Histamine metabolism during the menstrual cycle

Progesterone Inhibits Mast Cell Secretion

Mast cells are involved in allergic reactions, where they secrete numerous vasoactive, inflammatory and nociceptive mediators in response to immunoglobulin E (IgE) and antigen. However, they have also been implicated in inflammatory conditions, such as painful bladder syndrome/interstitial cystitis (PBS/IC), irritable bowel syndrome (IBS) and migraines, all of which occur more often in women and are exacerbated during ovulation, but are suppressed during pregnancy. Mast cells express high affinity estrogen receptors and estradiol augments their secretion, while tamoxifen inhibits it. Here we report that progesterone (100 nM), but not the structurally related cholesterol, inhibits histamine secretion from purified rat peritoneal mast cells stimulated immunologically or by substance P (SP), an effect also documented by electron microscopy. These results suggest that mast cell secretion may be regulated by progesterone and may explain the reduced symptoms of certain inflammatory conditions during pregnancy.

Carbachol-induced bladder mast cell activation: augmentation by estradiol and implications for interstitial cystitis

OBJECTIVES

Interstitial cystitis (IC) is a painful, sterile bladder disorder that occurs primarily in women, many of whom also experience allergies with symptoms that worsen perimenstrually. Increased numbers of activated bladder mast cells have recently been implicated in the pathophysiology of IC. These mast cells express high-affinity estrogen receptors and are located close to increased bladder nerves, many of which contain the neuropeptide substance P (SP). We therefore investigated whether the neurotransmitter acetylcholine (ACh) and SP could activate bladder mast cells and whether estradiol could influence this effect.

METHODS

Bladder pieces from male Sprague-Dawley rats were perfused with carbachol (the stable analogue of ACh), SP, or the mast cell secretagogue compound 48/80 (C48/80) with or without preincubation with beta-estradiol. The effect of carbachol was also investigated after pretreatment with the muscarinic antagonist atropine. Mast cell activation was assessed by release of 3H-serotonin and morphologic evidence of secretion by light and electron microscopy.

RESULTS

Carbachol triggered rat bladder mast cell serotonin release in a dose-dependent manner, an effect increased by tissue pretreatment with estradiol and blocked by atropine. The effect of carbachol was accompanied by ultrastructural evidence of mast cell activation and was stronger than that obtained by either C48/ 80 or SP.

CONCLUSIONS

Bladder mast cell activation is neurogenically mediated and augmented by estradiol, findings that could possibly explain the painful symptoms of IC and its prevalence in women, as well as the worsening of symptoms perimenstrually.

Progesterone-induced urticaria--need it be autoimmune?

A patient with persistent urticaria related to the premenstrual phase of the menstrual cycle is presented. Although systemic administration of progesterone provoked the eruption, we were unable to confirm that there was an immunological reaction to endogenous progesterone or oestrogen. Mechanisms whereby progesterone can augment subclinical types I and IV hypersensitivity reactions are discussed.

Bladder mast cell expression of high affinity oestrogen receptors in patients with interstitial cystitis

OBJECTIVE

To investigate the role of oestrogens in the pathophysiology of interstitial cystitis (IC), specifically with respect to activated bladder mast cells (MC), as well as urine concentrations of MC-derived histamine and methylhistamine, all of which are increased in patients with IC. This goal appeared important because IC is a bladder disorder which occurs almost exclusively in women, and is characterized by polyuria, nocturia and pelvic pain, which worsen perimenstrually.

PATIENTS AND METHODS

Biopsies from six patients with IC and four control patients were analysed blindly for the presence of oestrogen receptors (OR) using both custom-made and commercially available antibodies against OR.

RESULTS

Bladder MC alone were shown to express high-affinity OR and there was a higher number of such cells present in patients with IC compared with controls. The identity of MC in the bladder was documented with immunohistochemistry for tryptase. OR were also identified in human MC (HMC-1), a MC line kept in culture. These steps were necessary because of the unique finding that only MC express OR, in spite of the inflammatory infiltrate present.

CONCLUSION

These findings may help to explain why IC occurs primarily in women, why IC and other associated symptoms tend to be worst at the midcycle, and may also suggest that prognostic usefulness of staining bladder biopsies for OR. These results are particularly interesting because oestradiol has been shown to augment MC histamine secretion in response to the neuropeptide, substance P, which may be released in certain neuroinflammatory disorders which have a high prevalence in women, such as IC and irritable bowel syndrome.

Biogenic amines and their metabolites in body fluids of normal, psychiatric and neurological subjects

The biogenic monoamines and their metabolites have been isolated, identified and quantified in human body fluids over the past forty years using a wide variety of chromatographic separation and detection techniques. This review summarizes the results of those studies on normal, psychiatric and neurological subjects. Tables of normal values and the methods used to obtain them should prove to be useful as a reference source for benchmark amine and metabolite concentrations and for successful analytical procedures for their chromatographic separation, detection and quantification. Summaries of the often contradictory results of the application of these methods to psychiatric and neurological problems are presented and may assist in the assessment of the validity of the results of experiments in this field. Finally, the individual, environmental and the methodological factors affecting the concentrations of the amines and their metabolites are discussed.

Reversed-phase ion-pair high-performance liquid chromatographic procedure for determination of histamine and its metabolites in rat urine

A reversed-phase ion-pair high-performance liquid chromatographic procedure for quantitative determination of histamine and its metabolites in rat urine is described. This method allows simultaneous analysis of five major histamine metabolites. Good separations were obtained by using 1-pentanesulfonic acid as the ion-pair reagent. A gradient elution program was used; the total elution time was less than 22 min. Linear standard curves with high correlation coefficients were obtained. This procedure has the advantage of requiring little sample preparation time and handling, and therefore maximizes the recovery of metabolites.

Thermal entrainment and human ovulation

The changes in the peripheral vascular response to temperature have been studied for ten menstrual cycles by calculating thermal entertainment levels. The entrainment levels exhibited peaks at around the time of ovulation, a result which we believe is due to the fluctuating levels of the hormones oestrogen and progesterone in the blood. An attempt has been made to explain the influence of these hormones on the vasomotor control system and where interactions may occur.

Urinary excretion of histamine, methylhistamine (1-MeHi) and methylimidazoleacetic acid (MeImAA) in mastocytosis: comparison of new HPLC methods with other present methods

New HPLC-methods for the determination of histamine, 1- MeHi and MeImAA in human urine were compared with methods presently at use in our laboratory, the enzymatic double-isotope assay for histamine, the DNFB-method for 1- MeHi and the semiquantitative estimation of MeImAA by thin layer chromatography (TLC). A fairly good agreement between the methods was obtained for the measurement of histamine and 1- MeHi , although there was a rather large random error probably due to poor precision of the present methods. The TLC-method for MeImAA used so far overestimated by about 20% the HPLC-values, probably due to inaccurate correction for recovery by the internal standard technique. There was found to be a strong correlation between the urinary excretion of 1- MeHi and MeImAA in mastocytosis patients and the molar ratio MeImAA /1- MeHi appeared significantly higher compared to normal controls and patients with chronic granulocytic leukemia indicating in general a more efficient histamine catabolism in mastocytosis.

Studies on histamine metabolism in mastocytosis

The urinary excretion of histamine and its main metabolite, 1-methyl-4-imidazoleacetic acid (MeImAA), was determined in 30 adult patients with the clinical diagnosis of urticaria pigmentosa (UP). Clinical and laboratory investigations including skin histology, bone marrow examination, and scintigraphy of the skeleton, liver, and spleen revealed systemic manifestations in 14 cases. Among the 16 cases with dermal proliferation of mast cells only 3 cases classified as telangiectasia macularis eruptiva perstans (TMEP). All patients with systemic mastocytosis and UP excreted increased amounts of MeImAA in the urine while normal amounts were found in 2 of the patients with TMEP. A significant correlation existed between MeImAA excretion and the extent of mast cell infiltration in skin and internal organs. No such correlation was found for urinary histamine. Urinary MeImAA but not histamine is therefore considered a useful indicator of systemic involvement by reflecting the size of the mast cell histamine pool. The main symptom of the patients was pruritus, which was moderate to severe in 17 and mild or absent in 13 cases. Gastrointestinal symptoms were present in 14 patients. However, there was no obvious correlation between the excretion of MeImAA and any of the symptoms recorded. Neither was the severity of pruritus correlated to the histamine content of the skin, which was measured in both lesional and unaffected skin in 23 of the patients. Thus, symptoms possibly caused by histamine in mastocytosis patients are not directly related to urinary histamine metabolite excretion or tissue histamine content.

Histamine symptoms and histamine metabolism in chronic granulocytic leukaemia

Histamine metabolism was investigated in three patients with chronic granulocytic leukaemia (CGL) during symptoms suspected to be caused by histamine release. Plasma histamine levels were excessively high compared with periods when the patients were symptomless or with CGL patients without such symptoms. The patients seemed to be adapted to high plasma histamine levels as the symptoms were not typically systemic in nature, but rather localized phenomena like oedema and pruritus in the extremities. Also CGL patients without symptoms showed abnormally high plasma histamine concentrations, which were significantly related to the whole blood histamine concentration. The possibility must be considered that part of the plasma histamine increase is artificial due to rupture of the basophils during the blood collection procedure.

Measurement of tele-methylhistamine and histamine in human cerebrospinal fluid, urine, and plasma

A gas chromatographic-mass spectrometric method described by us to measure tele-methylhistamine (t-MH) in brain was used to measure t-MH in human cerebrospinal fluid (CSF), urine and plasma. The presence of t-MH in these body fluids was rigorously established. No pros-methyl-histamine could be detected, and it was used as internal standard to quantify t-MH in the fluids. The mean levels of t-MH were: urine, 943 pmol/mg creatinine; plasma, 12.3 pmol/ml; and CSF, 2.2 pmol/ml. Parallel measurements of histamine by a radioenzymatic method showed, respectively, 182 pmol/mg creatinine; 19.5 pmol/ml; and 388 pmol/ml. The levels of HA in CSF, much higher than those of its metabolite, t-MH, are high enough to stimulate HA receptors in the central nervous system.

Histamine and some of its metabolites in human body fluids

The concentrations of histamine, t-methylhistamine and t-methylimidazoleacetic acid were measured in human cerebrospinal fluid, plasma and urine, Especially noteworthy are the levels of histamine in cerebrospinal fluid which are far higher than those of t-methylhistamine and of t-methylimidazoleacetic acid, and high enough to stimulate histamine receptors in the central nervous system. It is suggested that mast cells, which surround the subarachnoid space, may contribute histamine to the cerebrospinal fluid and may offer a target for drugs and for immunologic actions. The t-methylhistamine and t-methylimidazoleacetic acid levels in cerebrospinal fluid may reflect central histaminergic activity, although a source of these metabolites in addition to histamine needs to be considered.

Increased urinary methylimidazoleacetic acid (MelmAA) as an indicator of systemic mastocytosis

The urinary excretion of histamine and its main metabolite, methylimidazoleacetic acid (MelmAA), was determined in 25 adult patients with the clinical diagnosis of urticaria pigmentosa (UP). Extensive clinical and laboratory investigation, including skin histology, bone marrow examination and scintigraphy of skeleton, liver and spleen, implied systemic manifestations in 16 cases. All patients with systemic mastocytosis (SM) excreted abnormal amounts of MelmAA (greater than 4.1 mg/24 h) and most of them 8.0 mg or more per day, while histamine excretion was increased in only nine (greater than 40 microgram/24 h). Thus, the urine content of MelmAA, but not histamine, could differentiate between UP and SM. Severe pruritus was found concomitant with increased urinary MelmAA and indicated systemic mastocytosis.

Decreased urinary histamine metabolite after successful PUVA treatment of urticaria pigmentosa

The effect of PUVA therapy on pruritus, the skin mast cell population and histamine metabolism has been studied in 3 patients with urticaria pigmentosa and manifestations of systemic mastocytosis. Relief of itch was found concomitant with a significant decrease of the major histamine metabolite 1-methyl-4-imidazoleacetic acid in the urine. The decrease occurred during the first 2 mo after starting PUVA therapy and was sustained during an observation period of 3 mo after discontinuation of the treatment. At this time a reduction of the number of mast cells was found in skin biopsy specimens. No evidence of acute histamine release in association with PUVA treatment was obtained. These results suggest that this effective new treatment for urticaria pigmentosa reduces the histamine turnover in the skin by inhibiting mast cell proliferation.

Studies on histamine metabolism in allergen-induced asthma

The excretion of histamine (Hi) and it metabolite methyhistamine (MeHi) was determined in separated fractions of urine up to 12h after standardized allergen provocations in 18 adult patients with defined extrinsic bronchial asthma. The main histamine metabolite, methylimidazoleacetic acid (MeImAA), was measured in six of the patients. After positive provocations (decrease in FEV1 greater than 20%) the excretion of Hi was significantly increased during 3h and that of MeHi during 4h after challenge. Negative provocations (decrease in FEV1 less than 20%) were not followed by any changes in the excretion of Hi and MeHi. MeImAA excretion increased in five out of six patients after positive provocation. It was calculated that the increased excretion of Hi and its metabolites after a positive provocation corresponded to a release of about 1 mg histamine in the body or about 1 microgram/g lung tissue if all histamine was liberated in the lung. Pretreatment with two anti-allergic drugs, disodium cromoglycate and ICI 74.917, giving significant allergen protection, resulted in a smaller increase of the excretion of both Hi and MeHi, indicating an inhibition of histamine release in vivo.

Studies on histamine metabolism in intrinsic bronchial asthma

Histamine metabolism was investigated in patients with intrinsic asthma, during the acute phase and in remission, by determination of the urinary excretion of histamine metabolites. During acute attacks the excretion of methylhistamine (MeHi) and 1-methyl-4-imidazoleacetic acid (MeImAA) was significantly increased compared with healthy subjects. The excretion of MeHi was significantly increased during acute attacks compared with remission. The excretion of MeImAA was also increased, but the difference was not significant. The correlation between the excretion of MeHi and MeImAA was highly significant. Corticosteroids, given to some patients during remission, did not affect the excretion of histamine and its metabolites. Smoking and respiratory infection during the acute attacks were both accompanied by increased excretion of MeHi. The results indicate that there is an increased histamine turnover in acute attacks of intrinsic bronchial asthma.

Histamine metabolism in severe obesity before and after jejuno-ileostomy

Histamine metabolism was studied in three patients during histamine-reduced diet before and at intervals after jejuno-ileostomy by analyses of the urinary excretion of non-labelled and 14C-labelled histamine and its metabolites. Labelled histamine was administered intravenously and orally. The preoperative excretion of free histamine and its endogenously formed metabolites was essentially the same as in controls. After intestinal bypass the inactivation of [14C]histamine by both routes of administration was not impaired. Pronounced increases in the excretion of non-labelled conjugated histamine (acetylhistamine) and methylimidazoleacetic acid were found at different intervals postoperatively. This was probably due to histamine synthesis by intestinal bacteria since the diet only contained minute quantities of histamine. It is concluded that the increased urinary excretion of conjugated histamine after intestinal bypass indicated an abnormal bacterial activity in the intestine.