When those with the disorder open a cupboard and spot a packet of stockpiled cookies before they know it, they’ll have eaten a whole packet. It’s not so much that they’re feeling hungry, more that they find that they can’t resist the cookies, and once they start eating them, they simply can’t stop.
If sufferers binge eat in this way a couple of times a week, over time they are likely to develop other conditions. Weight gain is common, as is type 2 diabetes. In the longer term, the knock-on effects of being overweight or obese may appear, particularly cardiovascular disease. There are also strong links to anxiety, stress and depression, with the resulting feelings of guilt, disgust and shame such bingeing can cause.
Over the past decades there has been increasing interest in the disorder and its combined psychological and pharmacological treatment. There is now one drug on the market indicated for binge-eating disorder, Shire’s lisdexamfetamine (Vyvanse). Shire (now part of Takeda) has been particularly active looking for drugs to treat patients with impulse control problems, but they are not alone.
The Sygnature Group has also been working hard in the field. It plays to the strengths of our preclinical arm, RenaSci, in CNS pharmacology and metabolic disease and we have developed a number of in vivo models to assess potential therapeutic leads for the treatment of binge eating disorder. These preclinical models were developed and published in collaboration with Shire and are extensively validated, including with single and repeated treatment with lisdexamfetamine.
In the standard model, rats are given chocolate, on an intermittent, irregular basis that they cannot predict. They soon adapt, becoming unable to resist the impulse to eat the chocolate straight away, in binge-type behaviour.
While this model focuses on binge eating, it is possible the drugs it helps to identify might have applications in other areas of impulsive behaviour, such as problem gambling. There is already some clinical evidence that this is the case.
We have also explored the physiological basis of this impulsive behaviour. After binge eating behaviour was induced, we looked for pathway changes in the brain tissue, particularly those that are associated with addictive, impulsive behaviours. It is clear that the drugs work by stopping the compulsive behaviour, and not merely increasing satiety to stop them wanting to eat.
We have carefully validated this model and it appears remarkably predictive for the treatment of binge eating disorder and impulsive behaviour in a way that translates into humans.
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