Multidimensional family therapy lowers the rate of cannabis dependence in adolescents: a randomised controlled trial in Western European outpatient settings

BACKGROUND

Noticing a lack of evidence-based programmes for treating adolescents heavily using cannabis in Europe, government representatives from Belgium, France, Germany, The Netherlands, and Switzerland decided to have U.S.-developed multidimensional family therapy (MDFT) tested in their countries in a trans-national trial, called the International Need for Cannabis Treatment (INCANT) study.

METHODS

INCANT was a 2 (treatment condition)×5 (time) repeated measures intent-to-treat randomised effectiveness trial comparing MDFT to Individual Psychotherapy (IP). Data were gathered at baseline and 3, 6, 9 and 12 months thereafter. Study participants were recruited at outpatient secondary level addiction, youth, and forensic care clinics in Brussels, Berlin, Paris, The Hague, and Geneva. Participants were adolescents from 13 through 18 years of age with a recent cannabis use disorder. 85% were boys; 40% were of foreign descent. One-third had been arrested for a criminal offence in the past 3 months. Three primary outcomes were assessed: (1) treatment retention, (2) prevalence of cannabis use disorder and (3) 90-day frequency of cannabis consumption.

RESULTS

Positive outcomes were found in both the MDFT and IP conditions. MDFT outperformed IP on the measures of treatment retention (p<0.001) and prevalence of cannabis dependence (p=0.015). MDFT reduced the number of cannabis consumption days more than IP in a subgroup of adolescents reporting more frequent cannabis use (p=0.002).

CONCLUSIONS

Cannabis use disorder was responsive to treatment. MDFT exceeded IP in decreasing the prevalence of cannabis dependence. MDFT is applicable in Western European outpatient settings, and may show moderately greater benefits than IP in youth with more severe substance use.

Parenting practices as mediators of treatment effects in an early-intervention trial of multidimensional family therapy

BACKGROUND

Contemporary intervention models use research about the determinants of adolescent problems and their course of symptom development to design targeted interventions. Because developmental detours begin frequently during early-mid adolescence, specialized interventions that target known risk and protective factors in this period are needed.

METHODS

This study (n = 83) examined parenting practices as mediators of treatment effects in an early-intervention trial comparing Multidimensional Family Therapy (MDFT), and a peer group intervention. Participants were clinically referred, low-income, predominantly ethnic minority adolescents (average age 14). Assessments were conducted at intake, and six weeks after intake, discharge, and at 6 and 12 months following intake.

RESULTS

Previous studies demonstrated that MDFT was more effective than active treatments as well as services as usual in decreasing substance use and improving abstinence rates. The current study demonstrated that MDFT improves parental monitoring-a fundamental treatment target-to a greater extent than group therapy, and these improvements occur during the period of active intervention, satisfying state-of-the-science criteria for assessing mediation in randomized clinical trials.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Findings indicate that change in MDFT occurs through improvements in parenting practices. These results set the foundation for examining family factors as mediators in other samples.

Fibroblast growth factor 2 reactivates G1 checkpoint in SK-N-MC cells via regulation of p21, inhibitor of differentiation genes (Id1-3), and epithelium-mesenchyme transition-like events

We have recently demonstrated that fibroblast growth factor (FGF)-2 promotes neuroblastoma cell differentiation and overrides their mitogenic response to IGF-I. However, the mechanisms involved are unknown. SK-N-MC cells were cultured with FGF-2 (50 ng/ml) and/or IGF-I (100 ng/ml) up to 48 h. Fluorescence-activated cell sorting analysis indicated that FGF-2 promotes G1/G0 cell cycle phase arrest. Gene expression by RT2-PCR and cellular localization showed up-regulation of p21. We then investigated whether FGF-2-induced differentiation of SK-N-MC cells (by GAP43 and NeuroD-6 expression) involves epithelium-mesenchyme transition interconversion. Real-time PCR (RT2-PCR) showed modulation of genes involved in maintenance of the epithelial phenotype and cell-matrix interactions (E-cadherin, Snail-1, MMPs). Zymography confirmed FGF-2 up-regulated MMP2 and induced MMP9, known to contribute to neuronal differentiation and neurite extension. Id1-3 expression was determined by RT2-PCR. FGF-2 induced Id2, while down-regulating Id1 and Id3. FGF-2 induced nuclear accumulation of ID2 protein, while ID1 and ID3 remained cytoplasmic. RNA interference demonstrated that Id3 regulates differentiation and cell cycle (increased Neuro-D6 and p21 mRNA), while d Id2 modulates epithelium-mesenchyme transition-like events (increased E-cadherin mRNA). In conclusion, we have shown for the first time that FGF-2 induces differentiation of neuroblastoma cells via activation of a complex gene expression program enabling modulation of cell cycle, transcription factors, and suppression of the cancer phenotype. The use of RNA interference indicated that Id-3 is a key regulator of these events, thus pointing to a novel therapeutic target for this devastating childhood cancer.

Integrating individual-based indices of contaminant effects. How multiple sublethal effects may ultimately reduce amphibian recruitment from a contaminated breeding site

Habitat contamination can alter numerous biological processes in individual organisms. Examining multiple individual-level responses in an integrative fashion is necessary to understand how individual health or fitness reflects environmental contamination. Here we provide an example of such an integrated perspective based upon recent studies of an amphibian (the bullfrog, Rana catesbeiana ) that experiences several, disparate changes when larval development occurs in a trace element-contaminated habitat. First, we present an overview of studies focused on specific responses of individuals collected from, or transplanted into, a habitat contaminated by coal combustion residues (CCR). These studies have reported morphological, behavioral, and physiological modifications to individuals chronically interacting with sediments in the CCR-contaminated site. Morphological abnormalities in the oral and tail regions in contaminant-exposed individuals influenced other properties such as grazing, growth, and swimming performance. Behavioral changes in swimming activities and responses to stimuli appear to influence predation risk in the contaminant-exposed population. Significant changes in bioenergetics in the contaminated habitat, evident as abnormally high energetic expenditures for survival (maintenance) costs, may ultimately influence production pathways (growth, energy storage) in individuals. We then present a conceptual model to examine how interactions among the affected systems (morphological, behavioral, physiological) may ultimately bring about more severe effects than would be predicted if the responses were considered in isolation. A complex interplay among simultaneously occurring biological changes emerges in which multiple, sublethal effects ultimately can translate into reductions in larval or juvenile survival, and thus reduced recruitment of juveniles into the population. In systems where individuals are exposed to low concentrations of contaminants for long periods of time, research focused on one or few sublethal responses could substantially underestimate overall effects on individuals. We suggest that investigators adopt a more integrated perspective on contaminant-induced biological changes so that studies of individual-based effects can be better integrated into analyses of mechanisms of population change.

Resource allocation-based life histories: a conceptual basis for studies of ecological toxicology

Whereas ecological assessments of contaminants are concerned with populations and higher levels of organization, most mechanistic work in toxicology is directed at effects on individuals and their parts. We propose that studies based on individuals can be useful in ecological analysis of polluted systems when based on the concepts of resource allocation-based life history analysis. At the heart of the resource allocation approach is the concept of operative environments of individuals (i.e., environmental factors influencing birth, death, or migration). Contaminants can have strong influences on operative environments, modifying resource allocation strategies that reflect changes in energy assimilation and demands. By examining contaminant-induced responses of individuals from the perspective of changing operative environments, individual-based changes and population dynamics can be addressed in an ecologically rigorous manner.

Metabolic costs incurred by crayfish (Procambarus acutus) in a trace element-polluted habitat: further evidence of similar responses among diverse taxonomic groups

Recent studies of several vertebrates and an invertebrate have shown elevated standard metabolic rate (SMR) following chronic exposure to a mixture of trace elements in a contaminated habitat. In this study, we examined whether another invertebrate, a crayfish (Procambarus acutus), also experienced elevated SMR in response to the same contaminants. We compared SMR of individuals inhabiting the contaminated site with SMR of individuals from uncontaminated reference sites. We also examined SMR of individuals collected from the reference areas and exposed in the laboratory for 50 days to sediment and food derived from the contaminated site. Individuals collected from the contaminated site had elevated SMR compared to individuals collected from the unpolluted areas (25.1 vs. 19.2 J g(-1) day(-1)). Individuals exposed to contaminated sediment and food in the laboratory experienced elevations in SMR compared to controls after 27 days of exposure (35.2 vs. 29.4 J g(-1) day(-1)), but after 50 days of exposure, metabolic rate no longer differed between treatments. Growth of contaminant-exposed individuals was lower than growth of reference animals throughout the laboratory study. Elevated SMR associated with contaminant exposure may reflect energy-demanding mechanisms required to combat deleterious effects of contaminants. Our results support the prediction that increases in energy expenditure in the contaminated habitat would negatively influence production processes, such as growth. Results from this study in conjunction with observations from other species suggest that increased SMR is a common response among several taxa to the mixture of contaminants in the study site.

Accumulation and selective maternal transfer of contaminants in the turtle Trachemys scripta associated with coal ash deposition

Coal combustion wastes are enriched in a number of potentially toxic compounds and may pose risks to biota exposed to the wastes. Slider turtles (Trachemys scripta) are common inhabitants of coal ash settling basins in South Carolina, USA, where they feed on contaminated prey items and accumulate high levels of potentially toxic compounds in their tissues. Furthermore, female sliders sometimes nest in contaminated spill piles and thus may expose embryos to contaminated soils. We examined two potential pathways by which female T. scripta may influence the survivorship and quality of their offspring in a contaminated habitat: (1) nesting in contaminated soil and (2) maternal transfer of pollutants. Eggs were collected from turtles captured in coal ash-polluted or unpolluted sites; individual clutches were incubated in both ash-contaminated and uncontaminated soil in outdoor, artificial nests. Incubation in contaminated soil was associated with reduced embryo survivorship. Adult females from the polluted site accumulated high levels of As, Cd, Cr, and Se in their tissues, yet Se was the only element transferred maternally to hatchlings at relatively high levels. Hatchlings from polluted-site females exhibited reduced O2 consumption rates compared to hatchlings from reference sites. Relatively high levels of Se transferred to hatchlings by females at the ash-polluted site might contribute to the observed differences in hatchling physiology.

Failed recruitment of southern toads (Bufo terrestris) in a trace element-contaminated breeding habitat: direct and indirect effects that may lead to a local population sink

We conducted a transplant study in which embryonic southern toads (Bufo terrestris) were held in a site polluted with coal ash (site AB; containing As, Cd, Cr, Cu, Se, and other elements) and a reference site (site R) through hatching and early larval development. To examine the remainder of the larval period, surviving larvae in AB were then transplanted to R and back-transplanted to AB, whereas surviving larvae from R were back-transplanted to R. Survival through early larval development was lower in AB than in R (34% versus 50%). However, site of hatching did not influence traits later in development (larval metabolic rate, larval morphology, duration of larval period, size at metamorphosis, or average hopping distance by metamorphs). Toads that spent the entire larval period in R had high rates of survival (70-94% of individuals transplanted after the embryonic period) regardless of where they spent the embryonic and early larval period. However, toads held in AB for the duration of the larval period suffered 100% mortality. Algal resources were scarce and their trace element concentrations high in AB compared to R, suggesting that mortality of larval toads resulted from a combination of direct toxicity (via sediment- and foodborne exposure) and indirect effects on resource abundance. The study suggests that the widespread practice of disposing of coal ash in open aquatic basins may result in sink habitats for some amphibian populations.

Nondestructive indices of trace element exposure in squamate reptiles

Compared with birds, mammals, fish, and even amphibians, very little is known about the effects of contaminants on reptiles. Recent evidence that many reptile populations may be declining has stimulated demand for toxicological studies of reptiles as well as development of nondestructive sampling techniques useful for assessing and monitoring contaminant exposure. The current study experimentally evaluated the utility of shed skins, tail clips, and blood samples as nondestructive indices of trace element exposure in banded water snakes, Nerodia fasciata. For 13.5 months, snakes were either fed fish from a coal ash-contaminated site or uncontaminated food from a reference site. Snakes fed contaminated prey accumulated As, Cd, Se, Sr, and V in various organs (i.e. liver, kidney, and/or gonads). Moreover, non-parametric discriminant function analysis revealed that snakes could be placed in two groups that reliably reflected their experimental diet based upon Se, Sr, and As concentrations in tail clips, blood, and/or shed skins. We suggest that nondestructive sampling techniques, particularly analyses of blood and tail clips, may be easily applied in evaluations of contaminant exposure in the field and laboratory and may prevent excessive destructive sampling of potentially threatened reptile species.

Striking similarity of murine nectin-1alpha to human nectin-1alpha (HveC) in sequence and activity as a glycoprotein D receptor for alphaherpesvirus entry

A cDNA encoding the murine homolog of human nectin-1alpha (also known as poliovirus receptor-related protein 1 [Prr1] and herpesvirus entry protein C [HveC]) was isolated. The protein encoded by this cDNA proved to be 95% identical in sequence to the human protein and to have similar herpesvirus entry activity. Upon expression of the murine cDNA in hamster cells resistant to alphaherpesvirus entry, the cells became susceptible to the entry of herpes simplex virus types 1 and 2 (HSV-1 and -2), pseudorabies virus, and bovine herpesvirus 1. HSV envelope glycoprotein D (gD), a viral ligand for human nectin-1alpha, is also a ligand for the murine homolog based on evidence that (i) a soluble hybrid protein composed in part of the murine nectin-1 ectodomain bound specifically to purified soluble forms of HSV-1 and HSV-2 gD as demonstrated by enzyme-linked immunosorbent assay, (ii) a soluble hybrid of HSV-1 gD bound to hamster cells expressing murine nectin-1alpha but not to control cells, and (iii) cells expressing both murine nectin-1alpha and one of the alphaherpesvirus gDs were resistant to entry of HSV-1, indicative of interference with entry resulting from interactions of cell-associated gD with the entry receptor. Northern blot analysis revealed that nectin-1 is expressed in most of the mouse tissues examined and at high levels in the brain, skin, and kidneys. Immunocytochemical localization demonstrated the presence of nectin-1 in epithelial cells of the mouse vagina and also in neuronal cells of the central nervous system, suggesting an expression pattern relevant to both infection at a portal of entry and spread of infection to the brain.

The murine homolog (Mph) of human herpesvirus entry protein B (HveB) mediates entry of pseudorabies virus but not herpes simplex virus types 1 and 2

A mouse member of the immunoglobulin superfamily, originally designated the murine poliovirus receptor homolog (Mph), was found to be a receptor for the porcine alphaherpesvirus pseudorabies virus (PRV). This mouse protein, designated here murine herpesvirus entry protein B (mHveB), is most similar to one of three related human alphaherpesvirus receptors, the one designated HveB and also known as poliovirus receptor-related protein 2. Hamster cells resistant to PRV entry became susceptible upon expression of a cDNA encoding mHveB. Anti-mHveB antibody and a soluble protein composed of the mHveB ectodomain inhibited mHveB-dependent PRV entry. Expression of mHveB mRNA was detected in a variety of mouse cell lines, but anti-mHveB antibody inhibited PRV infection in only a subset of these cell lines, indicating that mHveB is the principal mediator of PRV entry into some mouse cell types but not others. Coexpression of mHveB with PRV gD, but not herpes simplex virus type 1 (HSV-1) gD, inhibited entry activity, suggesting that PRV gD may interact directly with mHveB as a ligand that can cause interference. By analogy with HSV-1, envelope-associated PRV gD probably also interacts directly with mHveB during viral entry.

Quasispecies development by high frequency RNA recombination during MHV persistence

Recent studies suggest that infectious viruses and particularly persisting viral RNAs often exist as diverse populations or "quasispecies". We have developed an approach to characterize populations of the murine coronavirus mouse hepatitis virus (MHV) generated during persistent infection which has allowed us to begin to address the role of the viral quasispecies in MHV pathogenesis. We analyzed the population of persisting viral RNAs using reverse-transcription polymerase chain reaction amplification (RT-PCR) of the S1 "hypervariable" region of the spike gene followed by differential colony hybridization to identify spike deletion variants (SDVs) from acute and persistently infected mice. Sequence analysis revealed that mice with the most severe chronic paralysis harbored the most complex quasispecies. Mapping of the SDVs to the predicted RNA secondary structure of the spike RNA revealed that an isolated stem loop structure is frequently deleted. Overall, these results are consistent with high frequency recombination at sites of RNA secondary structure contributing to expansion of the viral quasispecies and persisting viral pathogenesis.

Elevated trace element concentrations in southern toads, Bufo terrestris, exposed to coal combustion waste

A number of recent studies have linked developmental, physiological, and behavioral abnormalities in amphibians to coal combustion wastes (coal ash). Few studies, however, have determined trace element concentrations in amphibians exposed to coal ash. In the current study we compare total body concentrations of 20 trace elements in adult southern toads, Bufo terrestris, inhabiting coal ash settling basins with toads that were not exposed to the combustion wastes (reference). In addition, we document the accumulation of trace elements in toads transplanted from reference sites to field enclosures in an ash settling basin for 7 and 12 weeks. Arsenic, selenium, and vanadium levels were significantly elevated in toads captured at the ash-contaminated site in comparison to toads from the reference site. All three of these elements were also significantly elevated in toads exposed to the contaminated habitat for only 7 weeks. Our study suggests that adult anurans can bioaccumulate particularly high levels of selenium and may be useful bioindicators in agricultural and coal ash-impacted habitats.

Elevated maintenance costs in an anuran (Rana catesbeiana) exposed to a mixture of trace elements during the embryonic and early larval periods

We investigated the relationship between maintenance costs (standard metabolic rates, measured as O2 consumption at rest) in tadpoles of the bullfrog, Rana catesbeiana, and exposure to contaminants in a coal ash-polluted habitat (characterized by a variety of trace elements). We compared metabolic rates of tadpoles collected from the polluted site with those from an unpolluted reference pond. Tadpoles collected in the polluted site had 40%-97% higher standard metabolic rates than those collected from the reference pond. We also reciprocally transplanted eggs of the bullfrog between the polluted site and another reference pond and compared standard metabolic rates of tadpoles at 25 and 80 d posthatching. Metabolic rates of tadpoles raised in the polluted site were from 39% to 175% higher than those raised in a reference pond, depending on tadpole age and temperature at which metabolic rates were measured. There were no effects of site of origin of the eggs (polluted or unpolluted) on metabolic rates. Survival to hatching did not differ between sites, although survival to the end of the experiment (80 d posthatching) was lower in the polluted area than in the reference site. Surviving tadpoles were larger in wet body mass in the polluted site than in the reference pond, possibly due to lower survival in the former, but there was no relationship between survival and metabolic rate. It is clear that some feature of the polluted habitat was responsible for causing substantial elevation of standard metabolic rates of tadpoles. We hypothesize that the mixture of trace elements present in sediment and water in the polluted site was responsible for the observed physiological differences.

Generation of coronavirus spike deletion variants by high-frequency recombination at regions of predicted RNA secondary structure

Coronavirus RNA evolves in the central nervous systems (CNS) of mice during persistent infection. This evolution can be monitored by detection of a viral quasispecies of spike deletion variants (SDVs) (C. L. Rowe, S. C. Baker, M. J. Nathan, and J. O. Fleming, J. Virol. 71:2959-2969, 1997). We and others have found that the deletions cluster in the region from 1,200 to 1,800 nucleotides from the 5' end of the spike gene sequence, termed the "hypervariable" region. To address how SDVs might arise, we generated the predicted folding structures of the positive- and negative-strand senses of the entire 4,139-nt spike RNA sequence. We found that a prominent, isolated stem-loop structure is coincident with the hypervariable region in each structure. To determine if this predicted stem-loop is a "hot spot" for RNA recombination, we assessed whether this region of the spike is more frequently deleted than three other selected regions of the spike sequence in a population of viral sequences isolated from the CNS of acutely and persistently infected mice. Using differential colony hybridization of cloned spike reverse transcription-PCR products, we detected SDVs in which the hot spot was deleted but did not detect SDVs in which other regions of the spike sequence were exclusively deleted. Furthermore, sequence analysis and mapping of the crossover sites of 25 distinct patterns of SDVs showed that the majority of crossover sites clustered to two regions at the base of the isolated stem-loop, which we designated as high-frequency recombination sites 1 and 2. Interestingly, the majority of the left and right crossover sites of the SDVs were directly across from or proximal to one another, suggesting that these SDVs are likely generated by intramolecular recombination. Overall, our results are consistent with there being an important role for the spike RNA secondary structure as a contributing factor in the generation of SDVs during persistent infection.

Evolution of mouse hepatitis virus: detection and characterization of spike deletion variants during persistent infection

High-frequency RNA recombination has been proposed as an important mechanism for generating viral deletion variants of murine coronavirus. Indeed, a number of variants with deletions in the spike glycoprotein have been isolated from persistently infected animals. However, the significance of generating and potentially accumulating deletion variants in the persisting viral RNA population is unclear. To study this issue, we evaluated the evolution of spike variants by examining the population of spike RNA sequences detected in the brains and spinal cords of mice inoculated with coronavirus and sacrificed at 4, 42, or 100 days postinoculation. We focused on the S1 hypervariable region since previous investigators had shown that this region is subject to recombination and deletion. RNA isolated from the brains or spinal cords of infected mice was rescued by reverse transcription-PCR, and the amplified products were cloned and used in differential colony hybridizations to identify individual isolates with deletions. We found that 11 of 20 persistently infected mice harbored spike deletion variants (SDVs), indicating that deletions are common but not required for persistent infection. To determine if a specific type of SDV accumulated during persistence, we sequenced 106 of the deletion isolates. We identified 23 distinct patterns of SDVs, including 5 double-deletion variants. Furthermore, we found that each mouse harbored distinct variants in its central nervous system (CNS), suggesting that SDVs are generated during viral replication in the CNS. Interestingly, mice with the most severe and persisting neurological disease harbored the most prevalent and diverse quasispecies of SDVs. Overall, these findings illustrate the complexity of the population of persisting viral RNAs which may contribute to chronic disease.

A rite of passage approach designed to preserve the families of substance-abusing African American women

This article approaches the treatment of addicted African American women in ways drawn from traditional African culture. While the modern African American woman is clearly not the same as her continental African foremother, the reality of her life is still predicated on the basis of her culture and her material wealth or lack of it. The approach recommended here, a rite of passage, derives from the belief that the value orientations drawn from the African wisdom of the ages offers the best way to work with families to recover both sobriety and a powerful understanding and repossession of culture that will help to ensure not only sobriety but also ways of holding together and rebuilding the families of today and the future.