Endocrinology Vol. 141, No. 7 2450-2457
Copyright © 2000 by The Endocrine Society
Immunohistochemical Localization, Biochemical Characterization, and Biological Activity of Neurotensin in the Frog Adrenal Gland1
Flavie Sicard,
Hubert Vaudry,
Benedicte Braun,
Nicolas Chartrel,
Jerome Leprince,
J. Michael Conlon and
Catherine Delarue
European Institute for Peptide Research (IFRMP 23), Laboratory of
Cellular and Molecular Neuroendocrinology, (INSERM U-413), Unité
Affiliée au Centre National de la Recherche Scientifique (UA
CNRS), University of Rouen, (F.S., H.V., B.B., N.C., J.L., C.D.), 76821
Mont-Saint-Aignan, France; and Regulatory Peptide Center, Department of
Biomedical Sciences, Creighton University Medical School (J.M.C.),
Omaha, Nebraska 68178
Address all correspondence and requests for reprints to: Dr. Hubert Vaudry, European Institute for Peptide Research (IFRMP 23), Laboratory of Cellular and Molecular Neuroendocrinology, INSERM U-413, UA CNRS, University of Rouen, 76821 Mont-Saint-Aignan, France. E-mail:
hubert.vaudry{at}univ-rouen.fr
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Abstract
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The primary structure of neurotensin has been recently determined for
the frog Rana ridibunda . In the present study, we have investigated the
distribution and biochemical characterization of neurotensin-like
immunoreactivity in the frog adrenal gland, using an antiserum directed
against the conserved C-terminal region of the peptide.
Neurotensin-like immunoreactivity was detected in two populations of
nerve fibers: numerous varicose fibers coursing between adrenal cells,
and a few processes located in the walls of blood vessels irrigating
the gland. Reversed-phase HPLC analysis of frog adrenal gland extracts
revealed the existence of a major peak of neurotensin-like
immunoreactivity that exhibited the same retention time as synthetic
frog neurotensin. The possible involvement of neurotensin in the
regulation of steroid secretion was studied in vitro
using perifused frog adrenal slices. For concentrations ranging from
10-10 to 10-5 M, synthetic frog
neurotensin increased corticosterone and aldosterone production in a
dose-dependent manner (EC50 = 1.2 x
10-9 M and 5.8 x 10-10
M, respectively). Repeated administration of neurotensin
induced a reproducible stimulation of steroid output without any
tachyphylaxis. Prolonged administration (3 h) of frog neurotensin
caused a transient increase in corticosterone and aldosterone secretion
followed by a decline of corticosteroid secretion. Neurotensin also
produced a significant stimulation of corticosteroid secretion from
dispersed frog adrenal cells. This study demonstrates that neurotensin
is located in nerve processes innervating the adrenal gland of
amphibians. The results also show that synthetic frog neurotensin
exerts a direct stimulatory effect on corticosteroid output. Taken
together, these data support the view that neurotensin, released by
nerve fibers, may act as a local regulator of corticosteroid secretion.
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Introduction
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NEUROTENSIN (NT) is a tridecapeptide that
was initially isolated from bovine hypothalami (1) and from bovine
intestine (2). The primary structure of NT has been subsequently
determined in various vertebrate species (Fig. 1
). The amino acid sequence of NT is
identical in all mammalian species yet studied except the opossum (3)
and the guinea pig (4). The sequence of NT is also known in chicken
(5), alligator (6), python (7), toad (8), and two species of frog (9, 10). Comparison of these various sequences indicates that the structure
of the carboxyterminal hexapeptide has been totally conserved, whereas
the sequence of the N-terminal heptapeptide has undergone a number of
substitutions (Fig. 1
). The NT precursor encompasses a hexapeptide
called neuromedin N (NMN), which exhibits the same C-terminal sequence
as NT (11, 12; Fig. 1
).

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Figure 1. Comparison of the primary structures of
neurotensin (NT) from different species and porcine neuromedin N (NMN).
, residue identity; pGlu, pyroglutamyl residue.
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Biochemical and immunohistochemical studies have shown that NT is
widely distributed in the brain, where it likely acts as a
neurotransmitter and/or a neuromodulator (13, 14). NT is also abundant
in the hypothalamo-pituitary complex (15) and in the gastrointestinal
tract, where it is thought to function as a neurohormone (16, 17).
Immunoreactive NT has been detected in the adrenal gland of various
species including flat snake, rat, guinea pig, rabbit, bovine, and cat
(18, 19). The distribution of NT in the adrenal gland of vertebrates
exhibits marked species differences. For instance, NT-like
immunoreactivity (NT-LI) has been detected in fibers innervating the
hamster adrenal medulla (20), in epinephrine-producing cells in guinea
pig (21) and rat (22), and in nerve fibers and norepinephrine-producing
cells in cat (23) and snake (18) adrenal glands.
Studies aimed at investigating the effect of NT on
corticosteroid secretion in mammals have led to contradictory results.
In particular, NT was found to exert either an inhibitory (24) or a
stimulatory effect (25, 26) on adrenal steroid secretion in rat. The
possible role of NT in the regulation of adrenal steroidogenesis has
never been investigated in nonmammalian vertebrates. In the present
study, we have determined the localization of neurotensin in the
adrenal gland of the frog Rana ridibunda. Biochemical
characterization of the immunoreactive peptide was performed by
combining HPLC analysis with RIA detection. Concurrently, the effect of
synthetic frog NT (f NT) on corticosteroid secretion was
studied in vitro on perifused frog adrenal slices.
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Materials and Methods
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Animals
Adult male frogs (Rana ridibunda; body weight 3040
g) originating from Albania were purchased from a commercial source
(Couétard, St. Hilaire de Riez, France). Frogs were housed for at
least 8 days in glass tanks with running water, at constant temperature
(8 C) with a 12-h dark, 12-h light regimen (lights on from 06001800
h). Animal manipulations were performed according to the
recommendations of the French Ethical Committee and under the
supervision of authorized investigators.
Reagents and test substances
Triaminobenzoic acid ethyl ester (MS 222) and
(N-[2-hydroxyethyl]
piperazine-N'-[2-ethanesulfonic acid]) (HEPES),
collagenase, protease and porcine NMN (pNMN) were purchased
from Sigma (St. Louis, MO). Bio-Gel P-2 (200400 mesh)
was from Bio-Rad Laboratories, Inc. (Richmond, CA).
(3-[125I]iodotyrosyl3)NT
(2000 Ci/mmol), [1,2,6,7-3H]corticosterone (84
Ci/mmol) and [1,2,6,7-3H]aldosterone (82
Ci/mmol) were from Amersham International (Les Ulis,
France). BSA was from Roche Molecular Biochemicals
(Mannheim, Germany). The antiserum to bovine NT was raised in rabbit
and the antibodies were directed against the conserved C-terminal
region of the peptide (8). f NT, frog pituitary
adenylate cyclase-activating polypeptide (f
PACAP), frog galanin (f GAL), and frog
calcitonin gene-related peptides (f CGRP) were
synthesized by solid phase methodology as previously described (10).
Fluorescein isothiocyanate-conjugated goat antirabbit
-globulins
(GAR-FITC) were obtained from Nordic Immunological Laboratories
(Tilburg, The Netherlands).
Immunofluorescence procedure
Frogs were anesthetized by immersion in 0.1% MS 222 for 15 min
and perfused through the aortic bulb with 20 ml 0.1 M PBS,
pH 7.3. The perfusion was carried on with 50 ml McLeans fixative
solution as previously described (27). The whole kidneys were quickly
removed and immersed in the same fixative solution for 2 h. The
tissues were rinsed overnight in PBS containing 15% sucrose and then
transferred into a 30% sucrose solution for at least 24 h.
Kidneys pieces were placed in an embedding medium (O.C.T. Tissue Tek,
Reichert Jung, Nussloch, Germany) and frozen at -80 C. Adrenal
sections were cut at 6 µm in a cryostat (Frigocut 2700, Leica Corp., Nussloch, Germany) and processed for indirect
immunofluorescence as previously described (27). Briefly, tissue
sections were incubated overnight at 4 C in a humid atmosphere with an
antiserum directed against the C-terminal fragment of NT diluted 1:400
in PBS containing 1% BSA and 0.3% Triton X-100. The sections were
rinsed in four baths of PBS and incubated for 90 min at room
temperature with GAR-FITC (1:100). Finally, the sections were rinsed in
PBS, mounted in PBS-glycerol (1:1) and coverslipped. The preparations
were examined on a Leitz Orthoplan microscope equipped
with a Vario-Orthomat photographic system (Leitz, Wetzlar,
Germany). To study the specificity of the immunoreaction, the
following controls were performed : 1) substitution of the NT antiserum
with PBS; 2) incubation with nonimmune rabbit serum instead of the
NT antiserum, and 3) preincubation of the NT antiserum (diluted 1:400)
with f NT, pNMN, f PACAP, f
GAL, f CGRP (10-6
M each).
Characterization of NT-like immunoreactivity in frog adrenal
extracts
The adrenal glands from 50 animals were quickly dissected and
kept frozen. The tissues were boiled in 0.5 M acetic acid
(10 ml) for 15 min and then homogenized in a glass Potter homogenizer.
The homogenate was centrifuged (4,000 x g; 15 min) and
the pellet was used for the measurement of protein concentrations. The
supernatant was submitted to partial purification on Sep-Pak
C18 cartridges (Waters Associates,
Milford, MA) as previously described (28). Bound material was eluted
from the cartridges with 70% (vol/vol) acetonitrile/water and
evaporated in a Speed-Vac concentrator (Savant Instruments, Hickville,
NY). The Sep-Pak-prepurified adrenal extract was redissolved in 0.1%
trifluoroacetic acid/water (1.5 ml) and injected directly onto a Vydac
218TP54 C18 reversed-phase HPLC column
equilibrated with acetonitrile/water/trifluoroacetic acid (7.0 : 92.9 :
0.1, vol/vol/vol) at a flow rate of 1 ml/min. The concentration of
acetonitrile in the eluting solvent was raised to 35% (vol/vol) over
40 min. The fractions were collected every 1 min and NT-LI was
determined by RIA. Synthetic f NT and pNMN, used
as reference peptides, were chromatographed under the same conditions
as the frog tissue extract.
The concentration of NT in the HPLC fractions was measured by RIA using
(3-[125I]iodotyrosyl3)NT
as a radioligand and the neurotensin antiserum at a dilution of
1:50,000. The IC50 of the assay was 1,000 pg/tube
and the minimum detectable amount of peptide was 150 pg/tube.
Perifusion experiments
The effect of f NT on corticosteroid secretion by the
frog adrenal gland was studied using a perifusion system technique
previously described (29). For each perifusion chamber, adrenal glands
from six frogs were dissected, sliced, and preincubated in 5 ml
Ringers solution (15 mM HEPES, 100
mM NaCl, 2 mM KCl, and 15
mM NaHCO3, 2 mg/ml glucose,
and 0.3 mg/ml BSA). The Ringers solution was gassed with
O2/CO2 (95/5), and the pH
was adjusted to 7.4. In some experiments, the effect of f NT
was studied on acutely dispersed adrenal cells. For this purpose,
adrenal cells were enzymatically dissociated using a 0.5%
collagenase-1% protease solution, as previously described (27). The
adrenal slices or the isolated cells were then transferred into a
perifusion chamber (12 adrenal glands or 750,000 cells per chamber) and
layered between several beds of Bio-Gel P-2. The adrenal slices or the
dispersed cells were continuously perifused with gassed Ringers
solution alone or with f NT freshly dissolved in Ringers
solution, at a constant flow rate (200 µl/min) and temperature (24
C). Fractions of effluent perifusate were collected every 5 min and
frozen until assay.
Corticosteroid RIA
Corticosterone and aldosterone concentrations were determined
directly, without prior extraction, in 200300 µl samples of
effluent perifusate, as previously described (27). Direct measurements
of corticosterone and aldosterone were validated by RIA quantification
of corticosteroid after HPLC analysis of the effluent perifusate (30).
The detection limits of the assays were 20 pg for corticosterone and 5
pg for aldosterone. For both assays, the intra and the interassay
coefficients of reproducibility were 3% and 6%, respectively.
Calculations
Each perifusion pattern was established as the mean profile of
corticosteroid production (± SEM) calculated over at least
three independent experiments. The levels of corticosterone and
aldosterone released were expressed as percentages of the basal values,
calculated as the mean of eight samples (40 min), taken just before the
infusion of the first pulse of f NT. ANOVA was performed to
assess the dose-related stimulation induced by f NT. Paired
t test was used after regression analysis for comparison
between values.
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Results
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Immunohistochemical localization of NT in the frog adrenal
gland
Immunofluorescence labeling of frog adrenal slices with an
antiserum against NT revealed the presence of numerous
immunopositive varicose nerve fibers coursing in the adrenal
parenchyma (Fig. 2A
). A few
immunoreactive fibers were also observed in the walls of the blood
vessels irrigating the adrenal gland (Fig. 2B
). Preincubation of the NT
antiserum with synthetic f NT or pNMN
(10-6 M) resulted in
complete extinction of the immunoreaction (Fig. 2C
).In contrast, the
immunofluorescence labeling was not affected after preincubation of the
NT antiserum with 10-6 M
f PACAP, f GAL, and f CGRP (data not
shown). No fluorescence was observed when the NT antiserum was replaced
with either nonimmune rabbit serum or PBS (data not shown).

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Figure 2. A and B, Immunofluorescence photomicrographs of
frog adrenal slices labeled with an antiserum directed against the
N-terminal portion of porcine neurotensin, showing the presence of
varicose nerve fibers coursing in the adrenal parenchyma (A) and a few
fibers within the walls of blood vessels (arrow)
irrigating the gland (B). C, Control section incubated with NT
antiserum preabsorbed with 10-6 M
synthetic frog neurotensin. Scale bar, 50 µm.
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Characterization of neurotensin-like immunoreactivity
The elution profile of a frog adrenal extract from the
semipreparative Vydac C18 column is shown in Fig. 3
. NT-like immunoreactivity eluted as a
major peak that exhibited the same retention time as synthetic
f NT. In contrast, no immunoreactive material co-eluted with
synthetic pNMN.

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Figure 3. Reversed-phase HPLC analysis of a frog adrenal
gland extract. Quantification of neurotensin in the elution fractions
was performed by RIA using frog neurotensin (f
NT) as a reference standard. The dashed line shows the
concentration of acetonitrile in the eluting solvent. The retention
times of synthetic f NT and porcine neuromedin N
(pNMN) are indicated by arrows.
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Effect of neurotensin on corticosteroid secretion
The effects of f NT on corticosteroid secretion by
perifused frog adrenal slices are illustrated in Fig. 4
. A 20-min pulse of
f NT induced a transient increase in corticosterone (Fig. 4A
) and aldosterone (Fig. 4B
) output. Administration of graded doses of
f NT (10-12 to
10-5 M) induced a
dose-dependent stimulation of corticosterone and aldosterone
[regression analysis, F (1, 30) = 78.39; P <
0.001 and F (1, 38) = 68.48; P < 0.001,
respectively] (Fig. 4C
). Half-maximum stimulation
(EC50) of corticosterone and aldosterone was
observed at concentrations of 1.2 x 10-9
M and 5.8 x 10-10
M, respectively, and maximum stimulation occurred
at a concentration of 10-6
M.

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Figure 4. A and B, Effect of three graded concentrations of
synthetic frog neurotensin (f NT) on the secretion of
corticosterone (A) and aldosterone (B) by perifused frog adrenal
slices. After a 120-min equilibration period, f NT was
administered for 20 min (arrows), and the tissue was
allowed to stabilize for another 90-min period before the next pulse of
f NT was applied. The profiles represent the mean (± SEM) secretion pattern of three independent
perifusion experiments. Each point is the mean
corticosteroid production (expressed as a percentage of spontaneous
steroid output) of eight consecutive fractions (40 min; open
symbols) just preceding the infusion of f NT. C,
Semilogarithmic plot comparing the effect of graded concentrations of
f NT on corticosterone () and aldosterone ( )
secretion. Experimental values were calculated from data similar to
those shown in A and B. Each point represents the
maximum amplitude of stimulation of corticosteroid secretion induced by
f NT (peak height) compared with the mean corticosteroid
levels observed just before the infusion of each dose of secretagogue
(100% basal level). The mean basal levels of corticosterone and
aldosterone secretion in these experiments were 0.73 + 0.1 and 1.24 +
0.36 ng/fraction, respectively.
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Infusion of three equimolar doses of f NT
(10-6 M; 20 min) induced a
reproducible stimulation of corticosterone (Fig. 5A
) and aldosterone (Fig. 5B
) secretion
without apparent tachyphylaxis. Figure 6
shows the kinetics of the response of adrenal glands during a 3-h
administration of f NT (10-6
M). The perifusion medium containing the
neuropeptide was renewed every 20 min to minimize degradation of the
diluted peptide. Prolonged exposure to f NT induced a
transient stimulation of corticosterone (Fig. 6A
) and aldosterone (Fig. 6B
) secretion which reached a maximum within 40 min. Thereafter,
despite continued perifusion with f NT, corticosteroid
release declined, and two rebounds of the secretory activity were
observed at approximately 60-min intervals.

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Figure 5. Effect of three equimolar concentrations of
synthetic frog neurotensin (f NT ; 10-6
M; 20 min each) on the secretion of corticosterone (A) and
aldosterone (B) by perifused frog adrenal slices. The pulses of
f NT (arrows) were administered at 90-min
intervals. The mean basal levels of corticosterone and aldosterone
secretion in these experiments were 0.97 ± 0.23 and 0.50 ±
0.01 ng/fraction, respectively. See legend to Fig. 4 for other
designations.
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Figure 6. Effect of prolonged infusion of synthetic frog
neurotensin (f NT ; 10-6 M;
3 h) on the secretion of corticosterone (A) and aldosterone (B) by
perifused frog adrenal slices. The f NT solution was
administered for 3 h (arrows) and the solution was
renewed every 20 min (arrowheads) to minimize
degradation of the peptide in the perifusion medium. The mean basal
levels of corticosterone and aldosterone secretion in these experiments
were 1.45 ± 0.23 and 0.32 ± 0.04 ng/fraction, respectively.
See legend to Fig. 4 for other designations.
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The ability of f NT to stimulate steroid secretion from
enzymatically dispersed adrenal cells was also tested (Fig. 7
). Administration of f NT
(10-6 M) for 20 min
elicited a rapid and transient stimulation of corticosterone (Fig. 7A
)
and aldosterone (Fig. 7B
) release. Application of a second dose of
f NT (10-6 M),
after a resting period of 120 min, induced a similar stimulation of
steroid secretion without any desensitization phenomenon.

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Figure 7. Effect of two equimolar concentrations of
synthetic frog neurotensin (f NT ; 10-6
M) on the secretion of corticosterone (A) and aldosterone
(B) by perifused dispersed frog adrenal cells. The pulses of
f NT were administered for 20 min
(arrows) at 120-min interval. The mean basal levels of
corticosterone and aldosterone in these experiments were 660 ± 48
and 6.36 ± 0.72 pg/fraction. See legend to Fig. 4 for other
designations.
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Discussion
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The present study has demonstrated the occurrence of a network of
NT-containing fibers in the adrenal gland of the frog Rana
ridibunda. This study has also shown that NT stimulates steroid
secretion by dispersed frog adrenocortical cells.
Previous studies have shown that the frog adrenal gland is richly
innervated by both extrinsic and intrinsic neurons (31). Extrinsic
fibers originate from multiple types of nerves including the vagus
nerve, the splanchnic nerve, sensitive nerves from dorsal root ganglia,
and nerve branches associated with the walls of blood vessels.
Intrinsic fibers mainly originate from subcapsular plexuses (32). Two
types of NT-immunoreactive fibers were observed in the frog adrenal
tissue, i.e. varicose fibers running between adrenal cells
and a few fibers coursing along the walls of blood vessels. Several
other regulatory peptides have previously been identified in fibers
innervating the frog adrenal parenchyma : atrial natriuretic factor
(33), tachykinins (32), PACAP (34), GAL (29), and CGRP (27). Most of
these neuropeptides are generally found in fibers running between
adrenal cells and along the walls of blood vessels irrigating the gland
(27, 32, 34). The origin of these fibers, including NT-containing
fibers is currently unknown. The occurrence of NT has previously been
detected in the adrenal gland of various vertebrates. Depending on the
species, NT is contained either in nerve fibers only (20), in
chromaffin cells only (21, 22) or in both nerve fibers and chromaffin
cells (18, 23).
The antiserum used in the present study was directed against the
C-terminal region of NT (8). As expected, preincubation of the NT
antiserum with pNMN, a peptide that possesses the same
C-terminal sequence as NT (Fig. 1
), completely abolished the
immunofluorescence labeling. To determine whether the immunostained
fibers innervating the frog adrenal gland contained NT, NMN, or both,
we have characterized the immunoreactive peptide(s) by reversed phase
HPLC analysis combined with RIA detection. The observation that a major
immunoreactive peak coeluted with synthetic f NT indicates
that the immunolabeled nerve fibers contain a mature form of NT.
Previous studies have shown that, in rat, NT can regulate the activity
of the hypothalamo-pituitary-adrenal axis at different levels. In the
paraventricular nucleus, NT stimulates the release of CRH (35, 36). At
the pituitary level, NT triggers ACTH secretion (37, 38, 39). In the
adrenal medulla, which contains a local CRH/ACTH system (40), NT can
stimulate the release of both peptides (41). The occurrence of
NT-immunoreactive fibers in the frog adrenal gland led us to examine
the possible effect of the neuropeptide on corticosteroid secretion.
The results presented herein show that synthetic f NT
stimulates corticosterone and aldosterone output by perifused frog
adrenal fragments in a dose-dependent manner.
In contrast to the mammalian adrenal gland, which is organized in
cortical and medullary zones, the adrenal gland of amphibians is
composed of adrenocortical cells tightly intermingled with chromaffin
cells (42, 43). This peculiar anatomical organization favors paracrine
communication between the two categories of cells (44). In fact, there
is now clear evidence that frog chromaffin cells contain various
biogenic amines (45, 46) and neuropeptides (47, 48, 49) that can modulate
the secretion of corticosteroids. It was thus conceivable that
f NT could stimulate the activity of adrenocortical cells
indirectly, via an action on the release of regulatory factors from
chromaffin cells. To determine whether NT acted directly on
adrenocortical cells to enhance steroid secretion, we investigated the
action of the peptide on enzymatically dispersed adrenal cells, a
preparation in which the connections between the cells are disrupted.
The fact that NT could stimulate corticosteroid secretion from isolated
adrenal cells indicated that the effect of the peptide can be ascribed
to a direct action on adrenocortical cells. However, nothing is known
concerning the type of receptor mediating the effect of NT on
corticosteroid production.
In mammals, studies designed to demonstrate a direct effect of NT on
steroidogenesis have led to contradictory results. In vivo
experiments have shown opposite effects of NT, either stimulatory in
rabbit (50) or inhibitory in rat (51) on adrenal steroid secretion.
Studies using in situ perfused rat adrenal glands indicate
that NT causes a moderate increase in both corticosterone and
aldosterone output (25, 26). In contrast, NT exerts an inhibitory
effect on basal corticosterone secretion from dispersed
fasciculata-reticularis cells (24) and on angiotensin II- or
K+-stimulated aldosterone production from
dispersed glomerulosa cells (52). Whether these divergent results can
be ascribed to the different methodological approaches used, or
actually reflect authentic species-specific responses, remains to be
established.
The perifusion model provides valuable information regarding the
kinetics of the response of the glands to secretagogues. Using this
technique, we observed that prolonged administration of f NT
(during 3 h) causes a rapid increase in steroid production which
peaked at 30 min, followed by a rapid decline toward the baseline
value. The decay of the response cannot be ascribed to degradation of
f NT because the solution of the peptide was renewed every
20 min to avoid peptide damage. These data indicate that NT induced
rapid desensitization of its own receptors. The occurrence of two
rebounds during the sustained infusion of f NT suggests that
the receptors are first internalized and then recycled at the cell
surface. This desensitization phenomenon appears to be reversible as
administration of repeated pulses of f NT at 90-min
intervals induced a reproducible stimulation of corticosteroid
secretion. A similar desensitization process has been described for
several other corticotropic peptides including CGRP (27), ranakinin
(32), and endothelins (53).
In conclusion, our results indicate that the adrenal gland of the frog
Rana ridibunda is innervated by a network of
neurotensinergic fibers. The immunoreactive peptide exhibits exactly
the same retention time as synthetic f NT during HPLC
analysis. Synthetic f NT directly stimulates in
vitro corticosteroid secretion by perifused frog adrenal glands.
These data support the view that endogenous NT, released by nerve
endings in the vicinity of adrenocortical cells, can act locally as a
modulator of corticosteroid secretion (54).
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Acknowledgments
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We thank Dr. A. Fournier (INRS-Institut Armand Frappier,
Montréal, Canada) for the generous gift of synthetic f
PACAP, f galanin and f CGRP and Dr. D.
Duterte-Boucher (CNRS UPRES-A 6036, Rouen, France) for valuable advice
on statistical analysis.
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Footnotes
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1 This work was supported by grants from INSERM (U-413), the National
Science Foundation (IBN-980 6997), and the Conseil Régional de
Haute-Normandie. 
Received December 10, 1999.
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