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Biomedical subjects

Yehonatan Sharabi

Publications and source records attributed to Yehonatan Sharabi.

At least 19 recordsLinked to original sources
PubMed2006

Differential role and tissue specificity of interleukin-1alpha gene expression in atherogenesis and lipid metabolism.

OBJECTIVE: We examined the role of IL-1alpha and IL-1beta expressed by bone marrow-derived cells in atherogenesis and lipid metabolism. METHODS AND RESULTS: We first studied the effect of atherogenic diet on wild-type C57BL/6 IL-1alpha or IL-1beta deficient mice. IL-1alpha KO resulted in a comparatively higher total cholesterol levels, compared to WT and IL-1beta KO mice (398+/-10; 266+/-19; 223+/-13 mg/dl, respectively, p<0.001), due to higher non-HDL cholesterol. Nevertheless, aortic sinus lesion area was 56% lower in IL-1alpha KO (p<0.05) and 50% lower in IL-1beta KO (p=0.08), compared to WT mice. Likewise, SAA levels in IL-1alpha KO mice were markedly lower compared to WT and IL-1beta KO mice (31+/-14; 220+/-33 and 106+/-39 microg/ml, respectively, p<0.001). To study the specific role of bone marrow-derived IL-1, irradiated C57BL/6 mice were transplanted with either IL-1+/+, IL-1alpha-/- or IL-1beta-/- bone marrow cells. Despite similar lipoprotein levels, aortic sinus lesion area was 59% lower in IL-1alpha-/- transplanted (p<0.05) compared to IL-1+/+ transplanted mice. Lesion area in IL-1beta-/- was 33% lower than in IL-1+/+ recipient mice, but it was not statistically significant. CONCLUSION: We demonstrated that early lesion formation is accelerated specifically by bone marrow-derived IL-1alpha. Furthermore, we showed that the expression of IL-1alpha in cells other than the bone marrow plays a significant role in non-HDL cholesterol metabolism.

Amyloid↗
PubMed2006

Prevalence of prehypertension and associated cardiovascular risk profiles among young Israeli adults.

Recently the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure introduced the term "prehypertension" for systolic blood pressure levels of 120 to 139 mm Hg and diastolic BP levels of 80 to 89 mm Hg. Little is known about the prevalence of this entity and the cardiovascular risk factors associated with it. We aimed to determine the prevalence of prehypertension and the cardiovascular risk factors associated with it in a large population-based sample of young Israeli adults. We studied 36,424 Israel Defense Forces employees during the years 1991 to 1999. Subjects completed a detailed questionnaire and underwent physical examination, and blood samples were drawn after a 14-hour fast. Prehypertension was defined as a systolic blood pressure of 120 to 139 mm Hg, and/or a diastolic blood pressure of 80 to 89 mm Hg. We calculated the age- and sex-specific prevalence of prehypertension and other cardiovascular risk factors associated with this condition. Prehypertension was observed among 50.6% of men and 35.9% of women. The prehypertensive group had higher levels of blood glucose, total cholesterol, low-density lipoprotein cholesterol, and triglycerides, higher body mass index, and lower levels of high-density lipoprotein cholesterol than did the normotensive group. Multivariate logistic regression analysis showed that body mass index was the strongest predictor of prehypertension among both males and females (odds ratio, 1.100; 95% CI, 1.078 to 1.122 and odds ratio, 1.152; 95% CI, 1.097 to 1.21, respectively, for every 1 kg/m2 increase). Our findings support the recommendation of lifestyle modification for prehypertensive patients. Further prospective studies are required to determine the role of pharmacotherapy in prehypertension.

Adult↗
PubMed2006

Coronary vascular resistance in primary chronic autonomic failure.

Patient groups with chronic autonomic failure and neuroimaging evidence of intact or absent cardiac sympathetic innervation had similar mean values for myocardial perfusion. Cardiac sympathetic outflow does not seem to contribute to coronary vascular resistance.

Adult↗
PubMed2006

Eosinophilia, myositis, and myasthenia gravis associated with a thymoma.

Hypereosinophilia has been associated with a wide variety of systemic disorders, including myositis. Myositis develops in a minority of patients with myasthenia gravis associated with a thymoma. We present a patient who developed a life-threatening myopathy in which testing demonstrated the concurrence of hypereosinophilia, myositis, and myasthenia gravis associated with thymoma. Thymoma-associated T-cell abnormalities may well have contributed to this rare association. This case underscores the need to reevaluate constantly the presumed cause of clinical complaints, as more than one cause may be present.

Aged↗
PubMed2006

Plasma catecholamines and blood volume in native Andeans during hypoxia and normoxia.

Plasma catechols and blood volume were measured in 20 male, native high-altitude residents of Cerro de Pasco, Peru (4338 m), while hypoxic and subsequently while normoxic at sea level. Ten subjects were healthy controls,with hematocrits lower than 61%, and ten had chronic mountain sickness (CMS), a syndrome of maladaptation to altitude, characterized by polycythemia (hematocrit > 61%), profound hypoxemia, and neurologic symptoms. The main aim of the study was to evaluate the chronic effects of hypoxia on plasma catechols and on blood volume, by studying these parameters during hypoxia at high altitude (HA) and shortly after exposure to normoxia at sea level (SL). Subjects were first studied at HA in their habitual hypoxic environment, and measurements were repeated within 4 hours of arrival at SL (Lima, Peru, 150 m). All subjects had higher plasma norepinephrine (NE), dopamine (DA), and dihydroxyphenylglycol (DHPG) levels in HA (NE in controls and CMS: 414+/-47 and 514+/-35 pg/mL; DA: 9+/-1 and 13+/-1 pg/mL, DHPG: 817+/-48 and 972+/-77 pg/mL) than at SL (NE: 164+/-9 and 243+/-28 pg/mL; DA: 4+/-0.5 and 5+/-1 pg/mL DHPG: 502+/-23 and 649+/-39 pg/mL). Group differences were statistically significant only for NE in the CMS group. Plasma volume was higher in HA in both groups (p<0.05); red cell volume was higher in HA only in the CMS group. The results indicate sympathetic nervous stimulation by chronic ambient hypoxia at altitude in Andean natives, independent of maladaptation to their native environment.

Adaptation, Physiological↗
PubMed2006

Efficacy of add-on aldosterone receptor blocker in uncontrolled hypertension.

BACKGROUND: Uncontrolled hypertension (UH) may be caused by hyperaldosteronism, and some experts recommend the routine use of aldosterone antagonists in this condition. The purpose of this study was to evaluate the efficacy of this approach and to characterize those who respond effectively to an add-on aldosterone antagonist. METHODS: We retrospectively analyzed the effectiveness of spironolactone, an aldosterone antagonist, used as add-on therapy, compared with a standard add-on treatment, in patients referred to a hypertension clinic with UH despite the use of two or more antihypertensive drugs. RESULTS: A total of 340 patients (186 male) with an average age of 63 +/- 14 years were followed for at least 3 months. Of the patients, 42 received add-on spironolactone and 298 received an additional antihypertensive drug other than spironolactone. Baseline characteristics were similar in both groups. Blood pressure (BP) decreased significantly in both groups. In patients who received spironolactone, BP decreased by 23.2/12.5 mm Hg from 165 +/- 27/94 +/- 15 to 142 +/- 25/81 +/- 9 mm Hg, whereas in patients who received other add-on therapy BP decreased by 7.6/5.8 mm Hg from 160 +/- 24/91 +/- 12 to 152 +/- 20/85 +/- 11 mm Hg (P < .05). Patients who received spironolactone had lower serum potassium levels than those who did not receive spironolactone 3.8 +/- 0.4 v 4.5 +/- 0.5 mmol/L respectively (P < .001). Potassium levels <4 mmol/L were associated with a greater reduction in BP. CONCLUSIONS: Add-on spironolactone is a highly effective add-on treatment in UH, mainly in patients with low serum potassium levels. Further studies assessing serum potassium as a marker for treatment approach are needed to establish the role of aldosterone antagonists in the management of UH.

Aged↗
PubMed2006

Melatonin reduces night blood pressure in patients with nocturnal hypertension.

PURPOSE: Nocturnal hypertension is associated with a high risk of morbidity and mortality. A blunted nocturnal surge in melatonin excretion has been described in nondipping hypertensive patients. We therefore studied the potency of melatonin to reduce nighttime blood pressure (BP) in treated hypertensive patients with nocturnal hypertension. PATIENTS AND METHODS: Thirty-eight treated hypertensive patients (22 males, mean age 64+/-11 years) with confirmed nocturnal hypertension (mean nighttime systolic BP >125 mm Hg), according to repeated 24-hour ambulatory blood pressure monitoring (ABPM), were randomized in a double-blind fashion to receive either controlled release (CR)-melatonin 2 mg or placebo 2 hours before bedtime for 4 weeks. A 24-hour ABPM was then performed. RESULTS: Melatonin treatment reduced nocturnal systolic BP significantly from 136+/-9 to 130+/-10 mm Hg (P=.011), and diastolic BP from 72+/-11 to 69+/-9 mm Hg (P=.002), whereas placebo had no effect on nocturnal BP. The reduction in nocturnal systolic BP was significantly greater with melatonin than with placebo (P=.01), and was most prominent between 2:00 AM and 5:00 AM (P=.002). CONCLUSIONS: Evening CR-melatonin 2 mg treatment for 4 weeks significantly reduced nocturnal systolic BP in patients with nocturnal hypertension. Thus, an addition of melatonin 2 mg at night to stable antihypertensive treatment may improve nocturnal BP control in treated patients with nocturnal hypertension.

Adult↗
PubMed2005

Neurocirculatory abnormalities in Parkinson disease with orthostatic hypotension: independence from levodopa treatment.

Patients with Parkinson disease often have orthostatic hypotension. Neurocirculatory abnormalities underlying orthostatic hypotension might reflect levodopa treatment. Sixty-six Parkinson disease patients (36 with orthostatic hypotension, 15 off and 21 on levodopa; 30 without orthostatic hypotension) had tests of reflexive cardiovagal gain (decrease in interbeat interval per unit decrease in systolic pressure during the Valsalva maneuver; orthostatic increase in heart rate per unit decrease in pressure); reflexive sympathoneural function (decrease in pressure during the Valsalva maneuver; orthostatic increment in plasma norepinephrine); and cardiac and extracardiac noradrenergic innervation (septal myocardial 6-[18F]fluorodopamine-derived radioactivity; supine plasma norepinephrine). Severity of orthostatic hypotension did not differ between the levodopa-untreated and levodopa-treated groups with Parkinson disease and orthostatic hypotension (-52+/-6 [SEM] versus -49+/-5 mm Hg systolic). The 2 groups had similarly low reflexive cardiovagal gain (0.84+/-0.23 versus 1.33+/-0.35 ms/mm Hg during Valsalva; 0.43+/-0.09 versus 0.27+/-0.06 bpm/mm Hg during orthostasis); and had similarly attenuated reflexive sympathoneural responses (97+/-29 versus 71+/-23 pg/mL during orthostasis; -82+/-10 versus -73+/-8 mm Hg during Valsalva). In patients off levodopa, plasma norepinephrine was lower in those with (193+/-19 pg/mL) than without (348+/-46 pg/mL) orthostatic hypotension. Low values for reflexive cardiovagal gain, sympathoneural responses, and noradrenergic innervation were strongly related to orthostatic hypotension. Parkinson disease with orthostatic hypotension features reflexive cardiovagal and sympathoneural failure and cardiac and partial extracardiac sympathetic denervation, independent of levodopa treatment.

Adult↗
PubMed2005

Neurocirculatory abnormalities in chronic orthostatic intolerance.

BACKGROUND: Chronic orthostatic intolerance (COI) occurs in postural tachycardia syndrome (POTS) and in some individuals with repeated neurocardiogenic syncope/presyncope (NCS), without POTS. This study addressed whether patients with COI and POTS or NCS have neurocirculatory abnormalities during supine rest. METHODS AND RESULTS: Adult patients referred for COI who had POTS (n=90, mean+/-SEM age 40+/-1 years, 86% women) or NCS (n=36, 41+/-2 years old, 78% women) underwent measurements of plasma levels of catecholamines and forearm hemodynamics. Comparison data were obtained from 32 age- and gender-matched normal volunteers (39+/-2 years old, 81% women). The POTS group had a relatively fast mean heart rate (79+/-2 bpm) during supine rest compared with the NCS group (69+/-1.6 bpm, P=0.03) and normal volunteers (66+/-3 bpm, P=0.0004). The POTS group also had higher mean arterial norepinephrine (1.61+/-0.11 nmol/L, n=37) and epinephrine (0.39+/-0.03 nmol/L, n=37) concentrations than the NCS group (1.03+/-0.12 nmol/L, n=20, P=0.0012; 0.21+/-0.03 nmol/L, n=20, P=0.0005) and normal volunteers (1.13+/-0.11 nmol/L, n=20, P=0.006; 0.17+/-0.03 nmol/L, n=15, P=0.0001). The NCS group had higher mean forearm vascular resistance (52+/-6 U) than the POTS group (36+/-2 U, P=0.003). CONCLUSIONS: Overall, POTS features increased heart rate and sympathetic nervous and adrenomedullary hormonal system outflows during supine rest. Increased sympathetic outflow may contribute to the relative tachycardia in POTS. NCS features forearm vasoconstriction during supine rest but not sympathoneural or adrenomedullary activation.

Adolescent↗
PubMed2005

Antianxiety treatment in patients with excessive hypertension.

OBJECTIVE: There are no guidelines on how to treat patients with excessive hypertension. Anxiety is a common cause of excessive hypertension and therefore antianxiety treatment may be beneficial in these patients. We therefore compared the efficacy and safety of antianxiety treatment with sublingual captopril administration in patients with excessive hypertension and no evidence of acute target organ damage. METHODS: Thirty-six patients (28 women and 8 men), mean age 60 +/- 2 years (range 36 to 85 years) who were referred to the emergency room because of excessive hypertension (>190/100 mm Hg) without evidence of acute target organ damage were randomized to receive either oral diazepam, 5 mg (n = 17, study group) or sublingual captopril, 25 mg (n = 19, control group). Blood pressure (BP) and heart rate were recorded hourly for 3 h. RESULTS: Both treatments decreased BP significantly (from 213 +/- 5/105 +/- 3 to 170 +/- 8/88 +/- 6 mm Hg in the study group, and from 208 +/- 5/107 +/- 3 to 181 +/- 8/95 +/- 3 mm Hg in the control group (P < .01 v initial BP). One patient in each group was hospitalized because of sustained excessive hypertension. CONCLUSIONS: Antianxiety treatment is effective in lowering BP in patients with excessive hypertension. Thus, anxiolytic treatment may be considered in patients with excessive hypertension without acute target organ damage. Further large placebo controlled studies are required to prove the benefit of anxiolytic agents.

Administration, Oral↗
PubMed2005

Peripartum hypertension from pheochromocytoma: a rare and challenging entity.

BACKGROUND: Pheochromocytoma, a rare and usually curable cause of hypertension, is characterized by symptoms and signs related to increased catecholamine secretion. Pregnancy can elicit clinical manifestations of otherwise unrecognized pheochromocytoma. METHODS AND RESULTS: Four women, ranging in age from 27 to 37 years, were referred to the hypertension clinic with the following presentations: 1) a 35-year-old woman, diagnosed with gestational hypertension and headaches during the third trimester of her pregnancy and 5 months after delivery, was hospitalized with pulmonary edema. Echocardiography revealed severe dilated left ventricular (LV) dysfunction. Cardiac function was normalized after surgical resection of a pheochromocytoma from her left adrenal; 2) a 37-year-old woman suffered from preeclampsia, persistent hypertension and orthostatic hypotension after a cesarean section. A diagnostic work-up revealed a catecholamine-secreting paraganglioma in the retroperitoneum. The patient underwent a laparosopic resection of the tumor; 3) a 27-year-old woman suffered from hypertension and episodes of palpitations, sweating, and dyspnea in the first trimester of her pregnancy. An ultrasound revealed a 5-cm mass in the left adrenal. She underwent a left adrenalectomy at the 17th week of pregnancy, which confirmed the diagnosis of pheochromocytoma; 4) a 34-year-old woman, at the 26th week of pregnancy, presented with an acute loss of vision and blood pressure of 230/140 mm Hg. Fundoscopy showed papilledema with soft exudates in both eyes. Chemical studies were positive and imaging revealed a left adrenal pheochromocytoma. Despite aggressive medical treatment, fetal distress mandated a laparotomy at the end of the 28th week of pregnancy. A healthy newborn was delivered and resection of the adrenal tumor confirmed the diagnosis of pheochromocytoma. CONCLUSIONS: Although rare, pheochromocytoma can cause severe peripartum hypertension. Screening for pheochromocytoma, ideally with plasma-free metanephrines, should be considered in cases of peripartum hypertension.

Adrenal Gland Neoplasms↗
PubMed2005

Sympathoneural and adrenomedullary functional effects of alpha2C-adrenoreceptor gene polymorphism in healthy humans.

OBJECTIVES: alpha2-Adrenoreceptors restrain sympathetic nervous outflows and inhibit release of noradrenaline from sympathetic nerves. In-frame deletion of the alpha2C-adrenoreceptor subtype (alpha2CDel322-325) increases the risk of congestive heart failure. Increased delivery of catecholamines to cardiovascular receptors might explain this increased risk. METHODS: Twenty-nine healthy African-Americans genotyped for alpha2-adrenoreceptor subtype polymorphisms underwent 3H-noradrenaline and 3H-adrenaline intravenous infusion and arterial blood sampling for measurements of rates of entry of endogenous noradrenaline and adrenaline into arterial plasma (total body spillovers) by the tracer dilution technique. Eleven subjects were homozygotes for the alpha2CDel322-325 polymorphism, nine heterozygotes, and nine non-carriers. Subjects were studied during supine rest and during and after i.v. infusion of the alpha2-adrenoreceptor antagonist, yohimbine. RESULTS: At rest, homozygotes for the alpha2CDel322-325 polymorphism had higher total body noradrenaline spillover than did heterozygotes (t=2.90, df=18, P=0.023) or non-carriers (t=3.22, df=18, P=0.010). Adrenaline spillover was higher in homozygotes than non-carriers (t=2.61, df=18, P=0.045). Administration of yohimbine produced larger, more sustained increments in noradrenaline spillover, heart rate, and anxiety in homozygotes than in the other groups. CONCLUSION: In healthy people, alpha2CDel322-325 polymorphism is associated with increased sympathetic nervous and adrenomedullary hormonal activities, both during supine rest and during pharmacologically evoked catecholamine release. Polymorphisms of the alpha2C-adrenoreceptor may help explain individual differences in predisposition to a variety of disorders of catecholaminergic function, such as cardiovascular disorders, depression or anxiety disorders.

Adolescent↗
PubMed2005

Adiponectin: linking the metabolic syndrome to its cardiovascular consequences.

Obesity and its related disorders, glucose intolerance, hypertension and hyperlipidemia, collectively named the metabolic syndrome, result in substantial cardiovascular morbidity and mortality. Recent data point to several underlying regulatory mechanisms through which obesity links these various outcomes. Adipose tissue is now understood to function not merely as a passive energy storage depot but as an active endocrine organ, producing a variety of bioactive substances termed adipocytokines. Adiponectin, an adipocytokine first described as the most abundant protein produced by adipocytes, appears to serve as a central regulatory protein in many of the physiologic pathways controlling lipid and carbohydrate metabolism, and to mediate various vascular processes. Adiponectin displays both anti-inflammatory and antiatherogenic properties. Unlike other adipocytokines, its levels are paradoxically decreased in obesity and insulin-resistance states including metabolic syndrome and diabetes, as well as hypertension and coronary artery disease. This review will detail the relationship of adiponectin to various features of obesity and insulin-resistance syndromes, as well as its relationship to the cardiovascular complications of these disorders.

Adiponectin↗
PubMed2005

Sleep apnea-induced hypertension: mechanisms of vascular changes.

Obstructive sleep apnea-induced hypertension appears to constitute a distinct pathophysiologic entity. Various neurohormonal and inflammatory mediators and hypoxia-induced injury link the two conditions. Obstructive sleep apnea-induced hypertension appears to be reversible in its early phases, but becomes a permanent condition with irreparable vascular changes in later stages. Hence, defining obstructive sleep apnea-induced hypertension and elucidating its role in cardiovascular disease will facilitate appropriate prevention and intervention. This review will clarify the unique set of features of hypertension associated with obstructive sleep apnea and examine the mechanisms that contribute to its cardiovascular consequences.

Humans↗
PubMed2004

Susceptibility of the influence of weight on blood pressure in men versus women: lessons from a large-scale study of young adults.

BACKGROUND: Weight and blood pressure (BP) are closely related. The aim of this study was to quantify this relationship and compare it to other factors in a population of relatively young adults, with particular focus on the possible role of gender. METHODS: We conducted a cross-sectional analysis of the Young Adult Periodic Examinations in Israel (YAPEIS) database of healthy people aged 25 to 45 years undergoing routine periodic examinations. Between 1991 and 1999, 38,558 subjects (88.1% men, mean age 36 +/- 8 years) were examined. The correlation between BP and weight was evaluated with adjustments for age, sex, physical activity, cigarette smoking, and fasting blood glucose levels. RESULTS: Blood pressure correlated positively with body mass index (BMI), spanning the spectrum of BMI values. Weight accounted for 8% to 10% of BP variance. The odds ratio for hypertension increased by 16% for each additional unit of BMI, compared to 6% for each year increase in age. The relative propensity of men toward hypertension, typical of this age group, was less pronounced at higher BMI values (male:female ratio = 2.2 at BMI <25 kg/m(2), and 1.28 at BMI > or =35 kg/m(2)). CONCLUSIONS: The association between BP and body weight is at least as strong as that between BP and age and is especially prominent in women.

Adult↗
PubMed2004

Sleep apnea as a risk factor for hypertension.

PURPOSE OF REVIEW: High blood pressure and obstructive sleep apnea are closely related, and the latter is considered to induce hypertension. The primary underlying mechanism is sympathetic activation triggered by apneic episodes. This type of hypertension is difficult to treat. The purpose of this review is (1) to evaluate the epidemiological data in view of the current focus on preclinical sleep apnea and prehypertension, (2) to examine additional factors that might contribute to high blood pressure, and (3) to indicate the best therapeutic strategy for treatment of hypertension in these patients. RECENT FINDINGS: Cardiovascular effects of sleep apnea can be detected early in the course of the disease, and young subjects are particularly susceptible to its deleterious effect. Blood pressure profiles in these patients show higher diastolic blood pressure and no nocturnal dipping. The renin-angiotensin axis in conjunction with other vasoactive hormones add to the sympathetic activation in elevating blood pressure in sleep apnea. Pro-inflammatory cytokines further contribute to the atherosclerotic consequences that primarily affect the heart and brain, and spare the kidneys. Mounting evidence indicates that treatment of sleep apnea using positive airway pressure, palato-nasal surgery and weight reduction correct the associated hypertension. Conversely, antihypertensive therapy is less effective. SUMMARY: Even the early stages of sleep apnea are associated with high blood pressure and cardiovascular consequences. Despite our knowledge of the role of the sympathetic activation and vasoactive hormones, no specific antihypertensive therapy is superior, and the optimal way of controlling hypertension is to treat sleep apnea and associated obesity.

Humans↗
PubMed2004

Does acetylcholinesterase inhibition affect catecholamine secretion by adrenomedullary cells?

BACKGROUND: Splanchnic nerve stimulation evokes adrenomedullary catecholamine secretion via acetylcholine release and occupation of nicotinic cholinergic receptors on chromaffin cells. OBJECTIVES: To assess whether among cultured adrenomedullary cells there exists a population that tonically secretes acetylcholine. If so, then blockade of enzymatic breakdown of acetylcholine by addition of a cholinesterase inhibitor to the medium would increase occupation of nicotinic receptors by endogenous acetylcholine and thereby induce catecholamine release. METHODS: Primary cultures of bovine adrenomedullary cells in 24-well plates (1 million cells per well) were incubated after 48-72 hours with fresh incubation medium (control), medium with added secretagogues (nicotine, angiotensin II, or K+) or the acetylcholinesterase inhibitor, edrophonium (10(-7) to 10(-3) M), for 1-20 minutes. Fractional release rates of epinephrine, norepinephrine and dopamine were compared to a control. We also examined whether coincubation with edrophonium enhanced the effects of the secretagogues. All experiments were performed in quadruplicate and repeated three times. RESULTS: Nicotine, angiotensin II, and K+ each elicited time-related release of epinephrine, norepinephrine and dopamine by up to fourfold compared to the control. At all tested concentrations, edrophonium had no such effect. Co-incubation with edrophonium also failed to augment the secretory responses to nicotine, angiotensin II, or K+. CONCLUSION: Bovine adrenomedullary cells in primary culture do not include a population of tonically active cholinergic cells.

Adrenal Medulla↗