OR07-5 PARP1 Contributes to the Glucocorticoid Receptor Transcriptional Response And Influences the Skeletal Muscle Phenotype

Background

NAD+-dependent PARP1 (Poly-(ADP-ribosyl)polymerase 1) generates the post-translational modification ADP-Ribosylation (ADPR). Given PARP1-ADPR determines cellular NAD+ availability, which in turn impacts a range of hormonally governed actions, we sought to identify the molecular roles of PARP1 in relation to glucocorticoids in the endocrine sensitive tissue skeletal muscle.

Importance: Activity of the glucocorticoid receptor (GR) is dictated by molecular partners whose actions skew the frequency with which GR produces meaningful transcriptional outcomes. As a result, our molecular understanding of this steroid hormone receptor remains incomplete.

Hypothesis

PARP1 through ADPR actions impacts skeletal muscle phenotype and co-regulates glucocorticoid-mediated transcriptional responses.

Experimental Design: Murine muscle myoblasts (C2C12) or primary murine muscle cultures were treated with PARP inhibitors (PJ34(10uM) or BYK204165(1uM)) or transfected with silencing RNA targeting PARP1. Cells were treated with ± dexamethasone (1uM).

Major Results

Analysis of differentiating muscle revealed PARP1 and ADPR are dynamic at days 0-5 (measured by Western immunoblot. p<0.001; n=6). Chemical inhibition of PARP1 significantly decreased ADPR (Western immunoblot. p<0.001; n=9) but did not prevent myotube formation. To identify if initial ADPR dynamics held consequence for fully differentiated myotubes, cells were treated with a single dose of the PARP1 inhibitor BYK204165 at induction of differentiation. Myotube lysates were collected 5 days later and were subjected to unlabelled SWATH-MS. This measured the abundance of 180 proteins as significantly different in PARP inhibitor-treated cells (n=7). Analyses of these proteins revealed over-representation of pathways governing muscle development (FDR 8.99-08), contraction (FDR 9.47-08, myofiber assembly (FDR 8.06-05), and energy metabolism (FDR 2.93-06). Indicating PARP1-ADPR regulates myogenesis and plays a role in the striated muscle contractile response.

ChIP assays for PARP1 binding in cells showed a (30-fold enrichment ±3.2SEM) at GR response elements and detectable ADPR was reduced when exposed to dexamethasone (Western immunoblot n=5). These data support ADPR as responsive to glucocorticoid exposure and PARP1 influences GR recruitment to the genome.

RNAseq of siPARP1 (n=4) versus scrambled myoblasts (n=5) identified differential expression of 165 genes. Gene ontology revealed over-representation in siPARP1 cells of those pathways regulating muscle differentiation, including actin-binding, cytoskeletal structure, and NAD+ binding genes. SiRNA of PARP1 had no influence over the ability of glucocorticoids to activate archetype target genes (DUSP1, MURF1, ATROGIN1 & GILZ), but differentially impacted the expression of 434 other genes.

Conclusions

PARP1 mediated ADPR is critical to the 'early phase' events of muscle cell differentiation. PARP1 influences short-term transcriptional behaviors of the glucocorticoid receptor; in turn, glucocorticoids themselves impact PARP1-genome interaction events. These findings are important for the understanding of general GR mechanisms and have relevance for the widespread functional decline observed during tissue glucocorticoid excess.

Presentation: Saturday, June 11, 2022 12:30 p.m. - 12:45 p.m.

The consequence of endothelial remodelling on the blood spinal cord barrier and nociception

Nociception is a fundamental acute protective mechanism that prevents harm to an organism. Understanding the integral processes that control nociceptive processing are fundamental to our appreciation of which cellular and molecular features underlie this process. There is an extensive understanding of how sensory neurons interpret differing sensory modalities and intensities. However, it is widely appreciated that the sensory neurons do not act alone. These work in harmony with inflammatory and vascular systems to modulate pain perception. The spinal cord has an extensive interaction with the capillary network in the form of a blood spinal cord barrier to ensure homeostatic control of the spinal cord neuron milieu. However, there is an extensive appreciation that disturbances in the blood spinal cord barrier contribute to the onset of chronic pain. Enhanced vascular permeability and impaired blood perfusion have both been highlighted as contributors to chronic pain manifestation. Here, we discuss the evidence that demonstrates alterations in the blood spinal cord barrier influences nociceptive processing and perception of pain.

FREQUENCY OF FIBROMYALGIA IN A SAMPLE OF IRAQI PATIENTS IN MOSUL WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

There is a paucity of data on the occurrence of fibromyalgia (FM) in chronic obstructive pulmonary disease (COPD). The objective of this study was to determine the frequency of fibromyalgia in a group of patients with COPD in Mosul, as well as characterization of the features of COPD patients with concomitant FM. Participants included seventy COPD-patients plus se-venty controls. The "2011 modification of the 2010 American College of Rheumatology's preliminary diagnostic criteria for fibromyalgia" was employed to make the diagnosis of FM. The demographic features and COPD data of the patients were documented. Pulmonary function tests and Chest-X-ray were evaluated for all patients. FM was present in 16 (22.9%) of 70 COPD patients, and only in 4 (5.7%) of the 70 controls, and the difference was significant. FM was found in 58.33% of female COPD patients compared to 15.52% of male COPD patients (p=0.004). There was no statistically significant difference in COPD patients with and without FM in respect to their age or BMI. However, patients with FM tended to have a longer duration of COPD (8.06±2.69 vs. 4.78±2.13, P value < 0.001), and higher scores on the Beck Depression Inventory (BDI) (20.7±9.200 vs. 14.8±7.900, P value=0.0139), and greater COPD severity (P< 0.001). The frequency of FM in patients with COPD was higher than control. FM is more likely to occur in female patients. Patients with comorbid FM and COPD tended to report more depressive symptoms, have longer disease duration, and higher disease severity.

The extent of pericardial involvement evaluated by cardiac MRI in patients with ST-Segment elevation myocardial infarction: predictors and outcomes

Background

The clinical diagnosis of peri-myocardial infarction pericarditis declined dramatically in the era of primary PCI and novel antiplatelet agents. However, recent data documents the presence of pericardial effusion in substantial proportion of acute MI patients, while recent randomized trial showed that anti-inflammatory drugs seem to improve cardiovascular outcomes, although the mechanism of the benefit remains uncertain.

Methods

We prospectively evaluated 187 consecutive patients, without known prior coronary disease, who underwent primary PCI for STEMI. All patients underwent cardiac MRI (CMR) on day 5±1 post admission. CMR was performed using a 1.5 T (n=101) and 3 T (n=86) scanners. Delayed enhancement (DE) and microvascular obstruction (MVO) were quantified as % of the left ventricular mass (LV). The presence of DE and MVO was recorded according to the AHA segments model. DE was also qualitatively assessed for the degree of transmurality in each segment. CMR pericarditis was defined as evidence of pericardial enhancement on DE images. The presence of pericardial effusion was also documented. Pericarditis extent was expressed as the number of pericardial segments with increased DE. Major adverse cardiac events were defined as the composite of death, recurrent myocardial infarction, stroke, urgent revascularization and hospitalization due to either heart failure or bleeding during the first year following STEMI.

Results

Pericardial effusion was found in 94 patients (50%) and enhancement of the pericardium on DE images in 120 patients (65%). In contrary, a clinical diagnosis of peri-myocardial infarction pericarditis was documented and anti-inflammatory therapy was initiated only in three patients (1%). A significant positive correlation was demonstrated between pericardial involvement and either quantitative or qualitative assessment of DE (p&lt;0.001, r=0.34) and MVO (p&lt;0.001, r=0.282). DE transmurality (per segment) was associated with both location of pericardial involvement and its extent (p&lt;0.001). A multivariate logistic regression analysis revealed that DE extent and MVO were independent predictors of pericardial involvement (OR 1.07; CI 95% 1.06–1.13, p=0.02 and OR 1.29; CI 95% 1.01–1.64, p=0.04 for DE and MVO respectively). Additional parameters that were associated with CMR diagnosis of pericarditis included higher maximal CRP levels and proximal coronary lesions. The 1-year incidence of major adverse events was similar in patients with or without CMR-defined pericarditis.

Conclusions

In contrast to the low rate of clinically diagnosed pericarditis, CMR documented pericardial involvement in more than 65% of STEMI patients. This finding is independently associated with the extent and degree and location of myocardial damage.

Funding Acknowledgement

Type of funding source: None

Frozen section analysis for organ-conserving surgery in penile cancer: Assessing oncological outcomes and trends of local recurrence

Introduction and objectives:

The local recurrence rate of penile cancer following surgical excision is reported in many series to be between 6 and 29%. Intra-operative frozen section (FS) is a useful tool to ensure safe microscopic margins in organ-sparing procedures in penile cancer. In this series, we assessed the rates of positive margins and patterns of local recurrence in a multicentre cohort of patients undergoing penile-preserving surgery assisted by intra-operative FS analysis.

Materials and methods:

We reviewed all those patients for whom intra-operative FS was employed during penile-preserving surgery in three tertiary referral centres between 2003 and 2016. We assessed whether the use of FS altered the surgical technique and what affect it had on positive margins and recurrence rates.

Results:

A total of 169 patients were identified. Of these, intra-operative FS examination of the surgical margin was positive in 21 (12%) cases. Final histological examination confirmed cancer-free margins in all but one patient (99.4%). Overall, 9 patients developed local recurrence (5.3%).

Conclusions:

In this series, intra-operative FS contributed to a very low rate (5.3%) of local recurrence. We noted an extremely low positive margin rate (0.6%) which highlights the benefit of incorporating FS analysis into organ-preserving surgery for penile cancer.

Level of evidence:

Not applicable for this multicentre audit.

P4650Sex differences in clinical presentation and in hospital outcomes among myocarditis and peri-myocarditis patients

Background

Data are scarce regarding sex differences among patients with myocarditis and peri-myocarditis. Our aim was to define the sex differences in clinical characteristics as well as in-hospital outcomes in a cohort of consecutive patients hospitalized due to myocarditis and peri-myocarditis.

Methods and results

We analyzed data of 322 consecutive patients between January 2007 and October 2017 who were hospitalized with the diagnosis of myocarditis or peri-myocarditis at our medical center. Eighty-four percent of the patients were males. Both males as well as females had similar rates of chronic medical conditions. However, males were more likely to present with ST elevation (75% vs. 44%. P<0.001) as well as PR depression in ECG compared to women and have higher admission troponin levels (7.6±11 vs. 2.3±4, P<0.001). Women were older (45±17 vs. 36±14, P<0.001) and tended to present with a rather normal ECG. There were no differences in the incidence of in-hospital mortality or the need for escalation therapy between male and female patients. However, males were more likely to have ventricular arrhythmias (7% vs. 0%, P=0.05). no differences in long term mortality were observed among males and females.

Variable Male (N=272) Female (N=50) P-value Age 36±14 45±17 <0.001 Cardiology Department 243 (90%) 39 (78%) 0.03 Dyspnea 63 (23%) 22 (44%) 0.002 Pericardial chest pain 94 (35%) 20 (40%) 0.52 Admission SBP (mmhg) 122±16 116±16 0.02 Admission HR (b/min) 82±16 89±21 0.04 Normal ECG 37 (14%) 12 (24%) 0.06 ST elevation 204 (75%) 22 (44%) <0.001 LVEF <50% 215 (80%) 45 (90%) 0.08 LGE 176 (88%) 20 (69%) 0.009 Albumin 4±0.3 3.6±0.4 <0.001 Troponin admission 7.6±11 2.3±4 <0.001

Conclusions

Male patients, which constitute the majority of patients. Admitted with myocarditis are younger, with higher troponin levels at admission, are more likely to present with ST elevation, and have a higher rate of ventricular arrythmias when compared to women. However, there are no differences in early as well as long term mortality rates between men and women.

Lymphoma survivors' experience of participation in a home-based intervention post-chemotherapy

Purpose

Further research on patient experience and involvement is recommended in order to develop evidence-based and meaningful care pathways for lymphoma survivors. This study aims to explore the experience of a sample of lymphoma survivors participating in a home-based intervention following chemotherapy.

Methods

Eligible participants who completed a 12-week home-based intervention were invited to complete the End of Study Questionnaire designed to explore perceptions, preferences and barriers to participation. Content analysis was used to generate codes, describe frequencies and identify themes.

Results

Participating in a home-based intervention post-treatment was a positive experience overall, and aided recovery in this sample of lymphoma survivors (n = 35). Participants felt the programme provided structure, motivation and liked contact with the researcher. Participants highlighted their need for advice on healthy lifestyle, diet in particular.

Conclusions

Lymphoma survivors in this study reported participation in a home-based intervention following treatment beneficial and aided recovery.

Implications for cancer survivors

A large proportion of lymphoma survivors would benefit from a rehabilitation intervention post-chemotherapy. Intervention programmes should include follow-ups to monitor progress and provide support and motivation. Health professionals should recommend healthy lifestyle guidelines to survivors on completion of treatment or refer patients to appropriate services for rehabilitation and advice.

Relaxation and Exercise in Lymphoma Survivors (REIL Study): A Randomised Clinical Trial Protocol

Background: Cancer survivors commonly report ongoing physical and psychological needs and adverse effects due to disease and treatment exposures including fatigue, pain, depression and decreased quality of life (QoL). Both relaxation and exercise interventions have demonstrated a positive effect on these symptoms. However these benefits have been relative to a control group, and there has been a call for further intervention studies in survivors to move beyond wait-list control groups and to compare with active control or other empirically supported interventions, such as comparison of relaxation to exercise intervention, to determine which is more beneficial. Aim: This paper presents the REIL (Relaxation and Exercise In Lymphoma) study protocol using recommended SPIRIT 2013 guidelines. The primary aim of the REIL Study is to compare the effect of two interventions - exercise and relaxation on QoL in a sample of lymphoma patients in remission postchemotherapy. Secondary aims are to investigate the effects of the two interventions on body composition, cardiovascular status, pulmonary function, muscle strength, functional exercise capacity, well-being and psychological status; and explore perceptions about participation in the posttreatment intervention program. Methods: Eligible participants (n=36) will be randomized to an exercise or relaxation home-based program to perform at least three times per week. The primary outcome measure is QoL, assessed by the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC QLQ-C30). Secondary outcome measures include body composition, cardiovascular status, pulmonary function, strength, functional exercise capacity, well-being and psychological status. Total duration of the study will be 12 weeks and outcome measures will be assessed at baseline, 6 weeks and at the end of the study. Results: Results from this study will inform development of effective care pathways for the increasing population of cancer survivors in general, and lymphoma in particular. It is anticipated that preliminary results from this study will be available by October 2018. Conclusion: Although it is well documented that cancer survivors commonly suffer from consequences of treatment which have a negative impact on their QoL, there are currently no recommended care pathways following completion of primary medical treatment. Evidence suggests that both relaxation and exercise can significantly improve ongoing symptoms in cancer survivors, but there is no consensus on which intervention is more effective. Results from the REIL study will aid in the development of evidence-based survivorship care pathways for cancer and lymphoma survivors, potentially prevent long-term complications, and help in a smooth transition from being a cancer patient to a fully-functioning member of society. This may lead to reduced use of healthcare resources by this population.

Informal health providers and the transmission of hepatitis C virus: pilot study in two Egyptian villages

The roles and practices of informal health care providers were studied in 2 Egyptian villages, focusing on practices which might be associated with the bloodborne transmission of hepatitis C virus (HCV). In the study areas, many people resorted to male providers for injections, dentistry, wound treatment and male circumcision. Traditional birth attendants oversaw > 50% of all births. "Injectionists", barbers and staff at pharmacies performed services that may be associated with HCV transmission. These providers knew little about HCV, but were willing to learn. As villagers trust these providers and visit them even if primary health care facilities are accessible, efforts should be made to upgrade their practices in order to reduce the transmission of HCV.

An outbreak of Streptococcus canis mastitis in a dairy herd in Israel

CASE HISTORY

An increase in the bulk somatic cell count (BSCC) of up to 1,000 x 103 cells/ml occurred in a dairy herd in Israel at the end of 2001 and beginning of 2002.

CLINICAL FINDINGS

Bacteriological examination of milk from 69 cows revealed a high prevalence of Streptococcus group G bacteria, identified as S. canis, affecting 38% of cows and 20% of all quarters. Isolates were sensitive to cephalothin and moderately sensitive to penicillin G. Infected cows were separated from the herd, treated with intramammary antibiotics, milked last, and strict hygiene practices were introduced to the milking routine. The pathogen was cleared from the herd and BSCC decreased to 250-350 x 103 cells/ml after 6 months.

DIAGNOSIS

Streptococcus canis mastitis.

CLINICAL RELEVANCE

Streptococcus canis infection may cause subclinical mastitis and high bulk SCC in dairy herds and be resolved by treatment with intramammary antibiotics and the introduction of strict hygiene practices.

Staphylococcus aureus strains isolated from bovine mastitis: virulence, antibody production and protection from challenge in a mouse model

Septic arthritis in mice was used as a model to evaluate the virulence of Staphylococcus aureus and coagulase-negative staphylococci (CNS) isolated from cases of bovine mastitis. In addition, the model was used to evaluate the cross protection elicited by heterologous antibodies. Mice were intramuscularly inoculated with serial bacterial doses of different strains of S. aureus or CNS, for virulence determination; they were monitored for arthritis, gangrene or death up to 20 days. Antibody response, cross reactivity and resistance to challenge were tested by subcutaneous inoculation with a low dose of one of the S. aureus or CNS strains followed by challenge with two S. aureus strains. S. aureus alpha-hemolysin isolate was the most virulent, followed by alpha+beta-hemolysin and beta-hemolysin isolates. The least virulent isolates were the non-hemolytic S. aureus strains but even they were more virulent than the CNS strains tested. Antibodies against three different S. aureus antigens were detected by the ELISA in all mice that were inoculated with the S. aureus strains but not in any of those with the CNS strains. Immunoblot test against various S. aureus strains as antigens showed high cross-reactivity among the S. aureus strains but only a slight similarity, restricted to the bands above 36 kDa, with the CNS sera. Low-dose inoculation of alpha or alpha+beta strains before challenge with homologous and heterologous strains protected the mice, whereas the two beta strains provided only partial protection. The inoculations of non-hemolytic S. aureus or the CNS strains did not elicit any protection. Our findings demonstrate that pre-exposure of mice to a low dose of certain S. aureus strains could provide protection and that the antibodies produced could have an important protective role.

Staphylococcus aureus exosecretions and bovine mastitis

The role of Staphylococcus aureus and coagulase-negative staphylococcal exosecretions in bovine udder infection was tested by monitoring the cows' response to in vivo inoculation of bacterial exosecretions into udder quarters. Twenty Israeli-Holstein dairy cows were included in the study; two or three of the udder quarters of each cow were intracisternally inoculated with 0.04-0.05 mg/quarter (total proteins) of the various sterile bacterial exosecretions in a sterile pyrogen-free saline. Each udder was inoculated with two or three different bacterial exosecretions or placebo (Columbia Broth). Cows were monitored for 96 h post-inoculation for rectal temperature, heart and respiratory rates, alimentary tract activity (rumen contraction), udder temperature, pain, oedema and udder size. Milk samples were examined bacteriologically and for somatic cell count, N-acetyl-D-glucosaminidase (NAGase) activity and somatic cell differentiation. No enterotoxins (beta-G) or toxic shock syndrome toxin-1 were detected in response to any of the bacteria tested. Control quarters or those inoculated with Columbia Broth, showed similar NAGase and somatic cell count values throughout the experiment. Twelve of the 18 strains tested, induced inflammation in the inoculated quarters while six did not. Of the 12 strains causing local inflammation, only six were found significantly different from the control and were considered as high response (group 1). The other six that caused a local inflammation did not differ significantly from the control, and were considered to be moderate response (group 2). The six S. aureus isolates that did not cause an inflammatory response were considered to have low response (group 3). In all quarters inoculated with S. aureus bacterial exosecretions belonging to groups 1 and 2, the polymorphonuclear cells and macrophages were proportionally increased while CD4+ and CD8+ T-lymphocyte populations decreased. One-dimensional NuPAGE (7%) Tris-acetate gel electrophoresisof the bacterial exosecretions revealed four different bands appearing between 36 and 31 kDa, marked from top to bottom as A, B, C and D. An association was found between the combinations of expressed bands and the cow responses: the majority of the cases could be linked to the expression of bands B and C.

Influence of Staphylococcus aureus exosecretions isolated from bovine mastitis on leukocyte activity in vitro

The role of Staphylococcus aureus and coagulase-negative staphylococcal exosecretions was tested for its ability to elicit in vitro proliferation of bovine blood lymphocytes, which we determined by means of the 3H-thymidine proliferation assay and by flow cytometry. Exosecretions of 32 field strains of S. aureus isolated from bovine udder infection and one of each of S. intermedius (M2), S. hyicus (M5), S. xylosus (M6) and S. chromogenes (M10) were used. Of the 32 S. aureus bacterial exosecretions, only 14 stimulated bovine mononuclear cells to proliferate. A high degree of association was found when the proliferation indexes were compared with the virulence as determined by intracisternal inoculation. All the six S. aureus strains that were categorized as highly virulent and that were tested in the proliferation assay exhibited a proliferation index > 20, whereas the five S. aureus strains that were categorized as low did not stimulate at all. Cells treated with media or Columbia broth supplemented with 0.1% D-glucose, yeast extract, and 0.5% NaCl (CBs) did not exceed 15% of the T-cells double positive with CD25+, whereas incubation with Con A activated the T-cells to display CD25+ up to 90%. Cells treated with one of the exosecretions that stimulated bovine mononuclear cells to proliferate, stimulated CD3+ and CD4+ T-cells to exhibit CD25+ receptor significantly higher (P < 0.05) than that found in media and CBs treatments, but lower than those found in Con A treatments. The exosecretions that did not stimulate mononuclear cells to proliferate also did not activate T-cells to exhibit CD25+ receptor. Con A activated 74% out of the total CD8+ to exhibit ACT2 receptor and 50% out of the total CD4+ to exhibit ACT3 receptor. A few but not all of the exosecretions that activated the CD25 receptor on T-cells also activated the ACT3 receptor on CD4+ cells.

Phenotypic characteristics of Staphylococcus aureus isolated from bovine mastitis in Israeli dairy herds

A study of the characterization of the phenotypic patterns of Staphylococcus aureus strains isolated from bovine subclinical mastitis in Israeli dairy herds and their correlation with the severity of the disease was undertaken. A total of 400 chronically S. aureus-infected Israeli-Holstein cows, from 15 dairy herds were included in this study. Based on the results of the biochemical reactions, of the anti-biogram and phage typing, one major type of S. aureus was determined in each herd, its prevalence being between 54 and 100% of the total isolates from that same herd. The majority of the isolates were found to be non-haemolytic (62.7%). The most common phage type was 3/A,3/C,55,71, which was predominant in five herds. In two herds none of the isolates (24) were typable by this set of phages. All isolates were susceptible to methicillin, erythromycin, cephalotin, norfloxacin, trimethoprin-sulphamethoxazole and novobiocin. Most isolates were resistant to penicillin (96.6%) and 52% to oxytetracyclin. Differences in protein patterns between 50 and 36 kDa were found by one-dimensional sodium dodecyl sulphate-polyacrylamide gel electrophoresis. No correlation between any combination of the phenotypic characteristics was found when correlation was done with milk yield and somatic cell count, corresponding to the 6 months before sampling. Otherwise, a positive correlation was found between type of haemolysis and the N-acetyl-beta-glucosaminidase (NAGase) values. In milk from quarters infected with the-non-haemolytic strains, the level of NAGase was significantly lower (P < 0.05) than that from quarters infected with the haemolytic strains (69.7 and 105.9, respectively). However, the level of NAGase activity in the milk of the quarters infected with the non-haemolytic strains was significantly higher (P < 0.05) when compared to the milk of quarters infected with coagulase-negative staphylococci (43.5).

Pediatric elbow dislocation associated with a milch type I lateral condyle fracture of the humerus

A Milch Type I lateral condyle fracture associated with a posterior elbow dislocation is described in a pediatric patient. Previously, Milch Type I fractures were thought to be stable injuries due to maintenance of the lateral trochlear rim. Prompt recognition and treatment are essential to avoid complications of this injury and to ensure a good functional result.

Circulating nitric oxide levels in galactorrheic, hyperprolactinemic, amenorrheic women

OBJECTIVE

To test the hypothesis that nitric oxide production is decreased in hyperprolactinemic, amenorrheic patients with estrogen (E) deficiency, augmenting the possible risk of cardiovascular disorders.

SETTING

Cairo University Hospitals.

DESIGN

Prospective, case-controlled study.

PATIENT(S)

Twenty-five galactorrheic, hyperprolactinemic patients with amenorrhea of more than 6 months and with low serum E2, as well as 30 healthy, fertile women (controls) matched for age and body mass index.

INTERVENTION(S)

Bromocriptine was administered orally to hyperprolactinemic patients, and blood samples were collected before and 6 weeks after treatment.

MAIN OUTCOME MEASURE(S)

Total nitric oxide production was determined photometrically using Greiss reagent after preliminary conversion of nitrate to nitrite by nitrate reductase.

RESULT(S)

Serum E2 and nitric oxide levels in hyperprolactinemic, amenorrheic patients (62.5 +/- 3.2 [SE] pg/mL [229 +/- 11.7 pmol/L] and 18.4 +/- 2.5 mumol/L, respectively) were significantly lower than E2 (114 +/- 6.4 pg/ml, [418 +/- 23.5 pmol/L]) and nitric oxide (41.2 +/- 4.1 mumol/L) levels observed in normal women during the follicular phase. The decrease of nitric oxide was associated with elevation of blood pressure. Treatment of hyperprolactinemia with bromocriptine restored normal values of serum nitric oxide and E2, and normal blood pressure.

CONCLUSION(S)

Hyperprolactinemia with E deficiency exhibits a significant decrease in nitric oxide production, and this decrease may subject the patient to certain cardiovascular disorders and disturbed ovarian function.