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Processing endopeptidase deficiency in neurohypophysial secretory granules of the diabetes insipidus (Brattleboro) rat.

The homozygote Brattleboro rat exhibits a hereditary diabetes insipidus due to a deficiency of vasopressin, the antidiuretic hormone. It has previously been shown that in this animal a single nucleotide deletion in the provasopressin gene leads to a mutant precursor with a C-terminal amino acid sequence different from that of the wild-type. However the N-terminal region including the hormone moiety, the processing signal as well as the first two-thirds of the neurophysin is entirely preserved and absence of maturation has to be explained by an additional cause. We show here that the neurohypophysis of the homozygote Brattleboro rat, in contrast to the adenohypophysis, displays a significant decrease in the Lys-Arg processing endopeptidase activity when compared to the heterozygote or the wild-type Wistar. It is suggested that hypothalamic vasopressinergic neurons of the homozygote Brattleboro rat display a deficiency in the processing enzyme in contrast to the oxytocinergic neurons in which processing of prooxytocin is normal.

Amino Acid Sequence↗

[Diabetes insipidus induced by post-resuscitation hypoxia].

A 13-year-old girl was admitted with meningeal signs. A lumbar puncture was followed shortly by cardiorespiratory arrest. In spite of intensive resuscitation she remained comatose and severe polyuria diagnosed as diabetes insipidus appeared. The differential diagnosis of dehydration and polyuria in patients after cardiorespiratory arrest and resuscitation should include hypothalamic injury causing diabetes insipidus.

Adolescent↗

Autophagy in hypothalamic neurones of rats expressing a familial neurohypophysial diabetes insipidus transgene.

We have tested the hypothesis that familial neurohypophysial diabetes insipidus (FNDI) is initiated by a process of autophagy. FNDI is a dominant, progressive inherited disorder characterized by pronounced drinking and urination caused by loss of secretion of antidiuretic hormone (vasopressin). In rats expressing an FNDI mutant transgene (Cys67stop) in vasopressin magnocellular neurones, the mutant protein fails to enter the regulated secretory pathway, and accumulates in a swollen and distended endoplasmic reticulum (ER) that also contains wild-type, endogenous vasopressin. Transmission electron microscopy suggested that these are autophagic vesicles. We have now examined the expression of vesicular markers in our transgenic rats, and demonstrate that activation of autolysosomal processes is a consequence of the expression of Cys67stop. Swollen vesicles containing Cys67stop are immunoreactive for cathepsin D (a lysosomal protease), endolyn (a marker of late endosomes) and lysosomal associated membrane protein 1, suggesting that they may be degradative autolysosomes. In addition, there is an up-regulation of lysosomal markers specifically in cells expressing Cys67stop. The expression of Cys67stop affects neither the trans-Golgi network nor early endosomes. These data support the proposal that Cys67stop mutant protein aggregates within the ER, which is targeted for lysosomal degradation by autophagy.

Animals↗

Mutations in the vasopressin prohormone involved in diabetes insipidus impair endoplasmic reticulum export but not sorting.

Familial neurohypophysial diabetes insipidus is characterized by vasopressin deficiency caused by heterozygous expression of a mutated vasopressin prohormone gene. To elucidate the mechanism of this disease, we stably expressed five vasopressin prohormones with a mutation in the neurophysin moiety (NP14G-->R, NP47E-->G, NP47DeltaE, NP57G-->S, and NP65G-->V) in the neuroendocrine cell lines Neuro-2A and PC12/PC2. Metabolic labeling demonstrated that processing and secretion of all five mutants was impaired, albeit to different extents (NP65G-->V >/= NP14G-->R > NP47DeltaE >/= NP47E-->G > NP57G-->S). Persisting endoglycosidase H sensitivity revealed these defects to be due to retention of mutant prohormone in the endoplasmic reticulum. Mutant prohormones that partially passed the endoplasmic reticulum were normally targeted to the regulated secretory pathway. Surprisingly, this also included mutants with mutations in residues involved in binding of vasopressin to neurophysin, a process implicated in targeting of the prohormone. To mimick the high expression in vasopressin-producing neurons, mutant vasopressin prohormones were transiently expressed in Neuro-2A cells. Immunofluorescence displayed formation of large accumulations of mutant prohormone in the endoplasmic reticulum, accompanied by redistribution of an endoplasmic reticulum marker. Our data suggest that prolonged perturbation of the endoplasmic reticulum eventually leads to degeneration of neurons expressing mutant vasopressin prohormones, explaining the dominant nature of the disease.

Biological Transport↗

Central diabetes insipidus due to cytomegalovirus infection of the hypothalamus in a patient with acquired immunodeficiency syndrome: a clinical, pathological, and immunohistochemical case study.

We report a case of central diabetes insipidus (CDI) in a patient with AIDS due to cytomegalovirus (CMV) infection of the vasopressin-producing areas of the hypothalamus. The clinical diagnosis is established by definitive clinical and laboratory evidence of CDI. Detailed histopathological and immunohistochemical studies establish CMV as the causative agent and demonstrate the deficit of vasopressin in the synthesizing neurons. Physicians caring for patients with AIDS should be aware of CDI and adipsic hypernatremia as potential complications of CMV infection. The case also demonstrates that patients with diabetes insipidus do not have polyuria when glucocorticoid deficiency coexists.

Acquired Immunodeficiency Syndrome↗

Mutations in the vasopressin V2 receptor gene in families with nephrogenic diabetes insipidus and functional expression of the Q-2 mutant.

Nephrogenic diabetes insipidus (NDI) is characterized by a resistance of the kidney towards arginine vasopressin (AVP). Following molecular cloning of the vasopressin V2 receptor, we identified different mutations in the V2 receptor gene in families with X-linked NDI, which segregated with the disease. The Hopewell mutation (W71X) causes the disease in the largest North American NDI pedigree, with most of its members residing on Nova Scotia. Different mutations were found in three families from the Quebec area (Q-2: R137H, Q-3: R113W, Q-5: 804delG) and in the large Cannon kindred residing in Utah (L312X). In an Iranian family (O-1), another mutation was detected (A132D). Three of the six mutations (Hopewell, Cannon, Q-5) are predicted to cause the expression of a truncated V2 receptor and are therefore unlikely to function. The functional consequences of missense mutations (Q-2, Q-3, O-1) are less obvious. We therefore introduced the Q-2 mutation into wild-type cDNA. When expressed in COS.M6 or Ltk cells, the Q-2 mutant bound AVP with normal affinity. However, cells expressing the Q-2 mutant failed to respond to AVP with an increase in adenylyl cyclase activity. Thus the Q-2 mutant is unable to interact with or to activate the stimulatory G-protein Gs. The present data indicate that X-linked NDI is frequently attributable to a mutation in the V2 receptor gene. In addition, the data prove biochemically that the Q-2 mutation is the cause of NDI in the Q-2 family.

Amino Acid Sequence↗

Characterization of vasopressin V2 receptor mutants in nephrogenic diabetes insipidus in a polarized cell model.

X-linked nephrogenic diabetes insipidus (NDI) is caused by mutations in the gene encoding the vasopressin V2 receptor (V2R). For the development of a tailored therapy for NDI, knowledge of the cellular fate of V2R mutants is needed. It would be useful when this fate could be predicted from the location and type of mutation. To identify similarities and differences in localization, maturation, stability, and degradation of COOH-terminal GFP-tagged V2R mutants, we stably expressed nine mutants in polarized Madin-Darby canine kidney cells. The mutants V2R-L44P, -Delta62-64, -I130F, -S167T, -S167L, and -V206D were mainly expressed in the endoplasmic reticulum (ER) as immature proteins. These mutants had relatively short half-lives due to proteasomal degradation, except for V2R-Delta62-64. In contrast, V2R-R113W, -G201D, and -T204N were expressed in the ER and in the basolateral membrane as immature, high-mannose glycosylated, and mature complex-glycosylated proteins. The immature forms of V2R-R113W and -T204N, but not V2R-G201D, were rapidly degraded. The mature forms varied extensively in their stability and were degraded by only lysosomes (V2R-T204N and wild-type V2R) or lysosomes and proteasomes (V2R-G201D, -R113W). These data reveal that most missense V2R mutations lead to retention in the ER and suggest that mutations that likely distort a transmembrane domain or introduce a charged amino acid close to it make a V2R mutant more prone to ER retention. Because six of the mutants tested showed significant increases in intracellular cAMP levels on transient expression in COS cells, activation of these six receptors following rescue of cell-surface expression might provide a cure for NDI patients.

Amino Acid Sequence↗

[Spinal anesthesia for empty sella syndrome associated with diabetes insipidus--a case report].

A 60-year-old woman was admitted to our hospital for surgical treatment of the left inguinal hernia. She had suffered from diabetes insipidus for ten years, and hormonal study revealed low plasma level of vasopressin. She has been taking nasally desmopressin acetate 5 micrograms twice a day and urinary output has been well controlled around 1200-1400 ml.day-1. CT-scan showed empty sella without any pituitary tumors. There were no evidences of increased intracranial pressure and neurological deficit. Following nasal instillation of desmopressin acetate 5 micrograms one hour before anesthesia, spinal anesthesia was performed with tetracaine 10 mg. Cephalad sensory block assessed by pinprick spread to T6 within 10 minutes. Systolic blood pressure gradually decreased from 120 to 90 mmHg, although no vasoconstrictors were needed. Arterial blood pressure was stable during the surgery. The operation lasted 80 minutes with 650 ml of fluid replacement, blood loss of 50 g and urinary output of 25 ml. She had no postspinal headache nor neurological deficit after surgery. Empty sella syndrome associated with diabetes insipidus is rare. Low spinal anesthesia can be performed safely whenever there is no evidence of increased intracranial pressure, although care should be taken for perioperative fluid and circulatory management.

Administration, Intranasal↗

Novel mutations in aquaporin-2 gene in female siblings with nephrogenic diabetes insipidus: evidence of disrupted water channel function.

Novel mutations of the aquaporin-2 (AQP2) gene have been detected in Japanese female siblings with autosomal-recessive nephrogenic diabetes insipidus. The patients were compound heterozygote for point mutations at nucleotide position 374 (C374T) and at position 523 (G523A) in exon 2 of the AQP2 gene, resulting in substitution of methionine for threonine at codon 125 (T125M) and arginine for glycine at codon 175 (G175R). The water permeability (Pf) of oocytes injected with wild-type complementary RNA increased 9.0-fold compared with the Pf of water-injected oocytes, whereas the increases in the Pf of oocytes injected with T125M and G175R complementary RNA were only 1.7-fold and 1.5-fold, respectively. Immunoblot and immunocytochemistry indicated that the plasma membrane expressions of T125M and G175R AQP2 proteins were comparable to that of the wild-type, suggesting that although neither the T125M nor G175R mutation had a significant effect on plasma membrane expression, they both distorted the structure and function of the aqueous pore of AQP2. These results provide evidence that the nephrogenic diabetes insipidus in patients with T125M and G175R mutations is attributable not to the misrouting of AQP2, but to the disrupted water channel function.

Amino Acid Sequence↗

Changes in tissue sensitivity to vasopressin in hereditary hypothalamic diabetes insipidus.

Specific binding of (125I) arg8-vasopressin to mononuclear phagocytes of the circulating blood was studied in 3 patients (one male, two females) with hereditary hypothalamic diabetes insipidus before, during and after therapy with 1-desamino-8-D-arginine vasopressin and compared with values of 15 normal donors (7 males, 8 females). Before therapy specific radioligand binding activity was considerably increased (0.3 +/- 0.08 fmoles/2.2 X 10(5) cells/ml) versus controls (0.23 +/- 0.04 fmoles/2.2 X 10(5) cells/ml). Increased binding was due to increase in receptor concentration per cell. In contrast, during treatment and after withdrawal of therapy the receptor binding activity was 0.1 +/- 0.05 fmoles/2.2 X 10(5) cells/ml. The dissociation constant (KD) for hormone binding before therapy (25 +/- 0.2 pM) was roughly identical with that of normal donors (24 +/- 0.8 pM), indicating insignificant changes in receptor affinity. During treatment and 48 h after withdrawal of therapy, however, the KD value was 11 +/- 0.45 pM, which amy be accounted for by an elevation in the binding affinity. We conclude that untreated patients with hereditary hypothalamic diabetes insipidus have increased tissue sensitivity to vasopressin, but have decreased binding capacity during and even two days after discontinuation of therapy, possibly as the result of 1-desamino-8-D arginine vasopressin-induced desensitization phenomena.

Adolescent↗

Nephrogenic diabetes insipidus, cystinosis, and vitamin D.

We describe a patient with early diagnosed cystinosis who presented with nephrogenic diabetes insipidus in addition to proximal tubular dysfunction. Another feature in this patient was abnormally low serum concentration of 24,25 dihydroxy vitamin D3 (24,25(OH)2D3) with normal 25 hydroxy vitamin D3 (25(OH)D3) and relatively low 1,25 dihydroxy vitamin D3 (1,25(OH)2D3).

Child, Preschool↗

Pharmacokinetics, pharmacodynamics, long-term efficacy and safety of oral 1-deamino-8-D-arginine vasopressin in adult patients with central diabetes insipidus.

1. The pharmacokinetics and pharmacodynamics of intranasal (IN) and oral 1-deamino-8-D-arginine vasopressin (DDAVP) were compared in 10 Chinese adults with central diabetes insipidus previously controlled on IN DDAVP. This was followed by comparison of the acute pharmacodynamics of commonly used oral preparations (containing 100, 200 and 400 micrograms per tablet) and a 1 year prospective evaluation of the long-term safety and efficacy of oral DDAVP. 2. Following 20 micrograms IN and 200 micrograms orally, respective plasma DDAVP concentrations peaked after 45.6 +/- 7.3 and 93.3 +/- 3.3 (mean +/- s.e.mean) min, reaching 24.1 +/- 4.7 and 15.1 +/- 3.2 pmol 1(-1) and respective terminal half-lives were 2.2 +/- 0.1 and 2.0 +/- 0.1 h. Based on the area under the concentration-time-curve, the bioequivalent IN/oral ratio was 1:16. 3. As judged by changes in urine flow rate and osmolality after IN or oral (100, 200 or 400 micrograms) DDAVP, antidiuretic activity increased rapidly during the second hour and peaked at 4 h. The antidiuresis duration and magnitude correlated with the oral dose (P < 0.001 and < 0.05 respectively), and was least following 100 micrograms (P < 0.01 vs 200 or 400 micrograms). Increasing the dose from 200 to 400 micrograms did not increase maximal antidiuretic activity significantly, but there was a trend towards a longer duration of action (P = 0.076). 4. During the 1-year prospective study with oral DDAVP 300-600 micrograms per day in two to three doses, stable and satisfactory antidiuresis (comparable with that on previous IN therapy) was maintained; tablets were well-tolerated and no side-effect warranted drug withdrawal. 5. These findings suggest that the 100 and 200 micrograms preparations of oral DDAVP are adequate for the long-term control of central diabetes insipidus in our population, and that the 400 micrograms preparation may have a role if the frequency of administration is to be reduced.

Administration, Intranasal↗

Hyperosmolarity associated with diabetes insipidus alters hepatocyte structure and function but not survival after orthotopic liver transplantation in rats.

BACKGROUND: This study was designed to evaluate the effect of donor hyperosmolarity secondary to diabetes insipidus, an almost universal occurrence among brain-dead patients, on hepatic function. METHODS: In vitro (isolated liver perfusion) and in vivo (hyaluronic acid and indocyanine green uptake, arterial ketone body ratio, orthotopic liver transplantation) experiments were conducted using Brattleboro rats, with hereditary hypothalamic diabetes insipidus, and Sprague-Dawley rats, with normal pituitary function. ATP content and recovery after cold preservation were measured during the perfusion. RESULTS: Cold-preserved livers from hyperosmolar rats were observed to have elevated hepatic enzyme release and decreased bile production compared with normosmolar controls. Moreover, in these livers, the recovery of ATP after cold preservation was completely absent. Transmission electron microscopy of liver biopsies collected from hyperosmolar rats demonstrated profound ultrastructural changes, particularly in the mitochondria, that were not evident in the biopsies from normosmolar rats. All the experimental groups demonstrated similar hyaluronic acid uptake, whereas indocyanine green uptake was markedly impaired in the hyperosmolar group, suggesting that hepatocyte and not sinusoidal endothelial cell function is adversely affected by hyperosmolarity. The arterial ketone body ratio was profoundly compromised by chronic and, to an even greater degree, by acute hyperosmolarity. Survival after transplantation using hyperosmolar donors was not affected in this study. CONCLUSIONS: These results are an important step toward understanding the mechanism whereby brain death, a complicated pathophysiologic phenomenon, adversely affects the hepatic allograft.

Adenosine Triphosphate↗

A study of the response to several dipsogenic treatments in rats with mammillary polydipsia and with centrally induced diabetes insipidus.

Several brain areas have been implicated in the regulation of water intake and body fluid homeostasis. Electrolytic lesions located in the mammillary area have proved to induce a strong polydipsia. The cause of this overconsumption is not understood, although other studies have indicated a possible relationship with the mechanisms involved in sodium control. In this paper, we consider whether mammillary polydipsia is related to diabetes insipidus. In this regard, animals with mammillary lesions were submitted to several dipsogenic treatments, both osmotic and volemic. These subjects showed a differential response to hypertonic NaCl compared with controls. No effect could be seen in relation to the other treatments employed, that is, sucrose and polyethylene glycol. On the other hand, this differential response to NaCl was not observed in those animals with diabetes insipidus centrally induced by means of lesions in the median eminence. Thus, mammillary polydipsia and diabetes insipidus-related water intake seem to be different phenomena. The possible relationship between mammillary polydipsia and sodium control is discussed.

Animals↗

[Treatment of central diabetes insipidus with a combination of chlorpropamide and carbamazepine (author's transl)].

Three patients suffering from central (=neurohormonal) diabetes insipidus were treated with chlorpropamide and carbamazepine simultaneously. This therapy with a combination of the two drugs was based on the aim of getting a good antidiuretic effect when the centrally-stimulating carbamazepine was combined with the peripherally-potentiating chlorpropamide; it was hoped, too, that the side effects of these two drugs, especially the chlorpropamide-induced hypoglycaemia, could be avoided by administration at low dosage. This combined drug therapy proved effective in all three cases: the good antidiuretic effect of chlorpropamide at high dosage is impaired by hypoglycaemia; the combination of carbamazepine allowed the dosage of chlorpropamide to be decreased without impairment of the obtained antidiuretic effect and with avoidance of hypoglycaemia and other side effects. Hence, the combination of chlorpropamide and carbamazepine seems to be recommendable in the treatment of central forms of diabetes insipidus in childhood.

Carbamazepine↗

Transient diabetes insipidus following electrical burns in two patients.

We report on two healthy white men who sustained high-voltage electrical burns and were transferred to our regional burn center for specialized care. Within 24 hours of admission, both patients developed clinical signs and laboratory evidence of diabetes insipidus. With appropriate treatment, no sequelae occurred and their endocrinopathy spontaneously resolved. Diabetes insipidus following traumatic events is not uncommon; however, it has never been reported following an electrical injury.

Adult↗