The atypical cannabinoid O-1602 stimulates food intake and adiposity in rats

AIMS

Cannabinoids are known to control energy homeostasis. Atypical cannabinoids produce pharmacological effects via unidentified targets. We sought to investigate whether the atypical cannabinoid O-1602 controls food intake and body weight.

METHODS

The rats were injected acutely or subchronically with O-1602, and the expression of several factors involved in adipocyte metabolism was assessed by real-time polymerase chain reaction. In vivo findings were corroborated with in vitro studies incubating 3T3-L1 adipocytes with O-1602, and measuring intracellular calcium and lipid accumulation. Finally, as some reports suggest that O-1602 is an agonist of the putative cannabinoid receptor GPR55, we tested it in mice lacking GPR55.

RESULTS

Central and peripheral administration of O-1602 acutely stimulates food intake, and chronically increases adiposity. The hyperphagic action of O-1602 is mediated by the downregulation of mRNA and protein levels of the anorexigenic neuropeptide cocaine- and amphetamine-regulated transcript. The effects on fat mass are independent of food intake, and involve a decrease in the expression of lipolytic enzymes such as hormone sensitive lipase and adipose triglyceride lipase in white adipose tissue. Consistently, in vitro data showed that O-1602 increased the levels of intracellular calcium and lipid accumulation in adipocytes. Finally, we injected O-1602 in GPR55 -/- mice and found that O-1602 was able to induce feeding behaviour in GPR55-deficient mice.

CONCLUSIONS

These findings show that O-1602 modulates food intake and adiposity independently of GPR55 receptor. Thus atypical cannabinoids may represent a novel class of molecules involved in energy balance.

Abstract 2399: Protocol for Rapid Acquisition and Interpretation of Head CT in Acute Stroke Patients Eligible for Thrombolysis

Introduction The American Heart Association’s quality improvement initiative, Target Stroke, is designed to reduce door-to-needle (DTN) times for IV r-tPA to improve patient outcomes. One of the quality indicators is time-to-CT scan and interpretation. Although, we were already meeting the recommended target, we sought to further enhance efficiency of this process in our institution.

Method We performed a retrospective chart review of patients with CT Brain Acute Stroke protocol orders from January to December 2010, which represents a one-year period after instituting changes to our CT protocol. Some of the changes included: improved emergency medical service communication, streamlined patient registration and emergency department (ED) training on time-sensitive stroke care elements. CT scan times were analyzed based on time ordered, time of completion, and radiology interpretation. Our review included DTN for IV r-tPA administration for acute stroke patients during the same time period.

Results Of the 571 acute stroke patients admitted through the ED during the study period, 12% received IV r-tPA. Of these, 79% received IV r-tPA within 60 minutes, with a mean (±SD) DTN time of 52 (±27) minutes. The relative efficiency of thrombolysis was attributed in part due to our fast-track CT head protocol process. The mean time from CT order to completion was 12 minutes and CT completion to verbal reporting to the ordering physician was 6 minutes.

Conclusion Using a multi-disciplinary approach for quality improvement in CT acquisition and interpretation times, we were able to enhance the efficiency of our overall DTN time. We believe that our protocol is easily adaptable in any Neurointensivist led stroke service, and would benefit patients on a national level to allow for more rapid administration of IV r-tPA by reducing delays in the CT head protocol. Developing a strong infrastructure that is hard-wired and part of the institutional culture resulted in decreased CT times along with 79% of stroke patients receiving r-tPA in less than 60 minutes. Are efforts have paid off; our hospital has been designated on the Target Stroke Honor Roll.

Seizures and anticonvulsants after aneurysmal subarachnoid hemorrhage

Seizures and seizure-like activity may occur in patients experiencing aneurysmal subarachnoid hemorrhage. Treatment of these events with prophylactic antiepileptic drugs remains controversial. An electronic literature search was conducted for English language articles describing the incidence and treatment of seizures after aneurysmal subarachnoid hemorrhage from 1980 to October 2010. A total of 56 articles were included in this review. Seizures often occur at the time of initial presentation or aneurysmal rebleeding before aneurysm treatment. Seizures occur in about 2% of patients after invasive aneurysm treatment, with a higher incidence after surgical clipping compared with endovascular repair. Non-convulsive seizures should be considered in patients with poor neurological status or deterioration. Seizure prophylaxis with antiepileptic drugs is controversial, with limited data available for developing recommendations. While antiepileptic drug use has been linked to worse prognosis, studies have evaluated treatment with almost exclusively phenytoin. When prophylaxis is used, 3-day treatment seems to provide similar seizure prevention with better outcome compared with longer-term treatment.

The endocannabinoid system in critical neurodevelopmental periods: sex differences and neuropsychiatric implications

This review focuses on the endocannabinoid system as a crucial player during critical periods of brain development, and how its disturbance either by early life stressful events or cannabis consumption may lead to important neuropsychiatric signs and symptoms. First we discuss the advantages and limitations of animal models within the framework of neuropsychiatric research and the crucial role of genetic and environmental factors for the establishment of vulnerable phenotypes. We are becoming aware of important sex differences that have emerged in relation to the psychobiology of cannabinoids. We will discuss sexual dimorphisms observed within the endogenous cannabinoid system, as well as those observed with exogenously administered cannabinoids. We start with how the expression of cannabinoid CB(1) receptors is regulated throughout development. Then, we discuss recent results showing how an experimental model of early maternal deprivation, which induces long-term neuropsychiatric symptoms, interacts in a sex-dependent manner with the brain endocannabinoid system during development. This is followed by a discussion of differential vulnerability to the pathological sequelae stemming from cannabinoid exposure during adolescence. Next we talk about sex differences in the interactions between cannabinoids and other drugs of abuse. Finally, we discuss the potential implications that organizational and activational actions of gonadal steroids may have in establishing and maintaining sex dependence in the neurobiological actions of cannabinoids and their interaction with stress.

Abstract P260: Mind the Time: A Quality Improvement Project to Increase the Percent of Ischemic Stroke Patients Receiving Intravenous Tissue Plasminogen Activator within 60 Minutes after Arrival at the Emergency Department

Background and Purpose: Stroke is the third leading cause of death and leading cause of long term disability in the USA. Intravenous administration of tissue plasminogen activator (t-PA) is the only FDA approved medical therapy for treatment of patients with acute ischemic stroke. It is recommended by the American Heart Association that earlier treatment with t-PA within 90 minutes of symptoms may result in a more favorable patient outcome. Initiating t-PA for ischemic stroke patients within 60 minutes after Emergency Department (ED) triage is an indicator tracked by the Get With The Guidelines database. The purpose of our project was to increase the number of ischemic stroke patients receiving t-PA within 60 minutes after triage.

Methods: The Six Sigma® process model was applied in order to develop an understanding of variations in the times of triage to initiation of IV t-PA data. We assembled a multidisciplinary team to develop and measure aspects of our current protocols, analyze data, investigate and identify the causes of delays and form action plans to enhance our new process. We tracked the patient flow from first responder contact to thrombolysis time. As a result the team acknowledged that it was imperative to impact the early recognition of ischemic stroke patients in the field. This led to local and regional stroke educational programs. Our neuroscience team of physicians and nurses proceeded to educate over 850 emergency responders.

Results: Initial analysis of the baseline data showed that 56 % (5 of 9) of the ischemic stroke patients received intravenous t-PA within 60 minutes of triage. Once the stroke code process was implemented, 79 % (15 of 19) of ischemic stroke patients received intravenous t-PA within 60 minutes after triage. These results were obtained within 9 months of process implementation. Specific process changes included the use of a standard time clock, shorter CT scan turn around times, dedicated 24/7 ED pharmacists, quicker availability of medication administration pumps and ongoing feedback by all team members on the acute stroke process.

Conclusions: The stroke team was able to identify barriers, institute process changes and ensure the implementation of change from the prehospital community setting to the acute inhospital care.

Role of estrogens on some cognition-related aspects

Two of the most studied brain areas related with learning and memory are prefrontal cortex and hippocampus. However, serious inconsistencies arise when these regions are analyzed in relation to the role of estrogens on cognitive deterioration. Some of these contradictions are reviewed in the context of the recently proposed critical period hypothesis, which takes into account the frame-time after cessation of ovarian function. Other factors related with cognition and influenced by estrogens include their role on; a) cholinergic central transmission, b) spinogenesis and synaptogenesis at hippocampus, and c) classical genomic and rapid non genomic effects. Understanding the cellular and molecular basis of these phenomena is vital for designing novel therapeutic actions applicable to human health and disease.

Polymorphisms of thymidylate synthase as prognostic factor in rectal cancer

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Background: Neoadjuvant fluoropyrimidine-based chemotherapy (ChT) plus radiotherapy (Rt) is a standard approach for locally advanced rectal cancer. Polymorphisms of thymidylate synthase (TS), the target for fluoropyrimidines, are recognized prognostic factors in colon cancer. The aim of this study was to evaluate the prognostic value of the polymorphisms of TS in rectal cancer after neoadjuvant ChT plus Rt.

Methods: We studied one-hundred consecutive patients with stage II/III rectal cancer between November 2001 and March 2009. Patients underwent surgery 6-8 weeks after neoadjuvant Rt (5,040 cGy) plus fluoropyrimidine-based ChT. DNA was extracted from paraffin embedded biopsies. TS1494del6 and 5′-28bp repeat +G/C SNP polymorphisms were determined.

Results: Sixty-seven percent were men and median age was 67 years. ypT stage was: T0 9%, T1 2%, T2 27%, T3 60% and T4 2%; 32% had locoregional adenopathies. The median follow-up was 45 months and relapse occurred in 20% of patients. Polimorphisms could be determined in 98% of pt: -6bp/-6bp 10%, - 6bp/+6bp 39%, +6bp/+6bp 51% and 2R/2R 72%, 2R/3R 21%, 3R/3R 6%. The grade of pathological tumour regression was not associated with polymorphisms. Relapses occurred in 40% of patients -6bp/-6bp, 22% of patients -6bp/+6bp and 21% of patients +6bp/+6bp. The difference in disease- free survival (DFS) between the first and the third groups was stadistically significative (p=0.049). No relation between 5′-28bp repeat +G/C SNP polymorphism and DFS was found.

Conclusions: Our data suggest that the TS1494del6 polimorphism may be an important prognosis factor in rectal cancer receiving neoadjuvant chemoradiotherapy.

No significant financial relationships to disclose.

HIV/STI co-infection among men who have sex with men in Spain

In Spain, neither the HIV nor the STI national surveillance systems collect information on HIV/STI co-infection. However, there are two networks based on HIV/STI clinics which gather this data. We describe HIV prevalence in men who have sex with men (MSM) diagnosed with infectious syphilis and/or gonorrhoea in 15 STI clinics; and concurrent diagnoses of STI in MSM newly diagnosed with HIV in 19 HIV/STI clinics. In total, 572 MSM were diagnosed with infectious syphilis and 580 with gonorrhoea during 2005-2007. HIV prevalence among syphilis and gonorrhoea cases was 29.8% and 15.2% respectively. In the multivariate analysis, HIV/syphilis co-infection was associated with being Latin American; having a history of STI; reporting exclusively anal intercourse; and having sex with casual or several types of partners. HIV and gonorrhoea co-infection was associated with age older than 45 years; having no education or only primary education completed; and having a history of STI. In total, 1,462 HIV infections were newly diagnosed among MSM during 2003-2007. Of these, 31.0% were diagnosed with other STI at the same time. Factors associated with STI co-infection among new HIV cases in MSM were being Latin American; and having sex with casual partners or with both steady and casual partners. In Spain, a considerable proportion of MSM are co-infected with HIV and STI.

Sex-dependent alterations in response to maternal deprivation in rats

We review here our latest results regarding short- and long-term effects of a neonatal maternal deprivation (MD) stress [24h at postnatal day (PND) 9] on diverse psychoneuroimmunoendocrine parameters, pointing out the existence of numerous sexual dimorphisms. Behavioral changes observed in MD animals might be at least in part attributable to neurodevelopmental effects of MD-induced elevated corticosterone levels. Our findings of short-term effects of MD on hippocampal and cerebellar neurons and glial cells appear to support this hypothesis. However, it is important to note that these cellular effects were more marked in males than in females. Moreover, in analyzing the effects of this neonatal stress on the endocannabinoid system (hippocampal endocannabinoid levels and CB1 receptors) we have also found that males were more affected by MD. Since all these sexual dimorphisms were found at an early neonatal age (PND 13), they are attributable to organizational effects of gonadal steroids. We discuss the potential implications of the elevated corticosterone and decreased leptin levels shown by MD animals in their diverse functional alterations, including the above mentioned neural effects as well as the intriguing persistent deficit in their immunological system. We also emphasize the necessity of analyzing the important influence of sex as regards the specific consequences of early life stress.

Klippel-Trenaunay syndrome and radial artery coronary graft spasm

A 75-year-old woman with known diagnosis of Klippel-Trenaunay syndrome presented with acute onset of chest pain, dyspnea and elevated cardiac enzymes. She had triple vessel coronary artery disease on subsequent coronary angiography. Given the unavailability of venous conduits secondary to lower extremity varicosities, coronary artery bypass grafting with radial and internal mammary arterial grafts was carried out. The radial artery graft went into spasm two days later and required intracoronary vasodilators to relieve the spasm. The patient remained hypotensive and finally expired.

Intra-arterial thrombolysis within three hours of stroke onset in middle cerebral artery strokes

BACKGROUND AND PURPOSE

The Prolyse in Acute Cerebral Thromboembolism II (PROACT II) trial showed improved outcomes in patients with proximal middle cerebral artery (MCA) occlusions treated with intra-arterial (IA) thrombolysis within 6 h of stroke onset. We analyzed outcomes of patients with proximal MCA occlusions treated within 3 h of stroke onset in order to determine the influence of time-to-treatment on clinical and angiographic outcomes in patients receiving IA thrombolysis.

METHODS

Thirty-five patients from three academic institutions with angiographically demonstrated proximal MCA occlusions were treated with IA thrombolytics within 3 h of stroke onset. Outcome measures included outcomes at 30-90 day follow-up, recanalization rates, incidence of symptomatic intracranial hemorrhage, and mortality in the first 90 days. The endpoints were compared to the IA treated and control groups of the PROACT II trial.

RESULTS

The median admission National Institutes of Health Stroke Scale (NIHSS) score was 16 (range 4-24). The mean time to initiation of treatment was 106 min (range 10-180 min). Sixty-six percent of patients treated, had a modified Rankin Scale (mRS) score of 2 or less at 1-3 month follow-up compared to 40% in the PROACT II trial. The recanalization rate was 77% (versus 66% in PROACT II). The symptomatic intracranial hemorrhage rate was 11% (versus 10% in PROACT II) and the mortality rate was 23% (versus 25% in PROACT II).

CONCLUSION

Time-to-treatment is just as important in IA thrombolysis as it is in IV thrombolysis, both for improving clinical outcomes and recanalization rates as well.

Oleoylethanolamide exerts partial and dose-dependent neuroprotection of substantia nigra dopamine neurons

Oleoylethanolamide (OEA), agonist of nuclear PPAR-alpha receptors and antagonist of vanilloid TRPV1 receptors, has been reported to show cytoprotective properties. In this study, OEA-induced neuroprotection has been tested in vitro and in vivo models of 6-OHDA-induced degeneration of substantia nigra dopamine neurons. First, PPAR-alpha receptors were confirmed to be located in the nigrostriatal circuit, these receptors being expressed by dopamine neurons of the substantia nigra, and intrinsic neurons and fibers bundles of the dorsal striatum. In the substantia nigra, their location was confined to the ventral tier. The in vitro study showed that 1 microM OEA exerted a significantly neuroprotective effect on cultured nigral dopamine neurons, effects following U-shaped dose-response curves. Regarding the in vivo study, rats were locally injected with OEA into the right striatum and vehicle into the left striatum 30 min before 6-OHDA-induced striatal lesion. In the short term, signals of heme oxygenase-1 (oxidation marker, 24 and 48 h post-lesion) and OX6 (reactive microglia marker, 96 h post-lesion) were found to be significantly less intense in the striatum pretreated with 5 microM OEA. In the long term (1 month), reduction in striatal TH and synaptophysin was less intense whether the right striatum was pretreated with 5 microM OEA, and nigral TH+ neuron death was significantly reduced after pretreatment with 1 and 5 microM OEA. In vivo effects also followed U-shaped dose-response curves. In conclusion, OEA shows U-shaped partial and dose-dependent neuroprotective properties both in vitro and in vivo models of substantia nigra dopamine neuron degeneration. The occurrence of U-shaped dose-response relationships normally suggests toxicity due to high drug concentration or that opposing intracellular pathways are activated by different OEA doses.

Analysis of effects of the herbal preparation Circulat on gene expression levels in cultured human fibroblasts

Circulat is a systemic standardized plant extract formulation that was developed for the prevention of severe manifestations of type 2 diabetes such as necrotic damage of the plantar foot. With the aim of revealing the molecular mechanisms underlying Circulat's biological activity, the effects of Circulat treatment on gene expression levels were examined in the cultured human fibroblast cell line MRC-5 using Affymetrix oligonucleotide microarrays. The analysis identified 187 genes, the expression levels of which underwent significant changes upon Circulat treatment. These include four genes (IL6, HMGA1, SLC19A2 and C4A) that have been implicated previously in the development of diabetes. A large proportion of the identified genes are involved in energy metabolism, protein synthesis, glucose metabolism and signaling pathways. Synergistic action of the Circulat components has also been revealed. Prospective applications of microarray analysis in phytopharmacology are discussed.

HLA genes in Cubans and the detection of Amerindian alleles

Caribbean Islands including Cuba were first inhabited by Meso-American and later by Arawak-speaking Amerindians from nowadays Venezuela. Spanish invaders brought to almost extinction to the Amerindian population after 1492. Black slaves from West Africa were taken into Cuba by Europeans. The degree of admixture among populations is approached. HLA alleles were studied by DNA techniques. Comparison with other worldwide populations (a total of 14.094 chromosomes) included genetic distances, Neighbour-Joining dendrograms, correspondence analyses and calculation of extended haplotypes. While African-European HLA features were clearly found, Amerindian HLA characteristics are less evident, indicating that Amerindian devastation was particularly marked after 1492 AD. However, typical Amerindian alleles have been found in our Cuban sample, i.e. DRB1*0403, DRB1*0404, DRB1*0407, DRB1*0411, DRB1*0802 and DRB1*1602. The presence of Amerindian alleles in Cubans [corrected] may have a bear in the making up of transplantation registries (both for bone marrow and solid organ transplantation) at the regional level and also be important for epidemiological studies of diseases linked to HLA.