sincalide and Panic-Disorder

Cholecystokinin (CCK) is a neurotransmitter found in high density in the brains of mammals. Microiontophoretic studies showing that benzodiazepines selectively antagonized CCK-induced excitation of rat hippocampal neurons have led to the hypothesis that CCK is an anxiogenic peptide. The hypothesis was supported by demonstrations that CCK-tetrapeptide (CCK4) induces panic attacks in humans. This paper reviews phases of investigations which studied the validity of CCK4 as a panicogenic agent and research strategies for the study of panic disorder using CCK4 as an investigative tool.

Topics: Amino Acid Sequence; Base Sequence; Benzodiazepines; Brain; Cerebrovascular Circulation; Cholecystokinin; Female; Hippocampus; Humans; Imipramine; Male; Molecular Sequence Data; Neurotransmitter Agents; Panic Disorder; Sincalide; Tetragastrin

Nitric oxide (NO) plays a major role in cardiopulmonary regulation as illustrated by the alterations of the NO system described in cardiopulmonary illnesses. Recent studies have found an association between panic disorder and cardiovascular death and illness, as well as pulmonary diseases. Our objective was to investigate whether pulmonary or systemic NO production was altered during induced panic attacks (PAs). We used a double-blind placebo-controlled crossover design with randomization of the order of an injection of placebo and pentagastrin, a cholecystokinin-B receptor agonist that induces PAs in healthy volunteers (HVs). A total of 17 HVs experienced a PA after pentagastrin challenge. Exhaled NO and NO metabolites were measured by chemiluminescence. During pentagastrin-induced PAs, HVs displayed significant decreases in plateau concentrations of NO exhaled, which were associated with proportional increases in minute ventilation. There were no significant changes in pulmonary or systemic NO production. These results suggest that the decrease in exhaled NO concentration observed during pentagastrin-induced PAs is related to the associated hyperventilation, rather than to any change in lung NO production. This study is the first to evaluate changes in NO measurements during acute anxiety.

Topics: Adult; Cross-Over Studies; Double-Blind Method; Fasting; Female; Food, Formulated; Humans; Lung; Male; Nitric Oxide; Panic; Panic Disorder; Peptide Fragments; Respiration; Sincalide; Time Factors

The authors report that cholecystokinin (CCK), via its subtype 2 receptor (CCK2R) located presynaptically on cerebral arteries, mediates the release of nitric oxide (NO), which induces vasodilatation. Whereas CCK octapeptide and its fragment CCK tetrapeptide (CCK-4) lack a direct effect on the smooth muscle of pial vessels, the authors showed that both CCK peptides modulate the neurogenic responses in bovine cerebral arteries. The neurogenic vasodilatation induced by CCK-4 was blocked by the CCK2R antagonist, L-365,260, and antagonized by neuronal NO synthase (nNOS) inhibitors, but was independent of the endothelium. In whole-mount arteries, CCK2Rs were detected in nerve fibers and colocalized with nNOS and synaptophysin. The findings provide, for the first time, a neural mechanism by which CCK may increase cerebral blood flow.

Topics: Animals; Cattle; Cerebral Arteries; Cholecystokinin; In Vitro Techniques; Nitric Oxide Synthase; Nitric Oxide Synthase Type I; Panic Disorder; Pia Mater; Presynaptic Terminals; Receptor, Cholecystokinin B; Receptors, Cholecystokinin; Sincalide; Tetragastrin; Tissue Distribution; Vasodilation

Older age is associated with diminished symptomatic and cardiovascular response to the panicogenic agent cholecystokinin tetrapeptide (CCK-4). We hypothesized that circulating concentrations of endogenous CCK-4 and/or CCK-8 are increased in later life, possibly due to decreased enzymatic degradation, and that this is associated with desensitization of CCK-B receptors. The study group consisted of 20 healthy subjects aged 18-30 years and 20 healthy subjects aged 65-85 years. The two groups were compared on fasting basal plasma concentrations of CCK-4, sulfated CCK-8 (CCK-8s) and nonsulfated CCK-8 (CCK-8 ns), and on binding capacity of lymphocyte CCK-B receptors. Under single-blind (to subject) conditions, subjects were then administered an intravenous bolus of placebo, followed 50 min later by an intravenous bolus of 50 micro g of CCK-4. Plasma concentrations of total CCK (CCK(T)) were measured 2 min before and 2, 5, 10, and 15 min after each injection. Compared with younger subjects, older subjects had a significantly higher basal plasma concentration of CCK-8s and significantly diminished binding capacity of CCK-B receptors. Following injection of placebo, plasma CCK(T) concentrations did not significantly change from baseline in either age group, but the elderly had significantly higher concentrations than the young at 2, 5, and 10 min. Following injection of CCK-4, the plasma concentration of CCK(T) was highest at 2 min and declined after that. The elderly had significantly higher CCK(T) concentrations (ie. a slower decline in CCK(T)) than the young at 5, 10, and 15 min. These findings are consistent with our hypothesis and suggest that age-related changes in the CCK system could contribute to the diminished panicogenic response to exogenous CCK-4 in older persons.

Topics: Adult; Aged; Aged, 80 and over; Aging; Brain; Cardiovascular Physiological Phenomena; Female; Humans; Lymphocytes; Male; Middle Aged; Panic Disorder; Receptor, Cholecystokinin B; Receptors, Cholecystokinin; Sincalide; Tetragastrin

We investigated the effects of brain cholecystokinin (CCK) receptors on the intracellular calcium concentration and protein kinase C in human T cells. CCK-4 produced a transient increase in calcium in the absence of extracellular calcium. CCK-B agonists stimulated calcium mobilization in a dose-dependent manner in T cells. CCK-B antagonists suppressed CCK-4-induced calcium mobilization more potently than CCK-A antagonist. The recovery of desensitization of the CCK-4-induced response was delayed by phosphoserine/phosphothreonine phosphatase inhibitor, calyculin A. The responsiveness to CCK-4 was also reduced by phorbol 12,13-dibutyrate (PDBu), and this effect of PDBu was abolished completely by preincubation with staurosporine. CCK-4-induced calcium mobilization was too small to attribute the desensitization to the protein kinase C transduction pathway. T cells from patients with untreated panic disorder exhibited significantly higher cholecystokinin-4-induced calcium mobilization than those from healthy controls or patients with treated panic disorder. These results suggest that cholecystokinin-B receptor function in T cells of patients with panic disorder is enhanced. Cholecystokinin-4-induced calcium mobilization in T cells may be state dependent and useful as a biological marker of panic disorder.

Topics: Adult; Alprazolam; Biomarkers; Calcium; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Nootropic Agents; Panic Disorder; Pentagastrin; Receptors, Cholecystokinin; Sincalide; T-Lymphocytes; Tetragastrin

Since cholecystokinin (CCK) is known to be anxiogenic in experimental animals and to induce panic attacks in humans, lymphocyte CCK-8 concentrations were measured in 15 patients with panic disorder and 15 age- and sex-matched healthy subjects. The patients' levels were measured again after a 30-day course of alprazolam therapy, 1.5 mg/day. The CCK-8 concentrations were significantly lower in the patients than in the control subjects and did not change after alprazolam therapy. There was no correlation between the peptide values and levels of anxiety or frequency and severity of panic attacks.

Topics: Adolescent; Adult; Alprazolam; Child; Female; Humans; Lymphocytes; Male; Panic Disorder; Severity of Illness Index; Sincalide; Tetragastrin

Cholecystokinin concentrations in the CSF of 25 patients with panic disorder and 16 normal comparison subjects were ascertained by radioimmunoassay. The patients with panic disorder had significantly lower CSF concentrations of cholecystokinin, which may reflect increased CNS cholecystokinin receptor sensitivity, reduced numbers of receptors, or a compensatory reduction in cholecystokinin octapeptide secondary to theoretically increased central cholecystokinin tetrapeptide activity.

Topics: Adolescent; Adult; Brain; Cholecystokinin; Female; Humans; Middle Aged; Panic Disorder; Receptors, Cholecystokinin; Sincalide; Tetragastrin