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F J Tilders

Publications and source records attributed to F J Tilders.

At least 37 records · Page 2Linked to original sources

Reduced activity of hypothalamic corticotropin-releasing hormone neurons in transgenic mice with impaired glucocorticoid receptor function.

Loss of central glucocorticoid receptor (GR) function is thought to be involved in the development of neuroendocrine and psychiatric disorders associated with corticotropin-releasing hormone (CRH) hyperactivity. The possible causal relationship between defective GR function and altered activity of CRH neurons was studied in transgenic mice (TG) expressing antisense RNA against GR. Immunocytochemical studies showed significant reductions in CRH immunoreactive neurons in the paraventricular nucleus (PVN) and in CRH and vasopressin (AVP) stores in the external zone of the median eminence. Concomitantly, stimulus-evoked CRH secretion from mediobasal hypothalami of TG mice in vitro was reduced significantly. However, CRH mRNA levels in the PVN of TG mice were marginally lower than those in wild-type (WT) mice. 125I-CRH binding autoradiography revealed no differences between WT and TG animals in any of the brain regions that were studied. Basal plasma corticosterone (cort) levels and 125I-CRH binding, CRH-R1 mRNA, POMC mRNA, and POMC hnRNA levels in the anterior pituitary gland were similar in WT and TG mice. Intraperitoneal injection of interleukin-1beta (IL-1beta) increased plasma cort levels, CRH mRNA in the PVN, and anterior pituitary POMC hnRNA similarly in WT and TG mice. The injection of saline significantly reduced anterior pituitary CRH-R1 mRNA levels in WT mice, but not in TG mice, whereas IL-1beta produced a decrease in these mRNA levels in both strains. The data show that long-term GR dysfunction can be associated with reduced activity of CRH neurons in the PVN and decreased sensitivity of pituitary CRH-R1 mRNA to stimulus-induced downregulation. Moreover, the hypothalamic changes observed in this model suggest that impaired GR function, at least if present since early embryonic life, does not necessarily result in CRH hyperexpression characteristics of disorders such as major depression.

Animals↗

Interleukin-1-induced plasticity of hypothalamic CRH neurons and long-term stress hyperresponsiveness.

Infections and endotoxin (LPS) can affect hypothalamic CRH neurons and activate the HPA system. This can be prevented by IL-1 receptor antagonist and mimicked by IL-1. Chronic activation of the HPA system by repeated or chronic administration of IL-1 (1 week) to rats is associated with plastic changes in hypothalamic CRH neurons. Single administration IL-1 beta (5 micrograms/kg i.p.) to male Wistar or Lewis rats induced a similar form of neuroplasticity 1-3 weeks later. This is characterized by a selective increase in coproduction, costorage, and cosecretion of AVP in hypothalamic CRH neurons. Exposure of IL-1-primed rats 1-2 weeks later to foot shocks or IL-1 resulted in exaggerated ACTH and CORT responses as compared to vehicle-primed controls. Thus, rats are hyperresponsive to stressors weeks after IL-1 exposure. In IL-1-primed animals, CRH binding and CRH- and V1b receptor mRNA levels in the pituitary glands are not altered by IL-1 exposure 2 weeks earlier. We conclude that IL-1-induced, long-lasting hyperresponsiveness to stressors is primarily caused by functional alterations in the brain that may be directly related to observed plasticity of hypothalamic CRH neurons.

Animals↗

Effects of peripheral administration of LPS on the expression of immunoreactive interleukin-1 alpha, beta, and receptor antagonist in rat brain.

The cytokine interleukin-1 (IL-1) appears to play a pivotal role in the orchestration of brain-mediated, nonspecific illness symptoms during an infection. In the present study, we examine the possibility that IL-1 is produced in the central nervous system itself, which may be responsible for the induction of brain-mediated responses. Using immunocytochemical techniques, we demonstrated that peripheral administration of bacterial endotoxin to rats caused a time- (1.5-24 hr) and dose-dependent (4 micrograms/kg-2.5 mg/kg) induction of IL 1 beta immunoreactivity in cells identified as macrophages in meninges and choroid plexus and microglial cells in various brain regions. At 8 hr after endotoxin (2.5 mg/kg), immunoreactive IL-1 alpha was observed in the same areas and cell types as IL-1 beta. Although no quantitative measurements have been performed, it appears that fewer cells express immunoreactive IL-1 alpha than IL-1 beta. Furthermore, IL-1ra was found to be constitutively expressed in neurons in the paraventricular nucleus and supraoptic nucleus, which is in accordance with mRNA data. After administration of endotoxin, we observed no additional cells that expressed immunoreactive IL-1ra. We conclude that IL-1 alpha and IL-1 beta production in the brain is induced in the same cell types, whereas IL-1ra is expressed constitutively by a different cell type--probably neurons.

Animals↗

Interleukin 1 (IL-1) type I receptors mediate activation of rat hypothalamus-pituitary-adrenal axis and interleukin 6 production as shown by receptor type selective deletion mutants of IL-1beta.

The cytokine interleukin 1 (IL-1) plays an important role in the activation of the hypothalamus-pituary-adrenal (HPA)-axis and interleukin 6 (IL-6) production during infection or inflammation. Which of the interleukin-1 receptor types mediates these effects is not known. To investigate this issue a pharmacological approach was chosen by using recently developed IL-1 receptor type selective ligands. Rats were given one of various doses of recombinant human IL-1beta (rhIL-1beta; 1 and 10 microg/kg) and of several IL-1beta mutants (DeltaSND, DeltaQGE and DeltaI; 1, 10 and 100 microg/kg), that differ in their affinities for the IL-1 type I receptor but have similar affinities for the IL-1 type II receptor. One hour after intravenous administration of rhIL-1beta or IL-1beta mutants, plasma levels of ACTH, corticosterone (cort) and IL-6 were measured. Doses of 1 and 10 microg/kg rhIL-1beta markedly elevated plasma levels of ACTH, cort and IL-6. However, 10-100-fold higher doses of IL-1beta mutants DeltaSND and DeltaQGE and at least 100-fold higher doses of DeltaI have to be administered to increase plasma levels of ACTH, cort and IL-6. The potency differences correlate with their respective affinity for the type I receptor but not with that of the IL-1 type II receptor. It is concluded that IL-1beta induced ACTH, cort and IL-6 production is mediated by interleukin 1 type I receptors.

Adrenocorticotropic Hormone↗

Effect of annexin-1 on experimental autoimmune encephalomyelitis (EAE) in the rat.

Annexin-1, a calcium-dependent phospholipid binding protein, has been shown to act as an endogenous central neuroprotectant, notably against cerebral ischaemic damage. In the present study we extend these findings to an animal model of multiple sclerosis, EAE, and report that endogenous annexin-1 is expressed in ED1+ macrophages and resident astrocytes localized within the lesions in the central nervous system (CNS). Intracerebroventricular (i.c.v.) administration of an NH2-terminal fragment spanning amino acids 1-188 of annexin-1 after the onset of the clinical symptoms significantly reduced both the neurological severity as well as weight loss of mild EAE. Immunoneutralization of endogenous brain annexin-1 failed to exacerbate the clinical features of EAE. Thus, although the role of endogenous annexin-1 in the pathogenesis of EAE remains to be determined, our findings suggest that annexin-1 may be of therapeutic benefit to the treatment of multiple sclerosis.

Animals↗

Role of astrocyte-derived tissue-type plasminogen activator in the regulation of endotoxin-stimulated nitric oxide production by microglial cells.

In mixed glial cell cultures from cerebral cortices of newborn rats, endotoxin induces nitric oxide (NO) production in microglial cells. Earlier we demonstrated that endotoxin induced NO production by microglial cells is inhibited in the presence of astroglial cells by transforming growth factor beta (TGFbeta). Both microglial and astroglial cells produce TGFbeta in a biologically inactive form, which can be activated by plasmin generated by plasminogen activators (PA). In the present paper we describe studies on the mechanism by which glial cells may activate inactive TGFbeta and its potential inhibitory effect on NO production by microglial cells. Inhibition of plasmin increased NO production in endotoxin-treated mixed glial cell cultures. Subsequently, antibodies against tissue-type plasminogen activator (tPA) increased NO production in endotoxin-treated mixed glial cell cultures while amiloride, an inhibitor for urokinase (uPA), had no effect. We hereby concluded that tPA is the crucial PA involved in plasmin production resulting in inhibition of NO production in mixed glial cell cultures. Zymography and Northern blot analysis of purified astroglial, microglial, and mixed glial cell cultures demonstrated that astroglial cells produce tPA and a plasminogen activator inhibitor (PAI-1) and are thereby responsible for the production of plasmin which may activate the inactive TGF in these cultures. In conclusion, astroglial-derived tPA plays a major role in the inhibition of NO production by endotoxin-treated microglial cells through enhanced plasmin production and possible subsequent TGFbeta activation.

Amiloride↗

Biological activity and brain actions of recombinant rat interleukin-1alpha and interleukin-1beta.

IL-1alpha and IL-1beta have potent effects on the central nervous system resulting in fever, activation of the hypothalamic-pituitary-adrenal axis and behavioural depression. These effects have mainly been studied in rats, using recombinant human and mouse IL-1. Because IL-1alpha and IL-1beta show some species specificity in the potency of their biological activities, the objective of the present work was to directly compare the effects of recombinant rat IL-1alpha and IL-1beta in the rat system as a first step to dissect out the mechanisms that are involved in these effects. In vitro, recombinant rat IL-1alpha and IL-1beta bound with the same affinity as human IL-1 to the rat insulinoma Rin m5F cell line that mainly expresses type I IL-1 receptors. This binding activated IL-1 receptors, as shown by induction of the synthesis of TNF-alpha mRNA. In vivo, recombinant rat IL-1alpha and IL-1beta enhanced body temperature, increased plasma levels of corticosterone and ACTH, and depressed social behaviour. All these effects were obtained at doses 100-1,000 fold lower when IL-1 was injected centrally than when it was administered peripherally, indicating that they are centrally mediated. The relative potencies of recombinant rat IL-1alpha and IL-1beta were not the same depending on the endpoint and the route of injection, indicating that different mechanisms are likely to be involved in the various effects of IL-1 on the brain.

Animals↗

Inhibition of endotoxin-induced nitric oxide synthase production in microglial cells by the presence of astroglial cells: a role for transforming growth factor beta.

In mixed glial cell cultures from cerebral cortices of newborn rats, endotoxin induces inducible nitric oxide (iNOS), nitric oxide (NO), and interleukin-1 beta (IL-1 beta) production in microglial cells. Earlier we demonstrated that endotoxin induced iNOS but not IL-1 beta expression in microglial cells is inhibited by the presence of astroglial cells. In the present paper we describe studies on the mechanism by which astroglial cells exert selective suppressive action on iNOS expression by microglial cells. Expression of iNOS and IL-1 beta was studied by single or double label immunocytochemical techniques and cell identification was performed with GSA-I-B4-isolectin and an antibody against GFAP. Production of IL-1 beta and NO was determined by measurement of IL-1 beta and nitrite concentrations in cell lysates and the culture medium, respectively. TGF beta, a cytokine known to inhibit NO production by endotoxin challenged macrophages, was measured in culture medium of mixed glial cell cultures using a bioassay. Microglial, astroglial, and mixed glial cell cultures produced similar concentrations of TGF beta. The potential effect of TGF beta was studied by using immunoneutralizing antibodies against TGF beta 1 and TGF beta 2 on the induction of iNOS in microglial cells in the presence of astroglial cells. Incubation of the mixed glial cell culture with these TGF beta antibodies (3 micrograms/ml) markedly increased endotoxin-induced NO production and iNOS expression in microglial cells, whereas the production of IL-1 beta was not affected. The antibodies against TGF beta 1 and TGF beta 2 marginally increased NO production in pure microglial cell cultures, nonetheless in cultures of purified microglial cells recombinant TGF beta 1 and TGF beta 2 together with endotoxin inhibited NO production. We conclude that the presence of astroglial cells is essential for the inhibitory effect of TGF beta on NO production by microglial cells (possibly) by activation of TGF beta or by increasing the sensitivity of microglial cells for TGF beta.

Animals↗

Effects of neonatal dexamethasone treatment on hypothalamo-pituitary adrenal axis and immune system of the rat.

Synthetic glucocorticoids (GC) are widely used drugs, also in the prevention of diseases that occur in the preterm newborn. Previously we have found that GC treatment of pregnant rats resulted in a persistent increase in the ratio of AVP over CRH in the mediobasal hypothalamus, and in an increased CD4/CD8 ratio in the thymus of the newborn. The objective of the present study was to investigate whether such effects were also seen after neonatal GC exposure, given in clinically-relevant doses. Dexamethasone-21-phosphate (DEX; 1.2 microg/g BW, i.p.) was given at day 5 and day 7 after birth. At day 18, 33, and 48 after birth effects of GC on the HPA-axis, and on CD4+ and CD8+ T cells in thymus and spleen were examined. Neonatal DEX treatment temporarily increased (p < 0.01) AVP stores in the external zone of the median eminence (ZEME) on day 18 after birth, and did not affect CRH stores. Resting plasma levels of ACTH and corticosterone remained unchanged after neonatal DEX treatment at any time interval studied. In the thymus and spleen, neonatal DEX treatment decreased (p < 0.0001) T cell numbers on day 18 after birth. Furthermore, neonatal DEX treatment increased (p < 0.01) the ratio of mature CD4-CD8+ over CD4-CD8+ thymocytes on day 18 after birth, but not on day 33 and day 48 after birth. In conclusion, neonatal DEX treatment has temporary effects on peptide expression in hypothalamic CRH neurons, and on thymocyte maturation. Apparently, neonatal exposure to GC affects potentially sensitive targets within the endocrine system and immune system but these alterations are reversible and readjusted during development.

Animals↗

Immunotargeted lesions of paraventricular CRF and AVP neurons in developing rats reveal the pattern of maturation of these systems and their functional importance.

Pituitary ACTH secretion in the rat is controlled by a number of hypothalamic secretagogues, like CRF and AVP and by inhibitory feedback provided by glucocorticoids. During development, little is known about the precise regulation of ACTH release by hypothalamic neuropeptides and glucocorticoids. We used immunotargeted chemical PVN lesions to investigate the role of CRF and AVP neurons of the hypothalamic paraventricular nucleus (PVN) in the control of ACTH secretion in neonatal rats under basal conditions and 5 days after adrenalectomy (ADX). Neonates aged day (d) 4 or d14 were injected over the PVN with ricin A toxin associated with either non-specific antibodies (IgG/Tx), or monoclonal antibodies directed towards CRF (CRF/Tx) or AVP (AVP/Tx). Rats from each group received either sham surgery (SHAM) or were adrenalectomized (ADX). Pups were sacrificed 5 days after PVN treatment and adrenal surgery (d9 or 19). Plasma ACTH and corticosterone (B) levels were measured by RIAs. Changes in CRF and AVP expression in the PVN and other brain regions were determined by immunohistochemistry (ICC) and in situ hybridization. Injection of the toxin associated with IgGs did not have non specific effects on body weight gain, neuropeptide expression or plasma ACTH and B secretion compared to intact, uninjected rats. Lesions of CRF or AVP neurons greatly reduced peptide expression and mRNA levels in the PVN and median eminence at both ages. However, the specificity of the lesion was greater in older than in young pups. At both ages, we observed a dissociation between the morphological effects of the lesions and hormonal responses. In d14-19 pups, CRF and AVP lesions prevented ADX-induced changes in mRNA levels and peptide expression but did not reduce ACTH secretion under basal or stimulated (post ADX) conditions. However, CRF and AVP lesions increased the expression of CRF in the central amygdala and the bed nucleus of the stria terminalis. Lesions with AVP also stimulated CRF expression in the PVN. Thus, these compensatory changes could take over some of the hypophysiotropic actions of the damaged PVN neurons. In young pups (d4-9), we did not observe the typical increase in CRF and AVP mRNA levels and peptide expression found after ADX in older pups or adults. Lesions of the CRF neurons also affected the AVP system and reciprocally. We suggest that this could be explained by a high degree of colocalization of CRF and AVP observed in parvocellular and small, immature magnocellular neurons in young pups. The lesions did not affect basal or ADX-induced ACTH secretion, suggesting that during the early neonatal period, the pituitary is the major site of glucocorticoid inhibitory feedback on ACTH secretion and that the hypothalamus does not exert a tonic control over basal pituitary secretion. These results unravel ontogenetical differences in the regulation of ACTH secretion by hypothalamic CRF and AVP. During the first 10 days of life, within the adrenal stress hyporesponsive period, hypothalamic CRF and AVP neurons are not sensitive to glucocorticoid feedback and basal ACTH secretion appears to be relatively independent from hypothalamic input. After the second week of life, maturation of glucocorticoid receptors, neuronal phenotype and connections of the PVN to other brain structures (bed nucleus of the stria terminalis, central amygdala) allows for the full expression of corticosterone effect on hypothalamic neurons and for compensatory changes to occur following lesions. These results emphasize the extraordinary capacity of the developing central nervous system to adapt to changes in functionning of some neuronal areas critical for homeostatic balance and the important potential role of intra-hypothalamic and extrahypothalamic relationships in maintaining control over ACTH and glucocorticoid production during development.

Adrenalectomy↗

Transient suppression of resting corticosterone levels induces sustained increase of AVP stores in hypothalamic CRH-neurons of rats.

Previous studies showed that various stressors can induce delayed (days) and long-lasting (weeks) increases of vasopressin (AVP) stores in terminals of CRH neurons in the external zone of the median eminence (ZEME) in adult rats. Here we tested whether this long-lasting neuroplastic change can be induced by mechanisms other than stressor provoked transsynaptic activation of CRH neurons. Single i.v. administration of a CRH antibody to adult rats causes a delayed (at least 1 day) and long-lasting (3 weeks) increase (2-3 fold) of AVP stores in the ZEME without affecting CRH stores. It suppresses ether-induced ACTH-responses for at least 8 days. In contrast, resting pm levels of ACTH and corticosterone (CORT) were suppressed only during the first 2 days. Suppletion of CORT levels on day 1 and 2, attenuates the antibody induced AVP-increase by 57%. CRH-immunoneutralization did not affect the AVP stores in CORT supplemented ADX rats. Thus, long-term increases of AVP stores induced by CRH-immunoneutralization largely depend on short-term suppression of pm CORT levels. Accordingly, single administration of metyrapone, which causes a transient suppression of pm CORT levels, increases AVP (1.5 fold) but not CRH stores one week later. We conclude that transient activation of hypothalamic CRH neurons results in long-lasting increases in AVP co-expression irrespective of the nature of the activating stimulus.

Adrenalectomy↗

Role of circulating endotoxin and interleukin-6 in the ACTH and corticosterone response to intraperitoneal LPS.

Peripheral administration of lipopolysaccharide (LPS) may activate the hypothalamus-pituitary-adrenal (HPA) axis by way of both neural and humoral mechanisms. We have investigated whether biologically active endotoxin appears in the general circulation after intraperitoneal administration of LPS (5 or 100 micrograms/kg) to rats and whether this is a prerequisite for activation of this HPA axis. Within 15 min, endotoxin appeared in the general circulation, whereas elevations of plasma adrenocorticotropic hormone (ACTH), corticosterone, and interleukin (IL)-6 concentrations were not detected until 90 min after LPS injection. At this time, a marked interindividual variation was observed in plasma concentrations of endotoxin, ACTH, corticosterone, and IL-6. Elevated levels of plasma endotoxin were associated with elevated levels of ACTH, corticosterone, and IL-6. Intravenous administration of the LPS antagonist cationic antimicrobial protein 18 (5 mg/kg), which did not affect cytokine production in the peritoneal cavity, markedly reduced plasma ACTH, corticosterone, and IL-6 levels after 5 micrograms/kg LPS. Our results suggest that circulating endotoxin is required for the activation of the HPA axis. They also favor a role for circulating IL-6 in this response.

Adrenocorticotropic Hormone↗

Acute and long-term effects of stressors on pulmonary immune functions.

To study the effects of different types or intensities of stressors on immune reactivity in the lungs, we studied the ex vivo production of nitric oxide (NO) and IL-1beta by alveolar macrophages (AM) after short exposure of rats to restraint stress or inescapable electric footshocks. Exposure to electric footshocks of various intensities resulted in an intensity-dependent decrease in NO production whereas the IL-1beta production by AM had increased. The secretory activity was similarly affected by restraint stress. When the time course of electric footshocks on secretory functions of AM was studied, it was found that the effects on NO and IL-1beta production by AM were normalized 3 days after the stress induction, but reappeared when cells were isolated 1 to 2 wk after stress exposure. Analysis of the effects of electric footshocks of various intensities on antibody production 10 days after the stress session and subsequent lung immunization with trinitrophenyl conjugated keyhole limpet hemocyanin (TNP-KLH), showed a footshock intensity-dependent response. Although exposure to stress induced an increase in plasma levels of adrenocorticotropic hormone (ACTH) and corticosterone (CORT), hormone levels did not differ between the various stress-exposed groups. This suggests that the observed stress effects on pulmonary immune functions were not mediated by ACTH or CORT but point to a direct involvement of the autonomic nervous system.

Animals↗

Regulation of sialoadhesin expression on rat macrophages. Induction by glucocorticoids and enhancement by IFN-beta, IFN-gamma, IL-4, and lipopolysaccharide.

Sialoadhesin is a macrophage-restricted member of the Ig superfamily that mediates adhesion with lymphoid and myeloid cells. It is expressed on a subpopulation of macrophages in lymphoid tissues and in chronic inflammation (e.g., during autoimmune diseases). We have studied the regulation of sialoadhesin expression in vitro and show that glucocorticoids (GC) induce sialoadhesin expression on freshly isolated rat macrophages and the rat macrophage cell line R2. The cytokines IFN-beta, IFN-gamma, IL-4, and LPS, although unable to induce sialoadhesin expression by themselves, were able to enhance GC-mediated induction of sialoadhesin. Sialoadhesin expression was functional as shown by cell adhesion assays with human RBCs. Northern blotting experiments indicated that regulation predominantly occurred at the mRNA level. Comparison of the different combinations of GC and cytokines/LPS revealed differences in the level of GC-dependent enhancement of sialoadhesin expression, with IFN-beta and IL-4 being more potent than IFN-gamma and LPS. Moreover, the effects of IFN-gamma and LPS could be reproduced by priming, whereas IFN-beta and IL-4 were required simultaneously with GC. The regulation of sialoadhesin expression was mediated by the GC receptor, and not by mineralocorticoid receptor, as shown by inhibition experiments with specific antagonists. Finally, it is demonstrated that macrophages in the adrenal gland, the major site of endogenous GC production, express sialoadhesin. This study demonstrates that GC act as a primary inducer of sialoadhesin expression on rat macrophages, and that the response can be enhanced by IFN-beta, T cell-derived cytokines, or LPS.

Animals↗

Chronic stimulation of the hypothalamus-pituitary-adrenal axis in rats by interleukin 1beta: central and peripheral mechanisms.

The authors have studied mechanisms which could be involved in the sustained activation of the hypothalamus-pituitary-adrenal (HPA) axis during continuous infusion of rats with recombinant human interleukin-1beta (IL-1beta). First, the effects of 3 days of intracerebroventricular (i.c.v.) infusion of rats with IL-1 on plasma adrenocorticotropin (ACTH) and corticosterone (B) levels were investigated. Thereafter, changes in plasma ACTH and B levels were followed in rats intraperitoneally (i.p.) infused with IL-1beta after immunoneutralization of corticotropin-releasing hormone (CRH), hypophysectomy (HPX), macrophage depletion using dichloromethylene diphosphonate (Cl2MDP)-containing liposomes, adrenalectomy (ADX) and dexamethasone (DEX) administration, respectively. Infusion of IL-1beta i.c.v., even in doses as low as 0.1 microg/day, induced significant increases in plasma ACTH and B levels. HPX and ADX rats died within 18 h after starting the IL-1beta infusion (0.5 microg/day). Immunoneutralization of CRH significantly decreased and macrophage depletion significantly increased the stimulation of the HPA axis by IL-1 (4.0 microg/day). Administration of high doses of DEX completely abolished the stimulation of the HPA axis by IL-1beta (2.0 microg/day). The present study demonstrates that lower doses of IL-1beta were able to activate the HPA axis when infused i.c.v. compared with i.p. Regarding stimulation of the HPA axis by chronic i.p. infusion of IL-1beta the present study: (1) provides evidence that the CRH system is involved; (2) provides no evidence for a direct stimulatory effect of IL-1beta on the release of B by the adrenal gland which is of sufficient magnitude to resist the stress of chronic i.p. IL-1beta infusion; (3) shows that endogenous macrophage-derived mediators, induced by i.p. IL-1beta infusion, express an overall inhibitory rather than a stimulatory effect on the activity of the HPA axis; (4) demonstrates that exogenous administration of DEX blocks the effect of IL-1beta, which fits well in the concept of an immunoregulatory feedback between IL-1beta and glucocorticoids.

Adrenalectomy↗