Pharmacotherapy of Sexual Offenders

Continuous exposure to LHRH or its agonistic analogs results in a reduction of LHRH receptor sites and messenger RNA (mRNA) transcripts as well as in desensitization of the pituitary gonadotropes. To determine, whether LHRH antagonists might be similar in this respect to the agonists, we treated male rats for 4 weeks with daily sc injections of LHRH antagonist [Ac-D-Nal2,Phe(4Cl)2,D-Pal(3)3, D-Cit6,D-Ala10]LHRH (Cetrorelix acetate) or LHRH agonist, [D-Trp6]LHRH, in doses of 100 micrograms/animal-day. Another group of rats received a single im injection of 4.5 mg Cetrorelix pamoate depot, a sustained delivery formulation of the LHRH antagonist. An iv stimulation test with LHRH (200 ng/rat) was performed after 4 weeks of treatment. The rats were killed, and pituitary LHRH receptor characteristics were measured by RRA. To examine the effect of LHRH antagonist treatment on the expression of the pituitary LHRH receptor gene, some of the rats injected with Cetrorelix pamoate depot were killed after 2 weeks, and levels of LHRH receptor mRNA were determined by Northern blot and dot blot hybridization to a 32P-labeled rat complementary DNA probe. Our data show that LHRH-stimulated LH secretion at 30 min was suppressed by approximately 33% (P < 0.01) in rats pretreated with [D-Trp6]LHRH compared to that in animals injected with LHRH alone. Pretreatment of the rats with the LHRH antagonist suppressed the LH response to LHRH more markedly, the LH levels at 30 min were decreased by 89.8% and 96% in groups treated with Cetrorelix acetate and Cetrorelix pamoate depot, respectively. The testosterone response was virtually abolished in groups receiving Cetrorelix. The concentration of pituitary receptors for LHRH fell by 69% in the [D-Trp6]LHRH group, whereas the reductions in the Cetrorelix acetate group and in the group that received Cetrorelix pamoate depot were 77% and 82%, respectively. Treatment with Cetrorelix pamoate depot led to a 75-80% decrease in the levels of 5.0- and 4.5-kilobase forms of LHRH receptor mRNA compared to those in the control group. Dot blot analysis also showed 83% reduction in the mRNA for LHRH receptor. In conclusion, these data demonstrate that prolonged administration of LHRH antagonists such as Cetrorelix causes an impairment of gonadotropin secretion and a marked decrease in the levels of LHRH receptors as well as in the expression of the LHRH receptor gene. Thus, the down-regulation of pituitary LHRH receptors produced by LHRH antagonists appears to be similar to that resulting from the agonists.

Two classes of luteinising hormone-releasing hormone (LHRH) analogues have been developed so far to be used for oncological therapies: LHRH agonists and antagonists. LHRH agonists are widely and successfully used for the management of steroid-dependent malignancies. Chronic administrations of these compounds result in downregulation and desensitisation of pituitary LHRH receptors and, therefore, in a complete suppression of gonadal function. LHRH agonist administration is effective, safe and reversible, suffering only from the ‘flare-up’ phenomenon at the beginning of treatment. LHRH antagonists suppress the pituitary-gonadal function by competing with native LHRH for binding to its pituitary receptor but without giving rise to the intracellular cascade of events evoked by the natural hormone or LHRH agonists. Synthetic peptides belonging to the last generations of LHRH antagonists have already been successful in clinical trials. They are completely devoid of the ‘flare-up’ phenomenon and seem to be free of side effects, such as histamine release. Recently, the expression of LHRH and LHRH receptors has been reported in a number of hormone-responsive tumours. In constrast with the pituitary LHRH receptor which is coupled to the Gq/11-PLC intracellular system of events, stimulation of the tumour LHRH receptor by LHRH is followed by the activation of a Gi protein and a decrease in cAMP levels. This intracellular pathway mediates the inhibitory action of the autocrine/paracrine LHRH system on tumour cell proliferation. The activation of LHRH receptors at tumour level may then represent an additional and more direct mechanism of action for the antitumoural activity of LHRH agonists. Surprisingly, LHRH antagonists also exert a marked antimitogenic activity on a number of hormone-responsive cancer cell lines, indicating that these compounds might behave as antagonists at pituitary level and as agonists at the level of the tumour. The observation that the inhibitory LHRH autocrine system is also present in some steroid-unresponsive cancer cell lines might suggest a possible clinical utility of LHRH analogues also for those tumours that have escaped the initial phase of hormone dependency.

Lymphocyte conditioned medium (CM) was prepared by incubating 0 (cell-free control) or 4 x 10(6) lymphocytes/ml in serum-supplemented RPMI containing 0, 10(-9), 10(-7), and 10(-5) M luteinizing hormone releasing hormone (LHRH), 10(-5) M LHRH antagonist (LHRHA), or 10(-7) M LHRH + 10(-5) M LHRHA. Treatments were applied with and without 10 micrograms/ml concanavalin A (con A), and media were analyzed for LH. Aliquots of the CM from cultures incubated for 48 h were later applied to porcine granulosa cell cultures (suspended to 1.25 x 10(5) cells in 450 mul). Thereafter, 50 mul of CM were added to granulosa cell cultures. Media were collected after 12, 24, and 48 h and progesterone determined. Immunoreactive LH increased with time of incubation in lymphocyte CM but not cell-free CM. LH content of lymphocyte CM increased as LHRH concentration increased. LHRHA significantly reduced the amount of LH measured. The presence of con A in the medium resulted in maximal concentrations of LH, irrespective of dose of LHRH or LHRHA. Cell-free CM containing LHRH, LHRHA, and/or con A did not affect progesterone production by granulosa cells at any of the time periods. Lymphocyte CM containing LHRH caused a dose-dependent increase in progesterone production at 48 h. This stimulation was blocked by lymphocyte CM containing LHRHA. Lymphocyte CM containing con A also stimulated progesterone production at all of the LHRH concentrations studied. This response was not inhibited by lymphocyte CM containing the LHRHA.(ABSTRACT TRUNCATED AT 250 WORDS)

Antisera against LHRH antagonists: Development and immunoactivity in vitro

Recent evidence shows that thyrotrophin-releasing hormone (TRH) immunoreactivity in the rat anterior pituitary gland is accounted for by the TRH-like tripeptide pyroglutamyl-glutamyl-prolineamide (pGlu-Glu-ProNH2, < EEP-NH2). The present study was undertaken to investigate further the regulation, localization and possible intrapituitary function of < EEP-NH2. Anterior pituitary levels of < EEP-NH2 were determined between days 5 and 35 of life, during the oestrous cycle and after treatment with the luteinizing hormone-releasing hormone (LHRH) antagonist Org 30276. Treatment of adult males with the LHRH antagonist either for 1 day (500 micrograms/100 g body weight) or for 5 days (50 micrograms/100 g body weight) reduced anterior pituitary < EEP-NH2 levels by 25-30% (P < 0.05 versus saline-treated controls). Anterior pituitary < EEP-NH2 increased between days 5 and 35 of life. In females, these levels were 2- to 3-fold higher (P < 0.05) than in males between days 15 and 25 after birth; these changes corresponded with the higher plasma follicle-stimulating hormone (FSH) levels in the female rats. After day 25, < EEP-NH2 levels in female rats decreased in parallel with a decrease in plasma FSH. Injections with the LHRH antagonist (500 micrograms/100 g body weight), starting on day 22 of life, led to reduced contents of < EEP-NH2 in the anterior pituitary gland of female rats on days 26 and 30 (55 and 35% decrease respectively). Levels of < EEP-NH2 in the anterior pituitary gland did not change significantly during the oestrous cycle.(ABSTRACT TRUNCATED AT 250 WORDS)

Chapter 60 - Analogs of Luteinizing Hormone-Releasing Hormone (LHRH) in Cancer

Simultaneous determination of five novel luteinizing hormone-releasing hormone antagonists by LC-MS and pharmacokinetics in rats following cassette dosing.

Back to table of contents Previous article Next article Book ReviewsFull AccessRemaking Relapse Prevention With Sex Offenders: A SourcebookLaurie L. Guidry, Psy.D.Laurie L. GuidrySearch for more papers by this author, Psy.D.Published Online:1 Sep 2001https://doi.org/10.1176/appi.ps.52.9.1264AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This sourcebook, Remaking Relapse Prevention With Sex Offenders, captures the field of sex offender treatment in an unselfconscious act of self-scrutiny as it attempts to propel forward the evolution of effective treatment of sexual perpetrators. Drawing on contributions from leading experts in sex offender research and treatment, the editors provide us with an essential "re-visioning" of the popular, yet largely critically unexamined, relapse prevention approach to treating sexual abusers. Offering overviews and reviews, critiques and reconsiderations, and expansions and applications of relapse prevention to the treatment of sex offenders, the editors present an updated and well-considered reexamination of the utility of using the relapse prevention approach.Based on addictions theory, relapse prevention is a clinical intervention that was originally formulated as a strategy to maintain behavior change. It promotes the acquisition of self-management skills for dealing with threats to abstinence. By heightening awareness of the pathways to, and the presence of, situations that increase the risk of relapse, along with facilitating access to effective coping strategies, the relapse prevention approach assumes that a motivated individual can successfully negotiate the threat of an alcohol or drug relapse.With an emphasis on preventing the reoccurrence of problematic behaviors, the relapse prevention model was intuitively appealing to professionals in the sex offender treatment field. If substance abuse relapse could be prevented, perhaps a return to sexually deviant behavior could also be prevented. In the early 1980s, sex offender treatment professionals began to make efforts to integrate relapse prevention into the emerging cognitive-behavioral model of treatment for sexual perpetrators.However, theoretical and conceptual differences between the substance abuse and sex offender treatment fields were left unaddressed and unreconciled. Sex offender treatment programs applied relapse prevention in a variety of idiosyncratic ways, including using it inappropriately and ineffectively as a stand-alone treatment model for sex offenders. Moreover, sex offenders often lacked the motivation necessary to maintain the behavior change.Over the 20 years since relapse prevention was first proposed as a possible approach to treating sex offenders, its weaknesses in this application have come to light. Remaking Relapse Prevention With Sex Offenders identifies and examines these weaknesses and offers an emerging and informed reformulation of the implementation of this treatment approach with the very challenging treatment population of sexual perpetrators.The book covers a great deal of ground, including a critique by Hanson of the relapse prevention model; a call by Mann and Thornton to sex offender treatment professionals to commit themselves to evidence-based treatment; and an efficient presentation by Haaven and Coleman of relapse prevention with developmentally disabled sex offenders.With these and many other significant essays, this book is a valuable resource in the ongoing effort to develop an effective and fully integrated treatment approach for sex offenders.Dr. Guidry is program director for a statewide initiative by the Massachusetts Department of Mental Health to develop assessment and treatment programming for psychiatric inpatients with co-occurring major mental illness and sexual behavior disorders.edited by D. Richard Laws, Stephen M. Hudson, Tony Ward; Thousand Oaks, California, Sage Publications, 2000, 550 pages, $95 FiguresReferencesCited byDetailsCited byNone Volume 52Issue 9 September 2001Pages 1264-1264 Metrics History Published online 1 September 2001 Published in print 1 September 2001

The mechanisms through which luteinizing hormone (LH)-releasing hormone (LHRH) antagonists suppress pituitary gonadotroph functions and LHRH-receptor (LHRH-R) expression are incompletely understood. Consequently, we investigated the direct effect of LHRH antagonist cetrorelix in vitro on the expression of the pituitary LHRH-R gene and its ability to counteract the exogenous LHRH and the agonist triptorelin in the regulation of this gene. We also compared the effects of chronic administration of cetrorelix and triptorelin on the LHRH-R mRNA level and gonadotropin secretion in ovariectomized (OVX) and normal female rats. The exposure of pituitary cells in vitro to 3-min pulses of 1 nM LHRH or 0.1 nM triptorelin for 5 h increased the LHRH-R mRNA level by 77-88%. Continuous perfusion of the cells with 50 nM cetrorelix did not cause any significant changes, but prevented the stimulatory effect of LHRH pulses on the receptor mRNA expression. In OVX rats, 10 days after administration of a depot formulation of cetrorelix, releasing 100 microg of peptide daily, the elevated LHRH-R mRNA level was decreased by 73%, whereas daily injection of 100 microg of triptorelin caused a 41% suppression. In normal female rats, cetrorelix treatment suppressed the LHRH-R mRNA level by 33%, but triptorelin increased it by 150%. The highly elevated serum LH levels in OVX rats and the normal LH concentration of cycling rats were rapidly and completely suppressed by cetrorelix. Triptorelin decreased the serum LH in OVX rats to the precastration level, but had no effect on basal LH in normal rats. Our results confirm that LHRH antagonists, such as cetrorelix, inhibit the gene expression of pituitary LHRH-R indirectly, by counteracting the stimulatory effect of LHRH. A rapid suppression of serum LH by LHRH antagonists would be advantageous in the treatment of sex hormone-dependent tumors and other conditions.

This paper proposes standards of care for the treatment of adult sex offenders, primarily in (but not limited to) outpatient settings. A first draft was presented at the International Conference on the Treatment of Sex Offenders at the University of Minnesota School of Medicine in May 1989. A second draft was compiled at the Conference of the Association for the Behavioral Treatment of Sexual Abusers, with input from some sixty professionals. A third draft was circulated to a variety of professionals in the United States, Canada, and Europe in Fall 1989. The current draft is published in the Journal of Offender Rehabilitatino prior to formal presentation at the Second International Conference on the Treatment of Sex Offenders to be held at the University of Minnesota in September 1991. Readers are urged to communicate their reactions and comments to the authors.

Luteinizing hormone-releasing hormone analogs: their impact on the control of tumorigenesis☆

Luteinizing hormone-releasing hormone (LHRH) agonists and antagonists are commonly used androgen deprivation therapies prescribed for patients with advanced prostate cancer (PCa). Both types of agent target the receptor for LHRH but differ in their mode of action: agonists, via pituitary LRHR receptors (LHRH-Rs), cause an initial surge in luteinizing hormone (LH), follicle-stimulating hormone (FSH) and, subsequently, testosterone. Continued overstimulation of LHRH-R down-regulates the production of LH and leads to castrate levels of testosterone. LHRH antagonists, however, block LHRH-R signalling causing a rapid and sustained inhibition of testosterone, LH and FSH. The discovery and validation of the presence of functional LHRH-R in the prostate has led to much work investigating the role of LHRH signalling in the normal prostate as well as in the treatment of PCa with LHRH agonists and antagonists. In this review we discuss the expression and function of LHRH-R, as well as LH/human chorionic gonadotropin receptors and FSH receptors and relate this to the differential clinical responses to agonists and antagonists used in the hormonal manipulation of PCa.

Chapter 21. Luteinizing Hormone Releasing Hormone (LHRH) Analogues

Sex offender management using the polygraph: A critical review

Recovery of Serum Testosterone Levels and Sexual Function in Patients Treated With Short-term Luteinizing Hormone-releasing Hormone Antagonist as a Neoadjuvant Therapy Before External Radiotherapy for Intermediate-risk Prostate Cancer: Preliminary Prospective Study.