The distribution of electrolytes and water in patients after taking lithium carbonate

Biphasic dose-dependent effect of lithium chloride on survival of human hormone-dependent breast cancer cells (MCF-7)

Lithium, the first element of Group I in the periodic system, is used to treat bipolar psychiatric disorders. Lithium chloride (LiCl) is a selective inhibitor of glycogen synthase kinase-3β (GSK-3β), a serine/threonine kinase that regulates many cellular processes, in addition to its role in the regulation of glycogen synthase. GSK-3β is emerged as a promising drug target for various neurological diseases, type-2 diabetes, cancer, and inflammation. Several works have demonstrated that lithium can either inhibit or stimulate growth of normal and cancer cells. Hence, the present study is focused to analyze the underlying mechanisms that dictate the biphasic oncogenic properties of LiCl. In the current study, we have investigated the dose-dependent effects of LiCl on human breast cancer cells (MCF-7) by assessing the consequences on cytotoxicity and protein expressions of signaling molecules crucial for the maintenance of cell survival. The results showed breast cancer cells respond in a diverse manner to LiCl, i.e., at lower concentrations (1, 5, and 10 mM), LiCl induces cell survival by inhibiting apoptosis through regulation of GSK-3β, caspase-2, Bax, and cleaved caspase-7 and by activating anti-apoptotic proteins (Akt, β-catenin, Bcl-2, and cyclin D1). In contrast, at high concentrations (50 and 100 mM), it induces apoptosis by reversing these effects. Moreover, LiCl also alters the sodium and potassium levels thereby altering the membrane potential of MCF-7 cells. Thus it is inferred that LiCl exerts a dose-dependent biphasic effect on breast cancer cells (MCF-7) by altering the apoptotic/anti-apoptotic balance.

Electrolytes in erythrocytes of patients with depressive disorders

The concentrations of calcium, sodium, potassium and magnesium in the erythrocytes of patients were measured in the active and remission phases of depressive disorders. Twelve patients in the active phase and 19 patients in remission with major depression were studied and compared with 20 age-matched healthy controls. Patients with major depression in both active and remission phases showed significantly lower calcium concentrations in the erythrocytes compared with controls, although no significant differences in sodium, potassium or magnesium concentrations were found among the three groups. In addition, no differences were found in the electrolyte concentrations between the active and remission phases in the same patients. This calcium concentration had no relationship to the age, gender, or medication drugs of the subjects. Low calcium concentrations were found in the erythrocytes of depressed patients, which may be a relevant marker for depression.

A pilot study of erythrocyte lithium-sodium countertransport in women during the menstrual cycle

OBJECTIVE

The study investigated lithium-sodium countertransport in erythrocytes of normal female volunteers during different phases of the menstrual cycle or during administration of oral contraceptives.

METHODS

Ten normally menstruating, and eight oral contraceptive using, normal female subjects were studied over at least one cycle. Erythrocyte lithium-sodium countertransport was determined using. standard, previously validated methods at different phases of the menstrual cycle. Hematological, electrolyte, blood pressure and other transport measures were also made and these were related to the self-reported incidence of premenstrual symptomatology.

RESULTS

A correlation, (p < 0.02), was found between lithium-sodium countertransport rate and the premenstrual symptom severity score but only in the premenstrual phase. There was no correlation between any of the electrolyte, blood pressure or hematological data and lithium-sodium countertransport rate nor between it and other ion transport measures. Pre-menstrual symptomatology was conspicuously absent from those subjects taking oral contraceptives. Cyclical fluctuations in normally menstruating women, and differences between them and oral contraceptive users, were seen in lithium-sodium countertransport rate although the groups were too small to show statistical significance.

CONCLUSIONS

Care was taken to exclude influences due to circadian, dietary and diurnal variations and the present results show somewhat less within-individual variability in erythrocyte lithium-sodium countertransport during the menstrual cycle than do other reports in the literature. Some interesting features were observed which justify a much larger scale study than the present pilot experiment which should involve a larger number of subjects studied over more than one cycle and in particular a more detailed study of the ovulatory phase.

Effect of chronic lithium chloride on membrane adenosine triphosphatases in certain postural muscles of rats

Lithium has been extensively used as an antidepressant in the treatment of manic depressive disorders requiring chronic administration. Here, we report a study of the effect of long-term lithium treatment on the activities of membrane adenosine triphosphatases (ATPases) in certain postural muscles of rat. Specifically, Ca(2+)-ATPase, Na+,K(+)-ATPase and Mg(2+)-ATPase activities were measured in the soleus, extensor digitorum longus and plantaris muscles following 6 weeks of treatment with LiCl. Increases were observed in the Na+,K(+)-ATPase activity whereas the Mg(2+)-ATPase activity decreased with prolonged LiCl treatment. The most pronounced effect was a highly significant (P < 0.001) increase in the mitochondrial Ca(2+)-ATPase and Na+,K(+)-ATPase activity to almost 50-100% above the control. The increases in the mitochondrial Ca(2+)-ATPase activity of extensor digitorum longus and plantaris were 70% and 100%, respectively. The corresponding increases in the Na+,K(+)-ATPase activity were 127%, 99% and 87% for soleus, extensor digitorum longus and plantaris, respectively. Irrespective of the differences in the fiber pattern and physiological function, all three muscles responded in a similar way to Li+. The changes in the membrane ATPases reflect a deranged ATP turnover, thus affecting the overall energy state of the animal. Based on these results, we hypothesize that Li+ produces its effects by interfering with cation transport processes. Since Li+ affects the neural excitability of the cell it is suggested that the stimulation of the ATPases may be important in the psychotropic properties of the ion.

Erythrocyte electrolytes in psychiatric illness

Erythrocyte sodium and potassium were measured in 71 patients with a variety of psychiatric disorders and 39 normal controls. Alterations in red cell sodium and potassium occurred in association with changes with mood state in affective illness. However, alterations in erythrocyte potassium may be a non-specific finding in all psychiatric illness. The methodological limitations of our study are discussed. Our data suggest that further study is required to clarify the role of intracellular electrolyte disturbances in psychiatric illness, particularly affective disorders.

The Na,K-ATPase hypothesis for manic-depression. II. The mechanism of action of lithium

A model as to how lithium may work in the treatment and prevention of manic-depression is presented. Lithium accumulates intracellularly, and accumulates preferentially in more active neurons. Intracellular accumulation of lithium displaces intracellular sodium, which, in turn, decreases intracellular calcium. A decrease of intracellular calcium normalizes neuron activity in both mania and depression. This model is supported by the majority of clinical and experimental data.

Changes in blood plasma osmolality and states of mania

Manic patients were studied systematically over a period of months. Fluctuations in their blood plasma osmolality were observed and these correlated significantly of and inversely with undulations in their mania rating scores. Successful treatment of patients with lithium carbonate was correlated with increasing levels of their plasma osmolality and with a significant remission of mania symptomatology. Animal studies have shown that adaptations to altered blood plasma osmolalities are accompanied by profound metabolic changes in tissues of the central nervous system. A similar relationship is likely to exist in man. We suggest, therefore, than an altered plasma osmolality is linked to changes in manic symptomatology, through osmotically regulated metabolic changes in the central nervous system.

Combined effects of alcohol and lithium on body composition in the rat model

Alcohol markedly enhances Li+ retention in blood and muscle in rats taking Li and alcohol. The marked enlargement of the exchangeable Na+ space which occurs with alcohol alone, Li+ alone, and to an even greater extent with combined therapy, results from extensive mobilization of "bound" bone sodium, which is transferred to intracellular sites, demonstrably in skeletal muscle, and presumably in other cells. This 87% increase in measured intracellular Na+, and concomitant decrease in K+, would be predicted to produce profound effects on the intracellular ionic milieu, and on membrane function. Lithium is associated with a decrease in food and fluid intake, and this effect is enhanced by alcohol. However the decrease in intake did not result in nutritionally significant deficits in either group, and therefore the observed abnormalities in body composition did not result from caloric, protein, K, Na, or Ca deficiency.

Biological component of the NIMH clinical research branch collaborative program on the psychobiology of depression: I. Background and theoretical considerations

There are many reports which suggest that patients with effective illness (mania and/or depression) have abnormalities in the functioning of one or more neurobiological systems. At a conference convened by the Clinical Research Branch, Division of Extramural Research Programs, National Institute of Mental Health, these findings were reviewed and some of the factors impeding movement towards a more complete and integrated view of the functioning of neurobiological systems in patients with mania or depression were identified. As a result, a multi-research centre, collaborative approach to the study of the psychobiology of affective disorders was developed. In this collaborative programme, which has now been underway for several years, the focus has been upon: (a) the assessment of the functioning of several different types of biological systems in the same patient, both before and during treatment; (b) obtaining a reasonably large number of patients and comparison subjects; and (c) the use within and across centres of standardized diagnostic categories and behavioural rating methodologies. In this paper the history, background, and rationale for this collaborative effort are reviewed. Those biological systems chosen for study are noted, and issues such as reliability and validity of diagnoses, measurement of state variables, assessment of change with treatment, and logistical and coordinating problems are discussed.

Weight gain and body composition in lithium treated rats

Long-term lithium treated growing animals given 0.8-2.0 mmol/kg/day had a slightly but significantly faster weight gain than control animals. Greater doses did not give rise to significantly increased weight gain. Body composition, i.e., the percentage of water, fat, ash and "protein" was not affected in the faster growing lithium treated animals. The wet weight and the weight after drying of the stomach (with content) was increased shortly (hours) after the acute administration of lithium. The duration of the effect depended on the dose given. The weight of the large intestine was also increased after a dose of lithium, but only after some days of lithium pretreatment and mainly the wet weight. The effect was small but similar on the small intestine. In long-term lithium treated rats did the faecal weight and volume increase mainly due to increased water content, but only after some days of lithium treatment.

The effects of administering lithium carbonate on the balance of Na, K and water in manic-depressive patients

Eleven patients in remission from manic-depressive illness were studied by means of metabolic balances before and after the administration of lithium carbonate. Lithium caused a sharp diuresis of isotonic saline and a smaller excretion of potassium over the course of two days. During the subsequent two days there occurred a compensatory retention of Na, K and water. These short-term changes were not associated with any significant alteration in the patients' mood. There was no significant and systematic retention of Na, K or water over the 14 days of Li administration. The recovery of Li was measured simultaneously. During the first week only a proportion of the administered Li was recovered in the urine and faeces, suggesting that a gradual distribution of Li throughout its body space was occurring. After the first week, nearly all the administered Li was recovered, indicating an equilibrium with an even distribution of the ion throughout its body space. This equilibrium was more complete at this early stage in those patients who had been given a smaller dose of lithium carbonate.

Plasma renin activity in depressed patients treated with increasing doses of lithium carbonate

Plasma renin activity (PRA) was measured in the supine position and after active upright stance in patients with endogenous depression and in a group of healthy volunteers serving as controls. In the depressed patients, PRA was further investigated in the same conditions during treatment with increasing doses of lithium carbonate. Basal PRA values were lower in depressed patients than in normal controls, particularly in the upright stance, and tended to rise gradually during lithium therapy. These findings suggest that lithium may work as a stimulant of the renin-angiotensin system, and possibly as an antidepressant, by way of producing functional activation of the norepinephrine system independent of its action on the water and electrolyte balance.

The distribution of lithium and its effects on the distribution and excretion of other ions in the rat

1. In rats, lithium (ca 1 mEquiv/kg body weight) decreased brain sodium and magnesium, bone sodium and calcium and increased muscle calcium, plasma magnesium, urinary calcium and urine volume.2. Lithium was particularly concentrated in bone.

Facilitation of noradrenaline uptake by lithium

It has been suggested that lithium exerts its antimanic effect by facilitation of noradrenaline uptake into adrenergic neurones. Evidence in support of this hypothesis has been obtained from pharmacological experiments in which the effects of lithium were observed on isolated tissue preparations and in whole animals. The effectiveness of lithium in facilitating the uptake of noradrenaline was greater under conditions of reduced noradrenaline uptake, as in the presence of cocaine, than under control conditions.