Molecular mechanisms of fever and endogenous antipyresis

This review summarizes recent studies on endogenous antipyretic mechanisms. Fever is the result of a balance between pyrogenic and cryogenic cytokines and hormones. Although there is considerable evidence that fever evolved as a host defense response, it is important that the rise in body temperature not be too high. Many endogenous cryogens or antipyretics that limit the rise in body temperature have been identified during the last 25 years. These include alpha-MSH, arginine vasopressin, glucocorticoids, TNF (under certain circumstances), and IL-10. Most recently, evidence has accumulated that cytochrome P-450 (P-450), part of the alternative pathway for arachidonic acid metabolism, plays an important role in reduction of fever and inflammation. Supporting a role for P-450 in endogenous antipyresis and antiinflammation includes evidence that (1) inducers of P-450 reduce fever, (2) inhibitors of P-450 cause a larger fever, (3) and P-450 arachidonic acid metabolites reduce fever.

Beta-adrenergic receptor subtype effects on stress fever and thermoregulation

Exposure to psychological stress increases body temperature (Tb). This stress fever may be immunologically beneficial in some patient populations but detrimental in others (e.g., HIV-infected individuals). For this reason, it is desirable to determine pharmacological methods of preventing stress fever. In rats, stress fever is modeled by exposure to a novel environment or 'open field.' The beta-adrenergic antagonists, nadolol and propranolol, block this stress fever. Neither of these beta-antagonists discriminates between subtypes of beta-receptors. The purpose of this study was to determine the relative contribution of the different beta-receptor types to stress fever using beta1-, beta2-, and beta3-receptor subtype selective antagonists (atenolol [beta1], ICI-118551 [beta2], and SR 59230A [beta3]) and agonists (dobutamine [beta1], salbutamol [beta2], and BRL 37344 [beta3]) on the Tb of rats. Tb was measured with a biotelemetry system. Our data suggest that central nervous system beta-receptor blockade with subtype-selective antagonists prevents the stress-induced rise in Tb; however, the beta3-antagonist was effective only at doses that produced hypothermia in a non-stressed control group. The stress-induced fever was mimicked by central nervous system administration of the selective beta2-agonist, salbutamol, and the beta3-agonist, BRL 37344. We hypothesize that the blockade of stress-induced fever by beta-blockers may be due to the sedative actions of these drugs.

Inhibitors of alternative pathways of arachidonate metabolism differentially affect fever in mice

Inhibitors of cyclooxygenases prevent fever. The purpose of this study was to test the hypothesis that selective and dual inhibitors of the other enzyme systems of arachidonic acid oxygenation (i.e., lipoxygenase and epoxygenase) affect the time course or magnitude of fever in mice. Swiss Webster mice kept at 30 degreesC ambient temperature were implanted with biotelemeters to monitor body temperature. Fever was induced by intraperitoneal injection of lipopolysaccharide at doses from 10 micrograms/kg to 2.5 mg/kg. Phenidone (20-30 mg/kg ip), a dual lipoxygenase and cyclooxygenase inhibitor, prevented fever in these mice, but esculetin (1-10 mg/kg ip), a selective inhibitor of lipoxygenases, did not affect fever. Intramuscular injection of nordihydroguaiaretic acid (10-20 mg/kg), a dual lipoxygenase and epoxygenase inhibitor, as well as SKF-525A (5 mg/kg ip) and clotrimazole (20 mg/kg im), inhibitors of the cytochrome P-450/epoxygenase pathway, augmented fever in mice. Indomethacin (5 mg/kg ip), an inhibitor of cyclooxygenase, suppressed the exacerbation of fever due to clotrimazole, suggesting that the epoxygenase inhibitor-induced potentiation of fever in mice is a prostaglandin-mediated effect. From this study, we hypothesize that the cytochrome P-450/epoxygenase branch of the arachidonate cascade is involved in antipyresis and in controlling the upper limit of fever.

Alkaloid delta agonist BW373U86 increases hypoxic tolerance

Activation of delta opioid receptors increases survival time during acute, lethal hypoxia in mice. delta Agonists therefore present a promising avenue for therapeutic application to reduce the morbidity and mortality associated with clinical hypoxia in settings such as drowning, head injury apnea, and complicated childbirths. However, most delta agonists now available are peptides, and may have limited clinical utility. In the present study, we evaluate the neuroprotective ability of an alkaloid delta agonist, BW373U86. Alkaloid compounds, due to increased stability and increased systemic distribution, may be more favorable for clinical use. We found that BW373U86, like the peptide delta agonist, DPDPE ([D-Pen2, D-Pen5]-enkephalin), increases survival time of mice during lethal hypoxia. The mechanism of neuroprotection induced by delta receptor activation appears to involve decreasing body temperature. Further, using selective opioid receptor antagonists, it appears that BW373U86 exerts these neuroprotective effects by acting at delta-opioid receptors.

Hypoxia decreases opioid delta receptor expression in mouse brain

Delta opioid receptor activation is protective during hypoxic injury. Many adaptive responses occur during exposure to hypoxia to facilitate survival. It is possible that increased activity of the delta opioid receptor system is one such adaptation. We tested the hypothesis that mice exposed to prolonged hypoxia have increased expression of the delta opioid receptor in brain tissue. Prolonged exposure to hypoxia (9% oxygen, balance nitrogen) continuously for seven days selectively decreased delta opioid receptor expression in mouse brain homogenate. The same hypoxic treatment had no effects on either mu or kappa opioid receptor expression, indicating that this response was not due to non-selective degradation of protein. Shorter term hypoxic treatments (one day and three days) did not induce changes in delta opioid receptor expression in whole brain homogenate. Binding assays were also conducted in grossly dissected brain regions (cortex, midbrain, hindbrain) to determine whether the shorter term treatments would induce changes in receptor expression in more discrete areas. No consistent changes in delta opioid receptor expression were detected in these brain regions. These data demonstrate that opioid delta receptors are hypoxia sensitive and may be a part of an adaptive process to increase survival in the organism. One possible cause for the decrease in delta opioid receptor expression following seven days of hypoxic exposure may be receptor down-regulation caused by an increased release of endogenous substances acting at delta receptors. As delta opioid receptor agonists appear promising for therapeutic potential in management of hypoxic injury, changes in delta receptor expression in response to long-term hypoxia could impact potential utilization of delta agonists in patients suffering chronic hypoxia.

Increased expression of opioid delta receptors by deoxy conformation heme proteins in NG108-15 cells

Adaptations to prolonged hypoxia include an increase in the expression of proteins that may facilitate survival. One mechanism by which hypoxia increases protein expression involves a change of heme proteins from oxygenated to deoxygenated conformations. In the present study, we tested the hypothesis that treatment of NG108-15 cells with metallic cations, which are known to induce a deoxygenated conformation of heme proteins, would increase delta opioid receptor (DOR) expression. Cells were treated with cobalt and nickel, which induce deoxygenated heme protein conformation, or zinc as a control for 48 h prior to quantifying DOR expression. Cobalt and nickel, but not zinc, significantly increased DOR expression. Heme synthesis inhibitors would block the synthesis of cobalt-substituted heme proteins which are locked in a deoxygenated conformation. The cobalt-induced increase in DOR expression was blocked by the heme synthesis inhibitor, 4,6-dioxoheptanoic acid. These experiments indicate that deoxygenated conformation heme proteins, which are thought to partially mimic hypoxia, increase DOR expression. The increase in DOR expression suggests that the DOR gene may be hypoxia-sensitive. Further, the increase in DOR expression suggests a potential adaptation strategy to hypoxia and may represent one of the first findings of physiological regulation of DOR expression.

Potential adaptations to acute hypoxia: Hct, stress proteins, and set point for temperature regulation

Severe, intermittent hypoxia (hypoxic conditioning, HC) increases survival time during subsequent lethal hypoxia in mice. This protective effect was blocked by naloxone, suggesting an opioid-dependent mechanism. We proposed and evaluated three potential mechanisms of this acute adaptation: 1) increased hematocrit (Hct), 2) protein synthesis, and 3) decreased set point for temperature regulation (set point). Increased hematocrit is a well-studied adaptation to chronic hypoxia and could be acutely initiated by sympathetically mediated splenic contraction. Survival during stress can be prolonged by synthesis of stress proteins. We tested this hypothesis using two protein synthesis inhibitors, anisomycin and cycloheximide. Our third hypothesis is that set point is decreased after HC. A regulated decrease in body temperature would lower oxygen demand during hypoxia. Our studies indicate that hematocrit and protein synthesis are not dominant mechanisms of acute adaptation to hypoxia. However, we have observed a naloxone blockable decrease in set point after HC, supporting a mechanism in which acute adaptation involves an endogenous opioid-dependent decrease in set point. These studies also demonstrate that set point could be a more dominant contributor than body temperature to hypoxic tolerance.

Delta-1 opioid agonist acutely increases hypoxic tolerance

Severe, intermittent hypoxia (hypoxic conditioning) induces an acute adaptation such that survival time during a subsequent hypoxic challenge is increased. The opioid antagonist, naloxone, and the delta-selective antagonists, naltrindole and 7-benzylide-nenaltrexone (BNTX), block this adaptation. The current study continued the pharmacological characterization of this acute adaptation to hypoxia by using selective opioid agonists. [D-Ala2,N-Me-Phe4,Gly5-ol]-enkephalin (1 mg/kg s.c.), U50488H [trans-(+/-)-3,4-dichloro-N-methyl-N-[2-(1-pyrrolidinyl)cyclohexyl] benzeacetamide methane sulfonate]; 30 mg/kg s.c.] and [D-Pen2,D-Pen5]-enkephalin (DPDPE; 100 mg/kg s.c.) further augmented the hypoxic conditioning induced increase in survival time. DPDPE (56.1 mg/kg of peptide i.v.) increased survival time of naive mice independently of hypoxic conditioning and decreased body temperature. The DPDPE-induced increase in survival time was blocked by the delta-1-selective antagonist, BNTX (0.6 mg/kg s.c.), but not by the delta-2-selective antagonist, naltrindole (10 mg/kg s.c.). However, the DPDPE-induced decrease in body temperature was not blocked by either BNTX or naltrindole. These results supported our hypothesis that the mechanism of acute hypoxic adaptation involves an endogenous delta-1 opioid pathway and demonstrated that activation of a delta-1 receptor mimicked acute hypoxic adaptation induced by intermittent hypoxia.

Delta-1 opioid receptor dependence of acute hypoxic adaptation

Previously an acute adaptation to hypoxia was induced by intermittent, severe hypoxia and this conditioned increase in survival time during subsequent hypoxia was blocked by naloxone. The current study further defined the opioid nature and the receptor type(s) involved in hypoxic adaptation by the use of (+)-naloxone (inactive isomer) and selective opioid antagonists. (+)-Naloxone failed to change significantly the survival times of hypoxic or sham conditioned mice during subsequent hypoxia. The selective opioid antagonists, 7-benzylidenenaltrexone, naltrindole, beta-funaltrexamine and norbinaltorphimine were administered subcutaneously before hypoxic or sham conditioning. The delta-1 and delta-2 selective antagonists, 7-benzylidenenaltrexone and naltrindole respectively, blocked the hypoxic conditioning-induced increase in survival time. The lowest effective 7-benzylidenenaltrexone dose was 3000-fold lower than the lowest effective naltrindole dose indicating that the acute adaptation to hypoxia was predominantly sensitive to delta-1 blockade. Neither the mu antagonist, beta-funaltrexamine, nor the kappa antagonist, norbinaltorphimine, significantly changed survival time in sham or hypoxic conditioned mice. These results support a delta-1 receptor mediated mechanism of acute adaptation to hypoxia.

Seasonal changes in gonadotropin-releasing hormone secretion in the ewe: alteration in response to the negative feedback action of estradiol

Two experiments were performed to test the hypothesis that there is a seasonal change in the negative feedback effect of estradiol on episodic secretion of GnRH in the ewe. The first experiment identified a specific estradiol treatment (delivered by s.c. Silastic implant) that produced a 50% decrease in the frequency of pulsatile secretion of LH in ovariectomized ewes during the anestrous season. In the second experiment, this estradiol treatment was administered to ovariectomized ewes during the mid-breeding and anestrous seasons. Separate groups of ovariectomized ewes not treated with estradiol were included during each season to test for a seasonal difference in the effect of estradiol on episodic GnRH and LH secretion. Samples of hypophyseal portal blood (for GnRH) and jugular blood (for LH) were obtained at 5-min intervals approximately one month after placement of the estradiol implants. During the breeding season, no effect of estradiol was observed on either the frequency or size of GnRH and LH pulses. During anestrus, however, estradiol produced a profound suppression of the frequency of GnRH and LH pulses, and an increase in GnRH pulse size. No significant seasonal change was observed in the characteristics of GnRH and LH pulses in ovariectomized ewes in the absence of estradiol treatment. These findings lead to the conclusion that there is a marked seasonal change in the negative feedback effect of estradiol on episodic GnRH secretion in the ewe, with the steroid being maximally effective during anestrus.

Role of endogenous opioid peptides in the acute adaptation to hypoxia

A non-lethal, hypoxic conditioning stimulus has been shown by Rising and D'Alecy to increase hypoxic survival time in mice. To determine if endogenous opioids alter the hypoxic conditioning-induced increase in hypoxic survival time, we administered naloxone (0.1, 1.0 mg/kg i.p.) or saline (0.3 ml i.p.) 5 min prior to conditioning. Sixty percent of the mice received the hypoxic conditioning stimulus consisting of three sequential hypoxic exposures (4.5% oxygen balance nitrogen for 1.5, 2 and 2.5 min) separated by 5 min of room air. The remaining mice did not receive hypoxic conditioning but instead remained in room air for this time. All mice were tested for hypoxic survival by first exposing them to 20 s of 8.5% oxygen balance nitrogen followed by exposure to 4.5% oxygen balance nitrogen. The hypoxic survival time was recorded as the time from the onset of the 4.5% oxygen to the cessation of spontaneous ventilation. Naloxone (1 mg/kg) completely blocked the adaptation to hypoxia induced by hypoxic conditioning (P = 0.003). Morphine (1, 5, 10 and 20 mg/kg) had no effect on hypoxic adaptation; however, 50 mg/kg morphine decreased the adaptation induced by conditioning (P less than 0.0001) possibly due to high dose toxicity. These data suggest that endogenous opioids are involved in the protective adaptation to hypoxia induced by prior exposure to non-lethal hypoxia.