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Wu YE, Zheng YY, Li QY, Yao BF, Cao J, Liu HX, Hao GX, van den Anker J, Zheng Y, Zhao W. Model-informed drug development in pediatric, pregnancy and geriatric drug development: States of the art and future. Adv Drug Deliv Rev 2024; 211:115364. [PMID: 38936664 DOI: 10.1016/j.addr.2024.115364] [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: 09/25/2023] [Revised: 06/09/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
The challenges of drug development in pediatric, pregnant and geriatric populations are a worldwide concern shared by regulatory authorities, pharmaceutical companies, and healthcare professionals. Model-informed drug development (MIDD) can integrate and quantify real-world data of physiology, pharmacology, and disease processes by using modeling and simulation techniques to facilitate decision-making in drug development. In this article, we reviewed current MIDD policy updates, reflected on the integrity of physiological data used for MIDD and the effects of physiological changes on the drug PK, as well as summarized current MIDD strategies and applications, so as to present the state of the art of MIDD in pediatric, pregnant and geriatric populations. Some considerations are put forth for the future improvements of MIDD including refining regulatory considerations, improving the integrity of physiological data, applying the emerging technologies, and exploring the application of MIDD in new therapies like gene therapies for special populations.
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Affiliation(s)
- Yue-E Wu
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuan-Yuan Zheng
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiu-Yue Li
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bu-Fan Yao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jing Cao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hui-Xin Liu
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guo-Xiang Hao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - John van den Anker
- Division of Clinical Pharmacology, Children's National Medical Center, Washington, DC, USA; Departments of Pediatrics, Pharmacology & Physiology, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA; Department of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, Basel, Switzerland
| | - Yi Zheng
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wei Zhao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Rog J, Wingralek Z, Nowak K, Grudzień M, Grunwald A, Banaszek A, Karakula-Juchnowicz H. The Potential Role of the Ketogenic Diet in Serious Mental Illness: Current Evidence, Safety, and Practical Advice. J Clin Med 2024; 13:2819. [PMID: 38792361 PMCID: PMC11122005 DOI: 10.3390/jcm13102819] [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: 04/01/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
The ketogenic diet (KD) is a high-fat, low-carbohydrate diet that mimics the physiological state of fasting. The potential therapeutic effects in many chronic conditions have led to the gaining popularity of the KD. The KD has been demonstrated to alleviate inflammation and oxidative stress, modulate the gut microbiota community, and improve metabolic health markers. The modification of these factors has been a potential therapeutic target in serious mental illness (SMI): bipolar disorder, major depressive disorder, and schizophrenia. The number of clinical trials assessing the effect of the KD on SMI is still limited. Preliminary research, predominantly case studies, suggests potential therapeutic effects, including weight gain reduction, improved carbohydrate and lipid metabolism, decrease in disease-related symptoms, increased energy and quality of life, and, in some cases, changes in pharmacotherapy (reduction in number or dosage of medication). However, these findings necessitate further investigation through larger-scale clinical trials. Initiation of the KD should occur in a hospital setting and with strict care of a physician and dietitian due to potential side effects of the diet and the possibility of exacerbating adverse effects of pharmacotherapy. An increasing number of ongoing studies examining the KD's effect on mental disorders highlights its potential role in the adjunctive treatment of SMI.
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Affiliation(s)
- Joanna Rog
- Laboratory of Human Metabolism Research, Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Nowoursynowska 66 Str., 02-787 Warsaw, Poland
| | - Zuzanna Wingralek
- 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Głuska 1 Str., 20-469 Lublin, Poland; (Z.W.); (K.N.); (M.G.); (A.B.); (H.K.-J.)
| | - Katarzyna Nowak
- 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Głuska 1 Str., 20-469 Lublin, Poland; (Z.W.); (K.N.); (M.G.); (A.B.); (H.K.-J.)
| | - Monika Grudzień
- 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Głuska 1 Str., 20-469 Lublin, Poland; (Z.W.); (K.N.); (M.G.); (A.B.); (H.K.-J.)
| | - Arkadiusz Grunwald
- 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Głuska 1 Str., 20-469 Lublin, Poland; (Z.W.); (K.N.); (M.G.); (A.B.); (H.K.-J.)
| | - Agnieszka Banaszek
- 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Głuska 1 Str., 20-469 Lublin, Poland; (Z.W.); (K.N.); (M.G.); (A.B.); (H.K.-J.)
| | - Hanna Karakula-Juchnowicz
- 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Głuska 1 Str., 20-469 Lublin, Poland; (Z.W.); (K.N.); (M.G.); (A.B.); (H.K.-J.)
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Shamshoum H, Medak KD, McKie GL, Jeromson S, Hahn MK, Wright DC. Salsalate and/or metformin therapy confer beneficial metabolic effects in olanzapine treated female mice. Biomed Pharmacother 2023; 168:115671. [PMID: 37839107 DOI: 10.1016/j.biopha.2023.115671] [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: 05/02/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023] Open
Abstract
Antipsychotic medications are used in the management of schizophrenia and a growing number of off-label conditions. While effective at reducing psychoses, these drugs possess noted metabolic side effects including weight gain, liver lipid accumulation and disturbances in glucose and lipid metabolism. To counter the side effects of antipsychotics standard of care has typically included metformin. Unfortunately, metformin does not protect against antipsychotic induced metabolic disturbances in all patients and thus additional treatment approaches are needed. One potential candidate could be salsalate, the prodrug of salicylate, which acts synergistically with metformin to improve indices of glucose and lipid metabolism in obese mice. The purpose of the current investigation was to compare the effects of salsalate, metformin and a combination of both drugs, on weight gain and indices of metabolic health in female mice treated with the antipsychotic, olanzapine. Herein we demonstrate that salsalate was equally as effective as metformin in protecting against olanzapine induced weight gain and liver lipid accumulation with no additional benefit of combining both drugs. Conversely, metformin treatment, either alone or in combination with salsalate, improved indices of glucose metabolism and increased energy expenditure in olanzapine treated mice. Collectively, our findings provide evidence that dual therapy with both metformin and salsalate could be an efficacious approach with which to dampen the metabolic consequences of antipsychotic medications.
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Affiliation(s)
- Hesham Shamshoum
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario N1G2 W1, Canada
| | - Kyle D Medak
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario N1G2 W1, Canada
| | - Greg L McKie
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario N1G2 W1, Canada
| | - Stewart Jeromson
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada; BC Children's Hospital Research Institute, 950 W. 28th Ave., Vancouver, British Columbia V5Z 4H4, Canada
| | - Margaret K Hahn
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada; Banting and Best Diabetes Centre, University of Toronto, Toronto, Ontario M5G 2C4, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - David C Wright
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada; BC Children's Hospital Research Institute, 950 W. 28th Ave., Vancouver, British Columbia V5Z 4H4, Canada; Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada.
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Monson ET, Shastri S, Chen D, Madden SL, Keeshin BR. The Utah psychotropic oversight program: collaboratively addressing antipsychotic use within youth in foster care without prior authorization. Front Psychiatry 2023; 14:1271165. [PMID: 38025462 PMCID: PMC10654962 DOI: 10.3389/fpsyt.2023.1271165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Fostered youth have increased risk of exposure to trauma. Antipsychotic medications are often utilized within the foster care system, potentially to address problematic behaviors that may be associated with trauma. The Utah Psychotropic Oversight Program (UPOP) was formed to support prescribers and encourage evidence-based treatment approaches for fostered youth. However, it is unclear what impact an oversight program can have on a high turnover population and without tools such as prior authorization. This study evaluates 4 years of collected data from the UPOP program for efficacy and to identify future intervention targets. Methods Deidentified data were collected as a routine function of the oversight program over 4 years (01/2019-12/2022), from individuals aged 0-18 years old (total N = 8,523, 48.3% female). UPOP oversight criteria: ≤6yo + any psychotropic medication, ≥7yo + 2 or more psychotropic medications. For this analysis, youth were divided by UPOP individuals ever receiving an antipsychotic (AP) prescription (UPOP_AP; N = 755, 42.3% female) or not (UPOP_NAP, N = 1,006, 48.3% female) and non-UPOP fostered (N = 6,762, 48.9% female). Comparisons were made across demographic and clinical variables via ANOVA, Chi-square, unpaired t-test, and logistic regression. Results UPOP_AP more likely to be older males with behavioral diagnoses, increased polypharmacy, longer duration of fostering, and higher care level. AP prescription rates dropped from 52.8 to 39.1% for males and 43.3 to 38.2% in females with unchanged number of psychotropic prescriptions and care level across 2019-2022. UPOP_AP that discontinued AP treatment had fewer average psychotropic medications, but increased antidepressant and sleep prescriptions, as compared with individuals that remained on AP. Conclusion Youth within the foster care system receive antipsychotics at high rates and in an uneven distribution. Prescribing practices can change in the context of supportive oversight programs without components such as prior authorization, and without increasing the need for higher levels of care. Specific emphasis on the treatment of mood, anxiety, and sleep issues may also lead to greater success in discontinuing AP treatment. Oversight may support treatment providers while reducing exposure to medications with considerable side effect burden that could cause future comorbidity.
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Affiliation(s)
- Eric T. Monson
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
| | - Sachi Shastri
- Medical Scholars Program, Augusta University/University of Georgia Medical Partnership, Athens, GA, United States
| | - Danli Chen
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
- Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT, United States
| | - Stacy L. Madden
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Brooks R. Keeshin
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
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Stogios N, Humber B, Agarwal SM, Hahn M. Antipsychotic-Induced Weight Gain in Severe Mental Illness: Risk Factors and Special Considerations. Curr Psychiatry Rep 2023; 25:707-721. [PMID: 37755655 DOI: 10.1007/s11920-023-01458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW Weight gain is a disconcerting issue experienced by patients treated with antipsychotics (APs). This review summarizes current knowledge on the prevalence, etiology, and risk factors for antipsychotic-induced weight gain (AIWG), and evidence for interventions, including special considerations. RECENT FINDINGS Predisposing risk factors for AIWG include lack of prior AP exposure, sex, and age. AP dose and duration of exposure are additional treatment-related factors that may contribute to this issue. Among current approaches to target AIWG, metformin has the most evidence to support its use, and this is increasingly reflected in clinical guidelines. While lifestyle approaches are recommended, cost-effectiveness and scalability represent limitations. More research is needed to identify newer treatment options and inform clinical recommendations for AIWG. Concerns around scope of practice in psychiatry to address AIWG and related comorbidities will require enhanced training opportunities and interdisciplinary collaborations, as well as updated position statements/practice guidelines emphasizing prevention.
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Affiliation(s)
- Nicolette Stogios
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Bailey Humber
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - Margaret Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada.
- Department of Pharmacology, University of Toronto, Toronto, Canada.
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Takano T. Cardiometabolic Effects of Antipsychotics in Challenging Behavior and Neuropsychiatric Symptoms in Patients With Intellectual Disability. Cureus 2023; 15:e48088. [PMID: 38046756 PMCID: PMC10691170 DOI: 10.7759/cureus.48088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Despite the well-established association between antipsychotics and metabolic adverse effects in psychiatric disorders, the variable influence of long-term and off-label antipsychotic medication on behavioral disorders has not been investigated in detail. Objective To clarify the impact of antipsychotic use on challenging behavior (CB) and neuropsychiatric symptoms (NPS), we evaluated the clinical findings and cardiometabolic effects in individuals with intellectual disability (ID) hospitalized in our residential facility for profoundly disabled patients. Patients and methods A total of 130 individuals hospitalized in our residential facility were retrospectively investigated and divided into two groups - individuals with and without CB and NPS. Antipsychotics (first- and second-generation antipsychotics) are prescribed to all individuals in the CB and NPS-positive ID group. Conversely, antipsychotics were not prescribed to any individuals in the CB- and NPS-negative ID groups. To investigate the cardiometabolic effects of antipsychotics, the following metabolic parameters were measured: body weight (BW), total calorie intake per day, body mass index (BMI), blood pressure, serum lipid levels (total cholesterol, high-density lipoprotein cholesterol, and triglyceride), and corrected QT interval (QTc) of electrocardiogram (ECG). The etiology of disabilities, level of ID, severity of motor disability, and presence or absence of epilepsy were also examined. Results Two main results were derived: (1) Autism spectrum disorder was the most predominant etiology in individuals with CB and NPS who were prescribed antipsychotics, and (2) the mean values of metabolic parameters were all normal in both medicated and nonmedicated individuals, but the total calorie intake was significantly higher in individuals who were prescribed antipsychotics. Conclusions Our investigation demonstrated that in individuals with an adequate energy intake, most metabolic parameters can be maintained within normal limits. We suggest that body weight control is the primary step in avoiding the cardiometabolic adverse effects of antipsychotics in intellectually disabled individuals with CB and NPS.
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Affiliation(s)
- Tomoyuki Takano
- Department of Pediatrics, Biwako-Gakuen Medical and Welfare Center of Yasu, Yasu, JPN
- Department of Pediatrics, Shiga University of Medical Science, Otsu, JPN
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Oshima M, Toyama T, Nakade Y, Yomogida D, Yuasa T, Horikoshi K, Minami T, Ogura H, Nakagawa S, Miyagawa T, Kitajima S, Hara A, Sakai N, Shimizu M, Mita M, Kinoshita M, Nakada M, Kikuchi M, Iwata Y, Wada T. Association Between Risperidone Use and Kidney Function Decline in Patients with Schizophrenia: A Retrospective Cohort Study. Clin Ther 2023; 45:889-893. [PMID: 37487866 DOI: 10.1016/j.clinthera.2023.07.002] [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: 01/30/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Several D-amino acids have been shown to be protective against kidney injury in mice. Risperidone, a currently used atypical antipsychotic agent for schizophrenia, is also known to inhibit the activity of D-amino acid oxidase, which degrades certain D-amino acids. Based on the hypothesis that risperidone would prevent kidney disease progression, this study investigated the association between risperidone use and kidney function decline in patients with schizophrenia. METHODS This retrospective cohort study included patients who were diagnosed with schizophrenia and had data available from two or more serum creatinine measurements between April 1, 2010, and March 31, 2020. Patients who used risperidone for at least 30 days were included in the risperidone group, whereas those who had no record of risperidone use were included in the control group. Cox regression models were used to evaluate the risk for 40% decline in estimated glomerular filtration rate (eGFR) in patients treated with risperidone compared to that in the control group. FINDINGS Overall, 212 patients used risperidone and 1468 patients had no record of risperidone use. The mean age was 55 years, 759 (45%) of the patients were male, and the mean eGFR at baseline was 88 mL/min/1.73 m2. The mean age in the risperidone group was less than that in the control group (52 vs 56 years); other baseline characteristics were comparable between the two groups. During a mean follow-up of 1.6 years, 267 patients (16%) had a 40% eGFR decline. The incidence rate of 40% eGFR decline was lower in the risperidone group than in the control group (60 vs 104 per 1000 person-years). After adjustment for baseline age, sex, and eGFR, risperidone use was associated with a decreased risk for 40% eGFR decline (hazard ratio = 0.54; 95% CI, 0.33-0.87; P = 0.01). IMPLICATIONS Risperidone use may be associated with decreased risk for kidney function decline in patients with schizophrenia. Further studies are warranted to validate these findings.
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Affiliation(s)
| | | | - Yusuke Nakade
- Department of Nephrology and Laboratory Medicine; Department of Clinical Laboratory Medicine
| | | | | | | | | | | | | | | | | | - Akinori Hara
- Department of Nephrology and Laboratory Medicine
| | | | - Miho Shimizu
- Department of Nephrology and Laboratory Medicine
| | | | | | | | - Mitsuru Kikuchi
- Department of Psychiatry and Behavioral Science, Kanazawa University Graduate School of Medical Sciences, and the; Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine
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Qian L, He X, Liu Y, Gao F, Lu W, Fan Y, Gao Y, Wang W, Zhu F, Wang Y, Ma X. Longitudinal Gut Microbiota Dysbiosis Underlies Olanzapine-Induced Weight Gain. Microbiol Spectr 2023; 11:e0005823. [PMID: 37260381 PMCID: PMC10433857 DOI: 10.1128/spectrum.00058-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
Olanzapine is one of the most effective medicines available for stabilizing schizophrenia spectrum disorders. However, it has been reported to show the greatest propensity for inducing body weight gain and producing metabolic side effects, which cause a great burden in patients with psychiatric disorders. Since the gut microbiota has a profound impact on the initiation and development of metabolic diseases, we conducted a longitudinal study to explore its role in olanzapine-induced obesity and metabolic abnormalities. Female Sprague-Dawley rats were treated with different doses of olanzapine, and metabolic and inflammatory markers were measured. Olanzapine significantly induced body weight gain (up to a 2.1-fold change), which was accompanied by hepatic inflammation and increased plasma triglyceride levels (up to a 2.9-fold change), as well as gut microbiota dysbiosis. Subsequently, fuzzy c-means clustering was used to characterize three clusters of longitudinal trajectories for microbial fluctuations: (i) genera continuing to increase, (ii) genera continuing to decrease, and (iii) genera temporarily changing. Among them, Enterorhabdus (r = 0.38), Parasutterella (r = 0.43), and Prevotellaceae UCG-001 (r = 0.52) positively correlated with body weight gain. In addition, two MetaCyc metabolic pathways were identified as associated with olanzapine-induced body weight gain, including the superpathway of glucose and xylose degradation and the superpathway of l-threonine biosynthesis. In conclusion, we demonstrate that olanzapine can directly alter the gut microbiota and rapidly induce dysbiosis, which is significantly associated with body weight gain. This may suggest gut microbiota targets in future studies on metabolic abnormalities caused by olanzapine. IMPORTANCE Olanzapine is one of the most effective second-generation antipsychotics for stabilizing schizophrenia spectrum disorders. However, olanzapine has multiple drug-induced metabolic side effects, including weight gain. This study provides insight to the gut microbiota target in olanzapine-induced obesity. Specifically, we explored the longitudinal gut microbiota trajectories of female Sprague-Dawley rats undergoing olanzapine treatment. We showed that olanzapine treatment causes a dynamic alteration of gut microbiota diversity. Additionally, we identified three genera, Parasutterella, Enterorhabdus, and Prevotellaceae UCG-001, that may play an important role in olanzapine-induced obesity. In this case, the supply or removal of specific elements of the gut microbiota may represent a promising avenue for treatment of olanzapine-related metabolic side effects.
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Affiliation(s)
- Li Qian
- Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiaoyan He
- Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yixin Liu
- Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Fengjie Gao
- Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Wen Lu
- Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yajuan Fan
- Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yuan Gao
- Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Wei Wang
- Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Feng Zhu
- Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Center for Translational Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yanan Wang
- Med-X institute, Center for Immunological and Metabolic Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
| | - Xiancang Ma
- Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Stogios N, Hahn MK, Lunsky Y, Desarkar P, Agarwal SM. Metformin for the treatment of antipsychotic-induced metabolic disturbances in people with intellectual and developmental disabilities. J Psychiatry Neurosci 2023; 48:E99-E101. [PMID: 36918196 PMCID: PMC10019321 DOI: 10.1503/jpn.220200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Affiliation(s)
- Nicolette Stogios
- From the Institute of Medical Science, University of Toronto, Toronto, Ont. (Stogios, Hahn, Desarkar, Agarwal); the Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ont. (Stogios, Hahn, Agarwal); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Hahn, Lunsky, Desarkar, Agarwal); the Banting and Best Diabetes Centre, University of Toronto, Toronto, Ont. (Hahn, Agarwal); the Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Lunsky, Desarkar)
| | - Margaret K Hahn
- From the Institute of Medical Science, University of Toronto, Toronto, Ont. (Stogios, Hahn, Desarkar, Agarwal); the Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ont. (Stogios, Hahn, Agarwal); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Hahn, Lunsky, Desarkar, Agarwal); the Banting and Best Diabetes Centre, University of Toronto, Toronto, Ont. (Hahn, Agarwal); the Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Lunsky, Desarkar)
| | - Yona Lunsky
- From the Institute of Medical Science, University of Toronto, Toronto, Ont. (Stogios, Hahn, Desarkar, Agarwal); the Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ont. (Stogios, Hahn, Agarwal); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Hahn, Lunsky, Desarkar, Agarwal); the Banting and Best Diabetes Centre, University of Toronto, Toronto, Ont. (Hahn, Agarwal); the Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Lunsky, Desarkar)
| | - Pushpal Desarkar
- From the Institute of Medical Science, University of Toronto, Toronto, Ont. (Stogios, Hahn, Desarkar, Agarwal); the Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ont. (Stogios, Hahn, Agarwal); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Hahn, Lunsky, Desarkar, Agarwal); the Banting and Best Diabetes Centre, University of Toronto, Toronto, Ont. (Hahn, Agarwal); the Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Lunsky, Desarkar)
| | - Sri Mahavir Agarwal
- From the Institute of Medical Science, University of Toronto, Toronto, Ont. (Stogios, Hahn, Desarkar, Agarwal); the Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ont. (Stogios, Hahn, Agarwal); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Hahn, Lunsky, Desarkar, Agarwal); the Banting and Best Diabetes Centre, University of Toronto, Toronto, Ont. (Hahn, Agarwal); the Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Lunsky, Desarkar)
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10
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Addressing Metabolic Comorbidity in Individuals With Intellectual and Developmental Disability on Antipsychotics: A Clinical Case Series. J Clin Psychopharmacol 2023; 43:60-63. [PMID: 36394921 DOI: 10.1097/jcp.0000000000001626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE/BACKGROUND Individuals with intellectual and developmental disabilities (IDDs) are at increased risk for serious metabolic comorbidities, which is further exacerbated by the high rate of antipsychotic use in this population. There is currently a lack of literature on effective treatment options for antipsychotic-induced weight gain and metabolic abnormalities in IDD. This case series reports on the clinical use of metformin in patients with IDD on antipsychotics. METHODS/PROCEDURES We conducted a retrospective review of patients in a novel clinical service at the Centre for Addiction and Mental Health in Toronto, Ontario, Canada for adults with IDD experiencing antipsychotic-related weight gain and other metabolic aberrations. Charts were reviewed for weight and other metabolic outcome measures before and after commencing metformin treatment. FINDINGS/RESULTS In 11 patients referred to this clinic, the mean weight loss while on metformin treatment was 11.1 kg, with over 50% of the sample achieving clinically meaningful weight loss of >7%. Additional adaptive changes were observed for fasting glucose, glycated hemoglobin, triglyceride, and high-density lipoprotein cholesterol levels. IMPLICATIONS/CONCLUSIONS In line with its use in severe mental illness, metformin may be a safe, effective, and accessible treatment option for patients with IDD experiencing metabolic adverse effects of antipsychotic medication. Further research and randomized controlled trials are needed to examine the efficacy of metformin in this population.
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11
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Investigating the effects of antipsychotics on brain insulin action: Study protocol for a multi-modality magnetic resonance imaging (MRI) study in healthy controls. PLoS One 2022; 17:e0277211. [PMID: 36441736 PMCID: PMC9704670 DOI: 10.1371/journal.pone.0277211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/29/2022] Open
Abstract
Antipsychotics (APs) are the cornerstone of treatment for schizophrenia (SCZ) but are unfortunately associated with serious metabolic adverse effects including weight gain and type 2 diabetes. The pathophysiology of AP-induced metabolic dysfunction is largely undetermined. Brain insulin resistance has been posited to be at the cross-roads of many cognitive and metabolic disorders, and disruption of central insulin action has emerged as a possible explanatory mechanism underlying AP induced metabolic dysfunction. Previous studies suggest that change in neuroimaging-based parameters with intranasal insulin administration can be leveraged to investigate brain insulin resistance. In this proof-of-concept study, we will utilize neural signatures of insulin action in the brain to examine if APs disrupt brain insulin signaling. It is hypothesized that: 1) intranasal insulin (INI), but not intranasal placebo (INP), will change cerebral blood flow and resting state connectivity, as well as increase glutamate levels in the striatum and dorsolateral prefrontal cortex; 2) oral olanzapine (OLA), but not oral placebo (PL), will inhibit the effect of INI on these parameters. Thirty-two healthy volunteers will undergo a single blind, cross-over design, wherein all participants receive the following four treatment combinations, 2-6 weeks apart, in a random sequence: INP + PL, INP + OLA, INI + PL, and INI + OLA. Participants will undergo an MRI-based assay of brain insulin resistance 15 minutes after administering 160 IU INI or INP. The scanning protocol includes resting and task-based functional MRI, arterial spin labelling, and proton magnetic resonance spectroscopy. Demonstrating that OLA can acutely induce brain insulin resistance is clinically relevant to metabolic health in SCZ. Evidence of brain insulin resistance induced by acute AP dosing can inform the early use of adjunctive insulin sensitizers for the treatment of metabolic comorbidities associated with AP treatment in severe mental illness. Trial registration ClinicalTrials.gov Registration: NCT03741478.
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12
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Zhou R, He M, Fan J, Li R, Zuo Y, Li B, Gao G, Sun T. The role of hypothalamic endoplasmic reticulum stress in schizophrenia and antipsychotic-induced weight gain: A narrative review. Front Neurosci 2022; 16:947295. [PMID: 36188456 PMCID: PMC9523121 DOI: 10.3389/fnins.2022.947295] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Schizophrenia (SCZ) is a serious mental illness that affects 1% of people worldwide. SCZ is associated with a higher risk of developing metabolic disorders such as obesity. Antipsychotics are the main treatment for SCZ, but their side effects include significant weight gain/obesity. Despite extensive research, the underlying mechanisms by which SCZ and antipsychotic treatment induce weight gain/obesity remain unclear. Hypothalamic endoplasmic reticulum (ER) stress is one of the most important pathways that modulates inflammation, neuronal function, and energy balance. This review aimed to investigate the role of hypothalamic ER stress in SCZ and antipsychotic-induced weight gain/obesity. Preliminary evidence indicates that SCZ is associated with reduced dopamine D2 receptor (DRD2) signaling, which significantly regulates the ER stress pathway, suggesting the importance of ER stress in SCZ and its related metabolic disorders. Antipsychotics such as olanzapine activate ER stress in hypothalamic neurons. These effects may induce decreased proopiomelanocortin (POMC) processing, increased neuropeptide Y (NPY) and agouti-related protein (AgRP) expression, autophagy, and leptin and insulin resistance, resulting in hyperphagia, decreased energy expenditure, and central inflammation, thereby causing weight gain. By activating ER stress, antipsychotics such as olanzapine activate hypothalamic astrocytes and Toll-like receptor 4 signaling, thereby causing inflammation and weight gain/obesity. Moreover, evidence suggests that antipsychotic-induced ER stress may be related to their antagonistic effects on neurotransmitter receptors such as DRD2 and the histamine H1 receptor. Taken together, ER stress inhibitors could be a potential effective intervention against SCZ and antipsychotic-induced weight gain and inflammation.
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Affiliation(s)
- Ruqin Zhou
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Meng He
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
- *Correspondence: Meng He,
| | - Jun Fan
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Ruoxi Li
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yufeng Zuo
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Benben Li
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Guanbin Gao
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, China
- Guanbin Gao,
| | - Taolei Sun
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
- Taolei Sun,
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13
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Shamshoum H, Medak KD, McKie GL, Hahn MK, Wright DC. Fasting or the short-term consumption of a ketogenic diet protects against antipsychotic-induced hyperglycemia in mice. J Physiol 2022; 600:2713-2728. [PMID: 35507699 DOI: 10.1113/jp282922] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/27/2022] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Antipsychotic medications cause rapid and robust increases in blood glucose Cotreatment approaches to offset these harmful metabolic side effects have not been identified We demonstrate that fasting or the consumption or a short-term ketogenic diet, but not treatment with βHB or oral ketone esters, protects against acute antipsychotic induced hyperglycemia Protective effects of fasting and ketogenic diets were paralleled by reductions in serum glucagon, but not improvements in whole body insulin action ABSTRACT: Antipsychotic (AP) medications, such as olanzapine (OLZ), are used in the treatment of schizophrenia and a growing number of "off-label" conditions. A single dose of OLZ causes robust increases in blood glucose within minutes following treatment. The purpose of the current study was to investigate if interventions which increase circulating ketone bodies (fasting, βHB, ketone esters or a ketogenic diet) would be sufficient to protect against acute metabolic side effects of OLZ. We demonstrate that fasting or the short-term consumption of a ketogenic diet (KD) protects against OLZ-induced hyperglycemia, independent of alterations in whole body insulin action, and in parallel with a blunted rise in serum glucagon. Interestingly, the effects of fasting and ketogenic diets were not recapitulated by acutely increasing circulating concentrations of ketone bodies through treatment with βHB or oral ketone esters, approaches which increase ketone bodies to physiological or supra-physiological levels respectively. Collectively our findings demonstrate that fasting and the short-term consumption of a KD can protect against acute AP-induced perturbations in glucose homeostasis, whereas manipulations which acutely increase circulating ketone bodies do not elicit the same beneficial effects. Abstract figure legend Model for fasting and ketogenic diet to protect against OLZ-induced hyperglycemia. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hesham Shamshoum
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Kyle D Medak
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Greg L McKie
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Margaret K Hahn
- Centre for Addiction and Mental Health, Toronto, ON.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Banting and Best Diabetes Centre, University of Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - David C Wright
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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14
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Chen CC, Nakano T, Hsu LW, Chu CY, Huang KT. Early Lipid Metabolic Effects of the Anti-Psychotic Drug Olanzapine on Weight Gain and the Associated Gene Expression. Neuropsychiatr Dis Treat 2022; 18:645-657. [PMID: 35355504 PMCID: PMC8958728 DOI: 10.2147/ndt.s345046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Atypical antipsychotics such as olanzapine often cause metabolic side effects such as obesity and diabetes, leading to an increased risk of nonalcoholic fatty liver disease. The aim of the present study was to investigate the effects of olanzapine treatment on hepatic lipid metabolism and its possible relationship with adipose tissue status. METHODS Using a female rat model, we investigated the effects of chronic olanzapine administration on the regulation of carbohydrate and lipid metabolism including lipid biosynthesis, oxidation, efflux, and lipolysis in liver and adipose tissue. RESULTS The body weight, liver mass and visceral adiposity after olanzapine treatment (2 mg/kg) for five weeks were not significantly different compared with vehicle controls. The serum level of triglycerides was higher in the vehicle controls than in olanzapine-treated rats. Unexpectedly, olanzapine treatment did not reduce glucose tolerance in our model. The expression of functional thermogenic protein uncoupling protein 1 (UCP1) was increased in brown adipose tissue (BAT) of the olanzapine group. Additionally, olanzapine treatment also reduced adipose inflammation in white adipose tissue (WAT). The transcription factor sterol regulatory element-binding protein (SREBP)-1c, a key early regulator of lipogenesis, was downregulated following olanzapine treatment. The expression of genes related to the triglycerides synthesis apparatus in the liver was upregulated in the olanzapine group. Olanzapine treatment induced genes involved in PPAR-α signaling and mitochondrial fatty acid oxidation in response to increased ATGL-mediated lipolysis in the liver. CONCLUSION Together, our findings suggest a complicated link between olanzapine therapy and metabolic disturbance and may garner interest in assessing the action of antipsychotic-induced metabolic disturbances.
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Affiliation(s)
- Chien-Chih Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Toshiaki Nakano
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Li-Wen Hsu
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia Yi Chu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuang-Tzu Huang
- Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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15
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Ebdrup BH, Knop FK. Weight gain on antipsychotics - A perfect storm of complex pathophysiology and psychopharmacology. Acta Psychiatr Scand 2021; 144:521-523. [PMID: 34587287 DOI: 10.1111/acps.13376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research, CNSR & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip K Knop
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
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