Phytanic acid activates the peroxisome proliferator-activated receptor alpha (PPARalpha) in sterol carrier protein 2-/ sterol carrier protein x-deficient mice

We showed recently that a targeted null mutation in the murine sterol carrier protein 2-/sterol carrier protein x-gene (Scp2) leads to defective peroxisomal catabolism of 3,7,11, 15-tetramethylhexadecanoic acid (phytanic acid), peroxisome proliferation, hypolipidemia, and enhanced hepatic expression of several genes that have been demonstrated to be transcriptionally regulated by the peroxisome proliferator-activated receptor alpha (PPARalpha). As a broad range of fatty acids activates PPARalpha in vitro, we examined whether the latter effects could be because of phytanic acid-induced activation of this transcription factor. Dietary phytol supplementation was used to modulate the concentration of phytanic acid in C57Bl/6 and Scp2 (-/-) mice. We found that the serum concentrations of phytanic acid correlated well with the expression of genes encoding peroxisomal beta-oxidation enzymes and liver fatty acid-binding protein, which have all been demonstrated to contain functionally active peroxisome proliferator response elements in their promoter regions. In accordance with these findings, a stimulating effect on acyl-CoA oxidase gene expression was also observed after incubation of the rat hepatoma cell line MH1C1 with phytanic acid. Moreover, reporter gene studies revealed that phytanic acid induces the expression of a peroxisome proliferator response element-driven chloramphenicol transferase reporter gene comparable with strong peroxisome proliferators. In addition, the ability of phytanic acid to act as an inductor of PPARalpha-dependent gene expression corresponded with high affinity binding of this dietary branched chain fatty acid to recombinant PPARalpha. We conclude that phytanic acid can be considered as a bona fide physiological ligand of murine PPARalpha.

Controlled comparison of RO 11-1163 (moclobemide) and placebo in the treatment of depression

Moclobemide was compared to placebo in two parallel groups of depressed patients, in a multicenter randomized, double-blind study of six weeks treatment duration. Forty seven patients participated in the study: 23 received moclobemide (flexible dose 300-600 mg/day) and 24 placebo. They were evaluated weekly for efficacy and tolerability. Moclobemide was more efficacious than placebo as judged by analysis on the total score on the Hamilton depression scale (p < 0.05) and by the overall assessment of efficacy (p < 0.01). Moclobemide was also more effective than placebo in the subgroup with neurotic depression (p < 0.05). In addition, the number of patients prematurely terminating treatment for inefficacy, was higher in the placebo than in the moclobemide group (12 versus 2, p < 0.01). The number and the severity of side-effects tended to be slightly greater in the moclobemide than in the placebo group, but this did not reach a level of significance. Cardiovascular tolerability was good in both treatment groups. No hypertensive crisis was reported. Hematology, clinical chemistry and urine analysis were not affected by the treatment in any clinically significant fashion.

Moclobemide versus placebo in the treatment of depression: a multicentre study in Belgium

Moclobemide was compared with placebo for antidepressant activity, tolerance and safety in 2 parallel groups of 23 and 24 depressed patients. At the end of treatment (4 weeks or longer), 9 patients on moclobemide (41%) showed an improvement greater than or equal to 50% on the Hamilton Rating Scale for Depression, compared with only 4 (17%) of those on placebo. The overall assessment of efficacy was significantly better for moclobemide (good or very good results in 50% of patients) than for placebo (80% poor results). Moclobemide was well or very well tolerated by 85% of patients and placebo by 100%. Moclobemide was thus shown to be clearly more effective than placebo and only slightly less well tolerated.

Moclobemide versus amitriptyline in the treatment of depression: two small double-blind multicentre studies in Belgium

Moclobemide was compared with amitriptyline for antidepressant efficacy, safety and tolerance. Two studies were conducted, both over at least 4 weeks; in the first, 8 patients were given moclobemide in doses ranging from 300 to 328 mg, and 9 patients amitriptyline in doses of 75 to 96 mg; in the second, the numbers were 13 on moclobemide and 14 on amitriptyline, and the mean doses were 294-408 mg and 95-129 mg respectively. Both studies showed the 2 treatments to be equally effective, and there were no significant differences at any point. Moclobemide appeared slightly more effective and slightly better tolerated than amitriptyline, but the numbers were too small for any valid conclusion.

Moclobemide versus clomipramine in the treatment of depression: a double-blind multicentre study in Belgium

Moclobemide and clomipramine were compared for efficacy, tolerance and safety in 63 mixed endogenous and nonendogenous depressed patients. Treatment was given for at least 4 weeks in a double-blind, randomized, parallel-group design. The mean Hamilton Rating Scale for Depression score decreased gradually during treatment with no differences between groups. Two patients on clomipramine and none on moclobemide were withdrawn for lack of efficacy, and poor tolerance caused 3 patients on moclobemide and 7 on clomipramine to stop treatment prematurely. Patients with endogenous depression responded better to clomipramine, whereas nonendogenous disorders did better on moclobemide. Adverse events were more frequent in the clomipramine group and more of these were severe or very severe than for moclobemide. Thus, although no significant difference in efficacy was seen, moclobemide appeared to be tolerated better than clomipramine. The numbers were small, however, and many patients received concomitant medication, and the results are therefore difficult to interpret.

Comparing the effects of pimozide and placebo in a single case experiment

A single case experiment as suggested by Edgington (1980) was carried out to answer the difficult question whether the continuation of treatment with neuroleptics was appropriate for a patient who still suffered from paranoia after inpatient treatment and continuous two-year administration of neuroleptics thereafter. A 24-weeks' experiment was arranged with the patient which was carried out under double-blind conditions. The experiment was planned in a way that it could be analysed with the help of a randomisation test. Physician's and patient's global ratings concerning the patient's condition and drug side effects were assessed weekly. In addition, psychopathological symptoms were measured by the Simpson-scale. Every week, the patient described her emotional state with the help of the Adjective Check List by Janke. Following the results of the experiment, medication was discontinued. This resulted in a distinct reduction of her complaints during a follow-up period of now 2 years. Although conducting single case experiments seems to be desirable for adequate problems, there are only few possibilities for practical application because of difficulties with planning and execution.

Single case experiments in psychopharmacological trials

Single case experiments have been used to make pharmacotherapeutic decision making more objective. 4 single case experiments are presented. In the case of 3 patients the question was whether flunitrazepam (Rohypnol) should be administered. In the 4th patient the issue was whether self-administration of Limbitrol (amitriptyline + chlordiazepoxide) should be terminated. Planning and analysis of these experiments was carried out by the randomization test.