12/30/2023 0 Comments Roger bannister family![]() Droxidopa increased plasma noradrenaline levels towards normal and has had a remarkable effect on the siblings, allowing them to lead full lives since they first started on the drug in 1986. The oral noradrenaline synthetic precursor agent l-dihydroxyphenylserine ( l-DOPS, droxidopa) was obtained from Japan, where it originally was used to treat orthostatic hypotension in patients with amyloidosis and to reduce gait abnormalities in Parkinson disease. A series of studies began on the only two siblings in the world diagnosed with dopamine beta-hydroxylase deficiency. An unusual case was a 20-year-old man with severe orthostatic hypotension who, unlike others with autonomic failure, had undetectable plasma noradrenaline and adrenaline but extremely high dopamine levels. Observations of exceptionally rare conditions can result in new areas of research and therapy. In 1984, the Wellcome Trust again enabled me, as Senior Lecturer in Medicine, to work alongside Sir Roger and Sir Stanley. Sir Roger’s drive and the critical mass of those working in the autonomic field in London resulted in the hospitals becoming the epicentre for the referral of patients with orthostatic hypotension and autonomic disorders. The autonomic field in the 1980s was still in its infancy, although this was changing rapidly. Sir Roger was also at St Mary’s Hospital, and our collaborations began, also at Queen Square in 1981. The Wellcome Trust enabled me to join his department in 1979 with a senior clinical research fellowship. He suggested I join him in the Medical Unit he directed, to study the neurogenic (autonomic) basis of essential hypertension, which was one of his major interests. Fortunately, from 1973 I had been collaborating with Professor Sir Stanley Peart at St Mary’s Hospital Medical School on the sympathetic nervous system control of renin and aldosterone release in patients with spinal cord injury. The brief elation of successful research and its clinical translation did not equate to reality, as the specialty was nonexistent, and patients with autonomic disorders were considered rare and usually were not recognised. As various mentors pointed out, a lifetime career in autonomic medicine was a pipe dream. ![]() After completing my postdoctoral clinical training, I considered my future. In 1979 a combination of events resulted in us working together. These findings would eventually support the renaming of Shy–Drager syndrome to its current nomenclature, multiple system atrophy. Of particular importance were his observations with the Oxford neuropathologist David Oppenheimer, that linked the clinical features of autonomic failure and cell loss in the intermediolateral column of the spinal cord with neuroanatomical changes in different regions of the brain (striatonigral and olivopontocerebellar atrophy). He evaluated these patients in detail, clinically and with physiological testing, collaborating with David Greenfield (Professor of Physiology at St Mary’s), Peter Fenton and Leslie Ardill, with publications on the defective physiology of the blood vessels of those patients and on treatment strategies. He additionally chose to focus on what was then a rare disorder, orthostatic hypotension due to autonomic failure. Each of these appointments was busy and demanding clinically, given that they were at different institutions in separate locations. In 1963, aged 33, he was appointed consultant physician at the National Hospital for Nervous Diseases, Queen Square, London, followed by a consultant neurology appointment at St Mary’s Hospital a year later. His later clinical and allied training included working with Derek Denny-Browne in Boston as a research fellow at Harvard University in 1962. This was the basis of his doctorate in medicine thesis on Temperature homeostasis and heat illness. He went on to describe the possible effects of pyrogens, and the prevention and treatment of hyperpyrexia, a frequently fatal condition. His astute observations and investigation of unacclimatized troops with hyperpyrexia led to his description of acute anhidrotic heat exhaustion, published in The Lancet in 1959. From 1957 to 1959 he completed his military national service at Millbank and Aden as a Junior Medical Specialist, and later was Captain in the Royal Army Medical Corps. His postmedical graduation clinical experience included being house physician to Professor Sir George Pickering at St Mary’s Hospital, whose expertise included the circulation and hypertension. ![]() He obtained his medical degree in 1954, soon after he broke the 4-minute mile barrier after which he retired from athletics. In 1952 he won a scholarship to study medicine at St Mary’s Hospital Medical School.
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