Aortic arch repair using hypothermic circulatory arrest technique associated with pharmacological brain protection

OBJECTIVE

Hypothermic circulatory arrest is a standard procedure for the treatment of aortic arch. However, there is a time limit for this procedure. There is now an urgent need to develop prophylactic measures to extend the time limit. We have used a pharmacological mixture of thiopental, nicardipine and mannitol for all patients undergoing circulatory arrest since 1991 to extend the safe limit. The purpose of this study was to analyze the neurological complications demonstrated by these patients and to evaluate the brain-protective effects of our measure.

METHODS

The clinical records of 75 consecutive patients undergoing an aortic arch repair using a hypothermic circulatory arrest technique during the past 8 years were retrospectively reviewed. Systemic cooling was continued until a total disappearance of EEG activity. Prior to circulatory arrest, 15 or 30 mg/kg of thiopental, 20 mg of nicardipine and 300 ml of mannitol were infused into the venous reservoir of a cardiopulmonary bypass circuit. Graft replacement was performed in all patients and the extent of replacement was a total aortic arch in 43 patients, a distal aortic arch in 17, a hemiarch in 13 and a distal aortic arch and a total descending aorta in two.

RESULTS

The duration of circulatory arrest ranged from 16 to 80 min (mean 41.5 min), and it exceeded 45 min in 37 patients. Operative mortality was 10.7% and two patients died of stroke. Three patients had permanent and three other patients had transient neural deficits. The incidence of stroke was 8.0% as a whole, and no correlation between the incidence of neurological complications and the duration of circulatory arrest was found. A multivariate analysis showed that the duration of circulatory arrest was determined as a predictor of neither operative mortality nor postoperative stroke.

CONCLUSIONS

The findings of the present study suggest that our pharmacological brain protection appears to be effective for safely extending hypothermic circulatory arrest.

Stroke after coronary artery bypass grafting in patients with cerebrovascular disease

BACKGROUND

Stroke has been associated with a significantly increased mortality from coronary artery bypass grafting (CABG). To determine the predictors of stroke in patients undergoing CABG, we collected data on 472 consecutive patients.

METHODS

From March 1991 to March 1999, all patients undergoing CABG at our institution underwent routine duplex scanning of the extracranial carotid and vertebral arteries. Seven patients with symptomatic carotid stenosis were treated by carotid endarterectomy (CEA) before CABG.

RESULTS

There was a 10-fold increase in mortality (12.5%) associated with postoperative stroke. Many variables were analyzed by a multivariate technique and the severity of extracranial carotid artery stenosis was determined to be the only independent predictor of postoperative stroke (p < 0.01). None of the patients with carotid artery occlusion and none of the patients who underwent CEA before CABG experienced a stroke.

CONCLUSIONS

To reduce the stroke rate, the indications for prophylactic CEA may be extended for asymptomatic patients with carotid artery stenosis greater than 75%.

Results of a total aortic arch replacement for an acute aortic arch dissection

OBJECTIVES

Recently, the immediate results of a surgical repair for an acute aortic arch dissection have dramatically improved. However, a total aortic arch replacement is recommended in a limited number of patients with an intimal tear located in the aortic arch. We have performed a total aortic arch replacement for all such patients with an acute aortic arch dissection since September 1995.

METHODS

During the past 4 years, 27 consecutive patients who had an aortic arch dissection underwent a total aortic arch replacement. Twenty-five patients underwent an emergency operation. In 5 patients the intimal tear was located in the aortic arch, but in the rest of the patients, it was located in the ascending aorta or the proximal descending aorta. To obliterate any false channels, gelatin-resorcin-formol glue was used.

RESULTS

The hospital mortality was 11%, and no cerebral complications were observed. Postoperative aortography and computed tomography showed no evidence of any persisting false channels in 15 patients (65%). During the follow-up period (ranging from 5 months to 4 years), two patients underwent a reoperation because of the recurrence of a dissection at the sinus of Valsalva. All patients, except for one who died after a reoperation, are still alive and free from any serious events at this writing.

CONCLUSIONS

Resecting both the ascending and transverse aorta, irrespective of whether the intimal tear is located in the aortic arch, may be an acceptable alternative at experienced centers because of its low mortality and good midterm results.

A study of conformational stability of polyglycine and poly(L-alanine), and polyglycine/poly(L-alanine) blends in the solid state by (13)C cross-polarization/magic angle spinning NMR

13C Cross-Polarization/Magic Angle Spinning nmr and T(1rhoH) experiments of polyglycine (PG), poly(L-alanine) (PLA), and PG/PLA blends prepared from dichloroacetic acid solution have been carried out, in order to elucidate the conformational stability of these polypeptides in the solid state. From these experimental results, it was clarified that the conformations of PG and PLA in their blends are strongly influenced by intermolecular hydrogen-bonding interactions that cause their miscibility at the molecular level.

Expression of gonadotropin and activin receptor messenger ribonucleic acid in human ovarian epithelial neoplasms

Activin receptors (ActRs) and gonadotropin receptor mRNA expression were investigated in 18 human ovarian epithelial neoplasms. Northern blot analysis showed the presence of 3.0-kb type Ia ActR, 6.0- and 3.0-kb type IIa ActR, and 5.0-kb type IIb ActR mRNA transcripts in total RNA prepared from the cancer tissues. One carcinoma showed two major transcripts of a follicle-stimulating hormone receptor (FSH-R) gene, 4.1 and 2.4 kb, whereas the other two carcinomas showed two major transcripts of the luteinizing hormone/human chorionic gonadotropin receptor (LH-R) gene, 5.4 and 2.4 kb. These results were further analyzed by studying the corresponding PCR-amplified FSH and LH-R cDNA obtained by reverse transcription of total RNA. Expression of FSH-R mRNA was confirmed in about half of the cancer tissues. The size of the FSH-R reverse transcription-PCR product was the same as in normal ovarian follicles. Similarly, expression of LH-R mRNA was also detected in about half of the cancers. Normal ovaries and cancer tissues were homogenized, and activin concentrations were measured in extracts. Activin levels in normal ovarian tissue were around 0.59 +/- 0.01 ng/mg protein (mean +/- SE; n = 5), and activin production was detected in every cancer tissue, except one--serous adenocarcinoma. The findings in this study demonstrated that activin and ActRs are present in and synthesized by human ovarian epithelial neoplasms. Thus, activin seems to be available as an autocrine/paracrine factor in epithelial neoplasms and may contribute to the expression of FSH-R, although the roles of activin and gonadotropin in tumorigenesis has yet to be defined.

Application of efficient and specific gene transfer systems and organ culture techniques for the elucidation of mechanisms of epithelial-mesenchymal interaction in the developing gut

Epithelial-mesenchymal interactions are very important in the development of the vertebrate gut. In the avian embryonic stomach (proventriculus), expression of embryonic chick pepsinogen (ECPg) gene, which is specific to developing glandular cells in stomach epithelium, is regulated by mesenchymal influence. Molecular mechanisms of tissue-specific transcriptional regulation of the ECPg gene and the molecular nature of the mesenchymal signals were analyzed using a combination of the classic organ culture system and gene transfer strategies. In the present review, three methods for the introduction of DNA into tissues are described: lipofection, electroporation and retroviral infection, and characteristics of each system are discussed.

Analysis of cartilage maturation using micromass cultures of primary chondrocytes

A micromass culture (MM-C) system of primary immature chondrocytes for functional analysis of soluble factors involved in the maturation step of cartilage was previously developed. Ectopically expressed BMP-2 was shown to induce the expression of the Ihh and Noggin genes. Here it is demonstrated that, upon longer culture, secreted bone morphogenetic protein-2 (BMP-2) further promotes the maturation step as judged by the induction of type X collagen and BMP-6 expression, which are known to be detectable in the later phase of cartilage maturation. Induction of all of these genes by secreted BMP-2 was not inhibited by ectopic expression of parathyroid hormone-related peptide (PTHrP) induced by retrovirus vector infection, although the same virus vector showed strong inhibitory effects on the expression of type X collagen gene or alkaline phosphatase activity in mature chondrocytes. These results suggest that the maturation-promoting activity exhibited by BMP-2 is dominant over the suppressive effect of PTHrP in immature chondrocytes. When the BMP-6 gene was introduced into the same virus vector as that used for BMP-2, it induced the same sets of genes (Ihh, Noggin, type X collagen and endogenous BMP-6) as BMP-2 did. These results also suggest that BMP-6 would autonomously maintain and/or promote a later stage of chondrocytic maturation.

The concentric structure of the developing gut is regulated by Sonic hedgehog derived from endodermal epithelium

The embryonic gut of vertebrates consists of endodermal epithelium, surrounding mesenchyme derived from splanchnic mesoderm and enteric neuronal components derived from neural crest cells. During gut organogenesis, the mesenchyme differentiates into distinct concentric layers around the endodermal epithelium forming the lamina propria, muscularis mucosae, submucosa and lamina muscularis (the smooth muscle layer). The smooth muscle layer and enteric plexus are formed at the outermost part of the gut, always some distance away from the epithelium. How this topographical organization of gut mesenchyme is established is largely unknown. Here we show the following: (1) Endodermal epithelium inhibits differentiation of smooth muscle and enteric neurons in adjacent mesenchyme. (2) Endodermal epithelium activates expression of patched and BMP4 in adjacent non-smooth muscle mesenchyme, which later differentiates into the lamina propria and submucosa. (3) Sonic hedgehog (Shh) is expressed in endodermal epithelium and disruption of Shh-signaling by cyclopamine induces differentiation of smooth muscle and a large number of neurons even in the area adjacent to epithelium. (4) Shh can mimic the effect of endodermal epithelium on the concentric stratification of the gut. Taken together, these data suggest that endoderm-derived Shh is responsible for the patterning across the radial axis of the gut through induction of inner components and inhibition of outer components, such as smooth muscle and enteric neurons.

Posterior ventricular septal perforation in an 80-year-old man

Ventricular septal perforation is a complication of acute myocardial infarction that is fatal unless treated surgically. Posterior ventricular septal perforation remains particularly difficult to repair successfully. We report an 80-year-old man with postinfarction posterior ventricular septal perforation who successfully underwent surgical repair using a technique similar to that described by Daggett et al. and was discharged in good health without postoperative septal shunt.

Cloning and function of rabbit peroxisome proliferator-activated receptor delta/beta in mature osteoclasts

Osteoclasts modulate bone resorption under physiological and pathological conditions. Previously, we showed that both estrogens and retinoids regulated osteoclastic bone resorption and postulated that such regulation was directly mediated through their cognate receptors expressed in mature osteoclasts. In this study, we searched for expression of other members of the nuclear hormone receptor superfamily in osteoclasts. Using the low stringency homologous hybridization method, we isolated the peroxisome proliferator-activated receptor delta/beta (PPARdelta/beta) cDNA from mature rabbit osteoclasts. Northern blot analysis showed that PPARdelta/beta mRNA was highly expressed in highly enriched rabbit osteoclasts. Carbaprostacyclin, a prostacyclin analogue known to be a ligand for PPARdelta/beta, significantly induced both bone-resorbing activities of isolated mature rabbit osteoclasts and mRNA expression of the cathepsin K, carbonic anhydrase type II, and tartrate-resistant acid phosphatase genes in these cells. Moreover, the carbaprostacyclin-induced bone resorption was completely blocked by an antisense phosphothiorate oligodeoxynucleotide of PPARdelta/beta but not by the sense phosphothiorate oligodeoxynucleotide of the same DNA sequence. Our results suggest that PPARdelta/beta may be involved in direct modulation of osteoclastic bone resorption.

BMPs are necessary for stomach gland formation in the chicken embryo: a study using virally induced BMP-2 and Noggin expression

Epithelial-mesenchymal interactions are necessary for the normal development of various digestive organs. In chicken proventriculus (glandular stomach), morphogenesis and differentiation of the epithelium depend upon the inductive signals coming from underlying mesenchyme. However, the nature of such signals is still unclear despite extensive analyses carried out using experimental tissue recombinations. In this study we have examined the possible involvement of bone morphogenetic proteins (BMPs) in the formation of stomach glands in the chicken embryo. Analysis of the expression patterns of BMP-2, −4 and −7 showed that these BMPs were present in the proventricular mesenchyme prior to the initiation of the proventricular gland formation. BMP-2 expression, in particular, was restricted to the proventriculus among anterior digestive organs. Virus-mediated BMP-2 overexpression resulted in an increase in the number of glands formed. Moreover, ectopic expression of Noggin, which antagonizes the effect of BMPs, in the proventricular mesenchyme or epithelium, led to the complete inhibition of gland formation, indicating that BMP signals are necessary for the proventricular gland formation. These findings suggest that BMPs are of prime importance as mesenchymal signals for inducing proventricular glands.

[Should arterial grafts be used for urgent coronary artery bypass surgery?]

It is not clear whether arterial grafts should be used for emergency or urgent coronary artery bypass grafting (CABG) because harvest of internal thoracic arteries (ITAs) is not easy under urgent conditions and the blood flow through the ITAs may be inadequate immediately after CABG. The purpose of this study was to assess whether the use of arterial grafts in urgent CABG affects the outcome adversely or not. Twenty consecutive patients who underwent urgent CABG within 48 hours following coronary angiography at our institute between July 1991 and October 1998 were reviewed. The patients who underwent CABG with associated procedures were excluded. Among these subjects, 11 patients received at least one arterial graft. Only 1 patient died of subarachnoidal hemorrhage, and the hospital mortality rate was 5.0%. According to the overall survival rate, cardiac-death-free rate, and cardiac-event-free rate, the long-term outcome was much better in the patients with arterial grafts than those with saphenous vein grafts alone. We suggest that arterial grafts should be used even for urgent CABGs since the use of arterial grafts may not affect operative results adversely and will confer better long-term benefits.

Coronary-coronary bypass using the internal thoracic artery: a sparing procedure of the arterial conduit

BACKGROUND

The internal thoracic artery (ITA) is well known to be the best conduit for coronary artery bypass grafting. However, the bilateral use of ITAs remains limited because in situ right ITAs (RITAs) do not possess an adequate length to be directed to the posterolateral myocardium. We thus considered using free ITAs for conduits between the two segments of the same coronary artery.

METHODS

From March 1997 to May 1999, 17 patients underwent coronary-coronary bypass grafting (C-CBG) using free ITAs. Early operative results were analyzed. C-CBG was indicated when the right ITA had an inadequate length or when a distal part of the ITA was left unused.

RESULTS

No patient died after C-CBG and none have experienced angina since C-CBG (mean follow-up period 27.3 +/- 19.8 months). Postoperative angiography was performed in all subjects at discharge. Only one coronary-coronary bypass graft was occluded, the other grafts were patent, and there were no stenotic changes. Bilateral ITAs were used in 75% of the patients undergoing CABG during the period of this study.

CONCLUSIONS

C-CBG can expand the use of bilateral ITAs and can provide an alternative method for revascularization of the posterolateral myocardium.

Protective effect of thiopental against cerebral ischemia during circulatory arrest

BACKGROUND

One of the most important disadvantages of the hypothermic circulatory arrest technique is the limited time allowable for circulatory arrest. Thiopental is usually used to protect the brain against ischemic injuries. However, it remains uncertain how well thiopental reduces cerebral metabolism. We investigated its effectiveness by comparing outcomes after different doses.

METHODS

Fifty patients who underwent aortic arch repair with hypothermic circulatory arrest had their records reviewed. Electroencephalograms (EEG) and partial pressures of oxygen in the internal jugular vein (PjO2) were monitored. Following confirmation of total disappearance of EEG activity, 15 or 30 mg/kg thiopental was administered before circulatory arrest Th duration of circulatory arrest ranged from 16 to 77 min.

RESULTS

Hospital mortality rate was 10% and 4 (8%) patients developed neu-rologic complications, but 3 of them were transient. After thiopental infusion, PjO2 increased significantly from 430 to 499mmHg (p <0.01), indicating that thiopental reduces cerebral oxygen consumption. The rate of the decrease in PjO2 during circulatory arrest was slower with the higher thiopental dose, suggesting that thiopental lowered the cerebral metabolic rate of oxygen during circulatory arrest.

CONCLUSION

It appears that thiopental has protective effects against cerebral ischemia under profound hypothermia.

Effects of coronary artery bypass grafting using internal mammary arteries for diabetic patients

OBJECTIVES

In our institute, internal mammary arteries (IMAs) have been preferred for coronary artery bypass grafting (CABG) in diabetic patients. The purpose of this study was to evaluate the influence of diabetes and IMA grafting on survival after CABG.

BACKGROUND

The influence of diabetes on the results of CABG is not well documented, and there is controversy about whether the use of IMAs conveys greater survival benefits to diabetic patients.

METHODS

A total of 420 consecutive patients who underwent CABG from April 1990 to July 1998 were reviewed; 211 of these patients had diabetes mellitus at the time of surgery. Internal mammary artery grafts have been used with increasing frequency, and bilateral IMAs have been used when possible since 1993. Internal mammary artery grafts were used in 164 nondiabetic patients (78%) and in 155 diabetic patients (73%). Seventy-eight nondiabetic patients and 74 diabetic patients received bilateral IMA grafts.

RESULTS

The postoperative mortality was 2.4% in the nondiabetic and 2.8% in the diabetic group. With regard to postoperative complications, diabetic patients had a significantly higher rate of chest wound infection (p < 0.05), irrespective of whether IMAs were used or not. The use of bilateral IMAs did not increase the risk of chest wound infection in nondiabetic or diabetic patients. Overall survival curve, cardiac death-free curve and cardiac event-free curve were not affected adversely by diabetes, and in diabetic patients, CABG with saphenous veins alone conveyed significantly (p < 0.01) less long-term benefit than did CABG with at least one IMA graft.

CONCLUSIONS

It was suggested that IMA grafts should be preferred in diabetic patients.

Effect of prolactin on the expression of luteinizing hormone receptors during cell differentiation in cultured rat granulosa cells

Chronic and transient hyperprolactinemia has been associated with luteal phase dysfunction. Recently, evidence has emerged to suggest that elevated PRL may exert its antigonadal effects through reducing available ovarian LH receptors. We have now examined the influences of PRL on LH receptor induction in cultured granulosa cells. Basal specific LH binding was negligible and remained unchanged in response to treatment with PRL by itself. Whereas treatment with FSH produced, as expected, a substantial increase in specific LH binding, concurrent treatment with PRL resulted in no significant change during the first 4 days of culture, followed by a significant decrease in LH binding on days 5 and 6 as well as an approximately 50% inhibition of FSH effect on day 6. Scatchard plot analysis showed that concurrent treatment with PRL resulted in inhibition of the granulosa cell LH binding capacity, whereas no difference could be detected in the binding affinity of LH to its receptor. Treatment with 8-bromo-cAMP produced a significant increase in specific LH binding; concurrent treatment with PRL (30 ng/ml) produced a significant attenuation of 8-bromo-cAMP action. In addition, treatment with FSH increased the intracellular accumulation of cAMP, and concurrent treatment with PRL did not result in inhibition of the FSH action, as assessed by the generation of intracellular cAMP. Taken together, these findings suggest that the ability of PRL to interfere with FSH action with regard to the induction of LH receptors is exerted at sites distal to those involved in cAMP generation. The effect of PRL on LH receptor messenger RNA (mRNA) levels was not significant during the increase in receptors, whereas after the maximal level of receptor expression was reached, the effect of PRL was apparent. Cotreatment with FSH (30 ng/ml) and increasing doses of PRL inhibited the levels of FSH-induced LH receptor mRNA in a dose-dependent manner, whereas PRL did not inhibit the effect of FSH on the FSH receptor mRNA. To investigate the hormonal regulation of the 5'-flanking region, we analyzed the effect of FSH on 1379 bp of LH receptor promoter in rat granulosa cells. Treatment with FSH (1-100 ng/ml) significantly enhanced the activity of 1379 bp of the LH receptor 5'-flanking region in dose-dependent manner. Treatment with 30 ng/ml PRL alone did not significantly influence the activity of the LH receptor promoter and did not affect the increased promoter activity induced by FSH. In addition, the rates of LH receptor mRNA gene transcription assessed by nuclear run-on transcription assay increased by the addition of FSH and were not affected by the addition of PRL in the presence of FSH. These data showed that PRL might not effect LH receptor gene transcription in the regulation of LH receptor mRNA. Next, an attempt was made to determine the effect of PRL on LH receptor mRNA stability by measuring the decay of LH receptor mRNA under conditions known to inhibit transcription. However, inhibitors of transcription were found to have a stabilizing effect on the LH receptor mRNA, thus potentially masking the effect of PRL. According to the expression of LH receptor mRNA, PRL might not affect the maximum level induced by FSH, but thereafter the maximum levels of LH receptor mRNA decreased faster than those of the control. Therefore, it may be possible that PRL acts to stimulate labile LH receptor mRNA-destabilizing factors.

Control of the expression of luteinizing hormone receptor by local factors in rat granulosa cells

To identify the mechanisms underlying the hormone-dependent induction and maintenance of luteinizing hormone receptor (LH-R) in rat granulosa cells, the effect of follicle-stimulating hormone (FSH) and local factors on the LH-R mRNA levels were studied. LH-R mRNA levels of the cells incubated with FSH decreased rapidly after medium removal, and readdition of FSH with the fresh medium did not restore these levels. On the other hand, 8-bromoadenosine 3,5-cyclic monophosphate significantly enhanced the expression of LH-R mRNA after medium removal, while the level of LH-R mRNA was lower than that of the cells replaced by original medium including FSH. In addition, the incubation with 8-Br-cAMP produced dose-dependent responses for LH-R mRNAs and enhanced the activity of 1379 bp of the LH-R 5'-flanking region, while the level of LH-R mRNA decreased 3 days after medium removal. Further studies were undertaken to assess the role of factors in maintaining the LH receptor once induced by FSH. Since FSH and cAMP increase follistatin production in granulosa cells, we examined the effect of follistatin on LH-R induction in the presence of activin and FSH. Activin induced LH-R in the presence of FSH significantly, and follistatin antagonized this effect in a dose-dependent manner. However, insulinlike growth factor-I (IGF-I) induced LH-R mRNA in the presence of FSH even after medium change. IGF-I might be one of the important factors that act in the medium to maintain LH-R levels in granulosa cells.

[A case report of coronary artery bypass grafting using hypothermic circulatory arrest technique for the severely calcified ascending aorta]

Severe calcification of the ascending aorta makes coronary artery bypass grafting (CABG) complicated since aortic cross-clamping may induce cerebral embolization of aortic debris or aortic dissection. Furthermore, there are problems that the distal aortic occlusion becomes incomplete and proximal anastomosis between the ascending aorta and saphenous veins becomes impossible. CABG for a 56 year-old male with severely calcified ascending aorta was successfully conducted using hypothermic circulatory arrest technique. His right internal thoracic artery was bypassed to LAD under fibrillatory arrest and then his right gastroepiploic artery was bypassed to the distal portion of RCA under hypothermic circulatory arrest. There was no complication and left ventricular ejection fraction improved from 16% to 38% postoperatively.

The effect of follicle-stimulating hormone (FSH) on the expression of FSH receptor in cultured rat granulosa cells

The acquisition of FSH receptors during folliculogenesis is believed to be a key event in the subsequent development of the follicle. The regulation by FSH of FSH receptor expression and function were further studied using cultured granulosa cells of diethylstilbestrol (DES)-primed immature rats. Incubation of rat granulosa cells with FSH led to a reduction in FSH receptor levels for a short time (6 h), followed by an increase in FSH receptor levels that reached maximum of around 150% of the initial level within 3 days after the addition of FSH. FSH stimulation caused a reduced cAMP response to subsequent FSH treatment and a time course experiment demonstrated that this response was detectable within 30 min of exposure to FSH and reached a plateau after 4 h to 24 h. The recovery of FSH responsiveness in cAMP production of granulosa cells was seen after 48 h of FSH-free interval. Treatment with forskolin (FSK) enhanced the effect of subsequent FSH on the production of intracellular cAMP. Treatment with PMA did not affect the response to subsequent FSH treatment. These data showed that the FSH is essential for the suppression of the FSH receptor function in the adenylyl cyclase pathway. Desensitization of cellular response to continuous agonist stimulation may occur because of changes in the numbers of FSH receptor, as well as changes in the functional properties of the effector system.

Regulation of cAMP responsive element binding modulator isoforms in cultured rat ovarian granulosa cells

A pituitary glycoprotein hormone FSH stimulates ovarian granulosa cells to induce ovarian follicular development. In this study we identified rat ovarian genes that were rapidly induced by FSH in the cultured rat granulosa cells by means of subtraction cloning. Complementary DNA clones encoding cAMP responsive element binding modulator (CREM) were identified as one of the FSH inducible genes. Northern blotting and reverse transcription and polymerase chain reaction (RT-PCR) analyses revealed that only the repressor type of CREM gene products, ICER (inducible cAMP early repressor) isoforms, were induced by FSH treatment in cultured rat granulosa cells. The induction of ICER by FSH was mimicked by reagents known to increase intracellular cAMP levels, indicating that the induction is through cAMP and protein kinase A signal transduction system. Induction of ICER was also confirmed as the protein levels. Electrophoretic mobility shift assay of granulosa cell extracts with a radiolabeled double stranded oligonucleotide corresponding to somatostatin cAMP responsive element also revealed that only the ICER proteins were induced by FSH treatment, whereas levels of CREM proteins were nearly constant regardless of the FSH treatment. Our present study demonstrates that FSH-induced and cAMP-mediated induction and attenuation of transcriptional responses by CREM gene products may be a key mechanistic component for the granulosa cell differentiation and proliferation.

Control of FSH receptor mRNA expression in rat granulosa cells by 3',5'-cyclic adenosine monophosphate, activin, and follistatin

FSH is required to maintain FSH and LH/hCG receptors at elevated steady-state levels after receptor induction. Although this function of FSH is mediated by cAMP, how cAMP level is related to the maintenance of gonadotropin receptors is unknown. To investigate cAMP's effect on changes in the levels of FSH receptor mRNAs in rat granulosa cells, total RNA from cells was prepared and analyzed by Northern blots. Incubation with 8-Br-cAMP for 24 h produced a dose-related increase in FSH receptor mRNA in granulosa cells of DES-primed immature rats. On the other hand, 8-Br-cAMP, washed at 24 h, exerted inverse dose-related effects on FSH receptor mRNA levels at 96 h. The addition of 1 mM cAMP resulted in higher levels of FSH receptor mRNA than that induced by 0.2 mM cAMP at 24 h, while 0.2 mM cAMP is as effective as 1-2 mM cAMP for the induction of FSH receptor mRNA at 96 h. To further analyze cAMP's role in the production of activin in granulosa cells, we measured activin levels in the culture medium after the addition of 8-Br-cAMP. The levels of activin A were suppressed by the addition of 8-Br-cAMP in a dose-dependent manner. In addition, the procedure by which 8-Br-cAMP was removed after 24 h incubation showed that the level of activin in the medium increased after medium change. With regard to the actions of activin A on gonadotropin receptors, our laboratory has demonstrated that activin A increases the levels of FSH receptor mRNAs. Therefore, cAMP has a negative effect on FSH receptor expression by suppressing the activin level. Since follistatin production is up-regulated by cAMP in this system, we examined the effect of follistatin on FSH receptor mRNA level, which is induced by activin and FSH. Cotreatment with follistatin (0-100 ng/ml) and activin (50 ng/ml) in the presence of FSH (30 ng/ml) caused a significant reduction in FSH receptor mRNA levels induced by activin. Based on these observations, it is possible that cAMP has both stimulatory and inhibitory effects on the expression of gonadotropin receptors, and the overall influence of cAMP on their expression might be determined by the integration of such opposing effects.

Etidronate (EHDP) inhibits osteoclastic-bone resorption, promotes apoptosis and disrupts actin rings in isolate-mature osteoclasts

Bisphosphonates, therapeutic reagents against tumoral bone diseases (Paget's disease or osteoporosis), are potent inhibitors of bone resorption. The mechanisms by which they directly act on mature osteoclasts remain unclear. Using a recently developed technique for isolation of highly purified mammalian mature osteoclasts, we demonstrated that etidronate [ethane-1-hydroxy-1,1-diphosphonate (EHDP), 1-hydroxy-1,1-ethylidenebisphosphonate], inhibited directly osteoclastic bone-resorbing activity by pit assay. In addition, EHDP also directly induced apoptosis and disrupted actin rings in osteoclasts. The data support previous data on non-purified osteoclasts and results in vivo.