Comparison of Corticotrophin and Corticosteroid Response to Lysine Vasopressin,Insulin, and Pyrogen in Man

Plasma corticotrophin (ACTH) and corticosteroid levels in response to lysine vasopressin (LVP), insulin hypoglycaemia, and pyrogen have been compared in seven subjects with normal pituitary adrenal function. Intramuscular vasopressin was a weak stimulus to corticotrophin release, peak values lying within the range 49 to 141 pg/ml. Insulin hypoglycaemia consistently caused a more noticeable increase, with peak levels between 114 and 364 pg/ml, while pyrogen was the most powerful, corticotrophin levels rising to between 209 and 1,725 pg/ml. Peak plasma corticosteroid levels showed less pronounced differences between the three tests, and correlated poorly with peak ACTH levels. Thus, relatively small acute changes in corticotrophin levels produce near-maximal adrenal stimulation. Under these conditions, plasma corticosteroid measurements do not accurately reflect circulating corticotrophin levels. These findings help to explain the physiological basis of several observations on the corticosteroid responses to these clinical test procedures.     

Comparison of Effects of Long-term Corticotrophin and Corticosteroid Treatment on Responses of Plasma Growth Hormone,ACTH, and Corticosteroid to Hypoglycaemia

The development of the highly sensitive cytochemical bioassay for ACTH has permitted the measurement of plasma ACTH levels during the insulin hypoglycaemia test (I.H.T.) in patients treated with corticosteroids and corticotrophin. The ACTH, corticosteroid, and growth hormone (GH) responses in the I.H.T. were measured in three groups of 12 rheumatoid arthritis patients. One group was receiving long-term corticotrophin treatment, the second was undergoing long-term corticosteroid treatment, and the third had never received systemic hormone therapy. The increments in plasma ACTH, corticosteroids, and GH were diminished in the corticosteroid-treated group, as were increments in plasma GH and ACTH in the corticotrophin-treated group; but in this group the corticosteroid increment was normal. Examination of the area under the curve of the ACTH response showed that the total amount of ACTH secreted was normal though the rate of secretion was reduced. In the corticosteroid-treated group both rate and total secretion were diminished.     

Assessment of Long-acting Synthetic Corticotrophin in Hypersensitive Asthmatics and Normal Subjects

The synthetic polypeptide depot-tetracosactrin (Synacthen-Depot) was given to nine steroid-treated asthmatic patients hypersensitive to animal corticotrophin. Eight had a satisfactory increase in plasma and urinary 17-hydroxycorticosteroids (17-OHCS). The remaining patient had been shown previously to have adrenal suppression. None of the patients developed allergic reactions to depot-tetracosactrin, and seven have been receiving regular injections of the polypeptide twice weekly for the past eight months.In 13 normal subjects intramuscular injections of 1 mg. and 0.5 mg. of depot-tetracosactrin and 40 units of corticotrophin-gel were equally potent in raising the plasma 17-OHCS, but depot-tetracosactrin had a significantly longer action than corticotrophin-gel.     

Cortisol and Growth Hormone Secretion in Relation to Linear Growth: Patients with Still's Disease on Different Therapeutic Regimens

Linear growth was studied in 20 children suffering from Still''s disease on various treatment regimens, and their ability to secrete growth hormone and cortisol was investigated. Growth recovered on reducing daily corticosteroid therapy or on changing to an alternative regimen. Retardation of growth was not due to an absolute inability to secrete growth hormone. Basal plasma cortisol levels and the plasma cortisol response to hypoglycaemia were reduced in patients on daily steroid therapy, but patients on alternate-day prednisone did not differ significantly in this respect from those on non-steroid regimens. Those on alternate-day corticotrophin showed preservation of the circadian rhythm but a subnormal response to hypoglycaemia.     

Influence of amphetamines on plasma corticosteroid and growth hormone levels in man

Plasma fluorogenic corticosteroid and immunoreactive growth hormone levels rose significantly after the intravenous administration of methylamphetamine to healthy young men at various times of the day. The rise in corticosteroids was most pronounced in the evening and was accompanied by an increase in circulating levels of immunoreactive corticotrophin. Oral dexamphetamine also resulted in significant rises in plasma corticosteroids but not in growth hormone. These hormonal changes were accompanied by evidence of mild central stimulation. Though they may be part of an associated and non-specific response, it is more likely that they represent specific effects of amphetamines on centres in the hypothalamus or midbrain controlling secretion of corticotrophin and growth hormone releasing factors.     

Intermittent corticotrophin treatment: Ventilatory tests in asthmatic subjects

Ventilatory tests (F.E.V.₁/F.V.C.) have been studied in 16 asthmatic subjects during intermittent administration of corticotrophin, and the responses correlated with the plasma cortisol levels. The improvement in respiratory function was found to last for a longer period than the enhanced adrenocortical activity.     

Benign Intracranial Hypertension following Corticosteroid Withdrawal in Childhood

In an 18-month period seven children who were treated for a variety of neurological and non-neurological diseases, and in whom the corticosteroid or corticotrophin dosage was reduced, developed a syndrome indistinguishable from “benign intracranial hypertension.” The total duration and rate of reduction of corticosteroid dosage and perhaps an underlying susceptibility to cerebral oedema appear to be important factors in this syndrome. Usually patients can be treated without the need for special neuroradiological studies. Possibly mild forms of this condition are not uncommon, but its pathogenesis is still uncertain.     

Adrenocortical and thyroid systems of rats at the initial stage of nociceptive influence

There are two phases in the initial period of formation of adrenocortical response to sharp nociceptive influence. The first phase (within 10-15 sec.) involves emergency mobilization of "basal" reserves of hormone active substances. It is characterized by reduction of corticoliberine activity in hypothalamic and extrahypothalamic structures of the rat brain with a parallel increase of corticotrophin concentration in plasma, devastation of corticosteroid reserves in adrenal glands; a decrease in the level of corticosteroids in blood against the background of accumulating hormone in bodies-targets. In the second phace: the phase of hypercompensation, the progressive increase of credit of the substances under study was quite obvious. The authentic changes in a level of aldosterone in adrenal glands and blood took place only in 2.5 minutes after the stress. The nociceptive influence was also biphasic when acting upon the reorganization of thyroid status number. However, unlike the initial adrenocortical response to stress in the first phase of thyroid reaction, the elevation of plasma thyroxine and tri-iodothyronine level was obvious. At the second stage, selective decrease in concentration of thyroxine to normal amounts occurred.     

Comparison of depot tetracosactrin and corticotrophin gel

Depot tetracosactrin has been compared with corticotrophin gel in 12 inpatients of a rheumatic diseases unit Every patient received one subcutaneous infection each of the synthetic and the animal preparation, with serial measurements of plasma 11-hydroxycorticosteroids, 12-hourly urinary 11-hydroxycorticosteroids, and 17-oxogenic steroids. The duration of action of the depot tetracosactrin was virtually twice that of corticotrophin gel, the dose relationship being about 0·25 mg. of depot tetracosactrin to 50 units of gel. Local reaction to the injection of depot tetracosactrin was relatively frequent.     

Flow cytometrical determination of regulatory cytokines (IL-10, IL-12) and circulating dendritic cell cytokines in allergic asthmatic children

Interleukin (IL)-10 and IL-12 have been suggested to be key regulators in the pathogenesis of allergic asthma. Several of the secretion products of dendritic cells (DC), such as IL-12, IL-10, IL-1beta and TNF-alpha, are considered to play a role in allergic asthma. This study compares the production of IL-10 and IL-12 in allergic asthmatic children (n = 17) and controls (n = 14) by measuring their extracellular secretion in whole blood samples after stimulation, using a microsphere-based immunoassay. Additionally, we assessed intracellular production of IL-1beta, TNF-alpha, IL-12 and IL-10 by circulating DC in stimulated whole blood samples of asthmatic and healthy children. The concentration of IL-10 in the supernatants of LPS-stimulated whole blood was significantly lower in allergic asthmatic children as compared to healthy children (463 (207-768) vs 881 (364-2626) pg/mL; p = 0.005). When a combined LPS and IFN-gamma stimulation was used, IL-10 production decreased significantly as compared to LPS alone, especially in healthy children. Consequently, no difference in IL-10 production after LPS/IFN-gamma stimulation was found between healthy and allergic children. In contrast to isolated LPS stimulation, stimulation with LPS/IFN-gamma induced higher IL-12 production; allergic asthmatic children showed a significantly lower IL-12 secretion after LPS/IFN-gamma stimulation as compared to healthy children (20 (5-247) vs 208 (7-775) pg/mL; p=0.03). Moreover, the number of IL-12 producing CD11c-positive DC (DC1) tended to be lower in asthmatic children compared to healthy children (0.05 (0.00-0.45) vs 0.27 (0.00-0.83) 10(6)/L) and correlated with the extracellular release of IL-12 in asthmatic children (r = 0.65; p = 0.016). The number of IL-1beta and TNF-alpha producing CD11c-positive DC (DC1) was comparable between healthy and asthmatic children. We hypothesize that the decreased production of IL-10 and IL-12 is responsible for Th2 polarized responses in allergic asthmatic children.     

Ability of human plasma to inhibit prostaglandin F2 alpha in asthma

Human plasma has been reported to inhibit the conversion of arachidonic acid into prostaglandin (PG) E2 and PGF2 alpha. In the present study the plasma inhibitory activity was determined in three groups (16 each) of plasma obtained from normal healthy volunteers, treated asthmatics and untreated asthmatic patients. The result showed that plasma from all three groups were equally effective in inhibiting the biosynthesis of PGE2. Plasma of normal volunteers and treated asthmatics also inhibited PGF2 alpha biosynthesis. In contrast the plasma obtained from untreated asthmatics was considerably less active in inhibiting the biosynthesis of PGF2 alpha than plasma from the other two groups.     

Galectin-7在哮喘儿童支气管黏膜中的表达及对支气管上皮细胞凋亡的影响

目的:探讨半乳糖凝集素-7(Galectin-7)在哮喘儿童支气管黏膜中的表达及对支气管上皮细胞凋亡的影响。方法:收集哮喘儿童支气管黏膜及支气管扩张非哮喘儿童支气管黏膜,Western blot检测其Galectin-7的表达。体外培养人支气管上皮细胞,分为正常组、对照组、感染组和实验组,正常组用正常的人支气管上皮细胞,对照组细胞用转染siRNA control后的人支气管上皮细胞,感染组细胞用RSV感染后的人支气管上皮细胞,实验组细胞为RSV感染后并转染siRNA Galectin-7的人支气管上皮细胞。培养24 h后,检测各组细胞中Galectin-7蛋白表达,并采用流式细胞术检测各组细胞的凋亡情况,Western blot检测细胞中Bcl-2、Bax、STAT3、p-STAT3蛋白的表达。结果:哮喘儿童支气管黏膜中Galectin-7的表达明显高于非哮喘儿童支气管黏膜组织(P0.01)。正常组和对照组Galectin-7水平比较差异无统计学意义(P0.05),感染组Galectin-7、Bax表达和细胞凋亡率均明显高于正常组,而Bcl-2、p-STAT3的表达均明显低于正常组(P0.01),实验组Galectin-7、Bax表达和细胞凋亡率明显低于感染组,而Bcl-2、p-STAT3的表达均明显高于感染组(P0.01)。结论:Galectin-7在哮喘儿童支气管黏膜中表达上调,可能通过活化STAT3,促进支气管上皮细胞凋亡。     

Modification of Plasma Corticosteroid Concentrations during and after Surgery by Epidural Blockade

The adrenocortical response to major surgery was assessed by the measurement of plasma corticosteroid concentrations in patients receiving either a general anaesthetic alone or in combination with an epidural block. The expected increase in plasma corticosteroid concentration seen in the general anaesthesia group was significantly inhibited by epidural block. The inhibition was related to the duration of the epidural block. The lack of the normal adrenocortical response to surgery was not associated with cardiovascular collapse and indeed did not seem detrimental in any way. These findings question the need for corticosteroid “cover” for the stress of surgery in patients who have been taking corticosteroid drugs.     

Hyperlipidaemia in Asthmatic Patients Receiving Long-term Steroid Therapy

Plasma lipids were measured in 100 female asthmatic patients receiving long-term steroid therapy. A significant increase in the incidence of endogenous hypertriglyceridaemia but not of hypercholesterolaemia was found. The hypertriglyceridaemia was not due to obesity or diabetes. Neither the dose of steroid, duration of therapy, nor the addition of corticotrophin gel or depot tetracosactrin influenced the prevalence of hypertriglyceridaemia.     

A case of histiocytosis X associated with panhypopituitarism and hyperimmunoglobulinemia G and E.

A 43 year old man with diabetes insipidus who showed panhypopituitarism and marked hypergammaglobulinemia due to histiocytosis X is reported. His low basal plasma adrenocorticotropin (ACTH) and growth hormone (GH) failed to respond to insulin-induced hypoglycemia. His basal serum thyroid hormone level was below normal and normal basal plasma thyrotropin (TSH) showed a delayed response with normal peak value to TSH-releasing hormone (TRH). Normal basal plasma pituitary gonadotropin also showed a delayed response with normal peak value to luteinizing hormone-releasing hormone (LH-RH). Suppression of plasma prolactin (PRL) by levodopa (l-dopa) was impaired and elevation of basal plasma PRL was noted at the second admission. These results, combined with diabetes insipidus, suggested that the panhypopituitarism in these patients was hypothalamic in origin. The polyclonal hypergammaglobulinemia was characterized by elevated serum IgG and IgE levels which returned to normal after corticosteroid treatment with concomitant clinical improvement. Elevated serum IgE levels, tissue and peripheral eosinophilia, and the effectiveness of corticosteroid therapy support the hypothesis that some allergic mechanism may be involved in the pathogenesis of this disease.     

MicroRNA Expression Profiling in Mild Asthmatic Human Airways and Effect of Corticosteroid Therapy

Background

Asthma is a common disease characterised by reversible airflow obstruction, bronchial hyperresponsiveness and chronic inflammation, which is commonly treated using corticosteroids such as budesonide. MicroRNAs (miRNAs) are a recently identified family of non-protein encoding genes that regulate protein translation by a mechanism entitled RNA interference. Previous studies have shown lung-specific miRNA expression profiles, although their importance in regulating gene expression is unresolved. We determined whether miRNA expression was differentially expressed in mild asthma and the effect of corticosteroid treatment.

Methodology/Principal Findings

We have examined changes in miRNA using a highly sensitive RT-PCR based approach to measure the expression of 227 miRNAs in airway biopsies obtained from normal and mild asthmatic patients. We have also determined whether the anti-inflammatory action of corticosteroids are mediated through miRNAs by determining the profile of miRNA expression in mild asthmatics, before and following 1 month twice daily treatment with inhaled budesonide. Furthermore, we have analysed the expression of miRNAs from individual cell populations from the airway and lung.We found no significant difference in the expression of 227 miRNAs in the airway biopsies obtained from normal and mild asthmatic patients. In addition, despite improved lung function, we found no significant difference in the miRNA expression following one month treatment with the corticosteroid, budesonide. However, analysis of bronchial and alveolar epithelial cells, airway smooth muscle cells, alveolar macrophages and lung fibroblasts demonstrate a miRNA expression profile that is specific to individual cell types and demonstrates the complex cellular heterogeneity within whole tissue samples.

Conclusions

Changes in miRNA expression do not appear to be involved in the development of a mild asthmatic phenotype or in the anti-inflammatory action of the corticosteroid budesonide.     

Exhaled nitric oxide and clinical phenotypes of childhood asthma

Whether exhaled NO helps to identify a specific phenotype of asthmatic patients remains debated. Our aims were to evaluate whether exhaled NO (FENO_0.05) is independently associated (1) with underlying pathophysiological characteristics of asthma such as airway tone (bronchodilator response) and airway inflammation (inhaled corticosteroid [ICS]-dependant inflammation), and (2) with clinical phenotypes of asthma.We performed multivariate (exhaled NO as dependent variable) and k-means cluster analyses in a population of 169 asthmatic children (age ± SD: 10.5 ± 2.6 years) recruited in a monocenter cohort that was characterized in a cross-sectional design using 28 parameters describing potentially different asthma domains: atopy, environment (tobacco), control, exacerbations, treatment (inhaled corticosteroid and long-acting bronchodilator agonist), and lung function (airway architecture and tone).Two subject-related characteristics (height and atopy) and two disease-related characteristics (bronchodilator response and ICS dose > 200 μg/d) explained 36% of exhaled NO variance. Nine domains were isolated using principal component analysis. Four clusters were further identified: cluster 1 (47%): boys, unexposed to tobacco, with well-controlled asthma; cluster 2 (26%): girls, unexposed to tobacco, with well-controlled asthma; cluster 3 (6%): girls or boys, unexposed to tobacco, with uncontrolled asthma associated with increased airway tone, and cluster 4 (21%): girls or boys, exposed to parental smoking, with small airway to lung size ratio and uncontrolled asthma. FENO_0.05 was not different in these four clusters.In conclusion, FENO_0.05 is independently linked to two pathophysiological characteristics of asthma (ICS-dependant inflammation and bronchomotor tone) but does not help to identify a clinically relevant phenotype of asthmatic children.     

Increased activity of 5-lipoxygenase in polymorphonuclear leukocytes from asthmatic patients

The formation of 5-lipoxygenase products of arachidonic acid, 5-HETE and 5,12-diHETE, was determined in 100,000 X g supernatant of polymorphonuclear leukocytes from 17 healthy subjects, 17 patients with extrinsic asthma and 15 patients with intrinsic asthma. After the supernatant was incubated with 14C-arachidonic acid in the presence of calcium and indomethacin, the lipoxygenase products of arachidonic acid were separated by thin layer chromatography. The results were expressed as the percentage conversion of 14C-arachidonic acid into the product per 10(7) cells. The formation of 5,12-diHETE, but not of 5-HETE, was significantly increased in the cells from the group of patients with extrinsic asthma (4.38 +/- 0.78%, mean +/- S.E.; p less than 0.01) and intrinsic asthma (6.09 +/- 1.11%; p less than 0.01), when compared to normal subjects (1.74 +/- 0.30%). Both extrinsic and intrinsic asthmatics had significantly enhanced 5-lipoxygenase activity, which was expressed as the sum of percentage conversion of 14C-arachidonic acid into 5-HETE and 5,12-diHETE. The percentage conversion in normal subjects was 4.19 +/- 0.39%, 6.24 +/- 0.84% for 17 patients with extrinsic asthma (p less than 0.05), and 8.59 +/- 1.29% for 15 patients with intrinsic asthma (p less than 0.01). There was no significant difference between these asthmatic groups. These results indicate that 5-lipoxygenase activity is increased in patients with bronchial asthma.     

Inhaled corticosteroid use is associated with increased circulating T regulatory cells in children with asthma

Background

T regulatory (Treg) cells are important in balancing immune responses and dysregulation of Treg cells has been implicated in the pathogenesis of multiple disease states including asthma. In this study, our primary aim was to determine Treg cell frequency in the peripheral blood of children with and without asthma. The secondary aim was to explore the association between Treg cell frequency with allergen sensitization, disease severity and medication use.

Methods

Peripheral blood mononuclear cells from healthy control subjects (N?=?93) and asthmatic children of varying disease severity (N?=?66) were characterized by multi-parameter flow cytometry.

Results

Our findings demonstrate that children with asthma had a significantly increased frequency of Treg cells compared to children without asthma. Using a multivariate model, increased Treg cell frequency in children with asthma was most directly associated with inhaled corticosteroid use, and not asthma severity, allergic sensitization, or atopic status of the asthma.

Conclusion

We conclude that low dose, local airway administration of corticosteroids is sufficient to impact the frequency of Treg cells in the peripheral blood. These data highlight the importance of considering medication exposure when studying Treg cells and suggest inhaled corticosteroid use in asthmatics may improve disease control through increased Treg cell frequency.     

维吾尔药神香草调节哮喘大鼠下丘脑-垂体-肾上腺轴功能紊乱的实验研究

目的：观察维吾尔药（维药）神香草对哮喘大鼠模型神经内分泌免疫网络若干组分的影响。方法：取雄性健康Wistar大鼠50只,随机分为正常对照组,哮喘模型组,神香草低、中、高剂量治疗组。采用致敏和雾化的方法制备哮喘模型。采用酶联免疫吸附试验（ELISA）方法检测血清中白介素-4（IL^4）、白介素-6（IL-6）、干扰素-γ（IFN-γ）、皮质酮（CORT）水平;放免法检测血浆中促肾上腺皮质激素（ACTH）的含量;采用实时定量-聚合酶链反应（RT—PCR）法测定下丘脑促肾上腺皮质激素释放激素（CRH）mRNA表达水平。结果：哮喘反复发作时,大鼠下丘脑-垂体-肾上腺（HPA）轴紊乱,哮喘大鼠下丘脑CRHmRNA表达和血浆ACTH无明显变化,实验各组血清CORT水平升高（P〈0．05）,神香草高剂量组血清CORT含量高于低剂量组（P〈0．05）。细胞因子IFN-γ无明显变化,IL-6、IL-4有下降趋势（P〈0．05）。结论：哮喘反复发作的大鼠存在NEI网络的紊乱;神香草可以增强下丘脑．垂体．肾上腺皮质（HPA）轴的功能,改善细胞因子的平衡。这些可能是其治疗哮喘的机制之一。