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Fw: Clarify Bethanecol

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Fwd: Clarify Bethanecol

>Hi,

>

>I was copied on your communications about bethanecol. I am not too

concerned

>about hypertrophy with either bethanecol or secretin. Hypertrophy is what

>your muscle cells do with exercise, so just getting bigger isn't

necessarily

>bad. One of the positive things we're seeing early-on with bethanecol is

>that some of the longer-term patients are requiring less as time goes on.

>

>I have read as much as I can find on bethanecol and one published study

used

>it in children for three years without evident problems. It has been used

>extensively in newborns for reflux. Some adults have been on it for many

>years for heartburn or urinary retention. We don't know about its specific

>application in autistic children, so we need to keep our eyes open. I do

>appreciate your caution.

>

>Could you please forward this into your discussion groups to balance the

>thinking?

>

>Sincerely,

>

>Woody McGinnis

>

Dear Willis,

Such an irony. Folks who like secretin are attacking bethanecol for the same

hypertrophy that secretin causes. I append the following, which was an

answer to the first such criticism of bethanecol some time ago. I hope

you'll pass it along to help folks understand...

Maybe bigger is better...

Date: 2/8/00

To: <A HREF= " mailto:dann-l@... " >dann-l@...</A>

Friends,

Various gastrointestinal hormones stimulate the maintenance and growth of

other target tissues in the gut, including the exocrine pancreas, the stomach

and the mucosa of the large and small bowel. A good article on this dynamic

is found in Endocrinology 1980 106(1): 323-8. It is one of three articles

which demonstrate that administration of Secretin to rats over 5 to 15 days

results in measureable hypertrophy of the pancreas.

This speaks to a recent negative parenthetical comment about pancreatic

hypertrophy from administration of Bethanecol to rats over a period of 14

days. The quoted Bethanecol study (Euro J Pharmacol 1994 292(1):47-55) and

the Secretin studies are comparable in that they both utilized very high

doses. They differ in that Secretin caused both hypertrophy (larger cells)

and hyperplasia (more cells, DNA proliferation), while Bethanecol did not

produce hyperplasia, but only larger cells. (Secretin was also noted to block

the trophic effect of gastrin on the stomach.)

In light of the generally diminished health of the GI system in autism,

trophic effects may be just what the doctor ordered. (And remember, Secretin

and Bethanecol may be exerting trophic effects in the brain, too. Consider

the time frames in these studies and the typical lag in behavioral

improvements with Secretin.) I think the question is how much stimulation

may be excessive. In this hypothetical area hyperplastic influences would be

more worrisome to the cytologically-minded than simple hypertrophy.

I do not take chronic administration of either Secretin or Bethanecol

lightly. I have told the parents that in the case of Bethanecol I want to

stick to the lowest dose producing behavioral improvement and that I may not

be prepared to treat for more than two months, which I hope will be enough

for sustained improvement. I haven't found any animal data on truly

long-term administration, and it would be wonderful if any of you had time to

help me look.

Salud,

Woody

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