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Guo M, Tao S, Xiong Y, Dong M, Yan Z, Ye Z, Wu D. Comparative analysis of psychiatric medications and their association with falls and fractures: A systematic review and network meta-analysis. Psychiatry Res 2024; 338:115974. [PMID: 38833938 DOI: 10.1016/j.psychres.2024.115974] [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: 02/01/2024] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024]
Abstract
An association between psychiatric medications and falls and fractures in people taking them has been demonstrated, but which class or medication leads to the greatest risk of falls or fractures should be further investigated. The aim of this study was to compare and rank the magnitude of risk of falls and fractures due to different psychiatric medications. Eight databases were searched for this meta-analysis and evaluated using a frequency-based network meta-analysis. The results included a total of 28 papers with 14 medications from 5 major classes, involving 3,467,314 patients. The results showed that atypical antipsychotics were the class of medications with the highest risk of falls, and typical antipsychotics were the class of medications with the highest risk of resulting in fractures. Quetiapine ranked first in the category of 13 medications associated with risk of falls, and class Z drugs ranked first in the category of 6 medications associated with risk of fractures. The available evidence suggests that atypical antipsychotics and typical antipsychotics may be the drugs with the highest risk of falls and fractures, respectively. Quetiapine may be the medication with the highest risk of falls, and class Z drugs may be the medication with the highest risk of fractures.
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Affiliation(s)
- Mengjia Guo
- School of Nursing, Chengdu University of Traditional Chinese Medicine, China
| | - Silu Tao
- School of Nursing, Chengdu University of Traditional Chinese Medicine, China
| | - Yi Xiong
- School of Nursing, Chengdu University of Traditional Chinese Medicine, China
| | - Meijun Dong
- School of Nursing, Chengdu University of Traditional Chinese Medicine, China
| | - Zhangrong Yan
- School of Nursing, Chengdu University of Traditional Chinese Medicine, China
| | - Zixiang Ye
- Department of Nursing, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Dongmei Wu
- Department of Nursing, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.
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2
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Langlais AL, Mountain RV, Kunst RF, Barlow D, Houseknecht KL, Motyl KJ. Thermoneutral housing does not rescue olanzapine-induced trabecular bone loss in C57BL/6J female mice. Biochimie 2023; 210:50-60. [PMID: 37236340 PMCID: PMC10357956 DOI: 10.1016/j.biochi.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023]
Abstract
Antipsychotic drugs are prescribed to a wide range of individuals to treat mental health conditions including schizophrenia. However, antipsychotic drugs cause bone loss and increase fracture risk. We previously found that the atypical antipsychotic (AA) drug risperidone causes bone loss through multiple pharmacological mechanisms, including activation of the sympathetic nervous system in mice treated with clinically relevant doses. However, bone loss was dependent upon housing temperature, which modulates sympathetic activity. Another AA drug, olanzapine, has substantial metabolic side effects, including weight gain and insulin resistance, but it is unknown whether bone and metabolic outcomes of olanzapine are also dependent upon housing temperature in mice. We therefore treated eight week-old female mice with vehicle or olanzapine for four weeks, housed at either room temperature (23 °C) or thermoneutrality (28-30 °C), which has previously been shown to be positive for bone. Olanzapine caused significant trabecular bone loss (-13% BV/TV), likely through increased RANKL-dependent osteoclast resorption, which was not suppressed by thermoneutral housing. Additionally, olanzapine inhibited cortical bone expansion at thermoneutrality, but did not alter cortical bone expansion at room temperature. Olanzapine also increased markers of thermogenesis within brown and inguinal adipose depots independent of housing temperature. Overall, olanzapine causes trabecular bone loss and inhibits the positive effect of thermoneutral housing on bone. Understanding how housing temperature modulates the impact of AA drugs on bone is important for future pre-clinical studies, as well as for the prescription of AA drugs, particularly to older adults and adolescents who are most vulnerable to the effects on bone.
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Affiliation(s)
- Audrie L Langlais
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, ME, USA; Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME, USA
| | - Rebecca V Mountain
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, ME, USA
| | - Roni F Kunst
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, ME, USA
| | - Deborah Barlow
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Karen L Houseknecht
- Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME, USA; Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Katherine J Motyl
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, ME, USA; Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME, USA; Tufts University School of Medicine, Tufts University, Boston, MA, USA.
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3
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Weerasinghe DK, Hodge JM, Pasco JA, Samarasinghe RM, Azimi Manavi B, Williams LJ. Antipsychotic-induced bone loss: the role of dopamine, serotonin and adrenergic receptor signalling. Front Cell Dev Biol 2023; 11:1184550. [PMID: 37305679 PMCID: PMC10248006 DOI: 10.3389/fcell.2023.1184550] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Antipsychotics are commonly used in treating psychiatric disorders. These medications primarily target dopamine the serotonin receptors, they have some affinity to adrenergic, histamine, glutamate and muscarinic receptors. There is clinical evidence that antipsychotic use decreases BMD and increases fracture risk, with dopamine, serotonin and adrenergic receptor-signalling becoming an increasing area of focus where the presence of these receptors in osteoclasts and osteoblasts have been demonstrated. Osteoclasts and osteoblasts are the most important cells in the bone remodelling and the bone regeneration process where the activity of these cells determine the bone resorption and formation process in order to maintain healthy bone. However, an imbalance in osteoclast and osteoblast activity can lead to decreased BMD and increased fracture risk, which is also believed to be exacerbated by antipsychotics use. Therefore, the aim of this review is to provide an overview of the mechanisms of action of first, second and third generation antipsychotics and the expression profiles of dopamine, serotonin and adrenergic receptors during osteoclastogenesis and osteoblastogenesis.
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Affiliation(s)
- D. Kavindi Weerasinghe
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Jason M. Hodge
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
| | - Julie A. Pasco
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine—Western Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rasika M. Samarasinghe
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Behnaz Azimi Manavi
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Lana J. Williams
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
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Gangopadhyay A, Ibrahim R, Theberge K, May M, Houseknecht KL. Non-alcoholic fatty liver disease (NAFLD) and mental illness: Mechanisms linking mood, metabolism and medicines. Front Neurosci 2022; 16:1042442. [PMID: 36458039 PMCID: PMC9707801 DOI: 10.3389/fnins.2022.1042442] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/21/2022] [Indexed: 09/26/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the world and one of the leading indications for liver transplantation. It is one of the many manifestations of insulin resistance and metabolic syndrome as well as an independent risk factor for cardiovascular disease. There is growing evidence linking the incidence of NAFLD with psychiatric illnesses such as schizophrenia, bipolar disorder and depression mechanistically via genetic, metabolic, inflammatory and environmental factors including smoking and psychiatric medications. Indeed, patients prescribed antipsychotic medications, regardless of diagnosis, have higher incidence of NAFLD than population norms. The mechanistic pharmacology of antipsychotic-associated NAFLD is beginning to emerge. In this review, we aim to discuss the pathophysiology of NAFLD including its risk factors, insulin resistance and systemic inflammation as well as its intersection with psychiatric illnesses.
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Affiliation(s)
| | | | | | | | - Karen L. Houseknecht
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States
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Zhang S, He W, Li A, Zhao C, Chen Y, Xu C, Zhang Q, Zheng D, Chen M, Miao H, Huang Y. Involvement of the TNF-α/SATB2 axis in the induced apoptosis and inhibited autophagy of osteoblasts by the antipsychotic Risperidone. Mol Med 2022; 28:46. [PMID: 35505281 PMCID: PMC9066868 DOI: 10.1186/s10020-022-00466-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 03/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Risperidone, an atypical antipsychotic, impedes serotonin and dopamine receptor systems. Meanwhile, tumor necrosis factor-α (TNF-α) is known to participate in regulating osteoblast functions. Consequently, the current study aimed to investigate whether the influences of Risperidone on osteoblast functions are associated with TNF-α and special AT-rich sequence-binding protein (SATB2). METHODS Firstly, we searched the DGIdb, MEM and GeneCards databases to identify the critical factors involved in the effects of Risperidone on osteoblasts, as well as their interactions. Afterwards, osteoblast cell line MC3T3-E1 was transduced with lentivirus carrying si-TNF-α, si-SATB2 or both and subsequently treated with Risperidone. Various abilities including differentiation, autophagy and apoptosis of osteoblasts were examined after different treatments. Finally, animal experiments were performed with Risperidone alone or together with lentivirus to verify the function of Risperidone in vivo and the mechanism. RESULTS It was found that Risperidone might promote TNF-α expression, thereby inhibiting the expression of SATB2 to affect the autophagy and apoptosis in osteoblasts. Furthermore, as shown by our experimental findings, Risperidone treatment inhibited the differentiation and autophagy, and promoted the apoptosis of osteoblasts, as evidenced by elevated levels of OPG, p62, cleaved PARP1, cleaved caspase-3, cleaved caspase-8, and cleaved caspase-9, and reduced levels of LC3 II/I, Beclin1, collagen I, and RANKL. In addition, Risperidone was also found to elevate the expression of TNF-α to down-regulate SATB2, thereby inhibiting the differentiation and autophagy and enhancing the apoptosis of osteoblasts in vitro and in vivo. CONCLUSIONS Collectively, our findings indicated that Risperidone affects the differentiation of osteoblasts by inhibiting autophagy and enhancing apoptosis via TNF-α-mediated down-regulation of SATB2.
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Affiliation(s)
- Shuyao Zhang
- Department of Pharmacy, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Wei He
- Department of Pharmacy, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Aiguo Li
- Department of Orthopaedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Chengkuan Zhao
- Department of Pharmacy, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
- Department of Pharmacology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Yun Chen
- Department of Pharmacy, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Chengcheng Xu
- Department of Pharmacy, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
- Department of Pharmacology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Qiuzhen Zhang
- Department of Pharmacy, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
- Department of Pharmacology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Danling Zheng
- Department of Pharmacology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Meini Chen
- Department of Pharmacology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Haixiong Miao
- Department of Orthopaedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
- Department of Pediatrics, Guangzhou Red Cross Hospital, Jinan University, No. 396, Tongfuzhong Road, Haizhu District, Guangzhou, 510220, Guangdong, China
| | - Yihui Huang
- Department of Pediatrics, Shantou University Medical College, Shantou, 515041, China
- Department of Pediatrics, Guangzhou Red Cross Hospital, Jinan University, No. 396, Tongfuzhong Road, Haizhu District, Guangzhou, 510220, Guangdong, China
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6
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The Effects of Osteoporotic and Non-osteoporotic Medications on Fracture Risk and Bone Mineral Density. Drugs 2021; 81:1831-1858. [PMID: 34724173 PMCID: PMC8578161 DOI: 10.1007/s40265-021-01625-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 12/26/2022]
Abstract
Osteoporosis is a highly prevalent bone disease affecting more than 37.5 million individuals in the European Union (EU) and the United States of America (USA). It is characterized by low bone mineral density (BMD), impaired bone quality, and loss of structural and biomechanical properties, resulting in reduced bone strength. An increase in morbidity and mortality is seen in patients with osteoporosis, caused by the approximately 3.5 million new osteoporotic fractures occurring every year in the EU. Currently, different medications are available for the treatment of osteoporosis, including anti-resorptive and osteoanabolic medications. Bisphosphonates, which belong to the anti-resorptive medications, are the standard treatment for osteoporosis based on their positive effects on bone, long-term experience, and low costs. However, not only medications used for the treatment of osteoporosis can affect bone: several other medications are suggested to have an effect on bone as well, especially on fracture risk and BMD. Knowledge about the positive and negative effects of different medications on both fracture risk and BMD is important, as it can contribute to an improvement in osteoporosis prevention and treatment in general, and, even more importantly, to the individual's health. In this review, we therefore discuss the effects of both osteoporotic and non-osteoporotic medications on fracture risk and BMD. In addition, we discuss the underlying mechanisms of action.
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7
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Kunst RF, Langlais AL, Barlow D, Houseknecht KL, Motyl KJ. Housing Temperature Influences Atypical Antipsychotic Drug-Induced Bone Loss in Female C57BL/6J Mice. JBMR Plus 2021; 5:e10541. [PMID: 34693191 PMCID: PMC8520062 DOI: 10.1002/jbm4.10541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/01/2021] [Accepted: 08/13/2021] [Indexed: 12/15/2022] Open
Abstract
Atypical antipsychotic (AA) drugs, such as risperidone, are associated with endocrine and metabolic side effects, including impaired bone mineral density (BMD) acquisition and increased fracture risk. We have previously shown that risperidone causes bone loss through the sympathetic nervous system and that bone loss is associated with elevated markers of thermogenesis in brown and white adipose tissue. Because rodents are normally housed in sub‐thermoneutral conditions, we wanted to test whether increasing housing temperature would protect against bone loss from risperidone. Four weeks of risperidone treatment in female C57BL/6J mice at thermoneutral (28°C) housing attenuated risperidone‐induced trabecular bone loss and led to a low‐turnover bone phenotype, with indices of both bone formation and resorption suppressed in mice with risperidone treatment at thermoneutrality, whereas indices of bone resorption were elevated by risperidone at room temperature. Protection against trabecular bone loss was not absolute, however, and additional evidence of cortical bone loss emerged in risperidone‐treated mice at thermoneutrality. Taken together, these findings suggest thermal challenge may be in part responsible for bone loss with risperidone treatment and that housing temperature should be considered when assessing bone outcomes of treatments that impact thermogenic pathways. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Roni F Kunst
- Center for Molecular Medicine Maine Medical Center Research Institute Scarborough ME USA
| | - Audrie L Langlais
- Center for Molecular Medicine Maine Medical Center Research Institute Scarborough ME USA.,Graduate School of Biomedical Sciences and Engineering, University of Maine Orono ME USA
| | - Deborah Barlow
- College of Osteopathic Medicine, University of New England Biddeford ME USA
| | | | - Katherine J Motyl
- Center for Molecular Medicine Maine Medical Center Research Institute Scarborough ME USA.,Graduate School of Biomedical Sciences and Engineering, University of Maine Orono ME USA.,Tufts University School of Medicine, Tufts University Boston MA USA
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8
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Pecorelli A, Cordone V, Schiavone ML, Caffarelli C, Cervellati C, Cerbone G, Gonnelli S, Hayek J, Valacchi G. Altered Bone Status in Rett Syndrome. Life (Basel) 2021; 11:life11060521. [PMID: 34205017 PMCID: PMC8230033 DOI: 10.3390/life11060521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022] Open
Abstract
Rett syndrome (RTT) is a monogenic neurodevelopmental disorder primarily caused by mutations in X-linked MECP2 gene, encoding for methyl-CpG binding protein 2 (MeCP2), a multifaceted modulator of gene expression and chromatin organization. Based on the type of mutation, RTT patients exhibit a broad spectrum of clinical phenotypes with various degrees of severity. In addition, as a complex multisystem disease, RTT shows several clinical manifestations ranging from neurological to non-neurological symptoms. The most common non-neurological comorbidities include, among others, orthopedic complications, mainly scoliosis but also early osteopenia/osteoporosis and a high frequency of fractures. A characteristic low bone mineral density dependent on a slow rate of bone formation due to dysfunctional osteoblast activity rather than an increase in bone resorption is at the root of these complications. Evidence from human and animal studies supports the idea that MECP2 mutation could be associated with altered epigenetic regulation of bone-related factors and signaling pathways, including SFRP4/WNT/β-catenin axis and RANKL/RANK/OPG system. More research is needed to better understand the role of MeCP2 in bone homeostasis. Indeed, uncovering the molecular mechanisms underlying RTT bone problems could reveal new potential pharmacological targets for the treatment of these complications that adversely affect the quality of life of RTT patients for whom the only therapeutic approaches currently available include bisphosphonates, dietary supplements, and physical activity.
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Affiliation(s)
- Alessandra Pecorelli
- Animal Science Department, Plants for Human Health Institute, North Carolina State University, Kannapolis, NC 28081, USA;
- Correspondence: (A.P.); (G.V.)
| | - Valeria Cordone
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy;
| | - Maria Lucia Schiavone
- Animal Science Department, Plants for Human Health Institute, North Carolina State University, Kannapolis, NC 28081, USA;
| | - Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy; (C.C.); (S.G.)
| | - Carlo Cervellati
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy;
| | - Gaetana Cerbone
- Division of Medical Genetics, “S.G. Moscati” Hospital, 74100 Avellino, Italy;
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy; (C.C.); (S.G.)
| | - Joussef Hayek
- Toscana Life Sciences Foundation, 53100 Siena, Italy;
| | - Giuseppe Valacchi
- Animal Science Department, Plants for Human Health Institute, North Carolina State University, Kannapolis, NC 28081, USA;
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy;
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea
- Correspondence: (A.P.); (G.V.)
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Taguchi T, Lopez MJ. An overview of de novo bone generation in animal models. J Orthop Res 2021; 39:7-21. [PMID: 32910496 PMCID: PMC7820991 DOI: 10.1002/jor.24852] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 02/04/2023]
Abstract
Some of the earliest success in de novo tissue generation was in bone tissue, and advances, facilitated by the use of endogenous and exogenous progenitor cells, continue unabated. The concept of one health promotes shared discoveries among medical disciplines to overcome health challenges that afflict numerous species. Carefully selected animal models are vital to development and translation of targeted therapies that improve the health and well-being of humans and animals alike. While inherent differences among species limit direct translation of scientific knowledge between them, rapid progress in ex vivo and in vivo de novo tissue generation is propelling revolutionary innovation to reality among all musculoskeletal specialties. This review contains a comparison of bone deposition among species and descriptions of animal models of bone restoration designed to replicate a multitude of bone injuries and pathology, including impaired osteogenic capacity.
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Affiliation(s)
- Takashi Taguchi
- Laboratory for Equine and Comparative Orthopedic Research, Department of Veterinary Clinical Sciences, School of Veterinary MedicineLouisiana State UniversityBaton RougeLouisianaUSA
| | - Mandi J. Lopez
- Laboratory for Equine and Comparative Orthopedic Research, Department of Veterinary Clinical Sciences, School of Veterinary MedicineLouisiana State UniversityBaton RougeLouisianaUSA
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Amini A, Namvarpour Z, Namvarpour M, Raoofi A. Risperidone accelerates bone loss in rats with autistic-like deficits induced by maternal lipopolysaccharides exposure. Life Sci 2020; 258:118197. [PMID: 32781059 DOI: 10.1016/j.lfs.2020.118197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/22/2020] [Accepted: 07/31/2020] [Indexed: 02/07/2023]
Abstract
AIMS Patients with neurodevelopmental disorders, usually suffer from bone diseases. Many studies have revealed a higher risk of fracture after atypical antipsychotic drug Risperidone (RIS) treatment, which is usually used to treat such disorders. It remains debatable whether neurodevelopmental disorders by itself are the cause of bone diseases or pharmacotherapy may be the reason. MATERIALS AND METHODS This study attempts to evaluate the biomechanical, histological, stereological, and molecular properties of bones in the offspring of Lipopolysaccharide (LPS) and saline-treated mothers that received saline, drug vehicle or the atypical antipsychotic drug risperidone (RIS) at different days of postnatal development. After postnatal drug treatment, animals were assessed for autistic-like behaviors. Then their bones were taken for evaluations. RESULTS Maternal LPS exposure resulted in deficits in all behavioral tests and RIS ameliorated these behaviors (p < 0.01& p < 0.05). The administration of LPS and RIS individually led to a significant decrease in the biomechanical parameters such as bone stiffness, strength and the energy used to fracture of bone. The numerical density of osteocalcin-positive cells were significantly decreased in these groups. These rats also had decreased RUNX2 and osteocalcin gene expression. When LPS rats were treated with RIS, these conditions were accelerated (p < 0.001). DISCUSSIONS The results of our preclinical study, consistent with previous studies in animals, explore that autistic-like deficits induced by prenatal exposure to LPS, can reduce bone stability and bone mass similar to those observed in neurodevelopmental disorders, and, for the first time, reveal that this condition worsened when these animals were treated with RIS.
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Affiliation(s)
- Abdollah Amini
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Namvarpour
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Institute for Cognitive Science Studies (ICSS), Tehran, Iran.
| | - Mozhdeh Namvarpour
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Raoofi
- Leishmaniasis Research Center, Department of Anatomy, Sabzevar University of Medical Sciences, Sabzevar, Iran
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11
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May M, Slitzky M, Rostama B, Barlow D, Houseknecht KL. Antipsychotic-induced immune dysfunction: A consideration for COVID-19 risk. Brain Behav Immun Health 2020; 6:100097. [PMID: 32835296 PMCID: PMC7308744 DOI: 10.1016/j.bbih.2020.100097] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 02/08/2023] Open
Abstract
Patients with severe mental illness are more susceptible to infections for a variety of reasons, some associated with the underlying disease and some due to environmental factors including housing insecurity, smoking, poor access to healthcare, and medications used to treat these disorders. This increased susceptibility to respiratory infections may contribute to risk of COVID-19 infection in patients with severe mental illness or those in inpatient settings. Atypical antipsychotic (AA) medications are FDA approved to treat symptoms associated with schizophrenia, bipolar disorder, depression and irritability associated with autism. Our team and others have shown that AA may have anti-inflammatory properties that may contribute to their efficacy in the treatment of mental health disorders. Additionally, AA are widely prescribed off-label for diverse indications to non-psychotic patients including older adults, who are also at increased risk for COVID-19 complications and mortality. The aim of this study was to determine if AA medications such as risperidone (RIS) alter the ability to mount an appropriate response to an acute inflammatory or adaptive immune challenge using a preclinical model. Short-term treatment of healthy mice with a dose of RIS that achieves plasma concentrations within the low clinical range resulted in disrupted response to an inflammatory (LPS) challenge compared to vehicle controls. Furthermore, RIS also prevented treated animals from mounting an antibody response following vaccination with Pneumovax23®. These data indicate that short-to intermediate-term exposure to clinically relevant levels of RIS dysregulate innate and adaptive immune responses, which may affect susceptibility to respiratory infections, including COVID-19.
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Affiliation(s)
- Meghan May
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Matthew Slitzky
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Bahman Rostama
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Deborah Barlow
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Karen L Houseknecht
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
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Tratwal J, Labella R, Bravenboer N, Kerckhofs G, Douni E, Scheller EL, Badr S, Karampinos DC, Beck-Cormier S, Palmisano B, Poloni A, Moreno-Aliaga MJ, Fretz J, Rodeheffer MS, Boroumand P, Rosen CJ, Horowitz MC, van der Eerden BCJ, Veldhuis-Vlug AG, Naveiras O. Reporting Guidelines, Review of Methodological Standards, and Challenges Toward Harmonization in Bone Marrow Adiposity Research. Report of the Methodologies Working Group of the International Bone Marrow Adiposity Society. Front Endocrinol (Lausanne) 2020; 11:65. [PMID: 32180758 PMCID: PMC7059536 DOI: 10.3389/fendo.2020.00065] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/31/2020] [Indexed: 12/14/2022] Open
Abstract
The interest in bone marrow adiposity (BMA) has increased over the last decade due to its association with, and potential role, in a range of diseases (osteoporosis, diabetes, anorexia, cancer) as well as treatments (corticosteroid, radiation, chemotherapy, thiazolidinediones). However, to advance the field of BMA research, standardization of methods is desirable to increase comparability of study outcomes and foster collaboration. Therefore, at the 2017 annual BMA meeting, the International Bone Marrow Adiposity Society (BMAS) founded a working group to evaluate methodologies in BMA research. All BMAS members could volunteer to participate. The working group members, who are all active preclinical or clinical BMA researchers, searched the literature for articles investigating BMA and discussed the results during personal and telephone conferences. According to the consensus opinion, both based on the review of the literature and on expert opinion, we describe existing methodologies and discuss the challenges and future directions for (1) histomorphometry of bone marrow adipocytes, (2) ex vivo BMA imaging, (3) in vivo BMA imaging, (4) cell isolation, culture, differentiation and in vitro modulation of primary bone marrow adipocytes and bone marrow stromal cell precursors, (5) lineage tracing and in vivo BMA modulation, and (6) BMA biobanking. We identify as accepted standards in BMA research: manual histomorphometry and osmium tetroxide 3D contrast-enhanced μCT for ex vivo quantification, specific MRI sequences (WFI and H-MRS) for in vivo studies, and RT-qPCR with a minimal four gene panel or lipid-based assays for in vitro quantification of bone marrow adipogenesis. Emerging techniques are described which may soon come to complement or substitute these gold standards. Known confounding factors and minimal reporting standards are presented, and their use is encouraged to facilitate comparison across studies. In conclusion, specific BMA methodologies have been developed. However, important challenges remain. In particular, we advocate for the harmonization of methodologies, the precise reporting of known confounding factors, and the identification of methods to modulate BMA independently from other tissues. Wider use of existing animal models with impaired BMA production (e.g., Pfrt-/-, KitW/W-v) and development of specific BMA deletion models would be highly desirable for this purpose.
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Affiliation(s)
- Josefine Tratwal
- Laboratory of Regenerative Hematopoiesis, Institute of Bioengineering and Swiss Institute for Experimental Cancer Research, Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Rossella Labella
- Tissue and Tumour Microenvironments Lab, The Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Nathalie Bravenboer
- Department of Clinical Chemistry, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Section of Endocrinology, Department of Internal Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, Netherlands
| | - Greet Kerckhofs
- Biomechanics Lab, Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
- Department Materials Engineering, KU Leuven, Leuven, Belgium
| | - Eleni Douni
- Laboratory of Genetics, Department of Biotechnology, Agricultural University of Athens, Athens, Greece
- Institute for Bioinnovation, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Erica L. Scheller
- Division of Bone and Mineral Diseases, Department of Medicine, Washington University, St. Louis, MO, United States
| | - Sammy Badr
- Univ. Lille, EA 4490 - PMOI - Physiopathologie des Maladies Osseuses Inflammatoires, Lille, France
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Dimitrios C. Karampinos
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Sarah Beck-Cormier
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
| | - Biagio Palmisano
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY, United States
| | - Antonella Poloni
- Hematology, Department of Clinic and Molecular Science, Università Politecnica Marche-AOU Ospedali Riuniti, Ancona, Italy
| | - Maria J. Moreno-Aliaga
- Centre for Nutrition Research and Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra's Health Research Institute, Pamplona, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Centre of Biomedical Research Network, ISCIII, Madrid, Spain
| | - Jackie Fretz
- Department of Orthopaedics and Rehabilitation, Cellular and Developmental Biology, Yale University School of Medicine, New Haven, CT, United States
| | - Matthew S. Rodeheffer
- Department of Comparative Medicine and Molecular, Cellular and Developmental Biology, Yale University School of Medicine, New Haven, CT, United States
| | - Parastoo Boroumand
- Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Clifford J. Rosen
- Maine Medical Center Research Institute, Center for Clinical and Translational Research, Scarborough, ME, United States
| | - Mark C. Horowitz
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, United States
| | - Bram C. J. van der Eerden
- Laboratory for Calcium and Bone Metabolism, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Annegreet G. Veldhuis-Vlug
- Section of Endocrinology, Department of Internal Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, Netherlands
- Maine Medical Center Research Institute, Center for Clinical and Translational Research, Scarborough, ME, United States
- Jan van Goyen Medical Center/OLVG Hospital, Department of Internal Medicine, Amsterdam, Netherlands
- *Correspondence: Annegreet G. Veldhuis-Vlug
| | - Olaia Naveiras
- Laboratory of Regenerative Hematopoiesis, Institute of Bioengineering and Swiss Institute for Experimental Cancer Research, Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Hematology Service, Departments of Oncology and Laboratory Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Olaia Naveiras ;
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13
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Beauchemin M, Geguchadze R, Guntur AR, Nevola K, Le PT, Barlow D, Rue M, Vary CPH, Lary CW, Motyl KJ, Houseknecht KL. Exploring mechanisms of increased cardiovascular disease risk with antipsychotic medications: Risperidone alters the cardiac proteomic signature in mice. Pharmacol Res 2019; 152:104589. [PMID: 31874253 DOI: 10.1016/j.phrs.2019.104589] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/29/2019] [Accepted: 12/05/2019] [Indexed: 02/07/2023]
Abstract
Atypical antipsychotic (AA) medications including risperidone (RIS) and olanzapine (OLAN) are FDA approved for the treatment of psychiatric disorders including schizophrenia, bipolar disorder and depression. Clinical side effects of AA medications include obesity, insulin resistance, dyslipidemia, hypertension and increased cardiovascular disease risk. Despite the known pharmacology of these AA medications, the mechanisms contributing to adverse metabolic side-effects are not well understood. To evaluate drug-associated effects on the heart, we assessed changes in the cardiac proteomic signature in mice administered for 4 weeks with clinically relevant exposure of RIS or OLAN. Using proteomic and gene enrichment analysis, we identified differentially expressed (DE) proteins in both RIS- and OLAN-treated mouse hearts (p < 0.05), including proteins comprising mitochondrial respiratory complex I and pathways involved in mitochondrial function and oxidative phosphorylation. A subset of DE proteins identified were further validated by both western blotting and quantitative real-time PCR. Histological evaluation of hearts indicated that AA-associated aberrant cardiac gene expression occurs prior to the onset of gross pathomorphological changes. Additionally, RIS treatment altered cardiac mitochondrial oxygen consumption and whole body energy expenditure. Our study provides insight into the mechanisms underlying increased patient risk for adverse cardiac outcomes with chronic treatment of AA medications.
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Affiliation(s)
- Megan Beauchemin
- College of Osteopathic Medicine, University of New England, Biddeford, ME, United States
| | - Ramaz Geguchadze
- College of Osteopathic Medicine, University of New England, Biddeford, ME, United States
| | - Anyonya R Guntur
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, ME, United States
| | - Kathleen Nevola
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, United States; Sackler School for Graduate Biomedical Research, Tufts University, Boston, MA, United States; Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, United States
| | - Phuong T Le
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, ME, United States
| | - Deborah Barlow
- College of Osteopathic Medicine, University of New England, Biddeford, ME, United States
| | - Megan Rue
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, United States
| | - Calvin P H Vary
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, United States
| | - Christine W Lary
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, United States
| | - Katherine J Motyl
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, United States
| | - Karen L Houseknecht
- College of Osteopathic Medicine, University of New England, Biddeford, ME, United States.
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14
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Abstract
The skeleton harbors an array of lineage cells that have an essential role in whole body homeostasis. Adipocytes start the colonization of marrow space early in postnatal life, expanding progressively and influencing other components of the bone marrow through paracrine signaling. In this unique, closed, and hypoxic environment close to the endosteal surface and adjacent to the microvascular space the marrow adipocyte can store or provide energy, secrete adipokines, and target neighboring bone cells. Adipocyte progenitors can also migrate from the bone marrow to populate white adipose tissue, a process that accelerates during weight gain. The marrow adipocyte also has an endocrine role in whole body homeostasis through its varied secretome that targets distant adipose depots, skeletal muscle, and the nervous system. Further insights into the biology of this unique and versatile cell will undoubtedly lead to novel therapeutic approaches to metabolic and age-related disorders such as osteoporosis and diabetes mellitus.
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Affiliation(s)
- Francisco J A de Paula
- Department of Internal Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo 14049-900, Brazil;
| | - Clifford J Rosen
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, Maine 04074, USA;
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15
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May M, Beauchemin M, Vary C, Barlow D, Houseknecht KL. The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice. PLoS One 2019; 14:e0218937. [PMID: 31242264 PMCID: PMC6594635 DOI: 10.1371/journal.pone.0218937] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/12/2019] [Indexed: 01/19/2023] Open
Abstract
Atypical antipsychotic medications such as risperidone are widely prescribed for diverse psychiatric indications including schizophrenia, bipolar disorder and depression. These medications have complex pharmacology and are associated with significant endocrine and metabolic side effects. This class of medications also carries FDA black box warnings due to increased risk of death in elderly patients. Clinical reports indicate that patients treated with these medications are more susceptible to infections; however, the underlying mechanisms/pharmacology are unclear. We have previously reported that risperidone and it’s active metabolite distributes to the bone marrow in clinically relevant concentrations in preclinical species, leading us to hypothesize that the hematopoietic system may be impacted by these medications. To test this hypothesis, using proteomic and cytokine array technology, we evaluated the expression of genes involved in inflammatory and immune function following short term (5 days) and longer term (4 weeks) treatment in healthy animals. We report that low-dose risperidone treatment results in global immunosuppression in mice, observed following 5 days of dosing and exacerbated with longer term drug treatment (4 weeks). These data are consistent with increased susceptibility to infection in patients administered these medications and have profound implications for the increasing off-label prescribing to vulnerable patient populations including children and the elderly.
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Affiliation(s)
- Meghan May
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States of America
| | - Megan Beauchemin
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States of America
| | - Calvin Vary
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, United States of America
| | - Deborah Barlow
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States of America
| | - Karen L. Houseknecht
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States of America
- * E-mail:
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16
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Camerino C, Conte E, Caloiero R, Fonzino A, Carratù M, Lograno MD, Tricarico D. Evaluation of Short and Long Term Cold Stress Challenge of Nerve Grow Factor, Brain-Derived Neurotrophic Factor, Osteocalcin and Oxytocin mRNA Expression in BAT, Brain, Bone and Reproductive Tissue of Male Mice Using Real-Time PCR and Linear Correlation Analysis. Front Physiol 2018; 8:1101. [PMID: 29375393 PMCID: PMC5768886 DOI: 10.3389/fphys.2017.01101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/13/2017] [Indexed: 11/13/2022] Open
Abstract
The correlation between the Ngf/p75ntr-Ntrk1 and Bdnf, Osteocalcin-Ost/Gprc6a and Oxytocin-Oxt/Oxtr genes, was challenged investigating their mRNA levels in 3 months-old mice after cold-stress (CS). Uncoupling protein-1 (Ucp-1) was used as positive control. Control mice were maintained at room temperature T = 25°C, CS mice were maintained at T = 4°C for 6 h and 5-days (N = 15 mice). RT-PCR experiments showed that Ucp-1 and Ngf genes were up-regulated after 6 h CS in brown adipose tissues (BAT), respectively, by 2 and 1.5-folds; Ucp-1 was upregulated also after 5-days, while Ngfr (p75ntr) and Ntrk1 genes were downregulated after 6 h and 5-days CS in BAT. NGF and P75NTR were upregulated in bone and testis following 5-days, and P75NTR in testis after 6 h CS. Bdnf was instead up-regulated in bone following 5-days CS and down-regulated in testis. OST was upregulated by 16 and 3-fold in bone and BAT, respectively, following 5-days CS. Gprc6a was upregulated after 6 h in brain, while Bglap (Ost) gene was downregulated. Oxt gene was upregulated by 5-fold following 5-days CS in bone. Oxtr was upregulated by 0.5 and 0.3-fold, respectively, following 6 h and 5-days CS in brain. Oxtr and Oxt were downregulated in testis and in BAT. The changes in the expression levels of control genes vs. genes following 6 h and 5-days CS were correlated in all tissues, but not in BAT. Correlation in BAT was improved eliminating Ngfr (p75ntr) data. The correlation in brain was lost eliminating Oxtr data. In sum, Ucp-1 potentiation in BAT after cold stress is associated with early Ngf-response in the same tissue and trophic action in bone and testis. In contrast, BDNF exerts bone and neuroprotective effects. Similarly to Ucp-1, Bglap (Ost) signaling is enhanced in bone and BAT while it may exert local neuroprotective effects thought its receptor. Ngfr (p75ntr) regulates the adaptation to CS through a feed-back loop in BAT. Oxtr regulates the gene-response to CS through a feed-forward loop in brain. Overall these results expand the understanding of the physiology of these molecules under metabolic thermogenesis.
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Affiliation(s)
- Claudia Camerino
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Elena Conte
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Roberta Caloiero
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Adriano Fonzino
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Mariarosaria Carratù
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Marcello D Lograno
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Domenico Tricarico
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, Bari, Italy
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17
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Nikolić T, Petronijević N. Schizophrenia and osteoporosis. MEDICINSKI PODMLADAK 2018. [DOI: 10.5937/mp69-17304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Houseknecht KL, Bouchard CC, Black CA. Elucidating the Mechanism(s) Underlying Antipsychotic and Antidepressant-Mediated Fractures. ACTA ACUST UNITED AC 2017; 1:9-13. [PMID: 31008454 PMCID: PMC6469345 DOI: 10.29245/2578-2959/2018/1.1106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mood spectrum disorders and medications used to treat these disorders, such as atypical antipsychotic drugs (AA), are associated with metabolic and endocrine side effects including obesity, dyslipidemia, hyperglycemia and increased risk of fractures. Antidepressant medications, including selective serotonin reuptake inhibitors (SSRI), have also been reported to increase fracture risk in some patients. The pharmacology underlying the increased risk of fractures is currently unknown. Possible mechanisms include alternations in dopaminergic and/or serotonergic signaling pathways. As these medications distribute to the bone marrow as well as to the brain, it is possible that drug-induced fractures are due to both centrally mediated effects as well as direct effects on bone turnover. Given the growing patient population that is prescribed these medications for both on- and off-label indications, understanding the level of risk and the mechanisms underlying drug-induced fractures is important for informing both prescribing and patient monitoring practices.
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Affiliation(s)
- Karen L Houseknecht
- College of Osteopathic Medicine, University of New England, 11 Hills Beach Road, Biddeford, ME 04005, USA.,College of Pharmacy, University of New England, 11 Hills Beach Road, Biddeford, ME 04005 USA
| | - C C Bouchard
- College of Osteopathic Medicine, University of New England, 11 Hills Beach Road, Biddeford, ME 04005, USA
| | - C A Black
- College of Pharmacy, University of New England, 11 Hills Beach Road, Biddeford, ME 04005 USA
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19
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Nikolić T, Petronijević M, Sopta J, Velimirović M, Stojković T, Jevtić Dožudić G, Aksić M, Radonjić NV, Petronijević N. Haloperidol affects bones while clozapine alters metabolic parameters - sex specific effects in rats perinatally treated with phencyclidine. BMC Pharmacol Toxicol 2017; 18:65. [PMID: 29020988 PMCID: PMC5637335 DOI: 10.1186/s40360-017-0171-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 10/03/2017] [Indexed: 01/26/2023] Open
Abstract
Background The presentation of schizophrenia (SCH) symptoms differs between the sexes. Long-term treatment with antipsychotics is frequently associated with decreased bone mineral density, increased fracture risk and metabolic side effects. Perinatal phencyclidine (PCP) administration to rodents represents an animal model of SCH. The aim of this study was to assess the effects of chronic haloperidol and clozapine treatment on bone mass, body composition, corticosterone, IL-6 and TNF-α concentrations and metabolic parameters in male and female rats perinatally treated with PCP. Methods Six groups of male and six groups of female rats (n = 6-12 per group) were subcutaneously treated on 2nd, 6th, 9th and 12th postnatal day (PN), with either PCP (10 mg/kg) or saline. At PN35, one NaCl and PCP group (NaCl-H and PCP-H) started receiving haloperidol (1 mg/kg/day) and one NaCl and PCP group (NaCl-C and PCP-C) started receiving clozapine (20 mg/kg/day) dissolved in drinking water. The remaining NaCl and PCP groups received water. Dual X-ray absorptiometry measurements were performed on PN60 and PN98. Animals were sacrificed on PN100. Femur was analysed by light microscopy. Concentrations of corticosterone, TNF-α and IL-6 were measured in serum samples using enzyme-linked immunosorbent assay (ELISA) commercially available kits. Glucose, cholesterol and triacylglycerol concentrations were measured in serum spectrophotometrically. Results Our results showed that perinatal PCP administration causes a significant decrease in bone mass and deterioration in bone quality in male and female rats. Haloperidol had deleterious, while clozapine had protective effect on bones. The effects of haloperidol on bones were more pronounced in male rats. It seems that the observed changes are not the consequence of the alterations of corticosterone, IL-6 and TNF-α concentration since no change of these factors was observed. Clozapine induced increase of body weight and retroperitoneal fat in male rats regardless of perinatal treatment. Furthermore, clozapine treatment caused sex specific increase in pro-inflammatory cytokines. Conclusion Taken together our findings confirm that antipsychotics have complex influence on bone and metabolism. Evaluation of potential markers for individual risk of antipsychotics induced adverse effects could be valuable for improvement of therapy of this life-long lasting disease. Electronic supplementary material The online version of this article (10.1186/s40360-017-0171-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tatjana Nikolić
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan Petronijević
- Military Medical Academy, Clinic of Rheumatology, University of Defence, Belgrade, Serbia
| | - Jelena Sopta
- Institute of Pathology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Velimirović
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tihomir Stojković
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gordana Jevtić Dožudić
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan Aksić
- Institute of Anatomy "Niko Miljanic", School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nevena V Radonjić
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Nataša Petronijević
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia.
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20
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Motyl KJ, Beauchemin M, Barlow D, Le PT, Nagano K, Treyball A, Contractor A, Baron R, Rosen CJ, Houseknecht KL. A novel role for dopamine signaling in the pathogenesis of bone loss from the atypical antipsychotic drug risperidone in female mice. Bone 2017; 103:168-176. [PMID: 28689816 PMCID: PMC5573184 DOI: 10.1016/j.bone.2017.07.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 01/19/2023]
Abstract
Atypical antipsychotic (AA) drugs, including risperidone (RIS), are used to treat schizophrenia, bipolar disorder, and autism, and are prescribed off-label for other mental health issues. AA drugs are associated with severe metabolic side effects of obesity and type 2 diabetes. Cross-sectional and longitudinal data also show that risperidone causes bone loss and increases fracture risk in both men and women. There are several potential mechanisms of bone loss from RIS. One is hypogonadism due to hyperprolactinemia from dopamine receptor antagonism. However, many patients have normal prolactin levels; moreover we demonstrated that bone loss from RIS in mice can be blocked by inhibition of β-adrenergic receptor activation with propranolol, suggesting the sympathetic nervous system (SNS) plays a pathological role. Further, when, we treated ovariectomized (OVX) and sham operated mice daily for 8weeks with RIS or vehicle we demonstrated that RIS causes significant trabecular bone loss in both sham operated and OVX mice. RIS directly suppressed osteoblast number in both sham and OVX mice, but increased osteoclast number and surface in OVX mice alone, potentially accounting for the augmented bone loss. Thus, hypogonadism alone cannot explain RIS induced bone loss. In the current study, we show that dopamine and RIS are present in the bone marrow compartment and that RIS can exert its effects directly on bone cells via dopamine receptors. Our findings of both direct and indirect effects of AA drugs on bone are relevant for current and future clinical and translational studies investigating the mechanism of skeletal changes from AA drugs.
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Affiliation(s)
- Katherine J Motyl
- Center for Molecular Medicine, Maine Medical Center Research Institute, Maine Medical Center, Scarborough, ME, USA
| | - Megan Beauchemin
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Deborah Barlow
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Phuong T Le
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Maine Medical Center, Scarborough, ME, USA
| | - Kenichi Nagano
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Annika Treyball
- Center for Molecular Medicine, Maine Medical Center Research Institute, Maine Medical Center, Scarborough, ME, USA
| | - Anisha Contractor
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Roland Baron
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Clifford J Rosen
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Maine Medical Center, Scarborough, ME, USA
| | - Karen L Houseknecht
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA.
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21
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Milovanovic DR, Stanojevic Pirkovic M, Zivancevic Simonovic S, Matovic M, Djukic Dejanovic S, Jankovic SM, Ravanic D, Petronijevic M, Ignjatovic Ristic D, Mladenovic V, Jovanovic M, Nikolic Labovic S, Pajovic M, Djokovic D, Petrovic D, Janjic V. Parameters of Calcium Metabolism Fluctuated during Initiation or Changing of Antipsychotic Drugs. Psychiatry Investig 2016; 13:89-101. [PMID: 26766951 PMCID: PMC4701691 DOI: 10.4306/pi.2016.13.1.89] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 05/19/2015] [Accepted: 05/29/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Serum parameters of calcium homeostasis were measured based on previously published evidence linking osteoporotic fractures and/or bone/mineral loss with antipsychotics. METHODS Prospective, four-week, time-series trial was conducted and study population consisted of patients of both genders, aged 35-85 years, admitted within the routine practice, with acute psychotic symptoms, to whom an antipsychotic drug was either introduced or substituted. Serial measurements of serum calcium, phosphorous, magnesium, 25(OH)D, parathyroid hormone, calcitonin, osteocalcin and C-telopeptide were made from patient venous blood samples. RESULTS Calcium serum concentrations significantly decreased from baseline to the fourth week (2.42±0.12 vs. 2.33±0.16 mmol/L, p=0.022, n=25). The mean of all calcemia changes from the baseline was -2.6±5.7% (-24.1 to 7.7) with more decreases than increases (78 vs. 49, p=0.010) and more patents having negative sum of calcemia changes from baseline (n=28) than positive ones (n=10) (p=0.004). There were simultaneous falls of calcium and magnesium from baseline (63/15 vs. 23/26, p<0.001; OR=4.75, 95% CI 2.14-10.51), phosphorous (45/33 vs. 9/40, p<0.001; 6.06, 2.59-14.20) and 25(OH)D concentrations (57/21 vs. 13/35, p<0.001; 7.31, 3.25-16.42), respectively. Calcemia positively correlated with magnesemia, phosphatemia and 25(OH)D values. Parathyroid hormone and C-telopeptide showed only subtle oscillations of their absolute concentrations or changes from baseline; calcitonin and osteocalcin did not change. Adjustment of final calcemia trend (depletion/accumulation) for relevant risk factors, generally, did not change the results. CONCLUSION In patients with psychotic disorders and several risks for bone metabolism disturbances antipsychotic treatment was associated with the decrease of calcemia and changes in levels of the associated ions.
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Affiliation(s)
- Dragan R. Milovanovic
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Marijana Stanojevic Pirkovic
- Department of Biochemistry, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Snezana Zivancevic Simonovic
- Department of Pathophysiology, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Milovan Matovic
- Deparment of Nuclear Medicine, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Slavica Djukic Dejanovic
- Clinic of Psychiatry, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Slobodan M. Jankovic
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Dragan Ravanic
- Clinic of Psychiatry, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Milan Petronijevic
- Clinic of Rheumatology, Military Medical Academy University of Defense, Belgrade, Serbia
| | - Dragana Ignjatovic Ristic
- Clinic of Psychiatry, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Violeta Mladenovic
- Clinic of Internal Diseases, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Mirjana Jovanovic
- Clinic of Psychiatry, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Sandra Nikolic Labovic
- Clinic of Psychiatry, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Marina Pajovic
- Clinic of Psychiatry, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Danijela Djokovic
- Clinic of Psychiatry, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Dusan Petrovic
- Clinic of Psychiatry, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | - Vladimir Janjic
- Clinic of Psychiatry, Faculty of Medical Sciences University of Kragujevac, Clinical Centre "Kragujevac", Kragujevac, Serbia
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Eugene AR, Nicholson WT. The Brain and Propranolol Pharmacokinetics in the Elderly. BRAIN : BROAD RESEARCH IN ARTIFICIAL INTELLIGENCE AND NEUROSCIENCE 2015; 6:5-14. [PMID: 26609425 PMCID: PMC4655970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Propranolol, a non-selective β-blocker, has been found to have a tremendous array of indications. Recent evidence has suggested that propranolol may be effective in patients suffering from post-traumatic stress disorder by suppressing activity in the amygdala and thereby inhibiting emotional memory formation. Dosage requirements have been well established in the pediatric and adult population, however, there has been no definitive geriatric dose recommended in the package inserts made available to the public. The aim of this paper is to use pharmacokinetic simulations in order to establish a pharmacokinetic profile dosage equivalent for the elderly as has been found in young patients. After completing the Monte-Carlo simulations for the elderly and young patients, a single 10mg dose in the elderly has shown comparable pharmacokinetic profiles as found in young patients administered a 40mg single dose.
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Affiliation(s)
- Andy R. Eugene
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Gonda 19, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA, Tel.: +1-507-284-2790; Fax: +1-507-284-4455
| | - Wayne T. Nicholson
- Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Henriksen K, Christiansen C, Karsdal MA. Role of biochemical markers in the management of osteoporosis. Climacteric 2015; 18 Suppl 2:10-8. [DOI: 10.3109/13697137.2015.1101256] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Motyl KJ, DeMambro VE, Barlow D, Olshan D, Nagano K, Baron R, Rosen CJ, Houseknecht KL. Propranolol Attenuates Risperidone-Induced Trabecular Bone Loss in Female Mice. Endocrinology 2015; 156:2374-83. [PMID: 25853667 PMCID: PMC4475716 DOI: 10.1210/en.2015-1099] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Atypical antipsychotic (AA) drugs cause significant metabolic side effects, and clinical data are emerging that demonstrate increased fracture risk and bone loss after treatment with the AA, risperidone (RIS). The pharmacology underlying the adverse effects on bone is unknown. However, RIS action in the central nervous system could be responsible because the sympathetic nervous system (SNS) is known to uncouple bone remodeling. RIS treatment in mice significantly lowered trabecular bone volume fraction (bone volume/total volume), owing to increased osteoclast-mediated erosion and reduced osteoblast-mediated bone formation. Daytime energy expenditure was also increased and was temporally associated with the plasma concentration of RIS. Even a single dose of RIS transiently elevated expression of brown adipose tissue markers of SNS activity and thermogenesis, Pgc1a and Ucp1. Rankl, an osteoclast recruitment factor regulated by the SNS, was also increased 1 hour after a single dose of RIS. Thus, we inferred that bone loss from RIS was regulated, at least in part, by the SNS. To test this, we administered RIS or vehicle to mice that were also receiving the nonselective β-blocker propranolol. Strikingly, RIS did not cause any changes in trabecular bone volume/total volume, erosion, or formation while propranolol was present. Furthermore, β2-adrenergic receptor null (Adrb2(-/-)) mice were also protected from RIS-induced bone loss. This is the first report to demonstrate SNS-mediated bone loss from any AA. Because AA medications are widely prescribed, especially to young adults, clinical studies are needed to assess whether β-blockers will prevent bone loss in this vulnerable population.
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Affiliation(s)
- Katherine J Motyl
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Victoria E DeMambro
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Deborah Barlow
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - David Olshan
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Kenichi Nagano
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Roland Baron
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Clifford J Rosen
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Karen L Houseknecht
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
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Calarge CA, Burns TL, Schlechte JA, Zemel BS. Longitudinal examination of the skeletal effects of selective serotonin reuptake inhibitors and risperidone in boys. J Clin Psychiatry 2015; 76:607-13. [PMID: 26035190 PMCID: PMC6734561 DOI: 10.4088/jcp.14m09195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/04/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE In a previous cross-sectional study, we found lower bone mass during treatment with selective serotonin reuptake inhibitors (SSRIs) and risperidone in youths. Here, we evaluate the skeletal effects of these psychotropics at follow-up. METHOD Between April 2005 and July 2011, medically healthy 7- to 17-year-old males treated with risperidone for 6 months or more were enrolled through child psychiatry outpatient clinics and returned for follow-up 1.5 years later. Treatment history was extracted from the medical and pharmacy records. Anthropometric, laboratory, and bone mass measurements were obtained. Multivariable linear regression analyses compared participants who remained on risperidone at follow-up to those who had discontinued risperidone treatment as well as SSRI-treated versus SSRI-unexposed participants. RESULTS The sample consisted of 94 boys with a mean age of 11.8 ± 2.7 years at study entry. The majority had an externalizing disorder and had received risperidone and SSRIs for 2.5 ± 1.7 years and 1.6 ± 1.9 years, respectively, at study entry. By follow-up, 26% (n = 24) had discontinued risperidone. Compared to discontinuing risperidone, continuing it was associated with a decline in participants' age-sex-height-race-specific areal bone mineral density (BMD) z score at the lumbar spine (P < .04) and failure to increase radius trabecular volumetric BMD (P < .03), after accounting for significant covariates. In addition, receiving an SSRI was associated with reduced lumbar spine areal BMD z score and radius trabecular volumetric BMD at both study entry (P < .02 and P < .03, respectively) and follow-up (P < .06 and P < .03, respectively), but without further decline between the 2 visits. CONCLUSIONS Chronic SSRI treatment in children and adolescents is associated with reduced, albeit stable, bone mass for age, while chronic risperidone treatment is associated with failure to accrue bone mass.
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Affiliation(s)
- Chadi A. Calarge
- Departments of Psychiatry and Pediatrics, The University of Iowa Carver College of Medicine, 500 Newton Road, Iowa City, IA 52242
| | - Trudy L. Burns
- Department of Epidemiology, The University of Iowa College of Public Health, Department of Pediatrics, The University of Iowa Carver College of Medicine, Iowa City, IA 52242
| | - Janet A. Schlechte
- Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, IA 52242
| | - Babette S. Zemel
- Department of Pediatrics, The University of Pennsylvania, Philadelphia, PA
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Jacobsen CM, Barber LA, Ayturk UM, Roberts HJ, Deal LE, Schwartz MA, Weis M, Eyre D, Zurakowski D, Robling AG, Warman ML. Targeting the LRP5 pathway improves bone properties in a mouse model of osteogenesis imperfecta. J Bone Miner Res 2014; 29:2297-306. [PMID: 24677211 PMCID: PMC4130796 DOI: 10.1002/jbmr.2198] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 01/09/2014] [Accepted: 01/30/2014] [Indexed: 11/07/2022]
Abstract
The cell surface receptor low-density lipoprotein receptor-related protein 5 (LRP5) is a key regulator of bone mass and bone strength. Heterozygous missense mutations in LRP5 cause autosomal dominant high bone mass (HBM) in humans by reducing binding to LRP5 by endogenous inhibitors, such as sclerostin (SOST). Mice heterozygous for a knockin allele (Lrp5(p.A214V) ) that is orthologous to a human HBM-causing mutation have increased bone mass and strength. Osteogenesis imperfecta (OI) is a skeletal fragility disorder predominantly caused by mutations that affect type I collagen. We tested whether the LRP5 pathway can be used to improve bone properties in animal models of OI. First, we mated Lrp5(+/p.A214V) mice to Col1a2(+/p.G610C) mice, which model human type IV OI. We found that Col1a2(+/p.G610C) ;Lrp5(+/p.A214V) offspring had significantly increased bone mass and strength compared to Col1a2(+/p.G610C) ;Lrp5(+/+) littermates. The improved bone properties were not a result of altered mRNA expression of type I collagen or its chaperones, nor were they due to changes in mutant type I collagen secretion. Second, we treated Col1a2(+/p.G610C) mice with a monoclonal antibody that inhibits sclerostin activity (Scl-Ab). We found that antibody-treated mice had significantly increased bone mass and strength compared to vehicle-treated littermates. These findings indicate increasing bone formation, even without altering bone collagen composition, may benefit patients with OI.
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Affiliation(s)
- Christina M. Jacobsen
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
- Division of Endocrinology, Boston Children's Hospital, Boston, MA
- Division of Genetics, Boston Children's Hospital Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Lauren A. Barber
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Ugur M. Ayturk
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
- Department of Genetics, Harvard Medical School, Boston, MA
| | - Heather J. Roberts
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Lauren E. Deal
- Department of Anatomy and Cell Biology, Indiana University, Indianapolis, IN
| | - Marissa A. Schwartz
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - MaryAnn Weis
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA
| | - David Eyre
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA
| | - David Zurakowski
- Department of Anesthesia, Children's Hospital Boston, Boston, MA
| | | | - Matthew L. Warman
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
- Department of Genetics, Harvard Medical School, Boston, MA
- Howard Hughes Medical Institute, Boston, MA
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Petronijevic N, Sopta J, Doknic M, Radonjic N, Petronijevic M, Pekic S, Maric N, Jasovic-Gasic M, Popovic V. Chronic risperidone exposure does not show any evidence of bone mass deterioration in animal model of schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2013; 46:58-63. [PMID: 23811489 DOI: 10.1016/j.pnpbp.2013.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/27/2013] [Accepted: 05/29/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND It has been shown that bone mass is centrally regulated. Thus schizophrenia being a disease of the central nervous system is an interesting model for studying bone. Most second generation antipsychotic drugs including risperidone are used in the treatment of schizophrenia. Weight gain and metabolic disturbances are common side effects. OBJECTIVE The aims of this study were to investigate bone mass, body composition and light microscopic pathology examinations of femur in an animal model of schizophrenia (pharmacologically induced by postnatally administered phencyclidine-PCP) and to further examine the effects of chronic treatment with risperidone on these parameters in rats. METHODS Four groups of male rats were studied:1) control group-NaCl postnatally administered, n=9; 2) PCP group-postnatal PCP administration to rat pups (on day 2,6,9 and 12), n=6; 3) risperidone group-rats treated with risperidone alone for 9weeks from day 35 (NaCl-RSP group, n=7); 4) PCP rats treated with risperidone for 9weeks from day 35 (PCP-RSP group, n=7). Bone mass and body composition were measured in vivo by dual X ray absorptiometry (areal DXA and fat mass). Light microscopic analysis of the femoral metaphysis was performed in all groups after sacrificing the animals. RESULTS Postnatal phencyclidine (PCP) administration to rat pups caused a long lasting reduction of total bone mass versus control animals (aDXA 128±2mg/cm(2) vs 139±5mg/cm(2), p<0.05). Examination of the femoral bone revealed a decrease in the number and thickness of the metaphyseal trabecule and cortical thinning. There was a decrease in total and retroperitoneal fat. Nine weeks of administration of risperidone alone to rats, resulted in significant weight gain and had no effect on bone mass versus control animals (aDXA was 136±7mg/cm(2) vs 139±5mg/cm(2), p>0.05). Furthermore, there were no changes in the light microscopic analysis of femoral metaphysis in comparison with controls. When PCP rats were treated with risperidone, they did not change their body weight nor bone mass versus PCP alone (aDXA 126±2mg/cm(2) vs 128±2mg/cm(2), p>0.05) but intriguingly on examination of the femoral bone an increase in the number and thickness of the metaphyseal trabecule was found (trabecular thickness 0.6±0.1μm vs 0.35±0.1μm, p<0.01). CONCLUSION This study shows that in the PCP rat model of schizophrenia bone mass is reduced. When PCP rats were treated with risperidone bone mass remained unchanged but intriguingly and unexpectedly light microscopic examination of femoral metaphysis showed an increase in thickness of metaphyseal trabeculae. The mechanism of risperidone's action on bone remains to be clarified.
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Affiliation(s)
- Natasa Petronijevic
- Institute of Biochemistry, University of Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia
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Calarge CA, Ivins SD, Motyl KJ, Shibli-Rahhal AA, Bliziotes MM, Schlechte JA. Possible mechanisms for the skeletal effects of antipsychotics in children and adolescents. Ther Adv Psychopharmacol 2013; 3:278-93. [PMID: 24167704 PMCID: PMC3805387 DOI: 10.1177/2045125313487548] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The increasing use of antipsychotics (APs) to treat pediatric psychiatric conditions has led to concerns over the long-term tolerability of these drugs. While the risk of cardiometabolic abnormalities has received most of the attention, preclinical and clinical studies provide preliminary evidence that APs can adversely impact bone metabolism. This would be most concerning in children and adolescents as suboptimal bone accrual during development may lead to increased fracture risk later in life. However, the potential mechanisms of action through which APs may impact bone turnover and, consequently, bone mineral content are not clear. Emerging data suggest that the skeletal effects of APs are complex, with APs directly and indirectly impacting bone cells through modulation of multiple signaling pathways, including those involving dopamine D2, serotonin, adrenergic, and prolactin receptors, as well as by affecting gonadotropins. Determining the action of APs on skeletal development is further complicated by polypharmacy. In children and adolescents, APs are frequently coprescribed with psychostimulants and selective serotonin reuptake inhibitors, which have also been linked to changes in bone metabolism. This review discusses the mechanisms by which APs may influence bone metabolism. Also covered are preclinical and pediatric findings concerning the impact of APs on bone turnover. However, the dearth of clinical information despite the potential public health significance of this issue underscores the need for further studies. The review ends with a call for clinicians to be vigilant about promoting optimal overall health in chronically ill youth with psychopathology, particularly when pharmacotherapy is unavoidable.
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Affiliation(s)
- Chadi A Calarge
- Associate Professor, Departments of Psychiatry and Pediatrics, University of Iowa Carver College of Medicine, Psychiatry Research, 2-209 MEB, 500 Newton Road, Iowa City, IA 52242, USA
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Li X, Johnson MS, Smith DL, Li Y, Kesterson RA, Allison DB, Nagy TR. Effects of risperidone on energy balance in female C57BL/6J mice. Obesity (Silver Spring) 2013; 21:1850-7. [PMID: 23408466 PMCID: PMC3657586 DOI: 10.1002/oby.20350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 12/12/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the effect of risperidone on energy expenditure and weight gain in female C57BL/6J mice. DESIGN AND METHODS Body weight and composition, food intake, energy expenditure, and activity were determined weekly. mRNA expression of uncoupling protein 1 in brown adipose tissue, orexin, and brain-derived neurotrophic factor in the hypothalamus were quantified using real-time PCR. RESULTS Risperidone tended to induce a greater body weight gain (P = 0.052) and significantly higher food intake (P = 0.038) relative to the placebo-treated group. Risperidone-treated mice had a higher resting energy expenditure (P = 0.001) and total energy expenditure (TEE) (P = 0.005) than the placebo group. There were no effects of treatment, time, and treatment by time on non-resting (or activity-related) energy expenditure between groups. Risperidone-treated mice showed a significantly lesser locomotor activity than placebo-treated mice over 3 weeks (P < 0.001). Risperidone induced a higher UCP1 mRNA (P = 0.003) and a lower orexin mRNA (P = 0.001) than placebo. CONCLUSION Risperidone-induced weight gain is associated with hyperphagia and a reduction in locomotor activity in C57BL/6J mice. Additionally, higher total and resting energy expenditure were accompanied by higher levels of UCP1 mRNA in BAT. The increased TEE could not offset the total intake of energy through risperidone-induced hyperphagia, therefore resulting in weight gain in female C57BL/6J mice.
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Affiliation(s)
- Xingsheng Li
- Department of Nutrition Sciences, University of Alabama at Birmingham
| | - Maria S. Johnson
- Department of Nutrition Sciences, University of Alabama at Birmingham
| | - Daniel L. Smith
- Department of Nutrition Sciences, University of Alabama at Birmingham
| | - Yan Li
- Department of Nutrition Sciences, University of Alabama at Birmingham
| | | | - David B. Allison
- Department of Nutrition Sciences, University of Alabama at Birmingham
- Department of Biostatistics, University of Alabama at Birmingham
| | - Tim R. Nagy
- Department of Nutrition Sciences, University of Alabama at Birmingham
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de Paula FJA, Rosen CJ. Bone Remodeling and Energy Metabolism: New Perspectives. Bone Res 2013; 1:72-84. [PMID: 26273493 DOI: 10.4248/br201301005] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 01/30/2013] [Indexed: 12/27/2022] Open
Abstract
Bone mineral, adipose tissue and energy metabolism are interconnected by a complex and multilevel series of networks. Calcium and phosphorus are utilized for insulin secretion and synthesis of high energy compounds. Adipose tissue store lipids and cholecalciferol, which, in turn, can influence calcium balance and energy expenditure. Hormones long-thought to solely modulate energy and mineral homeostasis may influence adipocytic function. Osteoblasts are a target of insulin action in bone. Moreover, endocrine mediators, such as osteocalcin, are synthesized in the skeleton but regulate carbohydrate disposal and insulin secretion. Finally, osteoblasts and adipocytes originate from the same mesenchymal progenitor. The mutual crosstalk between osteoblasts and adipocytes within the bone marrow microenvironment plays a crucial role in bone remodeling. In the present review we provide an overview of the reciprocal control between bone and energy metabolism and its clinical implications.
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Affiliation(s)
- Francisco J A de Paula
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo , Brazil
| | - Clifford J Rosen
- Center for Clinical and Translational Research, Maine Medical Center Research Institute , USA
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Li X, Nagy TR. Atypical antipsychotic drugs inhibit trabecular bone accrual in C57BL/6J mice. INTERNATIONAL JOURNAL OF BODY COMPOSITION RESEARCH 2013; 11:21-24. [PMID: 24839401 PMCID: PMC4023556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the effects of the atypical antipsychotics drugs (AADs), olanzapine and risperidone, on femoral bone characteristics in female C57BL/6J mice. METHODS Mice were treated with placebo or AADs (olanzapine or risperidone) for 3-4 weeks. Femoral cortical and trabecular bone characteristics were determined using micro-computed tomography. RESULTS Olanzapine-treated mice tended to have lower trabecular bone volume (P = 0.088) and connectivity (P = 0.057) but no significant differences in bone density (P = 0.521) relative to controls. Risperidone-treated mice had significantly lower trabecular bone density (P = 0.001) and volume (P = 0.008), bone volume/total volume (P = 0.001), connectivity (P = 0.007), and trabecular number (P = 0.003) relative to controls. Cortical bone was not significantly affected by olanzapine or risperidone treatment. CONCLUSION AADs inhibited trabecular bone accrual in C57BL/6J mice suggesting that alternative treatment options may need to be considered for the schizophrenia patient with potential osteoporosis risk.
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Affiliation(s)
- Xingsheng Li
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Tim R Nagy
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Wu H, Deng L, Zhao L, Zhao J, Li L, Chen J. Osteoporosis associated with antipsychotic treatment in schizophrenia. Int J Endocrinol 2013; 2013:167138. [PMID: 23690768 PMCID: PMC3652172 DOI: 10.1155/2013/167138] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/20/2013] [Accepted: 03/18/2013] [Indexed: 12/21/2022] Open
Abstract
Schizophrenia is one of the most common global mental diseases, with prevalence of 1%. Patients with schizophrenia are predisposed to diabetes, coronary heart disease, hypertension, and osteoporosis, than the normal. In comparison with the metabolic syndrome, for instance, there are little reports about osteoporosis which occurs secondary to antipsychotic-induced hyperprolactinaemia. There are extensive recent works of literature indicating that osteoporosis is associated with schizophrenia particularly in patients under psychotropic medication therapy. As osteoporotic fractures cause significantly increased morbidity and mortality, it is quite necessary to raise the awareness and understanding of the impact of antipsychotic-induced hyperprolactinaemia on physical health in schizophrenia. In this paper, we will review the relationship between schizophrenia, antipsychotic medication, hyperprolactinaemia, and osteoporosis.
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Affiliation(s)
- Haishan Wu
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Lu Deng
- Department of Nursing, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Lipin Zhao
- Department of Nursing, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Jingping Zhao
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Lehua Li
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Jindong Chen
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha 410011, China
- *Jindong Chen:
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Abstract
PURPOSE OF REVIEW Excessive bone mineral density (BMD) loss has been associated with schizophrenia, but its mechanisms and clinical implications are less clear. The aim of this review was to summarize the risk of osteoporosis and bone fractures in schizophrenia patients. Moreover, we aimed to examine the impact of antipsychotic-induced hyperprolactinemia on bone metabolism. RECENT FINDINGS Fifteen of 16 studies (93.8%) reported lower BMD or higher prevalence of osteoporosis in at least one region, or in at least one subgroup of schizophrenia patients compared with controls, but results were inconsistent across measured areas. Higher fracture risk was associated with schizophrenia in 2/2 studies (independently: n = 1), and 3/4 studies with antipsychotics. Reasons for this difference include insufficient exercise, poor nutrition, smoking, alcohol use, and low vitamin D levels. Altogether, 9/15 (60.0%) studies examining the relationship between antipsychotic-induced hyperprolactinemia and BMD loss found some effects of hyperprolactinemia. However, results were mixed, samples and effects were small, and only two studies were prospective. SUMMARY Schizophrenia is associated with reduced BMD and fracture risk. Prevention, early detection, and intervention are required. The relative contributions of antipsychotic-related hyperprolactinemia and unhealthy lifestyle behaviors remain unclear, needing to be assessed in well designed, prospective studies, including bone turnover markers as intermediary endpoints.
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Affiliation(s)
- Taishiro Kishimoto
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA
- Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Marc De Hert
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Harold E. Carlson
- Endocrinology Division, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Peter Manu
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA
- Hofstra North Shore LIJ School of Medicine, Hempstead, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
- Transilvania University, Brasov, Romania
| | - Christoph U. Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA
- Hofstra North Shore LIJ School of Medicine, Hempstead, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
- The Feinstein Institute for Medical Research, Manhasset, New York, USA
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