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Biomedical subjects

D H Ryan

Publications and source records attributed to D H Ryan.

At least 37 records · Page 2Linked to original sources
PubMed2000

Use of sibutramine and other noradrenergic and serotonergic drugs in the management of obesity.

Drugs that act through noradrenergic and serotonergic mechanisms have historically served as the mainstays of pharmacologic treatments for obesity. This review addresses the following three topics: a brief discussion of older weight loss medications approved for short-term use (benzphetamine, phendimetrazine, diethylpropion, mazindol, and phentermine), as well as over-the-counter adrenergic drugs (phenylpropanolamine and ephedrine); recent clinical studies documenting the safety and efficacy of a new medication for obesity treatment, sibutramine, recently approved by the Food and Drug Administration for long-term use; and recent studies characterizing the valvulopathy associated with fenfluramine and dexfenfluramine, serotonergic medications for obesity which have been removed from the markets.

Adrenergic Agents↗
PubMed1999

Effects of dietary patterns on blood pressure: subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial.

OBJECTIVE: To determine the effects of dietary patterns on blood pressure in subgroups. METHODS: Dietary Approaches to Stop Hypertension (DASH) was a randomized controlled feeding study conducted at 4 academic medical centers. Participants were 459 adults with untreated systolic blood pressure less than 160 mm Hg and diastolic blood pressure 80 to 95 mm Hg. For 3 weeks, participants were fed a "control" diet. They were then randomized to 8 weeks of (1) control diet; (2) a diet rich in fruits and vegetables; or (3) a combination diet rich in fruits, vegetables, and low-fat dairy foods, and reduced in saturated fat, total fat, and cholesterol (the DASH combination diet). Weight and salt intake were held constant. Change in diastolic blood pressure was the primary outcome variable, and systolic blood pressure a secondary outcome. Subgroups analyzed included race, sex, age, body mass index, years of education, income, physical activity, alcohol intake, and hypertension status. RESULTS: The combination diet significantly lowered systolic blood pressure in all subgroups (P<.008), and significantly lowered diastolic blood pressure (P<.01) in all but 2 subgroups. The fruits-and-vegetables diet also reduced blood pressure in the same subgroups, but to a lesser extent. The combination diet lowered systolic blood pressure significantly more in African Americans (6.8 mm Hg) than in whites (3.0 mm Hg), and in hypertensive subjects (11.4 mm Hg) than in nonhypertensive subjects (3.4 mm Hg) (P<.05 for both interactions). CONCLUSIONS: The DASH combination diet, without sodium reduction or weight loss, significantly lowered blood pressure in virtually all subgroups examined, and was particularly effective in African Americans and those with hypertension. The DASH combination diet may be an effective strategy for preventing and treating hypertension in a broad cross section of the population, including segments of the population at highest risk for blood pressure-related cardiovascular disease.

Adult↗
PubMed1999

Serial echocardiographic and clinical evaluation of valvular regurgitation before, during, and after treatment with fenfluramine or dexfenfluramine and mazindol or phentermine.

OBJECTIVE: The prevalence of cardiac valvular regurgitation demonstrated by echocardiography in patients who took appetite-suppressant medication for weight loss has been assessed at 5%-30%. We studied 86 patients who had echocardiograms before treatment with appetite suppressants to determine the incidence of new cases and to evaluate the clinical implication of the echocardiographic findings. RESEARCH METHODS AND PROCEDURES: We studied 69 men [Mean+/-Standard Deviation (S) age 49+/-8] and 17 women (mean+/-S age 50+/-7) who had 233 echocardiograms before, during, and after a weight-loss program that used predominantly fenfluramine (or dexfenfluramine) with mazindol (or phentermine). Mean drug exposure was 17 months. Blinded echocardiographic readings were performed to identify and grade aortic regurgitation (AR) or mitral regurgitation (MR). RESULTS: Seven of 86 patients (8%) had pre-existing regurgitation with five (6%) meeting our case definition. Thirteen (16.5%) of initially normal patients developed valvular regurgitation and were new cases. Of the new cases, 12 were grade I/IV AR and one was both grade II/III MR and II/IV AR. All 13 patients were asymptomatic, and only two aortic insufficiency murmurs could be auscultated. There was significantly greater risk for developing valvulopathy for those who took medications longer than 6 months (p = 0.03), and no new cases were observed in patients exposed for less than 8 months. No increased risk associated with age, presence of hypertension, or exposure to fenfluramine-phentermine combination was demonstrated. Although there was a higher incidence of new regurgitation in women (31% vs. 13% for men), this was not statistically significant (p = 0.093). DISCUSSION: Some patients who had normal echocardiograms at baseline developed cardiac valvular regurgitation after exposure to fenfluramine or dexfenfluramine with mazindol or phentermine. The development of valvulopathy was significantly correlated with duration of exposure. The clinical implications of echocardiographically demonstrated regurgitation are uncertain, since there were only two audible murmurs and no other clinically relevant signs or symptoms among the patients.

Aortic Valve Insufficiency↗
PubMed1999

Sibutramine produces dose-related weight loss.

OBJECTIVE: Sibutramine is a weight control drug that inhibits the reuptake of both serotonin and norepinephrine. In animals, it reduces food intake and increases thermogenesis and preliminary data in human beings showed weight loss. This paper reports a 24-week dose-ranging study to determine the effect of sibutramine on body weight of patients with obesity. RESEARCH METHODS AND PROCEDURES: Seven clinical centers screened 1463 patients with obesity and randomized 1047 to 24 weeks of treatment with 1 of 6 doses of sibutramine (1, 5, 10, 15, 20, or 30 mg) or placebo once daily. Six hundred eighty-three patients completed the study. A two-week placebo run-in period was used to initiate a standardized program of diet, physical activity, and lifestyle changes. RESULTS: Weight loss was dose-related and statistically significant vs. placebo (p<0.05) across all time-points for a 5 mg/day to 30 mg/day dosage of sibutramine. At week 24, percent weight loss from baseline for completers was: placebo, 1.2%; 1 mg, 2.7%; 5 mg, 3.9%; 10 mg, 6.1%; 15 mg, 7.4%; 20 mg, 8.8%; and 30 mg, 9.4%. Weight loss achieved at week 4 was predictive of weight loss achieved at week 24. Patients losing weight demonstrated an increase in serum high density lipoprotein cholesterol and reductions in serum triglycerides, total cholesterol, low density lipoprotein cholesterol, and uric acid. Small mean increases in blood pressure and pulse rate (with considerable individual variability) were observed in patients treated with sibutramine. The most frequent adverse events were dry mouth, anorexia, and insomnia. DISCUSSION: Sibutramine administered once daily for 24 weeks in the weight loss phase of treatment for uncomplicated obesity produced dose-related weight loss and was well tolerated. Improvements in serum lipids and uric acid accompany sibutramine-induced weight loss. Most of the adverse events observed on sibutramine are related to its pharmacology, including small mean increases in blood pressure and heart rate.

Adult↗
PubMed1999

Pharmaceutical cost savings of treating obesity with weight loss medications.

OBJECTIVE: To evaluate, in compliant patients, the pharmaceutical costs of treating obesity with fenfluramine/mazindol, fenfluramine/phentermine, caffeine/ephedrine, or mazindol relative to the pharmaceutical costs of treating obesity-related comorbid conditions and reducing cardiovascular risk. METHODS AND PROCEDURES: Subjects were between 18 and 60 years of age with a BMI of >30 kg/m2. Pharmaceutical costs were evaluated in 73 of 220 subjects taking medications for diabetes, hyperlipidemia, or hypertension before and after treatment using fenfluramine with mazindol or phentermine. The pharmaceutical cost of weight loss, cardiac risk reduction, and low-density lipoprotein (LDL) cholesterol reduction was calculated for fenfluramine with mazindol or phentermine, caffeine with ephedrine, or mazindol alone, and compared to approved lipid-lowering medications. RESULTS: Losses of 6% to 10% of initial body weight reduced pharmacy costs $122.64/month for insulin treated diabetes, $42.92/month for sulfonylurea-treated diabetes, $61.07/month for hyperlipidemia treated with medication, and $0.20/month for hypertension treated with medication. Blood pressure and laboratory evidence of insulin resistance improved in all medication groups. Caffeine/ephedrine was most cost-effective of the three treatments in reducing weight, cardiac risk, and LDL cholesterol. DISCUSSION: Obesity medications produced a substantial weight loss in compliant patients and resulted in a net pharmaceutical cost savings compared to treating obesity related comorbid conditions.

Adolescent↗
PubMed1999

Flexible vs. Rigid dieting strategies: relationship with adverse behavioral outcomes.

This study was designed to test the hypothesis that different types of dieting strategies are associated with different behavioral outcomes by investigating the relationship of dieting behaviors with overeating, body mass and mood. A sample of 223 adult male and female participants from a large community were studied. Only a small proportion of the sample (18%) was seeking weight loss treatment, though almost half (49.3%) of the subjects were significantly overweight (body mass index, BMI>30). Subjects were administered questionnaires measuring dietary restraint, overeating, depression and anxiety. Measurements of height and weight were also obtained in order to calculate BMI. Canonical correlation was performed to evaluate the relationship of dietary restraint variables with overeating variables, body mass, depression and anxiety. The strongest canonical correlation (r=0.65) was the relationship between flexible dieting and the absence of overeating, lower body mass and lower levels of depression and anxiety. The second strongest canonical correlation (r=0.59) associated calorie counting and conscious dieting with overeating while alone and increased body mass. The third canonical correlation (r=0.57) found a relationship between low dietary restraint and binge eating. The results support the hypothesis that overeating and other adverse behaviors and moods are associated with the presence or absence of certain types of dieting behavior.

Adult↗
PubMed1999

The effects of paradoxical sleep deprivation and valine on spatial learning and brain 5-HT metabolism.

We have previously reported that rapid eye movement sleep deprivation (REMSD), induced by the flower pot technique, causes a deficit in reference spatial memory and increases rates of serotonin (5-HT) metabolism in the brain. In this study we used increased concentrations of dietary valine to inhibit tryptophan (TRP) transport across the blood-brain barrier in an attempt to modify the REMSD-induced increase of 5-HT metabolism. Rats were fed either a control diet or the same diet supplemented to 2% by weight valine, and were allocated to one of three experimental groups: cage control (CC), stress tank control (TC), or REMSD. Reference and working spatial memory of all rats was tested in a Morris water maze on Days 2, 3, and 4. REMSD produced a significant decrement in reference memory on Days 2 and 4, independent of dietary condition. The valine diet had a detrimental effect on the reference memory of TC rats on Day 2 but not Day 4. Measurements made on Day 4 indicated that the valine diet decreased brain TRP only in the CC rats. In contrast, the valine diet did not prevent increases in brain TRP or 5-HT metabolism in REMSD rats, and increased hypothalamic and brain stem TRP concentrations and the hippocampal 5-HIAA/5-HT ratio in TC rats. These results indicate that dietary valine does not prevent REMSD-induced changes in spatial memory or serotonin metabolism, although it does reduce brain TRP in nonstressed rats.

Animals↗
PubMed1999

Neuroautoantibody immunoreactivity in relation to aging and stress in apolipoprotein E-deficient mice.

Progressive disruption of both the neuroendocrine and immune systems has been correlated with age-associated pathogenesis in patients with Alzheimer's disease and in mice lacking apolipoprotein E (ApoE). In this study, we examined neuroautoimmune and neuroendocrine activities in relation to aging and stress in ApoE-deficient mice. An elevated level of autoantibodies against brain antigens was found in sera from ApoE-deficient mice compared to that of wild-type mice as early as 7-8 weeks of age. However, there was no significant difference between the two genotypes at this age in the effect of stress on serum corticosterone or autoantibody titers. Higher titers of autoantibodies were observed in approximately 12-week-old ApoE-deficient mice, especially in those exposed to chronic stress. Based on Western analysis, sera from ApoE-deficient mice showed a strong immunoreactivity with approximately 78 kDa and approximately 40 kDa brain abundant polypeptides, approximately 58 kDa non-brain tissue abundant antigen, and others of approximately, 80-82 kDa in both the brain and non-brain tissues. Immunofluorescence confocal microscopy showed that the major cellular components recognized by the autoimmune sera from ApoE-deficient mice were associated with neuronal cell nuclei and fiber-like structures in different regions of the brain, including the frontal cortex, lateral cortex and hippocampus. These results suggest that neuroautoimmunity associated with the aging process and exposure to chronic stress may be involved in early development of neurodegeneration in mice with ApoE-deficiency.

Aging↗
PubMed1999

Treatment of chronic myelogenous leukemia with autologous bone marrow transplantation followed by roquinimex.

Unmanipulated autologous bone marrow transplant (ABMT) offers patients with chronic myelogenous leukemia (CML) a long-term survival of 10%, at best. Immunotherapy has a role in the myeloid leukemias, and there is increasing evidence that of all hematopoietic neoplasms, CML may be the most susceptible to immune regulation. Roquinimex is known to enhance T cell, NK cell and macrophage activity. A phase II study was initiated in March 1992 to evaluate the role of roquinimex in Ph chromosome-positive CML post ABMT. Patients were conditioned with busulfan/ cyclophosphamide followed by reinfusion of unmanipulated Ph-positive bone marrow stem cells (>1 x 108 NBC/kg). When engraftment of neutrophils (ANC) reached 100/microl, patients received oral roquinimex twice weekly, escalating to a maximal dose of 0.2 mg/kg in 2 weeks. Seventeen patients have entered the study; 11 in first chronic phase (CP1); two in second chronic phase (CP2) and four in accelerated phase (AP). All required significant myelosuppressive therapy prior to ABMT to maintain stable blood counts and most had also received prior interferon therapy. All patients survived the transplant. Subsequent toxicity consisted mainly of musculoskeletal aches and peripheral edema. Additionally, specific skin changes were observed including graft-versus-host-like disease and eccrine sweat gland necrosis. Eight out of 17 patients are alive 28-60 months post ABMT. Of the nine patients who died, two were in CP2 and three in AP. All patients in CP1 went into a complete hematological remission post ABMT and seven of the 11 patients had at least a major cytogenetic response (greater than 65% Ph-negative metaphases) at 1 year or beyond and four of the 11 patients had a complete cytogenetic response at 2 years or beyond. Cytogenetic response post transplant often developed over time and did not simply represent post ABMT engraftment with Ph-negative cells. The clinical and cytogenetic data in these patients are encouraging and suggest that roquinimex may have significant activity when given post ABMT to patients with Ph-positive CML.

Adult↗
PubMed1999

Prevention of stress-induced weight loss by third ventricle CRF receptor antagonist.

We previously reported that rats exposed to repeated restraint (3 h/day for 3 days) experience temporary hypophagia and a sustained reduction in body weight compared with nonrestrained controls. Studies described here determined the involvement of central corticotropin-releasing factor (CRF) receptors in the initiation of this chronic response to acute stress. In experiment 1, Sprague-Dawley rats were fitted with cannulas in the lateral ventricle and infused with 50 micrograms of alphahCRF-(9-41) or saline immediately before restraint on each of the 3 days of restraint. The receptor antagonist inhibited hypophagia and weight loss on day 1 of restraint but not on days 2 and 3. In experiment 2, 10 micrograms of alphahCRF-(9-41) or saline were infused into the third ventricle immediately before each restraint. The receptor antagonist totally blocked stress-induced hypophagia and weight loss. These results demonstrate that CRF receptors located in or near the hypothalamus mediate the acute responses to stress that lead to a permanent change in the hormonal or metabolic processes that determine body weight and body composition.

Animals↗
PubMed1999

Sustained effects of repeated restraint stress on muscle and adipocyte metabolism in high-fat-fed rats.

Repeated restraint stress 3 h/day for 3 days in rats causes a temporary hypophagia but a sustained weight loss. We investigated whether poststress changes in peripheral tissue metabolism contributed to these responses. One day after the last restraint, insulin sensitivity, measured by oral glucose tolerance test, was improved in restrained rats. Restraint and pair-fed rats weighed less than controls, but body fat content was the same in all groups. Muscle glucose uptake, measured in vitro, was not changed by treatment, whereas in vitro adipocyte glucose uptake was substantially inhibited only in restrained rats. Adipocytes from restrained rats had elevated rates of fatty acid oxidation but not fatty acid esterification, indicating a shift in energy supply from glucose to fatty acids. Five days after the last restraint, the reduced weight of restrained and pair-fed rats resulted from loss of both lean and fat tissue. These results demonstrate that restraint caused sustained, tissue-specific changes in metabolism that may contribute to changes in body composition and body weight of the rats.

Adipose Tissue↗
PubMed1998

The role of CRF2 receptors in corticotropin-releasing factor- and urocortin-induced anorexia.

The experiments presented in this study were designed to assess corticotropin-releasing factor (CRF) receptor subtype mediation of CRF- and urocortin (UCN)-induced decrease in food intake. Male Sprague-Dawley rats were treated with antisense and sense oligonucleotides (ON) to CRF2 receptor mRNAs for 36 h and then received an intracerebroventricular (i.c.v.) injection of CRF, UCN (3 micrograms) or saline. Antisense treatment significantly attenuated CRF- and UCN-induced suppression in food intake and HPA activation. Administration of CRF1 receptor antagonist did not affect the decrease in food intake or activation of the HPA axis induced by i.c.v. infusion of 3 micrograms CRF. The data suggest that down-regulation of CRF2 receptors selectively attenuates CRF- and UCN-induced anorexia and hypothalamo-pituitary-adrenocortical activation in rats.

Animals↗
PubMed1998

Apolipoprotein-E deficiency results in an altered stress responsiveness in addition to an impaired spatial memory in young mice.

It has been suggested that Alzheimer's disease (AD) is associated with an altered neurotrophic function of apolipoprotein-E (ApoE) and abnormal neuroendocrine activities. In the present study we investigated stress responsiveness of ApoE-deficient mice. Firstly, two sessions of restraint were introduced, 20 min per day for two (session 1) and three (session 2) consecutive days. In session 1, there was no difference between genotypes in open-field activity in response to restraint stress. In session 2, spatial memory was assessed in a Morris Water Maze 'Place Learning Set' task immediately following stress. Restraint stress caused a significant impairment of spatial memory in wild-type mice. The non-restraint ApoE-deficient mice showed a severe impairment of spatial memory similar to that of the restrained wild-type mice. Restraint stress had no obvious effect on spatial memory in ApoE-deficient mice until the third day of testing, when there was a decrease in reference memory compared with their non-restraint controls. In addition, the first session of restraint stress had an inhibitory effect on food intake in wild-type but not ApoE-deficient mice, and a longer-lasting effect on body weight in the wild-type than ApoE-deficient mice. ApoE-deficient mice showed a weaker corticosterone response to the initial restraint stress and a slower descending rate in serum corticosterone level during a 30-min post-stress period than their wild-type controls. However, higher baseline levels and stronger corticosterone responses were observed in ApoE-deficient mice than in wild-type mice when exposed to repeated restraint stress. The expression of ApoE mRNA was upregulated in the hypothalamus in wild-type mice exposed to repeated restraint stress. Taken together, these results demonstrate that ApoE deficiency causes a memory impairment and an altered stress responsiveness in mice.

Analysis of Variance↗
PubMed1998

Relation of factor V Leiden genotype to risk for acute deep venous thrombosis after joint replacement surgery.

BACKGROUND: A point mutation in coagulation factor V (A1691G) is associated with increased risk for venous thrombosis. However, limited information is available about the prospective risk for deep venous thrombosis in specific high-risk clinical settings. OBJECTIVE: To determine whether the factor V Leiden mutation is associated with an increased occurrence of deep venous thrombosis in patients undergoing hip or knee replacement surgery. DESIGN: Retrospective analysis of plasma samples obtained during six prospective clinical trials that compared different antithrombotic prophylaxis regimens in patients undergoing hip or knee replacement surgery. SETTING: Inpatients at the University of Rochester Medical Center, McMaster University Medical Center, Hamilton Civic Hospitals, and the Genesee Hospital. PATIENTS: 825 patients hospitalized for hip or knee replacement surgery. MEASUREMENTS: Venographically diagnosed postoperative deep venous thrombosis was correlated with factor V genotype. RESULTS: The factor V Leiden mutation was not associated with a significantly increased risk for venographically detected deep venous thrombosis. The absolute incidence of deep venous thrombosis was 31% (95% CI, 15% to 47%) in patients with the mutation and 26% (CI, 22% to 29%) in patients without the mutation (relative risk, 1.2 [CI, 0.6 to 2.9]). The factor V Leiden mutation was not significantly associated with deep venous thrombosis in subgroups of patients receiving warfarin or heparin. The incidence of clinical hemorrhage was similar in patients with (10%) and without (8%) the mutation. CONCLUSIONS: The factor V Leiden mutation is not a significant risk factor for acute deep venous thrombosis in this group of patients. Current data do not justify routine preoperative screening for this mutation or intensified perioperative prophylaxis in patients with the factor V Leiden mutation who are undergoing hip or knee joint replacement surgery and are receiving effective antithrombotic prophylaxis.

Aged↗
PubMed1998

Perception of sweetness intensity determines women's hedonic and other perceptual responsiveness to chocolate food.

This study tested 63 women for hedonic and other perceptual responsiveness to a chocolate food. Subjects tasted four chocolate puddings varying in sugar (high and low) and fat (high and low) content and rated them for pleasantness, caloric density, fillingness and flavor intensities. Results emphasised the importance of sweetness intensity in determining women's responses to the chocolate puddings. Women's perception of sweetness intensity was accurate to sugar content and results consistently indicated that their hedonic responses to the chocolate puddings were based on the perceived sweetness. Women's perception of the caloric density of the puddings was based on their perception of the fat content of the puddings; however, interpretation of that finding must be qualified because the subjects' perception of fat content was inaccurate. The women's perception of sweetness intensity accounted for 31% of the variability in fat perception. Women's perception of the intensity of chocolate flavor was also significantly associated with perceived sweetness of the puddings. These data suggest that the women's accurate perception of the sugar content of the chocolate puddings played a primary role in determining their hedonic and other perceptual responses.

Adult↗
PubMed1998

Association of dietary restraint and disinhibition with eating behavior, body mass, and hunger.

This study investigated the association of dietary restraint and disinhibition with self-reported and actual eating behavior, body mass, and hunger. A sample of 124 women were categorized into one of four groups based upon high and low scores on measures of Dietary Restraint and Disinhibition using the Three Factor Eating Questionnaire. Half of the participants in each group consumed a high sugar/high fat chocolate pudding as a dietary preload. All participants were given a meal comprised of a standard macaroni and beef product. The interaction of Dietary Restraint and Disinhibition was related to differences in body mass. The Dietary Restraint factor was related to self-reported pathological eating behavior and influenced both perceived hunger and subjective hunger ratings. However, actual eating behavior measured by calories consumed and rate of intake was unrelated to the Dietary Restraint factor. Disinhibition was associated with excessive eating, an increased rate of eating, self-reports of eating disorder symptomatology, and perceived hunger. Hence, actual eating behavior was significantly influenced by the ingestive motivational factor, Disinhibition, but not by the cognitive factor, Dietary Restraint. These data also suggest that the Disinhibition construct is measuring overeating rather than disinhibited eating which implies the disruption of Dietary Restraint.

Adolescent↗
PubMed1998

Effect of repeated stress on body weight and body composition of rats fed low- and high-fat diets.

Exposure to the moderate stressor of 3-h restraint for 3 consecutive days causes a temporary drop in food intake but a permanent reduction in body weight in adult rats. Young rats did not show the same response. Food intake of adult rats exposed to repeated restraint was significantly lower than that of controls for 4 days after the end of stress, and there was no rebound hyperphagia. Body weight remained significantly lower for at least 40 days after stress. When the rats were fed a high-fat diet of 80% chow and 20% vegetable shortening (48% kcal fat, 16% protein), lean body mass accounted for all of the weight loss in stressed rats. When the experiment was repeated with a purified high-fat diet containing corn oil and coconut oil as the source of fat (41% kcal fat, 16% protein), weight loss consisted of both lean and fat tissue. There were no sustained changes in single time point measures of corticosterone, insulin, or leptin that could account for the reduced body weight in these rats.

Aging↗