with the cation-exchange resin. Possible implications for the treatment of hepatic coma are discussed.

Biogenic amines in the nervous system of the cockroach, Periplaneta americana following envenomation by the jewel wasp, Ampulex compressa.

The emerald jewel wasp, Ampulex compressa, exploits the American cockroach, Periplaneta americana, as a host for its progeny. The wasp subdues the host by stinging directly into the brain and subesophageal ganglion, inducing long-term hypokinesia. The hypokinesic host lacks normal escape behavior and motivation to walk, making it easy for subjugation by the wasp. The mechanism underlying hypokinesia induction is not known, but depletion of monoamines induces behavior resembling venom-induced hypokinesia. To test whether amine depletion occurs in stung animals, we used high-performance liquid chromatography with electrochemical detection (HPLC-ED) to measure quantitatively amine levels in the central nervous system. Our data show clearly that levels of dopamine, serotonin, octopamine and tyramine remain unchanged in stung animals, whereas animals treated with reserpine exhibited marked depletion of all amines sampled. Furthermore, stung animals treated with reserpine show depletion of amines, demonstrating that envenomation also does not interfere with amine release. These results show that hypokinesia induced by Ampulex venom does not result from amine depletion or inability to release monoamines in the central nervous system.