Medical Bulletin 01/ January/ 2025 - Video

The hormone estrogen regulates binge drinking in females, causing them to “pregame” – consume large quantities of alcohol in the first 30 minutes after it’s offered, according to a preclinical study led by scientists at Weill Cornell Medicine. The findings, published in the journal Nature Communications.

To assess estrogen’s potential involvement, the researchers began by monitoring the hormone levels throughout estrous cycle of female mice. Then, they served up the alcohol. They found that when a female has a high level of circulating estrogen, she drinks much more than on days when her estrogen is low.

The enhanced bingeing behavior was reflected in heightened activity in the neurons in the bed nucleus of the stria terminalis.

Although the researchers suspected estrogen would have an effect on drinking, they were surprised by its mechanism of action. This steroid hormone typically regulates behaviors by binding to receptors which then travel to the nucleus, where they alter the activity of specific genes—a process that could take hours. However, researchers realized that something else must be happening when estrogen infused directly into the bed nucleus of the stria terminalis excited the neurons and triggered binge drinking within minutes.

So, the researchers tested estrogen that had been doctored so it could not enter cells and bind to nuclear receptors. They determined that when estrogen promotes bingeing, the hormone is binding to receptors on the neurons’ surface, where it directly modulates cell-cell communication.

The team identified the estrogen receptor that mediates this effect and determined that it is expressed in the excited bed nucleus of the stria terminalis neurons and in neurons from other brain regions that excite them. Inhibiting the enzyme that synthesizes estrogens could offer a novel treatment for selectively reducing alcohol consumption when hormone levels surge.

Reference: Zallar, L.J., Rivera-Irizarry, J.K., Hamor, P.U. et al. Rapid nongenomic estrogen signaling controls alcohol drinking behavior in mice. Nat Commun 15, 10725 (2024). https://doi.org/10.1038/s41467-024-54737-6

Patients with opioid use disorder can reduce their days of opioid use and stay in treatment longer when using a smartphone app as supportive therapy in combination with medication, a new study by The University of Texas Health Science Center at San Antonio shows. The findings are published in JAMA network open.

The cohort study of 600 underserved patients found that those who chose to use the app – which combines contingency management behavioral therapy and recovery support from peers – and alongside medication, reduced their days of opioid use by 35% compared with those treated with medication only. Additionally, app users remained in treatment nearly 19% longer than those treated with medication alone.

The retrospective cohort study, which refers to research that follows a group of people over time, used data from Nov.1, 2020, to Nov. 30, 2023, collected from opioid treatment programs across Texas. The cohort included 600 individuals aged 18 years or older who were uninsured or underinsured and who chose to receive Medication for opioid use disorder only or Medication for opioid use disorder plus contingency management delivered by the WEconnect smartphone app. The app delivers evidence-based contingency management embedded in a recovery-oriented framework.

Those who chose to receive Medication for opioid use disorder plus app-based contingency management reported a mean duration of 8.4 days of opioid use at the end of treatment compared with 12 days for those who chose to receive Medication for opioid use disorder only. Retention analysis showed that patients who chose to receive Medication for opioid use disorder plus app-based contingency management stayed with their treatment for a mean duration of 290.2 days, compared with 236.1 days for those choosing to receive Medication for opioid use disorder only.

“These findings suggest that augmenting medication for opioid use disorder with app-based contingency management may provide clinical benefits for underserved patients,” said Elise Marino, PhD, director of research operations at UT Health San Antonio’s Be Well Institute on Substance Use and Related Disorders. “Expanding the availability of app-based contingency management may contribute to decreasing the immense societal, economic and personal burden of opioid use.”

Reference: Marino EN, Karns-Wright T, Perez MC, Potter JS. Smartphone App–Based Contingency Management and Opioid Use Disorder Treatment Outcomes. JAMA Netw Open. 2024;7(12):e2448405. doi:10.1001/jamanetworkopen.2024.48405

Johns Hpkins Medicine researchers have shown that people 60 years or older with weakened immunity, primarily organ transplant recipients who take immunosuppressive medications do not respond as strongly to vaccines against the respiratory syncytial virus (RSV) as people in the same age group with normal immune function. The study was published in the Journal of the American Medical Association (JAMA).

The researchers used an ongoing, Johns Hopkins Medicine-led national study — the Emerging Pathogens of Concern in Immunocompromised Persons (EPOC) — to follow 38 people (between ages 64 and 72) who self-reported that they are immunocompromised and received either the RSVPreF3-AS01 (also known as Arexvy) or RSVpreF (also known as Abrysvo) vaccine. The study group was evenly split between males and females, with 82% being solid organ transplant recipients and 74% taking two or more immunosuppressive medications.

The two vaccines induce the immune system to target a critical protein on the surface of RSV, the F protein, in its pre-infection form, known as pre-fusion F. High levels of antibodies against pre-fusion F, particularly those that neutralize and block RSV from entering cells, are a major contributor in preventing RSV infections. Although most people are infected by RSV many times in their lives, natural infections do not lead to a sufficient level of virus-neutralizing, anti-pre-fusion F antibodies to prevent reinfections, and perhaps, prevent serious illness.

Arexvy contains an adjuvant while Abrysvo does not.

“When we compared the antibody responses between those study participants who received Arexvy with those who got Abrysvo, we found that the group receiving the adjuvanted vaccine tended to have higher levels of RSV-neutralizing, anti-pre-fusion F antibodies,” says study senior author William Werbel, M.D., Ph.D., assistant professor of medicine at the Johns Hopkins University School of Medicine. “So, adjuvant-enhanced vaccines as a means of improving immune response in people who are immunocompromised merits further investigation in larger, more comprehensive studies.”

However, researchers point out that this study does not suggest RSV vaccines will not reduce RSV disease in people who are immunocompromised.

Reference: https://www.newswise.com/articles/people-who-are-immunocompromised-may-not-produce-enough-protective-antibodies-against-rsv-after-vaccination