Administration of neurotoxic doses of MDMA reduces sensitivity to ethanol and increases GAT-1 immunoreactivity in mice striatum

Abstract Rationale Mice with reduced dopamine activity following neurotoxic doses of 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') consume more ethanol (EtOH) and show greater preference for EtOH. In keeping with human studies and other animal models where alcohol consumption and preference are also high, MDMA treatment will reduce sensitivity to certain physiological effects of EtOH. Objective We have examined the sensitivity to the acute effects of EtOH in MDMA-lesioned mice and the effects of EtOH on striatal gamma-aminobutyric acid (GABA) accumulation and expression of GABA subtype-1 transporter (GAT-1). Methods C57BL/6J mice were injected with neurotoxic MDMA (30 mg/kg, three times, every 3 h, i.p.). Seven days later, mice were given EtOH (3 g/kg, i.p.) to determine the loss of righting response and the development of rapid tolerance to the hypothermic effect of EtOH. The effect of EtOH on the striatal accumulation of GABA after inhibiting GABA transaminase and on GAT-1 immunoreactivity was also determined. Results Mice pre-treated with a neurotoxic dose of MDMA were less sensitive to the sedative-hypnotic effect of acute EtOH and exhibited alterations in the development of rapid tolerance to the hypothermic effect of EtOH. These animals showed an increase in striatal GAT-1 immunoreactivity. EtOH reduced GABA concentration in the striatum of non-lesioned mice, an effect not observed in MDMA-lesioned mice. Conclusion These findings indicate that mice with a MDMA-induced dopaminergic lesion show increased expression of striatal GAT-1 that may contribute to the lower sensitivity to EtOH-induced sedative effects and the resistance to the development of rapid tolerance to hypothermia produced by EtOH

The Global Risk Approach Should Be Better Applied in French Hypertensive Patients: A Comparison between Simulation and Observation Studies

The prediction of the public health impact of a preventive strategy provides valuable support for decision-making. International guidelines for hypertension management have introduced the level of absolute cardiovascular risk in the definition of the treatment target population. The public health impact of implementing such a recommendation has not been measured.We assessed the efficiency of three treatment scenarios according to historical and current versions of practice guidelines on a Realistic Virtual Population representative of the French population aged from 35 to 64 years: 1) BP≥160/95 mm Hg; 2) BP≥140/90 mm Hg and 3) BP≥140/90 mm Hg plus increased CVD risk. We compared the eligibility following the ESC guidelines with the recently observed proportion of treated amongst hypertensive individuals reported by the Etude Nationale Nutrition Santé survey. Lowering the threshold to define hypertension multiplied by 2.5 the number of eligible individuals. Applying the cardiovascular risk rule reduced this number significantly: less than 1/4 of hypertensive women under 55 years and less than 1/3 of hypertensive men below 45 years of age. This was the most efficient strategy. Compared to the simulated guidelines application, men of all ages were undertreated (between 32 and 60%), as were women over 55 years (70%). By contrast, younger women were over-treated (over 200%).The global CVD risk approach to decide for treatment is more efficient than the simple blood pressure level. However, lack of screening rather than guideline application seems to explain the low prescription rates among hypertensive individuals in France. Multidimensional analyses required to obtain these results are possible only through databases at the individual level: realistic virtual populations should become the gold standard for assessing the impact of public health policies at the national level

Virtual Patients and Sensitivity Analysis of the Guyton Model of Blood Pressure Regulation: Towards Individualized Models of Whole-Body Physiology

Mathematical models that integrate multi-scale physiological data can offer insight into physiological and pathophysiological function, and may eventually assist in individualized predictive medicine. We present a methodology for performing systematic analyses of multi-parameter interactions in such complex, multi-scale models. Human physiology models are often based on or inspired by Arthur Guyton's whole-body circulatory regulation model. Despite the significance of this model, it has not been the subject of a systematic and comprehensive sensitivity study. Therefore, we use this model as a case study for our methodology. Our analysis of the Guyton model reveals how the multitude of model parameters combine to affect the model dynamics, and how interesting combinations of parameters may be identified. It also includes a “virtual population” from which “virtual individuals” can be chosen, on the basis of exhibiting conditions similar to those of a real-world patient. This lays the groundwork for using the Guyton model for in silico exploration of pathophysiological states and treatment strategies. The results presented here illustrate several potential uses for the entire dataset of sensitivity results and the “virtual individuals” that we have generated, which are included in the supplementary material. More generally, the presented methodology is applicable to modern, more complex multi-scale physiological models

TRPV1 may increase the effectiveness of estrogen therapy on neuroprotection and neuroregeneration

Aging induces physical deterioration, loss of the blood brain barrier, neuronal loss-induced mental and neurodegenerative diseases. Hypotalamus-hypophysis-gonad axis aging precedes symptoms of menopause or andropause and is a major determinant of sensory and cognitive integrated function. Sexual steroids support important functions, exert pleiotropic effects in different sensory cells, promote regeneration, plasticity and health of the nervous system. Their diminution is associated with impaired cognitive and mental health and increased risk of neurodegenerative diseases. Then, restoring neuroendocrine axes during aging can be key to enhance brain health through neuroprotection and neuroregeneration, depending on the modulation of plasticity mechanisms. Estrogen-dependent transient receptor potential cation channel, subfamily V, member 1 (TRPV1) expression induces neuroprotection, neurogenesis and regeneration on damaged tissues. Agonists of TRPV1 can modulate neuroprotection and repair of sensitive neurons, while modulators as other cognitive enhancers may improve the survival rate, differentiation and integration of neural stem cell progenitors in functional neural network. Menopause constitutes a relevant clinical model of steroidal production decline associated with progressive cognitive and mental impairment, which allows exploring the effects of hormone therapy in health outcomes such as dysfunction of CNS. Simulating the administration of hormone therapy to virtual menopausal individuals allows assessing its hypothetical impact and sensitivity to conditions that modify the effectiveness and efficiency

High Risk versus Proportional Benefit: Modelling Equitable Strategies in Cardiovascular Prevention

<div><p>Objective</p><p>To examine the performances of an alternative strategy to decide initiating BP-lowering drugs called Proportional Benefit (PB). It selects candidates addressing the inequity induced by the high-risk approach since it distributes the gains proportionally to the burden of disease by genders and ages.</p><p>Study Design and Setting</p><p>Mild hypertensives from a Realistic Virtual Population by genders and 10-year age classes (range 35–64 years) received simulated treatment over 10 years according to the PB strategy or the 2007 ESH/ESC guidelines (ESH/ESC). Primary outcomes were the relative life-year gain (life-years gained-to-years of potential life lost ratio) and the number needed to treat to gain a life-year. A sensitivity analysis was performed to assess the impact of changes introduced by the ESH/ESC guidelines appeared in 2013 on these outcomes.</p><p>Results</p><p>The 2007 ESH/ESC relative life-year gains by ages were 2%; 10%; 14% in men, and 0%; 2%; 11% in women, this gradient being abolished by the PB (relative gain in all categories = 10%), while preserving the same overall gain in life-years. The redistribution of benefits improved the profile of residual events in younger individuals compared to the 2007 ESH/ESC guidelines. The PB strategy was more efficient (NNT = 131) than the 2013 ESH/ESC guidelines, whatever the level of evidence of the scenario adopted (NNT = 139 and NNT = 179 with the evidence-based scenario and the opinion-based scenario, respectively), although the 2007 ESH/ESC guidelines remained the most efficient strategy (NNT = 114).</p><p>Conclusion</p><p>The Proportional Benefit strategy provides the first response ever proposed against the inequity of resource use when treating highest risk people. It occupies an intermediate position with regards to the efficiency expected from the application of historical and current ESH/ESC hypertension guidelines. Our approach allows adapting recommendations to the risk and resources of a particular country.</p></div

Simulation steps to design the proportional benefit strategy to identify the treatment target population.

<p>The reference is the overall Proportional Benefit, i.e. the relative life-year gain obtained from the application of the 2007 ESH/ESC recommendation on the potentially eligible individuals from the Realistic Virtual French Population. Abbreviations: PB, proportional benefit; YPLL, years of potential life lost; LYG, life-years gained; NEP, number of events prevented; NNT, number needed to treat to gain a life-year.</p

Sensitivity analysis assessing the impact of the 2013 ESH/ESC Guidelines on costs, proportion of benefits and efficiency.

<p>Abbreviations: n, number of individuals potentially eligible; NES, number of eligible subjects; NE, number of events among the individuals potentially eligible; NEP, number of events prevented by BP-lowering drugs; NRE, number of residual events; YPLL, years of potential life lost; LYG, life-years gained; NNT, number needed to treat to gain a life-year</p><p>Sensitivity analysis assessing the impact of the 2013 ESH/ESC Guidelines on costs, proportion of benefits and efficiency.</p

Prescription scenarios according to ESH/ESC successive guidelines and the Proportional Benefit strategy.

<p>Prescription scenarios according to ESH/ESC successive guidelines and the Proportional Benefit strategy.</p