Psychopathology and eating behaviour in people with type 2 diabetes referred for bariatric surgery.

PURPOSE: Psychopathology and disordered eating behaviours are putative pre-operative risk factors for suboptimal outcomes post-bariatric surgery. Documented psychopathology prevalence rates vary in bariatric candidate samples. Further, less attention has been paid to vulnerable subgroups such as people with diabetes who might be at an elevated risk. For these reasons, this study aimed to investigate the rates of psychopathology and disordered eating in pre-surgical candidates with type 2 diabetes mellitus (T2DM). METHODS: Participants were 401 consecutive patients from a state-wide bariatric surgery service for people with T2DM. Psychopathology was measured using multi-modal assessment including diagnostic interview and battery of validated questionnaires. The mean age of the sample was 51 years with a mean BMI of 46 kg/m2. The majority of the sample was female (60.6%), born in Australia (87%) and 18.2% identified as Aboriginal and/or Torres Strait Islander. RESULTS: Rates of current psychopathology in this sample included: major depressive disorder (MDD; 16.75%), generalised anxiety disorder (GAD; 20.25%), insomnia (17.75%) and binge eating disorder (BED; 10.75%). There were no significant differences on measures between people who endorsed Aboriginal and/or Torres Strait Islander status compared to those who did not endorse. The mean total score on the BES was 21.82 ± 10.40 (range 0-39), with 8.2% of participants meeting criteria for severe binge eating. Presence of an eating disorder was not significantly associated with degree of glycemic compensation. Average emotional eating scores were significantly higher in this study, compared to reference samples. Significantly increased binge eating severity and emotional eating severity was revealed for people with T2DM and comorbid MDD, social anxiety and eating disorders. Binge eating severity was associated with GAD, food addiction, substance use disorders, and history of suicide attempt but not emotional eating severity. CONCLUSION: Amongst people with T2DM seeking bariatric surgery, MDD, GAD and emotional eating were common. Psychopathology in a sample of people with T2DM seeking bariatric surgery was significantly associated with severity of disordered eating. These findings suggest people with T2DM seeking bariatric surgery may be vulnerable to psychopathology and disordered eating with implications for early identification and intervention. LEVEL OF EVIDENCE: Evidence obtained from cohort or case-control analytic studies.

The way to a man's heart is through his stomach? A unique case report of transient constrictive pericarditis secondary to infarction of herniated omentum following bariatric surgery.

Background: Intrapericardial diaphragmatic hernias are a rare form of diaphragmatic hernia. The presentation is usually acute due to trauma or from iatrogenic causes. In some instances however, these patients can present years later. We describe an unusual case of transient constrictive pericarditis associated with herniation of omentum through a diaphgragmatic hernia extending into the pericardial space, which infarcted following recent bariatric surgery. A multi-disciplinary approach was required with surgical correction of the diaphragmatic defect and removal of omentum from the pericardial space. Case summary: A 38-year-old gentleman with a history of a remote abdominal stab wound and recent laparoscopic gastric sleeve procedure presented with sharp central chest pain radiating to the shoulder. Chest imaging [echocardiography, computed tomography (CT), and cardiac magnetic resonance imaging (MRI)] revealed the presence of an intrapericardial diaphragmatic hernia and herniation of devascularized omentum into the pericardial space. Surgery was undertaken to remove the pericardial omentum. Echocardiography and cardiac MRI revealed changes of pericardial constriction which resolved with anti-inflammatories. Discussion: A multi-disciplinary approach was required in this case with surgical correction of the diaphragmatic defect and removal of omentum from the pericardial space. Multi-modal imaging proved essential in the diagnosis of this rare condition, aiding in timely diagnosis, ongoing management decisions, and for assessing therapeutic response.

Relationship between amount and type of dietary fat in promotion of mammary carcinogenesis induced by 7,12-dimethylbenz[a]anthracene.

Female Sprague-Dawley rats were fed semipurified diets containing various fats, either alone or in combination, to provide different amounts of dietary fat and linoleic acid. One week before commencing the diets, each rat received an intra-gastric dose of the carcinogen 7,12-dimethylbenz[a]anthracene. Rats fed diets containing mixtures of 3% sunflower seed oil and 17% of either tallow or coconut oil developed twice as many tumors as those fed 3% sunflower seed oil or 20% of either saturated fat alone. Tumor yields in the rats fed these mixed-fat diets were comparable to those in rats fed a 20% lard diet, which provided about the same amount of linoleic acid. No further increase in tumor yield was observed in rats fed a 20% sunflower seed oil diet that contained more than five times as much linoleic acid. These results show that a certain amount of polyunsaturated fat, as well as a high level of dietary fat, is required to promote mammary carcinogenesis.

Effect of dietary polyunsaturated fat on the growth of a transplantable adenocarcinoma in C3HAvyfB mice.

Weaning male and female C3HAvyfB mice were fed a low-fat (4.5%) diet until they were 60-70 days of age when they were fed high-fat (18.6%) diets containing either sunflower-seed oil (polyunsaturated fat diet) or tallow (saturated fat diet). After receiving either of the high-fat diets for 4 weeks, each mouse received an inoculum of approximately 1,700 single cells from a transplantable mammary adenocarcinoma. The cumulative incidence of tumor-bearing mice was significantly greater among both males and females fed the polyunsaturated fat diet than among males and females fed the saturated fat diet. The mean times elapsed before palpable tumors developed were less when mice were fed the polyunsaturated fat diet than when mice were fed the saturated fat diet, but these differences were not statistically significant. The cumulative incidence of tumor-bearing mice was also significantly greater among females than males. The results supported the suggestion from previous work in this laboratory that the polyunsaturated fat diet exerts its effect on the promotional stage of carcinogenesis rather than on the initial event of neoplastic transformation.

Polyunsaturated fatty acids as promoters of mammary carcinogenesis induced in Sprague-Dawley rats by 7,12-dimethylbenz[a]anthracene.

The development of mammary tumors was examined in female noninbred Sprague-Dawley rats fed either a low-fat diet or high-fat diets containing different fats and fatty acid esters. Each rat was given 5 mg 7,12-dimethylbenz[a]anthracene by stomach tube 1 week before diets were introduced. Addition of 3% ethyl oleate (an ethyl ester of an unsaturated fatty acid) to a diet high in saturated fat (coconut oil) had no significant effect on tumor development, but the addition of 3% ethyl linoleate (an ethyl ester of a polyunsaturated fatty acid) increased the tumor yield to about twice that in rats fed either the high-saturated fat diet or a low-fat diet. Animals fed the high-saturated fat diet containing 3% ethyl linoleate developed as many tumors as those fed a 20% sunflower seed oil diet, though the sunflower seed oil diet contained about four times as much linoleate. Rats fed a high coconut oil diet containing 3% menhaden fish oil, which contains polyunsaturated fatty acids of the linolenate family (but having little linoleic acid), also developed as many tumors as those fed the 20% sunflower seed oil diet. These differences in mammary tumor yield could not be explained by alterations in the serum levels of prolactin, estrogen, or progesterone. However, the higher tumor yields were associated with increased unsaturation of mammary tissue phospholipids.

Carcinogenesis induced by 7,12-dimethylbenz[a]anthracene in c3H-A vyfB mice: influence of different dietary fats.

The effect of a diet containing either sunflower-seed oil (polyunsaturated fat diet) or tallow (saturated fat diet) on 7,12-dimethylbenz[a]anthracene (DMBA)-induced carcinogenesis in C3H-A vyfB mice was examined. After receiving either diet for 28 days, some of the mice were given an intragastric dose of 5 mg DMBA. To identify the stage of carcinogenesis that might be influenced by dietary fat, the diets of half of the mice were then interchanged so that those previously fed the saturated fat diet were fed the polyunsaturated fat diet and vice versa. The cumulative incidence of tumor-bearing mice was significantly greater among the females fed the polyunsaturated fat diet compared to those fed the saturated fat diet. This enhancement of carcinogenesis was observed only when the mice were fed the polyunsaturated fat diet after DMBA administration. Similar trends were observed in the male mice, but these mice developed fewer tumors and none of the differences between the tumor incidences were statistically significant. The most common sites for tumors in the male mice were the liver, lungs, and skin, whereas those for tumors in the females were the mammary glands and ovaries. The differences in tumor incidence suggest that carcinogenesis was enhanced by the polyunsaturated fat diet during the promotion stage of carcinogenesis.

Relative rates of incorporation of esterified cholesterol into human very low density lipoproteins and low density lipoproteins. In vitro studies of two separate pathways.

It has been shown previously that there are two pathways by which the esterified cholesterol formed in human plasma in the reaction catalysed by lecithin: cholesterol acyltransferase may be delivered to very low density lipoproteins (VLDL) and low density lipoproteins (LDL): (a) an indirect pathway in which esterified cholesterol which was incorporated initially into high density lipoproteins (HDL) is transferred subsequently to VLDL and LDL in a process mediated by an esterified cholesterol transfer/exchange protein and (b) a direct pathway in which a small proportion of the esterified cholesterol formed in the lecithin:cholesterol acyltransferase reaction is delivered to VLDL and LDL directly from its site of synthesis via a pathway which bypasses the bulk HDL fraction. These present studies have been designed to examine the incorporation of esterified cholesterol into VLDL relative to that into LDL via each of these two pathways. It has been found that a delivery of esterified cholesterol from HDL to VLDL and LDL via the indirect pathway has a marked preference for VLDL over LDL; equating the concentrations of esterified cholesterol in the two fractions revealed an incorporation into VLDL which was 7-11 times greater than that into LDL. By contrast, delivery via the direct pathway showed a marginal preference for LDL over VLDL.

An effect of very low density lipoproteins on the rate of cholesterol esterification in human plasma.

Rates of esterification of plasma cholesterol have been compared in two groups of human subjects with widely differing concentrations of very low density lipoproteins (VLDL). Group 1 consisted of subjects with fasting plasma triacylglycerol concentrations over 2.0 mM and group 2 consisted of subjects with concentrations under 1.6 mM. The rate of esterified cholesterol production in incubations of whole plasma from group 1 subjects was much greater than that from group 2 subjects. A clear difference between the rates of esterification was also evident when either total lipoproteins, total high density lipoproteins (HDL) or the HDL subfraction, HDL3, from the two types of subjects were incubated in the presence of a common source of lecithin:cholesterol acyltransferase. Since these findings appeared to reflect fundamental differences within the HDL3 subfractions, which may have been modified by prior exposure to the high concentrations of VLDL in group 1 subjects, VLDL-deficient plasma and the plasma fraction of d greater than 1.125 g/ml (containing HDL3) from hypotriglyceridaemic subjects were preincubated at 37 degrees C with an excess of added VLDL in the presence of a reversal of the inhibition of lecithin:cholesterol acyltransferase, the capacity of the original fractions to esterify cholesterol had been markedly increased. These studies, therefore, show that the lecithin:cholesterol acyltransferase substrate capacity of particles within the HDL3 subfraction is enhanced by exposure to VLDL and that this enhancement is not dependent on the continued presence of VLDL during the actual esterification reaction.

Capacity of lipoproteins to act as substrates for lecithin:cholesterol acyltransferase. Enhancement by pre-incubation with an artificial triacylglycerol emulsion.

Previous studies have shown that high concentrations of very low density lipoproteins (VLDL) stimulate the formation of cholesteryl esters in human plasma, possibly by acting as recipients of cholesteryl esters transferred from high density lipoproteins (HDL). To gain further insight into this phenomenon, experiments were performed to determine whether the triacylglycerol emulsion Intralipid, which acts as an artificial recipient of HDL cholesteryl esters, has an effect on cholesterol esterification similar to that of VLDL. Intralipid, in contrast to VLDL, is devoid of apolipoproteins which may stimulate cholesterol esterification. Human plasma, which had previously been depleted of VLDL, was pre-incubated in the presence or absence of Intralipid. After pre-incubation, the Intralipid was removed and rates of cholesterol esterification were measured in subsequent incubations of the Intralipid-depleted fractions. The presence of Intralipid during the pre-incubation had a marked stimulatory effect on cholesterol esterification, comparable to that of VLDL in earlier studies. The pre-incubation with Intralipid also markedly reduced the cholesteryl ester content, and increased the triacylglycerol content, of the HDL. These changes in composition coincided with two changes in the elution profile of HDL after density-gradient ultracentrifugation which were (i) a reduction in the density of particles in the HDL3 subfraction, which virtually disappeared as an identifiable peak, and (ii) the emergence of a discrete population of very dense lipoproteins consisting primarily of protein and phospholipid. Since all these changes were related to redistributions of lipids, the results highlight the importance of lipid transfers in the regulation of plasma cholesterol esterification.

Comparison of different methods of isotopically labelling the esterified cholesterol in human high density lipoproteins.

Different methods of incorporating esterified [3H]cholesterol into human high density lipoproteins (HDL) have been assessed in terms of their influence on the subsequent rate at which esterified [3H]cholesterol was transferred from HDL to other plasma lipoproteins in 37 degrees C incubations containing tracer amounts of the labelled preparations added to aliquots of a common pool of unlabelled human plasma. Two basic methods were used to label the HDL esterified cholesterol: (a) by the action of lecithin: cholesterol acyltransferase in incubations of plasma containing exogenous [3H]cholesterol and (b) by exchange in incubations of plasma containing preparations of prelabelled LDL. The exchange labelling approach was also used to examine the effects of various HDL compositional changes on the subsequent behaviour of its esterified [3H]cholesterol. It was found that the source of the label, per se, whether from the esterification of exogenous [3H]cholesterol or from exchange with labeled LDL, had no influence on the subsequent behaviour of HDL esterified [3H]cholesterol. However, modification of the HDL composition during the labelling process had profound effects. For example, in preparations in which the esterified cholesterol content of the labelled HDL was increased by the action of lecithin: cholesterol acyltransferase, there was a reduced rate of transfer of esterified [3H]cholesterol out of the HDL fraction in subsequent incubations of the labelled HDL with fresh, unlabelled plasma. Conversely, when the esterified cholesterol content of the labelled HDL had been decreased by pre-incubation with Intralipid or very low density lipoproteins (VLDL), the subsequent rate of transfer of esterified [3H]cholesterol out of the HDL fraction was increased markedly. It has been concluded that to obtain a biologically valid, labelled tracer of human HDL esterified cholesterol, the labelling should be achieved with minimal modification to the HDL composition. This means labelling by exchange in incubations in which lecithin: cholesterol acyltransferase is inhibited in plasma from which VLDL has been removed.

Comparison of human plasma low- and high-density lipoproteins as substrates for lecithin: cholesterol acyltransferase.

A recent observation that lecithin: cholesterol acyltransferase (EC 2.3.1.43) interacts with both low-density lipoproteins (LDL) and high-density lipoproteins (HDL) in human plasma is in apparent conflict with an earlier finding that the purified enzyme, while highly reactive with isolated HDL, was only minimally reactive with LDL. There is evidence, however, that lecithin: cholesterol acyltransferase may exist physiologically as a component of a complex with other proteins and that studies with the isolated enzyme may therefore provide misleading results. Consequently, interactions of the enzyme with isolated human lipoproteins have been re-examined in incubations containing lecithin: cholesterol acyltransferase as a component of human lipoprotein-free plasma in which a physiologically active complex of the enzyme with other proteins may have been preserved. In this system there was a ready esterification of the free cholesterol associated with both LDL and HDL-subfraction 3 (HDL3) in reactions that obeyed typical enzyme-saturation kinetics. For a given preparation of lipoprotein-free plasma the Vmax values with LDL and with HDL3 were virtually identical. The apparent Km for free cholesterol associated with HDL3 was 5.6 X 10(-5) M, while for that associated with LDL it was 4.1 X 10(-4) M. This implied that, in terms of free cholesterol concentration, the affinity of HDL3 for lecithin: cholesterol acyltransferase was about 7-times greater than that of LDL. When expressed in terms of lipoprotein particle concentration, however, it was apparent that the affinity of LDL for the enzyme was considerably greater than that of HDL3. When the lipoprotein fractions were equated in terms of lipoprotein surface area, the apparent affinities of the two fractions for the enzyme were found to be comparable.

Pathways for the incorporation of esterified cholesterol into very low density and low density lipoproteins in plasma incubated in vitro.

In vitro incubations of human or pig plasma containing a tracer amount of [3H]cholesterol have been performed to determine which lipoprotein fractions are the immediate recipients of the esterified cholesterol formed in the reaction catalysed by lecithin: cholesterol acyltransferase. In pig plasma, which is deficient in activity of the protein which promotes transfer of esterified cholesterol between different lipoprotein fractions, 87-90% of the lecithin: cholesterol acyltransferase-derived esterified cholesterol was incorporated into the high density lipoprotein (HDL) fraction. In human plasma there was an initial recovery of more than 80% in HDL, although the proportion recovered in very low density lipoproteins (VLDL) and low density lipoproteins (LDL) became progressively greater with increasing duration of incubation, consistent with a transfer from an HDL -esterified cholesterol pool of increasing specific activity. Nevertheless, as in the pig plasma incubations, there was evidence that some 10-15% of the esterified cholesterol formed in the lecithin: cholesterol acyltransferase reaction was incorporated directly into human VLDL and LDL. In quantitative terms, however, it was found that most of the esterified cholesterol delivered to human VLDL and LDL was the result of transfers from HDL rather than as a direct incorporation from its site of synthesis.

The rabbit as an animal model of hepatic lipase deficiency.

A natural deficiency of hepatic lipase in rabbits has been exploited to gain insights into the physiological role of this enzyme in the metabolism of plasma lipoproteins. A comparison of human and rabbit lipoproteins revealed obvious species differences in both low-density lipoproteins (LDL) and high-density lipoproteins (HDL), with the rabbit lipoproteins being relatively enlarged, enriched in triacylglycerol and depleted of cholesteryl ester. To test whether these differences related to the low level of hepatic lipase in rabbits, whole plasma or the total lipoprotein fraction from rabbits was either kept at 4 degrees C or incubated at 37 degrees C for 7 h in (i) the absence of lipase, (ii) the presence of hepatic lipase and (iii) the presence of lipoprotein lipase. Following incubation, the lipoproteins were recovered and subjected to gel permeation chromatography to determine the distribution of lipoprotein components across the entire lipoprotein spectrum. An aliquot of the lipoproteins was subjected also to gradient gel electrophoresis to determine the particle size distribution of the LDL and HDL. Both hepatic lipase and lipoprotein lipase hydrolysed lipoprotein triacylglycerol and to a much lesser extent, also phospholipid. There were, however, obvious differences between the enzymes in terms of substrate specificity. In incubations containing hepatic lipase, there was a preferential hydrolysis of HDL triacylglycerol and a lesser hydrolysis of VLDL triacylglycerol. By contrast, lipoprotein lipase acted primarily on VLDL triacylglycerol. When more enzyme was added, both lipases also acted on LDL triacylglycerol, but in no experiment did lipoprotein lipase hydrolyse the triacylglycerol in HDL. Coincident with the hepatic lipase-induced hydrolysis of LDL and HDL triacylglycerol, there were marked reductions in the particle size of both lipoprotein fractions, which were now comparable to those of human LDL and HDL3, respectively.

Competitive inhibition of plasma cholesterol esterification by human high-density lipoprotein-subfraction 2.

Mixtures containing subfractions of human plasma high-density lipoproteins (HDL) and human lipoprotein-free plasma were incubated in vitro at 37 degrees C. Esterification of cholesterol was observed both in incubations containing HDL-subfraction 3 (HDL3) and in those containing HDL-subfraction 2 (HDL2). The implication that the lecithin: cholesterol acyltransferase in lipoprotein-free plasma may therefore interact with lipoproteins in both HDL subfractions was developed further by proposing a simple model in which the two HDL subfractions may compete for interactions with the enzyme. This model was described mathematically and tested in experiments in which a constant amount of the enzyme was incubated with a wide range of concentrations of HDL2 and HDL3 present either alone or in combination. The model was able to predict experimentally observed rates of cholesterol esterification with great accuracy. The best fit was obtained with a Vmax for HDL3 that was 2.4-4-times greater than that for HDL2 and values of the apparent Km for HDL3 free cholesterol and HDL2 free cholesterol of 43-60 nmol/ml and 167-391 nmol/ml, respectively. The model thus predicts that, at physiological concentrations of lipoproteins, HDL2 will function as a competitive inhibitor of the cholesterol esterification reaction by displacing lecithin: cholesterol acyltransferase from a more effective substrate, HDL3, to a less effective substrate, HDL2.

Thrombolysis with recombinant unglycosylated single-chain urokinase-type plasminogen activator (saruplase) in acute myocardial infarction: influence of heparin on early patency rate (LIMITS study). Liquemin in Myocardial Infarction During Thrombolysis With Saruplase.

OBJECTIVES: The Liquemin in Myocardial Infarction During Thrombolysis With Saruplase (LIMITS) study was instituted to evaluate and characterize the effect of a prethrombolytic heparin bolus (5,000 IU) on the efficacy and safety of saruplase in patients with acute myocardial infarction. BACKGROUND: Heparin has been used after thrombolytic therapy for acute myocardial infarction to prevent reocclusion of the infarct-related artery. METHODS: The study was designed as a randomized, parallel-group, double-blind, multicenter trial. Patients were treated within 6 h of onset of symptoms with either a bolus of 5,000 IU of heparin (Liquemin) (n = 56, HSH group) or placebo (n = 62, PSH group) before thrombolytic treatment with saruplase given as a 20-mg bolus followed by an infusion of 60 mg over 60 min. Thirty minutes after completion of thrombolysis, an intravenous heparin infusion was administered for 5 days. Before coronary angiography was performed at 6 to 12 h after start of lysis, an additional bolus of 5,000 IU heparin was given to all patients. End points studied were patency of the infarct-related artery, changes in the hemostatic system and bleeding complications. RESULTS: In the HSH group (heparin-saruplase-heparin), 78.6% of patients had an open infarct-related vessel (Thrombolysis in Myocardial Infarction [TIMI] flow grade 2 or 3) compared with 56.5% in the PSH group (placebo-saruplase-heparin) (intention-to-treat analysis, p = 0.01). No significant difference was observed between the two groups with regard to changes in fibrinogen and fibrin/fibrinogen degradation products. A total of eight bleeding complications (14.3%) were observed in the HSH group and five (8.1%) in the PSH group; no cerebrovascular event occurred, and no allergic reaction was reported. A total of 12 patients died during the hospital stay, 3 in the HSH group (5.4%) and 9 in the PSH group (14.5%). CONCLUSIONS: In acute myocardial infarction, the administration of a heparin bolus before thrombolytic therapy with saruplase is associated with a significantly higher patency at angiography 6 to 12 h after the start of thrombolysis without any appreciable increase in risk of bleeding.

Randomized, double-blind study comparing saruplase with streptokinase therapy in acute myocardial infarction: the COMPASS Equivalence Trial. Comparison Trial of Saruplase and Streptokinase (COMASS) Investigators.

OBJECTIVES: This study sought to demonstrate the equivalence of saruplase and streptokinase in terms of 30-day mortality. BACKGROUND: The use of thrombolytic agents in the treatment of acute myocardial infarction is well established and has been shown to substantially reduce post-myocardial infarction mortality. METHODS: Three thousand eighty-nine patients with symptoms compatible with those of acute myocardial infarction for < 6 h entered the study at a total of 104 centers and were randomized to receive streptokinase (1.5-MU infusion over 60 min) or saruplase (20-mg bolus and 60-mg infusion over 60 min). In the saruplase group, a bolus of heparin (5,000 IU) was administered before saruplase, and a corresponding blinded double-dummy placebo bolus was administered before streptokinase. All patients received intravenous heparin infusions for > or = 24 h starting 30 min after the end of the thrombolytic infusions; the infusions were titrated to maintain an activated partial thromboplastin time at 1.5 to 2.5 times that of normal. RESULTS: Death of any cause up to 30 days after randomization occurred in 88 (5.7%) of 1,542 patients randomized to receive saruplase and 104 (6.7%) of 1,547 patients randomized to receive streptokinase (odds ratio 0.84, p < 0.01 for equivalence). Hemorrhagic strokes occurred more often in patients receiving saruplase (0.9% vs. 0.3%), whereas thromboembolic strokes were more prevalent in the streptokinase-treated patients (0.5% vs. 1.0%). The rate of bleeding was similar in the two treatment groups (10.4% vs. 10.9%). Hypotension and cardiogenic shock occurred less frequently in the saruplase group. Reinfarction rates were similar. CONCLUSIONS: Saruplase is a clinically safe and effective thrombolytic medication. This profile ranks saruplase favorably among the currently available thrombolytic agents.

History repeats itself: pharmacodynamic trends in the treatment of anxiety disorders.

The original treatment indicated for those suffering from neurotic anxiety was to employ psychotherapy to facilitate changes in behavior and coping with stressful events. A spectrum of somatic treatments "from cathartics and emetics to opium and "strengthening tonics", from atropine and digitalis to potassium bromide and chloral hydrate, from barbiturates to benzodiazepines", to serotonergics, came to be used as well [1]. The Food and Drug Administration originally approved many gamma-aminobutyric acid (GABA) facilitating drugs since the 1960s for anxiety treatment. The 1980s evidenced the approval of a few serotonergic treatments that cornered the prescribing market and the front line of most treatment protocols. More recently, GABAergic drugs are making a return in the treatment of anxiety disorders. The following paper details the pharmacodynamic history of treating anxiety and also updates the reader as to the newer GABA-based approaches mentioned above.

Role of esterified cholesterol transfers in the regulation of plasma cholesterol esterification.

The role of esterified cholesterol transfers in mediating the known effect of very low density lipoproteins (VLDL) on plasma cholesterol esterification has been examined. Advantage has been taken of the fact that pig plasma, in contrast to human plasma, is deficient in activity of the protein that transfers esterified cholesterol between plasma lipoproteins. The experimental protocol consisted of a pre-incubation in which VLDL-deficient pig plasma or isolated pig lipoproteins were incubated with added VLDL, in the presence or absence of an exogenous source of the esterified cholesterol transfer protein. After pre-incubation, any VLDL that may have been present was removed and rates of cholesterol esterification measured in subsequent incubations of the recovered VLDL-depleted fractions. It was, thus, possible to assess the effect of VLDL and/or transfer protein activity on the capacity of other lipoproteins to act as substrates for cholesterol esterification. In the absence of transfer protein activity, the presence of VLDL in pre-incubations had no effect on the subsequently measured rate of cholesterol esterification. However, when pig plasma was supplemented with human lipoprotein-free plasma (a source of esterified cholesterol transfer protein activity) the presence of VLDL in pre-incubations resulted in both a reduction in the esterified cholesterol content of the re-isolated VLDL-deficient fraction and a markedly enhanced rate of cholesterol esterification in subsequent incubations of this fraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Apolipoprotein A-I inhibits transformation of high density lipoprotein subpopulations during incubation of human plasma.

We have examined the effect of added apolipoprotein A-I (apoA-I) on the changes in high density lipoprotein (HDL) particle size that occur when human plasma is incubated in vitro. In the absence of added apoA-I, incubation of plasma at 37 degrees C resulted in a dramatic increase in HDL particle size. When these incubations contained an inhibitor of LCAT, an additional population of smaller HDL particles was formed. These changes in particle size were even more pronounced when the incubations were supplemented with an artificial triglyceride emulsion, Intralipid. All these changes in HDL particle size were markedly inhibited when incubations were supplemented with apoA-I. Even when the amount of added apoA-I was as little as 4.5% of the endogenous apolipoprotein there was an obvious inhibition of the changes in HDL particle size. The presence of added apoA-I sufficient to increase the plasma concentration by 18% virtually abolished the changes in HDL particle size. This effect did not relate to an inhibition of cholesterol esterification, nor did it appear to depend on an incorporation of the added apoA-I into the HDL.

Lipoprotein substrates for plasma cholesterol esterification. Influence of particle size and composition of the high density lipoprotein subfraction 3.

Subpopulations of lipoproteins within the high density lipoprotein subfraction 3 (HDL3) have been isolated from human plasma and characterized in terms of their chemical composition and particle size. Since HDL3 are the major substrates for the esterification of plasma cholesterol, and thus play a central role in the transport of cholesterol through the plasma, these studies also examined the relative capacities of different HDL3 subpopulations to interact with lecithin: cholesterol acyltransferase. Substrate reactivity of a given preparation of lipoproteins was defined in terms of the Vmax of the cholesterol esterification reaction in incubations containing a fixed amount of human lipoprotein-free plasma as a source of the enzyme. Substrate reactivity was found to correlate inversely with the radius of HDL3 particles. This inverse relationship between particle size and substrate reactivity was independent of the particle content of cholesteryl ester.