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Zhang Y, Zheng Y, Ni P, Liang S, Li X, Yu H, Wei W, Qi X, Yu X, Xue R, Zhao L, Deng W, Wang Q, Guo W, Li T. New role of platelets in schizophrenia: predicting drug response. Gen Psychiatr 2024; 37:e101347. [PMID: 38616969 PMCID: PMC11015174 DOI: 10.1136/gpsych-2023-101347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/29/2024] [Indexed: 04/16/2024] Open
Abstract
Background Elevated platelet count (PLTc) is associated with first-episode schizophrenia and adverse outcomes in individuals with precursory psychosis. However, the impact of antipsychotic medications on PLTc and its association with symptom improvement remain unclear. Aims We aimed to investigate changes in PLTc levels following antipsychotic treatment and assess whether PLTc can predict antipsychotic responses and metabolic changes after accounting for other related variables. Methods A total of 2985 patients with schizophrenia were randomised into seven groups. Each group received one of seven antipsychotic treatments and was assessed at 2, 4 and 6 weeks. Clinical symptoms were evaluated using the positive and negative syndrome scale (PANSS). Additionally, we measured blood cell counts and metabolic parameters, such as blood lipids. Repeated measures analysis of variance was used to examine the effect of antipsychotics on PLTc changes, while structural equation modelling was used to assess the predictive value of PLTc on PANSS changes. Results PLTc significantly increased in patients treated with aripiprazole (F=6.00, p=0.003), ziprasidone (F=7.10, p<0.001) and haloperidol (F=3.59, p=0.029). It exhibited a positive association with white blood cell count and metabolic indicators. Higher baseline PLTc was observed in non-responders, particularly in those defined by the PANSS-negative subscale. In the structural equation model, PLTc, white blood cell count and a latent metabolic variable predicted the rate of change in the PANSS-negative subscale scores. Moreover, higher baseline PLTc was observed in individuals with less metabolic change, although this association was no longer significant after accounting for baseline metabolic values. Conclusions Platelet parameters, specifically PLTc, are influenced by antipsychotic treatment and could potentially elevate the risk of venous thromboembolism in patients with schizophrenia. Elevated PLTc levels and associated factors may impede symptom improvement by promoting inflammation. Given PLTc's easy measurement and clinical relevance, it warrants increased attention from psychiatrists. Trial registration number ChiCTR-TRC-10000934.
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Affiliation(s)
- Yamin Zhang
- Department of Neurobiology, Zhejiang University School of Medicine Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University MOE Frontier Science Center for Brain Science and Brain Machine Integration, Hangzhou, Zhejiang, China
| | - Yanghao Zheng
- Department of Neurobiology, Zhejiang University School of Medicine Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
| | - Peiyan Ni
- Department of Neurobiology, Zhejiang University School of Medicine Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University MOE Frontier Science Center for Brain Science and Brain Machine Integration, Hangzhou, Zhejiang, China
| | - Sugai Liang
- Department of Neurobiology, Zhejiang University School of Medicine Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University MOE Frontier Science Center for Brain Science and Brain Machine Integration, Hangzhou, Zhejiang, China
| | - Xiaojing Li
- Department of Neurobiology, Zhejiang University School of Medicine Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University MOE Frontier Science Center for Brain Science and Brain Machine Integration, Hangzhou, Zhejiang, China
| | - Hua Yu
- Department of Neurobiology, Zhejiang University School of Medicine Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University MOE Frontier Science Center for Brain Science and Brain Machine Integration, Hangzhou, Zhejiang, China
| | - Wei Wei
- Department of Neurobiology, Zhejiang University School of Medicine Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University MOE Frontier Science Center for Brain Science and Brain Machine Integration, Hangzhou, Zhejiang, China
| | - Xueyu Qi
- Department of Neurobiology, Zhejiang University School of Medicine Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University MOE Frontier Science Center for Brain Science and Brain Machine Integration, Hangzhou, Zhejiang, China
| | - Xueli Yu
- Department of Neurobiology, Zhejiang University School of Medicine Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University MOE Frontier Science Center for Brain Science and Brain Machine Integration, Hangzhou, Zhejiang, China
| | - Rui Xue
- Department of Neurobiology, Zhejiang University School of Medicine Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University MOE Frontier Science Center for Brain Science and Brain Machine Integration, Hangzhou, Zhejiang, China
| | - Liansheng Zhao
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wei Deng
- Department of Neurobiology, Zhejiang University School of Medicine Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University MOE Frontier Science Center for Brain Science and Brain Machine Integration, Hangzhou, Zhejiang, China
| | - Qiang Wang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wanjun Guo
- Department of Neurobiology, Zhejiang University School of Medicine Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University MOE Frontier Science Center for Brain Science and Brain Machine Integration, Hangzhou, Zhejiang, China
| | - Tao Li
- Department of Neurobiology, Zhejiang University School of Medicine Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University MOE Frontier Science Center for Brain Science and Brain Machine Integration, Hangzhou, Zhejiang, China
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Vyas H, Nebhinani N, Suthar N, Sharma P. Vascular age, cardiovascular disease risk factors, and hematological parameters in patients with Schizophrenia: An exploratory study. J Neurosci Rural Pract 2023; 14:149-153. [PMID: 36891120 PMCID: PMC9945140 DOI: 10.25259/jnrp-2022-7-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Patients with schizophrenia have shortened life expectancy due to greater cardiovascular disease (CVD) risk. Due to sparse data, index study was planned to assess the CVD risk factors, vascular age (VA), and hematological parameters in patients with schizophrenia and the concordance between Framingham Risk Score (FRS) for lipids and body mass index (BMI) (FRSLIPIDS and FRSBMI). Materials and Methods Patients with schizophrenia (n = 53) were evaluated for the presence of metabolic syndrome (MS) using the modified NCEP ATP III criteria, along with their functionality, illness severity, physical activity and nutritional score, FRSLIPIDS and FRSBMI, and hematological parameters. Results Prevalence of MS was 39.6%; in addition, 47% of patients were at risk for developing MS as they fulfilled one or two components of MS criteria and 56% of patients were obese. BMI, obesity, and RBC count were found as significant correlates for MS. CVD risk (FRS) median score (3.10) was comparable for BMI and lipid criteria along with significant correlation for FRSLIPIDS and FRSBMI (r = 0.555, P < 0.001). Conclusion VA and 10-year CVD risk (FRS for BMI and lipid criteria) represent easier way to communicate with the patients and caregivers and also to guide for comprehensive treatment plan, appropriate nutrition, physical activity, and cardiometabolic screening.
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Affiliation(s)
- Hridyanshu Vyas
- Department of Cardiovascular Research, Mayo Clinic, Rochester, United States
| | - Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Navratan Suthar
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
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Regen F, Cosma NC, Otto LR, Clemens V, Saksone L, Gellrich J, Uesekes B, Ta TMT, Hahn E, Dettling M, Heuser I, Hellmann-Regen J. Clozapine modulates retinoid homeostasis in human brain and normalizes serum retinoic acid deficit in patients with schizophrenia. Mol Psychiatry 2021; 26:5417-5428. [PMID: 32488128 PMCID: PMC8589649 DOI: 10.1038/s41380-020-0791-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/24/2022]
Abstract
The atypical antipsychotic clozapine is one of the most potent drugs of its class, yet its precise mechanisms of action remain insufficiently understood. Recent evidence points toward the involvement of endogenous retinoic acid (RA) signaling in the pathophysiology of schizophrenia. Here we investigated whether clozapine may modulate RA-signaling. Effects of clozapine on the catabolism of all-trans RA (at-RA), the biologically most active metabolite of Vitamin A, were assessed in murine and human brain tissue and peripheral blood-derived mononuclear cells (PBMC). In patients with schizophrenia with and without clozapine treatment and matched healthy controls, at-RA serum levels and blood mRNA expression of retinoid-related genes in PBMCs were quantified. Clozapine and its metabolites potently inhibited RA catabolism at clinically relevant concentrations. In PBMC-derived microsomes, we found a large interindividual variability of the sensitivity toward the effects of clozapine. Furthermore, at-RA and retinol serum levels were significantly lower in patients with schizophrenia compared with matched healthy controls. Patients treated with clozapine exhibited significantly higher at-RA serum levels compared with patients treated with other antipsychotics, while retinol levels did not differ between treatment groups. Similarly, in patients without clozapine treatment, mRNA expression of RA-inducible targets CYP26A and STRA6, as well as at-RA/retinol ratio, were significantly reduced. In contrast, clozapine-treated patients did not differ from healthy controls in this regard. Our findings provide the first evidence for altered peripheral retinoid homeostasis in schizophrenia and suggest modulation of RA catabolism as a novel mechanism of action of clozapine, which may be useful in future antipsychotic drug development.
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Affiliation(s)
- Francesca Regen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Nicoleta-Carmen Cosma
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Lisa R Otto
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Vera Clemens
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Lana Saksone
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Janine Gellrich
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Berk Uesekes
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Thi Minh Tam Ta
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Eric Hahn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Isabella Heuser
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Julian Hellmann-Regen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany.
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de Filippis R, Gaetano R, Schoretsanitis G, Verde G, Oliveti CA, Kane JM, Segura-Garcia C, De Fazio P. Clozapine Management in Schizophrenia Inpatients: A 5-Year Prospective Observational Study of Its Safety and Tolerability Profile. Neuropsychiatr Dis Treat 2021; 17:2141-2150. [PMID: 34234440 PMCID: PMC8257059 DOI: 10.2147/ndt.s312095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/15/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Clozapine is well known for its efficacy and clinical superiority compared to other antipsychotics in treatment-resistant schizophrenia (TRS). However, it is frequently underutilized worldwide because of its acute adverse events, as well as for its long-term cardiometabolic and hematological consequences. OBJECTIVE The aim of the study was to evaluate 5-year safety in chronic TRS inpatients with continuous clozapine use. METHODS Patients with TRS and clozapine treatment were evaluated for 5 years. All participants were assessed using the Brief Psychiatric Rating Scale (BPRS), Glasgow Antipsychotic Side-effect Scale for Clozapine (GASS-C), Social Performance Scale (PSP) and Short Portable Mental Status Questionnaire (SPMSQ). Clinical, cardiometabolic and hematological data were collected periodically. General linear models (GLM) repeated measures controlling for CLZ dose were utilized to determine differences in variables across the time. RESULTS Overall, 189 inpatients were screened for study participation. The final sample included twenty-one TRS patients (16 males, 76%) with an average age of 57.6 years, all with 5-year continuous use of clozapine (mean dose 266 mg/day). There was not a significant effect of time on BPRS (p=0.774), PSP (p=0.855) and SPMSQ (p=0.066); differences remained not significant after controlling for CLZ dose (p=0.585, p=0.467 and p=0.105, respectively). No changes were found in blood and clinical parameters except for red blood cell count, which decreased over time (p=0.024; η2= 0.952). Patients reported a significant BMI decrease (-8.98 kg, p=0.008) between baseline and 5 years last observation. CONCLUSION The findings show how the application of a structured dietary, clinical and therapeutic monitoring program in psychiatric care facilities could allow the safe and effective long-term cardiometabolic and hematological management of clozapine. The unique role that clozapine plays in the current treatment of patients with TRS requires greater clinical awareness. Although its acute and chronic side effects are notorious, its safety management is feasible and broadens its potential practical application.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Gaetano
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Giuseppe Verde
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - John M Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Cristina Segura-Garcia
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Effects of olanzapine treatment on lipid profiles in patients with schizophrenia: a systematic review and meta-analysis. Sci Rep 2020; 10:17028. [PMID: 33046806 PMCID: PMC7552389 DOI: 10.1038/s41598-020-73983-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/07/2020] [Indexed: 02/08/2023] Open
Abstract
Olanzapine-induced dyslipidemia significantly increases the risk of cardiovascular disease in patients with schizophrenia. However, the clinical features of olanzapine-induced dyslipidemia remain hitherto unclear because of inconsistencies in the literature. This meta-analysis thus investigated the effects of olanzapine treatment on lipid profiles among patients with schizophrenia. Studies of the effects of olanzapine on lipids were obtained through the PubMed, Web of science, The Cochrane Library and Embase databases (up to January 1, 2020). Twenty-one studies and 1790 schizophrenia patients who received olanzapine therapy were included in our analysis. An olanzapine-induced increase was observed in plasma triglyceride (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) levels in patients with schizophrenia (all P < 0.05). Moreover, the time points analyzed included the following: baseline, 4 weeks, 6 weeks, 8 weeks, 12 weeks, and ≥ 24 weeks (data of ≥ 24 weeks were integrated). The significant elevation of TG, TC, and LDL-C was observed in patients with schizophrenia already by 4 weeks of olanzapine therapy (all P < 0.05), with no obvious changes observed in high-density lipoprotein cholesterol (HDL-C) (P > 0.05). In conclusion, olanzapine-induced dyslipidemia, characterized by increased TG, TC, and LDL-C levels, was observed in patients with schizophrenia already by 4 weeks of olanzapine treatment.
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