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Valencia FP, Marino AF, Noutsos C, Poon K. Concentration-dependent change in hypothalamic neuronal transcriptome by the dietary fatty acids: oleic and palmitic acids. J Nutr Biochem 2022; 106:109033. [DOI: 10.1016/j.jnutbio.2022.109033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/20/2021] [Accepted: 03/18/2022] [Indexed: 11/30/2022]
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Pelpolage SW, Yoshida A, Nagata R, Shimada K, Fukuma N, Bochimoto H, Hamamoto T, Hoshizawa M, Nakano K, Han KH, Fukushima M. Frozen Autoclaved Sorghum Enhanced Colonic Fermentation and Lower Visceral Fat Accumulation in Rats. Nutrients 2020; 12:E2412. [PMID: 32806549 PMCID: PMC7570106 DOI: 10.3390/nu12082412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 01/09/2023] Open
Abstract
As raw sorghum is not able to influence considerable colonic fermentation despite its higher resistant starch (RS) content, our study aimed to investigate the effects of frozen autoclaved sorghum on colonic fermentation. Fischer 344 rats were fed frozen cooked refined (S-Rf) and whole (S-Wh) sorghum diets and were compared against α-corn starch (CON) and high amylose starch (HAS) fed rats for zoometric parameters, cecal biochemical and microbiological parameters. Sorghum fed rats exhibited significantly lower feed intake and visceral adipose tissue mass compared to CON. Bacterial alpha diversity was significantly higher in the sorghum fed rats compared to HAS and the two sorghum fed groups clustered together, separately from HAS and CON in the beta diversity plot. Serum non-High Density Lipoprotein cholesterol and total cholesterol in S-Rf group were significantly lower compared to CON, while total fecal bile excretion was also significantly higher in the two sorghum fed groups. Lower visceral adiposity was correlated with lower feed intake, RS content ingested and cecal short chain fatty acid (SCFA) contents. Thus, higher RS inflow to the colon via frozen autoclaved sorghum might have influenced colonic fermentation of RS and the resultant SCFA might have influenced lower adiposity as manifested by the lower body weight gain.
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Affiliation(s)
- Samanthi W. Pelpolage
- Department of Life and Food Sciences, Obihiro University of Agriculture and Veterinary Medicine, West 2-11, Inada, Obihiro 080–8555, Hokkaido, Japan; (S.W.P.); (A.Y.); (K.S.); (R.N.); (N.F.); (K.-H.H.)
| | - Atsushi Yoshida
- Department of Life and Food Sciences, Obihiro University of Agriculture and Veterinary Medicine, West 2-11, Inada, Obihiro 080–8555, Hokkaido, Japan; (S.W.P.); (A.Y.); (K.S.); (R.N.); (N.F.); (K.-H.H.)
| | - Ryuji Nagata
- Department of Life and Food Sciences, Obihiro University of Agriculture and Veterinary Medicine, West 2-11, Inada, Obihiro 080–8555, Hokkaido, Japan; (S.W.P.); (A.Y.); (K.S.); (R.N.); (N.F.); (K.-H.H.)
| | - Kenichiro Shimada
- Department of Life and Food Sciences, Obihiro University of Agriculture and Veterinary Medicine, West 2-11, Inada, Obihiro 080–8555, Hokkaido, Japan; (S.W.P.); (A.Y.); (K.S.); (R.N.); (N.F.); (K.-H.H.)
| | - Naoki Fukuma
- Department of Life and Food Sciences, Obihiro University of Agriculture and Veterinary Medicine, West 2-11, Inada, Obihiro 080–8555, Hokkaido, Japan; (S.W.P.); (A.Y.); (K.S.); (R.N.); (N.F.); (K.-H.H.)
- Research Center for Global Agromedicine, Obihiro University of Agriculture and Veterinary Medicine, West 2-11, Inada, Obihiro 080-8555, Hokkaido, Japan
| | - Hiroki Bochimoto
- Division of Aerospace Medicine, Department of Cell Physiology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minatoku, Tokyo 105-8461, Japan;
| | - Tetsuo Hamamoto
- U.S. Grains Council, 11th Floor, Toranomon Denki Building No. 3, 1-2-20 Toranomon, Minato-ku, Tokyo 105-0001, Japan; (T.H.); (M.H.)
| | - Michiyo Hoshizawa
- U.S. Grains Council, 11th Floor, Toranomon Denki Building No. 3, 1-2-20 Toranomon, Minato-ku, Tokyo 105-0001, Japan; (T.H.); (M.H.)
| | - Koichi Nakano
- Nakano Industry Co., Asahishinmachi 33-25 Takamatsu, Kagawa 760-0064, Japan;
| | - Kyu-Ho Han
- Department of Life and Food Sciences, Obihiro University of Agriculture and Veterinary Medicine, West 2-11, Inada, Obihiro 080–8555, Hokkaido, Japan; (S.W.P.); (A.Y.); (K.S.); (R.N.); (N.F.); (K.-H.H.)
- Research Center for Global Agromedicine, Obihiro University of Agriculture and Veterinary Medicine, West 2-11, Inada, Obihiro 080-8555, Hokkaido, Japan
| | - Michihiro Fukushima
- Department of Life and Food Sciences, Obihiro University of Agriculture and Veterinary Medicine, West 2-11, Inada, Obihiro 080–8555, Hokkaido, Japan; (S.W.P.); (A.Y.); (K.S.); (R.N.); (N.F.); (K.-H.H.)
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Elliott JA, Reynolds JV, le Roux CW, Docherty NG. Physiology, pathophysiology and therapeutic implications of enteroendocrine control of food intake. Expert Rev Endocrinol Metab 2016; 11:475-499. [PMID: 30058920 DOI: 10.1080/17446651.2016.1245140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With the increasing prevalence of obesity and its associated comorbidities, strides to improve treatment strategies have enhanced our understanding of the function of the gut in the regulation of food intake. The most successful intervention for obesity to date, bariatric surgery effectively manipulates enteroendocrine physiology to enhance satiety and reduce hunger. Areas covered: In the present article, we provide a detailed overview of the physiology of enteroendocrine control of food intake, and discuss its pathophysiologic correlates and therapeutic implications in both obesity and gastrointestinal disease. Expert commentary: Ongoing research in the field of nutrient sensing by L-cells, as well as understanding the role of the microbiome and bile acid signaling may facilitate the development of novel strategies to combat the rising population health threat associated with obesity. Further refinement of post-prandial satiety gut hormone based therapies, including the development of chimeric peptides exploiting the pleiotropic nature of the gut hormone response, and identification of novel methods of delivery may hold the key to optimization of therapeutic modulation of gut hormone physiology in obesity.
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Affiliation(s)
- Jessie A Elliott
- a Diabetes Complications Research Centre, Conway Institute of Biomedical and Biomolecular Research , University College Dublin , Dublin , Ireland
- b Department of Surgery, Trinity Centre for Health Sciences , Trinity College Dublin and St. James's Hospital , Dublin , Ireland
| | - John V Reynolds
- b Department of Surgery, Trinity Centre for Health Sciences , Trinity College Dublin and St. James's Hospital , Dublin , Ireland
| | - Carel W le Roux
- a Diabetes Complications Research Centre, Conway Institute of Biomedical and Biomolecular Research , University College Dublin , Dublin , Ireland
- c Gastrosurgical Laboratory, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden
| | - Neil G Docherty
- a Diabetes Complications Research Centre, Conway Institute of Biomedical and Biomolecular Research , University College Dublin , Dublin , Ireland
- c Gastrosurgical Laboratory, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden
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Duca FA, Bauer PV, Hamr SC, Lam TKT. Glucoregulatory Relevance of Small Intestinal Nutrient Sensing in Physiology, Bariatric Surgery, and Pharmacology. Cell Metab 2015. [PMID: 26212718 DOI: 10.1016/j.cmet.2015.07.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Emerging evidence suggests the gastrointestinal tract plays an important glucoregulatory role. In this perspective, we first review how the intestine senses ingested nutrients, initiating crucial negative feedback mechanisms through a gut-brain neuronal axis to regulate glycemia, mainly via reduction in hepatic glucose production. We then highlight how intestinal energy sensory mechanisms are responsible for the glucose-lowering effects of bariatric surgery, specifically duodenal-jejunal bypass, and the antidiabetic agents metformin and resveratrol. A better understanding of these pathways lays the groundwork for intestinally targeted drug therapy for the treatment of diabetes.
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Affiliation(s)
- Frank A Duca
- Toronto General Research Institute and Department of Medicine, UHN, Toronto, ON M5G 1L7, Canada
| | - Paige V Bauer
- Toronto General Research Institute and Department of Medicine, UHN, Toronto, ON M5G 1L7, Canada; Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Sophie C Hamr
- Toronto General Research Institute and Department of Medicine, UHN, Toronto, ON M5G 1L7, Canada; Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Tony K T Lam
- Toronto General Research Institute and Department of Medicine, UHN, Toronto, ON M5G 1L7, Canada; Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada; Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; Banting and Best Diabetes Centre, University of Toronto, Toronto, ON M5G 2C4, Canada.
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Overduin J, Tylee TS, Frayo RS, Cummings DE. Hyperosmolarity in the small intestine contributes to postprandial ghrelin suppression. Am J Physiol Gastrointest Liver Physiol 2014; 306:G1108-16. [PMID: 24789208 PMCID: PMC4059977 DOI: 10.1152/ajpgi.00072.2014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Plasma levels of the orexigenic hormone ghrelin are suppressed by meals with an efficacy dependent on their macronutrient composition. We hypothesized that heterogeneity in osmolarity among macronutrient classes contributes to these differences. In three studies, the impact of small intestinal hyperosmolarity was examined in Sprague-Dawley rats. In study 1, isotonic, 2.5×, and 5× hypertonic solutions of several agents with diverse absorption and metabolism properties were infused duodenally at a physiological rate (3 ml/10 min). Jugular vein blood was sampled before and at 30, 60, 90, 120, 180, 240, and 300 min after infusion. Plasma ghrelin was suppressed dose dependently and most strongly by glucose. Hyperosmolar infusions of lactulose, which transits the small intestine unabsorbed, and 3-O-methylglucose (3-O-MG), which is absorbed like glucose but remains unmetabolized, also suppressed ghrelin. Glucose, but not lactulose or 3-O-MG, infusions increased plasma insulin. In study 2, intestinal infusions of hyperosmolar NaCl suppressed ghrelin, a response that was not attenuated by coinfusion with the neural blocker lidocaine. In study 3, we reconfirmed that the low-osmolar lipid emulsion Intralipid suppresses ghrelin more weakly than isocaloric (but hypertonic) glucose. Importantly, raising Intralipid's osmolarity to that of the glucose solution by nonabsorbable lactulose supplementation enhanced ghrelin suppression to that seen after glucose. Hyperosmolar ghrelin occurred particularly during the initial 3 postinfusion hours. We conclude that small intestinal hyperosmolarity 1) is sufficient to suppress ghrelin, 2) may combine with other postprandial mechanisms to suppress ghrelin, 3) might contribute to altered ghrelin regulation after gastric bypass surgery, and 4) may inform dietary modifications for metabolic health.
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Affiliation(s)
- Joost Overduin
- University of Washington School of Medicine, Seattle, Washington; and Veterans Affairs Puget Sound Health Care System Seattle, Washington
| | - Tracy S. Tylee
- University of Washington School of Medicine, Seattle, Washington; and Veterans Affairs Puget Sound Health Care System Seattle, Washington
| | - R. Scott Frayo
- University of Washington School of Medicine, Seattle, Washington; and Veterans Affairs Puget Sound Health Care System Seattle, Washington
| | - David E. Cummings
- University of Washington School of Medicine, Seattle, Washington; and Veterans Affairs Puget Sound Health Care System Seattle, Washington
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Overduin J, Gibbs J, Cummings DE, Reeve JR. CCK-58 elicits both satiety and satiation in rats while CCK-8 elicits only satiation. Peptides 2014; 54:71-80. [PMID: 24468546 PMCID: PMC3989439 DOI: 10.1016/j.peptides.2014.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/14/2014] [Accepted: 01/15/2014] [Indexed: 11/18/2022]
Abstract
Reduction of food intake by exogenous cholecystokinin (CCK) has been demonstrated primarily for its short molecular form, CCK-8. Mounting evidence, however, implicates CCK-58 as a major physiologically active CCK form, with different neural and exocrine response profiles than CCK-8. In three studies, we compared meal-pattern effects of intraperitoneal injections CCK-8 vs. CCK-58 in undeprived male Sprague-Dawley rats consuming sweetened condensed milk. In study 1, rats (N=10) received CCK-8, CCK-58 (0.45, 0.9, 1.8 and 3.6 nmol/kg) or vehicle before a 4-h test-food presentation. At most doses, both CCK-8 and CCK-58 similarly reduced meal size relative to vehicle. Meal-size reduction prompted a compensatory shortening of the intermeal interval (IMI) after CCK-8, but not after CCK-58, which uniquely increased the satiety ratio (IMI/size of the preceding meal). In the second study, lick patterns were monitored after administration of 0.9 nmol/kg CCK-58, CCK-8 or vehicle. Lick cluster size, lick efficiency and interlick-interval distribution remained unaltered compared to vehicle, implying natural satiation, rather than illness, following both CCK forms. In study 3, threshold satiating doses of the two CCK forms were given at 5 and 30 min after meal termination, respectively. CCK 58, but not CCK-8 increased the intermeal interval and satiety ratio compared to vehicle. In conclusion, while CCK 58 and CCK-8 both stimulate satiation, thereby reducing meal size, CCK-58 consistently exerts a satiety effect, prolonging IMI. Given the physiological prominence of CCK-58, these results suggest that CCK's role in food intake regulation may require re-examination.
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Affiliation(s)
- Joost Overduin
- Weill Medical College, Cornell University, White Plains, NY 10605, USA; Veterans Administration Puget Sound Health Care System, Office of Research and Development Medical Research Service, Seattle, WA 98108, USA; Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - James Gibbs
- Weill Medical College, Cornell University, White Plains, NY 10605, USA
| | - David E Cummings
- Veterans Administration Puget Sound Health Care System, Office of Research and Development Medical Research Service, Seattle, WA 98108, USA; Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Joseph R Reeve
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA and CURE: Digestive Diseases Research Center, Veterans Administration, Los Angeles, CA 90073, USA.
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Ozaki T, Mohammad S, Morioka E, Takiguchi S, Ikeda M. Infant satiety depends on transient expression of cholecystokinin-1 receptors on ependymal cells lining the third ventricle in mice. J Physiol 2012; 591:1295-312. [PMID: 23266937 DOI: 10.1113/jphysiol.2012.247676] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Cholecystokinin (CCK) is a hypothetical controller for suckling and infancy body weight, although the underlying mechanisms remain unclear. Therefore, the present study analysed the mechanisms using mice lacking the CCK-1 receptor (CCK1R-/-). Although CCK1R-/- mice displayed normal weights at birth and adulthood, CCK1R-/- pups had enlarged adipocytes and were overweight from the first to second week after birth, regardless of maternal genotype. The lacZ reporter gene assay and/or calcium imaging analysis demonstrated that CCK-1 receptors were abundant in satiety-controlling regions such as the hypothalamus, brainstem, nodose ganglion and pylorus in adults, whereas these signals were few to lacking at pre-weanling stages. At postnatal day (PD) 6, the increase in cFos expression in the medullary nucleus tractus solitarius was similarly triggered by gastrointestinal milk- or saline filling in both genotypes, further indicating immature CCK-1 receptor function in an ascending satiety-controlling system during infancy. Conversely, third ventricle ependymal tanycyte-like cells expressed CCK-1 receptors with expression peaking at PD6. At PD6, wild-type but not CCK1R-/- mice had increased cFos immunoreactivity in ependymal cells following gastrointestinal milk filling whereas the response became negligible at PD12. In addition, ependymal cFos was not increased by saline filling, indicating that these responses are dependent on CCK-1 receptors, developmental stage and nutrients. Furthermore, body weights of wild-type pups were transiently increased by blocking ependymal CCK receptor function with microinjection of a CCK-1 antagonist, but not a CCK-2 antagonist. Hence, we demonstrate de novo functions of ependymal CCK-1 receptors and reveal a new aspect of infant satiety-controlling mechanisms.
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Affiliation(s)
- Tomoya Ozaki
- 1Graduate School of Innovative Life Science, University of Toyama, 3190 Gofuku, Toyama 930-8555, Japan
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Mohammad S, Ozaki T, Takeuchi K, Unno K, Yamoto K, Morioka E, Takiguchi S, Ikeda M. Functional compensation between cholecystokinin-1 and -2 receptors in murine paraventricular nucleus neurons. J Biol Chem 2012; 287:39391-401. [PMID: 23038256 PMCID: PMC3501058 DOI: 10.1074/jbc.m112.416214] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 10/02/2012] [Indexed: 01/11/2023] Open
Abstract
Cholecystokinin (CCK) and its receptor subtypes CCK-1 and -2 have diverse homeostatic functions. CCK-1 and -2 receptors share a common phosphatidylinositol signaling pathway, yet little is known regarding their possible functional coupling. We focused on CCK-mediated Ca(2+) signaling in parvocellular paraventricular nucleus (PVN) cells, which control satiety and other autonomic functions. Analysis of mouse hypothalamic slices demonstrated that the general CCK receptor agonist CCK-8s (10 nM) triggered Ca(2+) transients most significantly in the posterior subregion of the PVN (PaPo). This 10 nM CCK-8s-induced response was absent in CCK-1 receptor knock-out (CCK1R(-/-)) slices, showing that the response is mediated by CCK-1 receptors. CCK-8s concentrations higher than 30 nM triggered a Ca(2+) rise similarly in wild-type and CCK1R(-/-) slices. The large CCK-8s (100 nM)-induced Ca(2+) responses in CCK1R(-/-) slices were blocked by a CCK-2 receptor antagonist (CI-988), whereas those in wild-type slices required a mixture of CI-988 and lorglumide (a CCK-1 receptor antagonist) for complete antagonism. Therefore, CCK-1 and -2 receptors may function synergistically in single PaPo neurons and deletion of CCK-1 receptors may facilitate CCK-2 receptor signaling. This hypothesis was supported by results of real-time RT-PCR, immunofluorescence double labeling and Western blotting assays, which indicated CCK-2 receptor overexpression in PaPo neurons of CCK1R(-/-) mice. Furthermore, behavioral studies showed that intraperitoneal injections of lorglumide up-regulated food accesses in wild-type but not in CCK1R(-/-) mice, whereas CI-988 injections up-regulated food accesses in CCK1R(-/-) but not in wild-type mice. Compensatory CCK signaling via CCK-2 receptors in CCK1R(-/-) mice shed light on currently controversial satiety-controlling mechanisms.
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Affiliation(s)
| | - Tomoya Ozaki
- From the Graduate School of Innovative Life Science and
| | - Kouhei Takeuchi
- the Graduate School of Science and Engineering, University of Toyama, 3190 Gofuku, Toyama-city, Toyama 930-8555 and
| | - Katsuya Unno
- the Graduate School of Science and Engineering, University of Toyama, 3190 Gofuku, Toyama-city, Toyama 930-8555 and
| | - Kurumi Yamoto
- the Graduate School of Science and Engineering, University of Toyama, 3190 Gofuku, Toyama-city, Toyama 930-8555 and
| | - Eri Morioka
- From the Graduate School of Innovative Life Science and
| | - Soichi Takiguchi
- the Institute for Clinical Research, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan
| | - Masayuki Ikeda
- From the Graduate School of Innovative Life Science and
- the Graduate School of Science and Engineering, University of Toyama, 3190 Gofuku, Toyama-city, Toyama 930-8555 and
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Blevins JE, Moralejo DH, Wolden-Hanson TH, Thatcher BS, Ho JM, Kaiyala KJ, Matsumoto K. Alterations in activity and energy expenditure contribute to lean phenotype in Fischer 344 rats lacking the cholecystokinin-1 receptor gene. Am J Physiol Regul Integr Comp Physiol 2012; 303:R1231-40. [PMID: 23115121 DOI: 10.1152/ajpregu.00393.2012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
CCK is hypothesized to inhibit meal size by acting at CCK1 receptors (CCK1R) on vagal afferent neurons that innervate the gastrointestinal tract and project to the hindbrain. Earlier studies have shown that obese Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which carry a spontaneous null mutation of the CCK1R, are hyperphagic and obese. Recent findings show that rats with CCK1R-null gene on a Fischer 344 background (Cck1r(-/-)) are lean and normophagic. In this study, the metabolic phenotype of this rat strain was further characterized. As expected, the CCK1R antagonist, devazepide, failed to stimulate food intake in the Cck1r(-/-) rats. Both Cck1r(+/+) and Cck1r(-/-) rats became diet-induced obese (DIO) when maintained on a high-fat diet relative to chow-fed controls. Cck1r(-/-) rats consumed larger meals than controls during the dark cycle and smaller meals during the light cycle. These effects were accompanied by increased food intake, total spontaneous activity, and energy expenditure during the dark cycle and an apparent reduction in respiratory quotient during the light cycle. To assess whether enhanced responsiveness to anorexigenic factors may contribute to the lean phenotype, we examined the effects of melanotan II (MTII) on food intake and body weight. We found an enhanced effect of MTII in Cck1r(-/-) rats to suppress food intake and body weight following both central and peripheral administration. These results suggest that the lean phenotype is potentially driven by increases in total spontaneous activity and energy expenditure.
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Affiliation(s)
- James E Blevins
- VA Puget Sound Health Care System, Office of Research and Development Medical Research Service, Department of Veterans Affairs Medical Center, Seattle, Washington, USA
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