Derek Denton

Investigations in collaboration with Professor Wolfgang Liedtke of Duke University, USA (2011) examined gene expression in the hypothalamus of mice associated with Na appetite, and its abolition by rapid voluntary intake of salt solution before the time of significant absorption from the gut.  Na deficiency caused up regulation of hypothalamic genes, including dopamine and cAMP regulated neuronal phosphoprotein 32 kDA (DARPP-32), dopamine receptors 1 and 2 and STEP.  Administration of D1and D2 receptor antagonists reduced gratification. The gene sets were gene sets previously linked to addiction (opiates and cocaine).  Salt appetite and gratification are evident in Metatheria (e.g. kangaroos) which evolved more than 100 million years ago, whereas drugs of addiction are recent. This raised the question whether contemporary hedonic indulgence and addiction has utilized ancient neural pathways and receptors of instinct processes, which may explain the many difficulties in treatment.

In parallel, his oesophageal fistula studies of thirst and sodium appetite and its gratification conducted with his colleagues, Elspeth Bott, Michael McKinley, Eva Tarjan, and Richard Weisinger revealed the role of the 5th, 7th, 9th and 10th cranial nerves as a chronological sequence contriving gratification. Neuroimaging has shown also a novel mechanism involved in the inhibiting of fluid intake when adequate has already been ingested.  At this time, the Florey Group led by McKinley showed the site of Verney’s osmoreceptor was outside the blood-brain-barrier in the lamina terminalis.

Apart from striking new knowledge on the brain sensors (sodium appetite) and organization of primordial emotions entrained, such as, for example, thirst, salt appetite or hunger for air, his work has led to a theory proposing that the primordial emotions, the subjective elements of the instincts, were phylogenetically the first emergence of consciousness, often instigated by dedicated interoceptors.  This hypothesis is set out comprehensively in a book “The Primordial Emotions : The Dawning of Consciousness”, published by Flammarion, Paris, 2005, and Oxford University Press 2006.

Denton was made a Companion of the Order of Australia in 2005 for leadership in medical research.

In 1995, on election to the National Academy of Sciences, he was cited as “the world’s leading authority on the regulation of salt and water metabolism and relevant endocrine control mechanisms”. He was also exploring the nature of consciousness in animals. In 1987 he was awarded the Macfarlane Burnet Medal and Lecture by the Australian Academy of Science for his lifetime’s work and in 1999 elected a Fellow of the Royal Society of London.

At election to the Academy of Science of the Institute of France, the same attribution of world leadership, that the Academy of Science of the US made was reiterated and the Danish group, Paul Astrup, Peter Bie and Hans Enzell in their book “Salt and Water in Culture and Medicine” (1993) stated “Australian Derek Ashworth Denton has contributed more than anyone in explaining the adrenal production of hormones and their importance in the regulation of salt metabolism”.

Denton synthesised a sweep of this work in his book “The Hunger for Salt: An Anthropological, Physiological and Medical Analysis” (Springer Verlag 1982) which was reviewed by Lewis Thomas, President of the Sloan Kettering Institute, nominated by Time to be ….…..”the best essayist on science now working anywhere in the world.”  Thomas wrote ……..”few researchers have the intellectual flexibility or the sheer courage to take on a really big subject and cover the whole.  Derek Denton has done this in “Hunger for Salt”, and the result is something astonishing among contemporary scientific letters – a single author book that covers everything – This grand book”, and by Harold Schmeck, lead Science Writer of the New York Times, as …………….”may be the most comprehensive treatment of the subject ever completed”, Dr. John Pappenheimer, the Emeritus Professor of Physiology at Harvard, characterized it as …….”the best example of integrative physiology to come of the second half of the 20th century”.

Following election to the Royal Swedish Academy of Science in 1974, Denton received the Pavlovian Award of the Pavlovian Society of North America for achievement toward understanding of factors in normal and abnormal behaviour (1975), and together with colleagues at the Howard Florey, the Biennial Prize of the International Society of Cardiology in 1976.  In 1979 he was elected Fellow of the Australian Academy of Science, and also the Royal Australian College of Physicians.  In 1982 awarded the P K Anokhin Medal by the Rector of the Schenov First Moscow Medical Institute “for contribution to world physiology”.  In 1986 elected as Honorary Foreign Member of the American Academy of Arts and Sciences. In 1987 elected Honorary Member, American Physiological Society, one of 50 so elected in the Society’s century of function.  In 1988, elected Honorary Fellow, Royal College of Physicians (London).  In 1995, elected Foreign Associate National Academy of Sciences USA. In 1999 elected Fellow of the Royal Society (London), and in 2000 elected Foreign Associate, Academie des Sciences, Institut de France.  In 2001 he received the Life Time Achievement Award of the International Commission on Food and Fluid Intake of the International Union of Physiological Sciences.  In 2005 and 2006, he received a Companion of the Order of Australia, and Doctor of Law (Honoris Causa) University of Melbourne, and in 2014 the World Hypertension League Award for Excellence in Dietary Salt Reduction.

The work attracted large financial support from private benefactors in Australia (Kenneth and Baillieu Myer, and Sir Ian Potter) and overseas, the Australian Government and Reserve Bank, the Rockefeller Foundation, and the National Institutes of Health (US).  This founded and supported the Howard Florey Laboratories in 1962, and then in 1970, the Howard Florey Institute of Experimental Physiology and Medicine, which has eventually become the largest neuroscience institute in the Southern Hemisphere (The Florey Institute of Neuroscience and Mental Health – 600 personnel).  He was the Founding Director and was termed by the Chancellor of Melbourne University, Professor Sir Douglas Wright AK, as the “fons et origo”.  Election by the Royal Swedish Academy of Science (1974) as one of 18 Foreign Medical Members, joining, inter alia, Lord Adrian, Hodgkin, A.V. Hill, Burnet, Monod, Best, Bronk, Page and Moruzzi.  One of 4 OECD Examiners of Scientific Policy of the Government of Sweden in 1986.  For twelve years (1978-1991) he was with Professor Sune Bergstrom, Chairman of the Nobel Foundation, one of two foreign members of the Lasker Jury in the U.S. He became a Council Member (1977-1989), and then First Vice President of the International Union of Physiological Sciences (1983-1989), working with President, Sir Andrew Huxley PRS. Australian representative on the International Human Rights Network of Academies and Learned Societies, 2000-2015.

Fifty years had passed since Pavlov was using Pavlov-Glinski parotid fistulae in dogs with discovery of conditioned reflexes. Nine papers from Russia and Germany had reported in the interim that a permanent unilateral parotid fistula was not surgically feasible in ruminants. Denton succeeded surgically in sheep which opened a new era in the study of body fluid regulation. In effect, the parotid fistula (1-4l/day) represented a tap on the blood stream letting out sodium. Many animal preparations made also embodied his novel idea of adrenal autotransplant into arterio-venous skin loops constructed in the neck, as executed by Wright and Goding. This allowed revelation of direct action on the gland by adrenal arterial infusion of e.g. Na, K, ACTH in a conscious undisturbed animal. Following the discovery of the salt retaining hormone aldosterone by the Taits in 1953, with major medical implications, the hunt for the mode of control of it was internationally intense.

From the outset of preparation of sheep with a permanent parotid fistula in 1953 it was evident that the animals vigorously licked any dried saliva on the walls of their cages and attacked a salt block placed in their cage. A clear-cut avid appetite for salt was evident, and opened a new way to investigate the neural organization of a classic instinct. Elaborating the general biological context, Denton showed that sodium was a rate limiting factor in reproduction, especially in animals with multiple litters, and that in pregnancy and lactation increased secretion of a quintet of steroid and peptide hormones caused a large increase of salt appetite.

Denton was married to pioneering ballet dancer and teacher Dame Margaret Scott from 1953 until her death in 2019. They had two sons.

Denton recognised also a crucial biological fact that no biologically relatively inactive cation had evolved in Metazoan organisms to play a role analogous to that which increase of bicarbonate plays on the anion side of the pattern during vomiting and excess Cl- loss. In this latter case no large urinary Na excretion was obligatory to keep acid-base balance compatible with life. The initial finding with pancreatic fistula was published by Nature (London, 1948). In 1949, he, and Dr Victor Wynn who had joined him in study of a second case, were supported by Professor R. D. Wright and Sir MacFarlane Burnet to set up the Ionic Research Unit of the NHMRC in the Physiology Department at Melbourne University. The Ionic Research Unit originated flame photometry in clinical medical practice internationally – a Wynn initiated step. Rapid measurement of sodium and potassium in blood and urine helped originate intensive care, and they published a monograph in Acta Medica Scandinavica. Denton and Wynn’s approach, particularly flame photometry with rapid assessment of biochemical disorder, eventually resulted in saving of tens of thousands of lives in Australia as well as in other countries by chemically accurate intervention. In 1952 Wynn went to London, where Professors Pickering and Robb at St Mary’s Hospital established a metabolic intensive care unit which Wynn directed. Some years later he was visited by Professor Francis Moore of Harvard who incorporated the Melbourne classification of distortion of body fluid status viz subtraction acidemia e.g. pancreatic fistula; addition acidemia e.g. diabetic coma; subtraction alkalemia e.g. vomiting gastric juice; and addition alkalemia (excess alkali ingestion) into his textbook ‘Metabolic Aspects of Surgery”

Three months after medical graduation in 1947, he made a basic discovery on kidney function at the Royal Melbourne Hospital. In the face of profuse alkaline drainage (Na+ in excess of Cl- relative to extracellular proportions) from a pancreatic fistula (2-3 litres/day) the patient’s kidneys primarily regulated the ionic pattern of the extra cellular fluid – not plasma concentration or the load of ions to the kidney tubules. As the fistula drained, blood pressure declined, respiration increased, and Cl- excretion in urine increased despite decline in plasma Cl- level below the so called “renal threshold “. Adequate intravenous infusion of sodium lactate, or oral sodium bicarbonate reduced or stopped the urinary Cl- excretion. In this era, urinary Cl- was measured at the bedside (Fantus test) to assess whether salt content of the body was adequate or whether salt administration was needed urgently. This was recommended by Marriott in his Croonian Lecture and was the practice of the British Army in India. The proposal was physiologically unsound in specific circumstances of loss of Na in excess of Cl, and Marriott altered his recommendations. It was the wrong approach in diseases such as e.g. dysentery, cholera and paralytic ileus. No rapid estimation of urinary sodium by flame photometry had yet emerged.

The months following graduation (1947), and the responsibility for the patient with a pancreatic fistula, led to study sojourns with Frank Fenner and Macfarlane Burnet in Melbourne, and Verney in Cambridge, UK in 1952.  On return from the UK, Denton’s discoveries starting from the two fistula patients, and several sheep in cages progressively revealed novel renal, endocrine and instinctive behavioural mechanisms of notable medical, integrative physiological, and evolutionary survival importance.

Derek Ashworth Denton AC FRS (27 May 1924 – 18 November 2022) was an Australian scientist who explained the regulation of electrolytes in extracellular fluid, the hormones controlling this regulation, particularly aldosterone, and the instinctive behaviours controlling intake of water and salts. He was cited in 1995 at election to the U.S. National Academy of Sciences as the world’s leading authority on the regulation of salt and water metabolism and relevant endocrine control mechanisms. He was one of Australia’s most eminent scientists.