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Norepinephrine-dependent selection of brown adipocyte cell lines.

A transgenic mouse carrying a simian virus-40 T-antigen gene under control of a mouse urinary protein promoter induced the formation of a brown fat tumor. In tissue culture, these tumor cells expressed the brown fat-specific mitochondrial uncoupling protein (Ucp) gene when stimulated by norepinephrine. To develop cell lines for the analysis of Ucp expression, we investigated growth conditions that would maintain expression. We found that the addition of 10(-7)-10(-6) M norepinephrine was critical for establishing cells with high Ucp expression, mitochondrial content, and adipogenesis. Norepinephrine exerts its effects by selectively stimulating the proliferation of brown fat cells. Results with receptor-specific agonists and antagonists indicate that norepinephrine interacts with the beta 1-adrenergic receptor to stimulate cell proliferation. The capacity of these brown fat cells to respond to norepinephrine by proliferating seems to be a manifestation of a normal physiological response of brown fat cells, because exposing an animal to the cold increases cell proliferation. Thus, this system indicates that two independent pathways for cell proliferation coexist in parallel, one based on transformation of the cell by the simian virus-40 T-antigen and the other on the normal response of the cell to stimulation by norepinephrine. Several clonal lines have been isolated that have similar levels of marker gene expression for adipogenesis and mitochondriogenesis, but differ in the level of Ucp expression. The results underscore the extreme sensitivity of mechanisms controlling Ucp expression and the fact that the expression of Ucp in brown fat is not coordinately linked to that of other nuclear genes which encode proteins associated with thermogenesis.

Adipocytes↗

Norepinephrine spillover from human adipose tissue before and after a 72-hour fast.

Adipose tissue lipolysis is at least in part stimulated by the sympathetic nervous system (SNS). Although there is a generalized decrease in SNS activity with fasting, the rate of lipolysis during fasting increases. The aim of this study was to determine whether there is an association between activation of sympathetic nerves innervating adipose tissue and the increase in lipolysis seen during fasting in humans. We used the isotope dilution technique to measure regional norepinephrine spillover from abdominal sc adipose tissue from seven healthy subjects before and after a 72-h fast. Our results showed a significant increase in adipose tissue spillover of norepinephrine (mean +/- SEM, 0.40 +/- 0.09 vs. 1.08 +/- 0.18 pmol.100 g(-1).min(-1), P < 0.05) and arterial norepinephrine concentrations (0.92 +/- 0.10 vs. 1.23 +/- 0.08 nmol.liter(-1), P < 0.05) after the fast with no significant change in total body norepinephrine spillover, forearm norepinephrine spillover, epinephrine concentrations, or energy expenditure. We show for the first time, in humans, a selective regional increase in adipose tissue norepinephrine spillover in response to a 72-h fast and suggest that the SNS may play a greater role in the regulation of lipid metabolism during fasting than previously thought.

Adipose Tissue↗

Uptake and release of norepinephrine by slices of rat cerebral cortex: effect of agents that increase cyclic AMP levels.

Cerebral cortical slices from rats were incubated in physiologic saline, and the uptake, release, and K+-stimulated release of norepinephrine were measured. Dibutyryl cyclic AMP, the phosphodiesterase inhibitors aminophylline and papaverine, and adenosine (which stimulates adenyl cyclase) all caused a variable increase in uptake of norepinephrine at concentrations ranging from 10(-7) to 10(-4) M. Prostaglandins E1 and E2 appeared to have no effect on uptake, but this may be because the alcohol required to dissolve them had an inhibitory effect on uptake. None of these compounds appeared to affect basal or K+-stimulated release of norepinephrine. These agents therefore seem to have an effect opposite to that of the tricyclic antidepressants (which inhibit uptake of norepinephrine). Since norepinephrine's postsynaptic effects are usually inhibitory in the cortex, the stimulatory effect of the drugs tested on the presynaptic uptake of norepinephrine may explain the stimulant and epileptogenic effects of these drugs.

Adenosine↗

Norepinephrine prolongs tetracaine spinal anesthesia in surgical patients: a preliminary study.

We conducted a double-blinded examination of the effects of norepinephrine as a vasoconstrictor on the onset and duration of tetracaine spinal anesthesia in 80 surgical patients. The patients were randomly allocated to four groups (n = 20 in each group). Each patient received 10 mg of tetracaine in a volume of 2.0 mL which contained either 0 micrograms/mL, 5 micrograms/mL, 10 micrograms/mL, or 15 micrograms/mL of norepinephrine. The onset of spinal anesthesia was determined by the time to reach Th-10 level as well as by the time required to obtain the highest level of sensory analgesia. The time for two-segment regression and full-motor recovery were defined as the duration of spinal anesthesia. The time to reach Th-10, the highest analgesia level, and the time to obtain the highest analgesia level did not differ among the groups. Two-segment regression was prolonged significantly by 175%, 103%, and 106% as compared with the plain tetracaine group, in 5 micrograms/mL, 10 micrograms/mL, and 15 micrograms/mL of norepinephrine groups, respectively. Motor recovery also was extended significantly by 111%, 152%, and 121% as compared with the plain tetracaine group, in 5 micrograms/mL, 10 micrograms/mL, and 15 micrograms/mL of norepinephrine groups, respectively. There were no differences in the changes of arterial blood pressure and heart rate associated with the addition of norepinephrine among the groups. We conclude that norepinephrine provides a clinically meaningful prolongation of the duration of tetracaine spinal anesthesia.

Abdomen↗

Greater tension is developed at the same level of cytosolic Ca2+ concentration in the presence of clonidine, an adrenergic partial agonist, than in the presence of norepinephrine.

Fura 2-loaded thoracic aorta strips from rabbits were used. Norepinephrine and clonidine induced an increase in cytosolic Ca2+ concentration ([Ca2+]i) and in muscle tension in a concentration-dependent manner. A positive correlation between [Ca2+]i and tension development due to norepinephrine and clonidine was noted in muscle strips both untreated and treated with phenoxybenzamine (PBZ). As the total receptor population was reduced by the PBZ treatment, norepinephrine acted as a partial agonist in the treated strips. The slope of a regression line for norepinephrine in the untreated muscle strips was significantly smaller than the slopes for the same drug in PBZ-treated strips and for clonidine, suggesting that norepinephrine in the PBZ-treated strips and clonidine induced a greater tension at same [Ca2+]i than did norepinephrine in the untreated strips.

Animals↗

The effects of different doses of dopamine and domperidone on increases of plasma norepinephrine induced by cold pressor test in normal man.

The effect of dopamine 1 and 3 micrograms/kg/min i.v., of dopamine 1 and 3 micrograms/kg/min i.v. combined with domperidone 30 mg per os and of placebo infusion on plasma norepinephrine concentration before and during sympathetic stimulation by a cold pressor test was investigated in 10 healthy volunteers (1 female, 9 males, mean age 28, range 19-41). Dopamine 1 microgram/kg/min resulted in a blunting of the rise in plasma norepinephrine concentration during the cold pressor test, compared with placebo infusion. The addition of domperidone to dopamine 1 microgram/kg/min abolished this effect. Plasma norepinephrine levels during dopamine 3 micrograms/kg/min infusion, both with and without domperidone, were not different from placebo, but significantly higher compared to dopamine 1 microgram/kg/min infusion. Dopamine 1 and 3 micrograms/kg/min infusion, both with and without domperidone resulted in a blunted increase in blood pressure compared to placebo infusion. Dopamine 1 microgram/kg/min infusion resulted in a lower systolic blood pressure during the cold pressor test compared to dopamine 3 micrograms/kg/min infusion. No significant changes in heart rate occurred during the cold pressor test comparing the different circumstances. We conclude that in healthy volunteers only dopamine 1 microgram/kg/min, but not dopamine 3 micrograms/kg/min, blunts the increase in plasma norepinephrine concentration during a cold pressor test; this effect is abolished by pretreatment with domperidone. We presume that for dopamine 1 microgram/kg/min the inhibitory effects of presynaptic DA-2 receptor or alpha-2 adrenoceptor stimulation on plasma norepinephrine concentration predominate. When dopamine 3 micrograms/kg/min is infused, the inhibitory effects might be counteracted by uptake-1 inhibition or enhanced synthesis and release of norepinephrine, either directly or indirectly.

Adult↗

Possible role of cardiac mast cells in norepinephrine-induced myocardial preconditioning.

The present study was designed to investigate the role of cardiac mast cells in the cardioprotective effect of norepinephrine-induced preconditioning. Isolated rat heart was subjected to 30 min of global ischemia followed by 30 min of reperfusion. Both ischemic and norepinephrine (100 microM) preconditioning markedly reduced ischemia-reperfusion-induced release of lactate dehydrogenose (LDH) in the coronary effluent and the incidence of ventricular premature beats (VPBs) and ventricular tachycardia/fibrillation (VT/VF) during the reperfusion phase. Ischemic and norepinephrine preconditioning also significantly reduced ischemia-reperfusion-induced release of mast cell peroxidase (MPO), a marker of mast cell degranulation. However, MPO release increased immediately after ischemic or norepinephrine preconditioning. Histological study with ruthenium red (0.005%) staining confirmed cardiac mast cell degranulation in ischemic and norepinephrine preconditioned isolated rat hearts. These findings tentatively suggest that pharmacological preconditioning with norepinephrine produces a cardioprotective and antiarrhythmic effect similar to ischemic preconditioning through degranulation of resident cardiac mast cells.

Animals↗

Refractory septic shock: efficacy and safety of very high doses of norepinephrine.

The aim of this study was to evaluate the safety, efficacy, and effects of administration of very high doses of norepinephrine (> 4 microg kg(-1) min(-1)) in catecholamine-resistant septic shock. We reviewed the charts of all patients with nonresponding to commonly used norepinephrine doses (< or = 4 microg kg(-1) min(-1)) septic shock from January 1999 to December 2002 in our Surgical Intensive Care Unit. All patients were treated with high norepinephrine doses (> 4 microg kg(-1) min(-1)), after initial resuscitation, so as to achieve a mean arterial pressure higher than or equal to 65 mmHg. During this 4-year period, 12 consecutive patients with catecholamine-resistant septic shock were included in our study. When compared with the values obtained prior to the administration of very high norepinephrine doses, the values of mean arterial pressure (p = 0.003) and systemic vascular resistance (p = 0.002) significantly increased after the administration of such doses, and additionally, lactate concentrations (p = 0.003) decreased. In contrast, no significant changes were observed regarding mean central venous pressure, pulmonary capillary wedge pressure, and pulmonary arterial pressure. Administration of high norepinephrine doses in our patients resulted in a survival rate of 33.4%. Management of catecholamine-resistant septic shock patients poses a challenging problem. Administration of very high norepinephrine doses is safe and effective and may improve survival of these patients with otherwise extremely high mortality rates.

APACHE↗

Norepinephrine or dopamine for the treatment of hyperdynamic septic shock?

STUDY OBJECTIVE: To compare the ability of dopamine and norepinephrine to reverse hemodynamic and metabolic abnormalities of human hyperdynamic septic shock. DESIGN: Prospective, double-blind, randomized trial. SETTING: An ICU in a university hospital. PATIENTS: Adult patients with hyperdynamic septic shock after fluid resuscitation. INTERVENTIONS: Patients were assigned to receive either dopamine (2.5 to 25 micrograms/kg/min) or norepinephrine (0.5 to 5.0 micrograms/kg/min). If hemodynamic and metabolic abnormalities were not corrected with the maximum dose of one drug, the other was added. MEASUREMENTS AND RESULTS: The aim of therapy was to achieve and maintain for at least 6 h all of the following: (1) systemic vascular resistance index > 1,100 dynes.s/cm5.m2 and/or mean systemic blood pressure > or = 80 mm Hg; (2) cardiac index > or = 4.0 L/min/m2; (3) oxygen delivery > 550 ml/min/m2; and (4) oxygen uptake > 150 ml/min/m2. With the use of dopamine 10 to 25 micrograms/kg/min, 5 of 16 patients (31 percent) were successfully treated, as compared with 15 of 16 patients (93 percent) by norepinephrine at a dose of 1.5 +/- 1.2 micrograms/kg/min (p < 0.001). Ten of 11 patients who did not respond to dopamine and remained hypotensive and oliguric were successfully treated with the addition of norepinephrine. CONCLUSIONS: At the doses tested, norepinephrine was found, in the present study, to be more effective and reliable than dopamine to reverse the abnormalities of hyperdynamic septic shock. In the great majority of the study patients, norepinephrine was able to increase mean perfusing pressure without apparent adverse effect on peripheral blood flow or on renal blood flow (since urine flow was reestablished). At the same time, oxygen uptake was increased.

Dopamine↗

[Urinary epinephrine and norepinephrine excretion in patients with medullary thyroid carcinoma and their relatives].

Medullary thyroid carcinoma can arise as a component of multiple endocrine neoplasia (MEN) syndrome which includes adrenal pheochromocytoma. Familial medullary thyroid carcinoma with no association of other components of MEN syndrome is also reported. Epinephrine and norepinephrine excreted in 24 hour urine and/or randomly voided urine were measured for screening of pheochromocytoma in patients with medullary thyroid carcinoma of either the hereditary or sporadic type and in their relatives. Six patients with clinical symptoms and signs suggesting pheochromocytoma had a markedly increased epinephrine and epinephrine/norepinephrine (E/N) ratio and a less dominant increase of norepinephrine in 24 hour urine. The diagnosis of pheochromocytoma was proved later at surgery. Among 10 patients with hereditary medullary thyroid carcinoma without any clinical symptoms and signs for pheochromocytoma, 6 patients had increased epinephrine and E/N ratio and normal norepinephrine, and the remaining 4 had normal epinephrine, norepinephrine and E/N ratio in 24 hour urine. The six patients with increased epinephrine and E/N ratios were regarded as having latent adrenal medullary hyperfunction. The mean ages of the 6 patients with proved pheochromocytoma, the 6 with latent adrenal medullary hyperfunction and the 4 with normal urinary catecholamine fractions were 51.3, 42.5 and 28.5 years, respectively. At least one patient in each family with hereditary medullary thyroid carcinoma had proved pheochromocytoma or latent adrenal medullary hyperfunction, leaving no family with hereditary medullary thyroid carcinoma only. Urinary epinephrine, norepinephrine and E/N ratios in patients with sporadic medullary thyroid carcinoma and relatives of patients with medullary thyroid carcinoma were not higher than those in normal subjects. Measurements of epinephrine and norepinephrine in randomly voided urine are also a valuable and convenient method for the screening of pheochromocytoma in patients with medullary thyroid carcinoma and their relatives, because they gave results similar to those in 24 hour urine.

Adolescent↗

Radioenzymatic determination of epinephrine, norepinephrine and dopamine in 0.1 ml plasma samples: plasma catecholamine response to submaximal and near maximal exercise.

A sensitive enzymatic isotope derivative method for simultaneous determination of epinephrine, norepinephrine, and dopamine in 0.1 ml plasma samples is described. The assay consists basically of 1. conversion of epinephrine, norepinephrine, and dopamine into their respective methyl-derivates in the presence of catechol-O-methyltransferase and S-adenosylmethionine-[3H]methyl, 2. extraction of the methylated 3H labelled amines with diethyl ether, 3. separation by thin-layer chromatography, 4. measurement in a beta radiation scintillation counter. The effect of standing upright and of submaximal and near-maximal steady state exercise on plasma epinephrine, norepinephrine, dopamine and plasma renin was studied in 16 young adults aged 22 to 34 years and 9 physically well trained boys 16-17 years old. Standing upright for 2 min did not results in significant changes in either epinephrine, norepinephrine, dopamine or plasma renin activity compared with supine (basal) values. During exercise, epinephrine, norepinephrine, dopamine and plasma renin activity increased exponentially with the work load, peak values being attained at the highest load or immediately after cessation of exercise. The respective maximal values for plasma renin activity and epinephrine and norepinephrine levels were approximately 3, 6 and 10 fold higher than basal values in the adults, and rose as high as 4, 10 and 20 fold in the boys. Peak dopamine values were only 2-3 times higher than the basal values in both adults and boys. It is concluded that the method described provides a suitable tool for a quantitative assessment of adreno-sympathetic tone during physiological and pathophysiological conditions.

Adolescent↗

Blood levels, clearance rates and effects of epinephrine and norepinephrine on insulin and metabolites during alpha- and beta-adrenergic blockade in cattle in vivo, and in vitro degradation of dopamine in bovine blood.

To study possible modifications of norepinephrine and epinephrine kinetics (metabolic clearance rate and half-times) by inhibition of binding to alpha- and/or beta-adrenergic receptors, norepinephrine and epinephrine were iv infused in the absence or presence of the alpha-adrenergic blocking agent phentolamine, the beta-adrenergic blocking agent propranolol, and during the combined administration of phentolamine and propranolol. In addition, recovery experiments were performed to investigate the in vitro degradation of dopamine, norepinephrine and epinephrine. Blood levels and kinetics of epinephrine were not modified by alpha- and beta-adrenergic blockade, whereas norepinephrine clearance was reduced by alpha-adrenergic blockade, and was greater than epinephrine clearance. alpha- and beta-adrenergic blockade markedly modified insulin, glucose and non-esterified fatty acid responses to epinephrine and norepinephrine. Norepinephrine and epinephrine could fully be recovered when added to bovine blood plasma. In contrast, dopamine obviously was immediately destructed by bovine, but not by human blood plasma, and should therefore barely be detectable in blood of cattle in vivo.

Adrenergic alpha-Antagonists↗

Slowered turnover of norepinephrine in the brain associated with an acute elevation in blood pressure of rats.

Acute responses of blood pressure and turnover of norepinephrine in the brain to intracisternally injected guanethidine were studied in rats. Systolic blood pressure in guanethidine-treated rats showed a dose-relating rise for over 9 hrs, while norepinephrine contents in cortex-cerebellum, brain stem and heart were not affected. The endogenous norepinephrine in brain samples, however, did not decrease against alpha-methyl-p-tyrosine to result in regression coefficients significantly different from those in the saline-treated group whereas norepinephrine in heart was reduced similarly in the 2 groups, indicating a slowered turnover of norepinephrine selectively in the brain. The results may indicate that the retarded norepinephrine turnover in the brain is causatively related with an acute elevation in blood pressure.

Animals↗

Effects of magnesium on the vasoconstrictor responses to norepinephrine and potassium chloride in the rat mesenteric artery.

In the perfused rat mesenteric vascular bed, the effects of magnesium and calcium on the vasoconstrictor responses to norepinephrine or potassium chloride were studied. Higher concentrations of magnesium in the perfusate attenuated the vascular responses to norepinephrine and potassium chloride in a dose-related manner. Higher concentrations of calcium in the perfusate enhanced greatly the vascular responses to potassium chloride, while the response to norepinephrine was only slightly potentiated by increasing calcium concentration. The attenuating effect of magnesium on the responses to norepinephrine and to potassium chloride were reversed by elevation of calcium concentration in the perfusate. The potentiating effects of calcium on the responses to potassium chloride were also reversed by increasing the concentration of magnesium. However, an inhibitory effect of magnesium on the responses to norepinephrine was not observed in the presence of higher concentrations of calcium. These results indicate that magnesium acts antagonistically on calcium movement in vascular contractions due to potassium chloride, but that the relationship between magnesium and calcium is more complex in vascular contractions induced by norepinephrine.

Animals↗

Contrasting effects of dopamine and dobutamine on myocardial release of norepinephrine during acute myocardial infarction.

The effects of dopamine and dobutamine on release of norepinephrine from normal and ischemic myocardium were compared in 2 groups of open-chest anesthetized dogs. Both agents were infused intravenously at a rate of 10 micrograms/Kg/min for 2 hours, beginning 40 min after snare occlusion of the left anterior descending coronary artery. There were no major differences in hemodynamic responses between the 2 groups. Blood samples were taken simultaneously from the aorta, coronary sinus and the cardiac vein that ran parallel to the left anterior descending coronary artery before and after coronary artery occlusion. Plasma norepinephrine increased 40 min after the occlusion, with a net efflux in both coronary sinus and cardiac venous blood. Dopamine caused further increases in plasma norepinephrine. At 20 min after the beginning of dopamine infusion the coronary sinus concentration (4.09 +/- 1.36 ng/ml) was significantly greater than the arterial concentration (2.84 +/- 0.87 ng/ml). This transcardiac difference disappeared during continuous infusion 2 hours after coronary artery occlusion. Differences in norepinephrine concentration between the arterial and cardiac venous blood, however, were not significant. In contrast, plasma norepinephrine did not increase during dobutamine infusion in either the ischemic or non-ischemic bed. Thus, the results suggest that while these two agents have similar systemic hemodynamic effects, only dopamine increases myocardial release of norepinephrine from either ischemic or normal myocardium during acute myocardial infarction.

Animals↗

Experimental hyperkalaemia in rabbits: effects of salbutamol and norepinephrine treatments on blood biochemistry and electrocardiography.

The effects of salbutamol and norepinephrine on the electrocardiogram (ECG), serum potassium level and enzyme activities were studied in rabbits with hyperkalaemia; norepinephrine and salbutamol may be therapeutically useful. For induction of hyperkalaemia, 300 mM KCl solution was used and then isotonic saline solution containing 6 microg salbutamol and 3.9 microg norepinephrine per ml were administered. Norepinephrine and salbutamol decreased the serum potassium from 7.36 +/- 0.26 and 7.21 +/- 0.31 mmol/L to 5.62 +/- 0.27 and 4.35 +/- 0.33 mmol/L, respectively, and caused the ECG changes (flatness of P wave, widening of QRS complex and bradycardia) to return to the control conditions (time 0). Norepinephrine, but not salbutamol, decreased the activities of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) to the control levels. These results suggest that monitoring of the enzyme activities might be useful as it yields indexes suitable for evaluating the therapeutic approach with norepinephrine in hyperkalaemia.

Adrenergic alpha-Agonists↗

Fixed-dose vasopressin compared with titrated dopamine and norepinephrine as initial vasopressor therapy for septic shock.

STUDY OBJECTIVE: To investigate the early blood pressure effects of vasopressin compared with titrated catecholamines as initial drug therapy in patients with septic shock. DESIGN: Retrospective cohort, single-center study. SETTING: Intensive care units at the Mayo Clinic, Rochester, Minnesota. PATIENTS: Fifty, 49, and 51 intensive care patients treated initially with vasopressin, norepinephrine, and dopamine, respectively. INTERVENTION: Patients received either intravenous infusion of fixed-dose vasopressin 0.04 U/minute or titrated infusions of norepinephrine or dopamine for low systemic arterial pressures. MEASUREMENTS AND MAIN RESULTS: Patients treated with vasopressin, norepinephrine, and dopamine were similar in all measured characteristics except for their score on the Acute Physiology and Chronic Health Evaluation (APACHE) III (dopamine > vasopressin, p=0.049), renal comorbidities (dopamine > vasopressin, p=0.03) and baseline mean arterial pressure (MAP) (norepinephrine < vasopressin, p=0.005 or dopamine < vasopressin, p=0.05). In all patients, MAP 1 hour before and 1 hour afte intervention, heart rate, and systolic blood pressure were obtained. No treatment differences were identified in achieving postvasopressin MAP after adjusting for APACHE III score, renal dysfunction, and baseline MAP. In patients receiving vasopressin, 28-day mortality was 52%, similar to those receiving norepinephrine (65%, p=0.28) and dopamine (60%, p=0.53). CONCLUSION: Initial, fixed-dose vasopressin infusions increased MAP to 70 mm Hg or greater at 1 hour in intensive care patients with septic shock, similar to titrated norepinephrine or dopamine. Fixed-dose vasopressin appears appropriate as an alternative agent for hemodynamic support in patients with septic shock.

APACHE↗

Different norepinephrine disappearance rate in venous and arterial plasma in man.

The disappearance of norepinephrine in both arterial (radial) and venous (antecubital) plasma was studied in five patients with mild essential hypertension following isometric exercise and norepinephrine infusion. Arterial levels of epinephrine throughout the study and of norepinephrine during norepinephrine infusion were consistently higher than venous levels, indicating that both amines are removed by passage through the forearm. Following infusion the disappearance rate of norepinephrine from arterial plasma was faster than from venous plasma. After isometric exercise there was a delay in fall of venous levels, consistent with a delayed efflux of norepinephrine from local tissues. Arterial plasma levels probably reflect total body contribution whereas venous plasma levels presumably reflect additional local removal and/or release from the forearm.

Adult↗