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García-Rodríguez C, Duarte Y, Ardiles ÁO, Sáez JC. The antiseizure medication valproate increases hemichannel activity found in brain cells, which could worsen disease outcomes. J Neurochem 2024; 168:1045-1059. [PMID: 38291613 DOI: 10.1111/jnc.16062] [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: 10/24/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
Glial cells play relevant roles in neuroinflammation caused by epilepsy. Elevated hemichannel (HC) activity formed by connexins (Cxs) or pannexin1 (Panx1) largely explains brain dysfunctions commonly caused by neuroinflammation. Glia express HCs formed by Cxs 43, 30, or 26, while glia and neurons both express HCs formed by Panx1. Cx43 HCs allow for the influx of Ca2+, which promotes glial reactivity, enabling the release of the gliotransmitters that contribute to neuronal over-stimulation. Valproate (VPA), an antiseizure medication, has pleiotropic actions on neuronal molecular targets, and their action on glial cell HCs remains elusive. We used HeLa cells transfected with Cx43, Cx30, Cx26, or Panx1 to determine the effect of VPA on HC activity in the brain. VPA slightly increased HC activity under basal conditions, but significantly enhanced it in cells pre-exposed to conditions that promoted HC activity. Furthermore, VPA increased ATP release through Cx43 HCs. The increased HC activity caused by VPA was resistant to washout, being consistent with in silico studies, which predicted the binding site for VPA and Cx43, as well as for Panx1 HCs on the intracellular side, suggesting that VPA first enters through HCs, after which their activity increases.
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Affiliation(s)
- Claudia García-Rodríguez
- Centro Interdisciplinario de Neurociencias de Valparaíso, Instituto de Neurociencias, Universidad de Valparaíso, Valparaíso, Chile
| | - Yorley Duarte
- Facultad de Ciencias de la Vida, Center for Bioinformatics and Integrative Biology, Universidad Andrés Bello, Santiago, Chile
| | - Álvaro O Ardiles
- Centro Interdisciplinario de Neurociencias de Valparaíso, Instituto de Neurociencias, Universidad de Valparaíso, Valparaíso, Chile
- Facultad de Medicina, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Juan C Sáez
- Centro Interdisciplinario de Neurociencias de Valparaíso, Instituto de Neurociencias, Universidad de Valparaíso, Valparaíso, Chile
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2
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Avrahami M, Liwinski T, Eckstein Z, Peskin M, Perlman P, Sarlon J, Lang UE, Amital D, Weizman A. Predictors of valproic acid steady-state serum levels in adult and pediatric psychiatric inpatients: a comparative analysis. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06603-y. [PMID: 38733528 DOI: 10.1007/s00213-024-06603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Abstract
RATIONALE Valproic acid (VPA) is commonly used as a second-line mood stabilizer or augmentative agent in severe mental illnesses. However, population pharmacokinetic studies specific to psychiatric populations are limited, and clinical predictors for the precision application of VPA remain undefined. OBJECTIVES To identify steady-state serum VPA level predictors in pediatric/adolescent and adult psychiatric inpatients. METHODS We analyzed data from 634 patients and 1,068 steady-state therapeutic drug monitoring (TDM) data points recorded from 2015 to 2021. Steady-state VPA levels were obtained after tapering during each hospitalization episode. Electronic patient records were screened for routine clinical parameters and co-medication. Generalized additive mixed models were employed to identify independent predictors. RESULTS Most TDM episodes involved patients with psychotic disorders, including schizophrenia (29.2%) and schizoaffective disorder (17.3%). Polypharmacy was common, with the most frequent combinations being VPA + quetiapine and VPA + promethazine. Age was significantly associated with VPA levels, with pediatric/adolescent patients (< 18 years) demonstrating higher dose-adjusted serum levels of VPA (β = 7.6±2.34, p < 0.001) after accounting for BMI. Women tended to have higher adjusted VPA serum levels than men (β = 5.08±1.62, p < 0.001). The formulation of VPA (Immediate-release vs. extended-release) showed no association with VPA levels. Co-administration of diazepam exhibited a dose-dependent decrease in VPA levels (F = 15.7, p < 0.001), suggesting a potential pharmacokinetic interaction. CONCLUSIONS This study highlights the utility of population-specific pharmacokinetic data for VPA in psychiatric populations. Age, gender, and co-administration of diazepam were identified as predictors of VPA levels. Further research is warranted to establish additional predictors and optimize the precision application of VPA in psychiatric patients.
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Affiliation(s)
- Matan Avrahami
- Young Children Department, Child & Adolescent Division, Petah Tikva and Faculty of Medicine, Geha Mental Health Center, Tel Aviv University, Tel Aviv, Israel
| | - Timur Liwinski
- University Psychiatric Clinics Basel, University of Basel, Clinic for Adults, Wilhelm Klein-Strasse 27, Basel, CH-4002, Switzerland.
| | - Zafrir Eckstein
- Faculty of Health Sciences, Geha Mental Health Center, Petah Tikva, and School of Pharmacy, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Miriam Peskin
- Young Children Department, Child & Adolescent Division, Petah Tikva and Faculty of Medicine, Geha Mental Health Center, Tel Aviv University, Tel Aviv, Israel
| | - Polina Perlman
- Young Children Department, Child & Adolescent Division, Petah Tikva and Faculty of Medicine, Geha Mental Health Center, Tel Aviv University, Tel Aviv, Israel
| | - Jan Sarlon
- University Psychiatric Clinics Basel, University of Basel, Clinic for Adults, Wilhelm Klein-Strasse 27, Basel, CH-4002, Switzerland
| | - Undine E Lang
- University Psychiatric Clinics Basel, University of Basel, Clinic for Adults, Wilhelm Klein-Strasse 27, Basel, CH-4002, Switzerland
| | - Daniela Amital
- Division of Psychiatry, Barzilai Medical Center, Ben-Gurion University of the Negev, Ashkelon, Israel
| | - Abraham Weizman
- Young Children Department, Child & Adolescent Division, Petah Tikva and Faculty of Medicine, Geha Mental Health Center, Tel Aviv University, Tel Aviv, Israel
- Laboratory of Biological and Molecular Psychiatry, Felsenstein Medical Research Center, Petah Tikva, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Shnayder NA, Grechkina VV, Trefilova VV, Kissin MY, Narodova EA, Petrova MM, Al-Zamil M, Garganeeva NP, Nasyrova RF. Ethnic Aspects of Valproic Acid P-Oxidation. Biomedicines 2024; 12:1036. [PMID: 38790997 PMCID: PMC11117587 DOI: 10.3390/biomedicines12051036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
The safety of the use of psychotropic drugs, widely used in neurological and psychiatric practice, is an urgent problem in personalized medicine. This narrative review demonstrated the variability in allelic frequencies of low-functioning and non-functional single nucleotide variants in genes encoding key isoenzymes of valproic acid P-oxidation in the liver across different ethnic/racial groups. The sensitivity and specificity of pharmacogenetic testing panels for predicting the rate of metabolism of valproic acid by P-oxidation can be increased by prioritizing the inclusion of the most common risk allele characteristic of a particular population (country).
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Affiliation(s)
- Natalia A. Shnayder
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia; (V.V.G.); (V.V.T.)
- Shared Core Facilities “Molecular and Cell Technologies”, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (E.A.N.); (M.M.P.)
| | - Violetta V. Grechkina
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia; (V.V.G.); (V.V.T.)
| | - Vera V. Trefilova
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia; (V.V.G.); (V.V.T.)
| | - Mikhail Ya. Kissin
- Department of Psychiatry and Addiction, I.P. Pavlov First St. Petersburg State Medical University, 197022 Saint Petersburg, Russia;
| | - Ekaterina A. Narodova
- Shared Core Facilities “Molecular and Cell Technologies”, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (E.A.N.); (M.M.P.)
| | - Marina M. Petrova
- Shared Core Facilities “Molecular and Cell Technologies”, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (E.A.N.); (M.M.P.)
| | - Mustafa Al-Zamil
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia, 117198 Moscow, Russia;
| | - Natalia P. Garganeeva
- Department of General Medical Practice and Outpatient Therapy, Siberian State Medical University, 634050 Tomsk, Russia;
| | - Regina F. Nasyrova
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia; (V.V.G.); (V.V.T.)
- International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, 443016 Samara, Russia
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Csoka AB, El Kouhen N, Bennani S, Getachew B, Aschner M, Tizabi Y. Roles of Epigenetics and Glial Cells in Drug-Induced Autism Spectrum Disorder. Biomolecules 2024; 14:437. [PMID: 38672454 PMCID: PMC11048423 DOI: 10.3390/biom14040437] [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: 02/29/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by severe deficits in social communication and interaction, repetitive movements, abnormal focusing on objects, or activity that can significantly affect the quality of life of the afflicted. Neuronal and glial cells have been implicated. It has a genetic component but can also be triggered by environmental factors or drugs. For example, prenatal exposure to valproic acid or acetaminophen, or ingestion of propionic acid, can increase the risk of ASD. Recently, epigenetic influences on ASD have come to the forefront of investigations on the etiology, prevention, and treatment of this disorder. Epigenetics refers to DNA modifications that alter gene expression without making any changes to the DNA sequence. Although an increasing number of pharmaceuticals and environmental chemicals are being implicated in the etiology of ASD, here, we specifically focus on the molecular influences of the abovementioned chemicals on epigenetic alterations in neuronal and glial cells and their potential connection to ASD. We conclude that a better understanding of these phenomena can lead to more effective interventions in ASD.
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Affiliation(s)
- Antonei B. Csoka
- Department of Anatomy, Howard University College of Medicine, Washington, DC 20059, USA
| | - Nacer El Kouhen
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Casablanca 20100, Morocco
| | - Samia Bennani
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Casablanca 20100, Morocco
| | - Bruk Getachew
- Department of Pharmacology, Howard University College of Medicine, Washington, DC 20059, USA
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, Washington, DC 20059, USA
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Lee HT, Liao FF, Kung SS, Hwang SJ, Hsieh KP. Trends of anti-seizure medication prescribing pattern in traumatic brain injury patients for the prevention of posttraumatic seizure in Taiwan. Epilepsy Behav Rep 2024; 26:100662. [PMID: 38590545 PMCID: PMC10999794 DOI: 10.1016/j.ebr.2024.100662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/06/2024] [Accepted: 03/23/2024] [Indexed: 04/10/2024] Open
Abstract
Traumatic brain injury (TBI) patients are recommended to receive anti-seizure medication (ASM) as posttraumatic seizure (PTS) prophylaxis. However, the utilization of ASM, including the prescription patterns and associated clinical characteristics, is limited in Taiwan. Thus, this study aimed to investigate the ASM trends and clinical characteristics. This retrospective cohort study enrolled TBI patients who received levetiracetam, phenytoin, and valproic acid during hospitalization using the National Health Insurance Research Database between 2012 and 2019. The primary outcome was the trend of the ASMs based on the index year. The duration of levetiracetam prescription was categorized as short-term (seven days or less) or long-term (more than seven days). Logistic regression identified the factors associated with long-term usage. A total of 64,461 TBI patients were included. Levetiracetam usage increased yearly, while phenytoin declined. Among the levetiracetam users, 5681 (30.38%) were short-term users, and 13,016 (69.62%) were long-term users. Diagnoses of contusions, intracranial hemorrhage, other intracranial injuries, receiving operations, and a history of cerebrovascular disease were significantly associated with longer duration. Conclusions This study revealed the rising trend of levetiracetam usage, indicating its potential as an alternative to phenytoin. TBI patients with more severe conditions were more likely to receive longer prescriptions.
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Affiliation(s)
- Hsin-Tien Lee
- Master Program in Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, 100, Shin-Chuan 1 Road, Kaohsiung City 80708, Taiwan
| | - Fen-Fen Liao
- Department of Pharmacy, Kaohsiung Medical University Hospital, 100, Shin-Chuan 1 Road, Kaohsiung City 80708, Taiwan
| | - Sui-Sum Kung
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, 100, Shin-Chuan 1 Road, Kaohsiung City 80708, Taiwan
| | - Shang-Jyh Hwang
- School of Medicine, College of Medicine, Kaohsiung Medical University, 100, Shin-Chuan 1 Road, Kaohsiung City 80708, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100, Shin-Chuan 1 Road, Kaohsiung City 80708, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan Town, Miaoli County 350, Taiwan
| | - Kun-Pin Hsieh
- Department of Pharmacy, Kaohsiung Medical University Hospital, 100, Shin-Chuan 1 Road, Kaohsiung City 80708, Taiwan
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, 100, Shin-Chuan 1 Road, Kaohsiung City 80708, Taiwan
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Li RK, Xiong YR, Pan SJ, Lei WT, Shu XM, Shi XQ, Tian MQ. Role of TRAK1 variants in epilepsy: genotype-phenotype analysis in a pediatric case of epilepsy with developmental disorder. Front Mol Neurosci 2024; 17:1342371. [PMID: 38410694 PMCID: PMC10894949 DOI: 10.3389/fnmol.2024.1342371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/23/2024] [Indexed: 02/28/2024] Open
Abstract
Purpose The TRAK1 gene is mapped to chromosome 3p22.1 and encodes trafficking protein kinesin binding 1. The aim of this study was to investigate the genotype-phenotype of TRAK1-associated epilepsy. Methods Trio-based whole-exome sequencing was performed on a cohort of 98 patients with epilepsy of unknown etiologies. Protein modeling and the VarCards database were used to predict the damaging effects of the variants. Detailed neurological phenotypes of all patients with epilepsy having TRAK1 variants were analyzed to assess the genotype-phenotype correlations. Results A novel TRAK1 compound heterozygous variant comprising variant c.835C > T, p.Arg279Cys and variant c.2560A > C, p.Lys854Gln was identified in one pediatric patient. Protein modeling and VarCards database analyses revealed that the variants were damaging. The patient received a diagnosis of early infantile epileptic spasms with a developmental disorder; he became seizure-free through valproate and adrenocorticotropic hormone treatment. Further results for six variants in 12 patients with epilepsy indicated that biallelic TRAK1 variants (including homozygous or compound heterozygous variants) were associated with epilepsy with developmental disorders. Among these patients, eight (67%) had epileptic spasms and seven (58%) were intractable to anti-seizure medicines. Moreover, eight patients experienced refractory status epilepticus, of which seven (88%) died in early life. To our knowledge, this is the first reported case of epilepsy caused by TRAK1 compound heterozygous variants. Conclusion Biallelic TRAK1 variants can cause epilepsy and developmental disorders. In these patients, seizures progress to status epilepticus, suggesting a high risk for poor outcomes and the requirement of early treatment.
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Affiliation(s)
| | | | | | | | | | | | - Mao-Qiang Tian
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Children’s Hospital of Guizhou Province, Zunyi, China
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Liu R, Xiao L, Hu Y, Yan Q, Liu X. Rescue strategies for valproic acid overdose poisoning: Case series and literature review. Clin Case Rep 2024; 12:e8367. [PMID: 38161627 PMCID: PMC10753133 DOI: 10.1002/ccr3.8367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/25/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
Valproic acid (VPA) is a wide-ranging anti-epileptic medication that primarily affects bipolar disorder, mania, and migraine. The leading causes of mortality associated with acute poisoning from VPA are nervous system toxicity, drug-induced shock due to encephalopathy from hyperammonemia, as well as acute liver and kidney failure, and respiratory depression that contribute to hemodynamic instability. Treatment of acute VPA poisoning primarily involves in vitro elimination methods, including hemoperfusion (HP), hemodialysis, and hemofiltration, as well as drug remedies such as L-carnitine and meropenem. Nonetheless, there are conflicting opinions regarding drug usage. This article details the three cases of acute poisoning from VPA. The fundamental approach to treatment employs HP assisted by blood concentration monitoring to alleviate shock and stabilize hemodynamics. This investigation presents guidance for the treatment and management of acute poisoning with VPA in clinical settings.
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Affiliation(s)
- Renzhu Liu
- Department of Clinical PharmacyXiangtan Central HospitalXiangtanChina
- Zhou Honghao Research Institute XiangtanXiangtan Central HospitalXiangtanChina
| | - Lu Xiao
- Department of Children Health CareXiangtan Maternal and Child Care Service CentreXiangtanChina
| | - Yixiang Hu
- Department of Clinical PharmacyXiangtan Central HospitalXiangtanChina
- Zhou Honghao Research Institute XiangtanXiangtan Central HospitalXiangtanChina
| | - Qingzi Yan
- Department of Clinical PharmacyXiangtan Central HospitalXiangtanChina
- Zhou Honghao Research Institute XiangtanXiangtan Central HospitalXiangtanChina
| | - Xiang Liu
- Department of Clinical PharmacyXiangtan Central HospitalXiangtanChina
- Zhou Honghao Research Institute XiangtanXiangtan Central HospitalXiangtanChina
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Kitahara G, Higashisaka K, Nakamoto Y, Yamamoto R, Okuno W, Serizawa M, Sakahashi Y, Tsujino H, Haga Y, Tsutsumi Y. Valproic acid elevates HIF-1α-mediated CGB expression and suppresses glucose uptake in BeWo cells. J Toxicol Sci 2024; 49:69-77. [PMID: 38296531 DOI: 10.2131/jts.49.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Placental dysfunction can disrupt pregnancy. However, few studies have assessed the effects of chemical-induced toxicity on placental function. Here, we examined the effects of valproic acid (VPA) as a model chemical on production of hormones and on glucose uptake in human choriocarcinoma cell line BeWo. Cells were treated with forskolin to differentiate into syncytiotrophoblasts, which were then treated with VPA for 72 hr. Real-time RT-PCR analysis showed that VPA significantly increased the mRNA expression of chorionic gonadotropin β (CGB), a hormone that is produced by the placenta in the first trimester of pregnancy, relative to that in the forskolin-only group. It also suppressed the increase in intracellular glucose uptake and GLUT1 level observed in the forskolin-only group. RNA-seq analysis and pathway database analysis revealed that VPA consistently decreased the level of HIF-1α protein and expression of its downstream target genes HK2 and ADM in the hypoxia pathway. Cobalt chloride, a HIF-1α inducer, inhibited CGB upregulation in VPA-treated cells and rescued VPA-induced suppression of glucose uptake and GLUT1 level. Thus, HIF-1α-mediated elevation of CGB expression and suppression of glucose uptake by VPA is a novel mechanism of placental dysfunction.
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Affiliation(s)
- Go Kitahara
- Graduate School of Pharmaceutical Sciences, Osaka University
| | - Kazuma Higashisaka
- Graduate School of Pharmaceutical Sciences, Osaka University
- Institute for Advanced Co-Creation Studies, Osaka University
| | - Yurina Nakamoto
- Graduate School of Pharmaceutical Sciences, Osaka University
| | - Rena Yamamoto
- Graduate School of Pharmaceutical Sciences, Osaka University
| | - Wakako Okuno
- Graduate School of Pharmaceutical Sciences, Osaka University
| | - Momoe Serizawa
- Graduate School of Pharmaceutical Sciences, Osaka University
| | - Yuji Sakahashi
- Graduate School of Pharmaceutical Sciences, Osaka University
| | - Hirofumi Tsujino
- Graduate School of Pharmaceutical Sciences, Osaka University
- The Museum of Osaka University
| | - Yuya Haga
- Graduate School of Pharmaceutical Sciences, Osaka University
| | - Yasuo Tsutsumi
- Graduate School of Pharmaceutical Sciences, Osaka University
- Global Center for Medical Engineering and Informatics, Osaka University
- Institute for Open and Transdisciplinary Research Initiatives, Osaka University
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Hernández García E, Naranjo L, Pichardo-Macías LA, Bernad Bernad MJ, Castro-Pastrana LI, Ruíz García M, García Bernal TA, Mendoza Solís JL, Calderón Guzmán D, Díaz-García L, Mendoza-Torreblanca JG, Chávez Pacheco JL. Analysis of Adverse Drug Reactions in Pediatric Patients with Epilepsy: An Intensive Pharmacovigilance Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1775. [PMID: 38002866 PMCID: PMC10670375 DOI: 10.3390/children10111775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023]
Abstract
Epilepsy is a chronic neurological disease characterized by the presence of spontaneous seizures, with a higher incidence in the pediatric population. Anti-seizure medication (ASM) may produce adverse drug reactions (ADRs) with an elevated frequency and a high severity. Thus, the objective of the present study was to analyze, through intensive pharmacovigilance over 112 months, the ADRs produced by valproic acid (VPA), oxcarbazepine (OXC), phenytoin (PHT), and levetiracetam (LEV), among others, administered to monotherapy or polytherapy for Mexican hospitalized pediatric epilepsy patients. A total of 1034 patients were interviewed; 315 met the inclusion criteria, 211 patients presented ADRs, and 104 did not. A total of 548 ASM-ADRs were identified, and VPA, LEV, and PHT were the main culprit drugs. The most frequent ADRs were drowsiness, irritability, and thrombocytopenia, and the main systems affected were hematologic, nervous, and dermatologic. LEV and OXC caused more nonsevere ADRs, and PHT caused more severe ADRs. The risk analysis showed an association between belonging to the younger groups and polytherapy with ADR presence and between polytherapy and malnutrition with severe ADRs. In addition, most of the severe ADRs were preventable, and most of the nonsevere ADRs were nonpreventable.
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Affiliation(s)
- Ernestina Hernández García
- Laboratorio de Farmacología, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Ciudad de Mexico 04530, Mexico;
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de Mexico 04960, Mexico
| | - Lizbeth Naranjo
- Departamento de Matemáticas, Facultad de Ciencias, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico 04510, Mexico;
| | - Luz Adriana Pichardo-Macías
- Departamento de Fisiología, Instituto Politécnico Nacional, Escuela Nacional de Ciencias Biológicas, Ciudad de Mexico 07738, Mexico;
| | - María Josefa Bernad Bernad
- Departamento de Farmacia, Facultad de Química, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico 04510, Mexico;
| | | | - Matilde Ruíz García
- Servicio de Neurología, Dirección Médica, Instituto Nacional de Pediatría, Ciudad de Mexico 04530, Mexico;
| | | | | | - David Calderón Guzmán
- Laboratorio de Neurociencias, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Ciudad de Mexico 04530, Mexico; (D.C.G.); (J.G.M.-T.)
| | - Luisa Díaz-García
- Departamento de Metodología de la Investigación, Subdirección de Investigación Clínica, Instituto Nacional de Pediatría, Ciudad de Mexico 04530, Mexico;
| | - Julieta Griselda Mendoza-Torreblanca
- Laboratorio de Neurociencias, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Ciudad de Mexico 04530, Mexico; (D.C.G.); (J.G.M.-T.)
| | - Juan Luis Chávez Pacheco
- Laboratorio de Farmacología, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Ciudad de Mexico 04530, Mexico;
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Zhao A, Hu L, Yao W, Chang X, Wang R, Li W. Effects of plateau hypoxia on pharmacokinetic parameters and cerebral-blood distribution of levetiracetam in rats. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:1445-1452. [PMID: 38432875 PMCID: PMC10929895 DOI: 10.11817/j.issn.1672-7347.2023.230201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Plateau hypoxia exposure causes changes in pharmacokinetic parameters and cerebral-blood distribution of drugs, including many substrates of P-glycoprotein (P-gp). Levetiracetam, a kind of antiepileptic drugs, is a substrate of P-gp. Whether plateau hypoxia exposure changes its pharmacokinetic characteristics and cerebral-blood distribution remains unclear. This study aims to investigate the effects of plateau hypoxia on the pharmacokinetics and cerebra-blood distribution of levetiracetam. METHODS Wistar rats were divided into a low-altitude control group, a high-altitude group, a solvent group, and a P-gp induction group. After 24 h of exposure at altitude of 4 010 m, rats in the high-altitude group were given levetiracetam orally or intravenously. The plasma was respectively collected at 0.083, 0.25, 0.5, 0.83, 1.25, 2, 4, 6, 8, 10, 12, and 24 h after oral administration of the drug, while both plasma and brain were respectively collected at 5, 45, 60,120 and 240 min after intravenous injection. After 3 days administration of dexamethasone, plasma and brain of rats in the P-gp induction group were collected at 120 min after intravenously giving levetiracetam. Plasma and brain concentrations of the drug were determined by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The expression of P-gp in blood-brain barrier was detected by Western blotting. RESULTS Compared with the low-altitude control group, the area under the curve (AUC) and mean residence time (MRT) of levetiracetam were respectively decreased by 14.69% (P<0.01) and 15.42% (P<0.01), while the clearance (CL) was increased by 16.67% (P<0.01) in the high-altitude group. The ratio of brain/blood plasma drug concentration was decreased by 22.82% (P<0.05), 12.42% (P<0.05), 17.40% (P<0.01), and 13.22% (P<0.01) at 5, 45, 120, and 240 min after injection, respectively. The expression of P-gp on the blood-brain barrier was increased by 86.3% (P<0.05). Compared with the solvent control group, the expression of P-gp on the blood-brain barrier in the P-gp induction group was increased by 56.3% (P<0.05), the ratio of brain/blood plasma drug concentration was decreased by 19.3% (P<0.05). CONCLUSIONS After acute plateau hypoxia exposure, the pharmacokinetic of levetiracetam in rats are altered, and the cerebral-blood distribution of the drug in rats is decreased, which may be related to the up-regulation of P-gp expression on the blood-brain barrier.
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Affiliation(s)
- Anpeng Zhao
- Department of Pharmacy, 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou 730050.
- School of Pharmacy, Lanzhou University, Lanzhou 730000.
- Gansu Plateau Pharmaceutical Technology Center, Lanzhou 730050, China.
| | - Lin Hu
- Department of Pharmacy, 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou 730050
- School of Pharmacy, Lanzhou University, Lanzhou 730000
| | - Wanteng Yao
- School of Pharmacy, Lanzhou University, Lanzhou 730000
| | - Xiwen Chang
- School of Pharmacy, Lanzhou University, Lanzhou 730000
| | - Rong Wang
- Department of Pharmacy, 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou 730050.
- School of Pharmacy, Lanzhou University, Lanzhou 730000.
- Gansu Plateau Pharmaceutical Technology Center, Lanzhou 730050, China.
| | - Wenbin Li
- Department of Pharmacy, 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou 730050.
- School of Pharmacy, Lanzhou University, Lanzhou 730000.
- Gansu Plateau Pharmaceutical Technology Center, Lanzhou 730050, China.
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Pless A, Ware D, Saggu S, Rehman H, Morgan J, Wang Q. Understanding neuropsychiatric symptoms in Alzheimer's disease: challenges and advances in diagnosis and treatment. Front Neurosci 2023; 17:1263771. [PMID: 37732300 PMCID: PMC10508352 DOI: 10.3389/fnins.2023.1263771] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) affect up to 97% of AD patients, with an estimated 80% of current AD patients experiencing these symptoms. Common AD-associated NPS include depression, anxiety, agitation, aggression, and apathy. The severity of NPS in AD is typically linked to the disease's progression and the extent of cognitive decline. Additionally, these symptoms are responsible for a significant increase in morbidity, mortality, caregiver burden, earlier nursing home placement, and greater healthcare expenditure. Despite their high prevalence and significant impact, there is a notable lack of clinical research on NPS in AD. In this article, we explore and analyze the prevalence, symptom manifestations, challenges in diagnosis, and treatment options of NPS associated with AD. Our literature review reveals that distinguishing and accurately diagnosing the NPS associated with AD remains a challenging task in clinical settings. It is often difficult to discern whether NPS are secondary to pathophysiological changes from AD or are comorbid psychiatric conditions. Furthermore, the availability of effective pharmaceutical interventions, as well as non-pharmacotherapies for NPS in AD, remains limited. By highlighting the advance and challenges in diagnosis and treatment of AD-associated NPS, we aspire to offer new insights into the complexity of identifying and treating these symptoms within the context of AD, and contribute to a deeper understanding of the multifaceted nature of NPS in AD.
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Affiliation(s)
- Andrew Pless
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Destany Ware
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Shalini Saggu
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Hasibur Rehman
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - John Morgan
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Qin Wang
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
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Schiavo A, Maldonado C, Vázquez M, Fagiolino P, Trocóniz IF, Ibarra M. Quantitative systems pharmacology Model to characterize valproic acid-induced hyperammonemia and the effect of L-carnitine supplementation. Eur J Pharm Sci 2023; 183:106399. [PMID: 36740101 DOI: 10.1016/j.ejps.2023.106399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
Valproic acid (VPA) is a short-chain fatty acid widely prescribed in the treatment of seizure disorders and epilepsy syndromes, although its therapeutic value may be undermined by its toxicity. VPA serious adverse effects are reported to have a significant and dose-dependent incidence, many associated with VPA-induced hyperammonemia. This effect has been linked with reduced levels of carnitine; an endogenous compound involved in fatty acid's mitochondrial β-oxidation by facilitation of its entrance via the carnitine shuttle. High exposure to VPA can lead to carnitine depletion causing a misbalance between the intra-mitochondrial β-oxidation and the microsomal ω-oxidation, a pathway that produces toxic metabolites such as 4-en-VPA which inhibits ammonia elimination. Moreover, a reduction in carnitine levels might be also related to VPA-induced obesity and lipids disorder. In turn, L-carnitine supplementation (CS) has been recommended and empirically used to reduce VPA's hepatotoxicity. The aim of this work was to develop a Quantitative Systems Pharmacology (QSP) model to characterize VPA-induced hyperammonemia and evaluate the benefits of CS in preventing hyperammonemia under both chronic treatment and after VPA overdosing. The QSP model included a VPA population pharmacokinetics model that allowed the prediction of total and unbound concentrations after single and multiple oral doses considering its saturable binding to plasma proteins. Predictions of time courses for 2-en-VPA, 4-en-DPA, VPA-glucuronide, carnitine, ammonia and urea levels, and for the relative change in fatty acids, Acetyl-CoA, and glutamate reflected the VPA induced changes and the efficacy of the treatment with L-carnitine. The QSP model was implemented to give a rational basis for the L-carnitine dose selection to optimize CS depending on VPA dosage regime and to assess the currently recommended L-carnitine rescue therapy after VPA overdosing. Results show that a L-carnitine dose equal to the double of the VPA dose using the same interdose interval would maintain the ammonia levels at baseline. The QSP model may be expanded in the future to describe other adverse events linked to VPA-induced changes in endogenous compounds.
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Affiliation(s)
- Alejandra Schiavo
- Department of Pharmaceutical Sciences, Faculty of Chemistry. Universidad de la República. Montevideo, Uruguay; Graduate Program in Chemistry, Faculty of Chemistry, Universidad de la República. Montevideo, Uruguay
| | - Cecilia Maldonado
- Department of Pharmaceutical Sciences, Faculty of Chemistry. Universidad de la República. Montevideo, Uruguay
| | - Marta Vázquez
- Department of Pharmaceutical Sciences, Faculty of Chemistry. Universidad de la República. Montevideo, Uruguay
| | - Pietro Fagiolino
- Department of Pharmaceutical Sciences, Faculty of Chemistry. Universidad de la República. Montevideo, Uruguay
| | - Iñaki F Trocóniz
- Pharmacometrics and Systems Pharmacology Research Unit, Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra. Pamplona, Spain; IdiSNA; Navarra Institute for Health Research, Pamplona, Spain
| | - Manuel Ibarra
- Department of Pharmaceutical Sciences, Faculty of Chemistry. Universidad de la República. Montevideo, Uruguay.
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