A New Specific Histamine-H2-Receptor Agonist R L Mcisaac,* B J JOHNSTON, and L P FIELDING from the Academic Surgical Unit, St
Total Page:16
File Type:pdf, Size:1020Kb
Gut: first published as 10.1136/gut.22.7.529 on 1 July 1981. Downloaded from Gut, 1981. 22, 529-533 Gastric mucosal blood flow and acid secretory changes in man with impromidine: a new specific histamine-H2-receptor agonist R L McISAAC,* B J JOHNSTON, AND L P FIELDING From The Academic Surgical Unit, St. Mary's Hospital Medical School, London SUMMARY The effect of impromidine, a new histamine-H2-receptor agonist, on gastric mucosal blood flow (neutral red clearance) and acid secretion was studied in nine volunteers. Impromidine stimulated a dose-dependent increase in neutral red clearance and acid secretion. Simultaneous cimetidine in three doses caused a parallel shift to the right for both acid output and clearance with unchanged maxima compatible with simple surmountable antagonism. There were small cardio- vascular changes: an increased heart rate with a decreased diastolic pressure during infusion of impromidine. These changes were antagonised by cimetidine. The involvement of histamine in the control of was approved by the local ethical committee and gastric acid secretion was supported by the informed written consent was obtained from each discovery of the specific inhibitors of H2-receptors volunteer in accordance with the Declaration of on the parietal cell.' Studies in animals have also Helsinki. Gastric mucosal blood flow was shown that the gastric vasculature is sensitive to measured by the neutral red clearance technique.8 http://gut.bmj.com/ histamine through a combination of Hl- and H2- receptors although with different relative contri- GASTRIC FUNCTION TESTS AND butions.2 3In man histamine stimulates a dose- E S T I M A T I ON O F M U C O S A L B L OO1) dependent increase in both acid secretion and F L O W mucosal blood flow but the blood flow component After an overnight fast each volunteer was is relatively resistant to inhibition by cimetidine.4 intubated with a double lumen nasogastric tube A specific histamine-H,-receptor agonist would be (Sherwood 12-14 French gauge), the position on September 26, 2021 by guest. Protected copyright. of value in the investigation of the role of being determined by a water recovery test.' histamine in the control of gastric acid secretion Overnight secretion was aspirated and discarded. and blood flow in both healthy man and in A 15 minute basal sample was collected as a patients with peptic ulcer disease. Recent studies reference for neutral red standards (see below). have indicated that impromidine is a potent Winged needles were inserted into a vein in each stimulant of gastric secretion in man with forearm; one for drug infusion and the other for relatively fewer side-effects than histamine." 6 blood sampling. A 15 ml venous sample was taken The purpose of the present investigation was to for processing of neutral red standards in whole study the stimulation of acid secretion and blood blood and then a loading dose of neutral red (NR, flow in healthy volunteers using increasing doses 125 gg/kg) was given followed by a constant in- of impromidine and to compare these effects with fusion (250 ,g/kg per h). Blood samples were taken our previous results using histamine.4 at 15 minute intervals for 45 minutes and then at 30 minute intervals thereafter. After a basal Methods period (45 minutes) gastric acid secretion was stimulated by an infusion of impromidine. Dose- In the study group there were nine volunteers, response curves were constructed on two separate mean age 22 years (range 21-26 years). The study days at least one week apart. On day one, *Address for correspondence: Dr R L Mcisaac, Academic Surgical impromidine was given in four sequential doses Unit, St. Mary's Hospital Medical School, London W2 1 PG. (125, 2.5, 5*0, and 10 ig/kg per h) each for one Received for publication 11 December 1980 hour (Fig. 1). Two volunteers received impromi- 529 Gut: first published as 10.1136/gut.22.7.529 on 1 July 1981. Downloaded from 53 Mc!saac, Johnston, and Fielding 600 60 .E a-- mm -- - - - - - m- - - - -- -------- . *~ f E- 500 00. 50 T ,o n =2) E 0 400 40 0 1 z E (n-2) 0 300 I- ° 30 U 200 /1 0 OK I- 20 t z T11T2;(=s 100 1 i itn=S) 10 [ -L 'F , I 0 -," . 0 B 1.25 2.5 5.0 10 20 40 80 B 1.25 2.5 5.0 10 20 40 80 Impromidine pjg/kg.h Impromidine pg/kg-h Fig. I Mean (: S E M ) a(id output ini volunteers durinig infiision ol graded doses of inpromidine ( 125-20 Fig. 2 Mean ( t S E M) neutral red clearance in the pg/kgper h). Baval secretion (B) 5444;13 3 pmpioll/nin has same volunteers as in Fig. 1. Basal NRC (B) 20 :t4*3 been subtracted. Tte theoretical maximunm was mIl/min has been subtracted. The calculated maximum calculated to be 530 4 -605 pmol/min and is shown by was 56 1 9-6 ml/min and is shown by the dotted line. the dotted line. (ED,,) and an inhibitory dose,,, (ID,,,) for cime- dine in the dose range 2-5-20 gg/kg per h. On day tidine. Standard errors for these calculations were two, the test was repeated with cimetidine (0 25, also derived from the least squares fit. 0.5, or 1[0 mg/kg) which was randomised among Blood pressure and heart rate were measured three groups of the volunteers (three, three, and electronically by inflating a cuff around the arm two volunteers respectively). The infusion of over the brachial artery (Digital 8000, Ueda cimetidine was begun 30 minutes before Electronics Ltd) and changes were analysed by impromidine (dose-range 5-80 gg/kg per h). means of Student's paired t test. http://gut.bmj.com/ Gastric juice was collected every 10 minutes. The volume of the aspirate was recorded and the Results concentration of H' measured by titration of 3 ml gastric juice to pH 7.0 with 0 1M NaOH using an I M P R O M I I) I N E 1) 0 S E - R E S P O N S E automatic titrator (Radiometer, Copenhagen). S T U I) I E S Acid secretion was expressed as gmol H+/min. Impromidine (1-25-10 Mg/kg per h) caused a NR concentration was determined in 3 ml blood dcse-dependent increase in both acid output and on September 26, 2021 by guest. Protected copyright. and 1 ml gastric juice after alkalinisation and NRC (Figs t and 2). In the two volunteers who extraction into diethyl ether (10 ml Analar grade, received an infusion of impromidine 20 ag/kg BDH Ltd) with further extraction into 0-1M per h, this dose caused a small increase in acid HCI. The aqueous layer was read in a spectro- output above that induced by 10 1Mg/kg per h, photometer (Pye-Unicam SP 1800) at 540 nm but NRC at the high dose began to decrease. against serial standards of NR made up in whole The best fit curves for these data give the follow- blood or gastric juice and processed along with ing calculated values (omitting the data for 20 the samples. Neutral red clearance (NRC) in Mg/kg per h). Maximal acid ouput was 530+60.5 mI/min was calculated from the equation NCR= (SEM) gumol H+/min and the ED>,, 2.3±0.26 (NR). xxV/(NR)h, where (NR). and (NR)b are M£g/kg per h. For NRC the calculated maximal gastric and whole blood concentrations of NR rate was 56+9-6 ml/min and the ED5,,, 1l7+0.34 and V is the volume of gastric aspirate in ml/min. Mg/kg per h. Dose-response curves were constructed using the mean of the last two 10 minute periods at EFFECT OF CIM ETI DINE ON each dose level of impromidine. The data were I M P R 0 M II) I N E- I N I) L' C E I) A C II) used to fit non-linear curves by the method of SECRETION AND NRC: COMk1PARISON least squares"' so as to calculate a best fit maxi- WITH PREVIOUS H ISTAMI NE DATA mum for acid secretion and NCR as well as In a previous study. cimetidine (06 mg/kg per obtaining calculated values for the dose of h) reduced acid secretion induced by histanmine imnromidine lroducing a half-maximal response but had no effect on neutral red clearance.4 Gut: first published as 10.1136/gut.22.7.529 on 1 July 1981. Downloaded from Impromidine and gastric blood flow 531 600 150 ._E E impromidline -. 500 r2= .57 0 E Y -.14X * 23 400 100 [ C * E 30 : ' * ' A A 0. E 300 1, A U C A CA a A C &* ,AA z 0 200 so g, 6A AA * histamine A An, #A A .61 AAA r2yy~ .1ox - 1g AA A 100 A A 0 0 1.25 2.5 5.0 10 20 40 500 1000 Impromidine pg/kg h ACID output pmol/min Fig. 3 The effect or cimetidine given in three doses Fig. 4 Comparison of the acid secretory and NRC 025(E),05( A), and 1-0( *) mg/kgperh on impromidine- responses during infusion ofgraded doses ofhistamine induced gastric acid secretion. The calculated ID50 for (A) and impromidine (*). The calculated regression cimetidine inhibition was 0-10 0014 mg/kg per h. line for histamine was Y=0 IOX - 19, r2=0-61, n=38 (p < 0001) andfor impromidine Y=0-14X -23, In the present study cimetidine caused a parallel, r2-0-57, n =44 (p <0O00J).