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Nezamoleslami S, Sheibani M, Mumtaz F, Esmaeili J, Shafaroodi H, Dehpour AR. Lithium reverses the effect of opioids on eNOS/nitric oxide pathway in human umbilical vein endothelial cells. Mol Biol Rep 2020; 47:6829-6840. [PMID: 32888132 DOI: 10.1007/s11033-020-05740-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
The main challenge of pain management with opioids is development of acute and chronic analgesic tolerance. Several studies on neuronal cells have focused on the molecular mechanisms involved in tolerance such as cyclic AMP (cAMP) activation, and nitric oxide (NO) pathway. However, the effects of opioids on non-neuronal cells and tolerance development have been poorly investigated. Lithium chloride is a glycogen synthase kinase 3β (GSK-3β) inhibitor and exert its effects through modulation of nitric oxide pathway. In this study we examined the effect of lithium on acute/chronic morphine and methadone administration in endothelial cells which express mu opioid receptors. Human umbilical vein endothelial cells (HUVECs) were treated with different doses of morphine, methadone, and lithium for six and 48 h. Then we evaluated cell viability, nitrite and cyclic AMP levels, as well as the expression of endothelial nitric oxide synthase (eNOS) protein using Immunocytochemistry (ICC) assay and phosphorylated GSK-3β enzyme by western blot analysis in cells. Both chronic morphine and methadone treatment increased NO level and eNOS expression in HUVECs. Morphine induced cAMP overproduction after 48 h exposure with cells. Lithium pretreatment (10 mM) in both morphine and methadone received groups significantly reduced nitrite and cAMP levels as well as eNOS expression as compared to the control. The decreased amount of phospho GSK-3β due to the opioid exposure was increased following lithium treatment. Tolerance like pattern may occur in non-neuronal cells with opioid receptors and this study clearly revealed the attenuation of morphine and methadone tolerance like behavior by lithium treatment in HUVECs.
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Affiliation(s)
- Sadaf Nezamoleslami
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
- Experimental Medicine Research Center, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Mohammad Sheibani
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
- Experimental Medicine Research Center, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Faiza Mumtaz
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
- Experimental Medicine Research Center, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Jamileh Esmaeili
- Department of Biology, Islamic Azad University, P.O. Box 1477893855, Tehran, Iran
| | - Hamed Shafaroodi
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran.
| | - Ahmad Reza Dehpour
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran.
- Experimental Medicine Research Center, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran.
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102
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Bame M, McInnis MG, O'Shea KS. MicroRNA Alterations in Induced Pluripotent Stem Cell-Derived Neurons from Bipolar Disorder Patients: Pathways Involved in Neuronal Differentiation, Axon Guidance, and Plasticity. Stem Cells Dev 2020; 29:1145-1159. [PMID: 32438891 PMCID: PMC7469698 DOI: 10.1089/scd.2020.0046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/21/2020] [Indexed: 12/17/2022] Open
Abstract
Bipolar disorder (BP) is a complex psychiatric condition characterized by severe fluctuations in mood for which underlying pathological mechanisms remain unclear. Family and twin studies have identified a hereditary component to the disorder, but a single causative gene (or set of genes) has not been identified. MicroRNAs (miRNAs) are small, noncoding RNAs ∼20 nucleotides in length, that are responsible for the posttranslational regulation of multiple genes. They have been shown to play important roles in neural development as well as in the adult brain, and several miRNAs have been reported to be dysregulated in postmortem brain tissue isolated from bipolar patients. Because there are no viable cellular models to study BP, we have taken advantage of the recent discovery that somatic cells can be reprogrammed to pluripotency then directed to form the full complement of neural cells. Analysis of RNAs extracted from Control and BP patient-derived neurons identified 58 miRNAs that were differentially expressed between the two groups. Using quantitative polymerase chain reaction we validated six miRNAs that were elevated and two miRNAs that were expressed at lower levels in BP-derived neurons. Analysis of the targets of the miRNAs indicate that they may regulate a number of cellular pathways, including axon guidance, Mapk, Ras, Hippo, Neurotrophin, and Wnt signaling. Many are involved in processes previously implicated in BP, such as cell migration, axon guidance, dendrite and synapse development, and function. We have validated targets of several different miRNAs, including AXIN2, BDNF, RELN, and ANK3 as direct targets of differentially expressed miRNAs using luciferase assays. Identification of pathways altered in patient-derived neurons suggests that disruption of these regulatory networks that may contribute to the complex phenotypes in BP.
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Affiliation(s)
- Monica Bame
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Melvin G. McInnis
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - K. Sue O'Shea
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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103
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Burdick KE, Millett CE, Russo M, Alda M, Alliey-Rodriguez N, Anand A, Balaraman Y, Berrettini W, Bertram H, Calabrese JR, Calkin C, Conroy C, Coryell W, DeModena A, Feeder S, Fisher C, Frazier N, Frye M, Gao K, Garnham J, Gershon ES, Glazer K, Goes FS, Goto T, Harrington GJ, Jakobsen P, Kamali M, Kelly M, Leckband S, Løberg EM, Lohoff FW, Maihofer AX, McCarthy MJ, McInnis M, Morken G, Nievergelt CM, Nurnberger J, Oedegaard KJ, Ortiz A, Ritchey M, Ryan K, Schinagle M, Schwebel C, Shaw M, Shilling P, Slaney C, Stapp E, Tarwater B, Zandi P, Kelsoe JR. The association between lithium use and neurocognitive performance in patients with bipolar disorder. Neuropsychopharmacology 2020; 45:1743-1749. [PMID: 32349118 PMCID: PMC7419515 DOI: 10.1038/s41386-020-0683-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/24/2020] [Accepted: 04/17/2020] [Indexed: 01/21/2023]
Abstract
Lithium remains the gold standard for the treatment of bipolar disorder (BD); however, its use has declined over the years mainly due to the side effects and the subjective experience of cognitive numbness reported by patients. In the present study, we aim to methodically test the effects of lithium on neurocognitive functioning in the largest single cohort (n = 262) of BD patients reported to date by harnessing the power of a multi-site, ongoing clinical trial of lithium monotherapy. At the cross-sectional level, multivariate analysis of covariance (MANCOVA) was conducted to examine potential group differences across neurocognitive tests [California Verbal Learning Test (CVLT trials 1-5,CVLT delayed recall), Wechsler Digit Symbol, Trail-making Test parts A and B (TMT-A; TMT-B), and a global cognition index]. At the longitudinal level, on a subset of patients (n = 88) who achieved mood stabilization with lithium monotherapy, we explored the effect of lithium treatment across time on neurocognitive functioning. There were no differences at baseline between BD patients that were taking lithium compared with those that were not. At follow-up a significant neurocognitive improvement in the global cognitive index score [F = 31.69; p < 0.001], CVLT trials 1-5 [F = 29.81; p < 0.001], CVLT delayed recall [F = 15.27; p < 0.001], and TMT-B [F = 6.64, p = 0.012] was detected. The cross-sectional and longitudinal (on a subset of 88 patients) investigations suggest that lithium may be beneficial to neurocognitive functioning in patients with BD and that at the very least it does not seem to significantly impair cognition when used therapeutically.
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Affiliation(s)
- Katherine E. Burdick
- grid.62560.370000 0004 0378 8294Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA ,James J Peters Veteran Administration (VA) Hospital, Bronx, NY USA
| | - Caitlin E. Millett
- grid.62560.370000 0004 0378 8294Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Manuela Russo
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Martin Alda
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | | | - Amit Anand
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Yokesh Balaraman
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Wade Berrettini
- grid.25879.310000 0004 1936 8972Center for Neurobiology and Behavior, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Holli Bertram
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Joseph R. Calabrese
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Cynthia Calkin
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | - Carla Conroy
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - William Coryell
- grid.214572.70000 0004 1936 8294University of Iowa, Iowa City, IA USA
| | - Anna DeModena
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Scott Feeder
- grid.66875.3a0000 0004 0459 167XMayo Clinic, Rochester, MN USA
| | - Carrie Fisher
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Nicole Frazier
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Mark Frye
- grid.66875.3a0000 0004 0459 167XMayo Clinic, Rochester, MN USA
| | - Keming Gao
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Julie Garnham
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | - Elliot S. Gershon
- grid.170205.10000 0004 1936 7822University of Chicago, Chicago, IL 60637 USA
| | - Kara Glazer
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Fernando S. Goes
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Toyomi Goto
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | | | - Petter Jakobsen
- grid.7914.b0000 0004 1936 7443NORMENT, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Masoud Kamali
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Marisa Kelly
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Susan Leckband
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Else Marie Løberg
- grid.7914.b0000 0004 1936 7443NORMENT, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Addiction Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Falk W. Lohoff
- grid.420085.b0000 0004 0481 4802National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, MD USA
| | - Adam X. Maihofer
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Michael J. McCarthy
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Melvin McInnis
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Gunnar Morken
- grid.412835.90000 0004 0627 2891Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | | | - John Nurnberger
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Ketil J. Oedegaard
- grid.7914.b0000 0004 1936 7443NORMENT, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Abigail Ortiz
- grid.17063.330000 0001 2157 2938Centre for Addiction and Mental Health, University of Toronto, Toronto, ON Canada
| | - Megan Ritchey
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Kelly Ryan
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Martha Schinagle
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Candice Schwebel
- grid.25879.310000 0004 1936 8972Center for Neurobiology and Behavior, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Martha Shaw
- grid.214572.70000 0004 1936 8294University of Iowa, Iowa City, IA USA
| | - Paul Shilling
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Claire Slaney
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | - Emma Stapp
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Bruce Tarwater
- grid.214572.70000 0004 1936 8294University of Iowa, Iowa City, IA USA
| | - Peter Zandi
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - John R. Kelsoe
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
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104
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Gibbons A, Sundram S, Dean B. Changes in Non-Coding RNA in Depression and Bipolar Disorder: Can They Be Used as Diagnostic or Theranostic Biomarkers? Noncoding RNA 2020; 6:E33. [PMID: 32846922 PMCID: PMC7549354 DOI: 10.3390/ncrna6030033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022] Open
Abstract
The similarities between the depressive symptoms of Major Depressive Disorders (MDD) and Bipolar Disorders (BD) suggest these disorders have some commonality in their molecular pathophysiologies, which is not apparent from the risk genes shared between MDD and BD. This is significant, given the growing literature suggesting that changes in non-coding RNA may be important in both MDD and BD, because they are causing dysfunctions in the control of biochemical pathways that are affected in both disorders. Therefore, understanding the changes in non-coding RNA in MDD and BD will lead to a better understanding of how and why these disorders develop. Furthermore, as a significant number of individuals suffering with MDD and BD do not respond to medication, identifying non-coding RNA that are altered by the drugs used to treat these disorders offer the potential to identify biomarkers that could predict medication response. Such biomarkers offer the potential to quickly identify patients who are unlikely to respond to traditional medications so clinicians can refocus treatment strategies to ensure more effective outcomes for the patient. This review will focus on the evidence supporting the involvement of non-coding RNA in MDD and BD and their potential use as biomarkers for treatment response.
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Affiliation(s)
- Andrew Gibbons
- The Florey Institute for Neuroscience and Mental Health, Parkville, The University of Melbourne, Melbourne, Victoria 3052, Australia; (S.S.); (B.D.)
- The Department of Psychiatry, Monash University, 27-31 Wright Street, Clayton, Victoria 3168, Australia
| | - Suresh Sundram
- The Florey Institute for Neuroscience and Mental Health, Parkville, The University of Melbourne, Melbourne, Victoria 3052, Australia; (S.S.); (B.D.)
- The Department of Psychiatry, Monash University, 27-31 Wright Street, Clayton, Victoria 3168, Australia
| | - Brian Dean
- The Florey Institute for Neuroscience and Mental Health, Parkville, The University of Melbourne, Melbourne, Victoria 3052, Australia; (S.S.); (B.D.)
- The Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
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105
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Jon DI, Woo YS, Seo JS, Lee JG, Jeong JH, Kim W, Shin YC, Min KJ, Yoon BH, Bahk WM. The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP): Changes in preferred treatment strategies and medications over 16 years and five editions. Bipolar Disord 2020; 22:461-471. [PMID: 32202033 DOI: 10.1111/bdi.12902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) is based on expert consensus and has been revised five times since 2002. This study evaluated the changes in treatment strategies advocated by the KMAP-BP over time. METHODS The five editions of the KMAP-BP were reviewed, and the recommendations of the KMAP-BP were compared with those of other bipolar disorder (BP) treatment guidelines. RESULTS The most preferred option for the initial treatment of mania was a combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP). Either MS or AAP monotherapy was also considered a first-line strategy for mania, but not for all types of episodes, including mixed/psychotic mania. In general, although lithium and valproic acid were commonly recommended, valproic acid has been increasingly preferred for all phases of BP. The most notable changes over time included the increasing preference for AAPs for all phases of BP, and lamotrigine for the depressive and maintenance phases. The use of antidepressants for BP has gradually decreased, but still represents a first-line option for severe and psychotic depression. CONCLUSIONS In general, the recommended strategies of the KMAP-BP were similar to those of other guidelines, but differed in terms of the emphasis on rapid effectiveness, which is often desirable in actual clinical situations. The major limitation of the KMAP-BP is that it is a consensus-based rather than an evidence-based tool. Nevertheless, it may confer advantages in actual clinical practice.
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Affiliation(s)
- Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong-Seok Seo
- Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Korea
| | - Jung Goo Lee
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Inje University College of Medicine and Paik Institute for Clinical Research, Busan, Korea.,Department of Health Science and Technology, Graduate School of Inje University, Busan, Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Kim
- Department of Psychiatry, Inje University College of Medicine, Seoul, Korea
| | - Young Chul Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Seoul, Korea
| | - Kyung Joon Min
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Bo-Hyun Yoon
- Department of Psychiatry, Naju National Hospital, Naju, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
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106
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The Effect of Lithium on Inflammation-Associated Genes in Lipopolysaccharide-Activated Raw 264.7 Macrophages. Int J Inflam 2020; 2020:8340195. [PMID: 32774832 PMCID: PMC7397420 DOI: 10.1155/2020/8340195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/31/2020] [Accepted: 05/11/2020] [Indexed: 11/17/2022] Open
Abstract
Lithium remains the preferred Food and Drug Administration- (FDA-) approved psychiatric drug for treatment of bipolar disorders since its medical establishment more than half a century ago. Recent studies revealed a promising role for lithium in the regulation of inflammation, oxidative stress, and neurodegeneration albeit unclear about its exact mode of action. Thus, the intention of this study is to delineate the regulatory mechanisms of lithium on oxidative stress in lipopolysaccharide- (LPS-) activated macrophages by evaluating its effects on nuclear factor-κB (NF-κB) activity and mRNA expression of multiple oxidative stress-related NF-κB genes. Raw 264.7 macrophages were treated with up to 10 mM lithium, and no change in cell proliferation, viability, growth, and cell adhesion was observed in real time. Pretreatment with low doses of lithium was shown to reduce nitric oxide (NO) production in LPS-activated macrophages. A reduced internal H2DCFDA fluorescence intensity, indicative of reduced reactive oxygen species (ROS) production, was observed in LPS-activated Raw 264.7 macrophages treated with lithium. Lithium has been shown to lower the production of the chemokine RANTES; furthermore, this inhibitory action of lithium has been suggested to be independent of glycogen synthase kinase-3 β (GSK3β) activity. It is shown here that lithium modulates the expression of several inflammatory genes including IκB-α, TRAF3, Tollip, and NF-κB1/p50 which are regulators of the NF-κB pathway. Moreover, lithium inhibits NF-κB activity by lowering nuclear translocation of NF-κB in LPS-activated macrophages. This is the first study to associate Tollip, Traf-3, and IκB-α mRNA expression with lithium effect on NF-κB activity in LPS-activated Raw 264.7 macrophages. Although these effects were obtained using extratherapeutic concentrations of lithium, results of this study provide useful information towards understanding the mode of action of lithium. This study associates lithium with reduced oxidative stress in LPS-activated Raw 264.7 macrophages and further suggests candidate molecular targets for the regulation of oxidative stress-related diseases using lithium beyond bipolar disorders.
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107
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Nelson SD, Walsh CG, Olsen CA, McLaughlin AJ, LeGrand JR, Schutz N, Lasko TA. Demystifying artificial intelligence in pharmacy. Am J Health Syst Pharm 2020; 77:1556-1570. [PMID: 32620944 DOI: 10.1093/ajhp/zxaa218] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To provide pharmacists and other clinicians with a basic understanding of the underlying principles and practical applications of artificial intelligence (AI) in the medication-use process. SUMMARY "Artificial intelligence" is a general term used to describe the theory and development of computer systems to perform tasks that normally would require human cognition, such as perception, language understanding, reasoning, learning, planning, and problem solving. Following the fundamental theorem of informatics, a better term for AI would be "augmented intelligence," or leveraging the strengths of computers and the strengths of clinicians together to obtain improved outcomes for patients. Understanding the vocabulary of and methods used in AI will help clinicians productively communicate with data scientists to collaborate on developing models that augment patient care. This primer includes discussion of approaches to identifying problems in practice that could benefit from application of AI and those that would not, as well as methods of training, validating, implementing, evaluating, and maintaining AI models. Some key limitations of AI related to the medication-use process are also discussed. CONCLUSION As medication-use domain experts, pharmacists play a key role in developing and evaluating AI in healthcare. An understanding of the core concepts of AI is necessary to engage in collaboration with data scientists and critically evaluating its place in patient care, especially as clinical practice continues to evolve and develop.
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Affiliation(s)
- Scott D Nelson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Colin G Walsh
- Department of Biomedical Informatics, Medicine, and Psychiatry, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | - Thomas A Lasko
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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108
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Effects of lithium on cytokine neuro-inflammatory mediators, Wnt/β-catenin signaling and microglial activation in the hippocampus of chronic mild stress-exposed rats. Toxicol Appl Pharmacol 2020; 399:115073. [DOI: 10.1016/j.taap.2020.115073] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 12/29/2022]
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109
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Dolab N, Kamkar MZ, Amiriani T, Yuzugulen J, Marjani M, Marjani A. The association between leptin and adiponectin, and metabolic syndrome components and serum levels of lipid peroxidation in bipolar disorder patients treated with lithium and valproic acid. Heliyon 2020; 6:e04553. [PMID: 32760840 PMCID: PMC7393417 DOI: 10.1016/j.heliyon.2020.e04553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/04/2020] [Accepted: 07/22/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of study is to assess a relation between the adiponectin and leptin levels, and metabolic syndrome components and lipid peroxidation treated with Li and VPA in bipolar disorder patients and compared with controls. MATERIALS AND METHODS 56 patients and 31 healthy controls were enrolled. The ATP III criteria were used to determine metabolic syndrome components. Leptin, adiponectin, lipid peroxidation and lipid profiles were measured. RESULTS Malondialdehyde in Li patients was higher than VPA patients. BMI, waist circumference (WC), triglyceride, malondialdehyde and adiponectin levels were increased, whereas HDL-cholesterol (VPA treated patients) and leptin were decreased in patients compared with controls. Leptin and adiponectin were correlated with WC, triglyceride and malondialdehyde in both groups. Adiponectin was correlated with HDL-cholesterol in VPA patients. CONCLUSION Patients should be checked metabolic syndrome components, serum leptin and adiponectin level occasionally to prevent possible deficiency or pathologic increase of these parameters.
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Affiliation(s)
- Neda Dolab
- Student Research Committee, Metabolic Disorders Research Center, Department of Biochemistry and Biophysics, Gorgan Faculty of Medicine, Golestan University Medical Sciences, Gorgan, Iran
| | - Mohammad Zaman Kamkar
- Department of Psychiatry, Golestan Research Center of Psychiatry, Golestan University of Medical Sciences, Gorgan, Golestan Province, Iran
| | - Taghi Amiriani
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Jale Yuzugulen
- Faculty of Pharmacy, Eastern Mediterranean University, Mersin 10, Famagusta, North Cyprus, Turkey
| | - Majid Marjani
- Faculty of Pharmacy, Eastern Mediterranean University, Mersin 10, Famagusta, North Cyprus, Turkey
| | - Abdoljalal Marjani
- Metabolic Disorders Research Center, Department of Biochemistry and Biophysics, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Golestan province, Iran
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110
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Biological Targets Underlying the Antisuicidal Effects of Lithium. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Lee HK, Prabhudesai S, Vadukapuram R, Eskander N, Patel RS. Combination Regimen With Lithium and Antipsychotic in Bipolar Manic Episodes: Impact on Adult Hospitalization Length of Stay. Cureus 2020; 12:e8568. [PMID: 32670704 PMCID: PMC7358937 DOI: 10.7759/cureus.8568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To discern the demographic predictors in bipolar disorder (BD) manic patients receiving combination regimen, that is, lithium and antipsychotic, and to study the impact of a combination regimen on hospitalization length of stay (LOS) and total charges. Methods We used the nationwide inpatient sample (NIS) and included 1,435 adult inpatients with BD, manic episodes, and receiving lithium. Independent sample T-test with equality measures was used for LOS and total charges. Logistic regression model was used to find the odds ratio (OR) for the combination regimen to estimate the predictors with 95% CI. Results Among the inpatient sample, 34.5% received a combination regimen. There was statistically no significant difference between the combination regimen versus non-combination regimen cohorts by age and sex. A higher proportion of inpatients receiving combination regimen were from high-income families above 75th percentile (56.4%) and covered by private insurance (47.5%). Blacks (OR 2.00, 95% CI 1.43-2.82) and hispanic (OR 2.31, 95% CI 1.49-3.57) had higher odds of receiving a combination regimen compared to whites. The combination regimen significantly reduced LOS for BD, manic episode management by 2.8 days (95% CI 1.13-4.53 days, P < 0.001). There was statistically no significant mean difference in total charges (P = 0.495). Conclusion A combination regimen with lithium and antipsychotics significantly reduced LOS for BD manic episodes by 2.8 days compared to inpatients receiving lithium monotherapy. So, starting the combination regimen from the initial day of hospitalization should be considered as an effective model for faster response.
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112
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Szabó I, Varga C. Finding possible pharmacological effects of identified organic compounds in medicinal waters (BTEX and phenolic compounds). INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:989-995. [PMID: 31673767 PMCID: PMC7266787 DOI: 10.1007/s00484-019-01808-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/15/2019] [Accepted: 08/17/2019] [Indexed: 05/09/2023]
Abstract
Medicinal thermal waters consist of a mixture of different organic and inorganic compounds. Traditionally, these waters are only characterized and classified by their inorganic composition; however, the bioavailability of the majority of these inorganic compounds is limited. Many authors investigate the organic fractions of thermal waters. These authors propose that these compounds have a potential effect on health. To elucidate the underlying mechanisms, it is crucial to know the composition of the organic fractions. The absorption of these compounds on intact skin or mucosa is notable. Some of them have local anaesthetic effect or affect receptors in the central nervous system. In the knowledge of the chemical composition, we are able to estimate the possible pharmacological effect or might be able to assess possible toxicity risks. In the present article, we aim to review possible health effects of two of the identified organic fractions: benzene and alkylbenzenes and phenolic compounds that might correlate with the therapeutic effect on rheumatological or other diseases.
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Affiliation(s)
- István Szabó
- Department of Environmental Health, Institute of Public Health Medicie, Medical School, University of Pécs, 12. Szigeti St., Pécs, H7624, Hungary.
| | - Csaba Varga
- Department of Environmental Health, Institute of Public Health Medicie, Medical School, University of Pécs, 12. Szigeti St., Pécs, H7624, Hungary
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113
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Qaswal AB. Lithium Stabilizes the Mood of Bipolar Patients by Depolarizing the Neuronal Membrane Via Quantum Tunneling through the Sodium Channels. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:214-218. [PMID: 32329302 PMCID: PMC7242109 DOI: 10.9758/cpn.2020.18.2.214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 01/02/2023]
Abstract
Objective Lithium is used as first line in treating bipolar patients to stabilize their mood. However, the exact mechanism of lithium is not yet established. One of the proposed mechanisms is that lithium depolarizes the hyperpolarized neuronal membrane of bipolar patients bringing it back to the normal potential. On the other hand, the only way that lithium causes significant therapeutic depolarization is to have a membrane conductance that must be at least an order of magnitude higher than that for sodium but this is not achieved since both; lithium and sodium have the same conductance because the membrane channels are selective for them approximately by the same degree. So, this study aimed to explain how lithium could achieve higher conductance than sodium. Methods The idea of quantum tunneling through closed channels was used in a way to calculate the tunneling probability and the quantum conductance for lithium ions. Results It was found that lithium could achieve higher conductance than sodium because it has a smaller mass than sodium making lithium to have higher probability of tunneling and consequently higher conductance through channels and membrane. Conclusion Lithium tunneling model provides a reasonable explanation for the therapeutic depolarization effect of lithium. This model is experimentally testable to prove the tunneling effect of ions through the closed channels and to show the variations of quantum conductance between ions according to their mass.
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114
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Exploring lithium's transcriptional mechanisms of action in bipolar disorder: a multi-step study. Neuropsychopharmacology 2020; 45:947-955. [PMID: 31652432 PMCID: PMC7162887 DOI: 10.1038/s41386-019-0556-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/01/2019] [Accepted: 10/17/2019] [Indexed: 12/22/2022]
Abstract
Lithium has been the first-line treatment for bipolar disorder (BD) for more than six decades. Although the molecular effects of lithium have been studied extensively and gene expression changes are generally believed to be involved, the specific mechanisms of action that mediate mood regulation are still not known. In this study, a multi-step approach was used to explore the transcriptional changes that may underlie lithium's therapeutic efficacy. First, we identified genes that are associated both with lithium exposure and with BD, and second, we performed differential expression analysis of these genes in brain tissue samples from BD patients (n = 42) and healthy controls (n = 42). To identify genes that are regulated by lithium exposure, we used high-sensitivity RNA-sequencing of corpus callosum (CC) tissue samples from lithium-treated (n = 8) and non-treated (n = 9) rats. We found that lithium exposure significantly affected 1108 genes (FDR < 0.05), 702 up-regulated and 406 down-regulated. These genes were mostly enriched for molecular functions related to signal transduction, including well-established lithium-related pathways such as mTOR and Wnt signaling. To identify genes with differential expression in BD, we performed expression quantitative trait loci (eQTL) analysis on BD-associated genetic variants from the most recent genome-wide association study (GWAS) using three different gene expression databases. We found 307 unique eQTL genes regulated by BD-associated variants, of which 12 were also significantly modulated by lithium treatment in rats. Two of these showed differential expression in the CC of BD cases: RPS23 was significantly down-regulated (p = 0.0036, fc = 0.80), while GRIN2A showed suggestive evidence of down-regulation in BD (p = 0.056, fc = 0.65). Crucially, GRIN2A was also significantly up-regulated by lithium in the rat brains (p = 2.2e-5, fc = 1.6), which suggests that modulation of GRIN2A expression may be a part of the therapeutic effect of the drug. These results indicate that the recent upsurge in research on this central component of the glutamatergic system, as a target of novel therapeutic agents for affective disorders, is warranted and should be intensified.
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Bobo WV, Riva-Posse P, Goes FS, Parikh SV. Next-Step Treatment Considerations for Patients With Treatment-Resistant Depression That Responds to Low-Dose Intravenous Ketamine. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:181-192. [PMID: 33162856 DOI: 10.1176/appi.focus.20190048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Numerous short-term randomized trials support the acute-phase efficacy of low-dose intravenous (IV) ketamine for patients with treatment-resistant unipolar or bipolar depression. Ketamine's antidepressive effects generally have limited duration, highlighting the need for maintenance treatment after an acute-phase response. It is increasingly likely that psychiatrists will be called upon to manage the care of patients with treatment-resistant unipolar or bipolar depression who have responded acutely to ketamine and to recommend or initiate next-step treatments. However, there is a paucity of controlled evidence to guide best practices for managing treatment of patients with treatment-resistant unipolar or bipolar depression who have had a positive initial response to ketamine. This article reviews the available evidence supporting specific strategies for extending and maintaining acute antidepressive responses to low-dose IV ketamine in patients with treatment-resistant unipolar or bipolar depression and provides some preliminary considerations for clinical practice.
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Affiliation(s)
- William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida (Bobo); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Riva-Posse); Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore (Goes); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh)
| | - Patricio Riva-Posse
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida (Bobo); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Riva-Posse); Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore (Goes); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh)
| | - Fernando S Goes
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida (Bobo); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Riva-Posse); Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore (Goes); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh)
| | - Sagar V Parikh
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida (Bobo); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Riva-Posse); Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore (Goes); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh)
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Moreira J, Noé G, Rangarajan S, Courtin C, Etain B, Geoffroy PA, Laplanche JL, Vidal M, Bellivier F, Marie-Claire C. Lithium effects on serine-threonine kinases activity: High throughput kinomic profiling of lymphoblastoid cell lines from excellent-responders and non-responders bipolar patients. World J Biol Psychiatry 2020; 21:317-324. [PMID: 29893160 DOI: 10.1080/15622975.2018.1487078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objectives: Lithium is the leading mood stabiliser for maintenance treatment in bipolar disorder (BD). However, response to lithium is heterogeneous with more than 60% of patients experiencing partial or no response. In vitro and in vivo molecular studies have reported the implication of kinases in the pathophysiology of BD.Methods: Since kinases are putative targets for lithium therapeutic action, we conducted the first pilot study using kinase array technology to evaluate the global serine/threonine kinases (STK) profiles in cell lines from BD I subtype patients classified as lithium excellent-responders (ER) and non-responder (NR) to lithium treatment.Results: We found significant differences in the basal STK profiles between ER and NR to lithium. We also tested lithium influence on the global STK profile and found no significant difference between ER vs NR cell lines.Conclusions: The results obtained in this exploratory study suggest that multiplex kinase activity profiling could provide a complementary approach in the study of biomarkers of therapeutic response in BD.
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Affiliation(s)
- Jeverson Moreira
- Variabilité de réponse aux psychotropes, INSERM U1144/Faculté de Pharmacie de Paris, Université Paris Descartes, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Gaëlle Noé
- AP-HP, Hôpital Cochin, Biologie du medicament-Toxicologie, Université Paris Descartes, Paris, France.,UMR8638 CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Cindie Courtin
- Variabilité de réponse aux psychotropes, INSERM U1144/Faculté de Pharmacie de Paris, Université Paris Descartes, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Bruno Etain
- Variabilité de réponse aux psychotropes, INSERM U1144/Faculté de Pharmacie de Paris, Université Paris Descartes, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.,Fondation FondaMental, Créteil, France
| | - Pierre A Geoffroy
- Variabilité de réponse aux psychotropes, INSERM U1144/Faculté de Pharmacie de Paris, Université Paris Descartes, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.,Fondation FondaMental, Créteil, France
| | - Jean-Louis Laplanche
- Variabilité de réponse aux psychotropes, INSERM U1144/Faculté de Pharmacie de Paris, Université Paris Descartes, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Département de Biochimie and Biologie moléculaire, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France
| | - Michel Vidal
- AP-HP, Hôpital Cochin, Biologie du medicament-Toxicologie, Université Paris Descartes, Paris, France.,UMR8638 CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Frank Bellivier
- Variabilité de réponse aux psychotropes, INSERM U1144/Faculté de Pharmacie de Paris, Université Paris Descartes, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.,Fondation FondaMental, Créteil, France
| | - Cynthia Marie-Claire
- Variabilité de réponse aux psychotropes, INSERM U1144/Faculté de Pharmacie de Paris, Université Paris Descartes, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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117
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Avram M, Brandl F, Cabello J, Leucht C, Scherr M, Mustafa M, Leucht S, Ziegler S, Sorg C. Reduced striatal dopamine synthesis capacity in patients with schizophrenia during remission of positive symptoms. Brain 2020; 142:1813-1826. [PMID: 31135051 DOI: 10.1093/brain/awz093] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 02/07/2023] Open
Abstract
While there is consistent evidence for increased presynaptic dopamine synthesis capacity in the striatum of patients with schizophrenia during psychosis, it is unclear whether this also holds for patients during psychotic remission. This study investigates whether striatal dopamine synthesis capacity is altered in patients with schizophrenia during symptomatic remission of positive symptoms, and whether potential alterations relate to symptoms other than positive, such as cognitive difficulties. Twenty-three patients with schizophrenia in symptomatic remission of positive symptoms according to Andreasen, and 24 healthy controls underwent 18F-DOPA-PET and behavioural-cognitive assessment. Imaging data were analysed with voxel-wise Patlak modelling with cerebellum as reference region, resulting in the influx constant kicer reflecting dopamine synthesis capacity. For the whole striatum and its subdivisions (i.e. limbic, associative, and sensorimotor), averaged regional kicer values were calculated, compared across groups, and correlated with behavioural-cognitive scores, including a mediation analysis. Patients had negative symptoms (Positive and Negative Syndrome Scale-negative 14.13 ± 5.91) and cognitive difficulties, i.e. they performed worse than controls in Trail-Making-Test-B (TMT-B; P = 0.01). Furthermore, kicer was reduced in patients for whole striatum (P = 0.004) and associative (P = 0.002) and sensorimotor subdivisions (P = 0.007). In patients, whole striatum kicer was negatively correlated with TMT-B (rho = -0.42, P = 0.04; i.e. the lower striatal kicer, the worse the cognitive performance). Mediation analysis showed that striatal kicer mediated the group difference in TMT-B. Results demonstrate that patients with schizophrenia in symptomatic remission of positive symptoms have decreased striatal dopamine synthesis capacity, which mediates the disorder's impact on cognitive difficulties. Data suggest that striatal dopamine dysfunction contributes to cognitive difficulties in schizophrenia.
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Affiliation(s)
- Mihai Avram
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Felix Brandl
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Department of Psychiatry, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jorge Cabello
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claudia Leucht
- Department of Psychiatry, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Martin Scherr
- Department of Psychiatry, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Mona Mustafa
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefan Leucht
- Department of Psychiatry, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Department of Psychosis Studies, King's College London, UK
| | - Sibylle Ziegler
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Christian Sorg
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Department of Psychiatry, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Electroacupuncture pretreatment prevents ischemic stroke and inhibits Wnt signaling-mediated autophagy through the regulation of GSK-3β phosphorylation. Brain Res Bull 2020; 158:90-98. [PMID: 32142833 DOI: 10.1016/j.brainresbull.2020.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 02/06/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
Electroacupuncture (EA), a traditional Chinese replacement therapy, is widely accepted to treat ischemic stroke. Increasing evidence show that autophagy is involved in the process of cerebral ischemia injury and the Wnt/GSK3β pathway, playing an important role in protecting central nervous system. In this study, rats were treated with EA prior to focal ischemia by middle cerebral artery occlusion (MCAO). Deficit score, infarct volumes and levels of autophagy markers, such as LC3I, LC3II and p62, were assessed with either PI3K inhibitor wortmannin or a GSK-3β inhibitor LiCl. Oxygen-glucose deprivation/re-oxygenation (OGD/R) was made in the primitive neuron in vitro, and was respectively treated with autophagy inhibitors 3-MA, LiCl, GSK3β siRNA, or mTOR inhibitor rapamycin. The results indicated that EA pretreatment increased the levels of autophagy marker LC3-II and reduced the levels of p62. Meanwhile, deficit outcome was improved, and infarct volumes were reduced by EA pretreatment. Furthermore, the beneficial effects of EA pretreatment were reversed by wortmannin. LiCl and GSK3β siRNA can mimic the neuroprotective effects of EA pretreatment by downregulating autophagy, and increasing protein levels of p-mTOR, p-GSK3β and β-catenin in OGD/R neurons. However, the protective effects of GSK3β siRNA were blocked by rapamycin. These results suggest that EA pretreatment induces tolerance to cerebral ischemia by inhibiting autophagy via the Wnt pathway through the inhibition of GSK3β.
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119
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Suresh SN, Chakravorty A, Giridharan M, Garimella L, Manjithaya R. Pharmacological Tools to Modulate Autophagy in Neurodegenerative Diseases. J Mol Biol 2020; 432:2822-2842. [PMID: 32105729 DOI: 10.1016/j.jmb.2020.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/03/2020] [Accepted: 02/12/2020] [Indexed: 12/11/2022]
Abstract
Considerable evidences suggest a link between autophagy dysfunction, protein aggregation, and neurodegenerative diseases. Given that autophagy is a conserved intracellular housekeeping process, modulation of autophagy flux in various model organisms have highlighted its importance for maintaining proteostasis. In postmitotic cells such as neurons, compromised autophagy is sufficient to cause accumulation of ubiquitinated aggregates, neuronal dysfunction, degeneration, and loss of motor coordination-all hallmarks of neurodegenerative diseases. Reciprocally, enhanced autophagy flux augments cellular and organismal health, in addition to extending life span. These genetic studies not-withstanding a plethora of small molecule modulators of autophagy flux have been reported that alleviate disease symptoms in models of neurodegenerative diseases. This review summarizes the potential of such molecules to be, perhaps, one of the first autophagy drugs for treating these currently incurable diseases.
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Affiliation(s)
- S N Suresh
- Centre for Brain Research, Indian Institute of Science, Bangalore, 560012, Karnataka, India
| | - Anushka Chakravorty
- Autophagy Laboratory, Molecular Biology and Genetics Unit, Jawaharlal Nehru Centre for Advanced Scientific Research, Jakkur, Bangalore, 560064, Karnataka, India
| | - Mridhula Giridharan
- Autophagy Laboratory, Molecular Biology and Genetics Unit, Jawaharlal Nehru Centre for Advanced Scientific Research, Jakkur, Bangalore, 560064, Karnataka, India
| | - Lakshmi Garimella
- Autophagy Laboratory, Molecular Biology and Genetics Unit, Jawaharlal Nehru Centre for Advanced Scientific Research, Jakkur, Bangalore, 560064, Karnataka, India
| | - Ravi Manjithaya
- Autophagy Laboratory, Molecular Biology and Genetics Unit, Jawaharlal Nehru Centre for Advanced Scientific Research, Jakkur, Bangalore, 560064, Karnataka, India; Neuroscience Unit, Jawaharlal Nehru Centre for Advanced Scientific Research, Jakkur, Bangalore, 560064, Karnataka, India.
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120
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Ananth M, Bartlett EA, DeLorenzo C, Lin X, Kunkel L, Vadhan NP, Perlman G, Godstrey M, Holzmacher D, Ogden RT, Parsey RV, Huang C. Prediction of lithium treatment response in bipolar depression using 5-HTT and 5-HT 1A PET. Eur J Nucl Med Mol Imaging 2020; 47:2417-2428. [PMID: 32055965 DOI: 10.1007/s00259-020-04681-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lithium, one of the few effective treatments for bipolar depression (BPD), has been hypothesized to work by enhancing serotonergic transmission. Despite preclinical evidence, it is unknown whether lithium acts via the serotonergic system. Here we examined the potential of serotonin transporter (5-HTT) or serotonin 1A receptor (5-HT1A) pre-treatment binding to predict lithium treatment response and remission. We hypothesized that lower pre-treatment 5-HTT and higher pre-treatment 5-HT1A binding would predict better clinical response. Additional analyses investigated group differences between BPD and healthy controls and the relationship between change in binding pre- to post-treatment and clinical response. Twenty-seven medication-free patients with BPD currently in a depressive episode received positron emission tomography (PET) scans using 5-HTT tracer [11C]DASB, a subset also received a PET scan using 5-HT1A tracer [11C]-CUMI-101 before and after 8 weeks of lithium monotherapy. Metabolite-corrected arterial input functions were used to estimate binding potential, proportional to receptor availability. Fourteen patients with BPD with both [11C]DASB and [11C]-CUMI-101 pre-treatment scans and 8 weeks of post-treatment clinical scores were included in the prediction analysis examining the potential of either pre-treatment 5-HTT or 5-HT1A or the combination of both to predict post-treatment clinical scores. RESULTS We found lower pre-treatment 5-HTT binding (p = 0.003) and lower 5-HT1A binding (p = 0.035) were both significantly associated with improved clinical response. Pre-treatment 5-HTT predicted remission with 71% accuracy (77% specificity, 60% sensitivity), while 5-HT1A binding was able to predict remission with 85% accuracy (87% sensitivity, 80% specificity). The combined prediction analysis using both 5-HTT and 5-HT1A was able to predict remission with 84.6% accuracy (87.5% specificity, 60% sensitivity). Additional analyses BPD and controls pre- or post-treatment, and the change in binding were not significant and unrelated to treatment response (p > 0.05). CONCLUSIONS Our findings suggest that while lithium may not act directly via 5-HTT or 5-HT1A to ameliorate depressive symptoms, pre-treatment binding may be a potential biomarker for successful treatment of BPD with lithium. CLINICAL TRIAL REGISTRATION PET and MRI Brain Imaging of Bipolar Disorder Identifier: NCT01880957; URL: https://clinicaltrials.gov/ct2/show/NCT01880957.
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Affiliation(s)
- Mala Ananth
- Neurobiology & Behavior, Stony Brook University, Stony Brook, NY, 11794, USA.
| | | | - Christine DeLorenzo
- Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.,Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Xuejing Lin
- Biostatistics, Columbia University, New York, NY, USA
| | - Laura Kunkel
- Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Nehal P Vadhan
- Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Great Neck, NY, USA
| | - Greg Perlman
- Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | | | | | - R Todd Ogden
- Biostatistics, Columbia University, New York, NY, USA
| | - Ramin V Parsey
- Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.,Psychiatry, Stony Brook University, Stony Brook, NY, USA.,Radiology, Stony Brook University, Stony Brook, NY, USA
| | - Chuan Huang
- Psychiatry, Stony Brook University, Stony Brook, NY, USA.,Radiology, Stony Brook University, Stony Brook, NY, USA
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121
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Almeida PG, Nani JV, Oses JP, Brietzke E, Hayashi MA. Neuroinflammation and glial cell activation in mental disorders. Brain Behav Immun Health 2020; 2:100034. [PMID: 38377429 PMCID: PMC8474594 DOI: 10.1016/j.bbih.2019.100034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 02/07/2023] Open
Abstract
Mental disorders (MDs) are highly prevalent and potentially debilitating complex disorders which causes remain elusive. Looking into deeper aspects of etiology or pathophysiology underlying these diseases would be highly beneficial, as the scarce knowledge in mechanistic and molecular pathways certainly represents an important limitation. Association between MDs and inflammation/neuroinflammation has been widely discussed and accepted by many, as high levels of pro-inflammatory cytokines were reported in patients with several MDs, such as schizophrenia (SCZ), bipolar disorder (BD) and major depression disorder (MDD), among others. Correlation of pro-inflammatory markers with symptoms intensity was also reported. However, the mechanisms underlying the inflammatory dysfunctions observed in MDs are not fully understood yet. In this context, microglial dysfunction has recently emerged as a possible pivotal player, as during the neuroinflammatory response, microglia can be over-activated, and excessive production of pro-inflammatory cytokines, which can modify the kynurenine and glutamate signaling, is reported. Moreover, microglial activation also results in increased astrocyte activity and consequent glutamate release, which are both toxic to the Central Nervous System (CNS). Also, as a result of increased microglial activation in MDs, products of the kynurenine pathway were shown to be changed, influencing then the dopaminergic, serotonergic, and glutamatergic signaling pathways. Therefore, in the present review, we aim to discuss how neuroinflammation impacts on glutamate and kynurenine signaling pathways, and how they can consequently influence the monoaminergic signaling. The consequent association with MDs main symptoms is also discussed. As such, this work aims to contribute to the field by providing insights into these alternative pathways and by shedding light on potential targets that could improve the strategies for pharmacological intervention and/or treatment protocols to combat the main pharmacologically unmatched symptoms of MDs, as the SCZ.
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Key Words
- AMPA, alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
- APCs, antigen presenting cells
- BBB, blood-brain barrier
- BD, bipolar disorder
- CCL, C–C motif chemokine ligand
- CLRs, C-type lectin receptors
- CNS, central nervous system
- CSF, cerebrospinal fluid
- CXCL, X–C motif chemokine ligand
- Glia
- IDO, indolamine 2,3-dioxygenase
- IFN, interferon
- IL, interleukin
- IRF, interferon regulatory factor
- Inflammation
- KYNA, kynurenic acid
- MD, mental disorders
- MDD, major depression disorder
- MRI, magnetic resonance imaging
- Mental disorders
- Microglial activation
- NF, necrosis factor
- NMDA, N-methyl-D-aspartate
- NMR, nuclear magnetic resonance
- PPI, prepulse inhibition
- PRRs, pattern recognition receptors
- QUIN, quinolinic acid
- SCZ, schizophrenia
- Schizophrenia
- TGF, tumor growth factor
- TLRs, toll-like receptors
- TNF, tumor necrosis factor
- α7-nAchR, alpha 7 nicotinic acetylcholine receptor
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Affiliation(s)
- Priscila G.C. Almeida
- Departamento de Farmacologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - João Victor Nani
- Departamento de Farmacologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Jean Pierre Oses
- Programa Multicêntrico de Pós-Graduação em Bioquímica e Biologia Molecular, Instituto de Biociências, Universidade Federal do Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Elisa Brietzke
- Department of Psychiatry, Queen’s University School of Medicine, Kingston, ON, Canada
| | - Mirian A.F. Hayashi
- Departamento de Farmacologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Mohammed DAE, Ahmed RR, Ahmed RG. Maternal lithium chloride exposure alters the neuroendocrine-cytokine axis in neonatal albino rats. Int J Dev Neurosci 2020; 80:123-138. [PMID: 31994228 DOI: 10.1002/jdn.10010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 01/09/2023] Open
Abstract
The aim of this work was to clarify whether maternal lithium chloride (LiCl) exposure disrupts the neonatal neuroendocrine-cytokine axis. Pregnant Wistar rats were orally administrated 50 mg LiCl/kg b.wt. from gestational day (GD) 1 to postpartum day 28. Maternal administration of LiCl induced a hypothyroid state in both dams and their neonates compared to the control dams and neonates at lactation days (LDs) 14, 21 and 28, where the levels of serum free triiodothyronine (FT3) and free thyroxin (FT4) were decreased and the level of serum thyrotropin (TSH) level was increased. A noticeable depression in maternal body weight gain, neonatal body weight and neonatal serum growth hormone (GH) was observed on all examined postnatal days (PNDs; 14, 21 and 28). A single abortion case was recorded at GD 17, and three dead neonates were noted at birth in the LiCl-treated group. Maternal administration of LiCl disturbed the levels of neonatal serum tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta (TGF-β), interleukin-1 beta (IL-1β), interferon-gamma (INF-γ), leptin, adiponectin and resistin at all tested PNDs compared to the control group. This administration produced a stimulatory action on the level of neonatal cerebral serotonin (5-HT) at PND 14 and on the level of neonatal cerebral norepinephrine (NE) at PNDs 21 and 28. However, this administration produced an inhibitory action on the level of neonatal cerebral dopamine (DA) at all examined PNDs and on the level of neonatal cerebral NE at PND 14 and the level of neonatal cerebral 5-HT at PNDs 21 and 28 compared to the corresponding control group. Thus, maternal LiCl exposure-induced hypothyroidism disrupts the neonatal neuroendocrine-cytokine system, which delay cerebral development.
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Affiliation(s)
- Dena A-E Mohammed
- Division of Anatomy and Embryology, Zoology Department, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| | - Rasha R Ahmed
- Division of Histology and Cytology, Zoology Department, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| | - R G Ahmed
- Division of Anatomy and Embryology, Zoology Department, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
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Ramoju S, Andersen M, Poddalgoda D, Nong A, Karyakina N, Shilnikova N, Krishnan K, Krewski D. Derivation of whole blood biomonitoring equivalents for lithium for the interpretation of biomonitoring data. Regul Toxicol Pharmacol 2020; 111:104581. [PMID: 31935483 DOI: 10.1016/j.yrtph.2020.104581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/28/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Lithium salts have numerous industrial uses and are also used in the treatment of bipolar disorders. The main source of lithium exposure to the general population is drinking water and foods. Lithium is nephrotoxic at higher doses. Thus, oral exposure guidelines for lithium have been derived, including ICH's permitted daily exposure (PDE = 0.008 mg lithium/kg-bw/day) adopted by Health Canada and the United States Environmental Protection Agency's (U.S. EPA) provisional peer reviewed toxicity value (PPRTV = 0.002 mg lithium/kg-bw/day), both based on human data. OBJECTIVE To derive whole blood biomonitoring equivalents (BEs) associated with PDE and PPRTV to interpret population-level biomonitoring data in health risk context. METHOD A simple kinetic relationship based on plasma clearance value (0.5 L/kg-bw/day) and the oral absorption fraction (100%) was used to derive blood BEs for PDE and PPRTV. RESULTS This analysis resulted in BE values in plasma and whole blood of 16 and 10 μg/L, respectively, based on the PDE values developed by the Health Canada and of 4.2 and 2.7 μg/L, respectively, based on the PPRTV developed by U.S. EPA. CONCLUSION The derived BE values can be used to interpret population-level biomonitoring data.
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Affiliation(s)
- S Ramoju
- Risk Sciences International, Ottawa, ON, Canada.
| | - M Andersen
- Risk Sciences International, Ottawa, ON, Canada
| | | | - A Nong
- Health Canada, Ottawa, ON, Canada
| | - N Karyakina
- Risk Sciences International, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
| | - N Shilnikova
- Risk Sciences International, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
| | - K Krishnan
- Risk Sciences International, Ottawa, ON, Canada.
| | - D Krewski
- Risk Sciences International, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
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124
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Vecchio D, Piras F, Piras F, Banaj N, Janiri D, Simonetti A, Sani G, Spalletta G. Lithium treatment impacts nucleus accumbens shape in bipolar disorder. Neuroimage Clin 2020; 25:102167. [PMID: 31972398 PMCID: PMC6974785 DOI: 10.1016/j.nicl.2020.102167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/12/2022]
Abstract
The effects of lithium treatment duration on deep grey matter structures in bipolar disorder are not well known. In this cross-sectional neuroimaging case-control study, we tested the hypothesis that shape characteristics of deep grey matter structures in bipolar disorder are associated with the duration of lithium treatment and with clinical phenomenology. In a setting of neuropsychiatry outpatient clinic, we included 74 patients with bipolar disorder (BD) and 74 matched healthy control subjects (HC). Both groups underwent a Magnetic Resonance Imaging acquisition and an exhaustive assessment of clinical and psychiatrics dimensions. Shape measures of seven deep grey matter structures (hippocampus, amygdala, caudate, nucleus accumbens, putamen, globus pallidus and thalamus) were obtained from T1 weighted images in both groups, using FSL FIRST segmentation tool. The segmented structures were then analysed vertex-by-vertex with FSL Randomise tool. First, we investigated the presence of significant associations between the duration of lithium treatment and shape measures in BD sample. Then, for structures that resulted significantly associated with the duration of lithium treatment, comparisons between BD and HC were performed either considering the BD group as a whole or dividing it in three groups based on the duration of treatment (lithium drug-naïve, short and long treated). Any deformation uncovered by group comparisons was subsequently associated with depressive and hypomanic/manic symptoms. The relationship between structures shape and the duration of lithium treatment in BD sample was significant for bilateral nucleus accumbens. Specifically, significant bilateral extroflection effects, related to longer duration of lithium treatment, were found bilaterally over the surface shape of core accumbens nuclei (r2R-Accu-Core = 0.12, p = 0.016, r2L-Accu-Core = 0.1, p = 0.031). Moreover, introflection effect related to longer duration of treatment resulted over the shell of right accumbens (r2R-Accu-Shell = 0.17, p = 0.002). Nucleus accumbens shape did not differ between BD and HC considering BD group as a whole. By contrast, categorizing BD in subgroups as a function of the duration of lithium treatment revealed significant inward deformation on the core of left accumbens nucleus and outward deformation on the shell of the right accumbens nucleus in lithium-naive patients, compared to both patients with long duration of lithium treatment (pL-Accu-Core = 0.016, pR-Accu-Shell = 0.005) and HC (pL-Accu-Core = 0.002; pR-Accu-Shell = 0.005). Moreover, compared to HC, inward deformation on the core of the left accumbens surface was found for patients with short duration of treatment (pLAccu-Core = 0.027). Finally, measures of surface deformation on the core of left accumbens observed in the group comparison showed significant positive correlations with depressive symptoms severity, as assessed by the Hamilton Depression Rating Scale (total score: r2L-AccuCore = 0.07, p = 0.02, somatic score: r2L-Accu-Core = 0.1, p = 0.005) and Beck Hopelessness Scale (r2LAccu-Core = 0.05, p = 0.03). Findings demonstrate that lithium untreated BD patients are characterised by localized shape abnormalities in the nucleus accumbens. Lithium treatment could act modulating these morphometric features as part of its mechanism of action in mood stabilizing.
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Affiliation(s)
- Daniela Vecchio
- IRCCS Santa Lucia Foundation, Neuropsychiatry Laboratory, Via Ardeatina 306, 00179 Rome, Italy
| | - Fabrizio Piras
- IRCCS Santa Lucia Foundation, Neuropsychiatry Laboratory, Via Ardeatina 306, 00179 Rome, Italy.
| | - Federica Piras
- IRCCS Santa Lucia Foundation, Neuropsychiatry Laboratory, Via Ardeatina 306, 00179 Rome, Italy
| | - Nerisa Banaj
- IRCCS Santa Lucia Foundation, Neuropsychiatry Laboratory, Via Ardeatina 306, 00179 Rome, Italy
| | - Delfina Janiri
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alessio Simonetti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy; Lucio Bini Mood Disorder Center, Rome, Italy; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Gabriele Sani
- Institute of Psychiatry, Università Cattolica del Sacro Cuore, Roma, Italy; Department of Psychiatry, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy; Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Gianfranco Spalletta
- IRCCS Santa Lucia Foundation, Neuropsychiatry Laboratory, Via Ardeatina 306, 00179 Rome, Italy; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
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125
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Ramaholimihaso T, Bouazzaoui F, Kaladjian A. Curcumin in Depression: Potential Mechanisms of Action and Current Evidence-A Narrative Review. Front Psychiatry 2020; 11:572533. [PMID: 33329109 PMCID: PMC7728608 DOI: 10.3389/fpsyt.2020.572533] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022] Open
Abstract
Major depressive disorder (MDD) is one of the most prevalent and debilitating disorders. Current available treatments are somehow limited, so alternative therapeutic approaches targeting different biological pathways are being investigated to improve treatment outcomes. Curcumin is the main active component in the spice turmeric that has been used for centuries in Ayurvedic medicine to treat a variety of conditions, including anxiety and depressive disorders. In the past decades, curcumin has drawn researchers' attention and displays a broad range of properties that seem relevant to depression pathophysiology. In this review, we break down the potential mechanisms of action of curcumin with emphasis on the diverse systems that can be disrupted in MDD. Curcumin has displayed, in a number of studies, a potency in modulating neurotransmitter concentrations, inflammatory pathways, excitotoxicity, neuroplasticity, hypothalamic-pituitary-adrenal disturbances, insulin resistance, oxidative and nitrosative stress, and endocannabinoid system, all of which can be involved in MDD pathophysiology. To date, a handful of clinical trials have been published and suggest a benefit of curcumin in MDD. With evidence that is progressively growing, curcumin appears as a promising alternative option in the management of MDD.
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126
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Fortinguerra S, Sorrenti V, Giusti P, Zusso M, Buriani A. Pharmacogenomic Characterization in Bipolar Spectrum Disorders. Pharmaceutics 2019; 12:E13. [PMID: 31877761 PMCID: PMC7022469 DOI: 10.3390/pharmaceutics12010013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/14/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022] Open
Abstract
The holistic approach of personalized medicine, merging clinical and molecular characteristics to tailor the diagnostic and therapeutic path to each individual, is steadily spreading in clinical practice. Psychiatric disorders represent one of the most difficult diagnostic challenges, given their frequent mixed nature and intrinsic variability, as in bipolar disorders and depression. Patients misdiagnosed as depressed are often initially prescribed serotonergic antidepressants, a treatment that can exacerbate a previously unrecognized bipolar condition. Thanks to the use of the patient's genomic profile, it is possible to recognize such risk and at the same time characterize specific genetic assets specifically associated with bipolar spectrum disorder, as well as with the individual response to the various therapeutic options. This provides the basis for molecular diagnosis and the definition of pharmacogenomic profiles, thus guiding therapeutic choices and allowing a safer and more effective use of psychotropic drugs. Here, we report the pharmacogenomics state of the art in bipolar disorders and suggest an algorithm for therapeutic regimen choice.
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Affiliation(s)
- Stefano Fortinguerra
- Maria Paola Belloni Center for Personalized Medicine, Data Medica Group (Synlab Limited), 35131 Padova, Italy; (S.F.); (V.S.)
- Department of Pharmaceutical & Pharmacological Sciences, University of Padova, 35131 Padova, Italy; (P.G.); (M.Z.)
| | - Vincenzo Sorrenti
- Maria Paola Belloni Center for Personalized Medicine, Data Medica Group (Synlab Limited), 35131 Padova, Italy; (S.F.); (V.S.)
- Department of Pharmaceutical & Pharmacological Sciences, University of Padova, 35131 Padova, Italy; (P.G.); (M.Z.)
- Bendessere™ Study Center, Solgar Italia Multinutrient S.p.A., 35131 Padova, Italy
| | - Pietro Giusti
- Department of Pharmaceutical & Pharmacological Sciences, University of Padova, 35131 Padova, Italy; (P.G.); (M.Z.)
| | - Morena Zusso
- Department of Pharmaceutical & Pharmacological Sciences, University of Padova, 35131 Padova, Italy; (P.G.); (M.Z.)
| | - Alessandro Buriani
- Maria Paola Belloni Center for Personalized Medicine, Data Medica Group (Synlab Limited), 35131 Padova, Italy; (S.F.); (V.S.)
- Department of Pharmaceutical & Pharmacological Sciences, University of Padova, 35131 Padova, Italy; (P.G.); (M.Z.)
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Tran HQ, Shin EJ, Saito K, Tran TV, Phan DH, Sharma N, Kim DW, Choi SY, Jeong JH, Jang CG, Cheong JH, Nabeshima T, Kim HC. Indoleamine-2,3-dioxygenase-1 is a molecular target for the protective activity of mood stabilizers against mania-like behavior induced by d-amphetamine. Food Chem Toxicol 2019; 136:110986. [PMID: 31760073 DOI: 10.1016/j.fct.2019.110986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 01/07/2023]
Abstract
It is recognized that d-amphetamine (AMPH)-induced hyperactivity is thought to be a valid animal model of mania. In the present study, we investigated whether a proinflammatory oxidative gene indoleamine-2,3-dioxygenase (IDO) is involved in AMPH-induced mitochondrial burden, and whether mood stabilizers (i.e., lithium and valproate) modulate IDO to protect against AMPH-induced mania-like behaviors. AMPH-induced IDO-1 expression was significantly greater than IDO-2 expression in the prefrontal cortex of wild type mice. IDO-1 expression was more pronounced in the mitochondria than in the cytosol. AMPH treatment activated intra-mitochondrial Ca2+ accumulation and mitochondrial oxidative burden, while inhibited mitochondrial membrane potential and activity of the mitochondrial complex (I > II), mitochondrial glutathione peroxidase, and superoxide dismutase, indicating that mitochondrial burden might be contributable to mania-like behaviors induced by AMPH. The behaviors were significantly attenuated by lithium, valproate, or IDO-1 knockout, but not in IDO-2 knockout mice. Lithium, valproate administration, or IDO-1 knockout significantly attenuated mitochondrial burden. Neither lithium nor valproate produced additive effects above the protective effects observed in IDO-1 KO in mice. Collectively, our results suggest that mood stabilizers attenuate AMPH-induced mania-like behaviors via attenuation of IDO-1-dependent mitochondrial stress, highlighting IDO-1 as a novel molecular target for the protective potential of mood stabilizers.
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Affiliation(s)
- Hai-Quyen Tran
- Neuropsychopharmacology and Toxicology Program, BK21 PLUS Project, College of Pharmacy, Kangwon National University, Chunchon, 24341, Republic of Korea
| | - Eun-Joo Shin
- Neuropsychopharmacology and Toxicology Program, BK21 PLUS Project, College of Pharmacy, Kangwon National University, Chunchon, 24341, Republic of Korea
| | - Kuniaki Saito
- Advanced Diagnostic System Research Laboratory, Fujita Health University Graduate School of Health Sciences, Toyoake, Japan.
| | - The-Vinh Tran
- Neuropsychopharmacology and Toxicology Program, BK21 PLUS Project, College of Pharmacy, Kangwon National University, Chunchon, 24341, Republic of Korea
| | - Dieu-Hien Phan
- Neuropsychopharmacology and Toxicology Program, BK21 PLUS Project, College of Pharmacy, Kangwon National University, Chunchon, 24341, Republic of Korea
| | - Naveen Sharma
- Neuropsychopharmacology and Toxicology Program, BK21 PLUS Project, College of Pharmacy, Kangwon National University, Chunchon, 24341, Republic of Korea
| | - Dae-Won Kim
- Department of Biochemistry and Molecular Biology, Research Institute of Oral Sciences, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457, South Korea
| | - Soo Young Choi
- Department of Biomedical Science and Research Institute of Bioscience and Biotechnology, Hallym University, Chunchon, 24252, Republic of Korea
| | - Ji Hoon Jeong
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Choon-Gon Jang
- Department of Pharmacology, School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Jae Hoon Cheong
- Department of Pharmacy, Sahmyook University, 815 Hwarangro, Nowon-gu, Seoul, 01795, Republic of Korea
| | - Toshitaka Nabeshima
- Advanced Diagnostic System Research Laboratory, Fujita Health University Graduate School of Health Sciences, Toyoake, Japan; Japanese Drug Organization of Appropriate Use and Research, Nagoya, Japan
| | - Hyoung-Chun Kim
- Neuropsychopharmacology and Toxicology Program, BK21 PLUS Project, College of Pharmacy, Kangwon National University, Chunchon, 24341, Republic of Korea.
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128
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Limanaqi F, Biagioni F, Ryskalin L, Busceti CL, Fornai F. Molecular Mechanisms Linking ALS/FTD and Psychiatric Disorders, the Potential Effects of Lithium. Front Cell Neurosci 2019; 13:450. [PMID: 31680867 PMCID: PMC6797817 DOI: 10.3389/fncel.2019.00450] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/20/2019] [Indexed: 12/12/2022] Open
Abstract
Altered proteostasis, endoplasmic reticulum (ER) stress, abnormal unfolded protein response (UPR), mitochondrial dysfunction and autophagy impairment are interconnected events, which contribute to the pathogenesis of amyotrophic lateral sclerosis (ALS)/frontotemporal dementia (FTD). In recent years, the mood stabilizer lithium was shown to potentially modify ALS/FTD beyond mood disorder-related pathology. The effects of lithium are significant in ALS patients carrying genetic variations in the UNC13 presynaptic protein, which occur in ALS/FTD and psychiatric disorders as well. In the brain, lithium modulates a number of biochemical pathways involved in synaptic plasticity, proteostasis, and neuronal survival. By targeting UPR-related events, namely ER stress, excitotoxicity and autophagy dysfunction, lithium produces plastic effects. These are likely to relate to neuroprotection, which was postulated for mood and motor neuron disorders. In the present manuscript, we try to identify and discuss potential mechanisms through which lithium copes concomitantly with ER stress, UPR and autophagy dysfunctions related to UNC13 synaptic alterations and aberrant RNA and protein processing. This may serve as a paradigm to provide novel insights into the neurobiology of ALS/FTD featuring early psychiatric disturbances.
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Affiliation(s)
- Fiona Limanaqi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Francesco Fornai
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,IRCCS Neuromed, Pozzilli, Italy
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129
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Milosevic L, Dallapiazza RF, Munhoz RP, Kalia SK, Popovic MR, Hutchison WD. Case Studies in Neuroscience: Lack of inhibitory synaptic plasticity in the substantia nigra pars reticulata of a patient with lithium-induced tremor. J Neurophysiol 2019; 122:1367-1372. [PMID: 31411948 DOI: 10.1152/jn.00203.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tremor is a well-known side effect from many psychiatric medications, including lithium and dopamine antagonists. In patients whose psychiatric symptoms are stabilized and only respond to certain medications, deep brain stimulation may offer relief of the consequent motor complications. We report the case of an elderly male with disabling tremor related to lithium therapy for bipolar affective disorder, who was subsequently treated with deep brain stimulation. In this patient, we obtained recordings from the substantia nigra pars reticulata and performed a high-frequency stimulation protocol that robustly elicits long-term potentiation (LTP)-like changes in patients with Parkinson's disease. We hypothesized that in this patient, who did not have Parkinson's disease, the levels of inhibitory plasticity would be much greater. However, we found an unanticipated lack of plasticity in the patient with lithium-induced tremor, compared with two de novo control patients with Parkinson's disease. This patient was successfully treated with deep brain stimulation in the vicinity of the ventral oral posterior nucleus, an area of the thalamus that receives inputs from the basal ganglia. We postulate that the lithium-induced blockade of LTP may bring about motor complications such as tremor while simultaneously contributing to the therapeutic mechanism for treating the symptoms of psychiatric disorders such as bipolar affective disorder.NEW & NOTEWORTHY Use of a dual-microelectrode technique enabled us to compare long-term potentiation (LTP)-like changes in a patient with lithium-induced tremor to that of patients with Parkinson's disease. This study corroborated the findings in rodent brain slices that chronic lithium treatment may block LTP. Whereas a deficit in LTP may underlie the therapeutic mechanism for treating psychiatric disorders such as bipolar affective disorder, it may simultaneously contribute to consequent appearance of tremor.
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Affiliation(s)
- Luka Milosevic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Robert F Dallapiazza
- Division of Neurosurgery, Toronto Western Hospital - University Health Network, Toronto, Ontario, Canada
| | - Renato P Munhoz
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Toronto Western Hospital - University Health Network, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Milos R Popovic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - William D Hutchison
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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130
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Hanna RM, Hasnain H, Sangalang MD, Han J, Arasu A, Arman F, Barsoum M, Poa H, Rastogi A, Harari A. Three Patients with Lithium-Associated Hyperparathyroidism: Literature Review Regarding Medical and Surgical Management. Case Rep Nephrol Dial 2019; 9:108-118. [PMID: 31559266 PMCID: PMC6751439 DOI: 10.1159/000502399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 07/22/2019] [Indexed: 11/28/2022] Open
Abstract
Lithium (Li) carbonate has been established as a mood stabilizer and an efficacious treatment for bipolar disorder since its discovery by Dr. John Cade in 1948. Li interacts significantly with organ systems and endocrine pathways. One of the most challenging side effects of Li to manage is its effect on the parathyroid glands. Dysregulation of parathyroid signaling due to Li results in hypercalcemia due to increased vitamin D<sub>3</sub> generation, increased calcium absorption from the gut, and bone resorption, occasionally resulting in concomitant hypercalciuria. However, hypercalciuria is not a definitive feature for hyperparathyroidism, and normal calcium excretion might be seen in these patients. Hypercalcemia may also result from volume contraction and decreased renal clearance, which are commonly seen in these patients. Anatomically the parathyroid abnormalities can present as single or multiglandular disease. We report 3 cases where the patients developed multiple side effects of Li therapy as well as hypercalcemia due to hyperparathyroidism. The literature is reviewed with regard to medical and surgical management of Li-associated hyperparathyroidism in the context of these 3 presented cases.
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Affiliation(s)
- Ramy M Hanna
- UCLA Department of Medicine, Division of Nephrology, Los Angeles, California, USA
| | - Huma Hasnain
- UCLA Department of Medicine, Division of Nephrology, Los Angeles, California, USA
| | | | - Jennifer Han
- UCLA Department of Medicine, Division of Endocrinology, Los Angeles, California, USA
| | - Aarthi Arasu
- UCLA Department of Medicine, Division of Endocrinology, Los Angeles, California, USA
| | - Farid Arman
- UCLA Department of Medicine, Division of Nephrology, Los Angeles, California, USA
| | - Marina Barsoum
- UCLA Department of Medicine, Division of Nephrology, Los Angeles, California, USA
| | - Hyunah Poa
- UCLA Department of Medicine, Los Angeles, California, USA
| | - Anjay Rastogi
- UCLA Department of Medicine, Division of Nephrology, Los Angeles, California, USA
| | - Avital Harari
- UCLA Department of Surgery, Division of Endocrine Surgery, Los Angeles, California, USA
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131
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Imaz ML, Torra M, Soy D, García-Esteve L, Martin-Santos R. Clinical Lactation Studies of Lithium: A Systematic Review. Front Pharmacol 2019; 10:1005. [PMID: 31551795 PMCID: PMC6746934 DOI: 10.3389/fphar.2019.01005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/08/2019] [Indexed: 12/21/2022] Open
Abstract
Background: There is substantial evidence that postpartum prophylaxis with lithium lowers the rate of relapse in bipolar disorder. However, it is contraindicated during breastfeeding due to the high variability of the transfer into breast milk. Aims: We conducted a systematic review of the current evidence of studies assessing the transfer of lithium to lactating infants and short-term infant outcomes. Methods: An a priori protocol was designed based on PRISMA guidelines. Searches in PubMed and LactMed were conducted until September 2018. Studies assessing lithium pharmacokinetic parameters and short-term infant outcomes were included. Quality was assessed using a checklist based on international guidelines (i.e., FDA). Results: From 344 initial studies, 13 case reports/series with 39 mother-child dyads were included. Only 15% of studies complied with ≥50% of the items on the quality assessment checklist. Infants breastfeed a mean (SD) of 58.9 (83.3) days. Mean maternal lithium dose was 904 (293) mg/day, corresponding lithium plasma/serum concentration was 0.73(0.26) mEq/L, and breast milk concentration was 0.84(0.14) mEq/L. Mean infant lithium plasma/serum concentration was 0.23(0.26) mEq/L. Twenty-six (80%) infants had concentrations ≤0.30 mEq/L without adverse effects. Eight (20%) showed a transient adverse event (i.e., acute toxicity or thyroid alterations). All of them were also prenatally exposed to lithium monotherapy or polytherapy. Conclusion: The current evidence comes from studies with a degree of heterogeneity and of low-moderate quality. However, it identifies areas of improvement for future clinical lactation studies of lithium and provides support for some clinical recommendations.
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Affiliation(s)
- Maria Luisa Imaz
- Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain
- Unit of Perinatal Mental Health, Department of Psychiatry and Psychology, Hospital Clínic, Institut d´Investigació Mèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mercè Torra
- Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics Service, Biomedical Diagnostic Center (CBD), Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Dolors Soy
- Division of Medicines, Hospital Clínic, IDIBAPS, Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Lluïsa García-Esteve
- Unit of Perinatal Mental Health, Department of Psychiatry and Psychology, Hospital Clínic, Institut d´Investigació Mèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rocio Martin-Santos
- Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain
- Department of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain
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Seidel U, Baumhof E, Hägele FA, Bosy-Westphal A, Birringer M, Rimbach G. Lithium-Rich Mineral Water is a Highly Bioavailable Lithium Source for Human Consumption. Mol Nutr Food Res 2019; 63:e1900039. [PMID: 31051049 DOI: 10.1002/mnfr.201900039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/27/2019] [Indexed: 01/24/2023]
Abstract
SCOPE Lithium is an important trace element in human nutrition and medicine. Mineral and medicinal waters may represent a significant source of dietary lithium intake. METHODS AND RESULTS The lithium concentration of 360 German mineral and 21 medicinal waters is determined. Based on a systematic screening, three different mineral waters exhibiting low (1.7 µg L-1 ), medium (171 µg L-1 ), and high lithium (1724 µg L-1 ) concentrations are chosen for an acute bioavailability study in male healthy volunteers. In Germany, a north-east to south-west gradient of analyzed lithium concentrations is observed in the 381 tested waters. The lithium concentration in the water is significantly correlated with its sodium (r = 0. 810), potassium (r = 0.716), and magnesium (r = 0.361), but not with its calcium concentration. In a randomized cross-over trial, volunteers (n = 3×10 each) drink 1.5 L of the respective mineral waters, and lithium concentrations in serum and urine are monitored over 24 h. Consumption of the mineral waters with a medium and high lithium content results in a dose-dependent response in serum lithium concentrations and total urinary lithium excretion. CONCLUSION Lithium-rich mineral and medicinal waters may be an important and highly bioavailable lithium source for human consumption.
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Affiliation(s)
- Ulrike Seidel
- Kiel University, Institute of Human Nutrition and Food Science, Devision of Food Science, 24118, Kiel, Germany
| | - Elena Baumhof
- Kiel University, Institute of Human Nutrition and Food Science, Devision of Food Science, 24118, Kiel, Germany
| | - Franziska A Hägele
- Kiel University, Institute of Human Nutrition and Food Science, Devision of Food Science, 24118, Kiel, Germany
| | - Anja Bosy-Westphal
- Kiel University, Institute of Human Nutrition and Food Science, Devision of Food Science, 24118, Kiel, Germany
| | - Marc Birringer
- Fulda University of Applied Science, Devision of Nutritional, Food and Consumer Science, 36037, Fulda, Germany
| | - Gerald Rimbach
- Kiel University, Institute of Human Nutrition and Food Science, Devision of Food Science, 24118, Kiel, Germany
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133
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The effects of proteasome on baseline and methamphetamine-dependent dopamine transmission. Neurosci Biobehav Rev 2019; 102:308-317. [DOI: 10.1016/j.neubiorev.2019.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 04/29/2019] [Accepted: 05/09/2019] [Indexed: 12/16/2022]
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Goldberg JF. Complex Combination Pharmacotherapy for Bipolar Disorder: Knowing When Less Is More or More Is Better. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:218-231. [PMID: 32047367 PMCID: PMC6999211 DOI: 10.1176/appi.focus.20190008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Combination pharmacotherapy for bipolar disorder is commonplace and often reflects the severity and complexity of the illness and the comorbid conditions frequently associated with it. Across treatment settings, about one-fifth of patients with bipolar disorder appear to receive four or more psychotropic medications. Practice patterns often outpace the evidence-based literature, insofar as few systematic studies have examined the efficacy and safety of two or more medications for any given phase of illness. Most randomized trials of combination pharmacotherapy focus on the utility of pairing a mood stabilizer with a second-generation antipsychotic for prevention of either acute mania or relapse. In real-world practice, patients with bipolar disorder often take more elaborate combinations of mood stabilizers, antipsychotics, antidepressants, anxiolytics, stimulants, and other psychotropics for indefinite periods that do not necessarily arise purposefully and logically. In this article, I identify clinical factors associated with complex combination pharmacotherapy for patients with bipolar disorder; describe approaches to ensuring that each component of a treatment regimen has a defined role; discuss the elimination of unnecessary, ineffective, or redundant drugs in a regimen; and address complementary, safe, rationale-based drug combinations that target specific domains of psychopathology for which monotherapies often provide inadequate benefit.
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Affiliation(s)
- Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City
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Duthie A, van Aalten L, MacDonald C, McNeilly A, Gallagher J, Geddes J, Lovestone S, Sutherland C. Recruitment, Retainment, and Biomarkers of Response; A Pilot Trial of Lithium in Humans With Mild Cognitive Impairment. Front Mol Neurosci 2019; 12:163. [PMID: 31316348 PMCID: PMC6610581 DOI: 10.3389/fnmol.2019.00163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 06/12/2019] [Indexed: 11/30/2022] Open
Abstract
Lithium has been used for decades to treat Bipolar Disorder. Some of its therapeutic benefits may be through inhibition of Glycogen Synthase Kinase (GSK)-3. Enhanced GSK3 activity associates with development of Alzheimer’s disease (AD), therefore lithium is a currently used therapeutic with potential to be repurposed for prevention of Dementia. An important step toward a clinical trial for AD prevention using lithium is to establish the dose of lithium that blocks GSK3 in Mild Cognitive Impairment (MCI), a high-risk condition for progression to AD. We investigated volunteer recruitment, retention, and tolerance in this population, and assessed biomarkers of GSK3 in MCI compared to control and after lithium treatment. Recruitment was close to target, with higher than anticipated interest. Drop out was not related to lithium blood concentration. Indeed, 33% of the withdrawals were in the first week of very low dose lithium. Most made it through to the highest dose of lithium with no adverse events. We analyzed 18 potential biomarkers of GSK3 biology in rat PBMCs, but only four of these gave a robust reproducible baseline signal. The only biomarker that was modified by acute lithium injection in the rat was the inhibitory phosphorylation of Ser9 of GSK3beta (enhanced in PBMCs) and this associated with reduced activity of GSK3beta. In contrast to the rat PBMC preparations the protein quality of the human PBMC preparations was extremely variable. There was no difference between GSK3 biomarkers in MCI and control PBMC preparations and no significant effect of chronic lithium on the robust GSK3 biomarkers, indicating that the dose reached may not be sufficient to modify these markers. In summary, the high interest from the MCI population, and the lack of any adverse events, suggest that it would be relatively straightforward and safe to recruit to a larger clinical trial within this dosing regimen. However, it is clear that we will need an improved PBMC isolation process along with more robust, sensitive, and validated biomarkers of GSK3 function, in order to use GSK3 pathway regulation in human PBMC preparations as a biomarker of GSK3 inhibitor efficacy, within a clinical trial setting.
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Affiliation(s)
- Ashleigh Duthie
- Ninewells Hospital and Medical School, NHS Tayside, Dundee, United Kingdom
| | - Lidy van Aalten
- Division of Cellular Medicine, University of Dundee, Dundee, United Kingdom
| | - Cara MacDonald
- Ninewells Hospital and Medical School, NHS Tayside, Dundee, United Kingdom
| | - Alison McNeilly
- Division of Cellular Medicine, University of Dundee, Dundee, United Kingdom
| | - Jennifer Gallagher
- Division of Cellular Medicine, University of Dundee, Dundee, United Kingdom
| | - John Geddes
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Simon Lovestone
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Calum Sutherland
- Division of Cellular Medicine, University of Dundee, Dundee, United Kingdom
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McKnight RF, de La Motte de Broöns de Vauvert SJ, Chesney E, Amit BH, Geddes J, Cipriani A. Lithium for acute mania. Cochrane Database Syst Rev 2019; 6:CD004048. [PMID: 31152444 PMCID: PMC6544558 DOI: 10.1002/14651858.cd004048.pub4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bipolar disorder is a common condition associated with high morbidity; developing efficacious, safe treatments is therefore essential. Lithium is an effective maintenance treatment for bipolar disorder. It acts as mood stabiliser and reduces the risk of suicide. However, evidence assessing the efficacy of lithium in the treatment of acute mania is less robust. Current evidence-based guidelines cite multiple anti-dopaminergic and mood-stabilising agents as initial treatments: more definite evidence is needed to decide if lithium should be the first-line therapy. OBJECTIVES 1. To assess the effects of lithium in comparison with placebo or other active treatment in alleviating the acute symptoms of a manic or mixed episode in people with bipolar disorder.2. To review the acceptability and tolerability of treatment with lithium in comparison with placebo or other active treatments in alleviating the acute symptoms of a manic or mixed episode in people with bipolar disorder. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register, CENTRAL, MEDLINE, Embase, and PsycINFO. We also searched the World Health Organization trials portal (ICTRP) and ClinicalTrials.gov. We checked the reference lists of all included studies and relevant systematic reviews. We have incorporated studies from searches to 18 May 2018 into the current analyses. SELECTION CRITERIA Prospective randomised controlled studies comparing lithium with placebo or alternative drug treatment in treatment of acute mania. We included anyone with bipolar disorder, male and female, of any age. DATA COLLECTION AND ANALYSIS At least two review authors independently extracted data and assessed methodological quality. We used odds ratios (ORs) to analyse binary efficacy outcomes, and mean differences (MDs) or standardised mean differences (SMDs) for continuously distributed outcomes. We used a fixed-effect model unless heterogeneity was moderate or substantial, in which case we used a random-effects model. We used Review Manager 5 to analyse data. We assessed the certainty of evidence for individual outcomes using the GRADE approach. MAIN RESULTS We found 36 randomised controlled studies comparing lithium with placebo, one of 12 drugs, or electroconvulsive therapy for treatment of acute mania. Studies included male and female participants (n = 4220), of all ages, who all fitted criteria for a manic episode within the context of a diagnosis of bipolar disorder.Risk of bias was variable; 12 studies had a high risk of bias in one domain and 27 gave inadequate information on randomisation leading to an 'unclear' rating for selection bias.Lithium versus placeboHigh-certainty evidence found that lithium was an effective treatment for acute mania and was more effective than placebo at inducing a response (OR 2.13, 95% confidence interval (CI) 1.73 to 2.63; participants = 1707; studies = 6; I2 = 16%; high-certainty evidence), or remission (OR 2.16, 95% CI 1.73 to 2.69; participants = 1597; studies = 5; I2 = 21%; high-certainty evidence).Lithium was more likely than placebo to cause tremor (OR 3.25, 95% CI 2.10 to 5.04; participants = 1241; studies = 6; I2 = 0%; high-certainty evidence), and somnolence (OR 2.28, 95% CI 1.46 to 3.58; participants = 1351; studies = 7; I2 = 0%; high-certainty evidence).There was insufficient evidence to determine the effect of lithium for all-cause dropouts (OR 0.76; 95% CI 0.46 to 1.25; participants = 1353; studies = 7; I2 = 75%; moderate-certainty evidence), and weight gain (OR 1.48, 95% CI 0.56 to 3.92; participants = 735, studies = 3; I2= 51%; moderate-certainty evidence).Lithium versus antipsychotics or mood stabilisersFor the outcome of inducing a response, there was only very low-certainty evidence regarding lithium compared to haloperidol (MD -2.40, 95% CI -6.31 to 1.50; participants = 80; studies = 3; I2 = 95%), quetiapine (OR 0.66, 95% CI 0.28 to 1.55; participants = 335; studies = 2; I2 = 71%), and carbamazepine (SMD 0.21, 95% CI -0.18 to 0.60; participants = 102; studies = 3; I2 = 0%).Lithium was probably less likely to induce a response than olanzapine (OR 0.44, 95% CI 0.20 to 0.94; participants = 180; studies = 2; I2 = 0%; moderate-certainty evidence).Lithium may be less likely to induce a response than risperidone (MD 7.28, 95% CI 5.22 to 9.34; participants = 241; studies = 3; I2 = 49%; low-certainty evidence).There was no evidence of a difference between lithium and valproate (OR 1.22, 95% CI 0.87 to 1.70; participants = 607; studies = 5; I2 = 22%; moderate-certainty evidence).There was moderate-certainty evidence that lithium was more effective than topiramate at treating acute mania (OR 2.28, 95% CI 1.63 to 3.20; participants = 660; studies = 1).Data on adverse events for these comparisons contained too few studies to provide high-certainty evidence. AUTHORS' CONCLUSIONS This systematic review indicates that lithium is more effective than placebo as a treatment for acute mania but increases the risk for somnolence and tremor. Limited evidence suggests little or no difference between lithium and other mood stabilisers (valproate, carbamazepine) or antipsychotics (risperidone, quetiapine, haloperidol). Olanzapine may be an exception, as it is probably slightly more effective than lithium. There is uncertain evidence that risperidone may also be more effective than lithium. Lithium is probably more effective at treating acute mania than topiramate. When compared to placebo, lithium was more likely to cause adverse events. However, when compared to other drugs, too few studies provided data on adverse effects to provide high-certainty evidence. More, rigorously designed, large-scale studies are needed to definitively conclude if lithium is superior to other interventions in treating acute mania.
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Affiliation(s)
- Rebecca F McKnight
- University of OxfordDepartment of PsychiatryWarneford HospitalWarneford LaneOxfordUKOX3 7JX
| | | | - Edward Chesney
- Institute of Psychiatry, Psychology and Neuroscience, King's College LondonDepartment of Psychosis StudiesDe Crespigny ParkLondonUKSE5 8AF
| | - Ben H Amit
- Tel Aviv UniversityDepartment of Psychiatry, Sackler Faculty of MedicineTel AvivIsrael
| | - John Geddes
- University of OxfordDepartment of PsychiatryWarneford HospitalWarneford LaneOxfordUKOX3 7JX
- Oxford Health NHS Foundation TrustWarneford HospitalOxfordUK
| | - Andrea Cipriani
- University of OxfordDepartment of PsychiatryWarneford HospitalWarneford LaneOxfordUKOX3 7JX
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Spielberg JM, Matyi MA, Karne H, Anand A. Lithium monotherapy associated longitudinal effects on resting state brain networks in clinical treatment of bipolar disorder. Bipolar Disord 2019; 21:361-371. [PMID: 30421491 PMCID: PMC8593846 DOI: 10.1111/bdi.12718] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Lithium is one of the most effective and specific treatments for bipolar disorder (BP), but the neural mechanisms by which lithium impacts symptoms remain unclear. Past research has been limited by a reliance on cross-sectional designs, which does not allow for identification of within-person changes due to lithium and has not examined communication between brain regions (ie, networks). In the present study, we prospectively investigated the lithium monotherapy associated effects in vivo on the brain connectome in medication-free BP patients. In particular, we examined the within-person impact of lithium treatment on connectome indices previously linked to mania and depression in bipolar disorder. METHODS Thirty-nine medication-free subjects - 26 BP (13 (hypo)manic and 13 depressed) and 13 closely matched healthy controls (HC) - were included. fMRI data were obtained at 3 timepoints: baseline, after 2 weeks, and after 8 weeks (total of 117 scans: 78 BP and 39 HC scans). BP subjects were clinically treated with lithium for 8 weeks while HC were scanned at the same time points but not treated. Graph theory metrics and repeated measures GLM were used to analyze lithium treatment associated effects. RESULTS Consistent with hypotheses, lithium treatment was associated with a normalizing effect on mania-related connectome indices. Furthermore, shifts in both mania- and depression-related connectome indices were proportional to symptom change. Finally, lithium treatment-associated impact on amygdala function differed depending on baseline mood. CONCLUSIONS Present findings provide deeper insight into the therapeutic neural mechanisms associated with lithium treatment.
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Affiliation(s)
| | - Melanie A. Matyi
- Department of Psychological and Brain Sciences, University of Delaware
| | - Harish Karne
- Center for Behavioral Health, Cleveland Clinic Foundation
| | - Amit Anand
- Center for Behavioral Health, Cleveland Clinic Foundation,Corresponding Author: Amit Anand, M.D., Cleveland Clinic Main Campus, Mail Code P57, 9500 Euclid Avenue, Cleveland, OH 44195, Phone: 216.636.5860,
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Lithium Preparations in Psychiatry, Addiction Medicine and Neurology. Part II. Biochemical Mechanisms of Its Action. ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2019-4.2.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Lithium is the first and the lightest in the series of alkali metals, to which, in addition to lithium, two very biologically important elements – sodium and potassium, as well as trace elements rubidium and cesium, belong. Despite its formal affiliation to the group of alkali metals, lithium, like many other chemical elements of the «atypical» second period of the periodic table (for example, boron), is more similar in its chemical properties not to its counterparts in the group, but to its «diagonal brother» – magnesium. As we will show in this article, the diagonal chemical similarity between lithium and magnesium is of great importance for understanding the mechanisms of its intracellular biochemical action. At the same time, the intragroup chemical similarity of lithium with sodium and potassium is more important for understanding the mechanisms of its absorption, its distribution in the body and its excretion. Despite the 70 years that have passed since John Cade’s discovery of the antimanic effect of lithium, the mechanisms of its therapeutic action are still not completely understood. In the end, it turns out that the mechanism of the therapeutic action of lithium is extremely complex, multicomponent, unique and not imitable. Certain aspects of the mechanism of its action may be compatible with the mechanisms of action of other mood stabilizers, or with the mechanisms of action of so-called «lithium-mimetics», such as ebselen. However, no other drug to date failed to fully reproduce the biochemical effect of lithium on the body.
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139
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Zhao K, So HC. Drug Repositioning for Schizophrenia and Depression/Anxiety Disorders: A Machine Learning Approach Leveraging Expression Data. IEEE J Biomed Health Inform 2019; 23:1304-1315. [DOI: 10.1109/jbhi.2018.2856535] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Miranda A, Shekhtman T, McCarthy M, DeModena A, Leckband SG, Kelsoe JR. Study of 45 candidate genes suggests CACNG2 may be associated with lithium response in bipolar disorder. J Affect Disord 2019; 248:175-179. [PMID: 30738251 PMCID: PMC7292366 DOI: 10.1016/j.jad.2019.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/15/2018] [Accepted: 01/12/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bipolar disorder is a neuropsychiatric disorder that is characterized by fluctuations between manic and depressive phases. Lithium is the original and best mood stabilizing treatment for bipolar disorder. While its mechanism is not well understood, it is believed to have a strong genetic component, as several studies suggest that lithium responsiveness, in bipolar disorder, is heritable. In this study we aimed to identify genetic variants that are associated with lithium responsiveness in bipolar disorder. METHODS Here we present two cohorts; a retrospective cohort in which patients were surveyed about their response to lithium, and a prospective cohort, in which patients were placed on a lithium monotherapy and monitored for their response to lithium. In both cohorts, patients were stratified into two categories in terms of lithium response; good responders and poor responders. 45 genes were selected based on previous associations with lithium pathways or bipolar disorder and 684 SNPs within these genes were selected to test for association with lithium response. RESULTS While no single SNP was significant after correcting for multiple comparisons, there were several that were nominally significant (p < 0.05). Of these nominally significant SNPs, the most highly significant SNP in both the prospective and retrospective cohorts were found to be in CACNG2, or Stargazin. The second best association with lithium response was several SNPs in NRG1, a gene that has previously been associated with schizophrenia. CONCLUSIONS Evidence for the association of lithium response with SNPs in CACNG2 is consistent with previous findings that have identified CACNG2 as associated with both bipolar disorder and lithium responsiveness.
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Affiliation(s)
- Alannah Miranda
- Department of Psychiatry, University of California San Diego, La Jolla 92093 CA, USA
| | - Tatyana Shekhtman
- Department of Psychiatry, University of California San Diego, La Jolla 92093 CA, USA; Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA, USA
| | - Michael McCarthy
- Department of Psychiatry, University of California San Diego, La Jolla 92093 CA, USA; Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA, USA
| | - Anna DeModena
- Department of Psychiatry, University of California San Diego, La Jolla 92093 CA, USA; Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA, USA
| | - Susan G Leckband
- Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA, USA
| | - John R Kelsoe
- Department of Psychiatry, University of California San Diego, La Jolla 92093 CA, USA; Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA, USA; Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, USA.
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Zoroddu MA, Aaseth J, Crisponi G, Medici S, Peana M, Nurchi VM. The essential metals for humans: a brief overview. J Inorg Biochem 2019; 195:120-129. [PMID: 30939379 DOI: 10.1016/j.jinorgbio.2019.03.013] [Citation(s) in RCA: 433] [Impact Index Per Article: 86.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 12/11/2022]
Abstract
The human body needs about 20 essential elements in order to function properly and among them, for certain, 10 are metal elements, though for every metal we do need, there is another one in our body we could do without it. Until about 1950 poor attention was given to the so-called "inorganic elements" and while researches on "organic elements" (C, N, O and H) and organic compounds were given high priority, studies on essential inorganic elements were left aside. Base on current knowledge it is ascertained today that metals such as Na, K, Mg, Ca, Fe, Mn, Co, Cu, Zn and Mo are essential elements for life and our body must have appropriate amounts of them. Here a brief overview to highlight their importance and current knowledge about their essentiality.
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Affiliation(s)
| | - Jan Aaseth
- Research Department, Innlandet Hospital, Brumunddal, Norway; Inland Norway University of Applied Sciences, Elverum, Norway
| | - Guido Crisponi
- Department of Life and Environmental Sciences, University of Cagliari, Italy
| | - Serenella Medici
- Department of Chemistry and Pharmacy, University of Sassari, Italy
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Insulin-stimulated mTOR activation in peripheral blood mononuclear cells associated with early treatment response to lithium augmentation in rodent model of antidepressant-resistance. Transl Psychiatry 2019; 9:113. [PMID: 30877268 PMCID: PMC6420640 DOI: 10.1038/s41398-019-0434-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 09/24/2018] [Accepted: 11/25/2018] [Indexed: 01/24/2023] Open
Abstract
Lithium has been shown to have some therapeutic efficacy as an adjunctive treatment for intractable forms of major depression. Activation of mammalian target of rapamycin (mTOR) and inhibition of glycogen synthase kinase-3β (GSK3β) have been implicated in its putative mechanisms of action. These proteins are integral components of the insulin signaling pathway, which may serve as a critical co-regulator of drug action. Utilizing an animal model of tricyclic antidepressant resistance, we investigated the relationship between insulin signaling and antidepressant response to lithium augmentation. Pre-treatment with adrenocorticotropic hormone (ACTH 100 µg/day i.p.) for 14 days effectively blocked the immobility-reducing effects of an acute dose of imipramine (10 mg/kg i.p.) in the forced swim test (FST). Lithium augmentation (100 mg/kg i.p.) rescued the antidepressant-like effects of imipramine in this model. Total and phosphorylated (p) levels of protein kinase B (Akt), mTOR, and GSK3β protein were quantified in the infralimbic cortex (ILPFC) following FST stress via Western blot. Levels of mTOR and pmTOR were further quantified in isolated peripheral blood mononuclear cells (PBMCs) following insulin stimulation (10 mg/mL for 5 min) via ELISA. Elevated levels of phosphorylated insulin signaling proteins were present in the ILPFC of ACTH-pretreated animals that received both imipramine and lithium, together with a concurrent increase in mTOR activation in PBMCs. Large correlations were observed between immobility time and insulin-stimulated mTOR levels in PBMCs. We propose that PBMC insulin challenge may be a useful probe for predicting antidepressant response to lithium administration, and potentially other therapies acting via similar mechanisms of action.
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Wang X, Luo Q, Tian F, Cheng B, Qiu L, Wang S, He M, Wang H, Duan M, Jia Z. Brain grey-matter volume alteration in adult patients with bipolar disorder under different conditions: a voxel-based meta-analysis. J Psychiatry Neurosci 2019; 44:89-101. [PMID: 30354038 PMCID: PMC6397036 DOI: 10.1503/jpn.180002] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The literature on grey-matter volume alterations in bipolar disorder is heterogeneous in its findings. METHODS Using effect-size differential mapping, we conducted a meta-analysis of grey-matter volume alterations in patients with bipolar disorder compared with healthy controls. RESULTS We analyzed data from 50 studies that included 1843 patients with bipolar disorder and 2289 controls. Findings revealed lower grey-matter volumes in the bilateral superior frontal gyri, left anterior cingulate cortex and right insula in patients with bipolar disorder and in patients with bipolar disorder type I. Patients with bipolar disorder in the euthymic and depressive phases had spatially distinct regions of altered grey-matter volume. Meta-regression revealed that the proportion of female patients with bipolar disorder or bipolar disorder type I was negatively correlated with regional grey-matter alteration in the right insula; the proportion of patients with bipolar disorder or bipolar disorder type I taking lithium was positively correlated with regional grey-matter alterations in the left anterior cingulate/paracingulate gyri; and the proportion of patients taking antipsychotic medications was negatively correlated with alterations in the anterior cingulate/paracingulate gyri. LIMITATIONS This study was cross-sectional; analysis techniques, patient characteristics and clinical variables in the included studies were heterogeneous. CONCLUSION Structural grey-matter abnormalities in patients with bipolar disorder and bipolar disorder type I were mainly in the prefrontal cortex and insula. Patients' mood state might affect grey-matter alterations. Abnormalities in regional grey-matter volume could be correlated with patients' specific demographic and clinical features.
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Affiliation(s)
- Xiuli Wang
- From the Department of Psychiatry, the Fourth People’s Hospital of Chengdu, Chengdu, China (Duan, He, H. Wang, S. Wang, X. Wang); the Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China (Luo, Jia); the Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China (Tian, Jia); the Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu, China (Cheng); and the Department of Radiology, the Second People’s Hospital of Yibin, Yibin, China (Qiu)
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144
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Vosahlikova M, Roubalova L, Ujcikova H, Hlouskova M, Musil S, Alda M, Svoboda P. Na+/K+-ATPase level and products of lipid peroxidation in live cells treated with therapeutic lithium for different periods in time (1, 7, and 28 days); studies of Jurkat and HEK293 cells. Naunyn Schmiedebergs Arch Pharmacol 2019; 392:785-799. [DOI: 10.1007/s00210-019-01631-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/08/2019] [Indexed: 12/20/2022]
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145
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Ng J, Sjöstrand M, Eyal N. Adding Lithium to Drinking Water for Suicide Prevention—The Ethics. Public Health Ethics 2019. [DOI: 10.1093/phe/phz002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Recent observations associate naturally occurring trace levels of Lithium in ground water with significantly lower suicide rates. It has been suggested that adding trace Lithium to drinking water could be a safe and effective way to reduce suicide. This article discusses the many ethical implications of such population-wide Lithium medication. It compares this policy to more targeted solutions that introduce trace amounts of Lithium to groups at higher risk of suicide or lower risk of adverse effects. The question of mass treatment with Lithium recalls other choices in public health between population-wide and more targeted interventions. The framework we propose could be relevant to some of these other dilemmas.
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Affiliation(s)
- Jared Ng
- Department of Developmental Psychiatry, Institute of Mental Health
| | - Manne Sjöstrand
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet
| | - Nir Eyal
- Department of Global Health and Population, Harvard TH Chan School of Public Health
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146
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Soni S. Lithium neurotoxicity presenting as dementia with therapeutic serum lithium levels. BMJ Case Rep 2019; 12:12/1/bcr-2018-227741. [PMID: 30659009 DOI: 10.1136/bcr-2018-227741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
After 25 years of continuous lithium therapy, a woman with moderate intellectual disability and bipolar disorder developed symptoms suggestive of dementia. In fact, she had developed lithium neurotoxicity, but this was overlooked for 18 months as serial lithium levels were in the therapeutic range.
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Affiliation(s)
- Sarita Soni
- Department of Learning Disabilities, NHS Greater Glasgow and Clyde, Glasgow, UK
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147
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Lago SG, Bahn S. Clinical Trials and Therapeutic Rationale for Drug Repurposing in Schizophrenia. ACS Chem Neurosci 2019; 10:58-78. [PMID: 29944339 DOI: 10.1021/acschemneuro.8b00205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
There is a paucity of efficacious novel drugs to address high rates of treatment resistance and refractory symptoms in schizophrenia. The identification of novel therapeutic indications for approved drugs-drug repurposing-has the potential to expedite clinical trials and reduce the costly risk of failure which currently limits central nervous system drug discovery efforts. In the present Review we discuss the historical role of drug repurposing in schizophrenia drug discovery and review the main classes of repurposing candidates currently in clinical trials for schizophrenia in terms of their therapeutic rationale, mechanisms of action, and preliminary results from clinical trials. Subsequently we outline the challenges and limitations which face the clinical repurposing pipeline and how novel technologies might serve to address these.
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Affiliation(s)
- Santiago G. Lago
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge CB3 0AS, U.K
| | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge CB3 0AS, U.K
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148
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Quintero M, Stanisic D, Cruz G, Pontes JGM, Costa TBBC, Tasic L. Metabolomic Biomarkers in Mental Disorders: Bipolar Disorder and Schizophrenia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1118:271-293. [PMID: 30747428 DOI: 10.1007/978-3-030-05542-4_14] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Psychiatric disorders are some of the most impairing human diseases. Among them, bipolar disorder and schizophrenia are the most common. Both have complicated diagnostics due to their phenotypic, biological, and genetic heterogeneity, unknown etiology, and the underlying biological pathways, and molecular mechanisms are still not completely understood. Given the multifactorial complexity of these disorders, identification and implementation of metabolic biomarkers would assist in their early detection and diagnosis and facilitate disease monitoring and treatment responses. To date, numerous studies have utilized metabolomics to better understand psychiatric disorders, and findings from these studies have begun to converge. In this chapter, we briefly describe some of the metabolomic biomarkers found in these two disorders.
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Affiliation(s)
- Melissa Quintero
- Laboratory of Chemical Biology, Department of Organic Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Danijela Stanisic
- Laboratory of Chemical Biology, Department of Organic Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Guilherme Cruz
- Laboratory of Chemical Biology, Department of Organic Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - João G M Pontes
- Laboratory of Microbial Chemical Biology, Institute of Chemistry, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Tássia Brena Barroso Carneiro Costa
- Laboratory of Chemical Biology, Department of Organic Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Ljubica Tasic
- Laboratory of Chemical Biology, Department of Organic Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
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149
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Sabir S, Akhtar MF, Saleem A. Endocrine disruption as an adverse effect of non-endocrine targeting pharmaceuticals. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:1277-1286. [PMID: 30467752 DOI: 10.1007/s11356-018-3774-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 11/15/2018] [Indexed: 06/09/2023]
Abstract
Endocrine disruptors have gained widespread attention owing to their severe adverse health impacts. These produce enormous burden of disease and are associated with high economic cost especially in developed countries. Environmental pollutants causing endocrine disruption include pesticides, industrial wastes, packaging materials, food constituents, plastics, and cosmetic products. Likewise, pharmaceutical drugs have the endocrine disrupting potential through a wide array of mechanisms. Antipsychotic, antiepileptic, antihypertensive, antiviral, antidiabetic, and anticancer drugs are among the foremost non-hormonal endocrine disruptors. Several drugs affect thyroid hormone synthesis via interaction with iodine uptake to the release of T3 and T4 by thyrocytes. Prolonged use of some drugs increase susceptibility to diabetes mellitus either by direct destruction of β cells or enhanced insulin resistance. Other drugs may cause serious developmental defects in male or female reproductive system. Appropriate understanding of the mechanisms of endocrine disruption associated with non-hormonal drugs will guide future drug development and help us prevent and cure endocrine-related toxicity of pharmaceuticals. Therefore, this review focuses on endocrine disruption by pharmaceutical drugs as their side effect.
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Affiliation(s)
- Shakila Sabir
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Muhammad Furqan Akhtar
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore Campus, Lahore, Pakistan.
| | - Ammara Saleem
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
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150
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Follo MY, Ratti S, Manzoli L, Ramazzotti G, Faenza I, Fiume R, Mongiorgi S, Suh PG, McCubrey JA, Cocco L. Inositide-Dependent Nuclear Signalling in Health and Disease. Handb Exp Pharmacol 2019; 259:291-308. [PMID: 31889219 DOI: 10.1007/164_2019_321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nuclear inositides have a specific subcellular distribution that is linked to specific functions; thus their regulation is fundamental both in health and disease. Emerging evidence shows that alterations in multiple inositide signalling pathways are involved in pathophysiology, not only in cancer but also in other diseases. Here, we give an overview of the main features of inositides in the cell, and we discuss their potential as new molecular therapeutic targets.
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Affiliation(s)
- Matilde Y Follo
- Cellular Signalling Laboratory, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Ratti
- Cellular Signalling Laboratory, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lucia Manzoli
- Cellular Signalling Laboratory, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giulia Ramazzotti
- Cellular Signalling Laboratory, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Irene Faenza
- Cellular Signalling Laboratory, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberta Fiume
- Cellular Signalling Laboratory, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sara Mongiorgi
- Cellular Signalling Laboratory, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Pann Ghill Suh
- Korea Brain Research Institute, Daegu, Republic of Korea.,School of Life Sciences, UNIST, Ulsan, Republic of Korea
| | - James A McCubrey
- Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Lucio Cocco
- Cellular Signalling Laboratory, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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