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Zubizarreta JR, Umhau JC, Deuster PA, Brenner LA, King AJ, Petukhova MV, Sampson NA, Tizenberg B, Upadhyaya SK, RachBeisel JA, Streeten EA, Kessler RC, Postolache TT. Evaluating the heterogeneous effect of a modifiable risk factor on suicide: The case of vitamin D deficiency. Int J Methods Psychiatr Res 2022; 31:e1897. [PMID: 34739164 PMCID: PMC8886287 DOI: 10.1002/mpr.1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/21/2021] [Accepted: 10/21/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To illustrate the use of machine learning methods to search for heterogeneous effects of a target modifiable risk factor on suicide in observational studies. The illustration focuses on secondary analysis of a matched case-control study of vitamin D deficiency predicting subsequent suicide. METHODS We describe a variety of machine learning methods to search for prescriptive predictors; that is, predictors of significant variation in the association between a target risk factor and subsequent suicide. In each case, the purpose is to evaluate the potential value of selective intervention on the target risk factor to prevent the outcome based on the provisional assumption that the target risk factor is causal. The approaches illustrated include risk modeling based on the super learner ensemble machine learning method, Least Absolute Shrinkage and Selection Operator (Lasso) penalized regression, and the causal forest algorithm. RESULTS The logic of estimating heterogeneous intervention effects is exposited along with the illustration of some widely used methods for implementing this logic. CONCLUSIONS In addition to describing best practices in using the machine learning methods considered here, we close with a discussion of broader design and analysis issues in planning an observational study to investigate heterogeneous effects of a modifiable risk factor.
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Affiliation(s)
- Jose R. Zubizarreta
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
- Department of StatisticsHarvard UniversityCambridgeMassachusettsUSA
- Department of BiostatisticsHarvard Chan School of Public HealthBostonMassachusettsUSA
| | | | - Patricia A. Deuster
- Consortium for Health and Military PerformanceDepartment of Military & Emergency MedicineF. Edward Hébert School of MedicineUniformed Services UniversityBethesdaMarylandUSA
| | - Lisa A. Brenner
- University of Colorado Anschutz School of MedicineAuroraColoradoUSA
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC)AuroraColoradoUSA
| | - Andrew J. King
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Maria V. Petukhova
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Nancy A. Sampson
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Boris Tizenberg
- Mood and Anxiety ProgramDepartment of PsychiatryUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Sanjaya K. Upadhyaya
- Mood and Anxiety ProgramDepartment of PsychiatryUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Jill A. RachBeisel
- Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Elizabeth A. Streeten
- Genetics and Personalized Medicine Clinic, Division of Endocrinology, Diabetes and NutritionUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Ronald C. Kessler
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Teodor T. Postolache
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC)AuroraColoradoUSA
- Mood and Anxiety ProgramDepartment of PsychiatryUniversity of Maryland School of MedicineBaltimoreMarylandUSA
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC)BaltimoreMarylandUSA
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2
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Warner D, Vatsalya V, Zirnheld KH, Warner JB, Hardesty JE, Umhau JC, McClain CJ, Maddipati K, Kirpich IA. Linoleic Acid-Derived Oxylipins Differentiate Early Stage Alcoholic Hepatitis From Mild Alcohol-Associated Liver Injury. Hepatol Commun 2021; 5:947-960. [PMID: 34141982 PMCID: PMC8183177 DOI: 10.1002/hep4.1686] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/05/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
Alcohol-associated liver disease (ALD) is a spectrum of liver disorders ranging from steatosis to steatohepatitis, fibrosis, and cirrhosis. Alcohol-associated hepatitis (AH) is an acute and often severe form of ALD with substantial morbidity and mortality. The mechanisms and mediators of ALD progression and severity are not well understood, and effective therapeutic options are limited. Various bioactive lipid mediators have recently emerged as important factors in ALD pathogenesis. The current study aimed to examine alterations in linoleic acid (LA)-derived lipid metabolites in the plasma of individuals who are heavy drinkers and to evaluate associations between these molecules and markers of liver injury and systemic inflammation. Analysis of plasma LA-derived metabolites was performed on 66 individuals who were heavy drinkers and 29 socially drinking but otherwise healthy volunteers. Based on plasma alanine aminotransferase (ALT) levels, 15 patients had no liver injury (ALT ≤ 40 U/L), 33 patients had mild liver injury (ALT > 40 U/L), and 18 were diagnosed with moderate AH (mAH) (Model for End-Stage Liver Disease score <20). Lipoxygenase-derived LA metabolites (13-hydroxy-octadecadienoic acid [13-HODE] and 13-oxo-octadecadienoic acid) were markedly elevated only in patients with mAH. The cytochrome P450-derived LA epoxides 9,10-epoxy-octadecenoic acid (9,10-EpOME) and 12,13-EpOME were decreased in all patients regardless of the presence or absence of liver injury. LA-derived diols 9,10-dihydroxy-octadecenoic acid (9,10-DiHOME) and 12,13-DiHOME as well as the corresponding diol/epoxide ratio were elevated in the mAH group, specifically compared to patients with mild liver injury. We found that 13-HODE and 12,13-EpOME (elevated and decreased, respectively) in combination with elevated interleukin-1β as independent predictors can effectively predict altered liver function as defined by elevated bilirubin levels. Conclusion: Specific changes in LA metabolites in individuals who are heavy drinkers can distinguish individuals with mAH from those with mild ALD.
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Affiliation(s)
- Dennis Warner
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineUniversity of LouisvilleLouisvilleKYUSA
| | - Vatsalya Vatsalya
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineUniversity of LouisvilleLouisvilleKYUSA.,Robley Rex Veterans Medical CenterLouisvilleKYUSA
| | - Kara H Zirnheld
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineUniversity of LouisvilleLouisvilleKYUSA
| | - Jeffrey B Warner
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineUniversity of LouisvilleLouisvilleKYUSA.,Department of Pharmacology and ToxicologyUniversity of Louisville School of MedicineKYUSA
| | - Josiah E Hardesty
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineUniversity of LouisvilleLouisvilleKYUSA.,Department of Pharmacology and ToxicologyUniversity of Louisville School of MedicineKYUSA
| | | | - Craig J McClain
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineUniversity of LouisvilleLouisvilleKYUSA.,Robley Rex Veterans Medical CenterLouisvilleKYUSA.,Department of Pharmacology and ToxicologyUniversity of Louisville School of MedicineKYUSA.,University of Louisville Alcohol CenterLouisvilleKYUSA.,Hepatobiology and Toxicology CenterUniversity of Louisville School of MedicineLouisvilleKYUSA
| | | | - Irina A Kirpich
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineUniversity of LouisvilleLouisvilleKYUSA.,Department of Pharmacology and ToxicologyUniversity of Louisville School of MedicineKYUSA.,University of Louisville Alcohol CenterLouisvilleKYUSA.,Hepatobiology and Toxicology CenterUniversity of Louisville School of MedicineLouisvilleKYUSA
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3
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Ryan AT, Postolache TT, Taub DD, Wilcox HC, Ghahramanlou-Holloway M, Umhau JC, Deuster PA. Serum Fatty Acid Latent Classes Are Associated With Suicide in a Large Military Personnel Sample. J Clin Psychiatry 2021; 82:20m13275. [PMID: 33988928 PMCID: PMC9308986 DOI: 10.4088/jcp.20m13275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Fatty acids (FAs) are involved in the functioning of biological systems previously associated with suicidal behavior (eg, monoamine signaling and the immune system). We sought to determine (1) whether observed FA levels in a sample of military suicide decedents and living matched controls were consistent with latent classes having distinctive FA profiles and (2) whether those latent classes were associated with suicide and mental health diagnoses. METHODS Serum samples from 800 US military suicide decedents who died between 2002 and 2008 and 800 demographically matched living controls were selected at random from a large military serum repository and assayed for 22 different FAs. A latent class cluster analysis was performed using values of 6 FAs previously individually associated with suicide. Once the latent classes were identified, they were compared in terms of suicide decedent proportion, demographic variables, estimated FA enzyme activity, diagnoses, and mental health care usage. RESULTS A 6-latent class solution best characterized the dataset. Suicide decedents were less likely to belong to 2 of the classes and more likely to belong to 3 of the classes. The low-decedent classes differed from the high-decedent classes on 9 FAs and on estimated indices of activity for 3 FA enzymes: 14:0, 24:0, 18:1 n-9, 24:1 n-9, 22:5 n-3, 22:6 n-3, 20:2 n-6, 20:4 n-6, 22:5 n-6, elongation of very long chain fatty acids protein 1 (ELOVL1), ELOVL6, and Δ9 desaturase. The FA profiles of the latent classes were consistent with biological abnormalities previously associated with suicidal behavior. CONCLUSIONS This study suggests the utility of methods that simultaneously examine multiple FAs when trying to understand their relationship with suicide and psychiatric illness.
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Affiliation(s)
- Arthur Thomas Ryan
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, Maryland.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland.,Now with Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado; Department of Psychiatry, University of Coloraso Anschutz School of Medicine, Aurora, Colorado; and Washington DC VA Medical Center, Washington, DC.,Corresponding author: Arthur Thomas Ryan, PhD, Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore VA Annex, 7th Floor, 209 West Fayette St, Baltimore, MD 21201
| | - Teodor. T. Postolache
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD, USA,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA,Rocky Mountain MIRECC for Suicide Prevention, Aurora, CO
| | | | - Holly C. Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - John C. Umhau
- Office of New Drugs, Division of Psychiatry Products Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA,Fort Belvoir Community Hospital, Fort Belvoir, MD, USA
| | - Patricia A. Deuster
- Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Schwandt ML, Diazgranados N, Umhau JC, Kwako LE, George DT, Heilig M. PPARγ activation by pioglitazone does not suppress cravings for alcohol, and is associated with a risk of myopathy in treatment seeking alcohol dependent patients: a randomized controlled proof of principle study. Psychopharmacology (Berl) 2020; 237:2367-2380. [PMID: 32445052 PMCID: PMC11018293 DOI: 10.1007/s00213-020-05540-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/27/2020] [Indexed: 12/12/2022]
Abstract
RATIONALE Proinflammatory processes have been implicated in alcohol addiction, craving, and relapse, while studies in experimental animals have suggested that activation of peroxisome proliferator-activated receptor gamma (PPARγ) inhibits proinflammatory signaling. Accordingly, it is hypothesized that medications with PPARγ activity may have therapeutic potential in alcohol dependence. OBJECTIVES We conducted a double-blind, placebo-controlled mechanistic proof of principle study in alcohol-dependent inpatients to investigate the effect of pioglitazone on alcohol craving. METHODS Participants were treated for withdrawal, if needed, and then randomized to pioglitazone (target dose 45 mg/day) or placebo. Once at target dose, they completed two experimental manipulations: guided imagery, which used personalized auditory scripts to induce alcohol cravings, and a low-dose challenge with i.v. lipopolysaccharide (LPS; 0.8 ng/kg) or placebo, on two separate sessions, in counterbalanced order. Behavioral and endocrine responses as well as CSF levels of proinflammatory cytokines were evaluated. RESULTS The study was prematurely terminated after randomization of 16 subjects, following an independent review that established a high risk of myopathy in the active treatment group. Analysis of those who completed the study indicated that pioglitazone was associated with elevated, rather than suppressed alcohol cravings in response to alcohol-associated stimuli. LPS did not induce cravings for alcohol and thus did not lend itself to evaluating pioglitazone effects; however, pioglitazone increased the neuroendocrine stress response to LPS. CSF levels of IL-6, TNF-α, or MCP-1 were unaffected by pioglitazone treatment. CONCLUSIONS Both safety and efficacy biomarker data suggest that pioglitazone lacks potential as a medication for the treatment of alcohol dependence. CLINICAL TRIAL REGISTRATION NCT01631630.
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Affiliation(s)
- Melanie L Schwandt
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive, CRC 1-5330, Bethesda, MD, 20892, USA.
| | - Nancy Diazgranados
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive, CRC 1-5330, Bethesda, MD, 20892, USA
| | - John C Umhau
- Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration, Washington, DC, USA
| | - Laura E Kwako
- Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - David T George
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive, CRC 1-5330, Bethesda, MD, 20892, USA
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
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5
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Umhau JC. Therapeutic Drug Monitoring and the Clinical Significance of Naltrexone Blood Levels at the Time of a First Drink: Relevance to the Sinclair Method. Alcohol Alcohol 2019; 54:192. [PMID: 30861062 DOI: 10.1093/alcalc/agz014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- John C Umhau
- Alcohol Recovery Medicine, 10804 Rock Run Drive, Potomac, MD 20854, USA, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, United States, and Food and Drug Administration, Silver Spring, MD, United States
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6
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Yassine HN, Croteau E, Rawat V, Hibbeln JR, Rapoport SI, Cunnane SC, Umhau JC. DHA brain uptake and APOE4 status: a PET study with [1- 11C]-DHA. Alzheimers Res Ther 2017; 9:23. [PMID: 28335828 PMCID: PMC5364667 DOI: 10.1186/s13195-017-0250-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/28/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND The apolipoprotein E ɛ4 (APOE4) allele is the strongest genetic risk factor identified for developing Alzheimer's disease (AD). Among brain lipids, alteration in the ω-3 polyunsaturated fatty acid docosahexaenoic acid (DHA) homeostasis is implicated in AD pathogenesis. APOE4 may influence both brain DHA metabolism and cognitive outcomes. METHODS Using positron emission tomography, regional incorporation coefficients (k*), rates of DHA incorporation from plasma into the brain using [1-11C]-DHA (J in), and regional cerebral blood flow using [15O]-water were measured in 22 middle-aged healthy adults (mean age 35 years, range 19-65 years). Data were partially volume error-corrected for brain atrophy. APOE4 phenotype was determined by protein expression, and unesterified DHA concentrations were quantified in plasma. An exploratory post hoc analysis of the effect of APOE4 on DHA brain kinetics was performed. RESULTS The mean global gray matter DHA incorporation coefficient, k*, was significantly higher (16%) among APOE4 carriers (n = 9) than among noncarriers (n = 13, p = 0.046). Higher DHA incorporation coefficients were observed in several brain regions, particularly in the entorhinal subregion, an area affected early in AD pathogenesis. Cerebral blood flow, unesterified plasma DHA, and whole brain DHA incorporation rate (J in) did not differ significantly between the APOE groups. CONCLUSIONS Our findings suggest an increase in the DHA incorporation coefficient in several brain regions in APOE4 carriers. These findings may contribute to understanding how APOE4 genotypes affect AD risk.
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Affiliation(s)
- Hussein N Yassine
- Department of Medicine, University of Southern California, 2250 Alcazar Street, Room 210, Los Angeles, CA, 90033, USA.
| | - Etienne Croteau
- Research Center on Aging, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Varun Rawat
- Department of Medicine, University of Southern California, 2250 Alcazar Street, Room 210, Los Angeles, CA, 90033, USA
| | - Joseph R Hibbeln
- Section on Nutritional Neurosciences, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD, USA
| | - Stanley I Rapoport
- Brain Physiology and Metabolism Section, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Stephen C Cunnane
- Research Center on Aging, University of Sherbrooke, Sherbrooke, QC, Canada
| | - John C Umhau
- Section on Nutritional Neurosciences, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD, USA.,Division of Psychiatry Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, College Park, MD, USA
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Kirpich IA, McClain CJ, Vatsalya V, Schwandt M, Phillips M, Falkner KC, Zhang L, Harwell C, George DT, Umhau JC. Liver Injury and Endotoxemia in Male and Female Alcohol-Dependent Individuals Admitted to an Alcohol Treatment Program. Alcohol Clin Exp Res 2017; 41:747-757. [PMID: 28166367 DOI: 10.1111/acer.13346] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/30/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Interactions between the liver, the gut, and the immune system are critical components of alcoholic liver disease (ALD). The aim of this study was to explore the associations between alcohol-induced liver injury, endotoxemia, and inflammation at admission and over time during abstinence, as well as to examine the sex-related differences in these parameters in alcohol-dependent individuals admitted to an alcohol treatment program. METHODS A cohort of 48 otherwise healthy participants with alcohol use disorder, but no clinical signs of alcoholic liver injury (34 males [M]/14 females [F]) admitted to an alcohol detoxification program, was stratified into 2 groups based on baseline plasma alanine aminotransferase (ALT) levels (as a marker of liver injury). Group 1 (ALT < 40 U/l, 7M/8F) and Group 2 (ALT ≥ 40 U/l, 27M/6F) were identified. Plasma biomarkers of liver damage, endotoxemia, and inflammation were examined at baseline, day 8, and day 15 of the admission. The drinking history was also evaluated. RESULTS Sixty-nine percent of patients had elevated ALT and other markers of liver damage, including aspartate aminotransferase and cytokeratin 18 (CK18 M65 and CK M30) at baseline, indicating the presence of mild ALD. Elevated CK18 M65:M30 ratio suggested a greater contribution of necrotic rather than apoptotic hepatocyte cell death in the liver injury observed in these individuals. Females showed greater elevations of liver injury markers compared to males, although they had fewer drinks per day and shorter lifetime duration of heavy drinking. Liver injury was associated with systemic inflammation, specifically, elevated plasma tumor necrosis factor-alpha levels. Compared to patients without liver injury, patients with mild ALD had greater endotoxemia (increased serum lipopolysaccharide levels), which decreased with abstinence and this decrease preceded the drop in CK18 M65 levels. CONCLUSIONS The study documented the association of mild alcohol-induced liver injury and endotoxemia, which improved with 2 weeks of abstinence, in a subset of individuals admitted to an alcohol detoxification program.
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Affiliation(s)
- Irina A Kirpich
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky.,Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, Kentucky.,Robley Rex Veterans Medical Center, Louisville, Kentucky.,University of Louisville Alcohol Research Center, University of Louisville, Louisville, Kentucky.,University of Louisville Hepatobiology & Toxicology Program, University of Louisville, Louisville, Kentucky
| | - Craig J McClain
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky.,Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, Kentucky.,Robley Rex Veterans Medical Center, Louisville, Kentucky.,University of Louisville Alcohol Research Center, University of Louisville, Louisville, Kentucky.,University of Louisville Hepatobiology & Toxicology Program, University of Louisville, Louisville, Kentucky
| | - Vatsalya Vatsalya
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky.,University of Louisville Alcohol Research Center, University of Louisville, Louisville, Kentucky.,University of Louisville Hepatobiology & Toxicology Program, University of Louisville, Louisville, Kentucky.,National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Melanie Schwandt
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Monte Phillips
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Keith Cameron Falkner
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky.,University of Louisville Alcohol Research Center, University of Louisville, Louisville, Kentucky.,University of Louisville Hepatobiology & Toxicology Program, University of Louisville, Louisville, Kentucky
| | - Lucy Zhang
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Catey Harwell
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - David T George
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland.,George Washington University Hospital, Washington, District of Columbia
| | - John C Umhau
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland.,Food and Drug Administration, Silver Spring, Maryland
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8
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Umhau JC, Schwandt M, Solomon MG, Yuan P, Nugent A, Zarate CA, Drevets WC, Hall SD, George DT, Heilig M. Cerebrospinal fluid monocyte chemoattractant protein-1 in alcoholics: support for a neuroinflammatory model of chronic alcoholism. Alcohol Clin Exp Res 2014; 38:1301-6. [PMID: 24689518 DOI: 10.1111/acer.12367] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 12/17/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Liver inflammation in alcoholism has been hypothesized to influence the development of a neuroinflammatory process in the brain characterized by neurodegeneration and altered cognitive function. Monocyte chemoattractant protein-1/chemokine (C-C motif) ligand 2 (MCP-1/CCL2) elevations have been noted in the alcoholic brain at autopsy and may have a role in this process. METHODS We studied cerebrospinal fluid (CSF) levels of MCP-1 as well as interleukin-1β and tumor necrosis factor-α in 13 healthy volunteers and 28 alcoholics during weeks 1 and 4 following detoxification. Serum liver enzymes were obtained as markers of alcohol-related liver inflammation. RESULTS Compared to healthy volunteers, MCP-1 levels were significantly higher in alcoholics both on day 4 and day 25 (p < 0.0001). Using multiple regression analysis, we found that MCP-1 concentrations were positively associated with the liver enzymes gamma glutamyltransferase (GGT; p = 0.03) and aspartate aminotransferase/glutamic oxaloacetic transaminase (AST/GOT; p = 0.004). CONCLUSIONS These preliminary findings are consistent with the hypothesis that neuroinflammation as indexed by CSF MCP-1 is associated with alcohol-induced liver inflammation, as defined by peripheral concentrations of GGT and AST/GOT.
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Affiliation(s)
- John C Umhau
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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9
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Hirvonen J, Zanotti-Fregonara P, Umhau JC, George DT, Rallis-Frutos D, Lyoo CH, Li CT, Hines CS, Sun H, Terry GE, Morse C, Zoghbi SS, Pike VW, Innis RB, Heilig M. Reduced cannabinoid CB1 receptor binding in alcohol dependence measured with positron emission tomography. Mol Psychiatry 2013; 18:916-21. [PMID: 22776901 PMCID: PMC3594469 DOI: 10.1038/mp.2012.100] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 06/06/2012] [Accepted: 06/12/2012] [Indexed: 11/09/2022]
Abstract
Brain cannabinoid CB1 receptors contribute to alcohol-related behaviors in experimental animals, but their potential role in humans with alcohol dependence is poorly understood. We measured CB1 receptors in alcohol dependent patients in early and protracted abstinence, and in comparison with control subjects without alcohol use disorders, using positron emission tomography and [(18)F]FMPEP-d2, a radioligand for CB1 receptors. We scanned 18 male in-patients with alcohol dependence twice, within 3-7 days of admission from ongoing drinking, and after 2-4 weeks of supervised abstinence. Imaging data were compared with those from 19 age-matched healthy male control subjects. Data were also analyzed for potential influence of a common functional variation (rs2023239) in the CB1 receptor gene (CNR1) that may moderate CB1 receptor density. On the first scan, CB1 receptor binding was 20-30% lower in patients with alcohol dependence than in control subjects in all brain regions and was negatively correlated with years of alcohol abuse. After 2-4 weeks of abstinence, CB1 receptor binding remained similarly reduced in these patients. Irrespective of the diagnostic status, C allele carriers at rs2023239 had higher CB1 receptor binding compared with non-carriers. Alcohol dependence is associated with a widespread reduction of cannabinoid CB1 receptor binding in the human brain and this reduction persists at least 2-4 weeks into abstinence. The correlation of reduced binding with years of alcohol abuse suggests an involvement of CB1 receptors in alcohol dependence in humans.
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Affiliation(s)
- Jussi Hirvonen
- Molecular Imaging Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | | | - John C. Umhau
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD
| | - David T. George
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD
| | - Denise Rallis-Frutos
- Molecular Imaging Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | - Chul Hyoung Lyoo
- Molecular Imaging Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | - Cheng-Ta Li
- Molecular Imaging Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | - Christina S. Hines
- Molecular Imaging Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | - Hui Sun
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD
| | - Garth E. Terry
- Molecular Imaging Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | - Cheryl Morse
- Molecular Imaging Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | - Sami S. Zoghbi
- Molecular Imaging Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | - Victor W. Pike
- Molecular Imaging Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | - Robert B. Innis
- Molecular Imaging Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | - Markus Heilig
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD
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10
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Abstract
BACKGROUND Episodes of explosive rage and violence comprise a symptom complex which can have a devastating effect on a person's life. In the community this behavior is seen as workplace violence, domestic abuse and road rage, while in the clinical setting, this behavior is rarely mentioned by patients, despite evidence that it can signify an important biological disorder that may afflict more than three percent of the population. DISCUSSION Patients are often reluctant to seek help for episodic attacks of rage, especially attacks which are accompanied by physical violence. Although, in the past, clinicians have had few treatment options to offer, recent neuroscience advances have created new possibilities to understand and help patients with this neglected problem. No formal medical guidelines for treating violence exist; however, many patients can be helped by diagnosis, referral and treatment. Treatment can include pharmaceuticals and nutrients, as well as referral for anger management or behavioral therapy. SUMMARY The astute clinician has an opportunity to positively impact an important problem through the diagnosis and treatment of patients with symptoms of intermittent explosive disorder.
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Affiliation(s)
- John C Umhau
- Laboratory of Clinical and Translational Studies, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive, Building 10-CRC Hatfield Center, Room 1-5330, Bethesda, MD 20892-1108, USA.
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Umhau JC, Garg K, Woodward AM. Dietary supplements and their future in health care: commentary on draft guidelines proposed by the Food and Drug Administration. Antioxid Redox Signal 2012; 16:461-2. [PMID: 22181059 PMCID: PMC3260964 DOI: 10.1089/ars.2011.4402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Dietary Supplement and Health and Education Act of 1994 gives the U.S. Food and Drug Administration (FDA) responsibility for oversight of the dietary supplement industry. Recent draft guidelines proposed by the FDA to insure the safety of new dietary ingredients would significantly alter the ability of manufacturers to bring new dietary ingredients to market, and may cause many products introduced since 1994 to be discontinued. These changes will have an impact on health care, but with limited research on dietary supplements and how their use affects the health care system, there is no way to predict what their overall effect on health will be. Since the natural raw materials for dietary supplements are often inexpensive and generally cannot be patented, manufactures have little incentive to conduct the research which might otherwise be warranted. Appropriate clinical trials that evaluate the use and efficacy of various supplements may be critical for our health care system. If inexpensive dietary supplements are found to be safe and effective, such research could yield significant cost savings as well as health benefits.
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Affiliation(s)
- John C Umhau
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA.
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Umhau JC, Schwandt ML, Usala J, Geyer C, Singley E, George DT, Heilig M. Pharmacologically induced alcohol craving in treatment seeking alcoholics correlates with alcoholism severity, but is insensitive to acamprosate. Neuropsychopharmacology 2011; 36:1178-86. [PMID: 21289601 PMCID: PMC3077446 DOI: 10.1038/npp.2010.253] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Modulation of alcohol craving induced by challenge stimuli may predict the efficacy of new pharmacotherapies for alcoholism. We evaluated two pharmacological challenges, the α(2)-adrenergic antagonist yohimbine, which reinstates alcohol seeking in rats, and the serotonergic compound meta-chlorophenylpiperazine (mCPP), previously reported to increase alcohol craving in alcoholics. To assess the predictive validity of this approach, the approved alcoholism medication acamprosate was evaluated for its ability to modulate challenge-induced cravings. A total of 35 treatment seeking alcohol dependent inpatients in early abstinence were randomized to placebo or acamprosate (2997 mg daily). Following two weeks of medication, subjects underwent three challenge sessions with yohimbine, mCPP or saline infusion under double blind conditions, carried out in counterbalanced order, and separated by at least 5 days. Ratings of cravings and anxiety, as well as biochemical measures were obtained. In all, 25 subjects completed all three sessions and were included in the analysis. Cravings were modestly, but significantly higher following both yohimbine and mCPP challenge compared with saline infusion. The mCPP, but not yohimbine significantly increased anxiety ratings. Both challenges produced robust ACTH, cortisol and prolactin responses. There was a significant correlation between craving and the degree of alcoholism severity. Acamprosate administration did not influence craving. Both yohimbine and mCPP challenges lead to elevated alcohol craving in a clinical population of alcoholics, and these cravings correlate with alcoholism severity. Under the experimental conditions used, alcohol cravings induced by these two stimuli are not sensitive to acamprosate at clinically used doses.
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Affiliation(s)
- John C Umhau
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Melanie L Schwandt
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Julie Usala
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Christopher Geyer
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Erick Singley
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - David T George
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Markus Heilig
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA,Laboratory of Clinical and Translational Studies, NIAAA/NIH, 10 Center Dr, Bethesda, MD 20892-1108, USA. Tel: +1 301 435 9386; Fax: +1 301 402 044; E-mail:
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George DT, Phillips MJ, Lifshitz M, Lionetti TA, Spero DE, Ghassemzedeh N, Doty L, Umhau JC, Rawlings RR. Fluoxetine treatment of alcoholic perpetrators of domestic violence: a 12-week, double-blind, randomized, placebo-controlled intervention study. J Clin Psychiatry 2011; 72:60-5. [PMID: 20673556 PMCID: PMC3026856 DOI: 10.4088/jcp.09m05256gry] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 07/20/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Behaviorally based therapies for the treatment of perpetrators who initiate intimate partner violence (IPV) have generally shown minimal therapeutic efficacy. To explore a new treatment approach for IPV, we examined the effects of a selective serotonin reuptake inhibitor on the irritability subscale score of the Modified Overt Aggression Scale. This score served as a surrogate marker for the anger and physical aggression that characterize perpetrators of IPV. METHOD A 12-week, double-blind, randomized, placebo-controlled intervention study employing fluoxetine, alcohol treatment, and cognitive-behavioral therapy was performed. Sixty (46 men) non-court-mandated, DSM-IV-diagnosed alcoholic perpetrators of IPV with a history of at least 2 episodes of IPV in the year prior to participation in the study were evaluated. The primary outcome measure was the score on the irritability subscale of the Modified Overt Aggression Scale. Secondary measures included anxiety, depression, and ratings by the perpetrator's spouse/significant other. The study was conducted from January 2002 through December 2007. RESULTS A repeated-measures analysis of variance using the irritability subscale scores obtained from perpetrators who completed the 12-week study (n = 24) showed a significant drug effect (F(1,21) = 12.09, P = .002). Last observation carried forward (F(1,32) = 4.24, P = .048) as well as intent-to-treat analysis (F(1,54) = 5.0, P = .034) also showed a significant drug effect. Spouses'/significant others' physical and nonphysical Partner Abuse Scale ratings showed a significant reduction of abuse over time (F(1,11) = 10.2, P = .009 and F(1,11) = 24.2, P = .0005, respectively). CONCLUSION This is the first controlled study to show that a pharmacologic intervention employing a selective serotonin reuptake inhibitor, in conjunction with alcohol treatment and cognitive-behavioral therapy, can reduce measures of anger and physical aggression in alcoholic perpetrators of IPV.
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Umhau JC, Momenan R, Schwandt ML, Singley E, Lifshitz M, Doty L, Adams LJ, Vengeliene V, Spanagel R, Zhang Y, Shen J, George DT, Hommer D, Heilig M. Effect of acamprosate on magnetic resonance spectroscopy measures of central glutamate in detoxified alcohol-dependent individuals: a randomized controlled experimental medicine study. ACTA ACUST UNITED AC 2010; 67:1069-77. [PMID: 20921123 DOI: 10.1001/archgenpsychiatry.2010.125] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Acamprosate is approved for the treatment of alcoholism, but its mechanism of action remains unclear. Results of animal studies suggest that a persistent hyperglutamatergic state contributes to the pathogenesis of alcoholism and that acamprosate may exert its actions by intervening in this process. Human translation of these findings is lacking. OBJECTIVE To examine whether acamprosate modulates indices of central glutamate levels in recently abstinent alcohol-dependent patients as measured using proton nuclear magnetic resonance spectroscopy (¹H-MRS). DESIGN A 4-week, double-blind, placebo-controlled, randomized controlled experimental medicine study, with ¹H-MRS measures obtained on days 4 and 25. SETTING An inpatient research unit at the NIH Clinical Center. Patients Thirty-three patients who met the DSM-IV criteria for alcohol dependence and who were admitted for medically supervised withdrawal from ongoing alcohol use. Intervention Four weeks of acamprosate (initial oral loading followed by 1998 mg daily) or matched placebo, initiated at the time of admission. MAIN OUTCOME MEASURES The glutamate to creatine ratio as determined using single-voxel ¹H-MRS in the anterior cingulate. Exploratory neuroendocrine, biochemical, and behavioral outcomes were also collected, as were safety- and tolerability-related measures. RESULTS There was a highly significant suppression of the glutamate to creatine ratio across time by acamprosate (time × treatment interaction: F₁(,)₂₉ = 13.5, P < .001). Cerebrospinal fluid levels of glutamate obtained in a subset of patients 4 weeks into abstinence were uncorrelated with the MRS measures and unaffected by treatment but were strongly correlated (R² = 0.48, P < .001) with alcohol dependence severity. Other exploratory outcomes, including repeated dexamethasone-corticotropin-releasing hormone tests, and psychiatric ratings were unaffected. Among tolerability measures, gastrointestinal symptoms were significantly greater in acamprosate-treated individuals, in agreement with the established profile of acamprosate. CONCLUSION The MRS measures of central glutamate are reduced across time when acamprosate therapy is initiated at the onset of alcohol abstinence. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00106106.
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Affiliation(s)
- John C Umhau
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-1108, USA
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Pinto LA, Sullivan EL, Rosenbaum A, Wyngarden N, Umhau JC, Miller MW, Taft CT. Biological Correlates of Intimate Partner Violence Perpetration. Aggress Violent Behav 2010; 15:387-398. [PMID: 23393423 PMCID: PMC3564655 DOI: 10.1016/j.avb.2010.07.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An extensive literature documents biological correlates of general aggression, but there has been less focus on biological correlates of intimate partner violence (IPV). The purpose of this review is to summarize the research literature to date that has reported on biological factors in IPV perpetration. We review the existing literature on four domains of biological processes that have been examined with respect to IPV perpetration, including: head injury and neuropsychology; psychophysiology; neurochemistry, metabolism and endocrinology; and genetics. We critique the literature, discuss the clinical relevance of research findings, and provide some recommendations for future biologically-oriented IPV research.
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Affiliation(s)
- Lavinia A. Pinto
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA
| | | | - Alan Rosenbaum
- Department of Psychology, Northern Illinois University, DeKalb, Illinois
| | - Nicole Wyngarden
- Department of Psychology, Northern Illinois University, DeKalb, Illinois
| | - John C. Umhau
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
| | - Mark W. Miller
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Casey T. Taft
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
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Linday LA, Umhau JC, Shindledecker RD, Dolitsky JN, Holick MF. Cod Liver Oil, the Ratio of Vitamins A and D, Frequent Respiratory Tract Infections, and Vitamin D Deficiency in Young Children in the United States. Ann Otol Rhinol Laryngol 2010; 119:64-70. [DOI: 10.1177/000348941011900112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Umhau JC, Zhou W, Carson RE, Rapoport SI, Polozova A, Demar J, Hussein N, Bhattacharjee AK, Ma K, Esposito G, Majchrzak S, Herscovitch P, Eckelman WC, Kurdziel KA, Salem N. Imaging incorporation of circulating docosahexaenoic acid into the human brain using positron emission tomography. J Lipid Res 2008; 50:1259-68. [PMID: 19112173 DOI: 10.1194/jlr.m800530-jlr200] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Docosahexaenoic acid (DHA; 22:6n-3) is a critical constituent of the brain, but its metabolism has not been measured in the human brain in vivo. In monkeys, using positron emission tomography (PET), we first showed that intravenously injected [1-(11)C]DHA mostly entered nonbrain organs, with approximately 0.5% entering the brain. Then, using PET and intravenous [1-(11)C]DHA in 14 healthy adult humans, we quantitatively imaged regional rates of incorporation (K*) of DHA. We also imaged regional cerebral blood flow (rCBF) using PET and intravenous [(15)O]water. Values of K* for DHA were higher in gray than white matter regions and correlated significantly with values of rCBF in 12 of 14 subjects despite evidence that rCBF does not directly influence K*. For the entire human brain, the net DHA incorporation rate J(in), the product of K*, and the unesterified plasma DHA concentration equaled 3.8 +/- 1.7 mg/day. This net rate is equivalent to the net rate of DHA consumption by brain and, considering the reported amount of DHA in brain, indicates that the half-life of DHA in the human brain approximates 2.5 years. Thus, PET with [1-(11)C]DHA can be used to quantify regional and global human brain DHA metabolism in relation to health and disease.
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Affiliation(s)
- John C Umhau
- Laboratory of Clinical Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892, USA.
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Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF, Giovannucci E. Epidemic influenza and vitamin D. Epidemiol Infect 2006; 134:1129-40. [PMID: 16959053 PMCID: PMC2870528 DOI: 10.1017/s0950268806007175] [Citation(s) in RCA: 669] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2006] [Indexed: 12/28/2022] Open
Abstract
In 1981, R. Edgar Hope-Simpson proposed that a 'seasonal stimulus' intimately associated with solar radiation explained the remarkable seasonality of epidemic influenza. Solar radiation triggers robust seasonal vitamin D production in the skin; vitamin D deficiency is common in the winter, and activated vitamin D, 1,25(OH)2D, a steroid hormone, has profound effects on human immunity. 1,25(OH)2D acts as an immune system modulator, preventing excessive expression of inflammatory cytokines and increasing the 'oxidative burst' potential of macrophages. Perhaps most importantly, it dramatically stimulates the expression of potent anti-microbial peptides, which exist in neutrophils, monocytes, natural killer cells, and in epithelial cells lining the respiratory tract where they play a major role in protecting the lung from infection. Volunteers inoculated with live attenuated influenza virus are more likely to develop fever and serological evidence of an immune response in the winter. Vitamin D deficiency predisposes children to respiratory infections. Ultraviolet radiation (either from artificial sources or from sunlight) reduces the incidence of viral respiratory infections, as does cod liver oil (which contains vitamin D). An interventional study showed that vitamin D reduces the incidence of respiratory infections in children. We conclude that vitamin D, or lack of it, may be Hope-Simpson's 'seasonal stimulus'.
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Affiliation(s)
- J J Cannell
- Atascadero State Hospital, 10333 El Camino Real, Atascadero, CA 93422, USA.
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Umhau JC, Dauphinais KM, Patel SH, Nahrwold DA, Hibbeln JR, Rawlings RR, George DT. The relationship between folate and docosahexaenoic acid in men. Eur J Clin Nutr 2006; 60:352-7. [PMID: 16278690 DOI: 10.1038/sj.ejcn.1602321] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Docosahexaenoic acid (DHA, 22:6n-3), an essential omega 3 fatty acid, may protect against disorders of emotional regulation as well as cardiovascular disease. Animal studies demonstrate that dietary folate can increase tissue concentrations of DHA, although the literature, to date, includes no human studies examining the possibility that folate status may affect plasma DHA concentrations. The objective of this study is to determine if the blood concentrations of folate and DHA are correlated in humans. DESIGN Retrospective study. SETTING An American research hospital. SUBJECTS A total of 15 normal and 22 hostile and aggressive subjects, with a mean age of 38 years. METHODS Concentrations of plasma polyunsaturated essential fatty acids and red blood cell folate (RBC folate) were obtained prior to 1996, before American flour was enriched with folate. RESULTS RBC folate was significantly correlated with plasma DHA, r=0.57, P=0.005 in the aggressive group. Age, smoking and alcohol consumption did not alter the results. No other essential fatty acids were significantly associated with RBC folate in either group. CONCLUSIONS The positive relationship between plasma DHA and RBC folate concentrations suggests that these two nutrients should be examined together in order to make the most accurate inferences about their relative contributions to disease pathogenesis. Our findings present one explanation why some conditions associated with hostility and low DHA status, such as cardiovascular disease and emotional disorders, are also associated with low folate status. SPONSORSHIP National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- J C Umhau
- Laboratory of Clinical Studies, National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health, MD 20892-1108, USA.
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George DT, Phillips MJ, Doty L, Umhau JC, Rawlings RR. A model linking biology, behavior and psychiatric diagnoses in perpetrators of domestic violence. Med Hypotheses 2006; 67:345-53. [PMID: 16580153 DOI: 10.1016/j.mehy.2006.01.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Revised: 01/11/2006] [Accepted: 01/16/2006] [Indexed: 11/29/2022]
Abstract
Research indicates that perpetrators of domestic violence have abnormalities in central serotonin and testosterone metabolism, an increased sensitivity to anxiogenic stimuli, and an impaired neuro-connection between their cortex and the amygdala. Clinical evaluations show that perpetrators of domestic violence also have a distinguishing set of behaviors and diagnoses related to anxiety, depression, intermittent explosive disorder, and borderline personality disorder. In this paper we propose a model to understand how the biological abnormalities can potentially explain the behaviors and diagnoses exhibited by the perpetrators. Changes in the perpetrator's neurotransmitters lead to a heightened sensitivity to environmental stimuli, anxiety, and conditioned fear. Lack of cortical input to the amygdala impairs the perpetrator's ability to extinguish anxiety and/or conditioned fear and gives rise to either innate behaviors (e.g., fight, flight, and shut down) or learned fear avoidant behaviors designed to avoid anxiety (e.g., alcohol consumption, self-injurious acts, and obsessive behaviors). Linking conditioned fear and fear avoidance to the behaviors and psychiatric diagnoses will serve to change the way the medical community perceives and treats perpetrators of domestic violence.
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Affiliation(s)
- David T George
- Laboratory of Clinical and Translational Studies, DICBR, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 10 Center Drive MSC-1540, Bldg 10 - Hatfield CRC Room 2-2352, Bethesda, MD 20892-1540, USA.
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Hibbeln JR, Bissette G, Umhau JC, George DT. Omega-3 status and cerebrospinal fluid corticotrophin releasing hormone in perpetrators of domestic violence. Biol Psychiatry 2004; 56:895-7. [PMID: 15576068 DOI: 10.1016/j.biopsych.2004.08.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Revised: 08/17/2004] [Accepted: 08/30/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND Elevated levels of corticotrophin-releasing hormone in the cortical-hippocampal-amygdala pathway increase fear and anxiety, which are components of defensive and violent behaviors. Prostaglandins E2 and F2alpha, which increase corticotrophin-releasing hormone RNA expression in this pathway, are reduced by dietary intakes of omega-3 fats. METHODS Among 21 perpetrators of domestic violence, cerebrospinal fluid and plasma were assessed for corticotrophin-releasing hormone and fatty acid compositions, respectively. RESULTS Lower plasma docosahexaenoic acid (wt% fatty acids) alone predicted greater cerebrospinal fluid corticotrophin-releasing hormone (pg/mL), in exponential (r = -.67, p < .006) and linear regressions (r = -0.68, p < .003 excluding four subjects with the highest docosahexaenate levels). CONCLUSIONS In this small observational study, low plasma docosahexaenoic acid levels were correlated to higher cerebrospinal fluid corticotrophin-releasing hormone levels. Placebo controlled trials can determine if dietary omega-3 fatty acids can reduce excessive corticotrophin-releasing hormone levels in psychiatric illnesses.
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Affiliation(s)
- Joseph R Hibbeln
- Laboratory of Membrane Biophysics and Biochemistry, National Institute on Alcohol Abuse and Alcoholism, NIH, Rockville, MD 20852, USA.
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George DT, Rawlings RR, Williams WA, Phillips MJ, Fong G, Kerich M, Momenan R, Umhau JC, Hommer D. A select group of perpetrators of domestic violence: evidence of decreased metabolism in the right hypothalamus and reduced relationships between cortical/subcortical brain structures in position emission tomography. Psychiatry Res 2004; 130:11-25. [PMID: 14972365 DOI: 10.1016/s0925-4927(03)00105-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2002] [Revised: 06/24/2003] [Accepted: 07/22/2003] [Indexed: 11/19/2022]
Abstract
In an earlier study, we reported that some perpetrators of domestic violence evidenced exaggerated fear-related responses to the panicogenic agent sodium lactate. In the current study, we employed positron emission tomography (PET) to investigate our hypothesis that there are differences in the neural structures and/or pathways that mediate and control the expression of fear-induced aggression in perpetrators of domestic violence. Regional cerebral glucose metabolism was measured in eight male perpetrators of domestic violence who fulfilled DSM-III-R criteria for alcohol dependence (DV-ALC), 11 male participants who fulfilled DSM-III-R criteria for alcohol dependence and had no history of interpersonal aggression (ALC) and 10 healthy male participants who did not fulfill criteria for any DSM-III-R axis I diagnosis and had no history of interpersonal aggression (HCS). DV-ALC had a significantly lower mean glucose uptake in the right hypothalamus compared to ALC and HCS. Correlations were performed between measures of glucose utilization in the brain structures involved in fear-induced aggression. The comparison of DV-ALC to HCS and to ALC differed in six and seven comparisons, respectively, involving various cortical and subcortical structures. HCS and ALC differed between the left thalamus and the left posterior orbitofrontal cortex. These PET findings show that some perpetrators of domestic violence differ from control participants in showing lower metabolism in the right hypothalamus and decreased correlations between cortical and subcortical brain structures. A possible psychological covariate of these changes in regional activity might be fear-induced aggression, but this hypothesis should be examined in larger study groups that undergo provocation during imaging.
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Affiliation(s)
- David T George
- Laboratory of Clinical Studies, DICBR, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive, MSC-1610, Building 10, Room 6S-240, Bethesda, MD 20892-1610, USA.
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Umhau JC, Petrulis SG, Diaz R, Rawlings R, George DT. Blood glucose is correlated with cerebrospinal fluid neurotransmitter metabolites. Neuroendocrinology 2003; 78:339-43. [PMID: 14688447 DOI: 10.1159/000074887] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2003] [Accepted: 10/13/2003] [Indexed: 11/19/2022]
Abstract
Medications which influence monoaminergic neurotransmission can also have an effect on glucose regulation. In order to better understand the role of central monoaminergic neurotransmission in blood glucose homeostasis, we explored the relation between blood glucose and cerebrospinal fluid metabolite concentrations of monoaminergic neurotransmitters. Under stringently controlled resting conditions, we measured fasting blood glucose and performed lumbar punctures on 41 healthy participants. Peripheral blood glucose concentrations were significantly correlated with the cerebrospinal fluid concentrations of the dopamine metabolite, homovanillic acid and the noradrenaline metabolite, 3-methoxy-4-hydroxyphenylglycol. These correlations may represent a homeostatic relation between brain neurotransmitter activity and blood glucose.
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Affiliation(s)
- John C Umhau
- Laboratory of Clinical Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-1610, USA.
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Umhau JC, Petrulis SG, Diaz R, Riggs PA, Biddison JR, George DT. Long-term abstinent alcoholics have a blunted blood glucose response to 2-Deoxy-d-glucose. Alcohol Alcohol 2002; 37:586-90. [PMID: 12414552 DOI: 10.1093/alcalc/37.6.586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS In this study we explored the relationship between alcohol and carbohydrate consumption in long-term abstinent alcoholics. METHODS We employed an established laboratory paradigm which allowed us to stimulate and measure dietary intake. 2-Deoxy-d-glucose (2-DG) is a glucose analogue that causes an intracellular energy deprivation resulting in exaggerated food consumption and a compensatory metabolic response to raise blood glucose. Using a double-blind design, we gave an infusion of 25 mg/kg 2-DG or placebo to 20 long-term abstinent alcoholics and 19 healthy volunteers. RESULTS There were no baseline differences in any dietary, behavioural or biochemical variables. As expected, 2-DG increased caloric consumption and blood glucose levels in a time-dependent fashion. There were no differences in food consumption between the alcoholics and the healthy volunteers following the 2-DG stimulus. However, the alcoholic group had a significantly blunted response in blood glucose. CONCLUSIONS The origin of this atypical blood glucose response may antedate the onset of alcoholism, or it may be secondary to alcohol-related damage that persists beyond 6 months. Previous accounts of increased sweet consumption in alcoholics were not substantiated, although they may be present in the peri-withdrawal period.
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Affiliation(s)
- John C Umhau
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892-1610, USA
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Umhau JC, George DT, Reed S, Petrulis SG, Rawlings R, Porges SW. Atypical autonomic regulation in perpetrators of violent domestic abuse. Psychophysiology 2002; 39:117-23. [PMID: 12212660 DOI: 10.1017/s0048577202990669] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Perpetrators of domestic violence describe symptoms that are compatible with exaggerated autonomic arousal at the time of the domestic violence. This inappropriate arousal may be reflected in altered heart rate regulation. If heart rate is systematically regulated by vagal mechanisms, then increases in heart rate should correlate with decreases in cardiac vagal activity, as indexed by respiratory sinus arrhythmia (RSA). We hypothesized that perpetrators of domestic violence have an alteration in heart rate regulation. To test this hypothesis we compared the results of a postural shift performed on perpetrators, healthy volunteers, and nonviolent alcoholics. Results showed there were no significant differences in heart rate, RSA, or catecholamines. However, the significant inverse relationship between posture-elicited changes in RSA and heart rate present in the healthy volunteers was not found in perpetrators. These differences in the covariation between heart rate and RSA may represent differences in the neural regulation of heart rate and may be related to difficulties in controlling autonomic state.
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Affiliation(s)
- John C Umhau
- Laboratory of Clinical Studies, DICBR, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892, USA.
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Umhau JC, George DT, Reed S, Petrulis SG, Rawlings R, Porges SW. Atypical autonomic regulation in perpetrators of violent domestic abuse. Psychophysiology 2002. [DOI: 10.1111/1469-8986.3920117] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
In a previous study we administered the panicogenic agent sodium lactate to a select group of perpetrators of domestic violence and comparison groups. Results of that study showed that perpetrators exhibited exaggerated lactate-induced fear, panic and rage. In this current study, we compared the cerebral spinal fluid (CSF) concentrations of 5-hydroxyindoleacetic acid (5-HIAA) and testosterone obtained from perpetrators of domestic violence and a group of healthy comparison subjects. All subjects were assessed for DSM-III-R diagnoses. Perpetrators with alcohol dependence (DV-ALC) (n=13), perpetrators without alcohol dependence (DV-NALC) (n=10) and healthy comparison subjects (HCS) (n=20) were clinically assessed using the Spielberger Trait Anxiety, Brown-Goodwin Aggression Scale, Buss Durkee Hostility Inventory and Straus Conflict Tactics. Following an overnight fast and bed rest, subjects received a lumbar puncture to obtain CSF concentrations of 5-HIAA and testosterone. Perpetrators scored significantly higher on measures of aggression than HCS. DV-NALC had significantly lower concentrations of CSF 5-HIAA and higher Straus Conflict Tactics (CT) physical violence scores than DV-ALC and HCS. DV-ALC had significantly higher concentrations of CSF testosterone than DV-NALC. DV-ALC also had significantly higher Straus CT physical violence scores than HCS. DV-NALC and DV-ALC differed on 5-HIAA concentrations, testosterone concentrations, Straus CT physical violence scores and alcohol dependence. These results suggest that DV-NALC and DV-ALC groups could have different biological mechanisms mediating domestic violence.
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Affiliation(s)
- D T George
- Laboratory of Clinical Studies, DICBR, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA.
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Umhau JC, Petrulis SG, Diaz R, Biddison JR, George DT. Hypothalamic Function in Response to 2-Deoxy-d-Glucose in Long-Term Abstinent Alcoholics. Alcohol Clin Exp Res 2001. [DOI: 10.1111/j.1530-0277.2001.tb02279.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Umhau JC, Petrulis SG, Diaz R, Biddison JR, George AD. Hypothalamic function in response to 2-deoxy-D-glucose in long-term abstinent alcoholics. Alcohol Clin Exp Res 2001; 25:781-6. [PMID: 11371728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND The body adapts to diverse stressful stimuli with a response characterized by activation of the hypothalamic-pituitary-adrenal (HPA) axis. Chronic alcohol consumption can cause changes in the function of this neuroendocrine system. Although many studies have examined this phenomenon in drinking and recently sober alcoholics, few studies have examined HPA axis function in long-term sober alcoholics. METHODS To characterize HPA axis function in long-term sober alcoholics, we used a challenge paradigm with 2-deoxy-d-glucose (2-DG). An infusion of 2-DG (a nonmetabolizable glucose analog) induces a well-characterized stress response. In a previous study, our laboratory found an exaggerated corticotropin and cortisol response in alcoholics abstinent 3 weeks; in this investigation we compared the effects of an infusion of 2-DG on 19 healthy volunteers and 20 community-living alcoholics who had been abstinent more than 6 months. RESULTS In contrast to the previous study, long-term sober alcoholics did not have an exaggerated corticotropin and cortisol response after 2-DG. CONCLUSIONS Previously observed abnormalities in cortisol regulation in 3-week-sober alcoholics may be related to the acute effects of recent alcohol consumption and withdrawal. Future investigations into the metabolic function of alcoholics, particularly investigations involving the HPA system, should consider the possibility that normalization may not occur until long-term abstinence has been achieved.
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Affiliation(s)
- J C Umhau
- National Institute on Alcohol Abuse and Alcoholism Bethesda, Maryland 20892-1610, USA.
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Affiliation(s)
- J R Hibbeln
- Laboratory of Membrane Biochemistry and Biophysics, DICBR, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md., USA
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George DT, Hibbeln JR, Ragan PW, Umhau JC, Phillips MJ, Doty L, Hommer D, Rawlings RR. Lactate-induced rage and panic in a select group of subjects who perpetrate acts of domestic violence. Biol Psychiatry 2000; 47:804-12. [PMID: 10812039 DOI: 10.1016/s0006-3223(99)00300-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Perpetrators of domestic violence frequently report symptoms of autonomic arousal and a sense of fear and/or loss of control at the time of the violence. Since many of these symptoms are also associated with panic attacks, we hypothesized that perpetrators of domestic violence and patients with panic attacks may share similar exaggerated fear-related behaviors. To test this hypothesis, we employed the panicogenic agent sodium lactate to examine the response of perpetrators to anxiety fear induced by a chemical agent. METHODS Using a double-blind, placebo-controlled design, we infused 0.5 mol/L sodium lactate or placebo over 20 min on separate days to a select group of subjects who perpetrate acts of domestic violence and two nonviolent comparison groups. We compared their behavioral, neuroendocrine, and physiologic responses. RESULTS Lactate administration elicited intense emotional responses in the perpetrators of domestic violence. Perpetrators evidenced more lactate-induced rage and panic and showed greater changes in speech, breathing, and motor activity than did nonviolent control subjects. There were no significant differences between the groups for any neuroendocrine or physiologic measure. CONCLUSIONS These results are consistent with our hypothesis that some perpetrators of domestic violence have exaggerated fear-related behavioral responses.
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Affiliation(s)
- D T George
- Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892-1610, USA
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Hibbeln JR, Umhau JC, George DT, Shoaf SE, Linnoila M, Salem N. Plasma total cholesterol concentrations do not predict cerebrospinal fluid neurotransmitter metabolites: implications for the biophysical role of highly unsaturated fatty acids. Am J Clin Nutr 2000; 71:331S-8S. [PMID: 10617992 DOI: 10.1093/ajcn/71.1.331s] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Low concentrations of a metabolite of serotonin found in cerebrospinal fluid (CSF), 5-hydroxyindolacetic acid (5-HIAA), are strongly associated with suicidal and violent behaviors. Although lowering of plasma total cholesterol has been suggested to increase mortality from suicide and violence by decreasing concentrations of CSF 5-HIAA via changes in membrane biophysical properties, highly unsaturated fatty acids may play a more important role. Violent and nonviolent comparison groups, early- and late-onset alcoholics, and healthy comparison subjects were studied to control for alcohol use and predisposition to violence. Fasting plasma total cholesterol and CSF were assayed under stringently controlled conditions. When all groups were combined (n = 234), plasma cholesterol concentrations had a weak positive correlation with CSF 5-HIAA (r = 0.18, P < 0.01). However, age correlated with both plasma total cholesterol and CSF 5-HIAA concentrations. When age was included in multiple regression models, the correlation between cholesterol and CSF 5-HIAA concentrations was not significant. Cholesterol correlated weakly with CSF 5-HIAA concentrations only in late-onset alcoholics after age was controlled for, but the relation was not significant after correction for multiple testing. CSF homovanillic acid did not correlate with plasma total cholesterol in any group. Plasma total cholesterol had no apparent relation to CSF neurotransmitter metabolites in any group of subjects. Highly unsaturated essential fatty acids, which are also critical determinants of membrane biophysical properties and may be linked to brain serotonin concentrations, should also be considered in studies examining the effect of lowering fat intake on the incidence of suicide and violence.
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Affiliation(s)
- J R Hibbeln
- Laboratories of Membrane Biochemistry and Biophysics and Clinical Studies, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20852, USA
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Lombardi WJ, Andreason PJ, Sirocco KY, Rio DE, Gross RE, Umhau JC, Hommer DW. Wisconsin Card Sorting Test performance following head injury: dorsolateral fronto-striatal circuit activity predicts perseveration. J Clin Exp Neuropsychol 1999; 21:2-16. [PMID: 10420997 DOI: 10.1076/jcen.21.1.2.940] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The Wisconsin Card Sorting Test (WCST) has been argued to be a sensitive indicator of frontal lobe function. However, several recent studies have failed to find a consistent relationship between structural damage to this cortical area and perseveration on the test. In the present study, positron emission tomography (PET) imaging with 18F-fluorodeoxyglucose was used to examine the relationship of regional brain metabolism to perseverative responding on the WCST in patients with a history of closed-head injury. An inverse relationship was found between perseverative responses and metabolism in the right, but not the left, dorsolateral prefrontal cortex and caudate nucleus. Perseverative responding was not related to metabolism in several other regions of the frontal lobes and basal ganglia, including the putamen and the frontal poles bilaterally. These data suggest that the functional integrity of the right dorsolateral frontal-subcortical circuit is critical for WCST performance.
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Affiliation(s)
- W J Lombardi
- Laboratory of Clinical Studies, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
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Hibbeln JR, Umhau JC, Linnoila M, George DT, Ragan PW, Shoaf SE, Vaughan MR, Rawlings R, Salem N. A replication study of violent and nonviolent subjects: cerebrospinal fluid metabolites of serotonin and dopamine are predicted by plasma essential fatty acids. Biol Psychiatry 1998; 44:243-9. [PMID: 9715355 DOI: 10.1016/s0006-3223(98)00143-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Among an independent group of subjects selected for their history of violent, impulsive behaviors and nonviolent control subjects, we attempted to replicate the finding that plasma docosahexaenoic acid concentrations were negatively correlated with cerebrospinal fluid 5-hydroxyindoleacetic acid (CSF 5-HIAA) concentrations. METHODS CSF 5-HIAA and homovanillic acid (HVA), fasting total cholesterol, and plasma fatty acid concentrations were examined in violent and nonviolent subjects matched for their severity of alcohol dependence. RESULTS Violent subjects had significantly higher lifetime violence and hostility ratings and lower concentrations of CSF 5-HIAA than nonviolent subjects. Plasma docosahexaenoic acid was negatively correlated with CSF 5-HIAA only among violent subjects. CONCLUSIONS This observational study suggests that dietary essential fatty acids may change neurotransmitter concentrations. Prospective dietary intervention trials will be required to determine if increasing dietary intake of docosahexaenoic acid will increase or decrease either CSF 5-HIAA concentrations or impulsive and violent behaviors.
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Affiliation(s)
- J R Hibbeln
- Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
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Hibbeln JR, Linnoila M, Umhau JC, Rawlings R, George DT, Salem N. Essential fatty acids predict metabolites of serotonin and dopamine in cerebrospinal fluid among healthy control subjects, and early- and late-onset alcoholics. Biol Psychiatry 1998; 44:235-42. [PMID: 9715354 DOI: 10.1016/s0006-3223(98)00141-3] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Impulsive violence, suicide, and depression are strongly associated with low concentrations of cerebrospinal fluid 5-hydroxyindoleacetic acid (CSF 5-HIAA). Increased suicide and trauma reported in some cholesterol-lowering trials may be related to altered concentrations of polyunsaturated fatty acids rather than cholesterol, a possible surrogate marker. METHODS CSF 5-HIAA and homovanillic acid (HVA), total cholesterol, and plasma fatty acid concentrations were examined in 176 subjects, including 49 healthy volunteers, and 88 early- and 39 late-onset alcoholics. RESULTS Among each group, polyunsaturated fatty acids predicted both CSF 5-HIAA and CSF HVA concentrations, but total cholesterol was unrelated to either neurotransmitter metabolite. The relationships between plasma 22: 6n3 and CSF 5-HIAA were significantly different when healthy volunteers (r = .35) were compared to early-onset alcoholics (r = -.38) (p < .0002). CONCLUSIONS Dietary studies are indicated to determine if essential fatty acid supplementation can influence central nervous system serotonin and dopamine metabolism and modify impulsive behaviors related to these neurotransmitters.
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Affiliation(s)
- J R Hibbeln
- Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
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Umhau JC. Re: "Heart rate variability from short electrographic recordings predicts mortality from all causes in middle-aged and elderly men: the Zutphen Study". Am J Epidemiol 1998; 147:511. [PMID: 9525539 DOI: 10.1093/oxfordjournals.aje.a009478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Umhau JC. Breast feeding and other aspects of infant nutrition. Am Fam Physician 1997; 55:785. [PMID: 9048501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Umhau TH, Umhau JC, Morgan RE. National and International Health Agencies. Infect Dis Clin North Am 1991. [DOI: 10.1016/s0891-5520(20)30733-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Umhau TH, Umhau JC, Morgan RE. National and international health agencies. Profile of key players. Infect Dis Clin North Am 1991; 5:197-220. [PMID: 1869806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The major players in international health and health policy have a tremendous potential to contribute to the wellbeing of humankind. Multilateral organizations, such as WHO, have universal areas of concern. The financial multilateral agencies play a key role in influencing development through the leverage of financial resources. Bilateral agencies of donor countries influence health policy direction by the magnitude of their financial resources. Private organizations, including universities, foundations, professional associations, nongovernmental organizations, and US industry, play an important role in identifying important policy issues through research, designing and developing appropriate technology, and acquiring the knowledge base necessary to form sound international health policy decisions.
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Affiliation(s)
- T H Umhau
- National Council for International Health Policy, Bethesda, Maryland
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