Yoshitaka Yamamoto

Immunohistochemical identification of adrenomedullin in human, rat, and porcine tissue

The histological localization was investigated of adrenomedullin (AM), a novel vasorelaxant peptide originally isolated from human pheochromocytoma. The immunohistological distribution was examined of AM in human, rat, and procine tissues using a polyclonal antibody to a fragment comprising C-terminal amino acids 40–52 of human adrenomedullin [AM(40–52)NH2]. Almost all of the human pheochromocytoma and normal adrenal medullary cells of all three species were immunostained and found to be intensely positive for AM. Furthermore, AM-immunoreactive cells were present in the pancreatic islets, gastrointestinal neuroendocrine system, anterior pituitary, and choroid plexus with some degree of interspecies heterogeneity. These findings indicate that AM-immunoreactive cells are widely distributed in the endocrine and neuroendocrine system, suggesting that AM plays some important role in the control of systemic and local circulation and also of humoral secretion.

Proadrenomedullin N‐Terminal 20 Peptide (PAMP), an Endogenous Anticholinergic Peptide: Its Exocytotic Secretion and Inhibition of Catecholamine Secretion in Adrenal Medulla

Abstract: In cultured bovine adrenal medullary cells, stimulation of nicotinic receptors by carbachol evoked the Ca2+‐dependent exocytotic cosecretion of proadrenomedullin N‐terminal 20 peptide (PAMP) (EC50 = 50.1 µM) and catecholamines (EC50 = 63.0 µM), with the molar ratio of PAMP/catecholamines secreted being equal to the ratio in the cells. Addition of PAMP[1–20]NH2 inhibited carbachol‐induced 22Na+ influx via nicotinic receptors (IC50 = 2.5 µM) in a noncompetitive manner and thereby reduced carbachol‐induced 45Ca2+ influx via voltage‐dependent Ca2+ channels (IC50 = 1.0 µM) and catecholamine secretion (IC50 = 1.6 µM). It did not alter high K+‐induced 45Ca2+ influx via voltage‐dependent Ca2+ channels or veratridine‐induced 22Na+ influx via voltage‐dependent Na+ channels. PAMP seems to be a novel antinicotinic peptide cosecreted with catecholamines by a Ca2+‐dependent exocytosis in response to nicotinic receptor stimulation.

Plasma Concentration of Human Brain Natriuretic Peptide in Patients on Hemodialysis

The plasma concentration of immunoreactive human brain natriuretic peptide (ir-BNP) was measured in 40 patients on hemodialysis (HD) and in 12 healthy subjects. Immunoreactive human atrial natriuretic peptide (ir-ANP) was also measured. The mean (+/- SE) plasma ir-BNP concentration in the patients before HD (18.4 +/- 3.4 fmol/mL) was markedly higher than that in the control group (0.39 +/- 0.08 fmol/mL). The plasma ir-BNP level was significantly decreased by HD from 18.4 +/- 3.4 fmol/mL to 10.5 +/- 2.2 fmol/mL (P < 0.001), but the latter value was still higher than the upper limit of the normal range for our laboratory. There were significant correlations between the plasma ir-ANP level and the mean blood pressure before HD (P < 0.05) and between the HD-induced changes in plasma ir-ANP level and mean blood pressure (P < 0.001). These correlations were not observed between the plasma ir-BNP level and mean blood pressure. The plasma ir-BNP level correlated with the cardiothoracic ratio and this correlation was closer to that between the plasma ir-ANP level and cardiothoracic ratio. Ultrasound echocardiographic studies in 13 patients revealed that the pre-HD state of high cardiac output was correlated by HD in association with decreases in plasma ir-BNP and ir-ANP levels. Correlations were observed between the pre-HD ir-ANP level and the interventricular septal thickness index (r = 0.68, P < 0.05) and between the change in ir-BNP level and that in left atrial diameter (r = 0.806, P < 0.001). In conclusion, BNP levels were high in HD patients compared with the control subjects and were decreased during HD. In addition, BNP and ANP levels correlated with several parameters of volume change and cardiac status.

Ca2+‐dependent cosecretion of adrenomedullin and catecholamines mediated by nicotinic receptors in bovine cultured adrenal medullary cells

Bovine cultured adrenal medullary cells (4 × 106) contained 4266.5 ± 370.0 fmol of immunoreactive adrenomedullin and 373.4 ± 32.6 mnol of catecholamines. Nicotinic (but not muscarinic) receptors mediated the Ca2+‐dependent co‐secretion of adrenomedullin and catecholamines, with the molar ratio of adrenomedullin/catecholamines secreted into the medium being equal to the ratio stored in the cells. The concentration‐response curve of carbachol for adrenomedullin secretion (EC50 42 μM) was similar to that for catecholamine secretion (EC50 63 μM). Reverse phase HPLC analysis showed that immunoreactive adrenomedullins in the cells and secreted into the medium were both eluted exclusively at the position almost identical to synthetic human adrenomedullin[1–52]NH2.

Minimal Change Nephrotic Syndrome in Adults: Response to Corticosteroid Therapy and Frequency of Relapse

Rate of response to a corticosteroid and frequency of relapse were studied in 33 patients with adult-onset minimal change nephrotic syndrome (MCNS). Of these, 28 patients were treated with oral prednisolone (PSL) at 1 mg/kg/d for from 4 to 8 weeks depending on their response, followed by PSL, at gradually tapering doses for 1 year. Five severely nephrotic patients received 1 g of methylprednisolone intravenously (IV) for 3 days, followed by 40 mg/d oral PSL for 4 to 8 weeks and finally PSL in gradually reduced doses. Sixteen patients (48%) were free of proteinuria within 4 weeks, and 25 (76%) within 8 weeks. Two patients required cyclophosphamide for induction of remission. Age at presentation was not significantly correlated with response time to corticosteroid therapy. Thirty-two (97%) went into remission, and relapse occurred in 11 (34%) of these. As assessed by the life-table method, 84% of patients were still in remission at 6 months after induction of remission, 75% after 1 year, and 63% during the follow-up period (mean, 47.1 +/- 29.1 months; range, 6 to 123 months). Incidence of relapse was not correlated with remission induction time, ie, earlier (less than or equal to 4 weeks) or later (greater than 4 weeks), but was greater in younger (less than 30 years of age) patients than older (greater than or equal to 30 years) patients (P less than 0.03). At the last follow-up, 31 patients (94%) were in complete remission and had normal renal function.(ABSTRACT TRUNCATED AT 250 WORDS)

Holter Electrocardiogram Monitoring in Nephrotic Patients during Methylprednisolone Pulse Therapy

We assessed the effect of intravenous methylprednisolone pulse therapy (IMPT) on cardiac rhythm and electrolyte metabolism in patients with nephrotic syndrome. A total of 25 patients had valid evaluations with continuous ambulatory electrocardiograms, and 20 of these had simultaneous sodium and potassium clearances. No significant difference of frequency in complex ventricular arrhythmias (Lowns grades 3-5) between the control and the therapy period was observed; however, 4 patients showed complex ventricular arrhythmias including ventricular tachycardia (2 patients) during the course of therapy. Fractional excretion of potassium and serum potassium significantly increased from baseline after IMPT. Complex ventricular arrhythmias, sometimes leading to sudden death, might ensue from IMPT. These dysrhythmias may be related to an abrupt change in potassium reflux from the cell.

Increased plasma brain natriuretic peptide levels in DOCA-salt hypertensive rats: relation to blood pressure and cardiac concentration.

Four experimental groups of rats treated with (1) DOCA-salt, (2) DOCA or (3) salt, and (4) controls were used to study the participation of brain natriuretic peptide (BNP) in the development of hypertension. Plasma and cardiac tissue concentrations of BNP as well as atrial natriuretic peptide (ANP) were measured in each group by using radioimmunoassays specific to rat BNP or ANP. Plasma BNP levels in DOCA-salt hypertensive group were higher than those in control (p less than 0.01), salt (p less than 0.01) and DOCA (p less than 0.01) groups. A positive correlation was observed between plasma BNP levels and blood pressure (r = 0.70, p less than 0.001) and between plasma ANP levels and blood pressure (r = 0.62, p less than 0.001). Plasma BNP/ANP ratio increased parallel with elevation of blood pressure. Plasma BNP levels correlated negatively with atrial BNP concentration (r = -0.33, p less than 0.05), but positively with ventricular BNP (r = 0.76, p less than 0.001). Compared with controls, tissue BNP-45/gamma-BNP ratio in the DOCA-salt rats was lower in atrium, but higher in ventricle. Thus, in DOCA-salt hypertension atrial BNP decreased with exhaustion of stored BNP-45, while ventricular BNP increased as BNP-45 accumulated. These results suggest that BNP is a novel cardiac hormone, synthesized, processed and secreted in response to changes in blood pressure. BNP may play different roles in controlling blood pressure than those assumed by ANP.

Nephrotic Syndrome Associated with Recombinant Interleukin-2

Adoptive immunotherapy using recombinant interleukin-2 (rIL-2) has recently been demonstrated to have antitumor effects in man. Adverse effects have included an apparent increase in capillary permeability (vascular leak syndrome) and a decrease in glomerular flow rate. To our knowledge, nephrotic syndrome (NS) associated with rIL-2 has not been reported. We would like to report a case of NS with human rIL-2 treatment

Increased secretion of brain natriuretic peptide and atrial natriuretic peptide, but not sufficient to induce natriuresis in rats with nephrotic syndrome

The levels of immunoreactive brain natriuretic peptide (ir-BNP) and immunoreactive atrial natriuretic peptide (ir-ANP) were evaluated by radioimmunoassay in both the atrium, ventricle and plasma of adriamycin-induced nephrotic rats and control rats. There was no difference in right and left atrial concentrations of ir-BNP, however, a higher right atrial concentration of ir-ANP was observed in nephrotic rats than in controls (p less than 0.01). The ventricular ir-BNP and ir-ANP were increased in nephrotic rats compared to controls (BNP: p less than 0.001, ANP: p less than 0.001). Cardiac BNPs were composed of pro-BNP (gamma-BNP) and its C-terminal 45-amino-acid peptide (BNP-45). The ratio of BNP-45/gamma-BNP in nephrotic rats was higher than that of controls in both atria and in the ventricle. Plasma ir-BNP and ir-ANP were significantly higher in nephrotic rats than in controls (BNP: p less than 0.001, ANP: p less than 0.001), and each level was negatively correlated with urinary sodium excretion in nephrotic rats (BNP: r = -0.84, p less than 0.001, ANP: r = -0.88, p less than 0.001). These results suggest that production and secretion of both BNP and ANP are concomitantly stimulated by a decreased renal ability to eliminate sodium and water, but this secretion is insufficient to induce effective natriuresis in nephrotic rats.

Neutral metalloproteinases in human urine from normal patients and renal disease patients

Summary: We examined the activity and the characteristics of gelatinolytic enzymes in the urine from normal subjects and the patients with glomerulonephritis (GN). Gelatinolytic activity was assayed by using [3H]gelatin (heat‐denatured type I collagen) as a substrate. the activity found to be 2463 ± 204 U/day (mean ± SEM, n = 17) in the urine from the healthy individuals, but was negligible in plasma samples. In GN patients (n=24) urinary gelatinolytic activity (724± 149 U/day, P < 0.001) was significantly lower compared with the healthy individuals. Partial purification (anion exchange column chromatography followed by gel filtration) revealed that two active gelatinolytic enzymes (molecular weight [Mr]92 kDa; high molecular weight [HMW] gelatinase, Mr 40 kDa; low molecular weight [LMW] gelatinase) were present in the urine obtained from the healthy individuals. the activity of these enzymes was inhibited by EDTA, 1,10‐phenanthroline and α2‐macroglobulin, but not by inhibitors for serine, cystein and aspartic proteinase. As the optimum pH was in the neutral range (pH 6–9), these gelatinases were considered to be neutral endometalloproteinases. These enzymes could degrade acid soluble type IV collagen and native rat glomerular basement membrane (GBM) in addition to gelatin, but not type I collagen. Immunoblotting with antibodies against human metalloproteinases (MP) identified HMW gelatinase with matrix metalloproteinase (MMP)‐9 (gelatinase B) and LMW gelatinase with MMP‐2 (gelatinase A), respectively. As these enzymes are metalloproteinase (MP) capable of degrading GBM and its component, urinary MP may be a useful subject as a tool searching the metabolic alteration of glomerular extracellular matrix in renal diseases.