Response to ethanol reduced by past thiamine deficiency

Ethanol enhances JWH-018-induced impairment of sensorimotor and memory functions in mice: From preclinical evidence to forensic implication in Driving Under the Influence of Drugs

BACKGROUND

Several new Synthetic Cannabinoids have appeared each year since their introduction into the illicit drug market as recreational drugs. Among these, naphtalen-1-yl-(1-pentylindol-3-yl) methanone (JWH-018) is one of the most detected compounds in biological samples from patients involved in intoxication or death cases. Furthermore, consumption of JWH-018 has been linked to several cases of Driving Under the Influence of Drugs (DUID) suggesting that effects induced by this compound can affect individuals' ability to drive.

METHODS

Given the high spread of polydrug consumption and the wide number of alcohol-related traffic accidents, this study aims to investigate the acute effects induced by co-administration of JWH-018 with ethanol on sensorimotor and motor responses, grip strength and memory functions in CD-1 male mice. Acute impairments induced by JWH-018 and ethanol alone have also been investigated, in order to compare their effects with that induced by their concurrent administration.

RESULTS

In vivo behavioral experiments revealed a worsening of the cognitive and sensorimotor disruption after the co-administration of JWH-018 with ethanol compared to single compounds.

CONCLUSIONS

These animal-based findings suggest a potential increased impairment on psychomotor performances which could be related to driving abilities posed by poly-drug consumption involving SCs and ethanol.

Double-blind, randomized placebo-controlled clinical trial of benfotiamine for severe alcohol dependence

Alcohol dependence is associated with severe nutritional and vitamin deficiency. Vitamin B1 (thiamine) deficiency erodes neurological pathways that may influence the ability to drink in moderation. The present study examines tolerability of supplementation using the high-potency thiamine analog, benfotiamine (BF), and BF's effects on alcohol consumption in severely affected, self-identified, alcohol dependent subjects. A randomized, double-blind, placebo-controlled trial was conducted on 120 non-treatment seeking, actively drinking, alcohol dependent men and women volunteers (mean age=47 years) from the Kansas City area who met DSM-IV-TR criteria for current alcohol dependence. Subjects were randomized to receive 600 mg benfotiamine or placebo (PL) once daily by mouth for 24 weeks with 6 follow-up assessments scheduled at 4 week intervals. Side effects and daily alcohol consumption were recorded. Seventy (58%) subjects completed 24 weeks of study (N=21 women; N=49 men) with overall completion rates of 55% (N=33) for PL and 63% (N=37) for BF groups. No significant adverse events were noted and alcohol consumption decreased significantly for both treatment groups. Alcohol consumption decreased from baseline levels for 9 of 10 BF treated women after 1 month of treatment compared with 2 of 11 on PL. Reductions in total alcohol consumption over 6 months were significantly greater for BF treated women (BF: N=10, -611 ± 380 standard drinks; PL: N=11, -159 ± 562 standard drinks, p-value=0.02). BF supplementation of actively drinking alcohol dependent men and women was well-tolerated and may discourage alcohol consumption among women. The results do support expanded studies of BF treatment in alcoholism.

Consuming a small-moderate dose of red wine alone can alter the glucose–insulin relationship

The aim in the present study was to assess the effect of small-moderate red wine ingestion on the level of serum insulin and plasma glucose when nutritional status is varied. Twenty nondiabetic males (19–22 years) participated in the study. In the fasting trial, all participants underwent a 6 h fast prior to consuming 4 standard units of red wine (40 g alcohol) or the equivalent amount of placebo as dealcoholized wine (containing <0.5% alcohol, 0% resveratrol) over a 135 min period. Alternatively, in the feeding trial, participants consumed food for 45 min prior to ingesting 4 standard units of red wine (40 g alcohol) or placebo over 135 min. Serum insulin and plasma glucose were assessed at regular 45 min intervals during all trials. The results showed a significant decrease in the level of serum insulin and no significant change in plasma glucose concentration in the fasting trial. Alternatively, a significant alcohol-induced decrease in plasma glucose and no change in serum insulin occurred when red wine alone was consumed after food. It was concluded that red wine can alter the glucose–insulin relationship and ingesting red wine alone (without food) should not be encouraged in nondiabetic individuals.

Effect of Moderate White Wine Consumption on Serum IgA and Plasma Insulin under Fasting Conditions

BACKGROUND/AIMS

The present study aims to investigate the contribution of alcohol toxicity to the development of malnutrition by assessing the effect of consuming a moderate amount of white wine on plasma insulin and serum IgA under fasting conditions.

METHODS

A total of 5 non-alcoholic males aged between 19 and 22 years participated in the current investigation. The experimental procedure required participants to undergo a 6-hour fast before ingesting 4 standard units of alcohol (40 g) in the form of white wine over a 120-min period. The level of blood alcohol, plasma insulin and serum IgA was assessed at 30-min intervals across the 120-min experimental period.

RESULTS

Consuming alcohol promotes a significant increase in serum IgA in the absence of any change in plasma insulin or ketone production in fasted individuals.

CONCLUSION

White wine prior to a meal does not promote glucose metabolism and utilization and may increase the risk of developing a transient diabetic condition due to an alteration in energy metabolism.

Effect on plasma insulin and plasma glucose of consuming white wine alone after a meal

BACKGROUND

Rodent studies have highlighted the possibility that alcohol may promote a significant decrease in the level of glucose-stimulated plasma insulin concentration. The aim of this study was to investigate whether a similar alcohol-induced decrease in plasma insulin occurs in humans, by assessing the level of plasma insulin and plasma glucose when a moderate amount of commercially available bottled white wine is consumed alone after a meal.

METHODS

Eight nondiabetic men aged 19 to 22 years participated in this investigation. Participants were required to consume some food for 45 min before ingesting three standard units of white wine (30 g of alcohol) over 90 min. Plasma insulin and plasma glucose levels were assessed at regular 45-min intervals across the experimental period.

RESULTS

The data showed a significant alcohol-induced decrease in the level of plasma insulin and a nonsignificant trend for a decrease in plasma glucose concentration in all participants after 15 g of alcohol had been consumed alone after a meal.

CONCLUSIONS

These findings highlight the possibility that white wine, if consumed alone after a meal, may significantly alter energy utilization and possibly cause an alteration in glucose metabolism.

In vivo and in vitro proton NMR spectroscopic studies of thiamine-deficient rat brains

Thiamine deficiency (TD) in rats produces lesions similar to those found in humans with Wernicke's encephalopathy, an organic mental disorder associated with alcoholism. Male Sprague-Dawley rats (n = 24) were deprived of thiamine in a regimen of thiamine-deficient chow and daily intraperitoneal injections of the thiamine antagonist pyrithiamine hydrobromide for 12 days (0.5 mg/kg). In rats with TD, significant changes were observed in the choline peak (reduction and dose-dependent recovery after thiamine replenishment), which was confirmed by the extraction study. Changes were mainly due to the reduction in glycerophosphorylcholine (GPC), suggesting that a reduction in GPC may be relevant to the primary biochemical lesion in TD. These data are compatible with the hypothesis that a decrease in choline compounds is the cause of the biochemical abnormalities that precede neuroanatomic damage characteristic of Wernicke's encephalopathy.

In vivo localized proton NMR spectroscopy of thiamine-deficient rat brain

Thiamine deficiency (TD) in rats produces lesions similar to those found in humans suffering from Wernicke's encephalopathy, an organic mental disorder associated with alcoholism. Male Sprague-Dawley rats (n = 29) were deprived of thiamine via a regimen of thiamine-deficient chow and daily intraperitoneal injections of the thiamine antagonist pyrithiamine hydrobromide. Spectra were obtained by using the STEAM sequence. No significant change occurred in the ratio of Cr/NAA, while the ratio of Cho/NAA declined significantly (60 +/- 11%) on Day 14. Eleven rats received intraperitoneal injections of thiamine hydrochloride at the end of 12 days, and dose-dependent recovery in Cho/NAA was observed.

Influence of thiamine on the behavioral sensitivity to ethanol

Changes in sensitivity to ethanol's rate-decreasing effects on operant performance were examined in control rats and cohorts that received diet-induced or diet+pyrithiamine-induced thiamine deficiency. Seven groups of male Sprague-Dawley rats (12 rats/group) were trained in a 5-cycle lever-press operant task under a fixed-ratio 30 schedule of food reinforcement. Once trained to maintain consistent operant performance across all 5 cycles, each rat was tested with various doses of ethanol injected at the beginning of each time-out cycle. Each group of rats demonstrated equivalent saline baseline operant performance and ED50 for ethanol's rate-suppressing effects. Training sessions were suspended and rats received either a short- (9 days) or long-term (5-week) exposure to regular rat chow diet or thiamine-deficient diet, and received either saline or pyrithiamine injections in a 2 x 2 design. Three additional control groups were maintained on a regular rat chow diet and received supplemental injections of either thiamine+pyrithiamine injections, thiamine+saline injections, or saline+pyrithiamine injections. The controlled diet phase continued until the development of overt signs of thiamine deficiency, at which time thiamine supplements were administered for 4 days. In phase 3, all rats were retrained in the operant task and a second ethanol dose-effect function was generated. A history of thiamine deficiency and recovery failed to shift the behavioral dose-effect functions significantly for ethanol and their associated blood alcohol curves. Most interestingly, significant behavioral sensitization to ethanol's rate suppressant effects was demonstrated in the two control groups of rats receiving regular rat chow diet in combination with supplemental injections of thiamine and either saline or pyrithiamine.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain lesions in alcoholics

Brain lesions in alcoholics are multifactorial in origin. Ethanol neurotoxicity, Wernicke's encephalopathy, hepatocerebral degeneration, head trauma, central pontine myelinolysis, Marchiafava-Bignami syndrome, pellagra, and premorbid pathological conditions, such as fetal alcohol syndrome, may all contribute to cognitive dysfunction in alcoholics. With the exception of ethanol neurotoxicity, all of these conditions are associated with specific neuropathological lesions. Wernicke's encephalopathy, the neurological syndrome of thiamine deficiency, is frequently overlooked during life and may cause global dementia as well as the more familiar Korsakoff's amnestic syndrome. Distinguishing ethanol neurotoxicity from nutritional deficiency can be facilitated by magnetic resonance imaging, which can visualize some of the specific macroscopic lesions of Wernicke's encephalopathy, central pontine myelinolysis, cerebellar degeneration, and Marchiafava-Bignami syndrome. Computerized morphometric studies of alcoholic brains have revealed ventricular enlargement, selective loss of subcortical white matter, and alterations in neuronal size, number, architecture, and synaptic complexity. These lesions tend to be more severe when there is coexisting nutritional deficiency or liver disease, suggesting that ethanol neurotoxicity may not be the sole cause. A search for similar lesions in nonalcoholic Wernicke's encephalopathy and nonalcoholic liver disease will help determine the specificity of these lesions.

Acceleration of ethanol metabolism by past thiamine deficiency

Six months after severe thiamine deficiency, when their body and liver weights had normalized, male Sprague-Dawley rats were exposed to constant ethanol vapor concentrations for 6 days in an inhalation chamber and blood ethanol concentrations (BECs) were determined. Previously induced thiamine deficiency was associated with about a 50% reduction of BECs and a significant increase in liver alcohol dehydrogenase (ADH) activity suggesting a persistent acceleration of ethanol metabolism. No significant changes were found in liver aldehyde dehydrogenase activity, plasma levels of thyroxine, testosterone, or estradiol, or brain or liver histology. Plasma growth hormone concentrations were about 60% lower in the experimental group than in controls, but this effect of previous thiamine deprivation did not correlate with changes in ADH activity. Therefore, it remains to be elucidated how thiamine deficiency-induced central nervous system alterations may contribute to the development of metabolic tolerance to ethanol.

Thiamine deficiency in utero alters response to ethanol in adulthood

To determine whether prenatal thiamine deficiency, a frequent concomitant of alcoholism, reduces the response to ethanol during adulthood in the rat as does ethanol exposure in utero (Abel et al. 1981), pregnant Sprague-Dawley rats received either control or thiamine deficient diets together with daily injections of the thiamine antagonist pyrithiamine. At 7 months of age, male offspring were exposed to precisely regulated ethanol vapor concentrations in an inhalation chamber for 24 h and blood ethanol concentrations (BECs) and ethanol-induced intoxication were determined. Prenatally thiamine deficient rats and controls were indistinguishable in terms of appearance, body and liver weights, and the ratios of liver to body weight and brain to liver weight. However, total body water was significantly greater, and BECs and behavioral impairment were decreased, in the experimental rats. These findings indicate that prenatal thiamine deprivation is associated with reduced pharmacologic effect of ethanol as a result of increases in its volume of distribution and rate of metabolism.

Treatment of chronic organic mental disorders associated with alcoholism

Considering the magnitude of the problem, the treatment of alcoholism-associated chronic organic mental disorders has not been extensively studied. Alcoholic organic brain disease is heuristically viewed as the admixture of clinical syndromes of impairment [alcoholic amnestic disorder or Korsakoff's psychosis (KP) and dementia associated with alcoholism (DAA)], each with its distinguishing cognitive, neuropathological, and neurochemical characteristics. Differences between KP and DAA are highlighted by studies that compare KP patients with those having Alzheimer's disease or depression. Furthermore, treatment of cognitive deficits in KP and DAA may be modeled after strategies that have proved effective for these other neuropsychiatric disorders. Although abstinence and proper nutrition remain the cornerstones of treatment, pharmacological modification of neurotransmitter function and/or enhancement of cerebral metabolism combined with behavioral methods may also be beneficial. Serotonergic approaches to improve memory in detoxified alcoholics may also reduce alcohol intake, and this has implication for treatment of less impaired alcoholics.

Alcoholic organic brain disease: nosology and pathophysiologic mechanisms

Study of alcoholic chronic organic brain syndrome may have applicability to the large population of alcoholics with less severe cerebral dysfunction. Brain impairment in alcoholics may be conceptualized as two clinically and neuropathologically distinguishable organic brain syndromes: alcohol amnestic disorder or Korsakoff's psychosis (KP) and alcoholic dementia. Alcoholic organic brain disease may result from two interacting pathophysiological processes: nutritional (thiamine) deficiency and ethanol neurotoxicity. Subcortical periventricular lesions associated with KP result primarily from thiamine deficiency, whereas ethanol neurotoxicity and various secondary effects of alcoholism may contribute to the cortical neuropathological changes associated with alcoholic dementia. These two patterns of brain damage may be differentiable in individual alcoholics using cognitive tests and other measures of CNS function and, therefore, allow selection of a treatment strategy based on pathophysiological considerations. Studies in animals and humans suggest that a genetic predisposition to thiamine deficiency may contribute to alcoholism-associated dysfunction of brain and other organ systems and possibly have a causative role in the development of alcoholism.