Persistent postural hypotension due to guanacline

Methods of sympathetic degeneration and alteration

The role of the sympathetic nervous system in health and disease has often been elucidated by inducing changes in, or degeneration of sympathetic neural pathways. Several methods of inducing peripheral lesions have been created from surgical removal, NGF depletion, auto-immune and chemical destruction to novel approaches using immunotoxins and transgenic animals. This review compares these methods in terms of their mechanism and specificity. The advantages and disadvantages of these techniques are discussed.

Sympathetic neuronal destruction in macaque monkeys by guanethidine and guanacline

To determine whether the peripheral sympathetic neurons of subhuman primates are destroyed by guanacline treatment, we treated Macaca fasicularis with 2 or 20 mg/kg of guanethidine, guanacline, or the saturated analog of guanacline (SAG) 5 times per week for 4 or 12 weeks. All monkeys given 20 mg/kg of guanethidine, guanacline, or SAG showed a marked loss of neurons in the ganglia of the peripheral sympathetic nervous system. Treatment of macaques with 2 mg/kg of the guanidinium compounds resulted in patches of small-cell infiltrate, slight neuronal loss, and degenerative alterations in the sympathetic ganglia. Neuronal alterations in sympathetic ganglia of all treated monkeys were accompanied by a prominent heterogeneous infiltrate of mononuclear cells arranged primarily in a perivascular distribution and extending into the ganglionic neuropil. Peripheral sensory ganglia were unaffected. These histological findings are similar to those described in the guanethidine-induced immune-mediated sympathectomy, which has been extensively studied in the rat.

Species and structural specificity of the lipopigment accumulation and neuronal destruction induced by N-(2-guanidinoethyl)-4-methyl-1,2,5,6-tetrahydropyridine (guanacline)

Guanacline, a guanidinium adrenergic neuron blocking agent similar to guanethidine, was studied clinically and experimentally during the late 1960s. Like guanethidine, it has been reported to produce sympathetic neuronal destruction in rats. Unlike guanethidine, it has been reported to produce irreversible sympathetic deficits in man and to produce fluorescent lipopigment in rat sympathetic neurons. Guanacline and its derivative in which the double bond of the tetrahydropyridine ring is reduced (saturated analog of guanacline, SAG) were prepared. Several species were treated chronically with varying doses of guanethidine, guanacline or SAG; the superior cervical ganglia were examined light microscopically for neuronal destruction and for osmiophilic fluorescent lipopigment accumulation. All 3 drugs produced rapid neuronal destruction in rats accompanied by massive small-cell infiltration. In striking contrast, treatment for many weeks with doses up to 100 mg/kg/day produced no small-cell infiltration or apparent neuronal destruction in mice or guinea pigs. The neuronal destruction produced by guanacline and SAG in the rat, like that caused by guanethidine, was prevented by immunosuppression or gamma-irradiation, indicating that all 3 agents produce neuronal destruction in rats by an immune-mediated mechanism. Thus, the ability of the drug to produce sympathectomy is species specific but not drug specific. The opposite was found with respect to fluorescent lipopigment accumulation. Guanacline, but not guanethidine or SAG, produced fluorescent lipopigment in all species examined. Therefore, the double bond of the tetrahydropyridine ring plays a critical role in the production of the fluorescent lipopigment.(ABSTRACT TRUNCATED AT 250 WORDS)

Primate model of parkinsonism: selective lesion of nigrostriatal neurons by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine produces an extrapyramidal syndrome in rhesus monkeys

Systemic administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) to rhesus monkeys (1.0-2.5 mg/kg i.v.) produces irreversible damage to nigrostriatal neurons. Dopaminergic neurons in the dorsolateral part of striatum were the most vulnerable. The major clinical signs of an extrapyramidal syndrome, but not resting tremor, appeared only in MPTP-treated monkeys suffering from more than 80% reduction in striatal dopamine. No chronic changes in the mesolimbic dopaminergic system were observed. Immunocytochemical staining of the mid-brain with a tyrosine hydroxylase antiserum indicated that MPTP produced a significant decrease of dopaminergic cell bodies in the A9, but not in the A10 ventrotegmental area. Despite greater than 80% decrease in A9 nigral cell bodies, the dopamine content decreased only by 50%. Sprouting of the surviving nigral A9 neurons was observed histologically and neurochemically in the area above substantia nigra. The present behavioral, neurochemical and histological results indicate that MPTP produces an ideal primate model for studying parkinsonism. Selective lesion of more than 80% of the nigrostrial neurons by MPTP is sufficient to produce the major clinical signs of the extrapyramidal syndrome in idiopathic parkinsonism.

Persistent parotid pain due to guanacline

Details are given of 17 patients who developed parotid pain during treatment with guanacline and which persisted after cessation of guanacline for upto five and a half years. These patients are compared with 17 patients who received similar treatment with guanacline and who did not develop parotid pain. There was no significant difference between patients who experienced parotid pain and those who did not with respect to sex, age, clinical diagnosis, blood urea, previous hypotensive therapy or other drugs given concurrently with guanacline. There was a slightly greater association of parotid pain with other side effects and with a larger daily dose of guanacline. It is suggested that persistent parotid pain after guanacline therapy is due to prolonged or permanent selective sympathetic nerve damage in the region of the cervical sympathetic nerve supply to the salivary glands.