An attempt to predict daily erythrocyte lithium fluctuations

How different methodologies of harvesting and analysing the samples affect the test results in determining joint mediators

Purpose. This study has researched the affect of different methodologies of harvesting and analysing the samples in determining the mediators emerging after the rat articular cartilage injury. Materials and Methods. One hundred and forty-four male wistar rats were divided into 2 groups. Synovial fluid samples were taken from all of the rats. We entered into the right knees of the rats in group I (n = 36) under anaesthesia and took cartilage tissue samples from their distal femur. Samples were taken as reference values for enzyme linked immunosorbent assay (ELISA) and histopathological evaluations. We entered into the right knees of the rats in group II (n = 108) and formed complete layer of cartilage injury in their medial femoral condyles. At the end of the 15th day, the rats were sacrificed after taking synovial fluid samples from their right knees creating defect in the rats in group II. The molecular markers in the synovial fluid and cartilage tissue samples which were taken from the experimental and control groups (MMP-9, MMP-13, TIMP-1, TNF- α , and NO) were analysed by direct or indirect methodologies. SPSS 18.0 Package program was used in the statistical evaluation. Students t-test where the measurement variables between the experimental and control groups were compared was applied. Receiver Operating Characteristics (ROC) curves were used in the determination of the diagnostic sufficiency from the tissue. Results. No difference was found between TIMP-1 (P = 0.67) and MMP-9 (P = 0.28) levels in synovial fluid and cartilage tissue. From the molecular markers, when MMP-9, MMP-13, NO, TIMP-1, TNF- α ', the area under ROC curve, and P values were examined, MMP-13 (P < 0.0001, 95% CI: 0.70-0.85), NO (P < 0.0001, 95% CI: 0.72-0.86), and TNF- α (P < 0.0001, 95% CI: 0.91-0.98) results were found to be statistically significant. Inferences. The indirect ELISA protocol which we apply for the cartilage tissue as an alternative to synovial lavage fluid is a reliable method which can be used in the determination of articular cartilage injury markers.

Comparison of lithium concentrations in red blood cells and plasma in samples collected for TDM, acute toxicity, or acute-on-chronic toxicity

BACKGROUND

Lithium salts (Li+) are still one of the most appropriate treatments in manic-depressive disorders. Since Li+ has a narrow therapeutic index, plasma levels must be closely monitored to verify maintenance pharmacotherapy, to prevent side effects, to evaluate compliance and to avoid increasing rates of relapse. Although it has been reported that Li+ concentrations in red blood cells (RBC) should be a better indicator of brain levels, therapeutic drug monitoring (TDM) of Li+ is not based on its routine assessment.

OBJECTIVE

The aim of this retrospective study was to compare Li+ concentrations in RBC and plasma and the calculated ratio (LiR= RBC/plasma concentrations) in the three groups of patients.

METHODS

During the past 3 years, 309 Li+ measures were collected corresponding to 165 patients classified into three subgroups (TDM, acute or acute-on-chronic intoxication). Li+ plasma (Cplasma) and RBC (CRBC) concentrations were determined by atomic absorption spectrophotometry.

RESULTS

Results showed that Li+ concentrations in plasma are significantly correlated to Li+ concentration in RBC (r=0.81, P<0.0001). Although a wide inter- and intra-variability was found, Cplasma, CRBC and LiR were statistically different in the three groups. Compared with TDM, Cplasma was more elevated in cases of acute intoxication whereas Li+ accumulated preferentially in RBC in cases of acute-on-chronic intoxication.

CONCLUSION

This study shows the interest of determining Li+ in RBC and plasma for TDM, and that LiR could be a sensitive marker of intoxication and of Li+ impregnation.

The effect of delayed gastric emptying and absorption on pharmacokinetic parameters of lithium

Gastrointestinal motility is one of the most important factors than can influence drug absorption from gastrointestinal tract. The aim of the present study was to investigate the effect of delayed gastric emptying and intestinal transit on pharmacokinetic parameters of lithium. Treatment animals were administered an anticholinergic agent (propantheline bromide, 4 mg/kg, p.o.) 10 min before lithium chloride (1.5 mM/kg, p.o.) administration, whereas the control group was administered the same dose of lithium p.o., alone. Plasma lithium levels were measured by flame spectrophotometry and calculated with a computer programme (SIPHAR). Differences detected in AUC, fractionated AUC values, Cmax and tmax suggest that using delayed absorption process, it is possible to prolong by 272% the plateau time of the drug in the therapeutic range and this approach might be an alternative way to prevent some undesirable effects due to peak plasma levels above the maximal therapeutic level. This approach might be more important as an alternative for suitable slow release formulations.