Hans Rommelspacher

Association of a regulatory polymorphism in the promoter region of the monoamine oxidase A gene with antisocial alcoholism

We analyzed a novel functional 30-bp repeat polymorphism in the promoter region of the X-chromosomal monoamine oxidase A gene (MAOA) to test whether length variation of the repeat polymorphism contributes to variation in the individual vulnerability to antisocial behavior and liability to alcohol dependence. The repeat number (3-5) of the MAOA polymorphism was assessed in 488 male subjects of German descent, a sample comprising 185 psychiatrically screened control subjects and 303 alcohol-dependent subjects including 59 alcoholics with antisocial personality disorder. The frequency of the low-activity 3-repeat allele was significantly increased in 59 antisocial alcoholics compared to 185 control subjects (51 vs. 35%; P = 0.031) and to 244 alcoholics without antisocial personality disorder (51 vs. 32%; P = 0.008), respectively. We found no significant difference in the frequency of the 3-repeat allele between 244 alcoholics without an antisocial personality disorder and the control subjects. Our findings suggest that the low-activity 3-repeat allele of the MAOA promoter polymorphism confers increased susceptibility to antisocial behavior rather than alcohol dependence per se in alcohol-dependent males.

Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract

Background: The prevalence of chronic alcohol misuse in patients with oral, pharyngeal, laryngeal or esophageal carcinomas exceeds 60%. No data is available, to our knowledge, on the morbidity and mortality of chronic alcoholics in surgical intensive care units (ICU) following tumor resection. We investigated whether the subsequent ICU stay in chronic alcoholics following tumor resection was prolonged and whether the incidence of pneumonia and sepsis was increased.

Association of a CB1 Cannabinoid Receptor Gene (CNR1) polymorphism with severe alcohol dependence

Due to the involvement of the endogenous cannabinoid system in brain reward mechanisms a silent polymorphism (1359G/A; Thr453Thr) in the single coding exon of the CB1 human cannabinoid receptor gene (CNR1) was analysed in 121 severely affected Caucasian alcoholics and 136 most likely non-alcoholic controls. The observed frequency of the A allele was 31.2% for controls and 42.1% for alcoholics with severe withdrawal syndromes (P=0.010). Post-hoc exploration indicated that this allelic association resulted from an excess of the homozygous A/A genotype in patients with a history of alcohol delirium (P=0.031, DF 2), suggesting s an increased risk of delirium (OR=2.45, 95% CI 1.14--5.25). This finding suggests that the homozygous genotype CNR1 1359A/A confers vulnerability to alcohol withdrawal delirium.

Alcohol withdrawal in the surgical patient: prevention and treatment.

In the literature on AWS, there is repeated emphasis on performing a thorough preanesthesia assessment in patients with suspected chronic alcohol use. Because these patients are difficult to diagnose and to treat in surgical settings if complications arise, a multimodal approach is highly recommended (86). Ideally, AWS should be prevented by adequate prophylaxis. If AWS develops after surgery or trauma, immediate therapy is required. The symptoms of AWS can be controlled using the combination of a benzodiazepine (in Europe, also chlormethiazole) with haloperidol or clonidine. The drug regimens must be individualized and symptom-oriented to treat hallucinations and autonomic signs. Dosages are generally larger than those in detoxification units. Other approaches to modulate the neuroendocrine-immune axis in patients with an increased risk of postoperative infectious complications look promising but await controlled trials.

Therapy of alcohol withdrawal syndrome in intensive care unit patients following trauma: results of a prospective, randomized trial.

OBJECTIVES To assess the effect of three different alcohol withdrawal therapy regimens in traumatized chronic alcoholic patients with respect to the duration of mechanical ventilation and the frequency of pneumonia and cardiac disorders during their intensive care unit (ICU) stay. DESIGN A prospective, randomized, blinded, controlled clinical trial. SETTING A university hospital ICU. PATIENTS Multiple-injured alcohol-dependent patients (n=180) transferred to the ICU after admission to the emergency room and operative management. A total of 180 patients were included in the study; however, 21 patients were excluded from the study after assignment. INTERVENTIONS Patients who developed actual alcohol withdrawal syndrome were randomized to one of the following treatment regimens: flunitrazepam/clonidine (n=54); chlormethiazole/haloperidol (n=50); or flunitrazepam/haloperidol (n=55). The need for administration of medication was determined, using a validated measure of the severity of alcohol withdrawal (Revised Clinical Institute Withdrawal Assessment for Alcohol Scale). MEASUREMENTS AND MAIN RESULTS The duration of mechanical ventilation and major intercurrent complications, such as pneumonia, sepsis, cardiac disorders, bleeding disorders, and death, were documented. Patients did not differ significantly between groups regarding age, Revised Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II score on admission. In all except four patients in the flunitrazepam/clonidine group, who continued to hallucinate, the Revised Clinical Institute Withdrawal Assessment for Alcohol Scale decreased to <20 after initiation of therapy. ICU stay did not significantly differ between groups (p=.1669). However, mechanical ventilation was significantly prolonged in the chlormethiazole/haloperidol group (p=.0315) due to an increased frequency of pneumonia (p=.0414). Cardiac complications were significantly (p=.0047) increased in the flunitrazepam/clonidine group. CONCLUSIONS There was some advantage in the flunitrazepam/clonidine regimen with respect to pneumonia and the necessity for mechanical ventilation. However, four (7%) patients had to be excluded from the study due to ongoing hallucinations during therapy. Also, cardiac complications were increased in this group. Thus, flunitrazepam/haloperidol should be preferred in patients with cardiac or pulmonary risk. Further studies are required to determine which therapy should be considered.

Intercurrent complications in chronic alcoholic men admitted to the intensive care unit following trauma

ObjectiveA chronic alcoholic group following trauma was investigated to determine whether their ICU stay was longer than that of a non-alcoholic group and whether their intercurrent complication rate was increasedDesignProspective study.SettingAn intensive care unit.PatientsA total of 102 polytraumatized patients were transferred to the ICU after admission to the emergency room and after surgical treatment. Of these patients 69 were chronic alcoholics and 33 were allocated to the non-alcoholic group. The chronic-alcoholic group met the DSM-III-R and ICD-10 criteria for alcohol dependence or chronic alcohol abuse/harmful use. The daily ethanol intake in these patients was ≥60 g. Diagnostic indicators included an alcoholismrelated questionnaire (CAGE), conventional laboratory markers and carbohydrate-deficient transferrin.Measurement and resultsMajor intercurrent complications such as alcohol withdrawal syndrome (AWS), pneumonia, cardiac complications and bleeding disorders were documented and defined according to internationally accepted criteria. Patients did not differ significantly between groups regarding age, TRISS and APACHE score on admission. The rate of major intercurrent complications was 196% in the chronic alcoholic vs 70% in the non-alcoholic group (P=0.0001). Because of the increased intercurrent complication rate, the ICU stay was significantly prolonged in the chronic-alcoholic group by a median period of 9 days.ConclusionsChronic alcoholics are reported to have an increased risk of morbidity and mortality. However, to our knowledge, nothing is known about the morbidity and mortality of chronic alcoholics in intensive care units following trauma. Since chronic alcoholics in the ICU develop mor major complications with a significantly prolonged ICU stay following trauma than non-alcoholics, it seems reasonable to intensify research to identify chronic alcoholics and to prevent alcohol-related complications.

Benzodiazepine antagonism by harmane and other β-carbolines in vitro and in vivo

Abstract Harmane and other related β-carbolines are putative endogenous ligands of the benzodiazepine receptor. Since the compounds are potent convulsants they may have agonist activities at the benzodiazepine receptor while the benzodiazepines may be antagonists. This hypothesis was proved by comparing the in vivo and in vitro antagonism of benzodiazepines by harmane and other β_carboliness. Harmane is clearly a competitive inhibitor of benzodiazepine receptor binding in vitro. Moreover, harmane-induced convulsions can be inhibited reversibly by diazepam in a manner which is consistent with the assumption of competitive antagonism in vivo. For some β-carboline derivatives a correlation was found between the affinity for the benzodiazepine receptor in vitro and the convulsive potency in vivo. Thus, the data reported suggest that harmane or other related β-carbolines are putative endogenous agonists of the benzodiazepine receptor. This suggestion is further supported by the observation that diazepam is equally potent in inhibiting harmane- or picrotoxin-induced convulsions, indicating a convulsive mechanism within the GABA receptor-benzodiazepine receptor system.

1-Methyl-β-carboline (Harmane), a potent endogenous inhibitor of benzodiazepine receptor binding

SummaryThe interaction of several β-carbolines with specific [3H]-flunitrazepam binding to benzodiazepine receptors in rat brain membranes was investigated. Out of the investigated compounds, harmane and norharmane were the most potent inhibitors of specific [3H]-flunitrazepam binding, with IC50-values in the micromolar range. All other derivatives, including harmine, harmaline, and several tetrahydroderivatives were at least ten times less potent. Harmane has been previously found in rat brain and human urine, so it is the most potent endogenous inhibitor of specific [3H]-flunitrazepam binding known so far, with a several hundred fold higher affinity for the benodiazepine receptor than inosine and hypoxanthine. Thus, we suggest that harmane or other related β-carbolines could be potential candidates as endogenous ligands of the benzodiazepine receptor.

Harman (1-methyl-β-carboline) is a natural inhibitor of monoamine oxidase type A in rats

Harman (1-methyl-beta-carboline) displaces [3H]pargyline in vitro from high affinity binding sites on membranes from cerebral cortex, provided that experimental conditions are chosen under which [3H]pargyline labels selectively monoamine oxidase type A. Norharman (beta-carboline) is a much weaker displacing compound. It is well known that the type A enzyme can be blocked irreversibly in vivo by treatment of rats with clorgyline. Under these conditions no specific binding of [3H]harman and [3H]pargyline to monoamine oxidase type A was detected in brain, whereas the specific binding was reduced to 5% in liver tissue. The in vitro and ex vivo experiments suggest that there is a specific binding site for harman on monoamine oxidase type A, thereby extending earlier in vitro findings. It has been postulated that harman operates as a natural inhibitor of monoamine oxidase type A in mammals. The present study demonstrates that harman and norharman occur in rat brain, blood plasma, heart, kidney and liver. It further shows that pretreatment with clorgyline induces a time-dependent increase in the blood plasma levels of harman, suggesting the displacement of harman from the enzyme in tissue with its subsequent delivery into the blood. These findings strongly support the hypothesis based on in vitro experiments, that harman binds reversibly to the active site of monoamine oxidase type A in vivo. Dietary sources for mammalian harman play probably only a minor role, because the concentrations in beer and wine as well as other foodstuffs are too low to contribute substantially to endogenous levels of harman.

On the neuropharmacology of Harmane and other β-carbolines

β-Carbolines have been recently proposed as candidates for the unknown endogenous ligand of the benzodiazepine receptor. Out of the β-carboline derivatives already found in the mammalian CNS, harmane is clearly the most potent inhibitor of benzodiazepine receptor binding. Therefore, it has been considered as possible endogenous ligand for this new receptor system. However, a certain degree of specificity might be a basic condition to accept the hypothesis of harmane as the endogenous ligand. Thus, the effects of harmane as well as other β-carbolines on several neurotransmitter receptor binding systems in vitro and on some neuropharmacological tests in vivo were investigated. Harmane developed the highest affinity towards the benzodiazepine binding site among all systems investigated. Its IC50-values for inhibiting opiate and muscarinic cholinergic receptor binding were about four times lower than those for dopamine and serotonin receptor binding but were about four times higher than that found for the benzodiazepine receptor binding. Norharmane exerted a remarkable displacing activity only at the benzodiazepine binding site. Harmine affected mainly the opiate and cholinergic muscarinic system, whereas tetrahydronorharmane turned out to be a potent inhibitor of serotonin and dopamine receptor binding. Doses of harmane needed to produce convulsions as indication of its possible benzodiazepine receptor agonistic properties are also sufficient to diminish nociception and decrease body temperature whereas the apomorphine-induced licking rate was affected at higher doses. The data demonstrate that harmane affects not only the benzodiazepine binding site but also other neuronal mechanisms. Furthermore, only minor changes of the β-carboline structure lead to substantially different effects. Therefore, the search for other β-carbolines with higher affinity for the benzodiazepine binding site as harmane seems to be promising.