Central and peripheral components of dermorphin's effect on rat intestinal propulsion in comparison to morphine

Dermorphin, injected intracerebroventricularly (ICV) to rats, provokes, like to morphine, an inhibition of intestinal propulsion linearly related to the log of the administered doses (in the range from 0.06 to 0.56 μg/rat), but it is 143 times more active than morphine. Naloxone, ICV or IP, antagonizes dermorphin less effectively than morphine. Quaternary naloxone ICV administered antagonizes the intestinal effect of ICV dermorphin, while IP administered it is not effective until 8 mg/kg. The dose of dermorphin maximally active by the ICV route (0.56 μg/rat) is completely inactive when injected IP. Increasing doses of dermorphin IP (from 12 to 6400 μg/kg) inhibit intestinal propulsion to the same extent irrespectively of the doses employed, but never by more than 50%. Only a high dose of naloxone (30 mg/kg/IP) antagonizes this IP effect. The central and peripheral components of this intestinal effect of dermorphin are discussed.     

Effect of naloxone in hypotension caused by acute blood loss in Papio hamadryas baboons

Naloxone or physiological solution were injected in different doses to 11 baboons (Papio hamadryas) weighing 7-8 kg after bloodletting in a volume of 40% of the total amount of the blood. Naloxone effectively raised (in all the doses) the arterial blood pressure which dropped after bloodletting. The action of naloxone injected in small doses was more pronounced and had unique time parameters. Besides, the respiratory rate was also increased. Injection of nalorphine in a dose of 1 mg/kg produced a similar but a more demonstrable action as compared with naloxone in a dose of 1 mg/kg. A conclusion is made about the possibility of using the antagonists of opioid peptides on a clinical basis for the treatment of shock conditions. An assumption of an inconclusive role played by the subtypes of opiate receptors in the formation of shock conditions is also confirmed.     

Effect of different doses of naloxone on the course of hemorrhagic shock in rats

Experiments on 52 Wistar rats were made to induce hemorrhagic shock by exemption of 40% blood from the jugular vein, which was followed by intravenous injection of either physiological solution or naloxone in doses of 0.4 and 1 mg/kg. Naloxone in a dose of 1 mg/kg was found to improve the animals' status as compared with the control (injection of physiological solution). On the contrary, injection of naloxone in a dose of 0.4 mg/kg led to the deterioration of the animals' status. Based on these data it is suggested that different opiate receptors play an inconclusive role in the development and progress of hemorrhagic shock induced by acute hemorrhage.     

The effect of naloxone on blood pressure, heart rate, plasma catecholamines, renin activity and aldosterone following exercise in healthy males

There is evidence that endogenous opioids are involved in blood pressure regulation. In the present study the effect of naloxone on the cardiovascular, sympathoadrenomedullary and renin-aldosterone response to physical exercise was investigated in 8 healthy males. Each subject performed a submaximal work test twice, i.e. with and without naloxone. The test consisted of ergometer bicycling for 10 minutes on 50% of the maximal working capacity (MWC), immediately followed by 10 min on 80% of MWC. Ten minutes before exercise the subjects received in a single blind randomized order a bolus dose of naloxone (100 micrograms/kg) or a corresponding volume of the preservatives of the naloxone preparation (control) followed by a slow infusion of naloxone (50 micrograms/kg/h) or preservatives, respectively. Naloxone was without effect on the exercise-induced changes in systolic blood pressure, heart rate, plasma noradrenaline, renin activity and aldosterone, but the adrenaline response increased markedly. The present results indicate that opioid receptors are involved in the plasma adrenaline response to submaximal exercise, but not in the regulation of systolic blood pressure, heart rate, plasma noradrenaline, renin activity and plasma aldosterone.     

Naloxone pretreatment prevents the bloody diarrhea of canine endotoxic shock

We examined the importance of timing with endorphin involvement in shock by giving the opiate receptor antagonist naloxone as a pretreatment in canine endotoxic shock. Dogs anesthetized with pentobarbital (30 mg/kg iv) were given Escherichia coli endotoxin at LD80 doses iv. Naloxone (2 mg/kg plus 2 mg/kg/hr iv, N = 10) started 15 min before endotoxin attenuated the fall in mean arterial pressure, cardiac index, and the first derivative of left ventricular pressure due to endotoxin in comparison with control animals given 0.9% NaCl (N = 10). Naloxone attenuated the endotoxin-induced decrease in superior mesenteric arterial blood flow and the increases in portal venous pressure and pulmonary arterial pressures. Moreover, naloxone pretreatment prevented the characteristic bloody diarrhea and reduced mortality. Our findings implicate endorphins acting on opiate receptors as important mediators of endotoxin-induced cardiovascular failure and bloody diarrhea in canine endotoxemia. These are early manifestations and dictate expeditious use of naloxone in endotoxic shock.     

Changes in morphine self-administration in rats induced by prostaglandin E1 and naloxone

Interactions of prostaglandin E₁ (PGE₁) with morphine have been reported in several test systems and an hypothesis has been advanced for a role of prostaglandins in morphine analgesia and physical dependence. In rats self-administering morphine intravenously, a simultaneous and continuous infusion of naloxone hydrochloride at 56 to 560 μg/kg/day caused the expected increase in injection rate for morphine. Infusion of PGE₁ by itself at 56 or 180 μg/kg/day had no effect on the rate of morphine intake. Likewise the addition of PGE₁ at 180 μg/kg/day did not potentiate the increase caused by naloxone (56 or 180 μg/kg/day) when it was added to the naloxone infusion. These results do not support a role for prostaglandins in the behavioral aspects of morphine addiction. However, larger doses of PGE₁ (1 and 1.8 mg/kg/day), which were without overt effects in normal rats, caused severe and incapacitating prostration in morphinized rats.     

Plasma cortisol and catecholamine responses to intracerebroventricular administration of CRF to rhesus monkeys

Synthetic ovine corticotropin releasing factor (CRF) was administered directly into the 4th ventricle of rhesus monkeys. A dose dependent increase in plasma cortisol was observed following 10 μg/kg, 20 μg/kg, and 60 μg/kg of CRF. Increases in plasma epinephrine were also evident following the highest dose of CRF. Plasma norepinephrine, mean arterial pressure, and heart rate did not increase significantly following CRF administration. These data suggest that in the rhesus monkey, central administration of ovine CRF leads to activation of the pituitary-adrenocortical axis at doses that do not raise plasma catecholamines.     

Sodium 5-(3′-pyridinylmethyl)benzofuran-2-carboxylate (U-63557A), a new,selective thromboxane synthase inhibitor: Intravenous and oral pharmacokintics in dogs and correlations with exsitu thromboxane B2 production

The pharmacokinetics of a new, selective thromboxane synthase inhibitor, sodium 5-(3′-pyridinylmethyl)benzofuran-2-carboxylate were determined for single dose, bolus intravenous injections (1, 3, and 10 mg/kg); for continuous 24 hr infusions (10 and 30 μg/kg/min); and for oral doses of gelatin encapsulated powdered drug (3, 10, and 30 mg/kg). Drug disappeared biexponentially after intravenous administration, and plasma concentrations were proportional to the dose. Absorption of drug occurred rapidly after its oral administration; peak plasma levels occurred 1–2 hours after ingestion, and circulating drug was detectable within 30 minutes. For all experiments, inhibition of cellular thromboxane B₂ production, $\text{ex situ}$, corresponded with plasma drug levels and its reactivation corresponded with disappearance of the drug indicating that it was not accumulated by platelets.     

Continuous Subcutaneous Pramlintide Infusion Therapy In Patients With Type 1 Diabetes: Observations From A Pilot Study

ObjectiveTo investigate the efficacy and safety of continuous (basal-bolus) subcutaneous pramlintide infusion (CSPI) in patients with type 1 diabetes mellitus.MethodsA 16-week, open-label, single-arm pilot study enrolled 11 patients (mean ± SD values: age, 39.9 ± 4.0 years; hemoglobin A1c, 8.20% ± 0.60%; weight, 92.3 ± 18.4 kg; body mass index, 29.7 ± 5.1 kg/m²) with longterm type 1 diabetes mellitus (20.7 ± 1.3 years; duration of pump therapy, 9.5 ± 6.0 years). Pramlintide basal infusion was begun with continuous subcutaneous infusion at 9 μg/h. After 3 days, premeal bolus doses of pramlintide were initiated at 15 μg and titrated to 60 μg per meal. Basal and bolus insulin doses were reduced 10% on initiation of CSPI and adjusted thereafter as needed to prevent hypoglycemia.ResultsAfter 16 weeks of pramlintide therapy, mean ± SD hemoglobin A1c decreased to 7.85% ± 0.74% (-0.35%). The fasting glucose level declined from 198.2 ± 66.9 mg/dL to 135.8 ± 63.9 mg/dL. The mean weight decreased to 91.8 ± 20.1 kg (-0.5 kg) at week 12. The daily bolus insulin requirement decreased 20%; daily basal insulin was unchanged (27.7 ± 11.7 U). All patients experienced mild postprandial hypoglycemia, but no severe hypoglycemia was reported. Three of the 11 study participants experienced mild initial nausea, but all patients successfully titrated bolus doses to 60 μg within 3 weeks.ConclusionIn this pilot study of 11 patients with type 1 diabetes using insulin pumps, CSPI seemed safe and well tolerated, did not alter pramlintide pharmacokinetic variables, and reduced fasting glucose levels. Larger studies of this method for pramlintide administration seem warranted. (Endocr Pract. 2009;15:689-695)     

Effects of high doses of selenium,as sodium selenite,in septic shock patients a placebo-controlled,randomized, double-blind,multi-center phase II study – Selenium and sepsis

Selenium has a double action. (i) Seleno-compounds, among them sodium selenite have a direct pro-oxidant action leading to acute toxicity but may be also beneficial as drug. (ii) Selenium is an essential anti-oxidant required for anti-oxidant seleno-enzymes. Septic shock is a common severe syndrome leading to endothelium damage and multiple organ failure, with increased data suggesting the principle role of oxidative stress. Selenoprotein P, main selenium constituent of the plasma, may decrease dramatically and specifically in septic shock patients and may be involved in the endothelium protection. A prospective, multi-center placebo-controlled, randomized, double-blind study in severe septic shock patients with documented infection has been preformed. Patients received, for 10 days, selenium as sodium selenite (4000 μg on the first day, 1000 μg/day on the 9 following days) or matching placebo using continuous intravenous infusion. Mortality rates did not significantly differ between groups at any time point. Adverse events rates were similar in the two groups. However, high-dose selenium administration has been associated with a tendency to decrease the mortality in septic shock animal and patients, especially when using a bolus administration, whereas studies using a continuous administration failed to find any benefit on mortality. The interest of the successive use of pro-oxidant action of seleno-compounds, followed by anti-oxidant action need to be the further studied in cellular and animal models, preceding new dose–effect phase II. The interest of the selenoprotein-P as a marker of septic shock and for endothelium protection needs also to be studied further.     

Anti-shock effect of pituitary adenylate cyclase activating polypeptide (PACAP) on experimental endotoxin shock in dogs

Effects of pituitary adenylate cyclase activating polypeptide with 38 amino acid residues (PACAP-38) on both cardiovascular functions and plasma hormone levels during endotoxin shock were studied in anesthesized dogs. When PACAP-38 (a bolus 420 pmol/kg injection or a bolus 420 pmol/kg injection followed by a continuous 30 pmol/kg/min infusion for 60 min) was administered intravenously 5 min after application of endotoxin, both mean arterial pressure and cardiac output were restored at 10 min. The continuous administration of PACAP-38 was more effective in improving the symptoms of shock. Plasma adrenalin and cortisol levels were significantly increased by both regimens. These results clearly indicate that the anti-shock properties of PACAP-38 may be attributed to its abilities to increase plasma cortisol and adrenalin levels and to stimulate cardiac function.     

The central effects of morphine on fetal breathing movements in the fetal sheep

The fetal respiratory and electrocortical effects of 0.6 microgram to 600 micrograms of morphine, administered into the lateral cerebral ventricle, have been studied in chronically catheterised, unanaesthetized fetal sheep at 115-135 days gestation. Morphine at 0.6 microgram had no effect on breathing movements or electrocorticographic activity, and at 6 micrograms induced a period of apnoea (43-122 min) but had no effect on electrocortical activity. Intravenous naloxone (2 mg bolus and infusion of 2 mg/kg/h for 2 h) to the fetus had no effect on this apnoea. Morphine at 60 micrograms induced an initial period of apnoea (30-65 min) followed by episodic but significantly deep breathing movements with no effect on electrocortical activity and at 600 micrograms induced an initial period of apnoea (22-95 min) which was followed by deep, irregular and continuous (126-302 min) breathing movements. During the apnoea electrocortical activity initially remained cyclic, but as apnoea progressed there was a gradual reduction in the voltage of the electrocorticogram to a low voltage state. Intravenous naloxone (2 mg bolus and infusion of 2 mg/kg/h for 2 h) reversed both the respiratory and electrocortical effects. The hyperventilation was also inhibited by hypoxia. Naloxone alone had no effect on fetal breathing activity.     

The cardiovascular pharmacology of prostacyclin (PGI2) in the rat

Physiological roles have been suggested for prostacyclin in the cardiovascular system. Prostacyclin was administered by intravenous infusion to unanesthetized rats. Over a 24 hr period, 0.32 mg/kg/day caused only flushing of the ears. Larger doses (0.56 and 1 mg/kg/day) caused hypothermia, behavioral depression, and swelling of the paws. Cumulative dose-response curves for its depressor action were determined in both unanesthetized and anesthetized, vagotimized, ganglion-blocked rats. In unanesthetized rats, the threshold dose was about 0.1 μg/kg/min. Respiratory depression precluded doses larger than 1 μg/kg/min. In anesthetized rats, the threshold dose was about 0.001 μg/kg/min, and the maximally effective dose was about 0.1 μg/kg/min. At 0.032 μg/kg/min, blood pressure first fell and then rose slightly. This compensatory rise did not occur in nephrectomized rats, suggesting renin release as the mechanism. Intravenous infusion of 0.1 but not 0.01 μg/kg/min in unanesthetized rats doubled plasma renin activity. In saline-loaded unanesthetized rats, urine volume and urinary sodium excretion were decreased by 0.1 μg/kg/min of prostacyclin.     

Effect of graded doses of naloxone on renal function in canine hemorrhagic shock.

All the parameters of renal function (inulin clearance, para amino hippuric acid clearance and urine flow) which were depressed during experimentally induced hemorrhagic shock in dogs improved significantly in addition to improvement in mean arterial pressure (MAP) after bolus administration (iv) of 1 or 2 mg/kg naloxone. A smaller dose (0.5 mg/kg) of naloxone, however, did not improve the renal function. Even renal arterial injection of the same dose of naloxone showed no improvement in the renal function. In both these cases the improvement in the MAP was significantly less as compared to other groups of animals which received 1 or 2 mg/kg naloxone. It may be concluded that (a) naloxone at doses of 1 or 2 mg/kg improved the renal function by improving MAP and (b) naloxone has no direct action on renal vasculature.     

The influence of naloxone on barbiturate anesthesia and toxicity in the rat

In rats 1 mg/kg naloxone significantly delayed the development and decreased the duration of the loss of righting reflex caused by 35 mg/kg intraperitoneally, or subcutaneously administered pentobarbital or by the same dose of intraperitoneally injected methohexital. Naloxone also antagonized the toxicity of 50–125 mg/kg intraperitoneally administered pentobarbital and increased the LD50 of pentobarbital from 59.0 (50.0–69.6) to 101.1 (85.5–119.1) mg/kg. The findings of this study indicate that therapeutic trials with relatively large doses of naloxone are justifiable in patients intoxicated with barbiturates.     

Comparison of low and high dose cosyntropin stimulation tests in the diagnosis of adrenal insufficiency in septic shock patients

Stress situations such as septic shock are accompanied by activation of the HPA axis. Some patients do not activate this axis in stress situations. This blunted response is currently designated as critical illness-related corticosteroid insufficiency (CIRCI). Currently the 250 μg cosyntropin stimulation test is the preferred diagnostic test for CIRCI. Few papers explored the role of the 1 μg cosyntropin test in septic shock patients. In this study, we compared both tests in septic shock patients taking a special interest in the population with intermediary baseline cortisol. Prospective noninterventional study included 74 septic shock patients. After measurement of baseline cortisol all patients received 1 μg of cosyntropin i. v. and 4 h later 249 μg of cosyntropin. We compared the cortisol increase after each test and its relation to mortality and vasopressor therapy. There was a moderate correlation in response to low and high dose cosyntropin, r(s)=0.55. This correlation in patients with baseline cortisol between 10-34 μg/dl is, r(s)=0.67. The increase induced by both tests was equally accurate to identify mortality and time of vasopressor withdrawal. Low and high dose cosyntropin tests presented a moderate correlation in patients with baseline cortisol between 10-34 μg/dl. Both tests are equally accurate to identify mortality and time of vasopressor therapy. These results suggest that both tests could be used to diagnose CIRCI.     

Activation of central opioid receptors determines the timing of hypotension during acute hemorrhage-induced hypovolemia in conscious sheep

After an initial compensatory phase, hemorrhage reduces blood pressure due to a widespread reduction of sympathetic nerve activity (decompensatory phase). Here, we investigate the influence of intracerebroventricular naloxone (opioid-receptor antagonist) and morphine (opioid-receptor agonist) on the two phases of hemorrhage, central and peripheral hemodynamics, and release of vasopressin and renin in chronically instrumented conscious sheep. Adult ewes were bled (0.7 ml x kg(-1) x min(-1)) from a jugular vein until mean arterial blood pressure (MAP) reached 50 mmHg. Starting 30 min before and continuing until 60 min after hemorrhage, either artificial cerebrospinal fluid (aCSF), naloxone, or morphine was infused intracerebroventricularly. Naloxone (200 microg/min but not 20 or 2.0 microg/min) significantly increased the hemorrhage volume compared with aCSF (19.5 +/- 3.2 vs. 13.9 +/- 1.1 ml/kg). Naloxone also increased heart rate and cardiac index. Morphine (2.0 microg/min) increased femoral blood flow and decreased hemorrhage volume needed to reduce MAP to 50 mmHg (8.9 +/- 1.5 vs. 13.9 +/- 1.1 ml/kg). The effects of morphine were abolished by naloxone at 20 microg/min. It is concluded that the commencement of the decompensatory phase of hemorrhage in conscious sheep involves endogenous activation of central opioid receptors. The effective dose of morphine most likely activated mu-opioid receptors, but they appear not to have been responsible for initiating decompensation as 1) naloxone only inhibited an endogenous mechanism at a dose much higher than the effective dose of morphine, and 2) the effects of morphine were blocked by a dose of naloxone, which, by itself, did not delay the decompensatory phase.     

The influence of the inter-dose time interval on the cardiovascular response to methionine-enkephalin in the conscious dog

Intravenous injection of methionineenkephalin (10 μg/kg) into the conscious dog increased both heart rate and mean systemic arterial pressure. Progressive shortening of the inter-dose time interval from 5 min to 1 min and then to 30 sec did not alter the response, as the maximal mean systemic arterial pressure elevation was maintained and the maximal heart rate response increased slightly. In contrast to the results after discrete bolus dosing, continuous infusion of methionine-enkephalin at a constant rate of 10 μg/kg/min produced an initial elevation in heart rate and mean arterial pressure, but these parameters then began to return toward pretreatment levels despite continuous infusion at the same rate, indicating receptor desensitization. This desensitization pattern is most compatible with receptors of the nicotinic-cholinergic type. These data indicate the importance of dosing techniques in assessing cardiovascular responses to systemically administered enkephalins.     

Naloxone alters locomotion and interaction with environmental stimuli

Rats were injected with saline or naloxone (0.5, 5.0 or 25 mg/kg) and monitored for locomotion and both frequency and duration of contact with stimuli in a multicompartment exploratory chamber. Naloxone produced a dose-related reduction in locomotion and in frequency of contact with stimuli. At the lowest dose tested this reduction was accompanied by an increase in total duration of contact and in time spent per contact with the stimuli. In contrast, the highest dose of naloxone decreased the duration of contact with stimuli and induced prolonged periods of inactivity. An intermediate response was observed with 5.0 mg/kg naloxone. These results indicate that lower doses of naloxone may enhance interaction with environmental stimuli while the predominant effect of higher doses is a general suppression in behavioral activity. Similarities with the antimanic agent lithium chloride and possible clinical implications are discussed.     

The effect of opiate receptor ligands on emotional cardiovascular reactions in lower primates

Intravenous naloxone injection (0.1 mg/kg) facilitated blood pressure increase in response to conditioned sound stimulus followed by electrocutaneous shock in conscious chair-restrained baboons (Papio hamadryas). Naloxone at a dose of 1.0 mg/kg had an opposite effect and led to the decrease in blood pressure and heart rate in conditioned fear reflex. Naloxone microinjections (50 microM) into the periventricular hypothalamus led to a significant diminution of blood pressure and heart rate increment in response to electrocutaneous shock; naloxone microinjections into tractus solitarius nuclei suppressed blood pressure and heart rate reactions both to conditioned (sound) and unconditioned (electrocutaneous shock) stimuli. Microinjections of equimolar morphine quantities in these brain regions facilitated such reactions. It is concluded that endogenous opioid system participates in the formation of cardiovascular reactions to emotional stimuli in monkeys, with multiple opioid receptors of periventricular hypothalamus and tractus solitarius nuclei involved in the generation of such reactions.