Cerebral ischemia in gerbils: effects of acute and chronic treatment with adenosine A 2A receptor agonist and antagonist

AIMSTo investigate the effects of chronic administration of nitric oxide synthase inhibition on ocular blood flow and metabolic demand in the rat and to compare these effects with changes in...

Section Editors: Marc Fisher MD Antoni Davalos MD The Food and Drug Administration (FDA) evaluates applications for new human drugs, biologics, and complex medical devices. Companies must obtain FDA approval to legally market these products. In August, the FDA gave Concentric Medical clearance to market its Merci Retriever system to “remove blood clots from the brain in patients experiencing an ischemic stroke.” Given that the FDA is charged with “protecting the public health by assuring the safety, efficacy, and security of… biological products and medical devices…, ” “advancing public health by helping to speed innovations that make medicines … more effective, safer, and more affordable,” and “helping the public get the accurate, science-based information they need to use medicines … to improve their health,”1 the FDA’s decision to approve the Merci Retriever system is of concern. The pathways to approval are reviewed by Felten et al in the accompanying article and are outlined in Figure 1. Figure 1. Potential pathways for device approval. The decision to approve the Merci Retriever was based on data from the MERCI (Mechanical Embolus Removal in Cerebral Ischemia) Trial; the approval was granted through the 510(k) process. The Merci Retriever system includes a flexible nickel titanium (nitinol) wire that obtains a helical shape once it is passed through the tip of the guidance catheter. In practice, the catheter/wire is passed distal to the thrombus, the catheter is removed, and the helical configuration assumed by the wire; the clot is then trapped in the helix and withdrawn from the vasculature (Figure 2). The 510(k) clearance means that the Merci Retriever was felt to be substantially equivalent to a predicate device. In this case, the predicate device was the Concentric Retriever, which itself received 510(k) clearance by the FDA in May 2001 for “use in …

5-HT 1A receptor antagonists and lordosis behavior

See related article, pages 2540-2545. Animal models have shown that cholesterol-lowering therapy with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (commonly called statins) may augment absolute cerebral blood flow (CBF) by enhancing nitric oxide synthase (eNOS).1 Statins upregulate type III endothelial eNOS in thrombocytes, decrease platelet activation, and protect from cerebral ischemia in normocholesterolemic mice.2 Statins may also provide additional beneficial effects by upregulating endogenous tissue plasminogen activator and enhancing clot lysis in a mouse model of embolic focal ischemia.3 Statins given 24 hours after experimental ischemia can enhance CBF, angiogenesis, neurogenesis and sinaptogenesis.4 How can these findings be applied in the clinical setting? A meta-analysis of published clinical trials showed that low-density lipoprotein–lowering with statins may decrease the risk of stroke in diabetic or hypertensive patients with normal low-density lipoprotein cholesterol at baseline, and in patients with coronary artery disease, with respectively 48%, 27% and 25% reduction in stroke incidence.5 Does any relationship exist among statins and cerebral vasomotor reactivity? Functional transcranial Doppler (TCD) ultrasonography permits the assessment of cognitively induced CBF velocity changes6 and the evaluation of cerebral vasomotor reactivity.7 TCD can be used to reliably evaluate age-related changes in the physiological response of the human cerebral circulation. A diminished nitric oxide–mediated cerebral vasomotor response may exist in aging subjects and in patients with vascular risk factors.8 Because there are no reliable markers for the functional status of the cerebral small vessels in elderly patients at risk of stroke, TCD studies may be useful. Although some parameters …

Manual acupuncture ameliorates inflammatory pain by upregulating adenosine A3 receptor in complete Freund’s adjuvant-induced arthritis rats

Evidence that 5-HT 2A receptors are not involved in 5-HT-mediated thermoregulation in mice

Effect of chronic treatments with tandospirone and imipramine on serotonin-mediated behavioral responses and monoamine receptors

There are conflicting reports in the literature regarding the adenosine receptor that mediates the increase in sodium transport in the A6 cell. In this study we used specific A1 and A2 adenosine receptor agonists and antagonists, as well as two different subclones of the A6 cell, to determine which adenosine receptor mediates the increase in sodium transport. In the A6S2 subclone, basolateral and apical N6-cyclohexyladenosine (CHA), a selective A1 receptor agonist, stimulated sodium transport at a threshold concentration <10(-7) M, whereas CGS-21680, a selective A2 receptor agonist, had a threshold concentration that was at least 10(-5) M. The A1 receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX) was found to have a nonspecific effect on CHA-stimulated sodium transport, whereas the A2 receptor antagonist 8-(3-chlorostyryl)caffeine (CSC) had no effect. As with the A6S2 subclone, basolateral and apical CHA stimulated sodium transport at a nanomolar concentration in the A6C1 subclone and the threshold concentration for CGS-21680 was in the high micromolar range. Concurrent with the increase in 1 receptor in different subclones of the A6 cell, including a subclone capable of anion secretion.

Stress-induced hyperthermia and basal body temperature are mediated by different 5-HT 1A receptor populations: A study in SERT knockout rats

Effect of propentofylline on cerebral blood flow in a gerbil focal cerebral ischemia

### Case A 68-year-old right-hand-dominant man was brought to the hospital because of a speech disturbance and right arm and leg weakness. He awoke with these deficits and was last known to be symptom-free when retiring to bed the previous evening 8 hours earlier. His past medical history was notable for coronary heart disease, the patient having underwent coronary artery bypass surgery 7 years previously for unstable angina, but he had no known history of myocardial infarction. He also had hypertension and hyperlipidemia, and smoked 1 pack of cigarettes daily for more than 40 years. He had no history of calf claudication. His hypertension was being treated with a diuretic and β-adrenergic receptor blocker. He was also prescribed 325 mg of aspirin daily and an HMG CoA-reductase inhibitor (statin); however, his wife remarked that he often forgot to take his medications. His last total cholesterol was 240 mg/dL, with LDL cholesterol of 130 mg/dL. He had a strong family history of coronary heart disease after the age of 50. He had no known drug allergies. #### Physical Examination The patient’s blood pressure was 195/100 mm Hg in both arms, with a regular pulse of 90 bpm. His weight was 225 lb (body mass index: 31.4 kg/m2). His lungs were clear to auscultation. Cardiac examination showed a laterally displaced point of maximum impulse with an S4 gallop and a soft nonradiating systolic murmur at the base. His abdomen was obese without organomegaly and no abdominal bruits were detected. He had no rashes and no joint deformities. The left superficial temporal artery pulse was stronger than the right. There were soft bilateral anterior cervical bruits, left louder than right, but no supraclavicular bruits. There were bilateral femoral bruits. Radial pulses were 2+ and symmetric. Dorsalis pedis and posterior tibial pulses were 1+. …

1. Acute treatment with the nitric oxide synthase (NOS) inhibitor NG-nitro-L-arginine methyl ester (L-NAME) produces cerebral oligaemia. The effects of repeated exposure to L-NAME upon cerebral blood flow were examined to determine whether the enhanced NOS inhibition reported following chronic treatment might reduce cerebral perfusion to ischaemic levels. 2. Rats were treated with L-NAME (75 mg kg-1, i.p.) once daily for 10 days. Local cerebral blood flow and glucose utilization were measured by [14C]-iodoantipyrine and [14C]-2-deoxyglucose quantitative autoradiography respectively, either 1 h or 15 h after the last injection. A second group of rats was injected (i.p.) only once with L-NAME, either 1 h or 15 h prior to the measurement procedures. 3. Mean arterial blood pressure (MABP) was significantly increased (+35%) 1 h after a single injection of L-NAME. Although the hypertension was reduced 15 h after the injection (+13%), MABP remained significantly higher than control. 4. Local cerebral blood flow was significantly decreased 1 h after a single injection of L-NAME (ranging from -45% to -54%), and remained so even after 15 h (-39% to -48%). At neither time-point was there any change in glucose utilization. 5. At 15 h after the final injection of the chronic L-NAME treatment protocol, MABP was significantly elevated from control (+58%) and was also significantly higher than at 1 h following a single injection (+20%). There was no effect upon the established hypertension when rats treated chronically with L-NAME were challenged with a further injection of the drug and MABP was measured 1 h later, suggesting saturation of NOS inhibition. 6. Although reduced, cerebral blood flow was not significantly different from control when measured 15 h after the last injection of the chronic L-NAME treatment. When rats treated chronically with L-NAME were subjected to a further challenge with the drug, cerebral blood flow was reduced when measured 1 h after the acute injection (ranging from -34% to -41%). There was however evidence of some attenuation in the response when compared to that measured 1 h after a single injection of L-NAME (ranging from -45% to -54%). Thus, the cerebral circulation shows no evidence of either sustained L-NAME-induced vasoconstriction or saturated NOS inhibition following 10 daily injections of L-NAME. Chronic L-NAME treatment had no effect upon cerebral glucose use. 7. The trend towards re-establishment of cerebrovascular dilator tone and the normalization of cerebral flow-metabolism relationships could explain the lack of any ischaemic damage found in chronically treated rats, but the loss of an extended autoregulatory range afforded by acute L-NAME treatment may be responsible for an increased incidence of stroke.

The abundance of protein kinase C-alpha and beta isoforms (PKC-alphabeta), PKC-alpha messenger (m) RNA and guanine nucleotide-binding G protein subunits (G alpha(i1/2), G alpha(o), and G beta) were quantitated in the rat cerebral cortex after acute and chronic treatments with various opiate drugs. Acute (100 mg/kg for 2 h) and chronic (10 to 100 mg/kg for 5 days) treatment with morphine decreased similarly the immunoreactivity of PKC-alphabeta (28% and 32%, respectively). Acute (2 h) and chronic treatment (5 days) with other mu-agonists heroin (30 mg/kg and 10 to 30 mg/kg) and methadone (30 mg/kg and 5 to 30 mg/kg) also induced similar decreases of PKC-alphabeta (acute: 25% and 23%; chronic: 28% and 18%). After the chronic treatments, spontaneous (48 h) or naloxone (2 mg/kg)-precipitated opiate withdrawal (2 h) resulted in up-regulation of PKC-alphabeta above control levels (30-38%), and in the case of morphine withdrawal in a concomitant marked increase in the expression of PKC-alpha mRNA levels (2.3-fold). Acute (2 h) treatments with pentazocine (80 mg/kg, mixed kappa/delta-agonist and mu-antagonist), spiradoline (30 mg/kg, selective kappa-agonist) and [D-Pen2, D-Pen5] enkephalin (14 nmol i.c.v., selective delta-agonist) induced significant decreases of PKC-alphabeta (19-33%). Chronic (5 days) treatment with pentazocine (10 to 80 mg/kg), but not spiradoline (2 to 30 mg/kg), also induced a similar decrease of PKC-alphabeta (35%). In pentazocine- or spiradoline-dependent rats, naloxone (2 mg/kg) did not induce up-regulation of brain PKC-alphabeta. Acute (10 mg/kg for 2 h) and chronic (2x10 mg/kg for 5 and 14 days) treatment with naloxone did not alter PKC-alphabeta immunoreactivity. Chronic, but not acute, treatment with mu-agonists (morphine, heroin and methadone) increased the immunoreactivities of G alpha(i1/2) (33-37%), G alpha(o), (25-41%) and G beta (10-33%) protein subunits. In heroin- and methadone-dependent rats naloxone (2 mg/kg)-precipitated withdrawal (2 h) did not modify the up-regulation of these G proteins induced by chronic mu-opiate treatment. In marked contrast to mu-agonists, chronic treatment with high doses of pentazocine and spiradoline or acute treatment with [D-Pen2, D-Pen5] enkephalin did not result in up-regulation of these G protein subunits. After chronic treatment with mu-agonists, significant negative correlations were found when the percentage changes in immunoreactivity of PKC-alphabeta were related to the percentage changes in immunoreactivity of G alpha(i1/2), (r = -0.53, n = 29) and G beta (r = -0.41, n = 24) in the same brains. PKC-alphabeta abundance did not correlate significantly with the density of G alpha(o) (r = -0.21, n = 28). Together the results indicate that the brain PKC-alphabeta system may play a major regulatory role in opiate tolerance and dependence. Moreover, the possible in vivo cross-communication between this regulatory enzyme and specific inhibitory G proteins may also be of relevance in the cellular and molecular processes of opiate addiction.

The 27th International Stroke Conference San Antonio, Texas, February 7-9, 2002.

The potent activity of the 5-HT 1A receptor agonists, S 14506 and S 14671, in the rat forced swim test is blocked by novel 5-HT 1A receptor antagonists