Low-Dose Oral Propranolol Could Reduce Brown Adipose Tissue F-18 FDG Uptake in Patients Undergoing PET Scans

Parysow, O.; Mollerach, A.; Jager, V.; Racioppi, S.; Román, José San; Gerbaudo, Victor H.

doi:10.1097/01.rlu.0000259570.69163.04

Cited by 132 publications

(83 citation statements)

References 22 publications

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“…Rather, other organs, such as skeletal muscle, may be involved (27). The nonspecific β-adrenergic receptor blocker propranolol has been used effectively to reduce BAT activity in patients undergoing 18 F-FDG PET/CT scanning at room temperature (32,33). These observations reinforce the role of the SNS in activating BAT.…”

Section: Discussionsupporting

confidence: 68%

Cold but not sympathomimetics activates human brown adipose tissue in vivo

Cypess

Chen

Sze

et al. 2012

Proc. Natl. Acad. Sci. U.S.A.

279

234

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As potential activators of brown adipose tissue (BAT), mild cold exposure and sympathomimetic drugs have been considered as treatments for obesity and diabetes, but whether they activate the same pathways is unknown. In 10 healthy human volunteers, we found that the sympathomimetic ephedrine raised blood pressure, heart rate, and energy expenditure, and increased multiple circulating metabolites, including glucose, insulin, and thyroid hormones. Cold exposure also increased blood pressure and energy expenditure, but decreased heart rate and had little effect on metabolites. Importantly, cold increased BAT activity as measured by 18 F-fluorodeoxyglucose PET-CT in every volunteer, whereas ephedrine failed to stimulate BAT. Thus, at doses leading to broad activation of the sympathetic nervous system, ephedrine does not stimulate BAT in humans. In contrast, mild cold exposure stimulates BAT energy expenditure with fewer other systemic effects, suggesting that cold activates specific sympathetic pathways. Agents that mimic cold activation of BAT could provide a promising approach to treating obesity while minimizing systemic effects.metabolism | thermogenesis | respiratory quotient | norepinephrine | white adipose tissue B rown adipose tissue (BAT) is a type of fat that consumes calories to generate heat. Multiple recent studies have shown that adult humans have functional BAT that can be activated in response to cold exposure in a process called nonshivering thermogenesis (1-4). In both small and large population studies (1, 2, 4, 5), there is an inverse correlation between BAT activity and obesity, suggesting that activating BAT, through pharmacological, environmental, or potentially nutritional interventions, could become a therapeutic means to treat obesity and diabetes. Indeed, human BAT energy expenditure may be a critical counterbalance to the weight gain and metabolic dysregulation caused by excess energy storage in white adipose tissue.Human BAT has a high density of both nerves and blood vessels (6), providing two general approaches to activate BAT. Based on studies in rodents, it is known that the sensation of cold by the skin and body core sends signals via peripheral neurons to the spinal cord and then up to the preoptic area of the hypothalamus for processing. From the hypothalamus, some signals go to the cerebral cortex for conscious thermal perception and localization, and others go to premotor neurons in the rostral raphe pallidus of the brainstem, projecting to neurons of the peripheral sympathetic nervous system (SNS) (reviewed in ref. 7). Ultimately, postganglionic SNS nerves release norepinephrine to activate BAT via induction of uncoupling protein-1, the tissue-specific protein that allows BAT to generate heat by uncoupling aerobic respiration from the generation of ATP.Because the endogenous pathways by cold exposure are complex and indirect, an attractive alternative for stimulation of BAT has been the use of pharmacological agents. As norepinephrine itself has too many adverse effects on the ...

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Section: Discussionsupporting

confidence: 68%

Cold but not sympathomimetics activates human brown adipose tissue in vivo

Cypess

Chen

Sze

et al. 2012

Proc. Natl. Acad. Sci. U.S.A.

279

234

View full text Add to dashboard Cite

show abstract

“…Despite reports of some success, there are clearly risks associated with prescription medications that, combined with potential side effects, contraindications, and adverse reactions, may make a universal protocol less than optimal. To date, the administration of propranolol (a nonselective b-blocker) has proven the most effective pharmaceutical, reducing the appearance in approximately 90% of patients (10)(11)(12). It works by blocking epinephrine and norepinephrine on both b-receptors and, thus, prevents the stimulation of BAT to produce heat.…”

mentioning

confidence: 99%

Thermal Control of Brown Adipose Tissue in 18F-FDG PET

Skillen

Currie

Wheat

2012

Journal of Nuclear Medicine Technology

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“…In patients submitted to PET/CT in winter, the accelerated glucose metabolism can simulate malignant lesions at FDG PET/CT imaging [14]. Yet, the physiological regulation of this metabolic pattern, and thus the benign nature of the tissue can be documented by pharmacologic interventions able to reduce tracer retention in physiological brown tissue [7][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…To justify the hazard related to surgery we thus planned to characterize the pathophysiological mechanisms underlying the high FDG uptake. To this purpose we planned to verify whether the intense glucose consumption was related to adrenergic activation by repeating PET/CT scanning under full dose beta-blocker therapy [7][8][9]. Repeated study, under propranolol treatment (120 mg per day, starting 5 days before the exam) documented the virtual disappearance of FDG uptake within the lesion, with a SUV max of 1.1 ( Figure 2B).…”

Section: Introductionmentioning

confidence: 99%