Thyrotropin-releasing hormone (TRH) stimulates pituitary thyrotropin synthesis and release and also regulates autonomic nervous system functions by acting as a neuromodulator and neurotransmitter. In experimental animals a stimulation of ventilation by thyrotropin-releasing hormone was shown when applied at central nervous system sites that affect respiratory motor output. It was the goal of our study to investigate the respiratory properties of thyrotropin-releasing hormone on basal and stimulated (i.e. CO2-rebreathing) conditions following systemic thyrotropin-releasing hormone application in healthy humans. Thyrotropin-releasing hormone (200 micrograms, 400 micrograms intravenous) initiated a rapid short lasting rise of minute volume, ventilatory air-flow and alveolar oxygen tension under steady state breathing (P less than 0.001). Breathing frequency was less affected, heart rate rose concomitantly (P less than 0.001). While breathing with increasing concentrations of carbon dioxide, minute volume was higher under thyrotropin-releasing hormone than under placebo alone. Further effects (e.g. nausea, dizziness, palpitations) mostly appeared later than respiratory changes and thus may not be responsible for their initiation. Our findings prove systemic thyrotropin-releasing hormone to be a strong respiratory stimulant in man. Response in respiratory output was also accompanied by central nervous system-effects (e.g. dizziness, restlessness, augmented vigilance). The mode of thyrotropin-releasing hormone effects on respiration after peripheral administration is still speculative. An augmented sympathetic output or a direct receptor mediated action at central nervous system sites may be responsible, while a peripheral effect cannot be excluded.

To examine whether bradykinin generated by the activation of the contact phase of blood coagulation is involved in the pathogenesis of edema occurring after acute exposure to high altitude, 15 mountaineers were examined at 490 m and 1, 3, and 5 days after arrival at 4,559 m. The clotting activity levels of factor XII, factor XI, plasma prekallikrein, and high-molecular-weight kininogen (HMWK) were measured, and plasma kallikrein-induced proteolytic cleavage of HMWK was assessed by ligand blotting by use of radiolabeled factor XI. After an ascent on foot from 1,170 to 4,559 m in 3 days, three subjects developed high-altitude pulmonary edema, and four subjects presented facial edema. There was no evidence for activation of the contact system in any subject as demonstrated by the lack of proteolytic cleavage of HMWK at high altitude. The absence of contact system activation was further supported by stable plasma levels of the individual factors of contact activation. Therefore, we conclude that bradykinin generated by plasma kallikrein-induced cleavage of HMWK is not involved in the pathogenesis of edema due to acute exposure to high altitude.

Human CRH (hCRH), which acts as a major neuroregulator within the hypothalamic-pituitary-adrenal axis, is also a respiratory stimulant. The broad distribution of CRH receptors in brain areas involved in respiratory regulation is consistent with this finding. This study was designed to investigate whether ACTH or cortisol mediates the respiratory stimulation effect of CRH. Bolus injection of 100 micrograms hCRH induced significant respiratory stimulation in all 10 normal subjects studied. hCRH given after the administration of 2 mg dexamethasone, which greatly reduced plasma cortisol levels, had the same respiratory effect on respiration. Thus, increase in plasma ACTH and cortisol concentrations are probably not involved in the respiratory analeptic effect of CRH.

Following an intravenous injection of 100 micrograms hCRH a facial flushing can frequently be observed along with respiratory stimulation. Both effects can be mediated by a common transmitter. Serotonin is well known to produce facial flush as well as to modulate respiration. In order to clarify is serotonin is a common mediator for facial flush and respiratory stimulation after i.v. application of hCRH, we studied the time course of facial skin temperatures and respiratory stimulation after intravenous injection of 100 micrograms hCRH in 10 healthy subjects. Furthermore, we measured respiratory stimulation after i.v. administration of 100 micrograms hCRH in 10 healthy subjects pretreated with the serotonin antagonist cyproheptadine. Facial skin temperatures reached maximum levels 9 min after CRH administration and remained raised for more than 60 min. Respiratory stimulation occurred within the first minute after CRH administration and reached a maximum during the second minute, but could no longer be observed after 10 min. Serum serotonin levels did not change after CRH stimulation in doses up to 3 micrograms/kg body weight), and cyproheptadine did not abolish the respiratory stimulation effect of hCRH in a dosage sufficient to suppress CRH.-induced cortisol secretion.

The respiratory stimulant properties of iv injections of 33, 67, and 100 micrograms synthetic human corticotropin-releasing hormone (hCRH) were studied in 12 normal men in a single blind, placebo-controlled trial. All doses of hCRH induced a respiratory stimulation in every subject, and the stimulation was dose dependent. The onset of respiratory stimulation occurred within 15-30 sec after hCRH infusion was started. Initially, there was an increase in tidal volume (VT), followed by an increase in respiratory rate. The maximum minute ventilation (VE) occurred 60-120 sec after starting the injection. The 33-micrograms hCRH dose induced a 35% increase in VE from 6.3 +/- 0.6 (+/- SD) to 9.7 +/- 1.3 liters/min (P less than 0.001) due to a marked increase in VT from 531 +/- 105 to 688 +/- 142 ml (P less than 0.001) and only a slight increase in the respiratory rate from 12.4 +/- 3.0 to 14.3 +/- 3.1 breaths/min (P less than 0.001); heart rate was not altered at this dose. The 100-micrograms hCRH dose increased the VE by 81% to 11.5 +/- 1.5 liters/min, mainly due to an increase in VT. VE was elevated for 5.8, 7.2, or 8.3 min after the end of injection of the three hCRH doses. Increases in VE markedly lowered the end-tidal partial pressure of carbon dioxide (P(ET)CO2; nearly identical with the arterial PCO2 in normal subjects). hCRH (33 micrograms) lowered P(ET)CO2 from 40.3 +/- 1.2 to 37.2 +/- 1.9 mm Hg (P less than 0.001), and 100 micrograms hCRH lowered P(ET)CO2 to 33.4 +/- 1.2 mm Hg. End-tidal partial pressure of oxygen, i.e. the most sensitive parameter for the duration of action of respiratory stimulation, was elevated for 8.5, 10.2, and 14 min after injection of 33, 67, or 100 micrograms hCRH. Sixty-seven micrograms of hCRH was the lowest effective dose for an increase in the heart rate (from 66.4 to 79.0 beats/min; P less than 0.001), and 100 micrograms hCRH markedly increased the heart rate by 20% to a peak value of 83.5 beats/min. Heart rate increased within 90 sec and returned to the control value after 5-10 min. These data suggest that hCRH is a rapidly acting, dose-dependent, and potent respiratory stimulant. Since this hyperventilatory effect of hCRH occurred in every subject after all doses tested, respiratory stimulation may represent specific biological activity of CRH rather than a side-effect.