Chemical Vagotomy Research Articles

Vagal nerve stimulation : less explored entity in surgical patients!

Vagal nerve stimulation has been used to treat refractory seizures and depression in humans. Vagal nerve stimulation in experimental animals have been found to be effective in controlling systemic inflammation. It has been found that animals who had a surgical or chemical vagotomy do not respond well to anti-inflammatory treatment than one in whom vagus is intact. In future, measures to stimulate vagus nerve could help in preventing mortality and morbidity in medical and surgical patients.

Membrane-bound ATP-dependent Energy Systems, as Extra- and Intracellular Key Signals for Gastrointestinal Functions and their Regulations in the Gastrointestinal Mucosa.

Our research group has carried out various biochemical examinations in rat gastric ulcer models and in human gastrointestinal resecates obtained from patient who underwent gastric intervention due to peptic ulcer disease. Biochemical methods gave excellent possibility to approach the biochemical events taking place in tissues, cellular and subcellular regulatory levels during of ulcer development and of its prevetions. This paper gives a brief summary of these biochemical examinations conducted during this study period started from the 1960's up till now. 1. The decreased action of gastric acid secretory responses is not needed for duodenal and gastric ulcer healing in patients with peptic ulcer; 2. The surgical and chemical vagotomy resulted in various biochemical changes in the rat stomach; 3. The presence of Na+-K+-dependent ATPase and adenylate cyclase can be demostrated both in the rat and human gastric fundic mucosa; 4. The mitocondrial ATP is a common substrate for these membrane-bound ATP-dependent enzymes, and a multiple feedback mechanism existing between these two membrane-bound enzymes altered by mediators, hormones and drugs; 5. This feedback mechanism exists in the GI mucosa under different pathological conditions and during certain drug actions; 6. The development of mucosal damage and prevention depends on the actual regulatory state of above mentioned feedback mechanism between the membrane-bound ATP-dependent energy systems; 7.The drug actions depend on the actual functional state of target organ; 8. Biochemical gradients exist between the biochemical structure of the fundic, antral, duodenal and jejunal mucosa in patients with gastric hyperacidity, which is gradually downregulated by the decrease of gastric acid secretory responses, and totally disappears in patients with hypacidity; 9. No biochemically proven tissue hypoxia - around the chronic ulcer, duodenal and jejunal ulcers - exists in patients with chronic peptic ulcer; 10. The cellular and tissue protection differ from each other in the gastrointestinal tract; 11. Helicobacter pylori does not produce damage at the level of cell membrane, mitochondrion and DNA - given alone or in combination with indomethacin - on freshly isolated rat gastric mucosal cells. 12. A biochemical explanation is given to ulcer development in humans and in different animal models.

Cellular Energetical Actions of "Chemical" and "Surgical" Vagotomy in Gastrointestinal Mucosal Damage and Protection: Similarities, Differences and Significance for Brain-Gut Function.

BackgroundThe authors, as internists, registered significant difference in the long lasting actions of surgical and chemical (atropine treatment) vagotomy in patients with peptic ulcer during second half of the last century (efficency, gastric acid secretion, gastrointestinal side effects, briefly benefical and harmful actions were examined).Aims1. Since the authors participated in the establishing of human clinical pharmacology in this field, they wanted to know more and more facts of the acute and chronic effects of surgical and chemical (atropine treatment) on the gastrointestinal mucosal biochemisms and their actions altered by bioactive compounds and scavengers regarding the development of gastric mucosal damage and protection.MethodsThe observations were carried out in animals under various experimental conditions (in intact, pylorus-ligated rats, in different experimental ulcer models, together with application of various mucosal protecting compounds) without and with surgical vagotomy and chemical vagotomy produced by atropine treatment.Results1. No changes were obtained in the cellular energy systems (ATP, ADP, AMP, cAMP, “adenylate pool”, “energy charge“ [(ATP+ 0.5 ADP)/ (ATP+ADP+AMP)] of stomach (glandular part, forestomach) in pylorus ligated rats after surgical vagotomy in contrast to those produced by only chemical vagotomy; 2. The effects of the gastric mucosal protective compounds [atropine, cimetidine, prostaglandins, scavengers (like vitamin A, β-carotene), capsaicin] disappeared after surgical vagotomy; 3. The extents of different chemical agents induced mucosal damaging effects were enhanced by surgical vagotomy and was not altered by chemical vagotomy; 4. The existence of feedback mechanisms of pharmacological (cellular and intracellular) regulatory mechanisms between the membrane-bound ATP-dependent energy systems exists in the gastric mucosa of intact animals, and after chemical vagotomy, but not after surgical vagotomy.Conclusions1. Increased vagal nerve activity takes place in the gastric mucosal damage; 2 both surgical and chemical vagotomy result mucosal protective affect on the gastric mucosal in different damaging experimental models; 3. The capsaicin-induced gastric mucosal damage depends on the applied doses, presence of anatomically intact vagal nerve (but independent from the chemical vagotomy), 4. The central and pheripheral neural regulations differ during gastric mucosal damage and protection induced by drugs, bioactive compounds, scavengers.

The effect of intraperitoneal administration of leptin on short-term food intake in rats

The effects of intraperitoneal (i.p.) injection of leptin (1, 5, and 10 μg/kg) were investigated on the food consumption during a 60 min test meal in 21 h fasted rats. All doses of leptin produced significant reductions in cumulative food intake during the first 15 min and 30 min (at least, P < 0.05) after administration. Similarly, i.p., but not subcutaneous (s.c.), administration of leptin (25 μg/kg) reduced food intake in 21 h fasted rats. Leptin (10 and 25 μg/kg, i.p.) did not reduce water intake in 16 h water-deprived rats, nor did leptin (25 μg/kg) produce aversion in a two-bottle conditioned taste aversion test indicating that the hypophagic effect of leptin is (i) behaviourally specific for food and not water intake, and (ii) not due to drug-induced malaise. Moreover, leptin (10 and 25 μg/kg, i.p.) did not significantly alter food intake in non-deprived rats when measured at 30 min intervals over a period of 24 h. Chemical vagotomy with capsaicin abolished the inhibitory effects of leptin (25 μg/kg, i.p) on food intake in fasted rats and suggest that the hypophagic effect is dependent on intact vagal afferent nerves. Furthermore, the hypophagia induced by leptin (10 μg/kg, i.p.) in fasted rats was not attenuated by systemic administration of the peripherally acting cholecystokinin 1 receptor antagonist, 2-naphthalenesulphanyl- l-aspartyl-2-(phenethyl) amide (2-NAP; 2 mg/kg, i.p.), indicating that the suppressant effects of leptin on food consumption are not secondary to the release of endogenous peripheral cholecystokinin.

Mechanism of rapid-phase insulin response to elevation of portal glucose concentration

The hepatoportal region is important for glucose sensing; however, the relationship between the hepatoportal glucose-sensing system and the postprandial rapid phase of the insulin response has been unclear. We examined whether a rapid-phase insulin response to low amounts of intraportal glucose infusion would occur, compared that with the response to intrajugular glucose infusion in conscious rats, and assessed whether this sensing system was associated with autonomic nerve activity. The increases in plasma glucose concentration did not differ between the two infusions at 3 min, but the rapid-phase insulin response was detected only in the intraportal infusion. A sharp and rapid insulin response was observed at 3 min after intraportal infusion of a small amount of glucose but not after intrajugular infusion. Furthermore, this insulin response was also induced by intraportal fructose infusion but not by nonmetabolizable sugars. The rapid-phase insulin response at 3 min during intraportal infusion did not differ between rats that had undergone hepatic vagotomy or chemical sympathectomy with 6-hydroxydopamine compared with control rats, but this response disappeared in rats that had undergone chemical vagotomy with atropine. We conclude that the elevation of glucose concentration in the hepatoportal region induced afferent signals from undetectable sensors and that these signals stimulate pancreas to induce the rapid-phase insulin response via cholinergic nerve action.

Does the vagus nerve inform the brain about preclinical tumours and modulate them?

The inflammatory microenvironment is thought to play a pivotal part in tumorigenesis. But, can the brain be informed about peripheral preclinical cancer cells? Can it modulate tumour development? One of the key routes for information to reach the brain from visceral regions is through the vagus nerve. Yet, patients with ulcers who have had a vagotomy have been shown to die from cancer more frequently than do those who have not had this procedure, and surgical and chemical vagotomy attenuates tumour-induced anorexia and leads to enhanced tumour progression. We therefore postulate that the vagus nerve participates in informing the brain about tumorigenesis by transmiting information to the brain about tumour-associated proinflammatory cytokines. Furthermore, activation of the vagus could slow tumorigenesis by suppression of peripheral proinflammatory cytokines.

Pharmacological stimulation of the cholinergic antiinflammatory pathway.

Efferent activity in the vagus nerve can prevent endotoxin-induced shock by attenuating tumor necrosis factor (TNF) synthesis. Termed the “cholinergic antiinflammatory pathway,” inhibition of TNF synthesis is dependent on nicotinic α-bungarotoxin-sensitive acetylcholine receptors on macrophages. Vagus nerve firing is also stimulated by CNI-1493, a tetravalent guanylhydrazone molecule that inhibits systemic inflammation. Here, we studied the effects of pharmacological and electrical stimulation of the intact vagus nerve in adult male Lewis rats subjected to endotoxin-induced shock to determine whether intact vagus nerve signaling is required for the antiinflammatory action of CNI-1493. CNI-1493 administered via the intracerebroventricular route was 100,000-fold more effective in suppressing endotoxin-induced TNF release and shock as compared with intravenous dosing. Surgical or chemical vagotomy rendered animals sensitive to TNF release and shock, despite treatment with CNI-1493, indicating that an intact cholinergic antiinflammatory pathway is required for antiinflammatory efficacy in vivo. Electrical stimulation of either the right or left intact vagus nerve conferred significant protection against endotoxin-induced shock, and specifically attenuated serum and myocardial TNF, but not pulmonary TNF synthesis, as compared with sham-operated animals. Together, these results indicate that stimulation of the cholinergic antiinflammatory pathway by either pharmacological or electrical methods can attenuate the systemic inflammatory response to endotoxin-induced shock.

ESTABELECIMENTO DE UM MODELO DE TUMOR EXPERIMENTAL PELA INOCULAÇÃO DO TUMOR DE WALKER EM ESTÔMAGO DE RATO

A incidência de câncer gástrico espontâneo em ratos é extremamente rara. Por outro lado, embora o câncer experimental de estômago possa ser induzido por carcinógenos químicos, através da ressecção da região fúndica do estômago, pela vagotomia ou pelo refluxo, esses métodos apresentam um percentual de desenvolvimento tumoral baixo e errático. Além disso, geralmente decorre um longo período de tempo até o pleno crescimento do tumor. O presente trabalho procurou estabelecer um modelo de tumor experimental de crescimento rápido, uniforme e com elevado índice de pega, que permitisse a avaliação de novas terapêuticas para o tratamento do câncer gástrico. Para tanto, utilizou-se uma suspensão de células do carcinossarcoma 256 de Walker que foi inoculada no estômago através de uma cânula orogástrica. A implantação ocorreu na mucosa previamente lesionada por clampeadura da parede, nas regiões da junção esôfago-gástrica, pequena curvatura e grande curvatura. O crescimento tumoral ocorreu em todos os animais e, embora na junção esôfago-gástrica a incidência de pega tenha sido de apenas 20%, possivelmente em função do epitélio queratinizado, na pequena curvatura a incidência foi de 80% e na grande curvatura todos os animais apresentaram tumor. Esses dados demonstraram que é possível implantar o tumor em 100% dos animais inoculados, o que comprova a exequibilidade da técnica. A vantagem dessa metodologia sobre as outras já descritas na literatura, também usando o carcinossarcoma 256 de Walker, é que o tumor cresce a partir da mucosa, reproduzindo as condições de desenvolvimento do tumor gástrico espontâneo. A média de sobrevida dos animais inoculados é de 13,2±1,98 dias. Além disso, como o tumor se desenvolve em todos os animais inoculados, pode-se dispensar métodos radiológicos e ultra-sonográficos para evidenciar a sua presença. Trata-se, portanto, de um método simples e eficaz e que possibilita a implantação do tumor em um grande número de animais, facilitando, inclusive, o estudo do tumor em diversas fases do seu desenvolvimento, testes de novos fármacos e esquemas terapêuticos.

Preventive effect of atropine on indomethacin-induced gastrointestinal mucosal and vascular damage in rats.

The protective effect of 'chemical vagotomy' (atropine given in three doses: 0.1, 0.5 and 1.0 mg/kg i.p.) was examined on indomethacin (IND, 20 mg/kg s.c.)-induced macroscopic gastrointestinal (GI) mucosal erosions and changes of vascular permeability in the stomach and three equal parts of small intestine and colon in rats. The different doses of atropine were administered at 0, 5, 10, 15 and 20 h after IND administration, then the number and severity of lesions were noted and the vascular damage was measured by Evans blue extravasation into the mucosa and intraluminal juice at 24 h after the IND treatment. Our results indicate that atropine ('chemical vagotomy') dose-dependently and significantly decreases the IND-induced mucosal erosions and vascular permeability in the vagal nerve-innervated parts of GI tract (i.e. the stomach, small intestine and proximal colon). Atropine in 0.5 and 1.0 mg/kg doses has a significantly higher protective effect on the vascular damage than on the macroscopic mucosal lesions in the stomach, small intestine and proximal colon. The vascular permeability is only one of those factors which have a role in the appearance of the GI mucosal erosions after IND treatment. These results suggest that the decrease of vascular permeability is involved in the protective effect of atropine against IND-induced GI mucosal damage.

Peptide histidine isoleucine amide stimulates thyroid hormone secretion and coexists with vasoactive intestinal polypeptide in intrathyroid nerve fibers from laryngeal ganglia.

Peptide histidine isoleucine amide (PHI) and vasoactive intestinal polypeptide (VIP) are fragments of the same precursor molecule, prepro-VIP, and coexistence of the two peptides is, therefore, to be expected. Nerve fibers displaying PHI and VIP immunoreactivity occurred around blood vessels and follicles in the thyroid gland of several species. Sequential staining with antibodies against PHI and VIP revealed coexistence of the two peptides in the same population of nerve cell bodies in ganglia situated along the laryngeal nerves and in intrathyroid nerve fibers. Chemical sympathectomy (6-hydroxydopamine treatment), surgical sympathectomy (removal of the superior cervical ganglia), and unilateral cervical vagotomy (removal of the nodose ganglion) failed to affect the number and distribution of PHI/VIP fibers in the thyroid gland. Taken together, the findings suggest that both the perivascular and interfollicular PHI/VIP fibers originate in laryngeal ganglia. PHI weakly stimulated basal thyroid hormone secretion in mice in vivo, but did not influence the response to TSH or VIP. PHI had no effect on calcitonin secretion in rats. Like VIP, PHI may play a physiological role in the regulation of thyroid hormone secretion.

Electrophysiological effects of ouabain in 6-hydroxydopamine pretreated dogs

Chemical sympathectomy and bilateral vagotomy were used to evaluate the contribution of each division of the autonomic nervous system in the electrophysiological actions of ouabain. Intact and chemically sympathectomized dogs were given successive and cumulative doses of ouabain until toxicity became manifest (ventricular extrasystoles and (or) ventricular tachycardia). An additional group of normal and sympathectomized animals was also submitted to bilateral vagotomy in the presence of a therapeutic dose of ouabain. Sinus cycle length, AH interval of the His bundle electrogram, atrioventricular junctional effective and functional refractory periods were increased by ouabain at therapeutic doses. These effects were no different in sympathectomized dogs than in intact dogs, indicating the absence of any significant contribution of efferent sympathetic neural activity. However, our results suggested that vagal enhancement was the main mechanism whereby ouabain produced sinus bradycardia and depression of atrioventricular conduction. Sympathectomy with 6-OHDA did not modify nor abolish ouabain toxicity. However, toxic doses were significantly higher in sympathectomized animals than in normal animals. Considering that increasing heart rate by cardiac pacing or vagotomy significantly lowered toxic doses of ouabain in both intact and sympathectomized dogs, it is possible that sympathectomy could influence ouabain toxicity by altering heart rate alone.

Effect of atropine sulfate in pulmonary hypertrophic osteoarthropathy.

A 49-year-old patient with pulmonary hypertrophic osteoarthropathy was treated with 0.4 mg of atropine sulfate every 4 hours for 14 days. A good clinical response was obtained as measured by handgrip strength, range of motion, and quantitative thermography. Chemical vagotomy supports the hypothesis of the vagal reflex as the pathophysiological mechanism in pulmonary hypertrophic osteoarthropathy.

The role of afferent barosensory neurons in respiratory and bronchomotor control

Ventilatory and bronchomotor responses to baroreceptor afferent stimulation were studied in anaesthetized rabbits breathing spontaneously. The stimuli used were either the increase in carotid sinus pressure or the electrical stimulation of the cut central end of the aortic nerve. Respiratory effects of aortic barodenervation were also studied. Normoxic, normocapnic steady state was verified by repeated measurement of PO2, PCO2 and pH in arterial blood. Stimulation of both aortic and carotid baroreceptors provoked an early decrease of tidal volume and total pulmonary resistances without change in respiratory frequency. Aortic nerve stimulation induced an important and slowly adapting ventilatory and bronchomotor effect, whereas changes in carotid sinus pressure produced slight variation in respiratory parameters. Aortic nerve section resulted in an early and prolonged increase of total pulmonary resistances. Surgical or chemical (atropine) vagotomy did not change the bronchodilation observed under stimulation of the carotid sinus; however this effect was suppressed by intravenous injection of propranolol. This observation shows the importance of the sympathetic outflow in the genesis of bronchomotor responses following baroreceptor stimulation. In conclusion the baroreceptor stimulation provokes simultaneous decrease of both ventilation and total pulmonary resistances; aortic nerves seemed to exert permanent control on bronchomotor tone.

IS BREATHING FUNDAMENTALLY A REFLEX PHENOMENON?

Whether the rhythmic discharge of the respiratory centre is a localised physico‐chemical process modified by afferent impulses, or a reflex phenomena modified by chemical conditions, is considered.Effects of varied combinations of afferent inflow suggest that breathing may be largely a resultant of numerous and various afferent nerve impulses.The effectiveness of afferent impulses is profoundly influenced by chemical changes capable of modifying breathing. Results indicate depression of excitatory and inhibitory respiratory reflexes by CO2 saturation and augmentation by CO2 depletion and anoxemia. These findings are tentatively employed to analyse respiratory phenomena.The indirect proportionality of rhythm to intrapulmonary pressure is a reflex effect of changing lung volume. Assuming only a single inhibitory vagal reflex, augmentation of this reflex by sodium carbonate could slow the rhythm and depression by CO2 could accelerate it, at any pulmonary volume. Graded volume change with a dual vagal reflex control could at some point reverse the effects of both CO3 and CO2. Experimentally CO3 retards breathing during inflation, accelerates during deflation and reduces amplitude at neutral volume. CO2 acceleration during inflation is reversed to retardation during deflation. Lung volume, therefore, importantly determines the mode of response to chemical influences by changing the relative dominance of individual pulmonary reflexes.Carbonate apnea is not due to lost excitability, but most probably to augmentation of vagal inhibitory reflexes and possibly other stretch reflexes, for saphenous stimulation during apnea produces superexcessive breathing.Carbon dioxide administrations under otherwise normal conditions may produce its relatively slow breathing by depressing the vagal accelerating function by chemical vagotomy. Anoxemia may produce its relatively rapid breathing by augmenting this function.The present experiments indicate the great importance of reflexes and their modification through chemical changes and suggest the breathing may be fundamentally a reflex phenomena. On the other hand, they are not necessarily opposed to an automatically discharging centre under the influence of chemical and afferent nerve impulse changes.It is suggested that the influence of chemical changes on circulatory reflexes may be a factor in the control of circulation.