Maintained intentional weight loss reduces cardiovascular outcomes: results from the Sibutramine Cardiovascular OUTcomes (SCOUT) trial.

AIM: The Sibutramine Cardiovascular OUTcomes trial showed that sibutramine produced greater mean weight loss than placebo but increased cardiovascular morbidity but not mortality. The relationship between 12-month weight loss and subsequent cardiovascular outcomes is explored. METHODS: Overweight/obese subjects (N = 10 744), ≥55 years with cardiovascular disease and/or type 2 diabetes mellitus, received sibutramine plus weight management during a 6-week Lead-in Period before randomization to continue sibutramine (N = 4906) or to receive placebo (N = 4898). The primary endpoint was the time from randomization to first occurrence of a primary outcome event (non-fatal myocardial infarction, non-fatal stroke, resuscitated cardiac arrest or cardiovascular death). RESULTS: For the total population, mean weight change during Lead-in Period (sibutramine) was -2.54 kg. Post-randomization, mean total weight change to Month 12 was -4.18 kg (sibutramine) or -1.87 kg (placebo). Degree of weight loss during Lead-in Period or through Month 12 was associated with a progressive reduction in risk for the total population in primary outcome events and cardiovascular mortality over the 5-year assessment. Although more events occurred in the randomized sibutramine group, on an average, a modest weight loss of approximately 3 kg achieved in the Lead-in Period appeared to offset this increased event rate. Moderate weight loss (3-10 kg) reduced cardiovascular deaths in those with severe, moderate or mild cardiovascular disease. CONCLUSIONS: Modest weight loss over short-term (6 weeks) and longer-term (6-12 months) periods is associated with reduction in subsequent cardiovascular mortality for the following 4-5 years even in those with pre-existing cardiovascular disease. While the sibutramine group experienced more primary outcome events than the placebo group, greater weight loss reduced overall risk of these occurring in both groups.

Weight and blood pressure response to weight management and sibutramine in diabetic and non-diabetic high-risk patients: an analysis from the 6-week lead-in period of the sibutramine cardiovascular outcomes (SCOUT) trial.

OBJECTIVE: To assess treatment responses to sibutramine and weight management in diabetic patients during the lead-in period of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial. METHODS: SCOUT is an ongoing, prospective, randomized, double-blind, placebo-controlled outcome trial in cardiovascular high-risk overweight/obese patients. A total of 10 742 patients received single-blind sibutramine and individualized weight management during the 6-week lead-in period; 84% had a history of type 2 diabetes mellitus and additional co-morbidities. Post-hoc analyses assessed anthropomorphic and vital sign responses between patients with and without diabetes. RESULTS: Concomitant antidiabetic medication use was reported by 86% of the diabetic patients (approximately 30% required insulin-alone or in combination). Body weight and waist circumference decreased in diabetic patients: median 2.1 kg; 2.0 cm (both men and women); for those on insulin: 1.9 kg; 1.5/2.0 cm (men/women); without insulin: 2.3 kg; 2.0 cm (both men and women); blood pressure (BP) was also reduced (median systolic/diastolic 3.5/1.0 mmHg) with larger reductions in diabetic patients who were hypertensive and/or lost the most weight (>5%). In diabetic patients who entered with BP at target (<130/<85 mmHg) but did not lose weight (N = 245), increases of 3.5/2.0 mmHg were observed. Non-diabetic patients had greater weight losses (2.5 kg) but smaller reductions in BP (systolic/diastolic -2.5/-0.5 mmHg). Pulse rate increases were less in diabetic vs. non-diabetic patients (1.5 vs. 2.0 bpm). CONCLUSION: In these high-risk diabetic patients, sibutramine and lifestyle modifications for 6 weeks resulted in small, but clinically relevant, median reductions in body weight, waist circumference and BP. A small median increase in pulse rate was recorded.

Forward and backward propagation of dendritic impulses and their synaptic control in mitral cells.

The site of impulse initiation is crucial for the integrative actions of mammalian central neurons, but this question is currently controversial. Some recent studies support classical evidence that the impulse always arises in the soma-axon hillock region, with back-propagation through excitable dendrites, whereas others indicate that the dendrites are sufficiently excitable to initiate impulses that propagate forward along the dendrite to the soma-axon hillock. This issue has been addressed in the olfactory mitral cell, in which excitatory synaptic input is restricted to the distal tuft of a single primary dendrite. In rat olfactory bulb slices, dual whole cell recordings were made at or near the soma and from distal sites on the primary dendrite. The results show that the impulse can be initiated in either the soma-axon hillock or in the distal primary dendrite, and that the initiation site is controlled physiologically by the excitatory synaptic inputs to the distal tuft and inhibitory synaptic inputs near the soma.

Evidence for olfactory function in utero.

Pregnant rats received 2-[14C]deoxy-D-glucose (2DG) intravenously on the last day of gestation, and their fetuses were delivered 1 hour later by cesarean section. Fetal brains showed high 2DG uptake spread throughout the accessory olfactory bulb and little or no differential uptake in the main olfactory bulb. These findings demonstrate that functional activity occurs in the accessory olfactory bulb in utero and suggest that the accessory olfactory system may be the pathway by which fetal rats detect the odor quality of their intrauterine milieu.

Blood pressure changes associated with sibutramine and weight management - an analysis from the 6-week lead-in period of the sibutramine cardiovascular outcomes trial (SCOUT).

OBJECTIVE: To explore vital sign changes among patient subgroups during the 6-week lead-in period of the sibutramine cardiovascular outcomes (SCOUT) trial. METHODS: SCOUT is an ongoing, double-blind, randomized, placebo-controlled outcome trial in overweight/obese patients at high risk of a cardiovascular event. During the 6-week lead-in period, 10,742 patients received sibutramine and weight management. Vital sign changes were assessed post hoc by initial blood pressure (mmHg) categorized as normal (<130/<85), high-normal (130 to <140/85 to <90) or hypertensive (>or=140/>or=90); weight change categories (weight gain/no weight change, >0 to 2.5% weight loss, >2.5 to 5% weight loss and >5% weight loss) and current antihypertensive medication class use (none, one, or two or more). To assess the impact of sibutramine on blood pressure and pulse rate, only patients (N = 10,025) who reported no change in the class of antihypertensive medication used and who did not report an increase in antihypertensive medication use were analysed. RESULTS: At entry, approximately 50% of patients were hypertensive and 26% were high-normal. In hypertensive patients, blood pressure changes (mmHg) decreased by median [5th, 95th percentile] of -6.5 systolic [-27.0, 8.0] and -2.0 diastolic [-15.0, 8.0] (p < 0.001). Hypertensive patients with no weight loss or with weight gain had median decreases of -3.5 systolic [-26.0, 10.0] and -1.5 diastolic [-16.0, 9.0] (p < 0.001). Normotensive patients had median increases of 1.5 systolic [-15.0, 19.5] and 1.0 diastolic [-10.5, 13.0] (p < 0.001) attenuated with increasing weight loss. Approximately 43% of patients initially categorized as hypertensive had a lower blood pressure category at end-point. Concomitant antihypertensive medication classes did not affect blood pressure reductions. Pulse rates were uniformly elevated (median 1-4 bpm, p < 0.001) across blood pressure and weight change categories. CONCLUSIONS: In hypertensive patients (>or=140/>or=90), blood pressure decreases were observed during 6-week treatment with sibutramine even when body weight was unchanged. In patients with normal blood pressure (<130/<85), weight loss of >5% induced decreases in systolic blood pressure; otherwise, small increases were observed. Small pulse rate increases were observed regardless of blood pressure or weight change status.

Activation of the sensory current in salamander olfactory receptor neurons depends on a G protein-mediated cAMP second messenger system.

Olfactory receptor neurons respond to odor stimulation with an inward cationic current. Under whole-cell patch clamp, individual, isolated olfactory receptors were exposed to pharmacological agents known to interact with distinct enzymes in a putative second messenger cascade, and their response to odors was measured. IBMX prolonged the odor-evoked current and also reduced its amplitude. cAMP and cGMP induced a current electrically identical to the odor current, but the current showed desensitization only with cAMP. GTP-gamma-s prolonged and GDP-beta-s interfered with the odor-evoked current. The long latency seen in the odor response appears to be mainly due to the loading of the G protein and secondarily to the requirement for cAMP accumulation. The main source of the response decay appears to be cyclic nucleotide hydrolysis.

Analysis of relations between NMDA receptors and GABA release at olfactory bulb reciprocal synapses.

In the mammalian olfactory bulb, signal processing is mediated by synaptic interactions between dendrites. Glutamate released from mitral cell dendrites excites dendritic spines of granule cells, which in turn release GABA back onto the mitral cell dendrites, forming a reciprocal synaptic pair. This feedback synaptic circuit was shown to be mediated predominantly by NMDA receptors. We further utilized caged Ca2+ compounds to obtain insight into the mechanism that couples NMDA receptor activation to GABA release. Feedback inhibition elicited by photo-release of caged Ca2+ in mitral cell secondary dendrites persisted when voltage-gated Ca2+ channels were blocked by cadmium (Cd2+) and nickel (Ni2+). These results indicate that Ca2+ influx through NMDA receptors can directly trigger presynaptic GABA release for local dendrodendritic feedback inhibition.

Tip-link integrity and mechanical transduction in vertebrate hair cells.

An attractive hypothesis for hair-cell transduction is that fine, filamentous "tip links" pull directly on mechanically sensitive ion channels located at the tips of the stereocilia. We tested the involvement of tip links in the transduction process by treating bundles with a BAPTA-buffered, low-Ca2+ saline (10(-9) M). BAPTA abolished the transduction current in a few hundred milliseconds. BAPTA treatment for a few seconds eliminated the tip links observed by either scanning or transmission electron microscopy. BAPTA also eliminated the voltage-dependent movement and caused a positive bundle displacement of 133 nm, in quantitative agreement with a model for regulation of tension. We conclude that tip links convey tension to the transduction channels of hair cells.

Calcium imaging of single stereocilia in hair cells: localization of transduction channels at both ends of tip links.

Mechanically gated "transduction" channels in inner ear hair cells are thought to be connected to tip links stretched between adjacent stereocilia. To locate active channels, calcium-green fluorescence in single stereocilia was measured with two-photon laser scanning microscopy. Bundle deflection increased fluorescence in many but not all stereocilia; the increase was blocked by depolarization. The number of stereocilia responding was proportional to the transduction current, consistent with Ca2+ influx through transduction channels. Fluorescence rose first in the tips of stereocilia and then in the bases, in agreement with channel localization at the tips. Some of the shortest stereocilia in a bundle showed a fluorescence increase, as did some of the tallest, indicating that transduction channels can be at either or both ends of tip links.

Retinal ganglion cells express a cGMP-gated cation conductance activatable by nitric oxide donors.

We have identified a putative cGMP-gated cation conductance in rat retinal ganglion cells. Both in situ hybridization and polymerase chain reaction amplification detected transcripts in ganglion cells that were highly homologous to the cGMP-gated cation channel expressed in rod photoreceptors. Whole-cell patch-clamp recordings detected a current stimulated by cGMP due to activation of nonselective cation channels. This current had a reversal potential near 0 mV, showed some outward rectification, and could be blocked by Cd2+. The current could also be activated by a phosphodiesterase inhibitor and the nitric oxide donors sodium nitroprusside and S-nitrosocysteine. We propose that nitric oxide released from an identified subpopulation of amacrine cells may activate this channel to modulate ganglion cell activity.

Olfactory discrimination ability of CD-1 mice for a large array of enantiomers.

With use of a conditioning paradigm, the ability of eight CD-1 mice to distinguish between 15 enantiomeric odor pairs was investigated. The results demonstrate a) that CD-1 mice are capable of discriminating between all odor pairs tested, b) that the enantiomeric odor pairs clearly differed in their degree of discriminability and thus in their perceptual similarity, and c) that pre-training with the rewarded stimuli led to improved initial but not terminal or overall performance. A comparison between the proportion of discriminated enantiomeric odor pairs of the CD-1 mice and those of other species tested in earlier studies on the same discrimination tasks (or on subsets thereof) shows a significant positive correlation between discrimination performance and the number of functional olfactory receptor genes. These findings provide the first evidence of a highly developed ability of CD-1 mice to discriminate between an array of non-pheromonal chiral odorants. Further, they suggest that a species' olfactory discrimination capabilities for these odorants may be correlated with its number of functional olfactory receptor genes. The data presented here may provide useful information for the interpretation of findings from electrophysiological or imaging studies in the mouse and the elucidation of odor structure-activity relationships.

Implications of the NO/cGMP system for olfaction.

The rapid and transient generation of pulses of either cAMP or IP3 is considered the primary reaction in olfactory signal transduction. There is some recent evidence suggesting that another second messenger system, involving cGMP, may also play an important role in olfactory signalling. High doses of odorant elicit a delayed and sustained elevation of cGMP levels due to the operation of the nitric oxide (NO) synthase/guanylyl cyclase system. The interplay of NO and cGMP is supposed to trigger molecular mechanisms, including adaptation processes, which enable the olfactory neuroepithelium to cope with strong stimuli. Furthermore, a characteristic pattern of staining for NO synthase in the olfactory bulb suggests that the NO/cGMP system may also participate in neuronal processing of the sensory input.

Centenary of the synapse: from Sherrington to the molecular biology of the synapse and beyond.

Few concepts have meant more to neuroscience than the synapse, commonly understood to mean the junction between two excitable cells. The term was introduced by Charles Sherrington in 1897. The centenary of this event is an appropriate time to review the term's origins and utility. There are some surprises. The term didn't actually come from him. His concept was more functional than structural. The pioneering physiological and structural studies in the 1950s in fact did not lead to a rigorous definition. There is still confusion on how to define neurotransmitters. As molecular biological approaches are increasingly refining the concept of a fundamental synaptic unit, many types of neuronal interactions are appearing that do not fit with the synaptic concept. Are the neural circuits underlying behaviour strictly synaptic? In dealing with these questions, a longer perspective is useful for understanding how the term arose, how it has evolved to the present, and what kinds of challenges may be coming in the future.

The Human Brain Project: neuroinformatics tools for integrating, searching and modeling multidisciplinary neuroscience data.

What is neuroinformatics? What is the Human Brain Project? Why should you care? Supported by a consortium of US funding agencies, the Human Brain Project aims to bring to the analysis of brain function the same advantages of Internet-accessible databases and database tools that have been crucial to the development of molecular biology and the Human Genome Project. The much greater complexity of neural data, however, makes this a far more challenging task. As a pilot project in this new initiative, we review some of the progress that has been made and indicate some of the problems, challenges and opportunities that lie ahead.

Synaptic transmission and modulation in the olfactory bulb.

Recent work in molecular biology and synaptic physiology has significantly increased our understanding of inhibitory and excitatory mechanisms in the olfactory bulb. Multiple subtypes of amino acid receptors with different functional and neuromodulatory properties are likely to play key roles in processing odor information transduced and relayed to the olfactory bulb by the olfactory sensory neurons, and in modulating that information during olfactory learning.

Cyclic nucleotide gated channels as regulators of CNS development and plasticity.

Cyclic nucleotide gated (CNG) cation channels are critical for signal transduction in vertebrate visual and olfactory systems. Members of the CNG channel gene family have now been cloned from a number of species, from Caenorhabditis elegans to humans. An important advance has been the discovery that CNG channels are present in many neurons of the mammalian brain. CNG channels act as molecular links between G-protein-coupled cascades, Ca2+-signalling systems, and gaseous messenger pathways. Perhaps most striking are recent data implicating CNG channels in both developmental and synaptic plasticity.

Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized adults.

BACKGROUND: A history (or lack thereof) of penicillin allergy is known to be unreliable in predicting reactions on subsequent administration of the drug. This study tests the usefulness of four penicillin allergen skin tests in the prediction of IgE-mediated reactions subsequent to administration of penicillin. METHODS: Eight centers cooperated in the National Institute of Allergy and Infectious Diseases trial of the predictive value of skin testing with major and minor penicillin derivatives. Hospitalized adults were tested with a major determinant (octa-benzylpenicilloyl-ocytalysine) and a minor determinant mixture and its components (potassium benzylpenicillin, benzylpenicilloate, and benzylpenicilloyl-N-propylamine). Patients then received a therapeutic course of penicillin and were observed, for 48 hours, for adverse reactions compatible with an IgE-mediated immediate or accelerated allergy. RESULTS: Among 726 history-positive patients, 566 with negative skin tests received penicillin and only seven (1.2%) had possibly IgE-mediated reactions. Among 600 history-negative patients, 568 with negative skin tests received penicillin and none had a reaction. Only nine of the 167 positive skin test reactors received a penicillin agent and then usually by cautious incremental dosing. Two (22%) of these nine patients had reactions compatible with IgE-mediated immediate or accelerated penicillin allergy; both were positive to the two determinants. CONCLUSIONS: These data corroborate previous data about the negative predictive value of negative skin tests to these materials. The reaction rate in skin test-positive patients was significantly higher than in those with negative skin tests, demonstrating the positive predictive value of positive tests to both major and minor determinants. The number of patients positive only to the major determinant or only to the minor determinant mix was too small to draw conclusions about the positive predictive value of either reagent alone.

Biochemical studies on muscarinic receptors in the salamander olfactory epithelium.

Muscarinic cholinergic receptors in the olfactory epithelium of the salamander, Ambystoma tigrinum, were studied via binding of 3-[3H]quinuclidinyl benzilate. The receptors are present on the olfactory receptor cells in the epithelium to an amount of 0.08 pmol/mg homogenate protein. Both choline acetyltransferase and acetylcholine esterase are present in the salamander olfactory epithelium.

Functional organization of rat olfactory bulb analysed by the 2-deoxyglucose method.

The spatial patterns of activity elicited in the rat olfactory bulb under different odor conditions have been analysed using the 2-deoxyglucose (2DG) technique. Rats were injected with 14C-2DG, exposed to controlled environments of amyl acetate, camphor, cage air, dimethyl disulfide, and pure air and autoradiographs prepared by the method of Sokoloff. Amyl acetate was associated with regions of glomerular layer densities in the anterolateral and mid- to posteromedial parts of the bulbar circumference, as previously reported. The extents of the densities increased with increasing concentration. Camphor odor was associated with regions of increased density in the anterodorsal and mid- to posteromedial parts of the bulb. Exposure to cage air produced scattered densities in the posteromedial and posterolateral bulb. Exposure to dimethyl disulfide gave variable results. Pure air was associated with a minimal number of small dense foci. The results with amyl acetate, camphor and cage air suggest that patterns for different odors are distinguishably different but overlapping. The regions of activity are greatest in extent and density with the highest odor concentrations. These define the regions within which more restricted and isolated foci appear at lower concentrations. The results thus provide evidence for the specific role of spatial factors in the neural processing of odor quality and odor concentration.

Mapping of an olfactory receptor population that projects to a specific region in the rat olfactory bulb.

An anatomically distinct group of glomeruli, termed the modified glomerular complex (MGC), is present in the posterior dorsomedial portion of the main olfactory bulb. This region has been strongly implicated as part of the pathway that processes odor cues for suckling in neonatal rat pups. We studied the distribution pattern of olfactory receptor neurons that project to the MGC region after ionophoretic injections of WGA-HRP into the olfactory bulbs of 12-day-old rat pups. HRP label was confined to an identifiable localized region in the MGC of the main olfactory bulb. Label extended over 2-7% of the glomerular sheet of the main olfactory bulb, including the MGC. Olfactory receptor neurons within the olfactory epithelium of the nasal cavity were labeled with HRP ipsilateral to the injected side. Maps constructed of the olfactory epithelium revealed that the labeled neurons occurred within topographically defined regions. Anteriorly, labeled olfactory neurons were confined to a narrow strip medial to the dorsal recess, and, more posteriorly, this strip widened medially along the septal wall and laterally onto a limited area on the nasal turbinates. Only a portion of the receptor population within a region was labeled. The boundaries between labeled and unlabeled regions were sharp. These findings support the concept that the olfactory epithelium is an anatomical mosaic in which receptors with different glomerular projections sites are intermingled. In conjunction with previous evidence on the functional specificity of the MGC, and staining of receptor neuron subgroups with monoclonal antibodies, these findings further suggest that olfactory receptor neurons form a functional mosaic within the olfactory epithelium.