Alcohol-Induced Increases in Inflammatory Cytokines Are Attenuated by Nicotine in Region-Selective Manner in Male Rats

Background

Heavy use of alcohol is commonly associated with heavy smoking (nicotine intake). Although many factors, including mood effects of these two drugs may contribute to their co-use, the exact neurobiological underpinnings are far from clear. It is well known that chronic alcohol exposure induces neuroinflammation that may precipitate depressive-like behavior, which is considered an important factor in alcohol relapse. Nicotine, on the other hand, possesses anti-inflammatory and antidepressant effects.

Purpose

In this study, we sought to determine which proinflammatory markers may be associated with the depressogenic effects of chronic alcohol and whether nicotine pretreatment may normalize these changes.

Study design

For this purpose, we treated adult male Wistar rats with alcohol (1.0 g/kg, IP), nicotine (0.3 mg/kg, IP) or their combination once daily for 14 days. Two prominent proinflammatory cytokines (IL-1β and TNF-α) in two primary brain regions, namely the hippocampus and frontal cortex that are intimately involved in mood regulation, were evaluated.

Results

Chronic alcohol resulted in increases in both cytokines in both regions as determined by Western blot. Nicotine completely blocked alcohol-induced effects in the hippocampus, but not in the frontal cortex. These data suggest that nicotine may mitigate the inflammatory effects of alcohol in brain-selective region. Hence, the previously observed depressogenic effects of alcohol and the antidepressant effects of nicotine may at least be partially mediated through manipulations of proinflammatory cytokines in the hippocampus.

Conclusion

These findings suggest possible therapeutic potential of anti-inflammatory cytokines in combating alcohol-induced depression and/or relapse.

Evaluation of the influence of alcohol dehydrogenase polymorphisms on alcohol elimination rates in African Americans

INTRODUCTION

The relationship between alcohol dehydrogenase (ADH) polymorphisms and alcohol use disorders in populations of African descent has not been clearly established. This study examined the effect of ADH1B polymorphisms on alcohol metabolism and subjective response, following intravenous (IV) alcohol administration, and the influence of gender, recent drinking history, and family history of alcoholism (FHA), in nondependent African American drinkers.

MATERIALS

The sample included eighty-seven 21- to 35-year-old, light social drinkers of African descent. Participants included 39 sib pairs, 2 sibships with 3 siblings each, and 3 individuals who were not part of a sibship. Participants received infusions via the use of the clamp method that refers to the goal of controlling breath alcohol concentration in 2 randomized sessions at 0.06 g% ethanol and 0 mg% (placebo), and a battery of subjective scales at predefined time points. Dependent measures included alcohol elimination rates (AERs), alcohol disappearance rates (ADRs), subjective measures peak scores, and area under the curve. General linear model and mixed models were performed to examine the relationship between ADH1B genotype, dependent measures, and influence of covariates.

RESULTS

Participants with ADH1B1/1 genotypes showed higher number of drinks (p = 0.023) and drinks per drinking day (p = 0.009) compared with the persons with ADH1B1/3 genotype. AER (adjusted for body weight) was higher in ADH1B*1 homozygotes (p = 0.045) compared with ADH1B1/3 heterozygotes. ADR differed significantly between males and females (p = 0.002), regardless of body weight (p = 0.004) and lean body mass (p < 0.001) adjustments. Although a few subjective measures differed across genotype, all measures were higher in alcohol sessions compared with placebo sessions (p < 0.001). These observations were mediated by drinks per drinking day, gender, and FHA.

CONCLUSIONS

ADH1B polymorphism had a marginal effect on alcohol pharmacokinetics following IV alcohol administration in nondependent drinkers of African descent. Session (alcohol vs. placebo) and ADH1B genotype did, however, influence subjective response to alcohol with some variation by gender, FHA, and drinks per drinking day.

Alcohol dependence and health care utilization in African Americans

OBJECTIVE

Ethnic and cultural differences in patterns of alcohol use disorders must be understood in order to address improvement in prevention of such disorders and accessibility to health care services. The purpose of this study was to evaluate factors that influence the utilization of medical and mental health services among alcohol-dependent and non-alcohol-dependent African Americans.

METHOD

A cohort of 454 African Americans was evaluated. Alcohol-dependent participants were recruited from various inpatient treatment facilities in the Washington, DC, metropolitan area and through advertisement and word of mouth. Non-alcohol-dependent participants were recruited by advertisements. Each participant was administered the Semi-Structured Assessment for the Genetics of Alcoholism to assess alcohol dependency and the Family History Assessment module to access family history of alcoholism. Xl Test and analysis of variance were used to analyze the data.

RESULTS

Alcohol dependence was more prevalent among men, those with lower income, those with less education, and they utilized mental health counseling as opposed to medical-based therapy. Increased reports of medical conditions such as migraine (p<.001), loss of consciousness (p=.001), and sexually transmitted diseases: (p<.001) were also associated with alcohol dependency. Other factors, including visits to inpatient treatment programs, were directly related to incidence of alcohol dependency regardless of gender status (p<.001).

CONCLUSIONS

This study suggests an association exists among alcohol dependence, medical conditions, health care, and mental care utilization among African Americans. Future research may benefit from investigating if an association exists between alcohol use disorders and health care utilization for other ethnic groups.

Alterations in ethyl alcohol pharmacokinetics during oral consumption of malt liquor beverages in African Americans

BACKGROUND

Malt liquor (ML) beverages have become increasingly popular among urban minority groups, due partly to their inexpensive price and targeted advertising. We hypothesized that nonfermented by-products contained in ML beverages will alter the pharmacokinetics (PK) and pharmacodynamic (PD) effects of its ethanol content. In addition, we determined the effect of alcohol dehydrogenase (ADH) genotypes on the PK following consumption of ML beverages.

METHODS

The study was conducted in 31 healthy adult African-American social drinkers, mean +/- SD age of 22.3 +/- 1.3 years, and weight of 70.7 +/- 10.9 kg. Participants were administered ethanol, in randomized order, 2-weeks apart, in the form of oral ML beverage (6%v/v), or isocaloric solution of diet soda-ethanol (DS-Etoh) beverage (6%v/v). During each session the beverage was consumed over 4 minutes and breath alcohol concentrations (BrAC) as well as subjective and behavioral effects of ethanol were evaluated over 180 minutes. Pharmacokinetic parameters of ethanol were calculated using Michaelis-Menten elimination kinetics. The effect of ML and ADH genotype on PK was evaluated using the Wilcoxon rank-sum test and the Wilcoxon signed rank test, respectively.

RESULTS

Results show a slower mean rate of absorption, K(a), (0.12 vs. 0.15 min(-1), p = 0.03) and a longer time to reach maximum concentration, T(max), (28 vs. 23 minute, p < 0.01) for the ML compared with DS-Etoh beverage. The ML beverage resulted in a larger area under the BrAC-time curve compared with DS-Etoh beverage (8.4 vs. 6.8 min g/dl, p = 0.02). There was no difference in the subjective PD effects between the 2 beverages.

CONCLUSION

Results show that exposure to ethanol following the consumption of ML beverages is different compared to that following nonmalt beverages in African-Americans. These differences may be related to nonfermented by-products present in commercially available ML products. These PK differences do not appear to result in significant perceived alcohol PD changes, nor are they related to ADH genotype.

Efficacy of acute administration of nicotine gum in relief of cue-provoked cigarette craving

RATIONALE

Acute cravings, often provoked by exposure to smoking cues, appear to be important triggers for smoking relapse. Relief of acute craving may therefore be an important step in preventing relapse.

OBJECTIVES

This study was undertaken to assess the effectiveness of nicotine gum in relieving acute craving.

METHODS

A multi-center, randomized, placebo-controlled study was conducted with smokers ( n=296) who quit by using either active or inactive gum for 3 days. On their third day of abstinence, smokers participated in a laboratory session in which they were exposed to a provocative smoking cue, chewed active or inactive gum, and then rated their craving at 5-min intervals for 35 min.

RESULTS

Craving initially decreased in both groups. After 15 min, however, the smokers using active nicotine gum experienced significantly greater craving reductions.

CONCLUSIONS

These results suggest that nicotine gum can effectively reduce acute craving following exposure to smoking cues.

Effects of vaginal distension on urethral anatomy and function

OBJECTIVE

To determine the effect of repeated and prolonged vaginal distension on the leak-point pressure (LPP) and urethral anatomy in the female rat, as prolonged vaginal distension has been clinically correlated with signs of stress urinary incontinence (SUI).

MATERIALS AND METHODS

Sixty female rats were placed into one of five groups; four groups underwent one of four vaginal distension protocols using a modified 10 F Foley catheter, i.e. prolonged (1 h), brief (0.5 h), intermittent (cycling inflated/deflated for 0.5 h) or sham distension. All animals had a suprapubic bladder catheter implanted 2 days after and were assessed urodynamically 4 days after vaginal distension. The fifth group of rats acted as controls and did not undergo vaginal distension, but did have a suprapubic bladder catheter placed and urodynamics assessed. To measure LPP the rats were anaesthetized with urethane, placed supine and the bladder filled with saline (5 mL/h) while bladder pressure was measured via the bladder catheter. LPPs were measured three times in each animal by manually increasing the abdominal pressure until leakage at the urethral meatus, when the external abdominal pressure was rapidly released. Peak bladder pressure was taken as the LPP and a mean value calculated for each animal. Immediately after measuring LPP the urethra was removed and processed routinely for histology (5 micro m sections, stained with haematoxylin/eosin and trichrome). The means (sem) were compared using a Kruskal-Wallis one-way anova on ranks, followed by a Dunn's test, with P < 0.05 indicating a significant difference.

RESULTS

Both LPP and the external increase in abdominal pressure were significantly lower after prolonged distension, at 31.4 (1.7) and 19.8 (1.2) cmH2O, than in the sham group, at 41.1 (3.2) and 32.0 (4.7) cmH2O, respectively. There were no significant differences in LPP or in the increase in abdominal pressure between the brief, intermittent and sham groups. Qualitative histology showed that prolonged distension resulted in extensive disruption and marked thinning of urethral skeletal muscle fibres. Brief and intermittent distension showed mild and focal disruptions, respectively.

CONCLUSIONS

As observed clinically, prolonged vaginal distension results in a lower LPP, greater anatomical injury and increased severity of SUI. These results suggest that ischaemia is important in the development of SUI after prolonged vaginal distension.

A retrospective quality of life analysis using the Lung Cancer Symptom Scale in patients treated with palliative radiotherapy for advanced nonsmall cell lung cancer

PURPOSE

To measure symptom palliation in patients treated with radiation therapy for advanced nonsmall cell lung cancer (NSCLC).

METHODS AND MATERIALS

Five hundred thirty patients with NSCLC were treated at the Medical College of Virginia between 1988 and 1993. Sixty-three patients with the least favorable prognostic features received palliative radiation to 30 Gy in 10 or 12 fractions for symptoms related to the presence of intrathoracic tumor. The observer portion of the Lung Cancer Symptom Scale (LCSS) was employed in a retrospective chart review, scoring measures of appetite, fatigue, cough, dyspnea, hemoptysis, and pain.

RESULTS

In 54 evaluable patients, median survival was 4 months and was independent of age, stage, performance status, or histology. Ninety-six percent of the patients had at least one LCSS symptom at presentation. Fatigue was unaffected by therapy. Improvements in appetite (p = 0.68) and pain (p = 0.61) were not statistically significant. There was, however, a statistically significant reduction in cough (p = 0.01), hemoptysis (p = 0.001), and dyspnea (p = 0.0003). Self-limiting acute side effects included transient esophagitis in 37% of patients, though no severe toxicities were noted.

CONCLUSIONS

These results suggest symptomatic benefit from radiotherapy even in those NSCLC patients with advanced disease and a limited life expectancy. Treatment should be given to patients whose symptoms are most amenable to palliation. A site-specific quality of life instrument such as the LCSS should be included within any future clinical trial of NSCLC management so that symptom control may be scored as a treatment outcome in addition to disease-free survival.

The additional hospital costs generated in the management of complications of pacemaker and defibrillator implantations

The rapid approach of capitated reimbursement mandates that providers examine their practice patterns associated with all surgical procedures. Documentation of (1) the complications associated with these procedures and (2) the additional hospital costs associated with the management of these complications is critical for comprehensive fiscal accountability. This study analyzed (1) the feasibility of obtaining accurate hospital cost data specific for complications and (2) the outcome in terms of fully loaded hospital costs generated in the management of the most common surgical complications associated with pacemaker and nonthoracotomy implantable defibrillator therapies. Between July 1989 and September 1994, a total of 1031 pacemaker and 105 implantable defibrillator procedures were performed by a cardiac surgeon in a tertiary-level teaching hospital setting. The additional fully loaded hospital costs were determined by (1) correlating clinical data from the complete medical record with complete hospital charge data for the admission(s) related to the complication, (2) carving out complication-related charges based on the clinical data, (3) converting complication-related charges to fully loaded costs based on conversion factors in effect at the time of service, and (4) correlating cost with hospital net reimbursement and payor source. The feasibility study determined that accurate and reliable cost data specific to complications can be obtained, although the process was cumbersome and difficult. The outcomes study determined that mean fully loaded complication costs were $4345 +/- $1540 for pacemaker lead revision and $4879 +/- $3167 for implantable defibrillator lead dislodgement, $24,459 +/- $14,585 for pacemaker infection, and $13,736 +/- $12,505 for defibrillator generator system malfunction. The one infected defibrillator cost $57,213 to treat. Costs exceeded reimbursement for almost all Medicare patients with complications in this study, suggesting that similar shortfalls would occur under a capitation scheme. This information is critical to a complete understanding of the financial impact of interventional procedures in a capitated reimbursement environment.

Mercury clearance from human plasma during in vitro dialysis: screening systems for chelating agents

Two in vitro systems were evaluated as potential screening methods for determining the most effective chelating agents for use in patients with inorganic mercury poisoning undergoing hemodialysis. The first system consisted of an in vitro clinical hemodialysis unit and the second system consisted of an in vitro equilibrium dialysis procedure. Both systems utilized pooled human plasma. Ten chelating agents were evaluated in these systems to determine their ability to enhance mercury clearance from human plasma. In the absence of chelators, plasma clearance of mercury was negligible. Of the chelating agents tested, 2,3-dimercaptopropanolol, which enhances biliary and fecal excretion of mercury poisoning, and dithiothreitol did not enhance mercury clearance at 90 min in the hemodialysis system. N-acetylcysteine appeared to be the most effective chelating agent of those tested in the hemodialysis system. N-acetylcysteine produced a 73% decrease in perfusate mercury concentration at 90 min. The results of equilibrium dialysis mirrored those of the hemodialysis in that N-acetylcysteine significantly enhanced mercury transfer across the dialysis membrane into the dialysate whereas dithiothreitol did not. If in vivo experiments confirm the present findings, then in vitro dialysis from pooled human plasma either using a standard clinical hemodialyzer or equilibrium dialysis system will be useful screening tools. Our results suggest that equilibrium dialysis may be a convenient and cost effective method to screen potential chelating agents as complementary to hemodialysis for the treatment of inorganic mercury poisoning.

Torsades de pointes occurring in association with terfenadine use

Torsades de pointes is a form of polymorphic ventricular tachycardia that is associated with prolongation of the QT interval. Although found in many clinical settings, torsades de pointes is most often drug induced. This report describes the first association (exclusive of drug overdose) of symptomatic torsades de pointes occurring with the use of terfenadine in a patient who was taking the recommended prescribed dose of this drug in addition to cefaclor, ketoconazole, and medroxyprogesterone. Measured serum concentrations of terfenadine and its main metabolite showed excessive levels of parent terfenadine and proportionately reduced concentrations of metabolite, suggesting inhibition of terfenadine metabolism. We believe that a drug interaction between terfenadine and ketoconazole resulted in the elevated terfenadine levels in plasma and in the cardiotoxicity previously seen only in cases of terfenadine overdose.

Effects of education and relaxation training with essential hypertension patients

Thirty subjects with essential hypertension were assigned randomly to either a no treatment control, education, or education with relaxation training group. Independent blood pressure recordings were collected by medical staff at pretest, posttest, and 8-week follow-up. Results suggest a significant interaction between treatment and time for the dependent physiological measure, systolic blood pressure. During the pretest to follow-up period, the control group averaged a 5.9 mm. Hg. increase, the education with relaxation group an 8.8 mm. Hg. decrease, and the education group a 14.9 mm. Hg. decrease in systolic blood pressure. There was no significant difference in group means for diastolic blood pressure within groups over time. As measured at follow-up, education appeared more effective in reducing systolic blood pressure than education with relaxation training. More than one-third of subjects associated unpleasant side effects with their antihypertensive medication. Almost all treatment subjects rated the education and relaxation as helpful for understanding and managing their hypertension.