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Chiș IA, Andrei V, Muntean A, Moldovan M, Mesaroș AȘ, Dudescu MC, Ilea A. Salivary Biomarkers of Anti-Epileptic Drugs: A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13111962. [PMID: 37296814 DOI: 10.3390/diagnostics13111962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
Saliva is a biofluid that reflects general health and that can be collected in order to evaluate and determine various pathologies and treatments. Biomarker analysis through saliva sampling is an emerging method of accurately screening and diagnosing diseases. Anti-epileptic drugs (AEDs) are prescribed generally in seizure treatment. The dose-response relationship of AEDs is influenced by numerous factors and varies from patient to patient, hence the need for the careful supervision of drug intake. The therapeutic drug monitoring (TDM) of AEDs was traditionally performed through repeated blood withdrawals. Saliva sampling in order to determine and monitor AEDs is a novel, fast, low-cost and non-invasive approach. This narrative review focuses on the characteristics of various AEDs and the possibility of determining active plasma concentrations from saliva samples. Additionally, this study aims to highlight the significant correlations between AED blood, urine and oral fluid levels and the applicability of saliva TDM for AEDs. The study also focuses on emphasizing the applicability of saliva sampling for epileptic patients.
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Affiliation(s)
- Ioana-Andreea Chiș
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Medicine and Pharmacy "Iuliu Hațieganu", 400012 Cluj-Napoca, Romania
| | - Vlad Andrei
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Medicine and Pharmacy "Iuliu Hațieganu", 400012 Cluj-Napoca, Romania
| | - Alexandrina Muntean
- Department of Paediatric Dentistry, Faculty of Dentistry, University of Medicine and Pharmacy "Iuliu Hațieganu", 400012 Cluj-Napoca, Romania
| | - Marioara Moldovan
- Department of Polymer Composites, Institute of Chemistry "Raluca Ripan", University Babes-Bolyai, 400294 Cluj-Napoca, Romania
| | - Anca Ștefania Mesaroș
- Department of Dental Propaedeutics and Aesthetics, University of Medicine and Pharmacy "Iuliu Hațieganu", 400012 Cluj-Napoca, Romania
| | - Mircea Cristian Dudescu
- Department of Mechanical Engineering, Faculty of Automotive, Mechatronics and Mechanical Engineering, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Aranka Ilea
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Medicine and Pharmacy "Iuliu Hațieganu", 400012 Cluj-Napoca, Romania
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Tashakori-Miyanroudi M, Ramazi S, Hashemi P, Nazari-Serenjeh M, Baluchnejadmojarad T, Roghani M. Acetyl-L-Carnitine Exerts Neuroprotective and Anticonvulsant Effect in Kainate Murine Model of Temporal Lobe Epilepsy. J Mol Neurosci 2022; 72:1224-1233. [PMID: 35320462 DOI: 10.1007/s12031-022-01999-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/09/2022] [Indexed: 02/07/2023]
Abstract
The most well-known type of focal epilepsy that is resistant to existing treatments is temporal lobe epilepsy (TLE), with seizure foci in various structures including temporal lobe, hippocampus, amygdala, entorhinal cortex, and subcortex. The most significant processes involved in the pathophysiology of temporal lobe epilepsy (TLE) are oxidative stress, inflammation, and pyroptosis. There are evidences indicating that acetyl-l-carnitine (ALC) has anti-oxidative, anti-inflammatory, and anti-pyroptotic effects. In the present study, rat model of TLE was induced by intrahippocampal kainate and animals received ALC (100 mg/kg, p.o.). ALC properly attenuated intensity of seizures and also incidence of kainate-induced status epilepticus (SE). As well, obtained findings showed that ALC can partially reverse hippocampal levels of MDA, ROS, SOD, TNFa, NF-kB, TLR4, GFAP, and caspase 1. Besides, treatment of kainate group with ALC exerted a protective effect against CA1 neuronal loss and abnormal mossy fiber sprouting (MFS). Conclusively, these results suggest that ALC is capable to attenuate kainate-induced SE which is somewhat mediated through its lowering of oxidative stress, neuroinflammation, and pyroptosis that are related to its neuroprotective effect.
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Affiliation(s)
- Mahsa Tashakori-Miyanroudi
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.,Department of Physiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Ramazi
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Paria Hashemi
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Mehrdad Roghani
- Neurophysiology Research Center, Shahed University, Tehran, Iran
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Kalloniatis M, Loh CS, Acosta ML, Tomisich G, Zhu Y, Nivison‐smith L, Fletcher EL, Chua J, Sun D, Arunthavasothy N. Retinal amino acid neurochemistry in health and disease. Clin Exp Optom 2021; 96:310-32. [DOI: 10.1111/cxo.12015] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/01/2012] [Accepted: 07/17/2012] [Indexed: 12/25/2022] Open
Affiliation(s)
- Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia,
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia,
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, Victoria, Australia,
- Department of Optometry and Vision Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand,
| | - Chee Seang Loh
- Department of Optometry and Vision Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand,
| | - Monica L Acosta
- Department of Optometry and Vision Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand,
| | - Guido Tomisich
- Department of Optometry and Vision Science, The University of Melbourne, Parkville, Victoria, Australia,
| | - Yuan Zhu
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia,
| | - Lisa Nivison‐smith
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia,
| | - Erica L Fletcher
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, Victoria, Australia,
| | - Jacqueline Chua
- Department of Optometry and Vision Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand,
| | - Daniel Sun
- Department of Optometry and Vision Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand,
| | - Niru Arunthavasothy
- Department of Optometry and Vision Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand,
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Gao M, Qu K, Zhang W, Wang X. Pharmacological Activity of Pyrazole Derivatives as an Anticonvulsant for Benefit against Epilepsy. Neuroimmunomodulation 2021; 28:90-98. [PMID: 33774633 DOI: 10.1159/000513297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/12/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Pediatric patients with epilepsy are prone to cognitive impairments during growth and long-term use of most antiepileptic drugs (AED). The affected children do not respond to conventional AED and may require novel drugs to manage the disease. Valproic acid, a first-line drug to treat epilepsy, is associated with serious side effects, which precludes its wider use. Thus, in the present study, we intended to develop novel substituted pyrazoles. METHODS The molecules were tested for anticonvulsive activity in Swiss albino mice via maximal electroshock seizure and subcutaneous pentylenetetrazole assays. The most potent molecule among the class was further assayed for its effect on behavioral and CNS depressant activity. The effect of the most potent compounds was also analyzed on various indices of oxidative stress and inflammation in mice. RESULTS The designed compounds showed significant anticonvulsive activity in mice revealing 7h as the most potent anticonvulsive agent. The most potent anticonvulsant molecule 7h further showed no behavioral alteration and considerable CNS depressant activity. It also reduces the level of oxidative stress and inflammation in the mice. CONCLUSION Our study demonstrated utility of pyrazole derivatives as anticonvulsants against epilepsy.
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Affiliation(s)
- Meizhe Gao
- Department of Child Healthcare, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Keli Qu
- Department of Child Healthcare, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenzhi Zhang
- Innoscience Research Sdn Bhd, Subang Jaya, Malaysia
| | - Xueying Wang
- Department of Child Healthcare, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Watson F, Rusbridge C, Packer RMA, Casey RA, Heath S, Volk HA. A review of treatment options for behavioural manifestations of clinical anxiety as a comorbidity in dogs with idiopathic epilepsy. Vet J 2018; 238:1-9. [PMID: 30103909 DOI: 10.1016/j.tvjl.2018.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 12/22/2022]
Abstract
Psychiatric comorbidities affect a large percentage of people with epilepsy and have a detrimental impact on their quality of life. Recently, behavioural comorbidities, with similar characteristics to human psychiatric diseases, have been identified in dogs with idiopathic epilepsy. In particular, behaviours motivated by the fear-anxiety emotional system have been found to be associated with the occurrence of idiopathic epilepsy in both dogs receiving anti-epileptic drugs, and drug-naïve dogs. There has been little research into the relationship between epilepsy and behavioural signs, and even less into potential treatment protocols. The following article will review available literature from human medicine to describe the current state of knowledge about the bi-directional relationship between anxiety and epilepsy, draw parallels from reported anxiogenic and anxiolytic properties of anti-epileptic drugs and attempt to provide pharmaceutical and behavioural guidance for veterinary patients with epilepsy and comorbid anxiety.
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Affiliation(s)
- F Watson
- The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK; Fitzpatrick Referrals, Halfway Lane, Godalming, Surrey, GU7 2QQ, UK.
| | - C Rusbridge
- Fitzpatrick Referrals, Halfway Lane, Godalming, Surrey, GU7 2QQ, UK; School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Main Academic Building (VSM), Daphne Jackson Road, Guildford, Surrey, GU2 7AL, UK
| | - R M A Packer
- The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
| | - R A Casey
- The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK; Dogs Trust, Clarissa Baldwin House, 17 Wakley Street, London, EC1V 7RQ, UK
| | - S Heath
- Behavioural Referrals Veterinary Practice, 10 Rushton Drive, Upton, Chester, CH2 1RE, UK
| | - H A Volk
- The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
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Wang X, He X, Li T, Shu Y, Qi S, Luan G. Anti-epileptic effect of ifenprodil on neocortical pyramidal neurons in patients with malformations of cortical development. Exp Ther Med 2017; 14:5757-5766. [PMID: 29285118 PMCID: PMC5740521 DOI: 10.3892/etm.2017.5311] [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] [Received: 10/19/2016] [Accepted: 06/22/2017] [Indexed: 02/06/2023] Open
Abstract
Ifenprodil has been demonstrated to reduce spontaneous action potentials observed by local field potential in animal models. To investigate whether ifenprodil exerts an anti-epileptic effect on neuronal levels in humans, whole-cell patch clamp recordings were used to study the electrophysiological membrane properties of neocortical pyramidal neurons in human brain tissues. Electrophysiological membrane properties and spontaneous spikes of neocortical pyramidal neurons were investigated by using whole-cell patch clamp recordings, prior to and following the application of ifenprodil. In the present study, ifenprodil significantly decreased the membrane input resistance (P<0.01), membrane time constant (P<0.01), action potential amplitude (P<0.01), action potential rising rate (P<0.05) and falling rate (P<0.05) on neocortical pyramidal neurons in patients with epilepsy caused by malformations of cortical development (MCD). These results suggested that ifenprodil decreased neuronal excitability of neocortical pyramidal neurons in patients with epilepsy and MCD and demonstrated that ifenprodil may be a potentially specific treatment for refractory epilepsy caused by MCD.
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Affiliation(s)
- Xiongfei Wang
- Beijing Key Laboratory of Epilepsy, Department of Functional Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China.,Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xun He
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510280, P.R. China
| | - Tianfu Li
- Beijing Key Laboratory of Epilepsy, Brain Research Institute, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Yousheng Shu
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, School of Brain and Cognitive Sciences, The Collaborative Innovation Center for Brain Science, Beijing Normal University, Beijing 100875, P.R. China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Guoming Luan
- Beijing Key Laboratory of Epilepsy, Department of Functional Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
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Abstract
Temporal lobe epilepsy (TLE) is a prevalent neurodegenerative disease associated with various neuropsychiatric disorders and decreased quality of life. Much has been said about the use of fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET), magnetic resonance imaging (MRI), and computed tomography in the qualitative assessment of TLE. However, research into the applications of quantitative measurements to treat and diagnose TLE is severely lacking in the literature. Global quantitative analysis using 18F-FDG-PET is a powerful tool in the metabolic assessment of TLE, and can more accurately identify seizure lateralization and the potential effects of treatment as compared with visual assessments and traditional biopsy region-of-interest quantification. Therefore, there is a pressing need to introduce these novel methods to the treatment of TLE. Although 18F-FDG-PET is most commonly used for visual assessments, qualitative analysis is associated with high levels of interobserver and intraobserver variability. Semiquantitative analysis using standardized uptake value is a more consistently accurate measure of the hypometabolic patterns seen in TLE patients. Novel methods of global quantitative analysis developed in our laboratory have the potential to improve TLE assessment by limiting variability and correcting for the partial volume effect. It is of great importance to adopt these techniques into the mainstream diagnosis and treatment of TLE in order to improve patient care worldwide.
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8
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Woldman W, Terry JR. Multilevel Computational Modelling in Epilepsy: Classical Studies and Recent Advances. VALIDATING NEURO-COMPUTATIONAL MODELS OF NEUROLOGICAL AND PSYCHIATRIC DISORDERS 2015. [DOI: 10.1007/978-3-319-20037-8_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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9
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Szilágyi T, Száva I, Metz EJ, Mihály I, Orbán-Kis K. Untangling the pathomechanisms of temporal lobe epilepsy—The promise of epileptic biomarkers and novel therapeutic approaches. Brain Res Bull 2014; 109:1-12. [DOI: 10.1016/j.brainresbull.2014.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/11/2014] [Accepted: 08/14/2014] [Indexed: 12/30/2022]
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10
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Adami R, Scesa G, Bottai D. Stem cell transplantation in neurological diseases: improving effectiveness in animal models. Front Cell Dev Biol 2014; 2:17. [PMID: 25364724 PMCID: PMC4206985 DOI: 10.3389/fcell.2014.00017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/22/2014] [Indexed: 12/14/2022] Open
Abstract
Neurological diseases afflict a growing proportion of the human population. There are two reasons for this: first, the average age of the population (especially in the industrialized world) is increasing, and second, the diagnostic tools to detect these pathologies are now more sophisticated and can be used on a higher percentage of the population. In many cases, neurological disease has a pharmacological treatment which, as in the case of Alzheimer's disease, Parkinson's disease, Epilepsy, and Multiple Sclerosis can reduce the symptoms and slow down the course of the disease but cannot reverse its effects or heal the patient. In the last two decades the transplantation approach, by means of stem cells of different origin, has been suggested for the treatment of neurological diseases. The choice of slightly different animal models and the differences in methods of stem cell preparation make it difficult to compare the results of transplantation experiments. Moreover, the translation of these results into clinical trials with human subjects is difficult and has so far met with little success. This review seeks to discuss the reasons for these difficulties by considering the differences between human and animal cells (including isolation, handling and transplantation) and between the human disease model and the animal disease model.
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Affiliation(s)
- Raffaella Adami
- Department of Health Science, Faculty of Medicine, University of Milan Milan, Italy
| | - Giuseppe Scesa
- Department of Health Science, Faculty of Medicine, University of Milan Milan, Italy
| | - Daniele Bottai
- Department of Health Science, Faculty of Medicine, University of Milan Milan, Italy
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Howard P, Twycross R, Shuster J, Mihalyo M, Wilcock A. Benzodiazepines. J Pain Symptom Manage 2014; 47:955-64. [PMID: 24681184 DOI: 10.1016/j.jpainsymman.2014.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/06/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Paul Howard
- Earl Mountbatten Hospice, Isle of Wight, United Kingdom
| | | | | | - Mary Mihalyo
- Mylan School of Pharmacy, Duquesne University, Pittsburgh, Pennsylvania, USA
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12
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Perucca P, Mula M. Antiepileptic drug effects on mood and behavior: molecular targets. Epilepsy Behav 2013; 26:440-9. [PMID: 23092694 DOI: 10.1016/j.yebeh.2012.09.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 09/06/2012] [Indexed: 01/09/2023]
Abstract
With almost 100 years of clinical experience, antiepileptic drugs (AEDs) remain the mainstay of epilepsy treatment. They suppress epileptic seizures by acting on a variety of mechanisms and molecular targets involved in the regulation of neuronal excitability. These include inhibitory-GABAergic and excitatory-glutamatergic neurotransmission, as well as ion (sodium and calcium) conductance through voltage-gated channels. On the other hand, accruing evidence indicates that these mechanisms and targets are also implicated in the regulation of mood and behavior, which may explain why each AED is associated with specific psychotropic effects. These effects, however, cannot be explained solely on the basis of the known mode of action of each AED, and other mechanisms or targets are likely to be implicated. In this article, we review positive and negative effects of AEDs on mood and behavior, discuss putative underlying mechanisms, and highlight knowledge gaps which should be addressed in future studies.
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Affiliation(s)
- Piero Perucca
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
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13
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Matveychuk D, Nunes E, Ullah N, Velázquez-Martinez CA, MacKenzie EM, Baker GB. Comparison of phenelzine and geometric isomers of its active metabolite, β-phenylethylidenehydrazine, on rat brain levels of amino acids, biogenic amine neurotransmitters and methylamine. J Neural Transm (Vienna) 2013; 120:987-96. [PMID: 23392617 DOI: 10.1007/s00702-013-0978-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 01/10/2013] [Indexed: 01/27/2023]
Abstract
Phenelzine is a monoamine oxidase (MAO) inhibitor used in treatment of depression and anxiety disorders. It also elevates brain levels of γ-aminobutyric acid (GABA) and inhibits primary amine oxidase (PrAO), an enzyme whose activity and/or expression has been reported to be increased in diabetes mellitus, Alzheimer's disease and cardiovascular disorders. Phenelzine is not only an inhibitor of, but also a substrate for, MAO and it has been suggested that an active metabolite, namely β-phenylethylidenehydrazine (PEH), is responsible for phenelzine's effects on amino acids. PEH is also a strong inhibitor of PrAO but has weak effects on MAO. PEH has a double bond and can thus exist as (E)- and (Z)-geometric isomers, but to date the two isomers have not been compared with regard to their neurochemical effects. We have investigated the effects of phenelzine, (E)- and (Z)-PEH on rat whole brain levels of amino acids, biogenic amine neurotransmitters and methylamine (an endogenous substrate of PrAO). Under the conditions used in the study, (E)- and (Z)-PEH appear to be equivalent in their neurochemical properties. Both PEH isomers and phenelzine produced marked increases in rat brain levels of GABA and alanine while decreasing brain levels of glutamine. Phenelzine increased brain levels of biogenic amine neurotransmitters (noradrenaline, dopamine and serotonin), whereas neither PEH isomer altered levels of these neurotransmitters to a considerable extent. All three drugs significantly increased rat brain levels of methylamine, with (E)- and (Z)-PEH causing a greater increase than phenelzine. These results are discussed in relation to the possible therapeutic applications of these drugs.
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Affiliation(s)
- Dmitriy Matveychuk
- Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB, T6G 2G3, Canada.
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Abstract
Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).
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Affiliation(s)
- Paul Howard
- Duchess of Kent House, Reading, United Kingdom, Oxford
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Abstract
SUMMARY Intrathecal therapy involves the subarachnoid delivery of medications where the administered agents have enhanced potency and diminished systemic exposure compared with oral administration. Baclofen exerts its therapeutic action by enhancing the inhibition produced by the endogenous neurotransmitter GABA. While well-established within the armamentarium of tools for spasticity management, the role of intrathecal baclofen for the management of chronic pain is less certain. The purpose of this review is to describe the pharmacology of intrathecal baclofen, relate the role of intrathecal baclofen in neurologic and non-neurologic conditions, and report upon the potential utility of coadministering baclofen with other agents via the intrathecal route of delivery.
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Affiliation(s)
- Michael Saulino
- MossRehab, Department of Rehabiliation Medicine, Thomas Jefferson University, PA, USA
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