A feedback-controlled ensemble model of the stress-responsive hypothalamo-pituitary-adrenal axis

The present work develops and implements a biomathematical statement of how reciprocal connectivity drives stress-adaptive homeostasis in the corticotropic (hypothalamo-pituitary-adrenal) axis. In initial analyses with this interactive construct, we test six specific a priori hypotheses of mechanisms linking circadian (24-h) rhythmicity to pulsatile secretory output. This formulation offers a dynamic framework for later statistical estimation of unobserved in vivo neurohormone secretion and within-axis, dose-responsive interfaces in health and disease. Explication of the core dynamics of the stress-responsive corticotropic axis based on secure physiological precepts should help to unveil new biomedical hypotheses of stressor-specific system failure.

Quantal release at a neuronal nicotinic synapse from rat adrenal gland.

The neuronal nicotinic synapse in tissue slices of the adrenal medulla was studied with whole-cell patch-clamp. Excitatory postsynaptic currents (EPSCs) were evoked by local field stimulation or occurred spontaneously especially when external [K+] was increased. EPSCs were carried by channels sharing biophysical and pharmacological properties of neuronal-type nicotinic receptors (nAChRs). A single-channel conductance (gamma) of 43-45 pS was found from nonstationary variance analysis of EPSCs. Spontaneous EPSCs were tetrodotoxin-insensitive and Ca(2+)-dependent and occurred in burst-like clusters. Quantal analysis of spontaneous EPSCs gave a quantal size of 20 pA and amplitude histograms were well described by binomial models with low values of quantal content, consistent with a small number of spontaneously active release sites. However, rare large amplitude EPSCs suggest that the total number of sites is higher and that extrajunctional receptors are involved. Our estimates of quantal content and size at the chromaffin cell neuronal nicotinic synapse may be useful in characterizing central neuronal-type nicotinic receptor-mediated cholinergic synaptic transmission.

Mice deficient in the orphan receptor steroidogenic factor 1 lack adrenal glands and gonads but express P450 side-chain-cleavage enzyme in the placenta and have normal embryonic serum levels of corticosteroids.

The orphan nuclear receptor steroidogenic factor 1 (SF-1) is expressed in the adrenal cortex and gonads and regulates the expression of several P450 steroid hydroxylases in vitro. We examined the role of SF-1 in the adrenal glands and gonads in vivo by a targeted disruption of the mouse SF-1 gene. All SF-1-deficient mice died shortly after delivery. Their adrenal glands and gonads were absent, and persistent Mullerian structures were found in all genotypic males. While serum levels of corticosterone in SF-1-deficient mice were diminished, levels of adrenocorticotropic hormone (ACTH) were elevated, consistent with intact pituitary corticotrophs. Intrauterine survival of SF-1-deficient mice appeared normal, and they had normal serum level of corticosterone and ACTH, probably reflecting transplacental passage of maternal steroids. We tested whether SF-1 is required for P450 side-chain-cleavage enzyme (P450scc) expression in the placenta, which expresses both SF-1 and P450scc, and found that in contrast to its strong activation of the P450scc gene promoter in vitro, the absence of SF-1 had no effect on P450scc mRNA levels in vivo. Although the region targeted by our disruption is shared by SF-1 and by embryonal long terminal repeat-binding protein (ELP), a hypothesized alternatively spliced product, we believe that the observed phenotype reflects absent SF-1 alone, as PCR analysis failed to detect ELP transcripts in any mouse tissue, and sequences corresponding to ELP are not conserved across species. These results confirm that SF-1 is an important regulator of adrenal and gonadal development, but its regulation of steroid hydroxylase expression in vivo remains to be established.

Rapid endocytosis coupled to exocytosis in adrenal chromaffin cells involves Ca2+, GTP, and dynamin but not clathrin.

Rapid endocytosis (RE) occurs immediately after an exocytotic burst in adrenal chromaffin cells. Capacitance measurements of endoocytosis reveal that recovery of membrane is a biphasic process that is complete within 20 sec. The ultimate extent of membrane retrieval is precisely controlled and capacitance invariably returns to its prestimulation value. The mechanism of RE specifically requires intracellular Ca2+; Sr2+ and Ba2+ do not substitute, although all three cations support secretion. Thus the divalent cation receptors for RE and exocytosis must be distinct molecules. RE is dependent on GTP hydrolysis; it is blocked by GTP removal or replacement with guanosine 5'-[gamma-thio]triphosphate. In the presence of GTP, multiple rounds of secretion followed by RE could be elicited from the same cell. RE requires participation of dynamin, a guanine nucleotide binding protein, as revealed by intracellular immunological antagonism of this protein. Intact microtubules may be essential, as nocodazole also blocked RE. Whereas anti-dynamin antibodies blocked RE, anti-clathrin antibodies did not, suggesting that clathrin-coated vesicles are not involved in this form of endocytosis. RE may represent the initial step in the rapid recycling of secretory granules in the chromaffin cell.

Colocalization of calcium entry and exocytotic release sites in adrenal chromaffin cells.

"Snapshot" images of localized Ca2+ influx into patch-clamped chromaffin cells were captured by using a recently developed pulsed-laser imaging system. Transient opening of voltage-sensitive Ca2+ channels gave rise to localized elevations of Ca2+ that had the appearance of either "hotspots" or partial rings found immediately beneath the plasma membrane. When the Ca2+ imaging technique was employed in conjunction with flame-etched carbon-fiber electrodes to spatially map the release sites of catecholamines, it was observed that the sites of Ca2+ entry and catecholamine release were colocalized. These results provide functional support for the idea that secretion occurs from "active zone"-like structures in neuroendocrine cells.

Linfoma renale del gatto:rilievi anatomopatologici, immunofenotipizzazione delle popolazioni linfocitarie ed espressione tissutale dell'antigene virale FeLV gp70.

Riassunto Il linfoma è una delle neoplasie più diffuse nel gatto. Questa neoplasia è stata classificata in base alla localizzazione anatomica nella forma Mediastinica (che interessa il timo e/o i linfonodi mediastinici), Alimentare, Multicentrica (che interessa diversi linfonodi e/o la milza e/o il fegato, Extranodale (che coinvolge i reni, SNC o la cute). Le cellule neoplastiche sono caratterizzate da diverse sottopopolazioni, che sono definite tramite immunofenotipizzazione ottenuta mediante tecniche immunoistochimiche (IHC), così che possano essere classificate come cellule B o T o non B/non T. I gatti infetti dal virus della leucemia felina (FeLV, Gammaretrovirus) presentano elevata incidenza di linfomi rispetto ai gatti non infetti. I meccanismi proposti di sviluppo neoplastico sono mutagenesi inserzionali o stimolazione persistente delle cellule immunitarie dell’ospite da parte di antigeni virali, i quali possono promuovere la trasformazione in senso maligno dei linfociti. Lo scopo di questo lavoro è stato esaminare i rilievi patologici, l’espressione di FeLV e l’immonofenotipo (B, T, nonB/nonT) nei reni felini affetti da linfoma. Abbiamo effettuato colorazione Ematossilina- Eosina ed Immunoistochimica per FeLV gp70, CD3 e CD79. Nello studio sono stati inclusi i tessuti di 49 gatti presentati all’Unità Operativa di Anatomia Patologica e Patologia Generale del Dipartimento di Scienze Medico Veterinarie dell’Università degli studi di Parma. Il 39% dei casi (19/49) sono caratterizzati dalla presenza di lesioni linfomatose a livello renale. Questa popolazione è costituita dal 52,6% 3 (10/19) maschi e dal 47,4% (9/19) femmine. L’età è compresa tra 8 mesi e 17 anni ed in particolare 26,6% (5/19) sono giovani (0-2 anni), 47,4% (9/19) sono adulti (2-10 anni) e 26,3% (5/19) sono anziani (>10 anni). Per quanto riguarda la classificazione anatomica la forma renale appare primitiva in 5 casi (25%), in 8 casi (42%) appare secondaria a linfomi multicentrici, in 3 casi (15,7%) a linfomi mediastinici e in altri 3 casi (15,7%) a linfomi gastrici e intestinali. Per quanto riguarda l’immunofenotipizzazione sono risultati CD3 positivi il 73,7% (14/19) e CD3 negativi il 27,3% (5/19); CD79 alpha positivi il 26,3% (5/19) e CD79 alpha negativi il 73,7% (14/19); l’espressione della proteina gp70 è stata individuata nel 78,9% (15/19) delle neoplasie renali, mentre il 21,1% (4/19) non presentava espressione della proteina. Nei 4 anni presi in considerazione nello studio si evince un’elevata incidenza della localizzazione anatomica renale sul totale di linfomi osservati. Non si è notata correlazione statistica tra linfomi renali, età e sesso dei soggetti presi in esame ma vi è un’elevata percentuale di animali adulti ed anziani affetti dalla patologia. Nella valutazione fenotipica dell’infiltrato neoplastico si è osservata l’elevata espressione di CD3, caratterizzando i linfociti come appartenenti alla sottopopolazione T. Inoltre si è evidenziato come un elevato numero di cellule neoplastiche esprimano gp70; ciò permette di affermare che i linfociti neoplastici sono infettati dal virus FeLV, il quale inoltre è in attiva replicazione. I marker CD3 e gp70 sono risultati fortemente correlati statisticamente; si può affermare perciò che l’espansione clonale dei linfociti T è correlata alla presenza e replicazione del virus.

Alterações em adrenais de cães relacionadas à morte súbita ou agônica: análise morfométrica, histopatológica, imunoistoquímica e correlação com os níveis de adrenalina e noradrenalina na medula adrenal

A necropsia é essencial para a identificação da causa de morte e dos processos que culminaram no óbito do animal. O presente estudo visou à pesquisa da real ocorrência de morte súbita e inesperada em cães submetidos à necropsia, e à determinação da discrepância entre as suspeitas dos proprietários em relação ao estado de saúde prévio e à causa de morte de seus cães, quando comparadas às conclusões necroscópicas. Este trabalho também focou nas alterações morfológicas e funcionais nas glândulas adrenais de cães necropsiados, a fim de se estudar a aplicação de possíveis marcadores da resposta adrenal ao estresse sofrido pelo animal na iminência do óbito. Foram utilizados os dados de 82 cães necropsiados na FMVZ-USP para análise da ocorrência real de morte súbita nestes animais. As alterações morfológicas nas adrenais de 46 cães necropsiados foram avaliadas através de análises morfométricas e histopatológicas. Também foram avaliados os índices de proliferação e apoptose nas células do córtex adrenal em relação à causa de morte do animal, através da marcação imunoistoquímica para o antígeno nuclear de proliferação celular (PCNA) e para BAX e Bcl-2, proteínas envolvidas na regulação da apoptose. A análise das alterações funcionais sofridas pelas adrenais focou na quantificação das concentrações das catecolaminas adrenalina e noradrenalina na medula adrenal dos cães por cromatografia líquida de alta eficiência com detecção eletroquímica (CLAE-DE). Dentre os resultados encontrados, a suspeita do proprietário de que seu cão sofreu uma morte súbita e inesperada é muito maior do que a real ocorrência deste tipo de morte em cães, sendo o óbito por decorrência de complicações de doenças muito mais frequente. As características morfométricas das adrenais dos cães apresentaram maior influência pelo peso corpóreo do animal e pela presença ou ausência de hiperplasia cortical do que pela associação com doenças crônicas ou condições agudas. Cães que vieram a óbito em decorrência de complicações de doenças crônicas exibiram fibrose em região corticomedular e focos de infiltrado inflamatório, ausentes nos animais com morte súbita ou doenças agudas, além de maior ocorrência de hiperplasia adrenocortical. Cães que sofriam de alterações cardíacas crônicas apresentaram alterações histopatológicas significativas mais marcantes em suas adrenais, como necrose, fibrose e depleção vacuolar cortical. Por outro lado, a congestão severa nas adrenais foi um achado mais frequente nos animais previamente saudáveis que sofreram morte súbita ou que vieram a óbito por doenças agudas. A avaliação dos índices de proliferação celular e apoptose no córtex das adrenais através da marcação imunoistoquímica para PCNA e BAX e Bcl-2, respectivamente, não apresentou potencial relevante para o estudo dos efeitos do estresse por doenças crônicas sobre as adrenais de cães. As concentrações de adrenalina e noradrenalina na medula adrenal se mostraram muito maiores em cães machos quando comparados às fêmeas. Os achados deste estudo podem auxiliar nas conclusões da necropsia, sendo especialmente relevantes em casos médico-legais, nos quais todos os achados possíveis devem ser relatados e analisados a fim de se prover um diagnóstico preciso, seguro e incontroverso

Psicobiología del estrés prenatal:implicaciones en el eje hipotálamo-hipofisiario-adrenal de los bebés

The womb is the first developmental environment. After developmental psychobiologists started to investigate intrauterine evolution of infant and its long-term impact, they found that prenatal and postnatal development is influenced by mother’s psychological health. Specifically, scientific research evidence indicates that prenatal stress is a possible cause of subsequent psychopathological vulnerability. This vulnerability comes from stress sensitivity and is the basis of many childhood disorders. In the last decade, there are evidences for a fetal origin of stress sensitivity in the context of the fetal programming theory (Entringer et al., 2009, Grant et al., 2009, Gutteling et al., 2004, Huizink et al., 2004, O’Connor et al., 2005). According to fetal programming hypothesis, babies that have been exposed to high levels of prenatal stress would develop elevated HPA axis reactivity and thus increased stress sensitivity in the postnatal period. In the field of animal psychobiology, several studies have shown that prenatal stress could play some role on fetal programming of neurodevelopment and HPA axis (Glover, 2010, Weinstock, 2005, 2008). In human psychobiology, evidences are less clear (Glover, 2010). Although research in this regard has been growing during the last few years, more studies are warranted to investigate the relationship between maternal stress and fetal programming of neurodevelopment and the HPA axis in humans, to confirm the findings which are evident from animal psychobiology...

Trasplante autólogo de progenitores hematopoyéticos (TAPH) en linfoma folicular (FL). Un análisis de muy largo seguimiento de los pacientes incluidos en el registro español Geltamo centrado en su eficacia y en la posibilidad de curación

Los pacientes con LF presentan un curso clínico indolente y una supervivencia relativamente prolongada, sin embargo el LF continúa considerándose una enfermedad incurable con los tratamientos convencionales y la recaída de los pacientes es la norma, alcanzando en las sucesivas recaídas un menor número de respuestas y de menor duración. Los enfermos con LF de alto riesgo intensificados con TAPH pueden alcanzar remisiones prolongadas, pero el mejor momento para dicho procedimiento es controvertido. Los enfermos trasplantados en primera remisión han demostrado un beneficio en la Supervivencia Libre de Progresión (SLP) en comparación con los tratados con la terapia convencional o con la inmunoquimioterapia. Sin embargo, ningún estudio randomizado (ER) ha demostrado todavía un beneficio en la Supervivencia Global (SG). No obstante, la mediana de seguimiento de los estudios fase III que evalúan el papel del TAPH es insuficiente para obtener beneficios en términos de SG. El único ER disponible que evalúa el rol del TAPH en pacientes con LF trasplantados en 2ª RC demuestra un beneficio en la SLP y la SG en comparación con la terapia convencional y ha sido confirmado en varios estudios retrospectivos con largos seguimientos...

Linfoma não Hodgkin da órbita : o sucesso de um caso raro

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Differential involvement of rat medial prefrontal cortex dopamine receptors in modulation of hypothalamic-pituitary-adrenal axis responses to different stressors

Recent investigations have implicated the medial prefrontal cortex (mPFC) in modulation of subcortical pathways that contribute to the generation of behavioural, autonomic and endocrine responses to stress. However, little is known of the mechanisms involved. One of the key neurotransmitters involved in mPFC function is dopamine, and we therefore aimed, in this investigation, to examine the role of mPFC dopamine in response to stress in Wistar rats. In this regard, we infused dopamine antagonists SCH23390 or sulpiride into the mPFC via retrodialysis. We then examined changes in numbers of cells expressing the c-fos immediate-early gene protein product, Fos, in subcortical neuronal populations associated with regulation of hypothalamic-pituitary-adrenal (HPA) axis stress responses in response to either of two stressors; systemic injection of interleukin-1beta, or air puff. The D-1 antagonist, SCH23390, and the D-2 antagonist, sulpiride, both attenuated expression of Fos in the medial parvocellular hypothalamic paraventricular nucleus (mpPVN) corticotropin-releasing factor cells at the apex of the HPA axis, as well as in most extra-hypothalamic brain regions examined in response to interleukin-1beta. By contrast, SCH23390 failed to affect Fos expression in response to air puff in any brain region examined, while sulpiride resulted in an attenuation of the air puff-induced response in only the mpPVN and the bed nucleus of the stria terminalis. These results indicate that the mPFC differentially processes the response to different stressors and that the two types of dopamine receptor may have different roles.

Evaluation of random plasma cortisol and the low dose corticotropin test as indicators of adrenal secretory capacity in critically ill patients: A prospective study

It is unclear whether a random plasma cortisol measurement and the corticotropin (ACTH) test adequately reflect glucocorticoid secretory capacity in critical illness. This study aimed to determine whether these tests provide information representative of the 24 hour period. Plasma cortisol was measured hourly for 24 hours in 21 critically ill septic patients followed by a corticotropin test with 1 μ g dose administered intravenously. Serum and urine were analysed for ACTH and free cortisol respectively. Marked hourly variability in plasma cortisol was evident (coefficient of variation 8-30%) with no demonstrable circadian rhythm. The individual mean plasma cortisol concentrations ranged from 286 59 nmol/l to 796 &PLUSMN; 83 nmol/l. The 24 hour mean plasma cortisol was strongly correlated with both random plasma cortisol (r(2) 0.9, P< 0.0001) and the cortisol response to corticotropin (r(2) 0.72, P< 0.001). Only nine percent of patients increased their plasma cortisol by 250 nmol/l after corticotropin (euadrenal response). However, 35% of non-responders had spontaneous hourly rises > 250 nmol/l thus highlighting the limitations of a single point corticotropin test. Urinary free cortisol was elevated (865&PLUSMN; 937 nmol) in both corticotropin responders and non-responders suggesting elevated plasma free cortisol. No significant relationship was demonstrable between plasma cortisol and ACTH. We conclude that although random cortisol measurements and the low dose corticotropin tests reliably reflect the 24 hour mean cortisol in critical illness, they do not take into account the pulsatile nature of cortisol secretion. Consequently, there is the potential for erroneous conclusions about adrenal function based on a single measurement. We suggest that caution be exercised when drawing conclusions on the adequacy of adrenal function based on a single random plasma cortisol or the corticotropin test.

Prolactin and the expression of suppressor of cytokine signaling-3 in the sheep adrenal gland before birth

Prolactin and the expression of suppressor of cytokine signaling-3 in the sheep adrenal gland before birth. Am J Physiol Regul Integr Comp Physiol 291: R1399-R1405, 2006. First published June 29, 2006; doi: 10.1152/ajpregu.00252.2006.-The fetal pituitary-adrenal axis plays a key role in the fetal response to intrauterine stress and in the timing of parturition. The fetal sheep adrenal gland is relatively refractory to stimulation in midgestation (90-120 days) before the prepartum activation, which occurs around 135 days gestation (term = 147 +/- 3 days). The mechanisms underlying the switch from adrenal quiescence to activation are unclear. Therefore, we have investigated the expression of suppressor of cytokine signaling-3 (SOCS-3), a putative inhibitor of tissue growth in the fetal sheep adrenal between 50 and 145 days gestation and in the adrenal of the growth-restricted fetal sheep in late gestation. SOCS-3 is activated by a range of cytokines, including prolactin (PRL), and we have, therefore, determined whether PRL administered in vivo or in vitro stimulates SOCS-3 mRNA expression in the fetal adrenal in late gestation. There was a decrease (P < 0.005) in SOCS-3 expression in the fetal adrenal between 54 and 133 days and between 141 and 144 days gestation. Infusion of the dopaminergic agonist, bromocriptine, which suppressed fetal PRL concentrations but did not decrease adrenal SOCS-3 mRNA expression. PRL administration, however, significantly increased adrenal SOCS-3 mRNA expression (P < 0.05). Similarly, there was an increase (P < 0.05) in SOCS-3 mRNA expression in adrenocortical cells in vitro after exposure to PRL (50 ng/ml). Placental and fetal growth restriction had no effect on SOCS-3 expression in the adrenal during late gestation. In summary, the decrease in the expression of the inhibitor SOCS-3 after 133 days gestation may be permissive for a subsequent increase in fetal adrenal growth before birth. We conclude that factors other than PRL act to maintain adrenal SOCS-3 mRNA expression before 133 days gestation but that acute elevations of PRL can act to upregulate adrenal SOCS-3 expression in the sheep fetus during late gestation.

Variability of cortisol assays can confound the diagnosis of adrenal insufficiency in the critically ill population

Objective: To compare the total plasma cortisol values obtained from three widely used immunoassays and a high pressure liquid chromatography (HPLC) technique on samples obtained from patients with sepsis. Design and setting: Observational interventional in the general intensive care unit of a metropolitan hospital. Patients and participants: Patients admitted to the intensive care unit with a diagnosis of sepsis and fulfilling criteria of systemic inflammatory response syndrome. Interventions: Standard short synacthen test performed with 250 mu g cosyntropin. Measurements and results: Two of the three immunoassays returned results significantly higher than those obtained by HPLC: Immulite by 95% (95%CI 31-188%) and TDx by 79% (21-165%). The limits of agreement for all three immunoassays with HPLC ranged from -62% to 770%. In addition, by classifying the patients into responders and non-responders to ACTH by standard criteria there was concordance in all assays in only 44% of patients. Conclusions: Immunoassay estimation of total plasma cortisol in septic patients shows wide assay related variation that may have significant impact in the diagnosis of relative adrenal insufficiency.