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Ornoy A, Echefu B, Becker M. Valproic Acid in Pregnancy Revisited: Neurobehavioral, Biochemical and Molecular Changes Affecting the Embryo and Fetus in Humans and in Animals: A Narrative Review. Int J Mol Sci 2023; 25:390. [PMID: 38203562 PMCID: PMC10779436 DOI: 10.3390/ijms25010390] [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: 12/11/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Valproic acid (VPA) is a very effective anticonvulsant and mood stabilizer with relatively few side effects. Being an epigenetic modulator, it undergoes clinical trials for the treatment of advanced prostatic and breast cancer. However, in pregnancy, it seems to be the most teratogenic antiepileptic drug. Among the proven effects are congenital malformations in about 10%. The more common congenital malformations are neural tube defects, cardiac anomalies, urogenital malformations including hypospadias, skeletal malformations and orofacial clefts. These effects are dose related; daily doses below 600 mg have a limited teratogenic potential. VPA, when added to other anti-seizure medications, increases the malformations rate. It induces malformations even when taken for indications other than epilepsy, adding to the data that epilepsy is not responsible for the teratogenic effects. VPA increases the rate of neurodevelopmental problems causing reduced cognitive abilities and language impairment. It also increases the prevalence of specific neurodevelopmental syndromes like autism (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). High doses of folic acid administered prior to and during pregnancy might alleviate some of the teratogenic effect of VPA and other AEDs. Several teratogenic mechanisms are proposed for VPA, but the most important mechanisms seem to be its effects on the metabolism of folate, SAMe and histones, thus affecting DNA methylation. VPA crosses the human placenta and was found at higher concentrations in fetal blood. Its concentrations in milk are low, therefore nursing is permitted. Animal studies generally recapitulate human data.
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Affiliation(s)
- Asher Ornoy
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel; (B.E.); (M.B.)
- Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 9112102, Israel
| | - Boniface Echefu
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel; (B.E.); (M.B.)
| | - Maria Becker
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel; (B.E.); (M.B.)
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2
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Dono F, Consoli S, Tappatà M, Evangelista G, Russo M, Lanzone J, Pozzilli V, Nucera B, Rinaldi F, Di Pietro M, Tinti L, Troisi S, Calisi D, D'Apolito M, Narducci F, Assenza G, Anzellotti F, Brigo F, Vollono C, Onofrj M, Sensi SL, Michelucci R. Autoimmune encephalitis during pregnancy: A diagnostic and therapeutic challenge-A systematic review with individual patients' analysis and clinical recommendations. Epilepsia Open 2023; 8:1221-1240. [PMID: 37562964 PMCID: PMC10690706 DOI: 10.1002/epi4.12806] [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: 05/25/2023] [Accepted: 08/06/2023] [Indexed: 08/12/2023] Open
Abstract
Several reports have described the autoimmune encephalitis' (AE) possible onset during pregnancy. In this systematic review, we summarize the available data on the diagnostic and therapeutic approach to AE during pregnancy, highlighting the associated maternal and fetal clinical outcomes. A systematic search of the literature was performed. The following databases were used: PubMed, Google Scholar, EMBASE, and CrossRef. The revision was registered on the PROSPERO platform (CRD42022336357). Forty-nine patients were included. AE onset was mainly observed during the first and the second trimester of pregnancy with psychiatric manifestations and seizures as main onset symptoms. CSF analysis showed AE-specific autoantibody positivity in 33 patients (anti-NMDA receptor as the most frequent). EEG generally showed normal findings. MRI revealed pathological findings in less than half of patients. Tumor screening was positive in 14 cases. First-line immunotherapy (single or combined) was generally employed while second line was administered in a minority of patients. Levetiracetam was the most used antiseizure medication. Cesarean section was performed in 18 women. Most of the women had an excellent early outcome after delivery but 22 showed persistent neurological deficits in long-term follow-up. Fetal outcome was positive in 33 cases, whereas 12 cases of fetal death were reported. A logistic regression showed that no variable significantly influenced the odds of good/bad maternal and fetal clinical outcome. Diagnosis and treatment of AE during pregnancy is challenging. The rate of miscarriage in women with AE seems to be higher than the general population. In addition, mothers may show long-term neurological deficits.
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Affiliation(s)
- Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
| | - Stefano Consoli
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
| | - Maria Tappatà
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
| | - Jacopo Lanzone
- Neurorehabilitation Department, IRCCS Salvatore Maugeri FoundationInstitute of MilanMilanItaly
- Department of Systems Medicine, NeuroscienceUniversity of Rome Tor VergataRomeItaly
| | - Valeria Pozzilli
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Bruna Nucera
- Department of NeurologyHospital of Merano (SABES‐ASDAA)MeranoItaly
| | - Fabrizio Rinaldi
- Department of NeurologyHospital of Merano (SABES‐ASDAA)MeranoItaly
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Lorenzo Tinti
- Department of NeurologySan Gerardo Hospital ASST MonzaMonzaItaly
| | - Serena Troisi
- Pediatric Neurology, Department of NeuroscienceSantobono‐Pausilipon Children's HospitalNaplesItaly
| | - Dario Calisi
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Maria D'Apolito
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Flavia Narducci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of MedicineUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of MedicineUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Francesca Anzellotti
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Francesco Brigo
- Department of NeurologyHospital of Merano (SABES‐ASDAA)MeranoItaly
| | - Catello Vollono
- Unit of Neurophysiopathology and Sleep Medicine, Department of Geriatrics, Neurosciences and OrthopedicsIRCCS Policlinico Universitario Agostino Gemelli, Catholic UniversityRomeItaly
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Stefano L. Sensi
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
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Mallan S, Singh S. Syringic acid alleviates valproic acid induced autism via activation of p38 mitogen-activated protein kinase: Possible molecular approach. ENVIRONMENTAL TOXICOLOGY 2023; 38:2400-2415. [PMID: 37357844 DOI: 10.1002/tox.23876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/09/2023] [Accepted: 06/11/2023] [Indexed: 06/27/2023]
Abstract
Autism spectrum disorder (ASD) is a multifactorial neurodevelopmental disorder characterized by restrictive and repetitive behavior followed by impairment in social, verbal, and non-verbal interaction and communication. Valproic acid (VPA) is a well-known anti-epileptic drug, but its prenatal exposure to animals causes social impairment, neurotransmitters imbalance, and neuroinflammation with ASD-like phenotypes. Syringic acid (SA) is a polyphenolic compound with anti-inflammatory, anti-apoptotic, antioxidant, and neuromodulator activity. The purpose of study was to investigate the protective effect of Syringic acid (SA) in prenatal VPA-treated rats through behavioral, neuroinflammation, oxidative stress, neurotransmitters, neuronal integrity, and apoptotic marker. Single dose of VPA was administered 600 mg/kg, i.p. on a gestational day (GD) 12th and SA was administrated from PnD 26th to 54th at the dose of 25, 50, and 100 mg/kg, p.o. On PnD 56th behavioral parameters (Pain sensitivity, open field test, narrow beam walks test and social impairment test) were performed and all animals were sacrificed, and brain tissue was isolated for oxidative stress (GSH, CAT, and LPO), neuroinflammation (TNF-α and IL-6) and neurotransmitters (GABA and Glutamate), histopathology (H&E, Nissl), immunohistochemistry (p38 MAPK) analysis. Rat treated with SA dose-dependently prevented behavioral alteration, restored antioxidant enzymes, neurotransmitters level, decreased neuroinflammatory markers, and improved neuronal integrity. Furthermore, immunohistochemistry confirmed the reduced p38 MAPK marker expression by SA in VPA induced autistic behavior.
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Affiliation(s)
- Sudhanshu Mallan
- Neuropharmacology division, Department of Pharmacology, ISF College of Pharmacy, Moga, India
| | - Shamsher Singh
- Neuropharmacology division, Department of Pharmacology, ISF College of Pharmacy, Moga, India
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Leung CS, Rosenzweig SJ, Yoon B, Marinelli NA, Hollingsworth EW, Maguire AM, Cowen MH, Schmidt M, Imitola J, Gamsiz Uzun ED, Lizarraga SB. Dysregulation of the chromatin environment leads to differential alternative splicing as a mechanism of disease in a human model of autism spectrum disorder. Hum Mol Genet 2023; 32:1634-1646. [PMID: 36621967 PMCID: PMC10162432 DOI: 10.1093/hmg/ddad002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/24/2022] [Accepted: 01/03/2023] [Indexed: 01/10/2023] Open
Abstract
Autism spectrum disorder (ASD) affects 1 in 44 children. Chromatin regulatory proteins are overrepresented among genes that contain high risk variants in ASD. Disruption of the chromatin environment leads to widespread dysregulation of gene expression, which is traditionally thought of as a mechanism of disease pathogenesis associated with ASD. Alternatively, alterations in chromatin dynamics could also lead to dysregulation of alternative splicing, which is understudied as a mechanism of ASD pathogenesis. The anticonvulsant valproic acid (VPA) is a well-known environmental risk factor for ASD that acts as a class I histone deacetylase inhibitor. However, the precise molecular mechanisms underlying defects in human neuronal development associated with exposure to VPA are understudied. To dissect how VPA exposure and subsequent chromatin hyperacetylation influence molecular signatures involved in ASD pathogenesis, we conducted RNA sequencing (RNA-seq) in human cortical neurons that were treated with VPA. We observed that differentially expressed genes (DEGs) were enriched for mRNA splicing, mRNA processing, histone modification and metabolism related gene sets. Furthermore, we observed widespread increases in the number and the type of alternative splicing events. Analysis of differential transcript usage (DTU) showed that exposure to VPA induces extensive alterations in transcript isoform usage across neurodevelopmentally important genes. Finally, we find that DEGs and genes that display DTU overlap with known ASD-risk genes. Altogether, these findings suggest that, in addition to differential gene expression, changes in alternative splicing correlated with alterations in the chromatin environment could act as an additional mechanism of disease in ASD.
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Affiliation(s)
- Calvin S Leung
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI 02912, USA
- Center for Translational Neuroscience, Carney Institute for Brain Science and Brown Institute for Translational Science (BITS), Brown University, Providence, RI 02912, USA
| | - Shoshana J Rosenzweig
- Center for Computational Molecular Biology, Brown University, Providence, RI 02906, USA
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Academic Medical Center, Providence, RI 02903, USA
| | - Brian Yoon
- Department of Biological Sciences, University of South Carolina, Columbia, SC 29208, USA
| | - Nicholas A Marinelli
- Department of Biological Sciences, University of South Carolina, Columbia, SC 29208, USA
| | - Ethan W Hollingsworth
- UCONN Health Comprehensive Multiple Sclerosis Center, Department of Neurology, University of Connecticut School of Medicine, Farmington, CT 06030, USA
- Division of Multiple Sclerosis and Translational Neuroimmunology, Department of Neurology, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Abbie M Maguire
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI 02912, USA
- Center for Translational Neuroscience, Carney Institute for Brain Science and Brown Institute for Translational Science (BITS), Brown University, Providence, RI 02912, USA
| | - Mara H Cowen
- Department of Biological Sciences, University of South Carolina, Columbia, SC 29208, USA
| | - Michael Schmidt
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI 02912, USA
- Center for Translational Neuroscience, Carney Institute for Brain Science and Brown Institute for Translational Science (BITS), Brown University, Providence, RI 02912, USA
| | - Jaime Imitola
- UCONN Health Comprehensive Multiple Sclerosis Center, Department of Neurology, University of Connecticut School of Medicine, Farmington, CT 06030, USA
- Division of Multiple Sclerosis and Translational Neuroimmunology, Department of Neurology, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Ece D Gamsiz Uzun
- Center for Computational Molecular Biology, Brown University, Providence, RI 02906, USA
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Academic Medical Center, Providence, RI 02903, USA
| | - Sofia B Lizarraga
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI 02912, USA
- Center for Translational Neuroscience, Carney Institute for Brain Science and Brown Institute for Translational Science (BITS), Brown University, Providence, RI 02912, USA
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Manthos K, Theotokis P, Dermitzakis I, Avramidou E, Meditskou S, Manthou ME, Emmanouil‐Nikoloussi E. Valproic acid induced selective apoptosis of ocular fibrous tunic in mice fetuses. Birth Defects Res 2022; 114:1257-1265. [DOI: 10.1002/bdr2.2076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Kyriakos Manthos
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Paschalis Theotokis
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
- Laboratory of Experimental Neurology and Neuroimmunology, Second Department of Neurology AHEPA University Hospital Thessaloniki Greece
| | - Iasonas Dermitzakis
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Eleni Avramidou
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Soultana Meditskou
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Maria Eleni Manthou
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Elpida‐Niki Emmanouil‐Nikoloussi
- Department of Histology‐Embryology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
- Department of Histology‐Embryology, Department of Dentistry, School of Medicine European University of Cyprus Nicosia Cyprus
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Nucera B, Brigo F, Trinka E, Kalss G. Treatment and care of women with epilepsy before, during, and after pregnancy: a practical guide. Ther Adv Neurol Disord 2022; 15:17562864221101687. [PMID: 35706844 PMCID: PMC9189531 DOI: 10.1177/17562864221101687] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/03/2022] [Indexed: 01/16/2023] Open
Abstract
Women with epilepsy (WWE) wishing for a child represent a highly relevant subgroup of epilepsy patients. The treating epileptologist needs to delineate the epilepsy syndrome and choose the appropriate anti-seizure medication (ASM) considering the main goal of seizure freedom, teratogenic risks, changes in drug metabolism during pregnancy and postpartum, demanding for up-titration during and down-titration after pregnancy. Folic acid or vitamin K supplements and breastfeeding are also discussed in this review. Lamotrigine and levetiracetam have the lowest teratogenic potential. Data on teratogenic risks are also favorable for oxcarbazepine, whereas topiramate tends to have an unfavorable profile. Valproate needs special emphasis. It is most effective in generalized seizures but should be avoided whenever possible due to its teratogenic effects and the negative impact on neuropsychological development of in utero-exposed children. Valproate still has its justification in patients not achieving seizure freedom with other ASMs or if a woman decides to or cannot become pregnant for any reason. When valproate is the most appropriate treatment option, the patient and caregiver must be fully informed of the risks associated with its use during pregnancies. Folate supplementation is recommended to reduce the risk of major congenital malformations. However, there is insufficient information to address the optimal dose and it is unclear whether higher doses offer greater protection. There is currently no general recommendation for a peripartum vitamin K prophylaxis. During pregnancy most ASMs (e.g. lamotrigine, oxcarbazepine, and levetiracetam) need to be increased to compensate for the decline in serum levels; exceptions are valproate and carbamazepine. Postpartum, baseline levels are reached relatively fast, and down-titration is performed empirically. Many ASMs in monotherapy are (moderately) safe for breastfeeding and women should be encouraged to do so. This review provides a practically oriented overview of the complex management of WWE before, during, and after pregnancy.
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Affiliation(s)
- Bruna Nucera
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Member of the ERN EpiCARE, Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Member of the ERN EpiCARE, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria
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Shin KO, Crumrine DA, Kim S, Lee Y, Kim B, Abuabara K, Park C, Uchida Y, Wakefield JS, Meyer JM, Jeong S, Park BD, Park K, Elias PM. Phenotypic overlap between atopic dermatitis and autism. BMC Neurosci 2021; 22:43. [PMID: 34157971 PMCID: PMC8218496 DOI: 10.1186/s12868-021-00645-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/01/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Autism, a childhood behavioral disorder, belongs to a large suite of diseases, collectively referred to as autism spectrum disorders (ASD). Though multifactorial in etiology, approximately 10% of ASD are associated with atopic dermatitis (AD). Moreover, ASD prevalence increases further as AD severity worsens, though these disorders share no common causative mutations. We assessed here the link between these two disorders in the standard, valproic acid mouse model of ASD. In prior studies, there was no evidence of skin involvement, but we hypothesized that cutaneous involvement could be detected in experiments conducted in BALB/c mice. BALB/c is an albino, laboratory-bred strain of the house mouse and is among the most widely used inbred strains used in animal experimentation. METHODS We performed our studies in valproic acid (VPA)-treated BALB/c hairless mice, a standard mouse model of ASD. Mid-trimester pregnant mice received a single intraperitoneal injection of either valproic acid sodium salt dissolved in saline or saline alone on embryonic day 12.5 and were housed individually until postnatal day 21. Only the brain and epidermis appeared to be affected, while other tissues remain unchanged. At various postnatal time points, brain, skin and blood samples were obtained for histology and for quantitation of tissue sphingolipid content and cytokine levels. RESULTS AD-like changes in ceramide content occurred by day one postpartum in both VPA-treated mouse skin and brain. The temporal co-emergence of AD and ASD, and the AD phenotype-dependent increase in ASD prevalence correlated with early appearance of cytokine markers (i.e., interleukin [IL]-4, 5, and 13), as well as mast cells in skin and brain. The high levels of interferon (IFN)γ not only in skin, but also in brain likely account for a significant decline in esterified very-long-chain N-acyl fatty acids in brain ceramides, again mimicking known IFNγ-induced changes in AD. CONCLUSION Baseline involvement of both AD and ASD could reflect concurrent neuro- and epidermal toxicity, possibly because both epidermis and neural tissues originate from the embryonic neuroectoderm. These studies illuminate the shared susceptibility of the brain and epidermis to a known neurotoxin, suggesting that the atopic diathesis could be extended to include ASD.
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Affiliation(s)
- Kyong-Oh Shin
- Department of Food Science/Nutrition, & Convergence Program of Material Science for Medicine/Pharmaceutics, and the Korean Institute of Nutrition, Hallym University, Chuncheon, South Korea
| | - Debra A Crumrine
- Dept. of Dermatology, University of California, NCIRE, and Veterans Affairs Medical Center, 4150 Clement Street, MS 190, San Francisco, CA, 94121, USA
| | - Sungeun Kim
- Department of Food Science/Nutrition, & Convergence Program of Material Science for Medicine/Pharmaceutics, and the Korean Institute of Nutrition, Hallym University, Chuncheon, South Korea
| | - Yerin Lee
- Department of Food Science/Nutrition, & Convergence Program of Material Science for Medicine/Pharmaceutics, and the Korean Institute of Nutrition, Hallym University, Chuncheon, South Korea
| | - Bogyeong Kim
- Department of Food Science/Nutrition, & Convergence Program of Material Science for Medicine/Pharmaceutics, and the Korean Institute of Nutrition, Hallym University, Chuncheon, South Korea
| | - Katrina Abuabara
- Department of Dermatology, University of San Francisco, San Francisco, CA, USA
| | - Chaehyeong Park
- Dept. of Dermatology, University of California, NCIRE, and Veterans Affairs Medical Center, 4150 Clement Street, MS 190, San Francisco, CA, 94121, USA
| | - Yoshikazu Uchida
- Dept. of Dermatology, University of California, NCIRE, and Veterans Affairs Medical Center, 4150 Clement Street, MS 190, San Francisco, CA, 94121, USA
| | - Joan S Wakefield
- Dept. of Dermatology, University of California, NCIRE, and Veterans Affairs Medical Center, 4150 Clement Street, MS 190, San Francisco, CA, 94121, USA
| | - Jason M Meyer
- Dept. of Dermatology, University of California, NCIRE, and Veterans Affairs Medical Center, 4150 Clement Street, MS 190, San Francisco, CA, 94121, USA
| | - Sekyoo Jeong
- Dept of Cosmetic Science, Seowon University, Cheongju, South Korea
| | - Byeong Deog Park
- Sphingobrain Inc., San Francisco, CA, USA
- Dr. Raymond Laboratories, Inc, Englewood Cliffs, NJ, USA
| | - Kyungho Park
- Department of Food Science/Nutrition, & Convergence Program of Material Science for Medicine/Pharmaceutics, and the Korean Institute of Nutrition, Hallym University, Chuncheon, South Korea.
| | - Peter M Elias
- Dept. of Dermatology, University of California, NCIRE, and Veterans Affairs Medical Center, 4150 Clement Street, MS 190, San Francisco, CA, 94121, USA.
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Koch BEV, Spaink HP, Meijer AH. A quantitative in vivo assay for craniofacial developmental toxicity of histone deacetylases. Toxicol Lett 2021; 342:20-25. [PMID: 33581288 DOI: 10.1016/j.toxlet.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/31/2020] [Accepted: 02/08/2021] [Indexed: 12/18/2022]
Abstract
Many bony features of the face develop from endochondral ossification of preexisting collagen-rich cartilage structures. The proper development of these cartilage structures is essential to the morphological formation of the face. The developmental programs governing the formation of the pre-bone facial cartilages are sensitive to chemical compounds that disturb histone acetylation patterns and chromatin structure. We have taken advantage of this fact to develop a quantitative morphological assay of craniofacial developmental toxicity based on the distortion and deterioration of facial cartilage structures in zebrafish larvae upon exposure to increasing concentrations of several well-described histone deacetylase inhibitors. In this assay, we measure the angle formed by the developing ceratohyal bone as a precise, sensitive and quantitative proxy for the overall developmental status of facial cartilages. Using the well-established developmental toxicant and histone deacetylase-inhibiting compound valproic acid along with 12 structurally related compounds, we demonstrate the applicability of the ceratohyal angle assay to investigate structure-activity relationships.
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Affiliation(s)
- Bjørn E V Koch
- Institute of Biology Leiden, Leiden University, the Netherlands
| | - Herman P Spaink
- Institute of Biology Leiden, Leiden University, the Netherlands
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Abstract
Interestingly, our case presenting with coronary AV fistula firstly reported in the literature with fetal valproate syndrome. Although differential diagnosis is sometimes difficult, it can be diagnosed with detailed history, physical examination and appropriate laboratory tests. Fetal valproate syndrome can be prevented by discontinue of the valproic acid especially during first trimester of pregnancy.
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Aykan DA, Ergün Y. Cross-sectional evaluation of prescription of valproate and other antiepileptic drugs to pregnant women. Acta Neurol Belg 2021; 121:503-508. [PMID: 31659713 DOI: 10.1007/s13760-019-01231-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/20/2019] [Indexed: 10/25/2022]
Abstract
Drug counseling is important in women with epilepsy since data about the effects of maternal antiepileptics on the developing fetus are limited. Although pregnant patients on the most teratogenic drugs are treated in accordance to the European Medicines Agency guidelines, a large amount of them may be exposed to the teratogenic medications unintentionally. We performed a tertiary center observational study about medications of pregnant women who were consulted to Teratology Information Service (TIS) unit for evidence-based teratogenic risk analysis. The registration records of 134 pregnant women between 2014 and 2018 were examined. We evaluated the diagnoses, prescriptions, usage of antiepileptic drugs, and distribution of drug subtypes and investigated the drug-related congenital anomalies after delivery. Women were recontacted after delivery to obtain information about health status of infants. We found that 33 women were diagnosed with neurological disorders. A total number of 60 neurologic drugs was prescribed, including 13 antiepileptics. Antiepileptic drugs covered 38.4% valproate (n = 5), 15.4% pregabalin/gabapentin (n = 2), 15.4% levetiracetam (n = 2), 15.4% lamotrigine (n = 2), 7.7% phenytoin (n = 1), and 7.7% carbamazepine (n = 1). Delivery outcomes revealed that valproate exposure resulted in one baby with congenital cataracts, one postnatal exitus with cardiac dysfunction, and one therapeutic abortion. Various antiepileptic drugs were prescribed to pregnant women prenatally or at different times of pregnancy and valproate was the most common antiepileptic drug consulted to TIS for teratogenic risk analysis. Disseminating TIS units and reporting the outcomes to the teratogenesis literature provide proper evaluation of teratogenic risks of drugs accordingly.
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11
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Spagnoli C, Rizzi S, Salerno GG, Frattini D, Koskenvuo J, Fusco C. Pharmacological Treatment of Severe Breathing Abnormalities in a Case of HNRNPU Epileptic Encephalopathy. Mol Syndromol 2021; 12:101-105. [PMID: 34012379 DOI: 10.1159/000512566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/26/2020] [Indexed: 11/19/2022] Open
Abstract
Abnormal breathing patterns are a typical feature of Rett and Pitt-Hopkins syndrome and their variants. Their treatment can be challenging, with a risk of long-term detrimental consequences. Early infantile epileptic encephalopathy (EIEE) type 54 is a rare epileptic encephalopathy caused by pathogenic variants in the heterogeneous nuclear ribonucleoprotein U (HNRNPU) gene. Only one case has been described in the literature with episodes of hyperventilation and apnea, but treatment was not discussed. We describe the clinical and genetic features and treatment strategies in a case of EIEE type 54 and severely abnormal breathing pattern. A novel and likely pathogenic c.2277dup, p.(Pro760Serfs*5) variant in the HNRNPU gene was found in a male patient with severe episodes of hyperventilation and apnea, leading to syncope. Combination therapy with acetazolamide, alprazolam and aripiprazole led to significant clinical improvement. Although HNRNPU has not been implicated in breathing control, pathogenic variants in this gene can be associated with the development of abnormal breathing patterns reminiscent of Rett and Pitt-Hopkins syndrome. Its function as a gene expression regulator and its interaction with transcription factors offers a potential pathogenetic link between these 3 disorders. Based on our experience, treatment strategies can be similar to those already applied for patients with Pitt-Hopkins and Rett syndrome.
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Affiliation(s)
- Carlotta Spagnoli
- Child Neurology Unit, Department of Pediatrics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Susanna Rizzi
- Child Neurology Unit, Department of Pediatrics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Grazia Gabriella Salerno
- Child Neurology Unit, Department of Pediatrics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Daniele Frattini
- Child Neurology Unit, Department of Pediatrics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Carlo Fusco
- Child Neurology Unit, Department of Pediatrics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Pediatric Neurophysiology Laboratory, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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12
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Lee Y, Kim D, Lee CJ. Suppressive effects of valproic acid on caudal fin regeneration in adult zebrafish. Anim Cells Syst (Seoul) 2020; 24:349-358. [PMID: 33456719 PMCID: PMC7782361 DOI: 10.1080/19768354.2020.1860126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Zebrafish can regenerate fins following injury through an epimorphic process that includes the formation of new tissues and reconstruction of the original morphology. In this study, the effects of valproic acid (VPA), a widely used anti-epileptic drug, on fin regeneration were studied after the caudal fin amputation of adult zebrafish. In the control group, zebrafish formed new tissues and reconstructed the original rays 14 days after amputation (dpa). Meanwhile, VPA treatments between 20 and 200 µM following amputation suppressed fin regeneration in a dose-dependent manner and altered morphological characteristics, such as bifurcation and segmentation, in the rays. Compared to the control, VPA also delayed blastema formation and decreased cell proliferation in the mesenchymal area of the regenerated fin. The mRNA expression of lef1, a downstream signaling gene in the Wnt pathway, was transiently increased in the regenerated fin of the control at 2 dpa; the same increase was not observed in the VPA-treated zebrafish. Sodium butyrate (SB), an histone deacetylase activity (HDAC) inhibitor, suppressed the fin regeneration without affecting the morphological characteristics of the regenerated ray. Furthermore, the transient increase of lef1 mRNA was not suppressed in the SB-treated zebrafish. These results suggested that VPA's suppressive effects on fin regeneration are partly mediated through decreased cell proliferation and lef1 mRNA expression.
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Affiliation(s)
- Yunkyoung Lee
- Department of Biological Sciences, Inha University, Incheon, Korea
| | - Dohee Kim
- Department of Biological Sciences, Inha University, Incheon, Korea
| | - Chang-Joong Lee
- Department of Biological Sciences, Inha University, Incheon, Korea
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13
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Ozkul Y, Taheri S, Bayram KK, Sener EF, Mehmetbeyoglu E, Öztop DB, Aybuga F, Tufan E, Bayram A, Dolu N, Zararsiz G, Kianmehr L, Beyaz F, Doganyigit Z, Cuzin F, Rassoulzadegan M. A heritable profile of six miRNAs in autistic patients and mouse models. Sci Rep 2020; 10:9011. [PMID: 32514154 PMCID: PMC7280218 DOI: 10.1038/s41598-020-65847-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/11/2020] [Indexed: 12/31/2022] Open
Abstract
Autism spectrum disorder (ASD) is a group of developmental pathologies that impair social communication and cause repetitive behaviors. The suggested roles of noncoding RNAs in pathology led us to perform a comparative analysis of the microRNAs expressed in the serum of human ASD patients. The analysis of a cohort of 45 children with ASD revealed that six microRNAs (miR-19a-3p, miR-361-5p, miR-3613-3p, miR-150-5p, miR-126-3p, and miR-499a-5p) were expressed at low to very low levels compared to those in healthy controls. A similar but less pronounced decrease was registered in the clinically unaffected parents of the sick children and in their siblings but never in any genetically unrelated control. Results consistent with these observations were obtained in the blood, hypothalamus and sperm of two of the established mouse models of ASD: valproic acid-treated animals and Cc2d1a+/- heterozygotes. In both instances, the same characteristic miRNA profile was evidenced in the affected individuals and inherited together with disease symptoms in the progeny of crosses with healthy animals. The consistent association of these genetic regulatory changes with the disease provides a starting point for evaluating the changes in the activity of the target genes and, thus, the underlying mechanism(s). From the applied societal and medical perspectives, once properly confirmed in large cohorts, these observations provide tools for the very early identification of affected children and progenitors.
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Affiliation(s)
- Yusuf Ozkul
- Erciyes University Medical Faculty, Medical Genetics Department, Kayseri, Turkey. .,Erciyes University, Betul-Ziya Eren Genome and Stem Cell Center, Kayseri, Turkey.
| | - Serpil Taheri
- Erciyes University, Betul-Ziya Eren Genome and Stem Cell Center, Kayseri, Turkey.,Erciyes University Medical Faculty, Medical Biology Department, Kayseri, Turkey
| | - Kezban Korkmaz Bayram
- Erciyes University Medical Faculty, Medical Genetics Department, Kayseri, Turkey.,Erciyes University, Betul-Ziya Eren Genome and Stem Cell Center, Kayseri, Turkey
| | - Elif Funda Sener
- Erciyes University, Betul-Ziya Eren Genome and Stem Cell Center, Kayseri, Turkey.,Erciyes University Medical Faculty, Medical Biology Department, Kayseri, Turkey
| | - Ecmel Mehmetbeyoglu
- Erciyes University, Betul-Ziya Eren Genome and Stem Cell Center, Kayseri, Turkey
| | - Didem Behice Öztop
- Ankara University, Medical Faculty, Child and Adolescent Psychiatry Department, Ankara, Turkey
| | - Fatma Aybuga
- Erciyes University, Betul-Ziya Eren Genome and Stem Cell Center, Kayseri, Turkey
| | - Esra Tufan
- Erciyes University, Betul-Ziya Eren Genome and Stem Cell Center, Kayseri, Turkey
| | - Arslan Bayram
- Erciyes University Medical Faculty, Medical Genetics Department, Kayseri, Turkey
| | - Nazan Dolu
- Baskent University, Medical Faculty, Physiology Department, Ankara, Turkey
| | - Gokmen Zararsiz
- Erciyes University, Betul-Ziya Eren Genome and Stem Cell Center, Kayseri, Turkey
| | | | - Feyzullah Beyaz
- Erciyes University Veterinary Faculty, Histology and Embryology Department, Kayseri, Turkey
| | - Züleyha Doganyigit
- Bozok University, Medical Faculty, Histology and Embryology Department, Yozgat, Turkey
| | | | - Minoo Rassoulzadegan
- Erciyes University, Betul-Ziya Eren Genome and Stem Cell Center, Kayseri, Turkey. .,Université Côte d'Azur, CNRS, Inserm, France.
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14
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Rybalko ON, Kaladze NN, Sukhareva IA, Khoo CS. A Case Series of Fetal Valproate Syndrome in the Republic of Crimea. J Neurosci Rural Pract 2019; 10:700-702. [PMID: 31831992 PMCID: PMC6906093 DOI: 10.1055/s-0039-1700599] [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] [Indexed: 11/06/2022] Open
Abstract
Valproic acid or valproate is a well-recognized potent teratogen. Antenatal exposure to this drug can cause fetal valproate syndrome (FVS), which is a constellation of distinctive dysmorphic features and congenital malformations. Despite an abundance of reports and registries about this syndrome, there is lack of information from Russia, in particular, the Republic of Crimea. We herein describe two cases of FVS from our registry.
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Affiliation(s)
- Olga Nikolaevna Rybalko
- Department of Pediatrics, Physiotherapy and Health Resorts, S.I. Georgievsky Medical Academy, V.I. Vernadsky Crimean Federal University, Simferopol, Crimea, Russia
| | - Nikolai Nikolaevich Kaladze
- Department of Pediatrics, Physiotherapy and Health Resorts, S.I. Georgievsky Medical Academy, V.I. Vernadsky Crimean Federal University, Simferopol, Crimea, Russia
| | - Irina Alexandrovna Sukhareva
- Department of Public Health, S.I. Georgievsky Medical Academy, V.I. Vernadsky Crimean Federal University, Simferopol, Crimea, Russia
| | - Ching Soong Khoo
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Arora V, Joshi A, Lall M, Agarwal S, Bijarnia Mahay S, Dua Puri R, Chander Verma I. Fetal valproate syndrome as a phenocopy of Kleefstra syndrome. Birth Defects Res 2018; 110:1205-1209. [PMID: 30151876 DOI: 10.1002/bdr2.1379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/07/2018] [Accepted: 07/17/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Veronica Arora
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Anju Joshi
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Meena Lall
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Shruti Agarwal
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Sunita Bijarnia Mahay
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Ratna Dua Puri
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Ishwar Chander Verma
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
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