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Neal MA, Strawbridge R, Wing VC, Cousins DA, Thelwall PE. Human brain 7Li-MRI following low-dose lithium dietary supplementation in healthy participants. J Affect Disord 2024; 360:139-145. [PMID: 38810780 DOI: 10.1016/j.jad.2024.05.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/10/2024] [Accepted: 05/24/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Lithium is an effective mood stabiliser, but its mechanism of action is incompletely defined. Even at very low doses, lithium may have neuroprotective effects, but it is not clear if these relate to brain lithium concentration in vivo. We have developed magnetic resonance imaging (7Li-MRI) methods to detect lithium in the brain following supplementation at a very low dose. METHODS Lithium orotate supplements were taken by nine healthy adult male subjects (5 mg daily) for up to 28 days, providing 2-7 % of the lithium content of a typical therapeutic lithium carbonate dose. One-dimensional 7Li-images were acquired on a 3.0 T MRI scanner. All subjects were scanned on day 14 or 28; seven were scanned on both, one at baseline and one after 7-days washout. RESULTS 7Li-MR signal amplitude was broadly stable between days 14 and 28. Two subjects had notably higher 7Li-signal intensities (approximately 2-4×) compared to other study participants. LIMITATIONS Lithium adherence was self-reported by all participants without formal validation. The coarse spatial resolution necessary for detection of low concentrations of 7Li exhibits imperfect spatial separation of signal from adjacent pixels. CONCLUSIONS 7Li-MRI performed using a clinical 3T scanner demonstrated detection of lithium in the brain at very low concentration, in the range of approximately 10-60 mM. The methods are suited to studies assessing low dose lithium administration in psychiatric and neurodegenerative disorders, and permit the comparison of different lithium salt preparations at a time of emerging interest in the field.
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Affiliation(s)
- Mary A Neal
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Newcastle Magnetic Resonance Centre, Health Innovation Neighbourhood, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Victoria C Wing
- Newcastle Magnetic Resonance Centre, Health Innovation Neighbourhood, Newcastle University, Newcastle upon Tyne, UK; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - David A Cousins
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Newcastle Magnetic Resonance Centre, Health Innovation Neighbourhood, Newcastle University, Newcastle upon Tyne, UK; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK.
| | - Peter E Thelwall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Newcastle Magnetic Resonance Centre, Health Innovation Neighbourhood, Newcastle University, Newcastle upon Tyne, UK
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Luo H, Chevillard L, Bellivier F, Mégarbane B, Etain B, Cisternino S, Declèves X. The role of brain barriers in the neurokinetics and pharmacodynamics of lithium. Pharmacol Res 2021; 166:105480. [PMID: 33549730 DOI: 10.1016/j.phrs.2021.105480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/14/2021] [Accepted: 02/01/2021] [Indexed: 12/14/2022]
Abstract
Lithium (Li) is the most widely used mood stabilizer in treating patients with bipolar disorder. However, more than half of the patients do not or partially respond to Li therapy, despite serum Li concentrations in the serum therapeutic range. The exact mechanisms underlying the pharmacokinetic-pharmacodynamic (PK-PD) relationships of lithium are still poorly understood and alteration in the brain pharmacokinetics of lithium may be one of the mechanisms explaining the variability in the clinical response to Li. Brain barriers such as the blood-brain barrier (BBB) and the blood-cerebrospinal fluid barrier (BCSFB) play a crucial role in controlling blood-to-brain and brain-to-blood exchanges of various molecules including central nervous system (CNS) drugs. Recent in vivo studies by nuclear resonance spectroscopy revealed heterogenous brain distribution of Li in human that were not always correlated with serum concentrations, suggesting regional and variable transport mechanisms of Li through the brain barriers. Moreover, alteration in the functionality and integrity of brain barriers is reported in various CNS diseases, as a cause or a consequence and in this regard, Li by itself is known to modulate BBB properties such as the expression and activity of various transporters, metabolizing enzymes, and the specialized tight junction proteins on BBB. In this review, we will focus on recent knowledge into the role of the brain barriers as key-element in the Li neuropharmacokinetics which might improve the understanding of PK-PD of Li and its interindividual variability in drug response.
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Affiliation(s)
- Huilong Luo
- Université de Paris, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France; Department of Chemical and Biological Engineering, University of Wisconsin-Madison, USA
| | - Lucie Chevillard
- Université de Paris, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France
| | - Frank Bellivier
- Université de Paris, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France; Department of Psychiatry, Lariboisière Hospital, AP-HP, 75010 Paris, France
| | - Bruno Mégarbane
- Université de Paris, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France; Department of Medical and Toxicological Critical Care, Lariboisière Hospital, AP-HP, 75010 Paris, France
| | - Bruno Etain
- Université de Paris, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France; Department of Psychiatry, Lariboisière Hospital, AP-HP, 75010 Paris, France
| | - Salvatore Cisternino
- Université de Paris, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France; Service de Pharmacie, AP-HP, Hôpital Necker, 149 Rue de Sèvres, 75015 Paris, France
| | - Xavier Declèves
- Université de Paris, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006 Paris, France; Biologie du Médicament, AP-HP, Hôpital Cochin, 27 rue du Faubourg, St. Jacques, 75679 Paris Cedex 14, France.
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Smith FE, Thelwall PE, Necus J, Flowers CJ, Blamire AM, Cousins DA. 3D 7Li magnetic resonance imaging of brain lithium distribution in bipolar disorder. Mol Psychiatry 2018; 23:2184-2191. [PMID: 29426954 PMCID: PMC5955212 DOI: 10.1038/s41380-018-0016-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/19/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022]
Abstract
Lithium is a major treatment for bipolar disorder and the likelihood of a favourable response may be determined by its distribution in the brain. Lithium can be directly detected by magnetic resonance (MR), but previous 7Li MR spectroscopy studies have demonstrated that this is challenging compared to conventional 1H MR imaging due to the MR properties of the lithium nucleus and its low concentration in brain tissue, as dictated by therapeutic dose. We have tested and implemented a highly efficient balanced steady-state free precession 7Li-MRI method to address these challenges and enable MRI of brain lithium in a short duration scan. We report a 3D 7Li-MRI acquisition with 25 mm isotropic resolution in an 8-min scan that demonstrates heterogeneity in lithium concentration within the brain in subjects with bipolar disorder. This represents the direct imaging of a pharmaceutical agent in its target organ and notably expands the repertoire of techniques available to investigate the effects of lithium in man.
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Affiliation(s)
- Fiona Elizabeth Smith
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
- Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Peter Edward Thelwall
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
- Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Joe Necus
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Carly Jay Flowers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Andrew Matthew Blamire
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
- Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - David Andrew Cousins
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.
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Lee JH, Adler C, Norris M, Chu WJ, Fugate EM, Strakowski SM, Komoroski RA. 4-T 7Li 3D MR spectroscopy imaging in the brains of bipolar disorder subjects. Magn Reson Med 2012; 68:363-8. [PMID: 22692991 PMCID: PMC3396736 DOI: 10.1002/mrm.24361] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 05/07/2012] [Accepted: 05/13/2012] [Indexed: 11/08/2022]
Abstract
This work demonstrates the first whole brain "high spatial resolution" (7)Li MR spectroscopy imaging in bipolar disorder subjects. The in vivo quantification is validated by a phantom containing 5 mM lithium salt using the identical radiofrequency sequence and imaging protocol. This study is the first demonstration of the (7)Li distribution in the brain of bipolar disorder patients on lithium therapy using a 3D MR spectroscopy imaging approach. The results show that brain lithium level is strongly correlated with serum lithium concentration. The brain-to-serum lithium ratios for the average brain and the local maximum were 0.39 ± 0.08 (r = 0.93) and 0.92 ± 0.16 (r = 0.90), respectively. The lithium distribution is found to be nonuniform throughout the brain for all patients, which is somewhat unexpected and highly intriguing. This uneven distribution is more evident in subjects at a higher therapeutic serum lithium level. This finding may suggest that lithium targets specific brain tissues and/or certain enzymatic and macromolecular sites that are associated with therapeutic effect. Further investigations of bipolar disorder patients on lithium therapy using 3D (7)Li MR spectroscopy imaging are warranted.
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Affiliation(s)
- Jing-Huei Lee
- School of Energy, Environmental, Biological, and Medical Engineering, University of Cincinnati, Cincinnati, Ohio45267-0583 , USA.
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Smith FE, Cousins DA, Thelwall PE, Ferrier IN, Blamire AM. Quantitative lithium magnetic resonance spectroscopy in the normal human brain on a 3 T clinical scanner. Magn Reson Med 2011; 66:945-9. [DOI: 10.1002/mrm.22923] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 01/18/2011] [Accepted: 02/21/2011] [Indexed: 11/12/2022]
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Abstract
The biomedical applications of 7Li MRS and MRI have been progressing slowly. The interest derives primarily from the clinical use of Li to treat bipolar disorder. One area of concern is the nature of ionic transport and binding, so as to elucidate the mechanism(s) of therapeutic action and toxicity. Another is the development of a non-invasive, in vivo analytical tool to measure brain Li concentration and environment in humans, both as an adjunct to treatment and as a mechanistic probe. Here we review the most recent progress toward these goals.
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Affiliation(s)
- Richard A Komoroski
- Department of Radiology, University of Arkansas for Medical Sciences, South Central Mental Illness Research, Education, and Clinical Center (MIRECC), US Veterans Healthcare System, Little Rock, Arkansas 72114, USA.
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Ramaprasad S. Lithium spectroscopic imaging of rat brain at therapeutic doses. Magn Reson Imaging 2004; 22:727-34. [PMID: 15172068 DOI: 10.1016/j.mri.2004.01.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2003] [Accepted: 01/30/2004] [Indexed: 10/26/2022]
Abstract
Since the discovery that lithium (Li) is efficacious for the treatment of manic depressive illness, the brain Li distribution of mammals treated with lithium has been of interest. However, the spatial relationship of lithium in the brain regions to its function remains largely unknown. Knowledge of Li distribution in the brain is necessary to localize its action in the brain. Both the therapeutic and neurotoxic side effects of Li are centered mainly in the central nervous system and hence there is considerable interest in understanding the extent of lithium penetration into the central nervous system. The mechanism by which neurotoxic side effects are generated is not known and may, in part, be related to the particular distribution of lithium in the brain. The regional specificity in lithium's brain distribution could underlie important steps on its action. Li levels in various brain regions for autopsied rats and humans have been reported. However, many results are conflicting due to ion redistribution at death or during sample preparation. A direct nondestructive measurement of Li levels in the brain where the drug exerts its effects is certainly desirable. Because magnetic resonance technique can be used to observe Li, it can be an appropriate method to monitor and map the distribution in the brain. The application of MR technology to rat brain regions has provided information on lithium distribution in a non-invasive manner. The earlier development work at lower field strengths provided brain lithium information at high dose of Li administration. Here we demonstrate the feasibility of quantitative spectroscopic imaging on rat brain under therapeutic doses.
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Affiliation(s)
- S Ramaprasad
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE 68198-1045, USA.
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Bosetti F, Seemann R, Rapoport SI. Chronic lithium chloride administration to rats decreases brain protein level of epsilon (epsilon) subunit of eukaryotic initiation factor-2B. Neurosci Lett 2002; 327:71-3. [PMID: 12098503 DOI: 10.1016/s0304-3940(02)00354-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The eukaryotic initiation factor-2B (eIF-2B) can regulate translation and protein synthesis. We used Western blot analysis to quantify the protein level of the catalytic epsilon (epsilon) subunit of eIF-2B in brains of rats fed lithium chloride (LiCl) for 6 weeks so as to produce a brain lithium concentration that is therapeutically effective in bipolar disorder. The ratio of eIF-2B (epsilon) to actin protein was significantly reduced (P<0.01) in LiCl-fed rats, 0.86+/-0.06 (SE) compared to 1.2+/-0.07 in control rats. These results suggest that a therapeutic level of lithium may downregulate the synthesis of proteins whose translation depends on eIF-2B.
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Affiliation(s)
- Francesca Bosetti
- Brain Physiology and Metabolism Section, National Institute on Aging, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 6N202, Bethesda, MD 20892, USA.
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