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Signorini C, Pannuzzo G, Graziano ACE, Moretti E, Collodel G, Cardile V. Dietary Supplementation with n-3 Polyunsaturated Fatty Acids Delays the Phenotypic Manifestation of Krabbe Disease and Partially Restores Lipid Mediator Production in the Brain-Study in a Mouse Model of the Disease. Int J Mol Sci 2024; 25:7149. [PMID: 39000257 PMCID: PMC11241235 DOI: 10.3390/ijms25137149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Lipid mediators from fatty acid oxidation have been shown to be associated with the severity of Krabbe disease (KD), a disorder linked to mutations in the galactosylceramidase (GALC) gene. This study aims to investigate the effects of n-3 polyunsaturated fatty acid (PUFA) supplementation on KD traits and fatty acid metabolism using Twitcher (Tw) animals as a natural model for KD. Wild-type (Wt), heterozygous (Ht), and affected Tw animals were treated orally with 36 mg n-3 PUFAs/kg body weight/day from 10 to 35 days of life. The end product of PUFA peroxidation (8-isoprostane), the lipid mediator involved in the resolution of inflammatory exudates (resolvin D1), and the total amount of n-3 PUFAs were analyzed in the brains of mice. In Tw mice, supplementation with n-3 PUFAs delayed the manifestation of disease symptoms (p < 0.0001), and in the bran, decreased 8-isoprostane amounts (p < 0.0001), increased resolvin D1 levels (p < 0.005) and increased quantity of total n-3 PUFAs (p < 0.05). Furthermore, total brain n-3 PUFA levels were associated with disease severity (r = -0.562, p = 0.0001), resolvin D1 (r = 0.712, p < 0.0001), and 8-isoprostane brain levels (r = -0.690, p < 0.0001). For the first time in a natural model of KD, brain levels of n-3 PUFAs are shown to determine disease severity and to be involved in the peroxidation of brain PUFAs as well as in the production of pro-resolving lipid mediators. It is also shown that dietary supplementation with n-3 PUFAs leads to a slowing of the phenotypic presentation of the disease and restoration of lipid mediator production.
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Affiliation(s)
- Cinzia Signorini
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (E.M.); (G.C.)
| | - Giovanna Pannuzzo
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.P.); (V.C.)
| | | | - Elena Moretti
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (E.M.); (G.C.)
| | - Giulia Collodel
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (E.M.); (G.C.)
| | - Venera Cardile
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.P.); (V.C.)
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Rheims S, Herbillon V, Gaillard S, Mercier C, Villeuve N, Villéga F, Cances C, Castelnau P, Napuri S, de Saint‐Martin A, Auvin S, Nguyen The Tich S, Berquin P, de Bellecize J, Milh M, Roy P, Arzimanoglou A, Bodennec J, Bezin L, Kassai B. Phosphatidylserine enriched with polyunsaturated n-3 fatty acid supplementation for attention-deficit hyperactivity disorder in children and adolescents with epilepsy: A randomized placebo-controlled trial. Epilepsia Open 2024; 9:582-591. [PMID: 38173190 PMCID: PMC10984292 DOI: 10.1002/epi4.12892] [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: 05/10/2023] [Revised: 09/24/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is a frequent comorbidity in children with epilepsy, which management mostly relies on the usual treatments of ADHD, especially methylphenidate. Supplementation with polyunsaturated n-3 Fatty Acid (PUFA) has been proposed as an alternative therapeutic approach in ADHD without epilepsy but has never been evaluated in epilepsy-associated ADHD. METHODS A multicenter double blind randomized placebo-controlled trial evaluating supplementation with PUFA, in eicosapentaenoic- and docosahexaenoic-acid form, conjugated to a phospholipid vector (PS-Omega3) in children aged >6 and <16-years old, and suffering from any type of epilepsy and ADHD (inattentive or combined type) according to DSM-V. After a 4-week baseline period, patients were allocated (1:1) either to placebo group or to PS-Omega 3 group and entered a 12 week-double-blind treatment period which was followed by a 12 week-open-label treatment period. The primary outcome was the reduction of the ADHD-rating scale IV attention-deficit subscore after 12 weeks of treatment. RESULTS The study was stopped early because of lack of eligible participants and the expected sample size was not reached. Seventy-four patients were randomized, 44 in PS-Omega3, and 30 in the placebo group. The reduction after 12 weeks of treatment in the inattention subscore of the ADHD-IV scale was -1.57 in the PS-Omega3 group, and -2.90 in the placebo group (p = 0.33, α = 5%). Results were similar after 24 weeks of treatment and for all other ADHD-related secondary outcomes, with no difference between placebo and PS-Omega3. CONCLUSION Our study remaining underpowered, no formal conclusion about the effect of Ps-Omega3 could be drawn. However, our data strongly suggested that the PS-Omega 3 formulation used in the current study did not improve ADHD symptoms in children with epilepsy. PLAIN LANGUAGE SUMMARY Supplementation with polyunsaturated n-3 Fatty Acid (PUFA) has been proposed in ADHD but has never been evaluated in patients with both epilepsy and ADHD. To address this issue, we conducted a multicenter double blind randomized placebo-controlled trial evaluating supplementation with PUFA in children with epilepsy and ADHD. The study was stopped early because of lack of eligible participants, hampering formal conclusion. However, the evolution of the ADHD symptoms at 12 and 24 weeks did not differ between placebo and PUFA supplementation, strongly suggesting that PUFA did not improve ADHD symptoms in children with epilepsy.
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Affiliation(s)
- Sylvain Rheims
- Department of Functional Neurology and EpileptologyHospices Civils de Lyon and Lyon 1 UniversityLyonFrance
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292Lyon 1 UniversityLyonFrance
- Epilepsy InstituteLyonFrance
| | - Vania Herbillon
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292Lyon 1 UniversityLyonFrance
- Epilepsy, Sleep and Paediatric Neurophysiology DepartmentHospices Civils de LyonLyonFrance
| | - Ségolène Gaillard
- Clinical Investigation Centre 1407, Hospices Civils de Lyon‐InsermHôpital Louis PradelBronFrance
| | | | | | | | | | | | | | | | - Stéphane Auvin
- Pediatric Neurology Department, AP‐HP, Robert‐Debré University HospitalCRMR Épilepsies Rares, EpiCARE MemberParisFrance
- INSERM NeuroDiderotUniversité Paris CitéParisFrance
- Institut Universitaire de France (IUF)ParisFrance
| | | | | | - Julitta de Bellecize
- Epilepsy, Sleep and Paediatric Neurophysiology DepartmentHospices Civils de LyonLyonFrance
| | - Mathieu Milh
- Department of Pediatric NeurologyAPHMMarseilleFrance
| | - Pascal Roy
- Department of BiostatisticsHospices Civils de LyonLyonFrance
| | - Alexis Arzimanoglou
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292Lyon 1 UniversityLyonFrance
- Epilepsy, Sleep and Paediatric Neurophysiology DepartmentHospices Civils de LyonLyonFrance
| | - Jacques Bodennec
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292Lyon 1 UniversityLyonFrance
- Epilepsy InstituteLyonFrance
| | - Laurent Bezin
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292Lyon 1 UniversityLyonFrance
- Epilepsy InstituteLyonFrance
| | - Behrouz Kassai
- Clinical Investigation Centre 1407, Hospices Civils de Lyon‐InsermHôpital Louis PradelBronFrance
- Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique‐Santé, CNRS, UMR 5558Lyon 1 UniversityVilleurbanneFrance
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Zhu Z, Dluzynski D, Hammad N, Pugalenthi D, Walser SA, Mittal R, Samanta D, Brown ML, Asadi-Pooya AA, Kakooza-Mwesige A, Spalice A, Capponi M, Lekoubou A, Kumar A, Paudel S, Carney PR, Mainali G, Naik S. Use of Integrative, Complementary, and Alternative Medicine in Children with Epilepsy: A Global Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:713. [PMID: 37189961 PMCID: PMC10136598 DOI: 10.3390/children10040713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
(1) Background: Epilepsy is one of the most common chronic neurological disorders in childhood. Complementary and alternative medicine (CAM) use is highly prevalent in patients with epilepsy. Despite CAM's widespread and increasing popularity, its prevalence, forms, perceived benefits, and potential risks in pediatric epilepsy are rarely explored. (2) Methods: We performed a scoping review of the available literature on the use of CAM in pediatric epilepsy. (3) Results: Overall, global cross-sectional studies showed a variable degree of CAM usage among children with epilepsy, ranging from 13 to 44% in prevalence. Popular types of CAMs reported were supplements, cannabis products, aromatherapy, herbal remedies, dietary therapy, massage therapy, and prayer. Families often report that CAM is effective, although there are limited objective measures of this. Potential risks lie in the use of CAM, such as herbal remedies, and/or unregulated, contaminated, or unpurified products. Studies also underscored inadequate patient-physician discussions regarding CAM. (4) Conclusions: A better understanding of this topic would aid clinicians in guiding patients/families on the use of CAM. Further studies on the efficacy of the different types of CAM used, as well as potential side effects and drug interactions are needed.
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Affiliation(s)
- Zahra Zhu
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
| | - Daniela Dluzynski
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
| | - Nouran Hammad
- School of Medicine, Jordan University of Science and Technology, Al-Ramtha 3030, Jordan
| | - Deepika Pugalenthi
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
| | - Sarah A. Walser
- Department of Psychiatry, Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Rea Mittal
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
| | - Debopam Samanta
- Section of Child Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Melanie L. Brown
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Ali A. Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz 71437, Iran
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Angelina Kakooza-Mwesige
- Department of Pediatrics & Child Health, Makerere University College of Health Sciences, Kampala 7062, Uganda
| | - Alberto Spalice
- Department of Maternal Sciences, University la Sapienza, 00185 Roma, Italy
| | - Martina Capponi
- Department of Maternal Sciences, University la Sapienza, 00185 Roma, Italy
| | - Alain Lekoubou
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
- Department of Neurology, Hershey Medical Center, Penn State University, Hershey, PA 17033, USA
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA 17033, USA
| | - Ashutosh Kumar
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Sita Paudel
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Paul R. Carney
- Pediatric Neurology Division, University of Missouri Health Care, Columbia, MO 65212, USA
| | - Gayatra Mainali
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Sunil Naik
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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