US Pharm. 2006;12:20. 

Next Generation of Cholesterol Drugs Focus on Raising HDL
Medications that increase high-density lipoprotein cholesterol (HDL-C), commonly known as "good cholesterol," were the topic of discussion at the 33rd Annual VEITHsymposium. These medications are thought to be a key component in the fight against athersclerosis.

Two drugs of particular interest, torcetrapib and rimonabant, were discussed by Dr. Russell H. Samson, former Associate Professor of Surgery at the Albert Einstein College of Medicine and current President of Mote Vascular Foundation.

Torcetrapib (discovered and developed by Pfizer) is a cholesteryl ester transfer protein (CETP) inhibitor. In theory, by blocking CETP, it should be possible to improve the ratio of HDL-C to low-density lipoprotein cholesterol (LDL-C, or "bad cholesterol"), thus slowing the development and progression of atherosclerosis. Early trials showed that torcetrapib 120 mg per day produced an HDL-C increase of 46%, and when given in combination with Pfizer's Lipitor, there was an increase of 61%; when the dose was doubled to 240 mg per day, HDL-C increased by more than 100%. These results were somewhat tempered by the fact that patients taking 60 mg of torcetrapib with Lipitor also experienced an increase in systolic blood pressure, which could outweigh the raised HDL-C benefit. Torcetrapib is targeted to reach the U.S. market by 2008.

Rimonabant (discovered and developed by Sanofi-Aventis) is a cannabinoid-1 (CB1) endocannabinoid receptor antagonist. This drug was originally intended for weight control and smoking cessation, since CB1 blockers act on the endocannabinoid system (which controls energy and nicotine dependence). In a recent study, patients taking rimonabant lost more weight than those in the placebo-controlled group, which led to improvements in HDL-C and triglyceride levels. The drug is currently approved for sale in Europe. The date of its availability in the U.S. is still uncertain.

Oxytocin Has Potential for Treatment of Autism
Intravenous (IV) oxytocin may have positive effects on adults with autism, based on findings presented at the American College of Neuropsychopharmacology's Annual Meeting.

High-functioning adults with autism or Asperger's syndrome received IV pitocin (synthetic oxytocin) or placebo (saline solution) for four hours. During this time, subjects were monitored for repetitive behaviors--a hallmark symptom of autism spectrum disorders--such as the need to tell/ask, touching, and repeating. Authors noted a rapid reduction of repetitive behaviors during oxytocin infusion, compared with no such reduction during placebo infusion.

Two weeks later, participants were given the alternate infusion compound, and the research team compared the patients' recognition of emotion in voice recordings on both occasions. They found that patients who received oxytocin on the first testing day retained the ability to assign affective significance to speech, performing above expectations when they returned two weeks later. This effect was not observed in patients who received placebo on the first testing day.

The researchers are currently studying the effect of intranasal oxytocin in a six-week controlled trial. Intranasal administration "may allow for better penetration of the blood-brain barrier and is easier to administer," explained the researchers.

Maternal Smoking Linked to Congenital Heart Defects
Women who smoke or are exposed to tobacco smoke early in pregnancy are more likely to have children with certain types of congenital heart defects (CHD), investigators reported at the American Heart Association's Scientific Sessions 2006.

Authors from the Collaborating with the National Birth Defects Prevention Study assessed 566 infants with CHD (e.g., left-sided or right-sided obstructive defects, septal heart defects, and conotruncal heart defects) and 491 infants without CHD. Mothers of infants with and without CHD were asked whether they had smoked from one month prior to pregnancy through the end of pregnancy. Exposure to tobacco smoke was also examined.

Thirty-four percent of women who had children with CHD reported that they had smoked at some time in the month prior to conception through the end of the first trimester. These women were 60% more likely to have infants with CHDthan women who had not smoked. This was true even in women who had taken prenatal vitamins and had limited alcohol intake, regardless of age or race.

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