INTRODUCTION
The Endocannabinoid System Tutorial  is based on sponsored symposia conducted by the North American Association for the Study of Obesity in Las Vegas, Nevada, and the American Diabetes Association in San Diego, California.

Persons who attended these symposia are NOT eligible for AMA PRA Category 1 Credit™ for completing this activity. Please note that the course is accredited only for physicians (MD, DO, or equivalent). All other participants receive a certificate of completion.

These materials are the product of many years of rigorous clinical trial and academic research into the discovery and impact of the endocannabinoid (EC) system relative to its role in maintaining metabolic homeostasis. After introducing the EC system, its physiologic functions are detailed, and the use of pharmacology to prevent its overstimulation is explained. Many of the studies discussed in this tutorial led to the development of a new pharmacologic agent that affects not only obesity but also the well-known multiple metabolic risk factors that contribute to cardiovascular disease (CVD).

In June 2006, European regulatory authorities granted marketing authorization to the first cannabinoid receptor blocker approved among European member countries for the treatment of obesity. This approval marks a significant step in the battle against not only obesity but also CVD, which may soon surpass infectious disease as the leading cause of worldwide morbidity and mortality.

In accordance with the Discovery Institute of Medical Education (DIME) policies regarding financial and off-label disclosures, participants are advised that this CME activity may contain references to off-label or unapproved uses of drugs or devices. Participants should note that the use of these agents outside current approved labeling is considered experimental and are advised to consult prescribing information for these products.

This activity is funded through an educational grant from the sanofi-aventis Group. The activity content was developed independently by the author. All materials are included with the permission of the author. The opinions expressed are those of the author and are not to be construed as those of the publisher or grantor.

© 2006-2007 Discovery Institute of Medical Education

Target Audience This activity is designed for scientists, physicians, dietitians, and other health care providers involved in obesity research or the management of patients with obesity and other associated diseases (including diabetes, heart disease, hypertension, and cancer). Release Date December 15, 2006 Expiration Date December 15, 2007 Term of Offering This activity has a release date of December 15, 2006, and is valid for 1 year. Requests for credit must be received no later than December 15, 2007. Upon successful completion of the course and test, participants will receive further instruction regarding instantaneous online receipt of credit. For inquiries regarding technical issues or registration, please email CME/CE Support. Please direct CME content–related questions to DIME at 312-553-8000 or dimeinfo@dimeded.org.

Estimated Completion Time A review committee has determined that this material can be completed in 0.75 hour. It is in accordance with this estimated study time that the credit for this enduring material has been made. Faculty Louis J. Aronne, MD, FACP Clinical Professor of Medicine Weill Cornell Medical College Cornell University Director Comprehensive Weight Control Program New York-Presbyterian Hospital New York, New York

Learning Objectives

Upon completion of this activity, participants should be able to

• explain the physiology of the EC system and review the potential role of cannabinoid-1 (CB1) blockade in treating cardiovascular disease risk factors associated with obesity and weight gain;
  
  
• elaborate on the role of obesity in lipotoxicity, inflammation, cardiovascular disease, and other clinical manifestations;
  
  
• assess the clinical data on the use of CB1 blockade in the treatment of cardiovascular risk factors related to obesity and other metabolic disorders; and
  
  
• evaluate CB1 blockade for use in associated weight gain management in relation to the clinical trial data and compare this modality against the available tools for weight loss.
  
  

DIME is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation Statement

DIME designates this educational activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Funding Statement

This activity is funded through an educational grant from the sanofi-aventis Group.

Activity Purpose

This tutorial slide presentation explains the EC system and discusses the potential for multirisk management through its regulation.

Statement of Need

Already a major health issue in the United States, the impact of obesity has also become worthy of worldwide concern. Obesity plays a central role in a constellation of morbidities, including CVD, diabetes, and related metabolic and vascular disorders (eg, dyslipidemias, hypertension). A recent study implicates the EC system as a significant contributor to metabolic homeostasis. EC receptors have been detected centrally, peripherally, and in endocrine and related tissues. EC blockade is thought to mitigate the effects of overstimulation of this system that can result in obesity and the ensuing morbidities of CVD, diabetes, and metabolic disorders.

Faculty Disclosure and Biography

DIME requires that those involved with content development and/or presentation disclose to participants any significant financial interest or other relationship with (1) the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) any commercial supporters of the activity.

This CME activity may include discussions regarding the use of medications that may be outside of the approved labeling for these products. Physicians should consult the current prescribing information for these products. DIME requires faculty members to disclose that a product is not labeled for the use under discussion. Compliance is documentation that demonstrates the provider has a practice in place to make this requirement known to the faculty.

Louis J. Aronne, MD, FACP
Sources of Funding for Research: Amylin Pharmaceuticals, Inc.; Medtronic, Inc.; Merck & Co., Inc; Orexigen Therapeutics, Inc; Pfizer Inc.; sanofi-aventis Group.
Consulting Agreements: Manhattan Pharmaceuticals, Inc; Metabolic Therapeutics; sanofi-aventis Group.
Speakers Bureau/Honorarium Agreements: None.
Financial Interests/Stock Ownership: Pfizer Inc., sanofi-aventis Group.
Discussion of Off-label, Investigational, or Experimental Drug Use: Rimonabant.

Louis J. Aronne, MD, FACP, is a leading authority on obesity and its treatment. He is a clinical professor of medicine at Weill Cornell Medical College and has an adjunct appointment at Columbia University College of Physicians and Surgeons. He is director of the Comprehensive Weight Control Program, a state-of-the-art, multidisciplinary obesity research and treatment program. Dr Aronne is a former president of the North American Association for the Study of Obesity and a fellow of the American College of Physicians. He has authored more than 40 papers and book chapters on obesity and edited the National Institutes of Health Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. He is also a consultant to the VA Weight Management/Physical Activity Executive Council.

A graduate of the Johns Hopkins University School of Medicine, he graduated Phi Beta Kappa from Trinity College with a BS in biochemistry. Dr Aronne has won several awards for medical teaching, including the Davidoff Prize from Albert Einstein College of Medicine and the Elliot Hochstein Award from Cornell University. He is a member of the Alpha Omega Alpha medical honor society.

Instructions to Participants

Activity participants are required to view the presentation in its entirety, pass the course test, and complete an evaluation form before receiving their CME certificates (via email and/or PDF download). No fees are charged to participate in the activity or to receive a certificate. Full instructions are available on the user instructions page.

Disclaimer

The opinions expressed herein are those of the faculty and do not necessarily represent the views of the provider, commercial supporter, or publisher. Please review complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Click here to view minimum system requirements.