Abstract P110: Low Dose Minocycline Lowers BP and Improves Inflammatory Status in Patients with Treatment Resistant Hypertension

Background: About 15% of hypertensive patients have treatment resistant hypertension (TRH), which substantially increases mortality risk. Based on our previous studies and evidence from literature, we have proposed that systemic and neuro-inflammation is crucial in development and establishment of TRH. This study was to test the hypothesis that minocycline (Mino), an anti-inflammatory antibiotic, would lower BP and inflammatory markers in patient with TRH. Selection of Mino was based on our preliminary studies showing that Mino can inhibit systemic inflammation and penetrate the blood brain barrier to attenuate neuroinflammation in addition to its antibiotic effects.

Methods: A total of 29 subjects was recruited for this study. Exclusion and inclusion criteria are described at Clinicaltrials.gov (NCT02133872). Office and ambulatory BP measurements (ABPM) were used to confirm TRH diagnosis and subsequently measured 30d and 60 d after Mino administration (50mg/d). If BP failed to decline after 60 d Mino treatment (50mg/d), Mino was increased to 100mg/d and patients were monitored at 60 d. Circulating high-sensitivity C-reactive protein (hs-CRP), high-mobility group box 1 (HMGB1), and Th17 levels were measured.

Results: Average BP of TRH patients was 149.5/78.5mmHg, 67% responded to 50mg/d Mino and 33% to 100mg/d. ABPM 24h average BP for all m-TRH was <136/69mmHg 60 d after Mino, and ABPM showed systolic and diastolic BP were significantly reduced by 14.5/10.5 mmHg. Plasma HMGB1 levels were 8- and 5-fold higher in TRH than normotensive (N) and controlled hypertensive (CH) patients, respectively (TRH: 45.2±25.10 vs N: 5.5±3.8 and CH: 8.9±10.2, ng/ml, p<0.05). Mino reduced HMGB1 level in TRH (m-TRH 3.0±0.7, ng/ml p<0.05). Furthermore, there were 3-4-fold increases in Th17 cells and 67% increase in hs-CRP levels in TRH patients compared to N and CH. Mino treatment resulted in significant reduction in these parameters and did not change BMI in TRH patients.

Conclusions: This study demonstrates that a low dose Mino has a significant antihypertensive effect and lowers inflammatory markers in TRH patients. Thus, Mino could be considered a promising therapeutic option for TRH patients.

Casein and whey exert different effects on plasma amino acid profiles, gastrointestinal hormone secretion and appetite

Protein, generally agreed to be the most satiating macronutrient, may differ in its effects on appetite depending on the protein source and variation in digestion and absorption. We investigated the effects of two milk protein types, casein and whey, on food intake and subjective ratings of hunger and fullness, and on postprandial metabolite and gastrointestinal hormone responses. Two studies were undertaken. The first study showed that energy intake from a buffet meal ad libitum was significantly less 90 min after a 1700 kJ liquid preload containing 48 g whey, compared with an equivalent casein preload (P<0.05). In the second study, the same whey preload led to a 28 % increase in postprandial plasma amino acid concentrations over 3 h compared with casein (incremental area under the curve (iAUC), P<0.05). Plasma cholecystokinin (CCK) was increased by 60 % (iAUC, P<0.005), glucagon-like peptide (GLP)-1 by 65 % (iAUC, P<0.05) and glucose-dependent insulinotropic polypeptide by 36 % (iAUC, P<0.01) following the whey preload compared with the casein. Gastric emptying was influenced by protein type as evidenced by differing plasma paracetamol profiles with the two preloads. Greater subjective satiety followed the whey test meal (P<0.05). These results implicate post-absorptive increases in plasma amino acids together with both CCK and GLP-1 as potential mediators of the increased satiety response to whey and emphasise the importance of considering the impact of protein type on the appetite response to a mixed meal.

The ability of habitual exercise to influence appetite and food intake in response to high- and low-energy preloads in man

The present study tested the hypothesis that habitual exercisers demonstrate an increased accuracy of regulation of food intake in compensation for previous dietary energy intake. Twenty-three lean healthy male subjects were divided into two groups on the basis of their habitual exercise levels: non-exercisers (no exercise sessions/week, n 9), and exercisers (>two exercise sessions of 40 min or more/week, n 14). The appetite response to covert liquid preloads of high (2513 kJ) energy (HE) and low (1008 kJ) energy (LE) was investigated Sixty minutes after the preload subjects were offered an ab libitum buffet-style meal and energy intake (EI) was calculated. Subjective hunger and satiety were assessed throughout using self-rated visual-analogue scales. Buffet EI in non-exercisers was not significantly different following the LE or HE preloads (mean compensation 7 %), but the exercise group significantly reduced their energy intake following the HE, compared with the LE, preload (mean compensation 90 %; P=0.0035). A broadly similar pattern of response was observed for both moderate (two to three sessions/week, n 7) and high exercisers (>four sessions/week, n 7). There were no significant differences between hunger or satiety ratings following HE or LE preloads for either group. However non-exercisers scored significantly higher on their self-ratings of hunger at the start of the study, before preload consumption, compared with the exercisers (P<0.01). These findings demonstrate that habitual exercisers have an increased accuracy of short-term regulation of food intake in compensation for preload manipulation, and provide additional support for advocating regular exercise in the prevention of overweight and obesity.

A meta-analysis of the effect of glucagon-like peptide-1 (7-36) amide on ad libitum energy intake in humans

Seven studies have now been published pertaining to the acute effect of iv administration of glucagon-like peptide-1 (7-36) amide on ad libitum energy intake. In four of these studies energy intake was significantly reduced following the glucagon-like peptide-1 infusion compared with saline. In the remaining studies, no significant effect of glucagon-like peptide-1 could be shown. Lack of statistical power or low glucagon-like peptide-1 infusion rate may explain these conflicting results. Our aim was to examine the effect of glucagon-like peptide-1 on subsequent energy intake using a data set composed of subject data from previous studies and from two as yet unpublished studies. Secondly, we investigated whether the effect on energy intake is dose dependent and differs between lean and overweight subjects. Raw subject data on body mass index and ad libitum energy intake were collected into a common data set (n = 115), together with study characteristics such as infusion rate, duration of infusion, etc. From four studies with comparable protocol the following subject data were included if available: plasma concentrations of glucagon-like peptide-1, subjective appetite measures, well-being, and gastric emptying rate of a meal served at the start of the glucagon-like peptide-1 infusion. Energy intake was reduced by 727 kJ (95% confidence interval, 548-908 kJ) or 11.7% during glucagon-like peptide-1 infusion. Although the absolute reduction in energy intake was higher in lean (863 kJ) (634-1091 kJ) compared with overweight subjects (487 kJ) (209-764 kJ) (P = 0.05), the relative reduction did not differ between the two groups (13.2% and 9.3%, respectively). Stepwise regression analysis showed that the glucagon-like peptide-1 infusion rate was the only independent predictor of the reduction in energy intake during glucagon-like peptide-1 (7-36) amide infusion (r = 0.4, P < 0.001). Differences in mean plasma glucagon-like peptide-1 concentration on the glucagon-like peptide-1 and placebo day (n = 43) were related to differences in feelings of prospective consumption (r = 0.40, P < 0.01), fullness (r = 0.38, P < 0.05), and hunger (r = 0.26, P = 0.09), but not to differences in ad libitum energy intake. Gastric emptying rate was significantly lower during glucagon-like peptide-1 infusion compared with saline. Finally, well-being was not influenced by the glucagon-like peptide-1 infusion. Glucagon-like peptide-1 infusion reduces energy intake dose dependently in both lean and overweight subjects. A reduced gastric emptying rate may contribute to the increased satiety induced by glucagon-like peptide-1.

Impact of exposure length and pupal source on Muscidifurax raptorellus and Nasonia vitripennis (Hymenoptera: Pteromalidae) parasitism in a New York poultry facility

Commercially obtained Nasonia vitripennis Walker and Muscidifurax raptorellus Kogan & Legner were released weekly for 12 wk into a high-rise, caged-layer poultry house. After the release period, parasitoids were sampled using sentinel house fly (Musca domestica L.) pupae that were either laboratory-reared or field-collected as larvae and exposed for 2, 4, 7, and 14 d. Parasitoid-induced mortality was observed in 31% of laboratory colony pupae and in 26% of field-collected pupae, whereas successful parasitism rates of 48 and 51% were observed from these pupal sources, respectively. Parasitism was primarily by M. raptorellus (88%), and Muscidifurax raptor Girault & Sanders (11%), while N. vitripennis accounted for <1%. Percent female progeny ranged from 43%, in M. raptorellus to 76% in N. vitripennis. Parasitoid emergence from 2-d exposed sentinel pupae was the lowest of all treatments. Parasitoid emergence from 7-d exposed sentinel pupae was the highest of all treatments. We found no differences between pupal source, suggesting that when sampling for M. raptor, M. raptorellus, and N. vitripennis, in poultry facilities, pupal source is not a confounding factor.

Parasitism rates of Muscidifurax raptorellus and Nasonia vitripennis (Hymenoptera: Pteromalidae) after individual and paired releases in New York poultry facilities

Commercially reared parasitoids were released into three high-rise, caged-layer poultry houses; one house received only N. vitripennis Walker, the second house received only M. raptorellus Kogan & Legner, and the third house received an equal ratio of both species. Overall, house fly parasitism by M. raptorellus was never higher than 7% in any house. Most parasitism in the M. raptorellus release house was attributed to N. vitripennis. Parasitism of house fly pupae by M. raptorellus did not significantly increase during or after the 6-wk release period in the house that received both parasitoids. However, a depression in total parasitism was not detected when releases of the two species were made in this house.

Larval production from field-collected Carcinops pumilio (Coleoptera: Histeridae) following three starvation periods

Carcinops pumilio (Erichson) were collected from high-rise, caged-layer poultry facilities using two trapping methods, a blacklight pitfall trap and a mesh-bottomed trap placed on poultry manure. Starvation for 14 d significantly reduced larval production during the first 3-d oviposition period regardless of trapping method. Beetles collected with blacklight traps and subsequently starved for 14 d had higher larval production in the third through fifth oviposition periods than those fed daily, indicating that lack of nutrition was a limiting factor in C. pumilio larval production. No differences were observed in larval production, after the first oviposition period, between the 14-d starved and daily fed groups collected with the mesh-bottom trap. In all blacklight-captured treatments, larval production was lowest during the first oviposition period with the largest differences found among the three starved treatments. Larval production in the 14-d starved treatment increased significantly during the later oviposition periods in mesh-bottom trap studies. Within the fed treatment, larval production was consistently greater among beetles collected with the mesh-bottom trap than among beetles collected with blacklight traps.

Prey- and density-mediated dispersal in Carcinops pumilio (Coleoptera: Histeridae), a predator of house fly (Diptera: Muscidae) eggs and larvae

Carcinops pumilio (Erichson) were collected using two trapping methods: a black light pitfall trap and a mesh-bottomed trap placed on poultry manure. C. pumilio collected with black lights and subsequently starved had a significantly higher dispersal rate during days 1-3 than fully fed groups. When densities of < 500 Caloglyphus berlesei (Michael) (Acarina: Acaridae) per 50 C. pumilio were provided, mite availability had a significant effect on dispersal of beetles captured with both black light traps and the mesh-bottomed trap during the day 1-3 period. Our results indicate that the availability of acceptable food sources can delay and possibly prevent dispersal by C. pumilio. Black light-captured beetles appeared to be in a state of dispersal when captured. A subset of dispersing beetles was present in groups captured with the mesh-bottomed trap.

Effect of habitual dietary-protein intake on appetite and satiety

To investigate whether appetite response to a high-protein test meal varies inversely with habitual protein intake, the satiating influence of dietary protein was investigated in 14 subjects. Subjects were divided into two groups on the basis of habitual protein intake: means of 1.0 g/kg/day (LP) and 1.4 g/kg/day (HP). Appetite was assessed in each group following high protein meals (test a). A 13-day period of dietary manipulation increased differences in protein intake between groups to a mean of 0.75 g/kg/day (LP) and 1.96 g/kg/day (HP) and a second satiety test (b) was performed. A third test (c) was performed in the HP group after protein intakes were reduced for 2 days to a mean of 0.85 g/kg/day. Differences in satiety were most marked, with significant correlations between satiety after the three meals and daily protein intake (r=-0.36). LP satiety was significantly greater than HP after test b (p=0.025), and approached significance when satiety response during LPb was compared with HPc (p=0.07). Results support the hypothesis that the satiating effect of dietary protein varies inversely with habitual protein intake.

Changes in the hormonal concentrations of pregnant rats and their fetuses following multiple exposures to a stressor during the third trimester

Human and animal studies indicate that stress during pregnancy can exert long-term effects on the development of the offspring, effects that appear to be mediated in part by the hypothalamic-pituitary-adrenal (HPA) axis. In this experiment changes in levels of a variety of HPA and other hormones in both pregnant rats and their fetuses were investigated. Trunk blood was collected from pregnant females and fetuses following repeated 45-min presentations of restraint, bright lights, and heat during the third trimester. In addition, testes were harvested from the male fetuses. Hormone concentrations were determined by radioimmunoassay. Pregnant females had elevated titers of plasma corticosterone, aldosterone, and ACTH for approximately 15 min following termination of the stressor. No differences were found for beta-endorphin or prolactin. Fetuses showed a pattern of changes in plasma corticosterone and aldosterone that was similar to that of pregnant females, but no effect was observed for fetal ACTH titers. These results are consistent with a role of the HPA axis in the effects of gestational stress. Testicular levels of CRF on gestational day 21 were lower in fetuses of stressed females than in those of nonstressed females. The reduced levels of testicular CRF suggest that CRF may be involved in the altered pattern of sexual differentiation of males stressed during gestation.

No effect of glucagon-like peptide-1 on short-term satiety and energy intake in man

Centrally administered glucagon-like peptide-1 (GLP-1) inhibits feeding in fasted rats, but its role in human satiety has been largely unexplored. The present study investigated the effect of peripheral GLP-1 infusion on gastric emptying and satiety in man. Ten non-obese male subjects were infused in a randomized single-blind within-subject crossover study using saline infusion as control. They received either a GLP-1 infusion (1.2 pmol/kg per min) or a saline infusion for 1 h, at 18.00 hours. At 20 min after starting the infusion the gastric emptying of a 400 ml water load was measured. Subjects completed behavioural self-rating scales to assess hunger and satiety. After 40 min subjects were given a buffet meal ad libitum and their food intake was recorded. GLP-1 infusion raised circulating GLP-1 concentrations to approximately twice those seen following a meal. It did not affect circulating insulin levels but caused a small fall in glucose levels. Gastric emptying of the water load was significantly delayed by the GLP-1 infusion. Energy intake from the buffet was unaffected by GLP-1 infusion. Self-assessment of hunger and satiety was similarly unaffected by the infusion before the buffet meal, although subjects tended to be less hungry after the buffet meal following GLP-1 infusion (P < 0.09). GLP-1 infusion delayed gastric emptying but had a minimal effect on food intake and satiety. This study casts doubts on whether GLP-1 is a major satiety factor in man, although a raised circulating plasma glucose level, as would normally occur postprandially, might be necessary for GLP-1 to increase satiety.

Effects of peripherally administered corticotropin-releasing factor (CRF) and a CRF antagonist: does peripheral CRE activity mediate behavior of guinea pig pups during isolation?

Guinea pig pups vocalized and ambulated when first isolated in a test cage; at 1 and 24 hr, levels of these behaviors had waned, and pups frequently exhibited a crouched stance, eye-closing, and piloerection. Injection (s.c.) of corticotropin-releasing factor (CRF) prior to isolation diminished the initial vocalization and locomotor responses and induced pups to exhibit the crouched stance, eye-closing, and piloerection at the beginning of the isolation period. Pretreatment with a CRF-receptor antagonist reversed the behavioral effects of CRF. CRF had no effect on blood pressure. Thus, s.c. CRF produced the same behavioral profile as seen with the passage of time in untreated isolated pups. The behavioral effects appeared to be CRF-receptor-mediated events and were not secondary to hypotension. These results support the hypothesis that during prolonged isolation, high or sustained peripheral CRF activity modulates behavior.

Biotherapy: enlisting the immune system in cancer treatment

Biotherapy has emerged as the fourth modality for the treatment of cancer. Biologic response modifiers (BRMs) alter the host-tumor relationship through immunomodulation to affect a biologic response. Currently, two BRMs, alpha-interferon and interleukin-2, have had clinical success in treating cancer and have gained approval by the U.S. Food and Drug Administration. Toxicities associated with BRMs are complex and often involve multiple systems. Understanding these toxicities and their corresponding pathophysiologic manifestations aides nurses in their assessment and management of patients receiving BRMs.

Effects of peripherally administered corticotropin-releasing factor (CRF) and a CRF antagonist: does peripheral CRE activity mediate behavior of guinea pig pups during isolation?

Guinea pig pups vocalized and ambulated when first isolated in a test cage; at 1 and 24 hr, levels of these behaviors had waned, and pups frequently exhibited a crouched stance, eye-closing, and piloerection. Injection (s.c.) of corticotropin-releasing factor (CRF) prior to isolation diminished the initial vocalization and locomotor responses and induced pups to exhibit the crouched stance, eye-closing, and piloerection at the beginning of the isolation period. Pretreatment with a CRF-receptor antagonist reversed the behavioral effects of CRF. CRF had no effect on blood pressure. Thus, s.c. CRF produced the same behavioral profile as seen with the passage of time in untreated isolated pups. The behavioral effects appeared to be CRF-receptor-mediated events and were not secondary to hypotension. These results support the hypothesis that during prolonged isolation, high or sustained peripheral CRF activity modulates behavior.

Plasma cortisol and vocalization responses of postweaning age guinea pigs to maternal and sibling separation: evidence for filial attachment after weaning

Postweaning guinea pigs housed with their mother and littermates since birth vocalized more and exhibited greater increases in plasma cortisol levels when placed for 1 hr into a novel test cage alone than they did when tested in the identical fashion with the mother present. These responses were apparent beyond 50 days of age, but had waned by 90 days of age. When tested with a familiar sibling cagemate, postweaning guinea pigs emitted fewer vocalizations than when tested alone but exhibited no less of an elevation of plasma cortisol levels. These results were obtained regardless of whether the subjects had been housed with mother and littermates from birth until the time of testing or with mother and littermates until weaning and then just the single sibling cagemate until the time of testing. The present findings closely approximate those seen in preweaning guinea pigs during tests of maternal and sibling separation, and indicate that guinea pigs can continue to exhibit a specific attachment to the mother beyond the time of weaning.