Quantitation of tryptic responses to endogenous and exogenous stimulation in chronic pancreatitis

Using validated double-marker techniques to quantitate tryptic secretion we found that the mean 10-min output of trypsin in duodenal juice after a test meal was very similar to the peak 10-min output of trypsin after pancreozymin (2 Crick-Harper-Raper units/kg, Boots) both in controls as well as in non-diabetic patients with idiopathic chronic pancreatitis. These results show that the disproportionate reduction in mean tryptic activity after endogenous compared with exogenous stimulation in chronic pancreatitis is not due to impaired release of cholecystokinin-pancreozymin from the small intestine, nor to refractoriness of the pancreas to endogenously released hormone: instead, it is due to overdilution of secreted pancreatic enzymes because of accelerated gastric emptying, with or without gastric acid hypersecretion.     

Effect of atropine on pancreatic responses to endogenous and exogenous secretin

The role of cholinergic innervation in endogenous release of secretin from the intestinal mucosa, and in exocrine pancreatic secretion was examined by means of atropine administration in 4 chronic gastric-fistula and pancreatic-fistula dogs during pancreatic response to various doses of synthetic secretin and to various rates of intraduodenal acid load. Atropine infused in a dose of 100µg/kg/hr caused a deep and prolonged decrease of pancreatic flow rate and bicarbonate output reaching a maximum of about 70% of the pre-atropine level of pancreatic secretion. The inhibition occurred regardless of the level of pancreatic response examined, and no significant difference between the effects of atropine on pancreatic responses to exogenous and endogenous secretin was found. Intraduodenal infusion of atropine caused significantly greater inhibition of the pancreatic response to intestinal acidification than that to exogenous secretin. This suggests that release of secretin from the intestinal mucosa might be under the cholinergic control of local nerves.     

Effect of atropine on pancreatic responses to endogenous and exogenous cholecystokinin

The role of cholinergic innervation in endogenous release of cholecystokinin from the intestinal mucosa and in exocrine pancreatic secretion was examined by means of atropine administration in 3 chronic gastric-fistula and pancreatic-fistula dogs during pancreatic responses to various rates of intraduodenal amino acid mixture and to various doses of intravenous cholecystokinin producing equal rates of pancreatic protein secretion. Atropine infused in a dose of 100 µg/kg-hr caused a deep and prolonged decrease in pancreatic flow rate, protein and bicarbonate output, reaching a maximum of about 80% of the pre-atropine level of pancreatic secretion. The inhibition occurred regardless of the level of pancreatic response examined. Atropine also caused an inhibition of pancreatic responses to smaller doses of exogenous cholecystokinin but did not affect responses to larger doses. The maximal observed pancreatic protein secretion in response to intraduodenal administration of amino acids was about 80% of the highest response to cholecystokinin. This study suggests that the release of cholecystokinin from the intestinal mucosa might be cholinergically dependent.     

Gastric acid,plasma gastrin,and somatostatin responses to feeding and exogenous gastrin alone and in combination in conscious cats

Meat in the stomach or duodenum potentiates pentagastrin-induced acid secretion in cats, presumably by a humoral mechanism. In the present study on cats, a meat meal significantly augmented the maximal acid response from a Heidenhain pouch (HP) to pentagastrin or to human synthetic gastrin I by 31 and 30%, respectively. The maximal HP acid response to pentagastrin was augmented also by peptone instilled into the stomach through a gastric fistula. Intravenous infusion of amino acids stimulated acid secretion but did not augment the maximal acid response to pentagastrin. The plasma concentrations of gastrin and somatostatin increased during infusion of pentagastrin and gastrin I and were not further altered by simultaneous feeding. The present results indicate that the mechanism for potentiation of gastrin-induced acid secretion is of physiological significance, since feeding augmented also the acid response to heptadecapeptide gastrin, the only gastrin secreted from the antrum and duodenum in cats. The potentiation of acid secretion is not dependent on the vagal excitation induced by oral feeding, since potentiation was demonstrated also by intragastric peptone instillation. The mechanism for the potentiation is not due to absorbed amino acids or a decrease of plasma somatostatin.This work was supported by grants from the Swedish Medical Research Council (No. 2324), the Karolinska Institute, and the Thuring's Foundation, Stockholm, Sweden.     

Studies on exogenous and endogenous interaction of gastrin and secretin in a case of achalasia

Studies were carried out in a case of achalasia. Administration of secretin caused relaxation of the spastic condition of LES, and high levels of serum gastrin and lower levels of plasma secretin are suggested to be related with the abnormally spastic condition of LES in the patient.     

Adrenocorticotropin responses to endogenous and exogenous secretagogues in the sheep: specificity of glucocorticoid action

Glucocorticoids act upon the hypothalamus and pituitary to regulate both corticotropin-releasing factors and adrenocorticotropin (ACTH) in a classical negative feedback loop. There are two distinct receptor systems in the central nervous system for glucocorticoids: type I corticosterone/cortisol-preferring, predominantly hippocampal receptors, and type II dexamethasone-binding receptors with a much broader distribution. To determine the relative roles played by these two receptors in determining basal and stress-induced ACTH/cortisol levels in the sheep, we have conducted two series of experiments. In the first, we infused 4 sheep with cortisol (50 micrograms/h), or dexamethasone (20 micrograms/h) for 17 h, collected 10-min blood samples for 3 h for basal hormone levels, and then subjected the sheep to an audiovisual stress (barking dog), 10 micrograms of ovine corticotropin-releasing factor (oCRF) 1 h later, and 100 U of insulin another 2 h later. Dexamethasone reduced ACTH and cortisol levels, both basal and in response to stress; cortisol infusion had no effect on any parameters; oCRF did not raise ACTH levels. In the second experiment, cortisol (100 micrograms/h) alone was infused into 4 sheep for 17 h, and blood samples were collected for 3 h for basal hormone levels; this was followed by the injection of 10 micrograms oCRF, and 2 h later a barking dog was introduced into the sheep shed. Again, cortisol infusion did not affect basal ACTH or cortisol levels, though both cortisol-infused and control animals had ACTH responses to oCRF when it was not preceded by the audiovisual stress. ACTH and cortisol levels were higher in the 2 h following oCRF injection.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pancreatic hyperplasia after small bowel resection in the rat: dissociation from endogenous gastrin levels

Extensive small bowel resection produces pancreatic hyperplasia and increases plasma gastrin levels in the rat. Because gastrin is known as a trophic factor for the exocrine pancreas, we studied the effect of endogenous variations of gastrin induced by different gastric operations on the rat pancreas in both resected and transected animals. Vagotomy increased plasma gastrin level while antrectomy decreased it; pyloroplasty was without any effect. These gastric operations enhanced slightly but not significantly the pancreatic weight, its protein and DNA content. A 90% jejunoileal resection alone increased markedly these parameters while mitotic figures appeared in acinar cells. Pyloroplasty, vagotomy and antrectomy did not modify the changes induced by intestinal resection itself except the level of protein. These findings suggest that hypergastrinemia produced by intestinal resection is not responsible for pancreatic hyperplasia.     

Altered peripheral vascular responses to exogenous and endogenous endothelin-1 in patients with well-compensated cirrhosis

Plasma endothelin concentrations are elevated in cirrhosis and correlate with disease severity. This study assessed forearm vascular responses to exogenous endothelin-1 (ET-1), and evaluated the contribution of endogenous ET-1 to the maintenance of basal peripheral vascular tone in patients with well-compensated cirrhosis (n = 11) and matched healthy controls (n = 8). Bilateral forearm blood flow (FBF) was measured at baseline and following unilateral, subsystemic, intrabrachial artery infusions of ET-1 (2 and 6 pmol/min); BQ-123, a selective ET(A) receptor antagonist (3 and 10 nmol/min); and BQ-788, a selective ET(B) receptor antagonist (0.3 and 1 nmol/min) using venous occlusion plethysmography. Baseline systemic hemodynamics and plasma ET-1 and big ET-1 concentrations were measured using electrical bioimpedance and radioimmunoassay, respectively. Patients and controls had similar baseline FBF, systemic hemodynamics, and plasma ET-1 and big ET-1 concentrations. In both groups, ET-1 and BQ-788 caused significant vasoconstriction (P < .001) and BQ-123 caused significant vasodilatation (P < .001). Compared with controls, cirrhotic patients had attenuated ET-1 responses (P < .001), augmented BQ-123 responses (P < .001), and similar BQ-788 responses (P = .62). Despite normal systemic hemodynamics and plasma ET-1 concentrations, forearm vascular responses to exogenous ET-1 are reduced in cirrhotic patients. The augmented vasodilatation to BQ-123 in cirrhotic patients is consistent with a compensated vasodilated state, and a greater contribution of ET-1 to the maintenance of basal vascular tone acting through the ET(A) receptor.     

Effects of exogenous and endogenous bombesin on gastrin secretion from rat antral mucosa in tissue culture

Effects of exogenous and endogenous bombesin on gastrin secretion were examined using rat antral mucosa in tissue culture. Gastrin secretion was significantly stimulated by exogenous bombesin at a dose of 10(-8) M. Atropine 10(-6) M, which abolished the action of the cholinergic agent carbachol to stimulate gastrin secretion, had no effect on bombesin-stimulated gastrin secretion. In addition, gastrin secretion was significantly inhibited by anti-bombesin antiserum used to block the effect of endogenous bombesin by immunoneutralization. These findings suggest that the stimulation of gastrin secretion by bombesin does not involve cholinergic neural pathways and that endogenous bombesin exerts a continuous stimulation on gastrin secretion in the basal state.     

Acute effect of captopril on aldosterone secretory responses to endogenous or exogenous adrenocorticotropin

The aldosterone secretory response to Captopril (12.5 mg, orally) was studied in five normal men. Endogenous ACTH and epinephrine secretion was stimulated by the induction of hypoglycemia. Normally this stimulus increases plasma cortisol, GH, aldosterone, and PRA. Administration of captopril resulted in a blunted plasma aldosterone response to hypoglycemia, but no concomitant blunting of the plasma cortisol response. The responses of other hormones, with the exception of PRA, were not affected. When exogenous ACTH was administered to the same men with and without captopril, the plasma aldosterone response was again blunted by captopril, while the plasma cortisol response was unaffected. We conclude that angiotensin II may be required for ACTH to stimulate aldosterone secretion. Alternatively, the possibility that captopril may selectively inhibit aldosterone secretion at the adrenal cellular level cannot be excluded.     

Immunological responses to exogenous insulin

Regardless of purity and origin, therapeutic insulins continue to be immunogenic in humans. However, severe immunological complications occur rarely, and less severe events affect a small minority of patients. Insulin autoantibodies (IAAs) may be detectable in insulin-naive individuals who have a high likelihood of developing type 1 diabetes or in patients who have had viral disorders, have been treated with various drugs, or have autoimmune disorders or paraneoplastic syndromes. This suggests that under certain circumstances, immune tolerance to insulin can be overcome. Factors that can lead to more or less susceptibility to humoral responses to exogenous insulin include the recipient's immune response genes, age, the presence of sufficient circulating autologous insulin, and the site of insulin delivery. Little proof exists, however, that the development of insulin antibodies (IAs) to exogenous insulin therapy affects integrated glucose control, insulin dose requirements, and incidence of hypoglycemia, or contributes to beta-cell failure or to long-term complications of diabetes. Studies in which pregnant women with diabetes were monitored for glycemic control argue against a connection between IAs and fetal risk. Although studies have shown increased levels of immune complexes in patients with diabetic microangiopathic complications, these immune complexes often do not contain insulin or IAs, and insulin administration does not contribute to their formation. The majority of studies have shown no relationship between IAs and diabetic angiopathic complications, including nephropathy, retinopathy, and neuropathy. With the advent of novel insulin formulations and delivery systems, such as insulin pumps and inhaled insulin, examination of these issues is increasingly relevant.     

Evidence for normal antidiuretic responses to endogenous and exogenous arginine vasopressin in patients with guanine nucleotide-binding stimulatory protein-deficient pseudohypoparathyroidism

In six patients with pseudohypoparathyroidism (PHP) who were deficient in guanine nucleotide-binding stimulatory protein (Ns) activity, the response to endogenous arginine vasopressin (AVP) was tested during water deprivation. Hourly plasma osmolality (Posm), urinary osmolality (Uosm), and urinary AVP (UAVP) values were compared to those in normal subjects. The Uosm vs. Posm and the UAVP vs. Uosm relationships of the patients were all within the normal range. Four patients with Ns-deficient PHP were subjected to maintained water loads and infused with AVP at three different rates for 1 h each to assess their responses to exogenous AVP. Urinary volume and osmolality values from the final 30 min of each infusion rate were measured. All volume values except 1 were within 1.6 SD of normal, and all osmolality values except 1 were within 1.1 SD of normal. In conclusion, these studies indicate that these six patients with Ns-deficient PHP are not resistant to the antidiuretic (cAMP-mediated) action of endogenous or exogenous AVP, in contrast to the previously documented resistance of patients with Ns-deficient PHP to the actions of PTH, TSH, glucagon, and gonadotropins.     

Action of ethanol on gastrin release in the dog

In conscious dogs with gastric and duodenal Thomas fistulas, we studied the effect of ethanol on plasma concentrations of gastrin. Ethanol was given either as an infusion into a peripheral vein (1.95 M, 200 ml/hr) or into the duodenum (0.95 M, 400 ml/hr) or as an intragastric bolus injection. The effect of the intragastric bolus injection of 200 ml of different concentrations (0.3 M, 1.7 M, 6.85 M) of ethanol was compared with that of equimolar solutions of urea and sucrose (0.3 M, 1.56 M), and with that of sodium taurocholate (0.06 M) and distilled water. The gastrin responses to an oral mixed-meat meal (35 g/kg) were also investigated. Intragastric bolus injection of isoosmolar *0.3 M) ethanol, but not of equimolar solutions of urea and sucrose or H₂O, significantly (P<0.05) increased plasma gastrin levels above basal. Hyperosmolar solutions of ethanol, urea, and sucrose as well as hypoosmolar sodium taurocholate produced a pronounced increase of plasma gastrin concentrations above basal. The comparison of the mean 2-hr integrated plasma gastrin responses (IRG) showed that ethanol (6.85 M), urea (6.85 M), and sodium taurocholate (0.06 M) are at least as potent stimuli of release of gastrin as the test meal used. Intraduodenal and intravenous infusion of ethanol did not significantly alter mean plasma gastrin concentrations. We conclude that in the dog ethanol, but not urea and sucrose, given in a concentration (0.3 M) which is known not to disrupt the gastric mucosal barrier, increases plasma gastrin levels. This release of gastrin by isoosmolar ethanol is not due to gastric distension and may be a specific effect of ethanol on the gastrin cells. Furthermore, the release of gastrin by hyperosmolar solutions of ethanol, sucrose, and urea is probably a nonspecific effect and due to damage of gastric mucosa. The effect of a hypoosmolar solution of sodium taurocholate, a well-known gastric mucosal barrier breaker, on gastrin release supports this hypothesis.