9C.09: TREATMENT WITH CANDESARTAN UNMASKS HIGHER URINARY NOREPINEPHRINE EXCRETION IN WHITE COAT HYPERTENSIVE PATIENTS COMPARED TO HEALTHY NORMOTENSIVE PARTICIPANTS.

OBJECTIVE: White coat hypertensive is a pre-hypertensive state that has been associated with increased sympathetic drive. The objective of the study was to compare the exposure of the kidney to sympathetic nerve activity using urinary normetanephrine (UNMN) as a marker of renal sympathetic exposure in white coat hypertensive (WCH) and healthy normotensive (HN) participants. DESIGN AND METHOD: This was a double-blind randomized placebo-controlled crossover study. WCH were included if office blood pressure was >140/80 mmHg and ambulatory blood pressure <135/85 mmHg and HN if OBP was <140/90 mmHg and ABP <135/85 mmHg Participants were randomized to receive either 16 mg of candesartan or a matched placebo for one week before study day. On the study day systemic and renal hemodynamics as well as plasma norepinephrine and urinary excretion of normetanephrine (measured by LC/MS-MS were measured after one hour of baseline, one hour of lower body negative pressure and one hour of recovery period. Excretion of UNMN was expressed as the total of UNMN excreted during these three hours (cumUNMN). Paired or unpaired t-test were used for comparison. RESULTS: 25 HN and 12 WCH participants were included in the study. Mean age (±standard deviation), BMI were respectively 31.0±10.5 years and 22.0 ± 2.2 Kg/m2 in HN and 40.7±17.8 years and 26.7 ± 6.3 Kg/m2 in WCH.Table 1 Baseline mean blood pressure, plasma noradrenaline and cumulated UNMN during placebo and candesartan(Figure is included in full-text article.)Mean blood pressure was higher during placebo and candesartan in WCH compared to HN. Cumulated UNMN was higher in both groups after candesartan treatment. Cumulated UNMN was higher in WCH than in HN only after candesartan treatment. CONCLUSIONS: Urinary excretion of normetanephrine is increased in WCH compared to HN when treated with candesartan. The increased excretion of uNMN when the renin angiotensin system is blocked might reflect an increased sensitivity of WCH to stress conditions such as orthostatic stress.

Heterogeneity of glomerular perfusion and filtration induced by epinephrine and norepinephrine

The role of catecholamines in the distribution of intrarenal blood flow and in single-nephron glomerular filtration rate (SNGFR) was evaluated in anesthetized Wistar rats by the Hanssen technique. Epinephrine (EPI) and norepinephrine (NOR) were infused to produce elevations of 20-30 mmHg in mean arterial pressure. Superficial and juxtamedullary nephron perfusion and filtration were determined by the presence of Prussian blue dye. In the control group, 100% of the nephrons presented a homogeneous pattern of perfusion and filtration. In contrast, a heterogeneous distribution of the dye was found even in the larger arteries (arciform and radial), indicating variable perfusion and filtration in both superficial and juxtamedullary nephrons. The effects of EPI and NOR were also evaluated in the superficial cortex by the micropuncture technique in two additional groups of Munich-Wistar rats. Mean SNGFR was 27% and 54% lower in the EPI- and NOR-treated groups, respectively. No change in mean intraglomerular hydraulic pressure was observed after EPI or NOR infusion in spite of a highly scattered pattern, indicating an important variability in perfusion along the superficial cortex, and/or different sensitivity of the pre- and post-glomerular arterioles. The present data suggest that EPI and NOR may affect intrarenal hemodynamics by modifying perfusion and filtration in both superficial and juxtamedullary glomeruli and not by shifting blood flow from superficial to juxtamedullary nephrons. The heterogeneous pattern of perfusion was a consequence of differential vasoconstriction along the intrarenal arteries, probably due to different density and/or sensitivity of the adrenergic receptor subtypes present in the intrarenal vascular tree.

Stress-related hormone norepinephrine induces interleukin-6 expression in GES-1 cells

In the current literature, there is evidence that psychological factors can affect the incidence and progression of some cancers. Interleukin 6 (IL-6) is known to be elevated in individuals experiencing chronic stress and is also involved in oncogenesis and cancer progression. However, the precise mechanism of IL-6 induction by the stress-related hormone norepinephrine (NE) is not clear, and, furthermore, there are no reports about the effect of NE on IL-6 expression in gastric epithelial cells. In this study, we examined the effect of NE on IL-6 expression in immortalized human gastric epithelial cells (GES-1 cells). Using real-time PCR and enzyme-linked immunoassay, we demonstrated that NE can induce IL-6 mRNA and protein expression in GES-1 cells. The induction is through the β-adrenergic receptor-cAMP-protein kinase A pathway and mainly at the transcriptional level. Progressive 5′-deletions and site-directed mutagenesis of the parental construct show that, although activating-protein-1 (AP-1), cAMP-responsive element binding protein (CREB), CCAAT-enhancer binding protein-β (C/EBP-β), and nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB) binding sites are all required in the basal transcription of IL-6, only AP-1 and CREB binding sites in the IL-6 promoter are required in NE-induced IL-6 expression. The results suggest that chronic stress may increase IL-6 secretion of human gastric epithelial cells, at least in part, by the stress-associated hormone norepinephrine, and provides basic data on stress and gastric cancer progression.

Randomized controlled trials of serotonin-norepinephrine reuptake inhibitor in treating major depressive disorder in children and adolescents: a meta-analysis of efficacy and acceptability

New generation antidepressant therapies, including serotonin-norepinephrine reuptake inhibitor (SNRIs), were introduced in the late 1980s; however, few comprehensive studies have compared the benefits and risks of various contemporary treatments for major depressive disorder (MDD) in young patients. A comprehensive literature search of PubMed, Cochrane, Embase, Web of Science, and PsycINFO databases was conducted from 1970 to January 2015. Only clinical trials that randomly assigned one SNRI or placebo to patients aged 7 to 18 years who met the diagnostic criteria for major depressive disorder were included. Treatment success, dropout rate, and suicidal ideation/attempt outcomes were measured. Primary efficacy was determined by pooling the risk ratios (RRs) of treatment response and remission. Acceptability was determined by pooling the RRs of dropouts for all reasons and for adverse effects as well as suicide-risk outcomes. Five trials with a total of 973 patients were included. SNRIs were not significantly more effective than placebo for treatment response but were for remission. The comparison of patients taking SNRIs that dropped out for all reasons and those taking placebo did not reach statistical significance. Significantly more patients taking SNRIs dropped out for adverse effects than those taking placebo. No significant difference was found in suicide-related risk outcomes. SNRI therapy does not display a superior efficacy and is not better tolerated compared to placebo in these young patients. However, duloxetine has a potential beneficial effect for depression in young populations, showing a need for further research.

Norepinephrine ignites local hot spots of neuronal excitation: how arousal amplifies selectivity in perception and memory

Arousal sometimes enhances and sometimes impairs perception and memory. In our Glutamate Amplifies Noradrenergic Effects (GANE) model, glutamate at active synapses interacts with norepinephrine released by the locus coeruleus to create local ‘hot spots’ of activity that enable the selective effects of arousal. This hot spot mechanism allows local cortical regions to self-regulate norepinephrine release based on current activation levels. In turn, hot spots bias global energetic delivery and functional network connectivity to enhance processing of high priority representations and impair processing of lower priority representations.

Insulin modulates norepinephrine-mediated melatonin synthesis in cultured rat pineal gland

The mammalian pineal gland synthesizes melatonin in a circadian manner, peaking during the dark phase. This synthesis is primarily regulated by sympathetic innervations via noradrenergic fibers, but is also modulated by many peptidergic and hormonal systems. A growing number of studies reveal a complex role for melatonin in influencing various physiological processes, including modulation of insulin secretion and action. In contrast, a role for insulin as a modulator of mclatonin synthesis has not been investigated previously. The aim of the current study was to determine whether insulin modulates norepinephrine (NE)-mediated melatonin synthesis. The results demonstrate that insulin (10(-8)M) potentiated norepinephrine-mediated melatonin synthesis and tryptophan hydroxylase (TPOH) activity in ex vivo incubated pineal glands. When ex vivo incubated pineal glands were synchronized (12h NE-stimulation, followed by 12h incubation in the absence of NE), insulin potentiated NE-mediated melatonin synthesis and arylalkylamine-N-acetyltransferase (AANAT) activity. Insulin did not affect the activity of hydroxyindole-O-methyltranferase (HIOMT), nor the gene expression of tpoh, aanat, or hiomt, under any of the conditions investigated. We conclude that insulin potentiates NE-mediated melatonin synthesis in cultured rat pineal gland, potentially through post-transcriptional events. (C) 2007 Elsevier Inc. All rights reserved.

Effects of swimming and nandrolone decanoate treatment on vas deferens response to norepinephrine

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

INVOLVEMENT OF SWIMMING-INDUCED ACUTE STRESS IN THE SENSITIVITY OF RAT VAS-DEFERENS TO NOREPINEPHRINE

1. The effects of swimming-induced stress on rat sensitivity to norepinephrine were studied.2. Through microscopic analysis of the stomach from swimming stressed rats significant ulceration was observed, confirming that the stress situation was really present.3. Sensitivity to norepinephrine either in the presence or in the absence of cocaine and propranolol in acutely swimming stressed rats was not altered significantly.4. Bilateral adrenalectomy was performed in rats 2 days before swimming and acute stress resulted in a supersensitivity to norepinephrine, indicating that adrenal glands may, at least, partially mediate the sensitivity to this drug in vasa deferentia isolated from these animals.

Acute swimming stress induces changes in noradrenergic mechanisms in order to maintain the response pattern of the rat vas deferens to norepinephrine

This study investigated mechanisms involved in the maintenance of the functional response pattern of the postjunctional alpha(1)-adrenoceptor in vas deferens isolated from rats submitted to acute swimming stress. The plasma corticosterone levels increased approximately three times after the swimming stress in the nontreated rats as well as after swimming stress in the rats pretreated with desipramine (DMI), yohimbine (YO), or DMI with YO. No alteration was detected in the sensitivity to norepinephrine (NE) in the vasa deferentia from the stressed rats or stressed rats treated with DMI or DMI with YO, in relation to their respective control. However, when the vasa deferentia were previously incubated with DMI, a reduction in sensitivity to NE in organs from stressed rats was observed. Vasa deferentia excised from rats pretreated with YO before the swimming stress showed an increase in postjunctional alpha(1)-response that was abolished by prazosin (PZ). Thus, the neuronal uptake, the prejunctional alpha(2)-adrenoceptors (mediating prejunctional inhibition), the occupancy and functional response of the postjunctional alpha(1)-adrenoceptors, and the emotional stress component were very important for the determination of the noradrenergic response pattern in vas deferens from rats submitted to acute swimming stress. (C) 2002 Elsevier B.V. Ltd. All rights reserved.

Study of the contraction induced by norepinephrine and clonidine in the isolated guinea-pig ileum

Norepinephrine (NE) and clonidine produce a phasic, dose-dependent contraction of the isolated guinea-pig terminal ileum. The effect of NE was blocked by prazosin which produced a parallel rightward shift of the concentration-effect curve to NE, with a significant depression of maximum effects. Yohimbine and indomethacin noncompetitively blocked, whereas practolol potentiated, the contractile effect of NE. The contractile effect of clonidine was not antagonized by indomethacin or atropine. These results suggest that the isolated guinea-pig terminal ileum has excitatory receptors sensitive to clonidine stimulation and excitatory alpha receptors sensitive to blockade by prazosin, and that the activation of the latter may be related to the activation of endogenous prostaglandin synthesis.

Role of androgenic deprivation on the contractile response to norepinephrine in vas deferens isolated from rats submitted to swimming-stress

The effects of androgenic deprivation induced by castration on the norepinephrine contractile response of vas deferens from rats, which have been submitted to acute swimming-stress were determined. Acute swimming-stress led to subsensitivity to norepinephrine in vas deferens excised from intact rats. Similarly, castration also induced subsensitivity to norepinephrine, but no further subsensitivity occurred in organs from castrated rats submitted to acute stress. The results indicate a different response to norepinephrine in terms of relative responsiveness ratio, when vas deferens was excised from castrated rats or castrated rats submitted to acute stress. It is suggested that androgenic steroids modulate the recovery of homeostasis in rat vas deferens during acute stress, and that this effect may involve mechanisms that affect both the sensitivity of adrenergic receptors and the system of neuronal uptake of catecholamines.

Changes in norepinephrine and epinephrine concentrations in adrenal gland of the rats submitted to acute immobilization stress

Catecholamines act as neurotransmitters and hormones. Studies conducted to understand the synthesis and metabolism of these monoamines during stress have been the main concern of many authors. This work proposes to investigate the time course of changes in epinephrine and norepinephrine concentration in adrenal gland obtained from rats submitted to acute immobilization stress. The results of the present study indicate that acute immobilization stress during 5 and 15min did not provoke changes in epinephrine and norepinephrine concentrations in adrenal gland in relation to the control group. Such results are justified due to the short time of the stress, showing that the stress did not provoke physiological alteration. The epinephrine and norepinephrine concentrations in adrenal gland increased significantly after the immobilization session in stressed groups during 30 and 50min as compared to control group. This increase probably is due to the emotional component of the immobilization stress. In this way, we suggested that the immobilization stress provoke increase in the biosynthesis of catecholamines in the adrenal gland from rats. However, the results shows that a maximum increase is reached at 30min of immobilization stress and then a decrement of catecholamines levels starts at 50min of the experimental design. This decline in catecholamines level may be consequence of adaptation to stress situations, an increase of the activity of the uptake systems and/or metabolization of catecholamines. In conclusion, these results suggest an effective participation of the adrenal glands to maintain the homeostasis of organism to the stressful conditions. © 2003 Elsevier Ltd. All rights reserved.

Differential phosphorylation, desensitization, and internalization of α1A-adrenoceptors activated by norepinephrine and oxymetazoline

Loss of response on repetitive drug exposure (i.e., tachyphylaxis) is a particular problem for the vasoconstrictor effects of medications containing oxymetazoline (OXY), an α1-adrenoceptor (AR) agonist of the imidazoline class. One cause of tachyphylaxis is receptor desensitization, usually accompanied by phosphorylation and internalization. It is well established that a1A-ARs are less phosphorylated, desensitized, and internalized on exposure to the phenethylamines norepinephrine (NE), epinephrine, or phenylephrine (PE) than are the a1B and a1D subtypes. However, here we show in human embryonic kidney-293 cells that the low-efficacy agonist OXY induces G protein-coupled receptor kinase 2-dependent a1A-AR phosphorylation, followed by rapid desensitization and internalization (∼40% internalization after 5 minutes of stimulation), whereas phosphorylation of α1A-ARs exposed to NE depends to a large extent on protein kinase C activity and is not followed by desensitization, and the receptors undergo delayed internalization (∼35% after 60 minutes of stimulation). Native α1A-ARs from rat tail artery and vas deferens are also desensitized by OXY, but not by NE or PE, indicating that thisproperty of OXY is not limited to recombinant receptors expressed in cell systems. The results of the present study are clearly indicative of agonist-directed a1A-AR regulation. OXY shows functional selectivity relative to NE and PE at a1A-ARs, leading to significant receptor desensitization and internalization, which is important in view of the therapeutic vasoconstrictor effects of this drug and the varied biologic process regulated by α1A-ARs. Copyright © 2013 by The American Society for Pharmacology and Experimental Therapeutics.