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Asmar A, Cramon PK, Asmar M, Simonsen L, Sorensen CM, Madsbad S, Moro C, Hartmann B, Rehfeld JF, Holst JJ, Hovind P, Jensen BL, Bülow J. Increased oral sodium chloride intake in humans amplifies selectively postprandial GLP-1 but not GIP, CCK, and gastrin in plasma. Physiol Rep 2020; 8:e14519. [PMID: 32770661 PMCID: PMC7413881 DOI: 10.14814/phy2.14519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 12/24/2022] Open
Abstract
Human studies have demonstrated that physiologically relevant changes in circulating glucagon-like peptide-1 (GLP-1) elicit a rapid increase in renal sodium excretion when combined with expansion of the extracellular fluid volume. Other studies support the involvement of various gastrointestinal hormones, e.g., gastrin and cholecystokinin (CCK) in a gut-kidney axis, responsible for a rapid-acting feed-forward natriuretic mechanism. This study was designed to investigate the hypothesis that the postprandial GLP-1 plasma concentration is sensitive to the sodium content in the meal. Under fixed sodium intake for 4 days prior to each experimental day, 10 lean healthy male participants were examined twice in random order after a 12-hr fasting period. Arterial blood samples were collected at 10-20-min intervals for 140 min after 75 grams of oral glucose + 6 grams of oral sodium chloride (NaCl) load versus 75 grams of glucose alone. Twenty-four-hour baseline urinary sodium excretions were similar between study days. Arterial GLP-1 levels increased during both oral glucose loads and were significantly higher at the 40-80 min period during glucose + NaCl compared to glucose alone. The postprandial arterial responses of CCK, gastrin, and glucose-dependent insulinotropic polypeptide as well as glucose, insulin, and C-peptide did not differ between the two study days. Arterial renin, aldosterone, and natriuretic peptides levels did not change within subjects or between study days. Angiotensin II levels were significantly lower at the time GLP-1 was higher (60-80 min) during glucose + NaCl. Sodium intake in addition to a glucose load selectively amplifies the postprandial GLP-1 plasma concentration. Thus, GLP-1 may be part of an acute feed-forward mechanism for natriuresis.
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Affiliation(s)
- Ali Asmar
- Department of Clinical Physiology, Nuclear Medicine and PET, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
- Department of Clinical Physiology and Nuclear MedicineBispebjerg and Frederiksberg HospitalUniversity Hospital of CopenhagenCopenhagenDenmark
| | - Per K. Cramon
- Department of Clinical Physiology and Nuclear MedicineBispebjerg and Frederiksberg HospitalUniversity Hospital of CopenhagenCopenhagenDenmark
| | - Meena Asmar
- Department of Clinical Physiology and Nuclear MedicineBispebjerg and Frederiksberg HospitalUniversity Hospital of CopenhagenCopenhagenDenmark
- Department of EndocrinologyOdense University HospitalOdenseDenmark
| | - Lene Simonsen
- Department of Clinical Physiology and Nuclear MedicineBispebjerg and Frederiksberg HospitalUniversity Hospital of CopenhagenCopenhagenDenmark
| | | | - Sten Madsbad
- Department of EndocrinologyHvidovre HospitalUniversity Hospital of CopenhagenCopenhagenDenmark
| | - Cedric Moro
- Institut National de la Santé et de la Recherche Médicale (Inserm) UMR 1048Institute of Metabolic and Cardiovascular DiseasesPaul Sabatier UniversityToulouseFrance
| | - Bolette Hartmann
- Department of Biomedical SciencesUniversity of CopenhagenCopenhagenDenmark
- Novo Nordisk Foundation Center for Basic Metabolic ResearchUniversity of CopenhagenCopenhagenDenmark
| | - Jens F. Rehfeld
- Department of Clinical Biochemistry, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Jens J. Holst
- Department of Biomedical SciencesUniversity of CopenhagenCopenhagenDenmark
- Novo Nordisk Foundation Center for Basic Metabolic ResearchUniversity of CopenhagenCopenhagenDenmark
| | - Peter Hovind
- Department of Clinical Physiology, Nuclear Medicine and PET, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
- Department of Clinical Physiology and Nuclear MedicineBispebjerg and Frederiksberg HospitalUniversity Hospital of CopenhagenCopenhagenDenmark
| | - Boye L. Jensen
- Department of Cardiovascular and Renal ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Jens Bülow
- Department of Clinical Physiology and Nuclear MedicineBispebjerg and Frederiksberg HospitalUniversity Hospital of CopenhagenCopenhagenDenmark
- Department of Biomedical SciencesUniversity of CopenhagenCopenhagenDenmark
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Alifieris CE, Trafalis DT, Efstratopoulos AD, Alifieris EK. Evidence of the role of the vagal nerves as a monitor in the gastrointestinal-renal axis of natriuresis in human: Effects of vagotomy. Auton Neurosci 2017; 205:99-109. [PMID: 28511917 DOI: 10.1016/j.autneu.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 03/27/2017] [Accepted: 05/09/2017] [Indexed: 11/30/2022]
Abstract
This study aimed to investigate the mechanism of gastrointestinal regulation of natriuresis. Sixteen subjects without (group I) and sixteen subjects with a truncal vagotomy (group II), were given a daily diet of 18mmol of sodium for 5days (D1-D5). The sodium deficit for this period was calculated for each subject and on the morning of day-6 (D6), their cumulative deficit (E) was given as 3% NaCl. In both groups the subjects were divided to receive the hypertonic saline either orally (Ior, IIor) or intravenously (Iiv, IIiv). During the period of low sodium diet when compared to group II subjects of group I (1) had a greater weight loss (p<0.005), (2) demonstrated a larger drop in pulse pressure (p<0.005), (3) achieved a positive sodium equilibrium later (D5 vs D4) and (4) developed a greater sodium deficit (p<0.005). During the two 12h periods of D6, both Ior and Iiv exhibited greater natriuresis during the first 12h period (p<0.0001) whereas both IIor and IIiv did so during the second 12h period (p<0.0001). On D6 Ior excreted the greatest percentage of E (E%; 35.63%±3.12%, p<0.0001) compared to Iiv (17.06%±1.78%), IIor (16.03%±3.54%) and IIiv (15.39%±2.77%) whereas E% was not different between the other subgroups. These results indicate that the differential natriuresis between oral and intravenous sodium loading in previously sodium deprived subjects, is due to a mechanism in which the vagal nerves play a significant role as part of neural reflex or via a natriuretic hormone.
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Affiliation(s)
- Constantinos E Alifieris
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Surgery, Agia Olga Hospital, Athens, Greece.
| | - Dimitrios T Trafalis
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aris D Efstratopoulos
- Third Internal Medicine and Hypertension Unit, General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanuel K Alifieris
- Medical School, National and Kapodistrian University of Athens, Athens, Greece; Second Surgery Department, General Hospital of Chania "Agios Georgios", Chania, Greece; Second Surgery Department, Piraeus General Hospital "Agios Pandeleimon", Piraeus, Greece
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Affiliation(s)
- Jian Yang
- Department of Nutrition, Daping Hospital, The Third Military Medical University, Chongqing, China.,Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Pedro A Jose
- Division of Renal Disease & Hypertension, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Chunyu Zeng
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, China
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Jose PA, Yang Z, Zeng C, Felder RA. The importance of the gastrorenal axis in the control of body sodium homeostasis. Exp Physiol 2016; 101:465-70. [PMID: 26854262 DOI: 10.1113/ep085286] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 02/01/2016] [Indexed: 12/27/2022]
Abstract
NEW FINDINGS What is the topic of this review? Sensing the amount of ingested sodium is one mechanism by which sodium balance is regulated. This review describes the role of gastrin in the cross-talk between the stomach and the kidney following the ingestion of sodium. What advances does it highlight? Neural mechanisms and several gut hormones, including cholecystokinin and uroguanylin, have been suggested to mediate the natriuresis after an oral sodium load. It is proposed that gastrin produced by G-cells via its receptor, cholecystokinin B receptor, interacts with renal D1 -like dopamine receptors to increase renal sodium excretion. Hypertension develops with chronically increased sodium intake when sodium that accumulates in the body can no longer be sequestered, extracellular fluid volume is expanded, and compensatory neural, hormonal and pressure-natriuresis mechanisms fail. Sensing the amount of ingested sodium, by the stomach, is one mechanism by which sodium balance is regulated. The natriuresis following the ingestion of a certain amount of sodium may be due to an enterokine, gastrin, secreted by G-cells in the stomach and duodenum and released into the circulation. Circulating gastrin levels are 10- to 20-fold higher than those for cholecystokinin. Of all the gut hormones circulating in the plasma, gastrin is the one that is reabsorbed to the greatest extent by renal tubules. Gastrin, via its receptor, the cholecystokinin type B receptor (CCKBR), is natriuretic in mammals, including humans, by inhibition of renal sodium transport. Germline deletion of gastrin (Gast) or Cckbr gene in mice causes salt-sensitive hypertension. Selective silencing of Gast in the stomach and duodenum impairs the ability to excrete an oral sodium load and also increases blood pressure. Thus, the gastrorenal axis, mediated by gastrin, can complement pronatriuretic hormones, such as dopamine, to increase sodium excretion after an oral sodium load. These studies in mice may be translatable to humans because the chromosomal loci of CCKBR and GAST are linked to human essential hypertension. Understanding the role of genes in the regulation of renal function and blood pressure may lead to the tailoring of antihypertensive treatment based on genetic make-up.
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Affiliation(s)
- Pedro A Jose
- Department of Medicine, The George Washington University School of Medicine, Washington, DC, USA.,Department of Physiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Zhiwei Yang
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences & Comparative Medicine Centre, Peking Union Medical College, Beijing, PR China
| | - Chunyu Zeng
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing Institute of Cardiology, Chongqing 400042, PR China
| | - Robin A Felder
- Department of Pathology, The University of Virginia, Charlottesville, VA, USA
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How JMY, Pumpa TJ, Sartor DM. Renal sympathoinhibitory and regional vasodilator responses to cholecystokinin are altered in obesity-related hypertension. Exp Physiol 2013. [DOI: 10.1113/expphysiol.2012.070151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jiang X, Wang W, Ning B, Liu X, Gong J, Gan F, Gao X, Zhang L, Jose PA, Qin C, Yang Z. Basal and postprandial serum levels of gastrin in normotensive and hypertensive adults. Clin Exp Hypertens 2012; 35:74-8. [PMID: 22680232 DOI: 10.3109/10641963.2012.690474] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Gastrin is a peptide hormone, which acts not only to regulate gastric acid secretion, but also to exert physiological actions such as the regulation of sodium balance. From a case (n = 95)-control (n = 82) study in Fuyang People's Hospital, Anhui Province, China, we found that the fasting serum gastrin levels are similar in normotensive and hypertensive adults but increased to higher levels in the latter group than in the former group after a mixed meal. We suggest that gastrin is involved in the regulation of blood pressure, possibly via the regulation of sodium and water metabolism and/or renin-angiotensin-aldosterone system. However, the mechanism remains to be determined.
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Affiliation(s)
- Xiaoliang Jiang
- Key Laboratory of Human Diseases Comparative Medicine, Ministry of Health, Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences & Comparative Medicine Centre, Peking Union Medical College, Beijing, PR China
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Grossini E, Caimmi P, Molinari C, Uberti F, Mary D, Vacca G. Intracoronary gastrin 17 increases cardiac perfusion and function through autonomic nervous system, CCK receptors, and nitric oxide in anesthetized pigs. J Appl Physiol (1985) 2011; 110:95-108. [DOI: 10.1152/japplphysiol.00625.2010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The release of gastrointestinal hormones has been reported to modulate reflex cardiovascular responses caused by gastric distension, although the role played by gastrin 17 is as yet unknown. The present study was therefore planned to determine the primary in vivo effect of gastrin 17 on coronary blood flow and cardiac function and the involvement of autonomic nervous system, CCK1/2 receptors, and nitric oxide (NO). In 40 anesthetized pigs, gastrin 17 was infused into the left anterior descending coronary artery at constant heart rate and arterial blood pressure. In 35 of the 40 pigs, the mechanisms of the observed hemodynamic responses were analyzed by repeating gastrin 17 infusion after autonomic nervous system and NO blockade, and after specific CCK receptors agonists/antagonists administration. Intracoronary gastrin 17 administration caused dose-related increases of both coronary blood flow and cardiac function. The intracoronary co-administration of CCK33/pentagastrin and gastrin 17 potentiated the coronary effects observed when the above agents were given alone ( P <0.05). The potentiation of the cardiac response was observed only with the co-administration of pentagastrin and gastrin 17 ( P <0.05). Moreover, blockade of muscarinic cholinoceptors (intravenous atropine) and of α-adrenoceptors (intravenous phentolamine) did not abolish the hemodynamic responses to gastrin 17. The cardiac and vascular effects of the hormone were prevented by blockade of β-adrenoceptors (intravenous atenolol and butoxamine), CCK1/2 receptors (intracoronary lorglumide and CAM-1028), and NO synthase (intracoronary Nω-nitro-l-arginine methyl ester). In conclusion, gastrin 17 primarily increased coronary blood flow and cardiac function through the involvement of CCK receptors, β-adrenoceptors, and NO release.
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Affiliation(s)
- Elena Grossini
- Dipartimento di Medicina Clinica e Sperimentale, Laboratorio di Fisiologia, Università degli Studi del Piemonte Orientale “A. Avogadro,” Novara, Italy
| | - Philippe Caimmi
- Dipartimento di Medicina Clinica e Sperimentale, Laboratorio di Fisiologia, Università degli Studi del Piemonte Orientale “A. Avogadro,” Novara, Italy
| | - Claudio Molinari
- Dipartimento di Medicina Clinica e Sperimentale, Laboratorio di Fisiologia, Università degli Studi del Piemonte Orientale “A. Avogadro,” Novara, Italy
| | - Francesca Uberti
- Dipartimento di Medicina Clinica e Sperimentale, Laboratorio di Fisiologia, Università degli Studi del Piemonte Orientale “A. Avogadro,” Novara, Italy
| | - David Mary
- Dipartimento di Medicina Clinica e Sperimentale, Laboratorio di Fisiologia, Università degli Studi del Piemonte Orientale “A. Avogadro,” Novara, Italy
| | - Giovanni Vacca
- Dipartimento di Medicina Clinica e Sperimentale, Laboratorio di Fisiologia, Università degli Studi del Piemonte Orientale “A. Avogadro,” Novara, Italy
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CCK as a modulator of cardiovascular function. J Chem Neuroanat 2009; 38:176-84. [DOI: 10.1016/j.jchemneu.2009.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 05/22/2009] [Accepted: 06/19/2009] [Indexed: 02/07/2023]
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Michell A, Debnam E, Unwin R. Regulation of Renal Function by the Gastrointestinal Tract: Potential Role of Gut-Derived Peptides and Hormones. Annu Rev Physiol 2008; 70:379-403. [DOI: 10.1146/annurev.physiol.69.040705.141330] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A.R. Michell
- Department of Biochemical Pharmacology, William Harvey Research Institute, St. Bartholomew's Hospital Medical School, London EC1M 6BQ, United Kingdom;
| | - E.S. Debnam
- Department of Physiology, Royal Free and University College Medical School, London NW3 2PF, United Kingdom;
| | - R.J. Unwin
- Department of Physiology, Royal Free and University College Medical School, London NW3 2PF, United Kingdom;
- Centre for Nephrology, Royal Free and University College Medical School, London NW3 2PF, United Kingdom;
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von Schrenck T, Ahrens M, de Weerth A, Bobrowski C, Wolf G, Jonas L, Jocks T, Schulz M, Bläker M, Neumaier M, Stahl RA. CCKB/gastrin receptors mediate changes in sodium and potassium absorption in the isolated perfused rat kidney. Kidney Int 2000; 58:995-1003. [PMID: 10972664 DOI: 10.1046/j.1523-1755.2000.00257.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND To evaluate the function of cholecystokinin B (CCKB)/gastrin receptors in the rat kidney, we identified the receptors by Northern blot and localized the receptors by immunohistochemistry. The functional effects of gastrin were studied under standardized in vitro conditions using the isolated perfused kidney. METHODS Rat kidneys were mounted in an organ bath by attaching the renal artery to a perfusion system. A catheter was inserted into the renal vein and the ureter to collect samples that were analyzed for the concentrations of electrolytes. After a preperfusion period, gastrin-17-I was given via the renal artery (10-8 to 10-6 mol/L). Subsequently, hemodynamic parameters (for example, perfusate flow) and changes in sodium and potassium absorption were determined. All data were subjected to a nonparametric analysis of variance and, in case of significant results, to subsequent paired comparisons by the a posteriori Wilcoxon test. RESULTS Northern blot analysis detected CCKB receptor transcripts in total RNA isolated from kidneys. Immunohistochemistry localized CCKB receptors on tubules and collecting duct cells. Compared with controls, gastrin (10-6 mol/L) caused a decrease in the fractional sodium reabsorption (basal 80%, 10 minutes after application of gastrin 71%, after 20 minutes 62%, P < 0.05). This effect was inhibited by the CCKB receptor antagonist L-365,260. Gastrin decreased urinary potassium excretion at 10-8 and 10-6 mol/L [maximal decrease at 10-6 mol/L from baseline values (100%) to 49% after 10 minutes and to 69% after 20 minutes, P < 0.05, N = 6]. This effect was also abolished by the CCKB receptor antagonist L-365,260. Gastrin (10-6 mol/L) reduced perfusate flow by 31% (P < 0.05). CONCLUSIONS CCKB receptors are expressed in the rat kidney on tubules and collecting ducts. These receptors mediate changes in renal potassium and sodium absorption. In addition, gastrin causes a decrease in perfusate flow, indicating that CCKB receptors might also modulate vascular resistance in the kidney.
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Affiliation(s)
- T von Schrenck
- Department of Medicine, Divisions of Nephrology and Clinical Chemistry, University Hospital Eppendorf, Hamburg, and Institute of Pathology, University of Rostock, Rostock, Germany.
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de Weerth A, Jonas L, Schade R, Schöneberg T, Wolf G, Pace A, Kirchhoff F, Schulz M, Heinig T, Greten H, von Schrenck T. Gastrin/cholecystokinin type B receptors in the kidney: molecular, pharmacological, functional characterization, and localization. Eur J Clin Invest 1998; 28:592-601. [PMID: 9726041 DOI: 10.1046/j.1365-2362.1998.00310.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gastrin/cholecystokinin type B receptors (CCKBRs) can be found on parietal cells and smooth muscle cells and are the predominant brain CCK receptors. Recent cloning studies indicate that this is receptor type might also be expressed in the kidney. MATERIALS AND METHODS We used Northern blot analysis in guinea pig. kidney and reverse transcriptase polymerase chain reaction (RT-PCR) in several murine kidney cells lines to evaluate this organ for the expression of the CCKBRs. The receptor was pharmacologically characterized by displacement experiments using [125I]-BH-CCKs and various agonists and antagonists. Polyclonal antibodies vs. the CCKBRs were raised in chicken, and immunohistochemistry on tissue sections was used to localize the receptor within the organ. The effect of gastrin on renal cell growth was measured using proximal tubulus (MCT) cells, which were cultured with gastrin (10-9 M) for 24-72 h. Cell counts and [3H]-thymidine incorporation experiments were performed. RESULTS CCKBR transcripts can be detected in kidney RNA (tubules > glomeruli > interstitium). RT-PCR revealed CCKBR transcripts in proximal tubules (MCT cells) and in mesangium (MMC). The medullary thick ascending limb of Henle's loop and several control tissues such as liver and muscle were negative. Displacement experiments using [125I]-BH-CCK and various agonists and antagonists identified binding sites with typical CCKBR pharmacology. CCKBRs were localized in the proximal tubulus, distal collecting ducts and mesangium cells. Treatment of rested MCT cells with gastrin 17-1 induced cell proliferation and [3H]-thymidine incorporation by at least 40% compared with normal growth (P < 0.05). CONCLUSION These results show for the first time that CCKBRs are present in selected areas of the kidney, and strongly confirm our previous observation that this organ expresses binding sites for [125I]-gastrin. Furthermore, gastrin might act as a growth factor in the kidney.
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Affiliation(s)
- A de Weerth
- Universitäts-Krankenhaus Eppendorf, Hamburg, Germany.
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Wiśniewska RJ, Wiśniewski K. The effect of cholecystokinin (CCK-33) and C-terminal fragments of cholecystokinin: CCK-8 and CCK-4 on the cardiovascular system in rats. GENERAL PHARMACOLOGY 1996; 27:159-63. [PMID: 8742514 DOI: 10.1016/0306-3623(95)00080-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
1. The effects of cholecystokinin (CCK-33) and its fragments CCK-8 and CCK-4 on arterial blood pressure and the function of isolated rat heart and the amount of catecholamines in plasma, heart tissue were studied. 2. The results indicated that shortening of CCK to CCK-8 and CCK-4 eliminates the circulatory effect of this peptide. 3. A correlation was found between the results of in vivo and in vitro experiments and the amount of catecholamines.
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Affiliation(s)
- R J Wiśniewska
- Department of Pharmacology, Medical Academy, Białystok, Poland
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Affiliation(s)
- R J Unwin
- Department of Clinical Pharmacology, Royal Postgraduate Medical School, Hammersmith Hospital, London, England
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