L-arginine, the precursor of nitric oxide, abolishes the effect of estrogens on bleeding time in experimental uremia.

We have reported previously that conjugated estrogens that are effective in shortening the prolonged bleeding time in uremic patients are also effective on bleeding time in a rat model of uremia. Using such a rat model we have recently demonstrated that nitric oxide (NO), an endothelium-derived vasodilator, is involved in mediating the bleeding tendency of uremia. With the present study we wanted to investigate whether conjugated estrogen mixture or its active component, 17 beta-estradiol, reduce uremic bleeding by interfering with the NO pathway. Our results showed that the shortening effect of conjugated estrogen and 17 beta-estradiol on bleeding time of uremic rats was completely reversed by giving the animals the NO precursor L-arginine, but not D-arginine, which is not a precursor of NO. Dexamethasone which at variance to progesterone inhibits the process of induction of NO-forming enzyme, shortened the prolonged bleeding time of uremic rats within 4 hours from injection. This effect was eliminated by L-arginine but not D-arginine administration. The glucocorticoid receptor antagonist cortexolone prevented the shortening of bleeding time induced by dexamethasone, suggesting that a receptor-mediated mechanism is involved in the hemostatic effect of dexamethasone as previously reported for estrogens. Unlike conjugated estrogens and dexamethasone, progesterone had no effect on bleeding time. All these findings would indicate that the effect of estrogens and dexamethasone on primary hemostasis in uremia might be mediated by changes in NO synthetic pathway.     

Reduced effect of NMDA glutamate receptor antagonist on ethanol-induced ataxia and striatal glutamate levels in mice lacking ENT1

Alcohol-sensitive type 1 equilibrative nucleotide transporter (ENT1) is known to regulate glutamate signaling in the striatum as well as ethanol intoxication. However, it was unclear whether altered extracellular glutamate levels in ENT1^−/− mice contribute to ethanol-induced behavioral changes. Here we report that altered glutamate signaling in ENT1^−/− mice is implicated in the ethanol-induced locomotion and ataxia by NMDA receptor antagonist, CGP37849. ENT1^−/− mice appear less intoxicated following sequential treatment with CGP37849 and ethanol, compared to ENT1^+/+ littermates on the rotarod. These results indicate that inhibiting NMDA glutamate receptors is critical to regulate the response and susceptibility of alcohol related behaviors. Interestingly, a microdialysis experiment showed that the ventral striatum of ENT1^−/− mice is less sensitive to the glutamate-reducing effect of the NMDA receptor antagonist compared to the dorsal striatum. Our findings suggest that differential glutamate neurotransmission in the striatum regulates ethanol intoxication.     

Synergism between immunosuppressive agents and uremia?

The susceptibility of uremic patients to infectious disease has been widely reported, but the host immune factors associated with the increased incidence of infection have not been clearly defined. In this study, the possibility of synergism between biologically active components that accumulate in uremia and immunosuppressive drugs used in the course of management was investigated. An animal model of chronic stable uremia was used in these experiments to assess the effect of cyclophosphamide, methotrexate, and azathioprine on antibody response in the uremic host. Chronic uremia did not affect the immunosuppressive activity of cyclophosphamide, methotrexate, or azathioprine, and synergism between these agents and uremic components is unlikely to complicate further the immune status of the host in renal failure.     

Neuropsychological patterns in uremia

Administered the Halstead-Reitan Battery (HRB) of neuropsychological tests to 24 patients with advanced renal failure, 24 patients with neurological disorders, and 24 patients with medical and/or non-psychotic psychiatric conditions in order to assess the effects of uremic encephalopathy on human neuropsychological functioning. The groups did not differ significantly in age, education, verbal intelligence, or level of affective disturbance. Results indicated that the uremic and neurological groups were equal in overall level of neuropsychological impairment and that both were significantly more impaired than the medical-psychiatric group. However, the uremic group showed a pattern of deficits that was qualitatively different from both the neurological and medical-psychiatric groups. Results were discussed with reference to selective cortical dysfunctions in uremia and contrasted with earlier studies that did not consider differential sparing of abilities in renal patients.     

Detection and characterization of modified nucleosides in serum and urine of uremic patients using capillary liquid chromatography-frit-fast atom bombardment mass spectrometry

To determine RNA metabolism in uremia, capillary liquid chromatography-frit-fast atom bombardment mass spectrometry was employed for the characterization of ribonucleosides in serum and urine of uremic patients, and the profiles were compared with those of healthy subjects. We have characterized 20 nucleosides in serum and 23 nucleosides in urine from both healthy subjects and uremic patients; most of them were modified nucleosides derived from tRNA breakdown products. Four metabolites derived from allopurinol were detected as exogenous nucleosides in patients receiving allopurinol; these include allopurinol-1-riboside, oxipurinol-1-riboside, oxipurinol-7-riboside and a unknown oxipurinol riboside. The endogenous and exogenous ribonucleosides were retained at higher levels in uremic serum, and may play a contributory role as toxins responsible for clinical symptoms of uremia.     

Effect of uremia on lymphocyte transformation and chemiluminescence by spleen cells of normal and Cryptococcus neoformans-infected mice.

The effect of uremia on immune incompetence was studied. BALB/c mice were infected with a minimally virulent strain of Cryptococcus neoformans 6 weeks before immune assay. Uremia was induced by intramuscular injection of 0.15 ml of glycerol. Pooled spleen cells from four experimental groups (normal, uremic, infected, and infected and uremic) were assayed by lymphocyte transformation (LT) and luminol-dependent chemiluminescence (CL) 24 h after induction of uremia. A greater response to phytohemagglutinin and concanavalin A stimulation in tests of LT and CL was exhibited by uremic cells than by nonuremic cells; however, the presence of BALB/c uremic serum resulted in lower responses by both LT and CL. Infected mice showed a greater response to mitogens than did noninfected mice, but no significant stimulation in response to heat-killed whole cells of C. neoformans. Spleen cell populations of uremic mice had a lower viability and a different composition of spleen cell subpopulations than did cell preparations from nonuremic mice.     

Production of seizures and brain damage in rats by alpha-dendrotoxin, a selective K+ channel blocker.

alpha-Dendrotoxin (Dtx), a snake polypeptide, increases neuronal excitability by blocking certain fast-activating, voltage-dependent K+ channels. Thus, the behavioural, electrocortical (ECoG) and neuropathological effects of Dtx, injected into rat brain areas, were studied. A unilateral injection of 35 pmol of Dtx into the CA1 hippocampal area or the dendate gyrus (DG; upper blade) immediately produced motor and ECoG seizures, followed at 24 h by multi-focal brain damage and significant neuronal loss. Whilst brain damage was seen bilaterally, significant neuronal loss occurred only in regions (CA1, CA3, CA4 and DG) ipsilateral to the site of injection. A lower dose (3.5 pmol) of toxin elicited motor and ECoG seizures but failed to produce brain damage. Seizures were observed 50 min after injecting Dtx (35 pmol) into the amygdala, though significant neuronal loss was not evident. 4-Aminopyridine (100 nmol), given into the CA1 area elicited a similar motor and ECoG pattern to that of Dtx except no brain damage could be seen at 24 h. Systemic pretreatment with antagonists of N-methyl-D-aspartate receptors (MK-801 or CGP 37849) did not protect against the effects typically evoked by injecting Dtx into the CA1 area.     

Increased cardiac contractility in acute uremia: interrelationships with hypertension.

To study the effects of acute uremia on the inotropic state of the rat heart, we subjected rats to bilateral nephrectomy and studied their hearts in the open chest 24 h later. Uremic rats had significantly higher systolic blood pressure than sham-operated animals. Left ventricular systolic pressure and maximum dP/dt, both during ejection and isovolumic contrations, were higher for any given end-diastolic pressure in hearts of uremic rats than in sham-operated animals. This difference in performance charcteristics was not abolished by doses of propranolol that blocked the heart rate response to isoproterenol. The administration of phenoxybenzamine during the 24 h of uremia abolished the blood pressure rise in uremic rats, but the increased contractile state persisted. Treatment of sham-operated animals with methoxamine to produce the same course of blood pressure as observed in uremic rats was also associated with an increased inotropic state. These results indicate that in the rat, acute uremia is associated with an increased inotropic state that is not mediated by beta-adrenergic mechanisms. The systolic hypertension of acute uremia is not the major cause of the increased contractility, although systolic hypertension without uremia can mimic the performance characteristics found in hearts of uremic rats.     

Plasma aldosterone and cortisol levels in experimental acute renal failure

Deranged adrenal cortical function was previously described in different stress situations. The aim of this work was to study the plasma cortisol and aldosterone levels in acute renal failure induced by the uranyl nitrate injection or bilateral ureteral ligation. In both groups of uremic dogs on the first day of uremia there was a significant elevation of the plasma cortisol level, being more pronounced and lasting longer after bilateral ureteral ligation. In sham operated controls a modest elevation was recorded. The plasma aldosterone level rose significantly from the first day in both groups of uremic animals. A further progressive elevation continued the following days and a highly elevated aldosterone levels remained until the end of the experiments. A minor but significant elevation of plasma aldosterone was also found in sham operated controls. This study has established increased plasma cortisol and aldosterone levels attributable to the operative stress and failing kidney function in acute uremia.     

NMDAR antagonist action in thalamus imposes delta oscillations on the hippocampus

Work on schizophrenia demonstrates the involvement of the hippocampus in the disease and points specifically to hyperactivity of CA1. Many symptoms of schizophrenia can be mimicked by N-methyl-d-aspartate receptor (NMDAR) antagonist; notably, delta frequency oscillations in the awake state are enhanced in schizophrenia, an abnormality that can be mimicked by NMDAR antagonist action in the thalamus. Given that CA1 receives input from the nucleus reuniens of the thalamus, we sought to determine whether an NMDAR antagonist in the thalamus can affect hippocampal processes. We found that a systemic NMDAR antagonist (ketamine; 50 mg/kg) increased the firing rate of cells in the reuniens and CA1 in awake rats. Furthermore, ketamine increased the power of delta oscillations in both structures. The thalamic origin of the change in hippocampal properties was demonstrated in three ways: 1) oscillations in the two structures were coherent; 2) the hippocampal changes induced by systematic ketamine were reduced by thalamic injection of muscimol; and 3) the hippocampal changes could be induced by local injection of ketamine into the thalamus. Lower doses of ketamine (20 mg/kg) did not evoke delta oscillations but did increase hippocampal gamma power, an effect not dependent on the thalamus. There are thus at least two mechanisms for ketamine action on the hippocampus: a low-dose mechanism that affects gamma through a nonthalamic mechanism and a high-dose mechanism that increases CA1 activity and delta oscillations as a result of input from the thalamus. Both mechanisms may be important in producing symptoms of schizophrenia.     

Significance of reactive oxygen in kidney disease elucidated by uremic toxins

Synthesis of guanidinosuccinic acid (GSA) and methylguanidine (MG) is markedly increased in end-stage renal disease (ESRD), and these substances have been known as uremic toxins.GSA has been identified as one of the major causes of bleeding tendency, a Na-K ATPase inhibitor, and the cause of convulsions in ESRD. Recently, GSA (N-amidino-l-aspartate) was found to be an activator of theN-methyl-d-aspartate (NMDA) receptor that generates NO and plays an important role in nerve development and the death of neurons. In peripheral nerves, it functions in pain and itching sensations. I have shown that GSA is formed from ASA and the hydroxyl radical. The combination of NO and superoxide anion also generates GSA. Thus, in the system involving the GSA-NMDA receptor-NO+O₂ ^–, GSA may act as an amplifier of reactive oxygen generation. MG, another major uremic toxin, causes hypertension and a shortening of the life span. We have also shown that MG is formed through the hydroxyl adduct of creatinine (creatol). Therefore, MG and/or creatol can be used to estimate hydroxyl radical generation. We reported a marked increase of creatol synthesis in severely hyperparathyroid patients. Additionally, using this method we demonstrated an increase in hydroxyl radical generation by puromycin aminonucleoside (PAN), which induces heavy proteinuria. We further showed that the increased hydroxyl radical generation induced by PAN was caused by the activation of calcium-dependent protein kinase C (PKC) and was prevented by the inhibitors of PKC. We also showed increased hydroperoxides in PAN-treated glomeruli. Thus, increased MG and GSA may indicate hydroxyl radical generation in renal failure.     

Opiates and the anorexia of uremia

Uremia results in a decrease in food intake. In the present study we investigated whether opiates known to stimulate feeding would alter food intake in rats made uremic by 1 and 5/6 nephrectomy. Morphine increased food intake in sham nephrectomized rats, but failed to alter food intake in uremic animals and depressed the ingestion of rat chow in a group of weight restricted rats. Butorphanol tartrate increased feeding in sham and uremic animals but did not alter intake in the weight restricted group. Higher doses of butorphanol were needed to stimulate feeding in the uremic rats compared to the sham group, suggesting a relative resistance to opioid-induced feeding in the uremic rats. The opiate antagonist, naloxone, suppressed food intake in the uremic and sham groups more effectively than in the weight restricted rats. These data suggest that the opioid feeding system functions in a reduced fashion in uremic rats, but probably is not the sole factor involved in producing the anorexia associated with uremia.     

Application of a novel Active Allothetic Place Avoidance task (AAPA) in testing a pharmacological model of psychosis in rats: comparison with the Morris Water Maze

Administration of a non-competitive NMDA antagonist dizocilpine (MK-801) was proposed to be an animal model of psychosis. NMDA-receptor blockade is accompanied by increased locomotion, behavioral deficits, and other changes resembling psychotic symptoms. However, the role of NMDA-receptors in organizing brain representations is not understood yet. We tested the effect of NMDA-receptor blockade by systemic administration of dizocilpine at two different doses (0.1 or 0.2 mg/kg) in a recently designed Active Allothetic Place Avoidance (AAPA), a task which requires rats to separate spatial stimuli from two continuously dissociated subsets. The effect of dizocilpine on learning in the AAPA task was compared with its effect on acquisition of the reference memory version of the Morris Water Maze task. Both doses impaired performance in the Morris Water Maze task, whereas only the higher dose impaired performance in the AAPA task. The Morris Water Maze appears to be more sensitive to dizocilpine-induced behavioral deficit than the AAPA task. These findings support the notion that these two tasks are differentially dependent on the NMDA-receptor function.     

Increased free phenytoin concentrations in predialysis serum compared to postdialysis serum in patients with uremia treated with hemodialysis. Role of uremic compounds.

Patients with uremia are reported to have elevated concentrations of free phenytoin as a result of decreases in protein binding. This appears to be related to the presence of uremic compounds. To determine the dialyzability of these compounds, the in vitro protein binding levels of phenytoin in pre- and postdialysis serum (supplemented with phenytoin) of 12 patients with uremia were compared. For these patients, the concentrations of free phenytoin were significantly greater in predialysis serum (lower protein binding) compared to postdialysis serum, although the concentrations of total phenytoin did not vary. Low levels of protein binding of phenytoin in predialysis serum also were observed in two hemodialysis patients receiving phenytoin. Several serum pools, prepared from both normal volunteers and the predialysis sera of uremic patients, were dialyzed (in vitro equilibrium dialysis). Then both undialyzed and dialyzed sera were supplemented with phenytoin and analyzed to determine free and total phenytoin concentrations. The free phenytoin concentrations were increased in equilibrium-dialyzed normal serum pools compared to undialyzed original pools because of decreases in albumin concentrations after equilibrium dialysis. In contrast, free phenytoin concentrations were decreased in the equilibrium-dialyzed uremic serum pools, thereby indicating an attenuation of the albumin dilution effect on free phenytoin concentration, probably by the preexisting uremic compounds. These compounds can be removed completely by treating sera with activated charcoal at pH 3. The results obtained from charcoal treatment experiments, in combination with other results, indicate that these uremic compounds can be removed partially by in vivo hemodialysis and by in vitro equilibrium dialysis.     

The degeneration of the excitatory climbing fibers enhances [3H]MK-801 and [3H]CGP 39653 binding sites in the rat cerebellar cortex.

The effect of a single injection of 3-acetylpyridine (3-AP), which led to a degeneration of the excitatory cerebellar climbing fibers, was studied on the binding of [3H]MK-801, a non-competitive NMDA antagonist, in the rat cerebellar cortex. The same treatment increased also the binding of [3H]CGP 39653, a new NMDA competitive antagonist. Saturation isotherms showed a significant increase of the maximal number of binding sites (Bmax) for [3H]CGP 39653 and [3H]MK-801 (+48 and 36% respectively) with no change in the affinity 4-9 days after the administration of 3-AP. Our data demonstrate that in the cerebellar cortex both NMDA recognition site labelled by [3H]CGP 39653 and its modulatory site labelled by [3H]MK-801 may undergo plastic changes when the glutamatergic receptors and transmission are denervated.     

Nitric oxide/L-arginine in uremia

Nitric oxide (NO), a gaseous free radical derived from L-arginine, is a potent modulator of vascular tone and platelet functions. A number of recent studies, both in the experimental model of renal mass reduction (RMR) in rats and in uremic patients, have raised the hypothesis that abnormalities of NO synthetic pathway could have a key role in mediating the complex hemodynamic and hemostatic disorders associated to the progression of renal disease. Thus, kidneys from rats with RMR produce less NO than normal rats and NO generation negatively correlates with markers of renal damage. The abnormality is due to a strong defect of inducible NO synthase (iNOS) content in the kidney. Recent in vitro and in vivo data have raised the possibility that excessive renal synthesis of the potent vasoconstrictor and promitogenic peptide endothelin-1 (ET-1) is a major determinant for progressive iNOS loss in the kidney of RMR rats. In contrast, uremia is associated with excessive systemic NO release, both in experimental model and in human beings. In the systemic circulation of uremic rats, as well as uremic patients, NO is formed in excessive amounts. Possible cause of the increased NO levels is higher release from systemic vessels due to the augmented expression of both iNOS and endothelial NOS. A putative cause for excessive NO production in uremia can be guanidinosuccinate, an uremic toxin that accumulates in the circulation of uremic patients and upregulates NO synthesis from cultured endothelial cells. Upregulation of systemic NO synthesis might be a defense mechanism against hypertension of uremia. On the other hand, more NO available to circulating cells may sustain the bleeding tendency, a well-known complication of uremia.     

NMDA-receptor blockers but not NBQX, an AMPA-receptor antagonist, inhibit spreading depression in the rat brain.

The effect of different glutamate-receptor antagonists on the induction of cortical spreading depression of Leao and of cortical anoxic membrane depolarization were investigated in the anaesthetized rat. Spreading depression (SD), elicited by mechanical stimulation of the cortical surface, was inhibited by the non-competitive N-methyl-D-aspartate (NMDA)-receptor blocker, (+-)-5-methyl-10,11-dihydro-5H-dibenzo(a,d)-cyclo-hepten-5,10-imi ne maleate (dizocilpine or MK-801), (0.30 mumol kg-1 (0.10 mg kg-1)), and the competitive NMDA-receptor antagonists; cis-4-phosphonomethyl-2-piperidine carboxylate (CGS 19755), (3.36 mumol kg-1 (0.75 mg kg-1)), D-(E)-2-amino-4-methyl-5-phosphono-3-pentenoic acid (CGP 40116), (1.20 mumol kg-1 (0.25 mg kg-1)) and its carboxylester CGP 43487, (6.30 mumol kg-1 (1.50 mg kg-1)). The alpha-amino-3-hydroxy-5-methyl-4-isoxazolepripriate (AMPA)-receptor blocker, 2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo(F) quinoxaline (NBQX), administered as an intravenous dose of 29.76 and 89.29 mumol kg-1 (10 & 30 mg kg-1), which is sufficient to block seizures and protect against ischaemic brain damage, did not inhibit spreading depression. None of the drugs utilized inhibited the anoxic membrane depolarization. The data demonstrate that NMDA-receptor activation is essential for the initiation and propagation of spreading depression, while activation of AMPA-receptors is not obligatory. The observed initiation and propagation of SD, during AMPA-receptor blockade, suggest that activation of voltage-operated ion channels may contribute to release the magnesium block of the NMDA-receptor operated channel and to the initiation of SD.     

In vitro immune functions in patients with minor, moderate, and severe kidney impairment

We examined the in vitro immune response of lymphocytes from 86 non-dialyzed patients with progressive renal failure and 48 healthy control subjects by comparing the production of interleukin-2, the mitogen-induced proliferative response and sensitivity to glucocorticoid of lymphocyte cultures. The patients were divided in three groups with minor, moderate, and severe uremia. The uremic lymphocyte responses to stimulation with concanavalin A (Con A) were significantly lower than those of control lymphocyte cultures. A similar but not significant decrease was also seen in phytohemagglutinin (PHA) and pokeweed mitogen stimulated cultures. There was no trend towards diminishing mitogen responses with decreasing renal function. The median interleukin-2 activity in the uremic cell cultures was decreased by 50% during the culture period but the decrease was not significant. However, PHA and Con A stimulated lymphocyte cultures from all groups of patients were significantly more sensitive to the immunosuppressive effect of methylprednisolone. Thus an increased sensitivity to the immunosuppressive effect of glucocorticoid can be demonstrated in vitro at an early stage of progressive renal disease.     

GABAB receptors in various in vitro and in vivo models of epilepsy: a study with the GABAB receptor blocker CGP 35348.

The effect of the GABAB receptor blocker CGP 35348 on epileptic processes in vitro and in vivo was studied. In hippocampal slices of the rat maintained in vitro, CGP 35348 (100 microM) induced a moderate increase in the frequency of extracellularly recorded spontaneous epileptiform burst discharges induced in CA3 by penicillin (1.2 mM), bicuculline (5 microM) and low Mg(2+) (0.1 mM). This effect was observed in 50-75% of the slices. A similar but less consistent increase was also observed in CA1 in bicuculline and low Mg2+. Data obtained by intracellular recordings from CA1 pyramidal cells in the presence of bicuculline (10 microM) demonstrated that CGP 35348 (100 microM) increased the duration of the paroxysmal depolarization underlying an evoked epileptiform burst and reduced the early component of the after hyperpolarization which followed the burst. In mice pretreated with isoniazid, CGP 35348 (300 mg/kg, i.p.) significantly increased the number of convulsing mice. However, convulsions induced by submaximal doses of pentylenetetrazol, picrotoxin or strychnine were not facilitated by CGP 35348. We conclude that GABAB receptors appear to exert a suppressant effect on various kinds of epileptiform discharges of hippocampal neurons in vitro. In vivo, however, the role of GABAB receptors in regulating convulsions is less prominent since only isoniazid-induced convulsions were facilitated by GABAB receptor blockade.     

cGMP对脑缺血再灌流后海马区星形胶质细胞活化的作用机制研究

为了观察 c GMP对海马区胶质纤维酸性蛋白合成调节的作用 ,本研究用钳夹沙土鼠的双侧颈总动脉制造脑缺血模型 ,进行了免疫荧光法染色。结果表明 :脑缺血再灌流后海马区 c GMP合成增加 ,多数 c GMP阳性细胞为星形胶质细胞 ,此细胞的多数呈 c GMP强阳性染色 ,胶质纤维酸性蛋白反应也多呈强阳性 ;使用鸟苷酸环化酶 ( GC)抑制剂 ODQ,则 c GMP合成减少 ,c GMP阳性细胞多呈弱阳性 ,同一细胞的胶质纤维酸性蛋白反应也多呈弱阳性。本实验结果提示 :c GMP可能与海马胶质纤维酸性蛋白的合成调节有关