Renin and aldosterone but not the natriuretic peptide correlate with obsessive craving in medium-term abstinent alcohol-dependent patients: a longitudinal study

Both animal and human studies suggest that volume-regulating hormones could play a role in alcohol dependence as well as in alcohol craving. The role of the volume-regulating hormones, renin, aldosterone, and the N-terminal pro B-type natriuretic peptide (NT-proBNP) in alcohol craving was therefore evaluated in the present study. Twenty-five actively drinking alcohol-dependent patients satisfied the inclusion criteria and were enrolled into the study. The volume-regulating hormones, renin, aldosterone, and the NT-proBNP, and craving measurements-Obsessive-Compulsive Drinking Scale (OCDS) and Penn Alcohol Craving Scale (PACS)-were performed at baseline and after 12 weeks. Sixteen patients remained totally abstinent for the entire 12 weeks and were available for the second assessments. At baseline, no correlations between hormones and craving scores were found with either the 25 patients initially enrolled or the 16 abstinent patients. At 12 weeks, a significant increase of renin and a significant decrease of aldosterone were observed. Aldosterone showed a significant direct correlation with the obsessive OCDS subscore (r = 0.59, P = .016) and a trend toward a significant direct correlation with the PACS score (r = 0.48, P = .057). Renin demonstrated a significant direct correlation with the obsessive OCDS subscore (r = 0.51, P = .041) and with the PACS score (r = 0.56, P = .025). The NT-proBNP never correlated with craving measurements. In conclusion, the renin-aldosterone axis could play a role in craving in medium-term abstinent patients and thereby leading to the hypothesis that alcohol craving could be influenced by the fluid volume intake

Genomic medicine: genetic variation and its impact on the future of health care

Advances in genome technology and other fruits of the Human Genome Project are playing a growing role in the delivery of health care. With the development of new technologies and opportunities for large-scale analysis of the genome, transcriptome, proteome and metabolome, the genome sciences are poised to have a profound impact on clinical medicine. Cancer prognostics will be among the first major test cases for a genomic medicine paradigm, given that all cancer is caused by genomic instability, and microarrays allow assessment of patients' entire expressed genomes. Analysis of breast cancer patients' expression patterns can already be highly correlated with recurrence risks. By integrating clinical data with gene expression profiles, imaging, metabolomic profiles and proteomic data, the prospect for developing truly individualized care becomes ever more real. Notwithstanding these promises, daunting challenges remain for genomic medicine. Success will require planning robust prospective trials, analysing health care economic and outcome data, assuaging insurance and privacy concerns, developing health delivery models that are commercially viable and scaling up to meet the needs of the whole population

Baclofen promotes alcohol abstinence in alcohol dependent cirrhotic patients with hepatitis C virus (HCV) infection

Hepatitis C virus (HCV) and alcoholic liver disease (ALD), either alone or in combination, count for more than two thirds of all liver diseases in the Western world. There is no safe level of drinking in HCV-infected patients and the most effective goal for these patients is total abstinence. Baclofen, a GABA(B) receptor agonist, represents a promising pharmacotherapy for alcohol dependence (AD). Previously, we performed a randomized clinical trial (RCT), which demonstrated the safety and efficacy of baclofen in patients affected by AD and cirrhosis. The goal of this post-hoc analysis was to explore baclofen's effect in a subgroup of alcohol-dependent HCV-infected cirrhotic patients. Any patient with HCV infection was selected for this analysis. Among the 84 subjects randomized in the main trial, 24 alcohol-dependent cirrhotic patients had a HCV infection; 12 received baclofen 10mg t.i.d. and 12 received placebo for 12-weeks. With respect to the placebo group (3/12, 25.0%), a significantly higher number of patients who achieved and maintained total alcohol abstinence was found in the baclofen group (10/12, 83.3%; p=0.0123). Furthermore, in the baclofen group, compared to placebo, there was a significantly higher increase in albumin values from baseline (p=0.0132) and a trend toward a significant reduction in INR levels from baseline (p=0.0716). In conclusion, baclofen was safe and significantly more effective than placebo in promoting alcohol abstinence, and improving some Liver Function Tests (LFTs) (i.e. albumin, INR) in alcohol-dependent HCV-infected cirrhotic patients. Baclofen may represent a clinically relevant alcohol pharmacotherapy for these patients