Effects of inhibition of prostaglandin-synthesis on renal electrolyte excretion and concentrating ability in healthy man

In five healthy subjects inhibition of prostaglandin (PG)-synthesis with indomethacin did not significantly alter glomerular filtration, urinary flow rate or sodium and potassium excretion during control urine collection periods or i.v. hypertonic saline infusion. Saline administration was accompanied by a fall in urinary PGE₂-excretion from 0.58±0.14 to 0.26±0.09 ng/min (p < 0.05). While indomethacin had no effect on basal urinary osmolality (I_osm),renal concentrating ability following hypertonic saline or i.v. administration of 100 mU lysine-vasopressin significantly increased in the presence of indomethacin with U_osm rising from 805±25 to 970±53 mosm/L (p < 0.01)and from 839±47 to 996±62 mosm/L (p < 0.01),resp. Since this was not accompanied by respective changes in urinary excretion of cyclic adenosine monophosphate (cAMP) mechanisms other than PG-antagonism of vasopressin, such as decreased medullary washout of solute, may contribute to enhanced renal concentrating ability following inhibition of PG-synthesis with indomethacin.     

Dissociation between renal medullary PGE2-synthesis and urine PGE2-excretion. Antagonism by bumetanide of chlorazanil induced urine PGE2-excretion in rats

Normal conscious female Sprague-Dawley rats were treated with chlorazanil (3 mg/kg i.p.), and urine was collected for 3 hours. Urine prostaglandin E₂-excretion increased from 25±3 to 271±32 ng/kg/3 h. The enhancement of urine PGE₂-excretion was inhibited by pretreatment with bumetanide (75 mg/kg p.o.). In separate experiments the papillary quantity of PGE₂ was determined in freshly homogenized tissue. The basal level (14±2 ng PGE₂/papilla) was increased by chlorazanil to 51±11 ng PGE₂/papilla and 24±7 ng PGE₂/papilla at one and two hours respectively after drug administration. The capacity of chlorazanil to increase medullary PGE₂ accumulation was unaffected by bumetanide dissociated the medullary PGE₂ level from the excretion of PGE₂ in urine, when the former was elevated by chlorazanil.     

Role of prostaglandis in the control of renin secretion in the dog (II)

Infusion of prostaglandin E₁ (PGE₁) into the renal artery of anesthetized dogs (1.03 μg/min) caused increases in urine flow rate (V), renal plasma flow (RPF) and renin secretion rate without any change in mean arterial blood pressure (MABP), whereas infusion of prostaglandin F₂α (PGF_2α), (1.03 μg/min) caused no consistent change in V, RPF, or renin secretion rate. Infusion of prostaglandin E₂ (PGE₂) (1.03 μg/min) into the renal artery of “non-filtering” kidneys caused renin secretion rate to rise from 567.7 ± 152.0 U/min(M ± SEM) during control periods to 1373.6 ± 358.5 U/min after 60 minutes of infusion of PGE₂ (P < 0.01), without significant change in MABP (P > 0.1). The data suggest that PGE₁ and PGE₂ play a role in the control of renin secretion. The data further suggest that PGE may control renin secretion through a direct effect on renin-secreting granular cells.     

Urinary 6-keto PGF1α and PGE2 in two kidney-one clip hypertension in the rat

The 24 hour urinary excretion of 6-keto PGF_1α and PGE₂ was compared in 2 kidney-1 clip rats developing hypertension within 12 weeks of renal artery clipping with rats remaining normotensive over this period. Although systolic blood pressure was markedly elevated in the hypertensive (210 ± 5.1 mm Hg), in contrast with the normotensive (141 ± 1.9 mm Hg) group, urinary levels of 6-keto PGF_1α (26.1 ± 3.4 and 22.1 ± 2.7 ng/24h, respectively) and PGE₂ (52.8 ± 28 and 53.3 ± 10.8 ng/24h) were not significantly different. Treating the 2 kidney-1 clip normotensive group with indomethacin (3.0 mg/kg, by intraperitoneal injection) twice-weekly for 3 weeks reduced 6-keto PGF_1α excretion from 22.1 ± 2.7 to 8.4 ± 2.2 ng/24h (P < 0.002) and PGE₂ from 53.3 ± 10.8 to 8.7 ± 1.8 ng/24h (P < 0.002) but did not change blood pressure when compared with a similar group given buffer vehicle only. These findings do not support a role for renal prostaglandins in 2 kidney-1 clip hypertension in the rat.     

The role of renal metabolism of PGE2 in determining its activity as a renal vasodilator in the dog

Since the mammalian renal cortex avidly metabolizes prostaglandin E₂ (PGE₂), we examined the importance of renal metabolism of PGE₂ in determining its renal vascular activity in the dog. We used 13, 14 dihydro PGE₂ (DHPGE₂) as a model compound to study this because DHPGE₂ retains similar activity to the parent prostaglandin, PGE₂, but is a poorer substrate than PGE₂ for both the metabolism and the cellular uptake of the prostaglandins. Using dog renal cortical slices, we found that under similar experimental conditions, PGE₂ was metabolized several-fold faster than DHPGE₂. Both prostaglandins were metabolized to the 15 keto 13, 14 dihydro PGE₂, which was positively identified using GC-MS. In vivo, we infused increasing concentrations of DHPGE₂ into the renal artery of dogs and measured renal hemodynamic changes using radioactive microspheres. DHPGE₂ was a potent renal vasodilator beginning at an infusion rate of 10⁻⁹g/kg/min. When compared to PGE₂, DHPGE₂ was about 10 times more potent in affecting renal vasodilation. The intrarenal redistribution of blood flow towards the inner cortex seen with DHPGE₂ was identical to that seen with PGE₂. We conclude that renal catabolism of PGE₂ is very important in limiting the in vivo biological activity of PGE₂, but regional differences in metabolism of PGE₂ within the cortex are an unlikely determinant of the pattern of redistribution of renal blood flow.     

Modulation of prostaglandin of the renal vascular action of arginne vasopressin

To determine whether the renal vascular effect of arginine vasopressin (AVP) is modulated by renal prostaglandin E₂ (PGE₂) were determined during the infusion of AVP in dogs during control conditions and after the administration of the inhibitor of prostaglandin synthesis, indomethacin. During control conditions, intrarenal administration for 10 min of a dose of AVP calculated to increase arterial renal plasma AVP concentration by 75 pg/ml produced a slight renal vasodilation (p<0.01) and an increase in renal venous plasma concentration of PGE₂. Renal venous PGE₂ concentration during control and AVP infusion averaged 33 ± 7 and 52 ± 12 pg/ml (p<0.05), respectively. After administration of indomethacin, the same dose of AVP induced renal vasoconstriction (p<0.05) and failed to enhance renal venous PGE₂ concentration (9 ± 1 to 8 ± 1 pg/ml). Intrarenal administration of 20 ng/kg. min of AVP for 10 min induced a marked renal vasoconstriction (p<0.01) and increased renal venous plasma PGE₂. Renal venous PGE₂ during control and AVP infusion averaged 31 ± 10 and 121 ± 31 pg/ml (p<0.01), respectively. Administration of the same dose of AVP following indomethacin produced a significantly greater and longer lasting renal vasoconstriction (p<0.01) and failed to increase renal venous plasma PGE₂ (10 ± 1 to 9 ± 1 pg/ml). These results indicate that a concentration of AVP comparable to that observed in several pathophysiological conditions induces a slight renal vasodilation which is mediated by renal prostaglandins. The results also indicate that higher doses of AVP induce renal vasoconstriction and that prostaglandin synthesis induced by AVP attenautes the renal vasoconstriction produced by this peptide.     

Interaction between prostaglandin E2 and leukotriene D4 on the excretion of electrolytes by the dog kidney in vivo

Recent experiments indicate that prostaglandin E₂ potentiates the vasodilatory properties of leukotrienes in the skin microcirculation. The present experiments were undertaken to study the effect of leukotriene D₄ and prostaglandin E₂ on renal hemodynamics and urinary electrolytes in the dog. Experiments were performed in three groups of anesthetized Mongrel dogs: the first group was studied under hydropenia, whereas the two remaining groups were studied during water diuresis with (Group 3) or without indomethacin (Group 2). LTD₄ (100ng/min) and PGE₂ (3ug/min) were infused in the left renal artery to minimize systemic effects of these compounds. LTD₄ alone failed to influence urinary sodium excretion in all 3 groups. In Group 1, urinary sodium increased from 77 ± 6 to 393 ± 74uEq/min during PGE₂, and further increased to 511 ± 52uEq/min during LTD₄ + PGE₂. No change occured in the contralateral right kidney. In this group, glomerular filtration as well as renal plasma flow were not statistically influenced. In Group 2, the same phenomenon was observed for urinary sodium. The combined infusion of LTD₄ + PGE₂ increased urinary sodium without significant changes in glomerular filtration and renal plasma flow. Finally, in Group 3, indomethacin was shown to reduce the natriuretic effects of LTD₄ and PGE₂: during PGE₂ alone, urinary sodium increased from 90 ± 14 to 260 ± 66uEq/min, and only rose from 80 ± 10 to 175 ± 19uEq/min during the combined infusion of LTD₄ and PGE₂. In groups 2 and 3, free water clearance was utilized as an index of sodium chloride reabsorption in the thick ascending limb: this parameter increased from 2.35 ± 0.25 to 4.70 ± 0.30ml/min, while urinary volume was increasing from 3.55 ± 0.25 to 10.05 ± 0.65ml/min, during LTD₄ + PGE₂. Indomethacin, administered in Group 3, (3mg/kg/hr) again abolished the effect of combined PGE₂ + LTD₄. These results indicate a potentiating effect of leukotriene D₄ on the PGE₂-induced natriuresis in the anesthetized dog. These phenomena occured in the absence of significant changes in renal hemodynamics, therefore suggesting a direct tubular effect of these arachidonic acid metabolites. Finally, the water diuresis experiments suggest a proximal site of action of PGE₂ and LTD₄.     

Urinary prostaglandin and kallikrein excretion are not flow dependent in the rat

To study the relationship between urine flow, urinary prostaglandin (PG) and kallikrein excretion in the rat high urine flow was induced in hydropenic Long-Evans rats by either hypotonic volume expansion or with manniitol or with furosemide. PGE, excretion remained unchanged during hypotonic volume expansion (134.5 ± 29.7 before and 153.0 ± 48.9 pg/min after) while it decreased significantly with mannitol (from 166.3 ± 32.4 to 45.2 ± 8.2 pg/min, p<0.01) and with furosemide (from 170.0 ± 20.4 to 29.5 ± 5.3 pg/min, p<0.001). PGF_2α excretion rates were slightly reduced following all three interventions. Urinary kallikrein excretion remained unchanged in all three groups of animals. It is concluded that, in contrast to human and dogs in the rat urine flow and urinary PG excretion are not interlinked.     

Localization of exaggerated prostaglandin synthesis associated with renal damage

Regional localization of the exaggerated prostaglandin E₂ (PGE₂) synthesis caused by hydronephrosis was studied in unilateral ureteral ligated rabbits. The renal distribution of PGE₂ production was compared in the hydronephrotic and contralateral kidneys. Basal and bradykinin-stimulated PGE₂ synthesis were increased in cortical and medullary slices of the hydronephrotic kidneys. Contralateral (control) cortical slices produced very low levels of PGE₂ and were insensitive to stimulation by bradykinin (BK). The hydronephrotic cortex produced 10 times more PGE₂ than the contralateral cortex and responded to BK stimulation with increased PGE₂ synthesis. Cortical slices from the hydronephrotic kidney exhibited a time-dependent increase in PGE₂ release, presumably as a result of new protein synthesis. The division of the hydronephrotic cortex into outer and inner regions revealed that the inner cortex produced more PGE₂ than the outer cortex. A similar division of the hydronephrotic medulla showed that the inner medulla produced slightly greater amounts of PGE₂ than the outer medulla. The present study demonstrates that hydronephrosis causes increases in prostaglandin synthesis throughout the kidney. We suggest from these results and other studies that a possible explanation for this finding is the involvement of the collecting duct system in this response. The gradient of PGE₂ production detected in the cortex may have a very significant role in the control of renal hemodynamics and could provide an explanation for the large decrease in blood flow to the inner cortex caused by indomethacin treatment.     

Ovulation rate and serum LH levels in rats treated with indomethacin or prostaglandin E2

Serum LH levels were determined by radioimmunoassay at the normal time of the proestrous LH peak (17.30 – 18.00) and ovulatory performance was examined on the morning of estrus in rats treated with indomethacin, an inhibitor of prostaglandin synthesis. When the drug was administered at 14.30 on the day of proestrus, only 21% of the rats ovulated and the total number of ova shed was reduced to 4% of that found in the untreated control group, but there was no significant change in peak serum LH level (1122 ± 184 vs. 975 ± 240 ng/ml ± S.E., treated vs. control). Prostaglandin E₂ (PGE₂) given late on the day of proestrus (25 to 750 μ g/rat at 24.00) was effective in overcoming this antiovulatory action of indomethacin: 71–90% of the rats ovulated, though the number of eggs shed was low (24–55% of control value). Indomethacin was still effective in blocking ovulation when given at 20.00, that is after completion of the proestrous LH surge, but not at 24.00. Administration of PGE₂ (2 × 750 μ g/rat) in the early afternoon of proestrus elicited a rise in serum LH levels in rats in which the cyclic LH surge had been blocked with Nembutal (470 ± 87 vs. 106 ± 17 ng/ml ± S.E.) and induced ovulation in two-thirds of these animals.The results confirm, by direct measurement, that indomethacin does not block LH release but interferes with a late phase of the ovulatory process. PGE₂ reverses this action of indomethacin on the ovary. In addition, PGE₂ has a central effect causing LH release.     

Effect of uterine luminal perfusion of PGF2α and PGE2 on uterine vasomotor response and PGF2α output in cyclic cattle

Six cyclic Holstein dairy cows were anesthetized on days 12–14 post-oestrus. Reproductive tract was exposed by midventral incision, and the ovarian (utero-ovarian) vein and facial artery cannulated. Oviduct was ligated, and a catheter (affluent) introduced into the tip of the uterine horn. The uterine horn was ligated above the uterine body, a second catheter (effluent) introduced into the uterine lumen, and an electromagnetic blood flow transducer placed around the uterine artery. On the day following surgery, the uterine horn was infused constantly for 9 h with PGF_2α dissolved in PBS (0.7 ml/min, 177 ng/ml). During periods 1 and 3 (first 3 h and last 3 h, respectively) only PGF_2α was perfused; during period 2 (between 3 h and 6 h) 101tgμg/ml of PGE₂ were added to the perfusate together with PGF_2α. Uterine venous and peripheral blood samples were collected simultaneously every 15 min, and uterine blood flow recorded continuously. Least-square means for PGF measured in uterine venous drainage for periods 1, 2 and 3 were 315 ± 26, 557 ± 24 and 511 ± 26 pg/ml, respectively (P < 0.05). Uterine blood flow values were 52 ± 5, 67 ± 4 and 61 ± 4 ml/min for periods 1, 2 and 3 (P < 0.08), respectively.Results do not support the hypothesis that the antiluteolytic effect of PGE₂ is associated with a suppression of uterine PGF_2α release into the circulation. Greater release of PGF to the circulation in period 2 (addition of PGE₂) is probably the result of the vasodilatory effect of PGE₂ on uterine endometrial vasculature.     

Failure of prostaglandins E1 and E2 to alter canine gastric mucosal cyclic nucleotides

The action of prostaglandins and indomethacin on gastric mucosal cyclic nucleotide concentrations was evaluated in 18 anesthetized mongrel dogs. Prostaglandins E₁ (PGE₁) and E₂ (PGE₂) (25 μg/kg bolus, then 2 μg/kg/min) were administered both intravenously (4 experiments; femoral vein) and directly into the gastric mucosal circulation (10 experiments; superior mesenteric artery). The possible synergistic effect of pre-treatment and continuous arterial infusion of indomethacin (5 mg/kg bolus for 5 min, then 5 mg/min), a prostaglandin synthetase inhibitor, with PGE₂ was studied in 4 experiments. Antral and fundic mucosa were biopsied and measured by radioimmunoassay for cyclic nucleotides. Doses of PGE₁ and PGE₂ which inhibited histamine-stimulated canine gastric acid secretion did not significantly alter antral or fundic mucosal cyclic nucleotide concentrations. Concomitant infusion of PGE₂ with indomethacin did not potentiate the mucosal nucleotide response compared to PGE₂ alone. These studies fail to implicate cyclic nucleotides as mediators of the inhibitory acid response induced by PGE₁ or PGE₂ in intact dog stomach.     

Effects of alfa-receptor and adrenergic neuron blockade on indomethacin-induced changes of renal haemodynamics

The effect of prostaglandin synthesis inhibitor indomethacin was studied on renal haemodynamics by radioactive microspheres in untreated control dogs and in animals treated by the alfa-adrenergic receptor blocking agent phentolamine or by the adrenergic neuron blocking agent guanethidine. RBF was reduced by indomethacin. The reduction of blood flow was more pronounced in the inner cortical zones, which resulted in a blood flow redistribution towards the superficial cortical regions. Urine flow, osmotic concentration and electrolyte excretion did not change significantly. Pretreatment by phentolamine or by guanethidine did not influence the effect of indomethacin on renal haemodynamics or renal function. These data suggest that the sympathetic nervous system is not involved in the renal effects of indomethacin.     

Characterization of biological properties of synthetic and biological leukotriene B3

The effect of micropuncture of the renal papilla through an intact ureter on urinary concetrating ability of rats was examined. Micropuncture of the renal papilla caused a fall in urine osmolality in the punctured kidney from 1718 ± 106 to 1035 ± 79 mosmol/kg·H₂O. In order to investigate the role of renal prostaglandins in this process, PGE₂ excretion was measured and found to increase from 63.4 ± 14.0 to 205.5 ± 57.1 pg/min. Urine osmolality and PGE₂ excretion from the contralateral kidney were not significantly altered. In animals given meclofenamate (2 mg/kg·hr), renal PGE₂ excretion was reduced to 22.3 ± 5.1 pg/min prior to micropuncture and it remained low at 8.9 ± 1.8pg/min after papillary micropuncture. Meclofenamate also blocked the fall in urine osmolality caused by micropuncture of the renal papilla, with urine osmolality averaging 1940 ± 122 before and 1782 ± 96 mosmol/kg·H₂O after the micropuncture. These results indicated that papillary micropuncture through an intact ureter increased renal PGE₂ excretion and that a rise in renal production of PGE₂ or some other prostanoid is associated with a fall in urine concentrating ability.     

Rapid changes in the activities of the enzymes of cyclic AMP metabolism after addition of A23187 to macrophages

The ionophore A23187 stimulated adenylate cyclase activity in intact macrophages within 1 min. This action was blocked by pretreatment with indomethacin (25 μmol/l) suggesting the involvement of a prostaglandin (PG). PGE₂ (500 nmol/l) also stimulated adenylate cyclase activity in intact cells, but this was not prevented by indomethacin pretreatment. Colchicine (100 μmol/l) potentiated the increases in macrophage cyclic AMP production seen after addition of PGE₂ or A23187. The high affinity form of cyclic AMP phosphodiesterase (PDE) was activated within 1 min of the addition of A23187 to intact macrophages. The data suggest that the increase in macrophage cyclic AMP production after A23187 is a consequence of adenylate cyclase activation and not PDE inhibition. The endogenous production of a prostaglandin probably mediates this effect of A23187, emphasizing the importance of arachidonic acid metabolites in the regulation of macrophage functions.     

Is urinary flow rate a major regulator of prostaglandin E excretion in man?

Urinary PGE₂ excretion is enhanced in several polyuric states in man suggesting that PGE₂ synthesis could be a mediator of diuresis. To explore the alternate hypothesis that polyuria is the cause of the increased PGE₂ excretion, we increased urine flow rate by intravenous administration of dextrose and water with different magnesium, calcium and potassium solutions in four normal males. Urinary PGE excretion rose in parallel with urine volume (r = 0.65 p < 0.01) independently of the electrolyte solution. To determine the effects of chronic alterations in water balance in 5 female subjects, we sequentially regulated oral water intake to induce 1, 2, 4 and 8 liters of urine volume/day. During low (40 mEq) sodium diets, PGE increased from 540 ± 50 to 4880 ± 1240 ng/d with increasing urinary volume (r = 0.81, p < 7.01). Similarly, for 200 mEq sodium intake PGE paralleled urinary volume (from 630 ± 100 to 4740 ± 800 ng/d, r = 0.61, p <0.01). In vitro sample dilution studies demonstrated no interference from method blank, and the addition of thin layer chromatography prior to Sephadex chromatography failed to alter assay measurements. We conclude that extreme increases in urinary flow rate may directly enhance PGE excretion in man.     

Prostaglandins and renin release: II. Assessment of renin secretion following infusion of PGI2, E2 and D2 into the renal artery of anesthetized dogs

The influence of intra-renal infusions of prostaglandin (PG) I₂, PGE₂ and PGD₂ on renin secretion and renal blood flow was investigated in renally denervated, beta-adrenergic blocked, indomethacin treated dogs with unilateral nephrectomy. All three prostaglandins when infused at doses of 10⁻⁸ g/kg/min and 10⁻⁷ g/kg/min resulted in marked renal vasodilation. Renin secretory rates increased significantly with both PGI₂ and PGE₂ at the 10⁻⁸ g/kg/min and 10⁻⁷ g/kg/min infusion rates in a dose dependent manner. However, PGD₂ was inactive. At 10⁻⁷ g/kg/min, PGI₂ infusions resulted in systemic hypotension indicating recirculation of this prostaglandin. These findings suggest that PGI₂ should be included among the cyclooxygenase derived metabolites of arachidonic acid to be considered as possible mediators of renin release.     

Oral PGE2 inhibits gastric acid secretion in man

The effect of oral prostaglandin E₂ (PGE₂) on gastric acid secretion was examined in healthy subjects. The gastic secretion was stimulated by a modified shamfeeding procedure. Each subject underwent one control test and three tests with intragastrically administered graded doses of PGE₂: 0.5, 1.0 and 2.0 mg.Oral PGE₂ significantly suppressed the peak and total acid response to vagal stimulation. The total acid output in controls was 27.5 ± 3.2 mol/90 min and 20.8 ± 2.8, 15.8 ± 2.2 (p<0.01) and 15.9±3.8 (p<0.005)mol/90 min in test series with 0.5, 1.0 and 2.0 mg PGE₂ respectively. The two higher doses were equally inhibitory to an average 40%. Gastric outputs on sodium and potassium in response to modified shamfeeding were reduced by PGE₂.In controls there was a significant release of plasma-gastrin in response to shamfeeding. Plasma-gastrin was apparently suppressed after the two lower doses of PGE₂ but 2.0 mg PGE₂ gave an elevation similar to controls.Thus the study demonstrates that the oral natural PGE₂ suppresses the gastric acid secretion in man. The absence of such an effect in prior studies has been one of the objections against an acid regulatory action of endogenously formed prostaglandins. The present results do not support this argument.     

Protection against ischemic acute renal failure by prostaglandin infusion

We have shown that intravenous infusion of epinephrine (4ug/kg/min for 6 hours) into mongrel dogs consistently produces renal hemodynamic and histopathologic characteristics of ischemic acute renal failure (ARF). This study describes renal responses that were modified by intravenous infusion of prostaglandin E (PGE₂)(10 ug/min) one hour before and during a 6 hour infusion of epinephrine (4 ug/kg/min). Two groups of animals were studied: Group I (epinephrine alone) and Group II (epinephrine + PGE₂). Urine volume, glomerular filtration rate, urinary sodium excretion rate, urine osmolality, and serum urea nitrogen were measured. Renal tissues were studied using light and electron microscopy. While urine volume or glomerular filtration rate decreased significantly in both groups, they were slightly but significantly better in Group II than Group I. Urine osmolality significantly decreased in Group I but significantly increased in Group II. Group I animals became azotemic (mean serum urea nitrogen, 27 ± 1 mg/dl), whereas Group II animals showed serum urea nitrogen at the upper limits of normal (mean 20 ± 2 mg/dl). The difference was significant (P <.01). Severe acute tubular lesions were a consistent feature in Group I. Tubular lesions were less severe and infrequent in Group II animals. While mitochondrial dark bodies (electron microscopy) characterized tubular lesions in Group I, fewer mitochondria contained dark bodies in Group II animals. These dark bodies appear to be calcium and constitute a definitive sign of ischemia. Therefore, this study indicates that PGE₂ attenuates epinephrine-induced tubular ischemia and injury and ARF which may be attributed to excessive solute excretion or to inhibition of calcium influx into tubular mitochondria.     

Hypercalcemia in association with a Leydig cell tumor in the rat: A model for tumor-induced hypercalcemia in man

The etiology of tumor-induced hypercalcemia was investigated in a transplantable Leydig cell tumor of the Fischer rat. In this model, serum calcium rose from a baseline of 10.4 ± 0.3 m mg/dl to 12.5 ± 0.4 mg/dl at day 10 and 16.4 ± 1.3 mg/dl (p<0.001) at day 13 post transplant. Urinary calcium also increased from 1.52 ± 0.17 mg/d to 3.52 ± 0.72 mg/d (Day 12, p<0.01). Serum phosphate decreased from a baseline of 7.5 ± 0.3 mg/dl to 5.5 ± 0.6 mg/dl at day 13 (p<0.05). At day 13 serum immunoreactive parathyroid hormone levels fell 76% from baseline (p<0.01). Calcitonin increased from 59 ± 2 pg/ml to 88 ± 9 pg/ml (p<0.01). The plasma prostaglandin E metabolite, 13, 14-dihydro-15-keto-PGE₂ increased from 407 ± 103 pg/dl to 647 ± 62 pg/ml (p<0.05) and the active Vit D compound 1, 25(OH)₂D increased from 94.8 ± 5.2 pg/ml to 162.3 ± 11.8 pg/ml (p<0.01). Urinary cyclic AMP did not decrease in parallel with the parathyroid hormone level and, in fact, increased from 146 ± 3 nmol/d to 172 ± 27 nmol/d (NS). Administration of the cyclooxygenase inhibitor indomethacin (20 mg/Kg/d) or hydrocortisone (50 mg/Kg/d) did not prevent the development of hypercalcemia. This model is similar to many patients with humoral hypercalcemia of malignancy who demonstrate suppression of parathyroid hormone with elevated urinary cyclic AMP excretion and may prove useful in the understanding of the responsible mechanisms.