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Li H, Gao J, Song H, Yang X, Li C, Zhang Y, Wang J, Liu Y, Wang D, Li H. Changes in the medial prefrontal cortex metabolites after 6 months of medication therapy for patients with bipolar disorder: A 1H-MRS study. CNS Neurosci Ther 2024; 30:e70048. [PMID: 39300492 PMCID: PMC11412791 DOI: 10.1111/cns.70048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 08/22/2024] [Accepted: 09/02/2024] [Indexed: 09/22/2024] Open
Abstract
AIMS The study aimed to assess brain metabolite differences in the medial prefrontal cortex (mPFC) between acute and euthymic episodes of bipolar disorder (BD) with both mania and depression over a 6-month medication treatment period. METHODS We utilized 1H-MRS technology to assess the metabolite levels in 53 individuals with BD (32 in depressive phase, 21 in manic phase) and 34 healthy controls (HCs) at baseline. After 6 months of medication treatment, 40 subjects underwent a follow-up scan in euthymic state. Metabolite levels, including N-acetyl aspartate (NAA), glutamate (Glu), and Glutamine (Gln), were measured in the mPFC. RESULTS Patients experiencing depressive and manic episodes exhibited a notable reduction in NAA/Cr + PCr ratios at baseline compared to healthy controls (p = 0.004; p = 0.006) in baseline, compared with HCs. Over the 6-month follow-up period, the manic group displayed a significant decrease in Gln/Cr + PCr compared to the initial acute phase (p = 0.03). No significant alterations were found in depressed group between baseline and follow-up. CONCLUSION This study suggests that NAA/Cr + PCr ratios and Gln/Cr + PCr ratios in the mPFC may be associated with manic and depressive episodes, implicating that Gln and NAA might be useful biomarkers for distinguishing mood phases in BD and elucidating its mechanisms.
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Affiliation(s)
- Haijin Li
- Department of PsychiatryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Ju Gao
- Department of Geriatric Psychiatry, Suzhou Mental Health Center, Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouChina
| | - Huihui Song
- Department of Geriatric Psychiatry, Suzhou Mental Health Center, Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouChina
| | - Xuna Yang
- Department of Geriatric Psychiatry, Suzhou Mental Health Center, Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouChina
| | - Cai Li
- Department of PharmacyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yue Zhang
- Department of PsychiatryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Jiahui Wang
- Department of PsychiatryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yitong Liu
- Department of PsychiatryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Dong Wang
- Department of Geriatric Psychiatry, Suzhou Mental Health Center, Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouChina
| | - Hong Li
- Department of PsychiatryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
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Hyppönen J, Paanila V, Äikiä M, Koskenkorva P, Könönen M, Vanninen R, Mervaala E, Kälviäinen R, Hakumäki J. Progressive myoclonic epilepsy type 1 (EPM1) patients present with abnormal 1H MRS brain metabolic profiles associated with cognitive function. Neuroimage Clin 2023; 39:103459. [PMID: 37541097 PMCID: PMC10412857 DOI: 10.1016/j.nicl.2023.103459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE Progressive myoclonic epilepsy, type 1A (EPM1, Unverricht-Lundborg disease), is a rare neurodegenerative autosomal recessive disorder characterized by stimulus-sensitive and action myoclonus and tonic-clonic epileptic seizures. Patients develop neurological symptoms, including ataxia, intention tremor, and dysarthria, over time, with relatively limited and nonspecific MRI atrophy findings. The effects of the disease on brain metabolism are largely unknown. METHOD Eighteen EPM1 patients (9 M, 9F) underwent clinical evaluation and neuropsychological testing, which included the assessment of intellectual ability, verbal memory, and psychomotor and executive functions. Magnetic resonance spectroscopy (MRS) and imaging (MRI) were performed on a 1.5 T MRI system. 2D MRS chemical shift imaging (CSI) maps (TE = 270) were obtained from the following regions of the brain: basal ganglia, thalamus, insula, splenium, and occipital white and gray matter, and N-acetyl-aspartate (NAA)-, choline (Cho)-, and lactate (Lac)-to-creatine (Cr) ratios were analyzed. Ten healthy age-and sex-matched subjects (5M, 5F) were used as controls for MRS. RESULTS We found significant brain metabolic changes involving lactate, NAA, and choline, which are widespread in the basal ganglia, thalamic nuclei, insula, and occipital areas of EPM1 patients. Changes, especially in the right insula, basal ganglia, and thalamus, were associated with intellectual abilities and impairment of the psychomotor and executive functions of EPM1 patients. CONCLUSION Multiple brain metabolic alterations suggest the presence of neurodegeneration associated with EPM1 progression. The changes in metabolite ratios are associated with the neurocognitive dysfunction caused by the disease. However, the role of MRS findings in understanding pathophysiology of EPM1 warrants further studies.
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Affiliation(s)
- Jelena Hyppönen
- Department of Clinical Neurophysiology, Epilepsy Center, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Vili Paanila
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Marja Äikiä
- Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Päivi Koskenkorva
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Ritva Vanninen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Epilepsy Center, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Reetta Kälviäinen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Juhana Hakumäki
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland.
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Chabert J, Allauze E, Pereira B, Chassain C, De Chazeron I, Rotgé JY, Fossati P, Llorca PM, Samalin L. Glutamatergic and N-Acetylaspartate Metabolites in Bipolar Disorder: A Systematic Review and Meta-Analysis of Proton Magnetic Resonance Spectroscopy Studies. Int J Mol Sci 2022; 23:ijms23168974. [PMID: 36012234 PMCID: PMC9409038 DOI: 10.3390/ijms23168974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
The exact neurobiological mechanisms of bipolar disorder (BD) remain unknown. However, some neurometabolites could be implicated, including Glutamate (Glu), Glutamine (Gln), Glx, and N-acetylaspartate (NAA). Proton Magnetic Resonance Spectroscopy (1H-MRS) allows one to quantify these metabolites in the human brain. Thus, we conducted a systematic review and meta-analysis of the literature to compare their levels between BD patients and healthy controls (HC). The main inclusion criteria for inclusion were 1H-MRS studies comparing levels of Glu, Gln, Glx, and NAA in the prefrontal cortex (PFC), anterior cingulate cortex (ACC), and hippocampi between patients with BD in clinical remission or a major depressive episode and HC. Thirty-three studies were included. NAA levels were significantly lower in the left white matter PFC (wmPFC) of depressive and remitted BD patients compared to controls and were also significantly higher in the left dorsolateral PFC (dlPFC) of depressive BD patients compared to HC. Gln levels were significantly higher in the ACC of remitted BD patients compared to in HC. The decreased levels of NAA of BD patients may be related to the alterations in neuroplasticity and synaptic plasticity found in BD patients and may explain the deep white matter hyperintensities frequently observed via magnetic resonance imagery.
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Affiliation(s)
- Jonathan Chabert
- Service de Psychiatrie Adulte, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, 58 Rue Montalembert, 63003 Clermont-Ferrand, France
- Correspondence: (J.C.); (L.S.); Tel.: +33-4-73-752-124 (J.C. & L.S.)
| | - Etienne Allauze
- Service de Psychiatrie Adulte, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, 58 Rue Montalembert, 63003 Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, Université Clermont Auvergne, 7 Place Henri Dunant, 63000 Clermont-Ferrand, France
| | - Carine Chassain
- Imaging Department, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, Clermont Auvergne INP, 58 Rue Montalembert, 63003 Clermont-Ferrand, France
| | - Ingrid De Chazeron
- Service de Psychiatrie Adulte, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, 58 Rue Montalembert, 63003 Clermont-Ferrand, France
| | - Jean-Yves Rotgé
- Service de Psychiatrie Adulte, Pitié-Salpêtrière Hospital, CNRS UMR 7593, 47-83 Bd de l’Hôpital, 75651 Paris, France
| | - Philippe Fossati
- Service de Psychiatrie Adulte, Pitié-Salpêtrière Hospital, CNRS UMR 7593, 47-83 Bd de l’Hôpital, 75651 Paris, France
| | - Pierre-Michel Llorca
- Service de Psychiatrie Adulte, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, 58 Rue Montalembert, 63003 Clermont-Ferrand, France
| | - Ludovic Samalin
- Service de Psychiatrie Adulte, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, 58 Rue Montalembert, 63003 Clermont-Ferrand, France
- Correspondence: (J.C.); (L.S.); Tel.: +33-4-73-752-124 (J.C. & L.S.)
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Pereira Herrera M, Zimmerman AM. Case of refractory delirious mania responsive to lithium. BJPsych Open 2021; 7:e119. [PMID: 34184627 PMCID: PMC8269925 DOI: 10.1192/bjo.2021.957] [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] [Indexed: 11/23/2022] Open
Abstract
Delirious mania is an uncommon condition that is challenging to diagnose and treat. More often seen in patients with a history of bipolar disorder, it frequently presents with prominent catatonic features and overlaps with other diseases in the catatonic spectrum, such as neuroleptic malignant syndrome, serotonin syndrome and malignant catatonia. We present a case of delirious mania refractory to high doses of lorazepam, several antipsychotics and valproic acid, which responded dramatically to therapy with lithium after 26 days of minimal improvement with the other medications. The pathophysiology of delirious mania is reviewed, and the unique actions of lithium are discussed, highlighting possible reasons as to why lithium might offer advantages in the treatment of this disease.
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Mansur RB, Subramaniapillai M, Lee Y, Pan Z, Carmona NE, Shekotikhina M, Iacobucci M, Rodrigues N, Nasri F, Rosenblat JD, Brietzke E, Cosgrove VE, Kramer NE, Suppes T, Newport J, Hajek T, McIntyre RS. Effects of infliximab on brain neurochemistry of adults with bipolar depression. J Affect Disord 2021; 281:61-66. [PMID: 33296798 DOI: 10.1016/j.jad.2020.11.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To explore the relationship between inflammation and neuronal metabolism in bipolar disorder (BD) by evaluating the neurochemical effects of the tumor necrosis factor-α (TNF-α) antagonist infliximab among individuals with bipolar depression METHODS: This is a post-hoc, exploratory analysis from a 12-week, randomized, double-blind, placebo-controlled trial with infliximab for adults with bipolar depression. We assessed the effects of infliximab on concentration of metabolites in the prefrontal cortex, using proton-magnetic resonance spectroscopy (1H-MRS), as well as its association with clinical outcomes (i.e. depressive symptom severity and cognitive function). RESULTS Eighteen participants in the placebo and 15 in the infliximab group were included in this analysis. In the pre-specified primary outcome, there were no significant effects of treatment on prefrontal concentrations of N-acetylaspartate (NAA; p = 0.712). In the secondary analyses, there was a significant treatment by time interaction for glutamate (Glx; p = 0.018), indicating that Glx levels decreased in infliximab-treated patients, relative to placebo. Treatment group significantly moderated the association between changes in Glx levels and changes in a neurocognitive test (i.e. Digit Symbol Substitution Test; p = 0.014), indicating that in infliximab-treated participants reductions in Glx were associated with cognitive improvement. CONCLUSIONS Treatment with infliximab did not affect prefrontal NAA concentration in adults with BD. Exploratory analysis suggested a potential effect of treatment on the glutamate system, a finding that should be confirmed and validated by additional studies.
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Affiliation(s)
- Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Zihang Pan
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Nicole E Carmona
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Margarita Shekotikhina
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; University of Ottawa, Department of Psychiatry, Ottawa, ON, Canada
| | - Michelle Iacobucci
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Nelson Rodrigues
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Flora Nasri
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Elisa Brietzke
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Kingston General Hospital, Providence Care Hospital, Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Victoria E Cosgrove
- Department of Psychiatry & Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Nicole E Kramer
- Department of Psychiatry & Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Trisha Suppes
- Department of Psychiatry & Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, CA, USA; VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jason Newport
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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6
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Delvecchio G, Ciappolino V, Perlini C, Barillari M, Ruggeri M, Altamura AC, Bellani M, Brambilla P. Cingulate abnormalities in bipolar disorder relate to gender and outcome: a region-based morphometry study [corrected]. Eur Arch Psychiatry Clin Neurosci 2019; 269:777-784. [PMID: 29594394 DOI: 10.1007/s00406-018-0887-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/16/2018] [Indexed: 12/22/2022]
Abstract
Structural magnetic resonance imaging (MRI) studies reported gray matter (GM) loss in bipolar disorder (BD) in cingulate cortices, key regions subserving emotional regulation and cognitive functions in humans. The aim of this study was to further explore cingulate GM volumes in a sizeable group of BD patients with respect to healthy controls, particularly investigating the impact of gender and clinical variables. 39 BD patients (mean Age = 48.6 ± 9.7, 15 males and 24 females) and 39 demographically matched healthy subjects (mean Age = 47.9 ± 9.1, 15 males and 24 females) underwent a 1.5T MRI scan. GM volumes within the cingulate cortex were manually detected, including anterior and posterior regions. BD patients had decreased left anterior cingulate volumes compared with healthy controls (F = 6.7, p = 0.01). Additionally, a significant gender effect was observed, with male patients showing reduced left anterior cingulate cortex (ACC) volumes compared to healthy controls (F = 5.1, p = 0.03). Furthermore, a significant inverse correlation between right ACC volumes and number of hospitalizations were found in the whole group of BD patients (r = - 0.51, p = 0.04) and in male BD patients (r = - 0.88, p = 0.04). Finally, no statistically significant correlations were observed in female BD patients. Our findings further confirm the putative role of the ACC in the pathophysiology of BD. Interestingly, this study also suggested the presence of gender-specific GM volume reductions in ACC in BD, which may also be associated to poor outcome.
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Affiliation(s)
| | - Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via F. Sforza 35, 20122, Milan, Italy
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Interuniversity Centre for Behavioural Neurosciences, AOUI Verona, Verona, Italy
| | - Marco Barillari
- Section of Radiology, Department of Neurological and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - Mirella Ruggeri
- Interuniversity Centre for Behavioural Neurosciences, AOUI Verona, Verona, Italy.,Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Carlo Altamura
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via F. Sforza 35, 20122, Milan, Italy
| | - Marcella Bellani
- Interuniversity Centre for Behavioural Neurosciences, AOUI Verona, Verona, Italy.,Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via F. Sforza 35, 20122, Milan, Italy. .,Department of Psychiatry and Behavioural Neurosciences, University of Texas at Houston, Houston, TX, USA.
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7
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Soeiro-de-Souza MG, Otaduy MCG, Machado-Vieira R, Moreno RA, Nery FG, Leite C, Lafer B. Lithium-associated anterior cingulate neurometabolic profile in euthymic Bipolar I disorder: A 1H-MRS study. J Affect Disord 2018; 241:192-199. [PMID: 30130684 DOI: 10.1016/j.jad.2018.08.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE In the treatment of Bipolar disorder (BD), achieving euthymia is highly complex and usually requires a combination of mood stabilizers. The mechanism of action in stabilizing mood has not been fully elucidated, but alterations in N-Acetylaspartate (NAA), Myo-Inositol (mI) and Choline (Cho) have been implicated. Proton magnetic resonance spectroscopy (1H-MRS) is the gold standard technique for measuring brain NAA, Cho and mI in vivo. The objective of this study was to investigate the association of lithium use in BD type I and brain levels of NAA, mI and Cho in the (anterior cingulate cortex) ACC. METHODS 129 BD type I subjects and 79 healthy controls (HC) were submitted to a 3-Tesla brain magnetic resonance imaging scan (1H-MRS) using a PRESS ACC single voxel (8cm3) sequence. RESULTS BD patients exhibited higher NAA and Cho levels compared to HC. Lithium prescription was associated with lower mI (combination + monotherapy) and higher NAA levels (monotherapy). CONCLUSION The results observed add to the knowledge about the mechanisms of action of mood stabilizers on brain metabolites during euthymia. Additionally, the observed decrease in mI levels associated with lithium monotherapy is an in vivo finding that supports the inositol-depletion hypothesis of lithium pharmacodynamics.
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Affiliation(s)
- Marcio Gerhardt Soeiro-de-Souza
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, University of Sao Paulo, Brazil; Genetics and Pharmacogenetics Unit (PROGENE), Department and Institute of Psychiatry, University of Sao Paulo, Brazil.
| | - Maria Concepcion Garcia Otaduy
- Laboratory of Magnetic Resonance LIM44, Department and Institute of Radiology, University of São Paulo (InRad-FMUSP), Brazil
| | | | - Ricardo Alberto Moreno
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, University of Sao Paulo, Brazil
| | - Fabiano G Nery
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, USA
| | - Claudia Leite
- Laboratory of Magnetic Resonance LIM44, Department and Institute of Radiology, University of São Paulo (InRad-FMUSP), Brazil
| | - Beny Lafer
- Bipolar Disorders Program (PROMAN), Department and Institute of Psychiatry, University of São Paulo, Brazil
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Szulc A, Wiedlocha M, Waszkiewicz N, Galińska-Skok B, Marcinowicz P, Gierus J, Mosiolek A. Proton magnetic resonance spectroscopy changes after lithium treatment. Systematic review. Psychiatry Res Neuroimaging 2018; 273:1-8. [PMID: 29414126 DOI: 10.1016/j.pscychresns.2018.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/10/2017] [Accepted: 01/12/2018] [Indexed: 01/03/2023]
Abstract
1H MRS is widely used in the research of mental disorders. It enables evaluation of concentration or ratios of several metabolites, which play important roles in brain metabolism: N-acetylaspartate (NAA), choline containing compounds, myo-inositol and glutamate, glutamine and GABA (together as Glx complex or separately). Specifically in bipolar disorder brain metabolite abnormalities include mostly NAA reduces and Glx increases in different brain regions. Bipolar disorder is associated with impairment in neurotrophic and cellular plasticity, resilience pathways and in neuroprotective processes. Lithium, which is commonly used in BD treatment, modulates neurotransmitter release, reduces oxidative stress and apoptosis, induces angiogenesis, neurogenesis and neurotrophic response. Thus brain metabolite abnormalities may elucidate the mechanisms of this processes. In the present article we systematically reviewed 26 studies - the majority of them investigated bipolar disorder ( 7 follow-up and all 11 cross-sectional studies). Moreover we dispute whether the influence of lithium on brain metabolites in bipolar disorder could explain the background of its potential neuroprotective action. The results of our literature review do not equivocally confirm Lithium's influence the metabolite changes in the brain. The majority of the follow-up studies do not support the initially assumed influence of Lithium on the increase of NAA level in various brain structures. The results of studies are inconclusive with regard to levels of Glx or Glu and Lithium intake, rather point a lack of relationship. The above results were reviewed according to the most recent theories in the field accounting for the impact of lithium (1)HMRS measures.
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Affiliation(s)
- Agata Szulc
- Department of Psychiatry, Medical University of Warsaw, Pruszkow, Poland
| | | | | | - Beata Galińska-Skok
- Department of Psychiatry, Medical University of Białystok, Choroszcz, Poland
| | - Piotr Marcinowicz
- Department of Psychiatry, Medical University of Warsaw, Pruszkow, Poland
| | - Jacek Gierus
- Department of Psychiatry, Medical University of Warsaw, Pruszkow, Poland
| | - Anna Mosiolek
- Department of Psychiatry, Medical University of Warsaw, Pruszkow, Poland; Department of Psychiatry, Medical University of Białystok, Choroszcz, Poland
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9
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Biochemical abnormalities in basal ganglia and executive dysfunction in acute- and euthymic-episode patients with bipolar disorder: A proton magnetic resonance spectroscopy study. J Affect Disord 2018; 225:108-116. [PMID: 28818755 DOI: 10.1016/j.jad.2017.07.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent studies found abnormal biochemical metabolism and executive cognitive deficits in acute bipolar disorder (BD). However, the evidence concerning in euthymic BD is limited. Thus, a comparison between acute and euthymic BD is conductive to better understanding the association between cognition and the outcome of neuroimaging. This study sought to investigate the relationship between the executive function and the biochemical metabolism in acute- and euthymic-episode BD patients and delineate the prominent endophenotype of BD. METHODS Three groups of participants were recruited in this study: 30 BD patients with an acute depressive episode, 22 euthymic BD patients, and 31 healthy controls. All participants were interviewed using the Structured Clinical Interview for DSM-IV, and underwent two-dimensional multivoxel proton magnetic resonance spectroscopy (1H-MRS) to obtain the bilateral metabolite levels in the lenticular nucleus of basal ganglia(BG). The ratios of N-acetylaspartate (NAA)/creatine (Cr) and Choline-containing compounds (Cho) /Cr ratios were calculated. Executive function was assessed by using the Wisconsin Card Sorting Test (WCST) and Trail Making Test, Part-B(TMT-B). RESULTS The comparison of biochemical changes showed that the NAA/Cr ratios in bilateral lenticular nucleus in both acute and euthymic BD patients was significantly lower than that in healthy controls at a confidence level of p<0.05. In the comparison of executive function, both acute and euthymic BD patients showed significantly decreased numbers of categories completed, and increased numbers of total errors, perseverative and noperseverative errors, and TMT-B uptake compared to the healthy controls at a confidence level of p<0.05. There were no significant differences between the acute BD and euthymic BD groups in the biochemical metabolite ratios and executive function. We found that the NAA/Cr ratio in the left in BG in the acute -episode BD patients was positively correlated with the number of categories completed, whereas it was negatively correlated with the total errors and TMT-B uptake. There was no correlation between the NAA/Cr and Cho/Cr ratios in the bilateral BG and the scores of SWCT and TMT-B in euthymic-episode BD patients. LIMITATION The sample size was relatively small and not all the euthymic-episode patients are the ones with an acute episode. CONCLUSIONS Our findings suggest that biochemical abnormalities in the lenticular nucleus and the executive dysfunction may occur early in the course of BD, and persist during remission, and are the most likely markers of endophenotypes of BD. The dysfunction of the neuronal function in the lenticular nucleus may be correlated with the cold dysfunction in patients with acute BD.
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Mathias LK, Monette PJ, Harper DG, Forester BP. Application of magnetic resonance spectroscopy in geriatric mood disorders. Int Rev Psychiatry 2017; 29:597-617. [PMID: 29199890 DOI: 10.1080/09540261.2017.1397608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The prevalence of mood disorders in the rapidly-growing older adult population merits attention due to the likelihood of increased medical comorbidities, risk of hospitalization or institutionalization, and strains placed on caregivers and healthcare providers. Magnetic resonance spectroscopy (MRS) quantifies biochemical compounds in vivo, and has been used specifically for analyses of neural metabolism and bioenergetics in older adults with mood disorders, usually via proton or phosphorous spectroscopy. While yet to be clinically implemented, data gathered from research subjects may help indicate potential biomarkers of disease state or trait or putative drug targets. Three prevailing hypotheses for these mood disorders are used as a framework for the present review, and the current biochemical findings within each are discussed with respect to particular metabolites and brain regions. This review covers studies of MRS in geriatric mood disorders and reveals persisting gaps in research knowledge, especially with regard to older age bipolar disorder. Further MRS work, using higher field strengths and larger sample sizes, is warranted in order to better understand the neurobiology of these prevalent late-life disorders.
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Affiliation(s)
- Liana K Mathias
- a Division of Geriatric Psychiatry , McLean Hospital , Belmont , MA , USA
| | - Patrick J Monette
- a Division of Geriatric Psychiatry , McLean Hospital , Belmont , MA , USA
| | - David G Harper
- a Division of Geriatric Psychiatry , McLean Hospital , Belmont , MA , USA.,b Department of Psychiatry , Harvard Medical School , Boston , MA , USA
| | - Brent P Forester
- a Division of Geriatric Psychiatry , McLean Hospital , Belmont , MA , USA.,b Department of Psychiatry , Harvard Medical School , Boston , MA , USA
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A comparison of neurometabolites between remitted bipolar disorder and depressed bipolar disorder: A proton magnetic resonance spectroscopy study. J Affect Disord 2017; 211:153-161. [PMID: 28126615 DOI: 10.1016/j.jad.2017.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 12/07/2016] [Accepted: 01/03/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recent many studies found the abnormal neurometabolites in the acute bipolar disorder (BD). However, limited studies were to detect neurometabolites in remitted BD, comparison between acute and remitted BD is conductive to understand the outcome of neurometabolites. This study sought to investigate the differences in neurometabolites between remitted and depressed BD patients using proton magnetic resonance spectroscopy (1H-MRS). METHODS Three subject groups were enrolled: 22 remitted BD patients, 22 depressed BD patients and 24 healthy controls. All subjects underwent 1H-MRS to measure N-acetylaspartate (NAA), Choline (Cho), myo-Inositol (mI) and Creatine (Cr) of several bilateral areas potentially involved in BD: prefrontal whiter matter (PWM), thalamus and putamen. The neurometabolite ratios were compared among three groups. The correlations between abnormal neurometabolite ratios and clinical data were computed. RESULTS The lower bilateral PWM NAA/Cr ratios were found in depressed BD patients than remitted BD patients and healthy controls, no differences were found between the remitted BD patients and controls. For depressed BD patients, left PWM NAA/Cr ratios showed negative correlation with age of onset, right PWM NAA/Cr ratios showed positive correlation with duration of illness. CONCLUSIONS Our findings suggest the abnormal neurometabolites in the prefrontal lobe whiter may occur in the depressed BD. The remitted BD may resemble healthy subjects in terms of neurometabolites. In addition, abnormal neurometabolites in prefrontal lobe whiter may correlate with the age of onset and illness length.
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12
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Diagnosis and body mass index effects on hippocampal volumes and neurochemistry in bipolar disorder. Transl Psychiatry 2017; 7:e1071. [PMID: 28350397 PMCID: PMC5404613 DOI: 10.1038/tp.2017.42] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/14/2016] [Accepted: 01/15/2017] [Indexed: 12/14/2022] Open
Abstract
We previously reported that higher body mass index (BMI) was associated with greater hippocampal glutamate+glutamine in people with bipolar disorder (BD), but not in non-BD healthy comparator subjects (HSs). In the current report, we extend these findings by examining the impact of BD diagnosis and BMI on hippocampal volumes and the concentrations of several additional neurochemicals in 57 early-stage BD patients and 31 HSs. Using 3-T magnetic resonance imaging and magnetic resonance spectroscopy, we measured bilateral hippocampal volumes and the hippocampal concentrations of four neurochemicals relevant to BD: N-acetylaspartate+N-acteylaspartylglutamate (tNAA), creatine+phosphocreatine (Cre), myoinositol (Ins) and glycerophosphocholine+phosphatidylcholine (Cho). We used multivariate factorial analysis of covariance to investigate the impact of diagnosis (patient vs HS) and BMI category (normal weight vs overweight/obese) on these variables. We found a main effect of diagnosis on hippocampal volumes, with patients having smaller hippocampi than HSs. There was no association between BMI and hippocampal volumes. We found diagnosis and BMI effects on hippocampal neurochemistry, with patients having lower Cre, Ins and Cho, and overweight/obese subjects having higher levels of these chemicals. In patient-only models that controlled for clinical and treatment variables, we detected an additional association between higher BMI and lower tNAA that was absent in HSs. To our knowledge, this was the first study to investigate the relative contributions of BD diagnosis and BMI to hippocampal volumes, and only the second to investigate their contributions to hippocampal chemistry. It provides further evidence that diagnosis and elevated BMI both impact limbic brain areas relevant to BD.
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13
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Leu SJ, Yang YY, Liu HC, Cheng CY, Wu YC, Huang MC, Lee YL, Chen CC, Shen WW, Liu KJ. Valproic Acid and Lithium Meditate Anti-Inflammatory Effects by Differentially Modulating Dendritic Cell Differentiation and Function. J Cell Physiol 2016; 232:1176-1186. [PMID: 27639185 DOI: 10.1002/jcp.25604] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 09/16/2016] [Indexed: 12/20/2022]
Abstract
Valproic acid (VPA), with inhibition activity mainly toward histone deacetylase (HDAC) and Glycogen Synthase Kinase (GSK)-3, and lithium, with inhibition activity mainly toward GSK-3, are both prescribed in clinical as mood-stabilizers and anticonvulsants for the control of bipolar disorder. This study aims to compare the immuno-modulation activities of VPA and lithium, especially on the differentiation and functions of dendritic cells (DC). Our data show that treatment with VPA or lithium effectively alleviated the severity of collagen-induced arthritis triggered by LPS in mice. Both agents reduced the serum level of IL-6 and IL-10 after LPS challenge in mice. VPA and lithium both induce significant down-regulation of group I CD1 expression and secretion of IL-6 during differentiation of human monocyte-derived immature DC, while they differ in the induction of CD83 and CD86 expression, secretion of IL-8, IL-10, and TNF-α. Upon stimulation of immature DC with LPS, VPA, and lithium both reduced the secretion of IL-6 and TNF-α. However, only lithium significantly increased the production of IL-10, while VPA increased the production of IL-8 but substantially reduce the secretion of IL-10 and IL-23. Treatment with VPA resulted in a reduced capacity of LPS-stimulated DC to promote the differentiation of T helper 17 cells that are critical in the promotion of inflammatory responses. Taken together, our results suggest that VPA and lithium may differentially modulate inflammation through regulating the capacity of DC to mediate distinct T cell responses, and they may provide a complementary immunomodulatory effects for the treatment of inflammation-related diseases. J. Cell. Physiol. 232: 1176-1186, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sy-Jye Leu
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Center for Reproductive Medicine and Sciences, Taipei Medical University, Taipei, Taiwan
| | - Yi-Yuan Yang
- School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei, Taiwan.,Department of Laboratory Medicine, Taipei Municipal Wan Fang Hospital, Taipei, Taiwan
| | - Hsing-Cheng Liu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chieh-Yu Cheng
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chen Wu
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yuen-Lun Lee
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Ching Chen
- Department of Pathology and Laboratory Medicine, Landseed Hospital, Taoyuan, Taiwan
| | - Winston W Shen
- Department of Psychiatry, School of Medicine and Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Ko-Jiunn Liu
- School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei, Taiwan.,National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.,Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
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Haarman BCM'B, Burger H, Doorduin J, Renken RJ, Sibeijn-Kuiper AJ, Marsman JBC, de Vries EFJ, de Groot JC, Drexhage HA, Mendes R, Nolen WA, Riemersma-Van der Lek RF. Volume, metabolites and neuroinflammation of the hippocampus in bipolar disorder - A combined magnetic resonance imaging and positron emission tomography study. Brain Behav Immun 2016; 56:21-33. [PMID: 26348581 DOI: 10.1016/j.bbi.2015.09.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/11/2015] [Accepted: 09/04/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The hippocampus is one of the brain regions that is involved in several pathophysiological theories about bipolar disorder (BD), such as the neuroinflammation theory and the corticolimbic metabolic dysregulation theory. We compared hippocampal volume and hippocampal metabolites in bipolar I disorder (BD-I) patients versus healthy controls (HCs) with magnetic resonance imaging (MRI) and spectroscopy (MRS). We post hoc investigated whether hippocampal volume and hippocampal metabolites were associated with microglial activation and explored if potential illness modifying factors affected these hippocampal measurements and whether these were associated with experienced mood and functioning. MATERIALS AND METHODS Twenty-two BD-I patients and twenty-four HCs were included in the analyses. All subjects underwent psychiatric interviews as well as an MRI scan, including a T1 scan and PRESS magnetic resonance spectroscopy (MRS). Volumetric analysis was performed with Freesurfer. MRS quantification was performed with LC Model. A subgroup of 14 patients and 11 HCs also underwent a successful [(11)C]-(R)-PK11195 neuroinflammation positron emission tomography scan. RESULTS In contrast to our hypothesis, hippocampal volumes were not decreased in patients compared to HC after correcting for individual whole-brain volume variations. We demonstrated decreased N-acetylaspartate (NAA)+N-acetyl-aspartyl-glutamate (NAAG) and creatine (Cr)+phosphocreatine (PCr) concentrations in the left hippocampus. In the explorative analyses in the left hippocampus we identified positive associations between microglial activation and the NAA+NAAG concentration, between alcohol use and NAA+NAAG concentration, between microglial activation and the depression score and a negative relation between Cr+PCr concentration and experienced occupational disability. Duration of illness associated positively with volume bilaterally. CONCLUSION Compared to HCs, the decreased NAA+NAAG concentration in the left hippocampus of BD-I patients suggests a decreased neuronal integrity in this region. In addition we found a positive relation between microglial activation and neuronal integrity in vivo, corresponding to a differentiated microglial function where some microglia induce apoptosis while others stimulate neurogenesis.
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Affiliation(s)
- Bartholomeus C M 'Benno' Haarman
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands; Radiology Morphological Solutions, Berkel en Rodenrijs, The Netherlands.
| | - Huibert Burger
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands
| | - Janine Doorduin
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, The Netherlands
| | - Remco J Renken
- University of Groningen, Neuroimaging Center, Groningen, The Netherlands
| | | | | | - Erik F J de Vries
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, The Netherlands
| | - Jan Cees de Groot
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Hemmo A Drexhage
- Erasmus MC, Department of Immunology, Rotterdam, The Netherlands
| | - Richard Mendes
- Radiology Morphological Solutions, Berkel en Rodenrijs, The Netherlands
| | - Willem A Nolen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Rixt F Riemersma-Van der Lek
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
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15
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Scaini G, Rezin GT, Carvalho AF, Streck EL, Berk M, Quevedo J. Mitochondrial dysfunction in bipolar disorder: Evidence, pathophysiology and translational implications. Neurosci Biobehav Rev 2016; 68:694-713. [PMID: 27377693 DOI: 10.1016/j.neubiorev.2016.06.040] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 06/26/2016] [Accepted: 06/30/2016] [Indexed: 01/05/2023]
Abstract
Bipolar disorder (BD) is a chronic psychiatric illness characterized by severe and biphasic changes in mood. Several pathophysiological mechanisms have been hypothesized to underpin the neurobiology of BD, including the presence of mitochondrial dysfunction. A confluence of evidence points to an underlying dysfunction of mitochondria, including decreases in mitochondrial respiration, high-energy phosphates and pH; changes in mitochondrial morphology; increases in mitochondrial DNA polymorphisms; and downregulation of nuclear mRNA molecules and proteins involved in mitochondrial respiration. Mitochondria play a pivotal role in neuronal cell survival or death as regulators of both energy metabolism and cell survival and death pathways. Thus, in this review, we discuss the genetic and physiological components of mitochondria and the evidence for mitochondrial abnormalities in BD. The final part of this review discusses mitochondria as a potential target of therapeutic interventions in BD.
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Affiliation(s)
- Giselli Scaini
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Laboratory of Bioenergetics, Graduate Program in Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Gislaine T Rezin
- Laboratory of Clinical and Experimental Pathophysiology, Graduate Program in Health Sciences, Universidade do Sul de Santa Catarina, Tubarão, SC, Brazil
| | - Andre F Carvalho
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Emilio L Streck
- Laboratory of Bioenergetics, Graduate Program in Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Faculty of Health, Geelong, Victoria, Australia; Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, The Department of Psychiatry and The Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
| | - João Quevedo
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA; Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
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16
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Dell'Osso L, Del Grande C, Gesi C, Carmassi C, Musetti L. A new look at an old drug: neuroprotective effects and therapeutic potentials of lithium salts. Neuropsychiatr Dis Treat 2016; 12:1687-703. [PMID: 27468233 PMCID: PMC4946830 DOI: 10.2147/ndt.s106479] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Increasing evidence highlights bipolar disorder as being associated with impaired neurogenesis, cellular plasticity, and resiliency, as well as with cell atrophy or loss in specific brain regions. This has led most recent research to focus on the possible neuroprotective effects of medications, and particularly interesting findings have emerged for lithium. A growing body of evidence from preclinical in vitro and in vivo studies has in fact documented its neuroprotective effects from different insults acting on cellular signaling pathways, both preventing apoptosis and increasing neurotrophins and cell-survival molecules. Furthermore, positive effects of lithium on neurogenesis, brain remodeling, angiogenesis, mesenchymal stem cells functioning, and inflammation have been revealed, with a key role played through the inhibition of the glycogen synthase kinase-3, a serine/threonine kinase implicated in the pathogenesis of many neuropsychiatric disorders. These recent evidences suggest the potential utility of lithium in the treatment of neurodegenerative diseases, neurodevelopmental disorders, and hypoxic-ischemic/traumatic brain injury, with positive results at even lower lithium doses than those traditionally considered to be antimanic. The aim of this review is to briefly summarize the potential benefits of lithium salts on neuroprotection and neuroregeneration, emphasizing preclinical and clinical evidence suggesting new therapeutic potentials of this drug beyond its mood stabilizing properties.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudia Del Grande
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Camilla Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Laura Musetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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17
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Ehrlich A, Schubert F, Pehrs C, Gallinat J. Alterations of cerebral glutamate in the euthymic state of patients with bipolar disorder. Psychiatry Res 2015; 233:73-80. [PMID: 26050195 DOI: 10.1016/j.pscychresns.2015.05.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/08/2015] [Accepted: 05/18/2015] [Indexed: 12/23/2022]
Abstract
The pathophysiology of bipolar disorder (BD) mostly remains unclear. However, some findings argue for a dysfunction in glutamatergic neurotransmission in BD. Proton magnetic resonance spectroscopy at 3T was used to determine glutamate concentrations in the anterior cingulate cortex (ACC) and the hippocampus (HC) of euthymic outpatients with BP-I disorder and age- and sex-matched healthy controls. In patients with BD, glutamate concentrations were significantly increased in the ACC and decreased in the HC compared with concentrations in controls. Significant group differences were also measured for N-acetyl aspartate and choline; no differences were found for other metabolites examined. An inverse correlation was observed for glutamate concentrations in the ACC and number of episodes. The findings of the study add to the concept of abnormalities in glutamatergic regulation in the ACC and HC in patients with BD.
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Affiliation(s)
- André Ehrlich
- Department of Psychiatry and Psychotherapy, Psychiatric University Hospital, St. Hedwig Krankenhaus, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Florian Schubert
- Physikalisch-Technische Bundesanstalt (PTB), Abbestrasse 2-12, 10587 Berlin, Germany
| | - Corinna Pehrs
- Cluster Languages of Emotion, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246 Hamburg, Germany
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18
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Croarkin PE, Thomas MA, Port JD, Baruth JM, Choi DS, Abulseoud OA, Frye MA. N-acetylaspartate normalization in bipolar depression after lamotrigine treatment. Bipolar Disord 2015; 17:450-7. [PMID: 25495884 PMCID: PMC4655601 DOI: 10.1111/bdi.12285] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/10/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of the present study was to examine N-acetylaspartate (NAA), a general marker of neuronal viability, and total NAA (tNAA), the combined signal of NAA and N-acetylaspartylglutamate, in bipolar depression before and after lamotrigine treatment. Given that NAA is synthesized through direct acetylation of aspartate by acetyl-coenzyme A-l-aspartate-N-acetyltransferase, we hypothesized that treatment with lamotrigine would be associated with an increase in NAA level. METHODS Patients with bipolar depression underwent two-dimensional proton magnetic resonance spectroscopy of the anterior cingulate at baseline (n = 15) and after 12 weeks of lamotrigine treatment (n = 10). A group of age-matched healthy controls (n = 9) underwent scanning at baseline for comparison. RESULTS At baseline, patients with bipolar depression had significantly lower NAA [mean standard deviation (SD) = 1.13 (0.21); p = 0.02] than controls [mean (SD) = 1.37 (0.27)]. Significant increases in NAA [mean (SD) = 1.39 (0.21); p = 0.01] and tNAA [mean (SD) = 1.61 (0.25); p = 0.02] levels were found after 12 weeks of lamotrigine treatment. CONCLUSIONS These data suggest an NAA deficit in bipolar depression that is normalized after lamotrigine treatment. Future research is warranted to evaluate whether baseline NAA level is a potential biomarker for identifying lamotrigine response patterns and whether this functional brain change has an associated clinical response.
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Affiliation(s)
- Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - M Albert Thomas
- Department of Radiology, Psychiatry, and Biomedical Engineering, Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - John D Port
- Department of Radiology, Mayo Clinic, Rochester, MN
| | | | - Doo-Sup Choi
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | | | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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Curran G, Ravindran A. Lithium for bipolar disorder: a review of the recent literature. Expert Rev Neurother 2014; 14:1079-98. [DOI: 10.1586/14737175.2014.947965] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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de Sousa RT, Machado-Vieira R, Zarate CA, Manji HK. Targeting mitochondrially mediated plasticity to develop improved therapeutics for bipolar disorder. Expert Opin Ther Targets 2014; 18:1131-47. [PMID: 25056514 DOI: 10.1517/14728222.2014.940893] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Bipolar disorder (BPD) is a severe illness with few treatments available. Understanding BPD pathophysiology and identifying potential relevant targets could prove useful for developing new treatments. Remarkably, subtle impairments of mitochondrial function may play an important role in BPD pathophysiology. AREAS COVERED This article focuses on human studies and reviews evidence of mitochondrial dysfunction in BPD as a promising target for the development of new, improved treatments. Mitochondria are crucial for energy production, generated mainly through the electron transport chain (ETC) and play an important role in regulating apoptosis and calcium (Ca²⁺) signaling as well as synaptic plasticity. Mitochondria move throughout the neurons to provide energy for intracellular signaling. Studies showed polymorphisms of mitochondria-related genes as risk factors for BPD. Postmortem studies in BPD also show decreased ETC activity/expression and increased nitrosative and oxidative stress (OxS) in patient brains. BPD has been also associated with increased OxS, Ca²⁺ dysregulation and increased proapoptotic signaling in peripheral blood. Neuroimaging studies consistently show decreased energy levels and pH in brains of BPD patients. EXPERT OPINION Targeting mitochondrial function, and their role in energy metabolism, synaptic plasticity and cell survival, may be an important avenue for development of new mood-stabilizing agents.
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Affiliation(s)
- Rafael T de Sousa
- University of Sao Paulo, Institute and Department of Psychiatry, Laboratory of Neuroscience, LIM-27, Faculty of Medicine , Paulo Rua Ovidio Pires de Campos 785, São Paulo, SP , Brazil
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21
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Bustillo JR. Use of proton magnetic resonance spectroscopy in the treatment of psychiatric disorders: a critical update. DIALOGUES IN CLINICAL NEUROSCIENCE 2014. [PMID: 24174904 PMCID: PMC3811104 DOI: 10.31887/dcns.2013.15.3/jbustillo] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Because of the wide availability of hardware as well as of standardized analytic quantification tools, proton magnetic resonance spectroscopy ((1)H-MRS) has become widely used to study psychiatric disorders. (1)H-MRS allows measurement of brain concentrations of more traditional singlet neurometabolites like N-acetylaspartate, choline, and creatine. More recently, quantification of the more complex multiplet spectra for glutamate, glutamine, inositol, and γ-aminobutyric acid have also been implemented. Here we review applications of (1)H-MRS in terms of informing treatment options in schizophrenia, bipolar disorder, and major depressive disorders. We first discuss recent meta-analytic studies reporting the most reliable findings. Then we evaluate the more sparse literature focused on 1H-MRS-detected neurometabolic effects of various treatment approaches in psychiatric populations. Finally we speculate on future developments that may result in translation of these tools to improve the treatment of psychiatric disorders.
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Affiliation(s)
- Juan R Bustillo
- Departments of Psychiatry and Neuroscience, University of New Mexico, Albuquerque, New Mexico, USA
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Forlenza OV, Coutinho AMN, Aprahamian I, Prando S, Mendes LL, Diniz BS, Gattaz WF, Buchpiguel CA. Long-term lithium treatment reduces glucose metabolism in the cerebellum and hippocampus of nondemented older adults: an [¹⁸F]FDG-PET study. ACS Chem Neurosci 2014; 5:484-9. [PMID: 24730717 DOI: 10.1021/cn5000315] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Lithium modulates several intracellular pathways related to neuroplasticity and resilience against neuronal injury. These properties have been consistently reported in experimental models, and involve the up-regulation of neurotrophic response and autophagy, and down-regulation of apoptosis, oxidative stress, and inflammation. Clinical and epidemiological studies in bipolar disorder show that acute treatment with lithium increases plasma concentrations of brain-derived neurotrophic factor, and long-term treatment lowers the risk of dementia. Neuroimaging studies indicate that lithium use is further associated with increased cortical thickness and larger hippocampal volumes. The objective of the present study was to evaluate whether these neurobiological properties of lithium reflect in increased regional brain glucose metabolism, as shown by [(18)F]FDG-PET. Participants (n = 19) were nondemented older adults recruited at the end point of a controlled trial addressing clinical and biological effects of lithium in a sample of patients with amnestic mild cognitive impairment. Twelve patients who had received low-dose lithium carbonate for 4 years were compared to seven matched controls. Chronic lithium treatment was not associated with any significant increase in brain glucose metabolism in the studied areas. Conversely, we found a significant reduction in glucose uptake in several clusters of the cerebellum and in both hippocampi. These findings were not associated with any clinical evidence of toxicity. The clinical implications of the present findings need to be clarified by future controlled studies, particularly in the light of the potential use of lithium as a disease-modifying treatment approach for certain neurodegenerative disorders, namely, Alzheimer's disease and amyotrophic lateral sclerosis.
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Affiliation(s)
- Orestes V. Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, SP, Brazil
| | - Artur Martins Novaes Coutinho
- Laboratory of Clinical Radioisotopy (LIM-43), Nuclear Medicine Center, Department and Institute of Radiology, Faculty of Medicine, University of São Paulo, SP, Brazil
| | - Ivan Aprahamian
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, SP, Brazil
| | - Silvana Prando
- Laboratory of Clinical Radioisotopy (LIM-43), Nuclear Medicine Center, Department and Institute of Radiology, Faculty of Medicine, University of São Paulo, SP, Brazil
| | - Luciana Lucas Mendes
- Laboratory of Clinical Radioisotopy (LIM-43), Nuclear Medicine Center, Department and Institute of Radiology, Faculty of Medicine, University of São Paulo, SP, Brazil
| | - Breno S. Diniz
- Department of Mental Health and National Institute of Science and Technology, Molecular Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Wagner F. Gattaz
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, SP, Brazil
| | - Carlos A. Buchpiguel
- Laboratory of Clinical Radioisotopy (LIM-43), Nuclear Medicine Center, Department and Institute of Radiology, Faculty of Medicine, University of São Paulo, SP, Brazil
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23
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Leeds PR, Yu F, Wang Z, Chiu CT, Zhang Y, Leng Y, Linares GR, Chuang DM. A new avenue for lithium: intervention in traumatic brain injury. ACS Chem Neurosci 2014; 5:422-33. [PMID: 24697257 DOI: 10.1021/cn500040g] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of disability and death from trauma to central nervous system (CNS) tissues. For patients who survive the initial injury, TBI can lead to neurodegeneration as well as cognitive and motor deficits, and is even a risk factor for the future development of neurodegenerative disorders such as Alzheimer's disease. Preclinical studies of multiple neuropathological and neurodegenerative disorders have shown that lithium, which is primarily used to treat bipolar disorder, has considerable neuroprotective effects. Indeed, emerging evidence now suggests that lithium can also mitigate neurological deficits incurred from TBI. Lithium exerts neuroprotective effects and stimulates neurogenesis via multiple signaling pathways; it inhibits glycogen synthase kinase-3 (GSK-3), upregulates neurotrophins and growth factors (e.g., brain-derived neurotrophic factor (BDNF)), modulates inflammatory molecules, upregulates neuroprotective factors (e.g., B-cell lymphoma-2 (Bcl-2), heat shock protein 70 (HSP-70)), and concomitantly downregulates pro-apoptotic factors. In various experimental TBI paradigms, lithium has been shown to reduce neuronal death, microglial activation, cyclooxygenase-2 induction, amyloid-β (Aβ), and hyperphosphorylated tau levels, to preserve blood-brain barrier integrity, to mitigate neurological deficits and psychiatric disturbance, and to improve learning and memory outcome. Given that lithium exerts multiple therapeutic effects across an array of CNS disorders, including promising results in preclinical models of TBI, additional clinical research is clearly warranted to determine its therapeutic attributes for combating TBI. Here, we review lithium's exciting potential in ameliorating physiological as well as cognitive deficits induced by TBI.
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Affiliation(s)
- Peter R. Leeds
- Molecular
Neurobiology Section, National Institute of Mental Health, National Institutes of Health, 10 Center Drive, MSC 1363, Bethesda, Maryland 20892-1363, United States
| | - Fengshan Yu
- Molecular
Neurobiology Section, National Institute of Mental Health, National Institutes of Health, 10 Center Drive, MSC 1363, Bethesda, Maryland 20892-1363, United States
| | - Zhifei Wang
- Molecular
Neurobiology Section, National Institute of Mental Health, National Institutes of Health, 10 Center Drive, MSC 1363, Bethesda, Maryland 20892-1363, United States
| | - Chi-Tso Chiu
- Molecular
Neurobiology Section, National Institute of Mental Health, National Institutes of Health, 10 Center Drive, MSC 1363, Bethesda, Maryland 20892-1363, United States
| | | | - Yan Leng
- Molecular
Neurobiology Section, National Institute of Mental Health, National Institutes of Health, 10 Center Drive, MSC 1363, Bethesda, Maryland 20892-1363, United States
| | - Gabriel R. Linares
- Molecular
Neurobiology Section, National Institute of Mental Health, National Institutes of Health, 10 Center Drive, MSC 1363, Bethesda, Maryland 20892-1363, United States
| | - De-Maw Chuang
- Molecular
Neurobiology Section, National Institute of Mental Health, National Institutes of Health, 10 Center Drive, MSC 1363, Bethesda, Maryland 20892-1363, United States
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24
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Forlenza OV, De-Paula VJR, Diniz BSO. Neuroprotective effects of lithium: implications for the treatment of Alzheimer's disease and related neurodegenerative disorders. ACS Chem Neurosci 2014; 5:443-50. [PMID: 24766396 DOI: 10.1021/cn5000309] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Lithium is a well-established therapeutic option for the acute and long-term management of bipolar disorder and major depression. More recently, based on findings from translational research, lithium has also been regarded as a neuroprotective agent and a candidate drug for disease-modification in certain neurodegenerative disorders, namely, Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), and, more recently, Parkinson's disease (PD). The putative neuroprotective effects of lithium rely on the fact that it modulates several homeostatic mechanisms involved in neurotrophic response, autophagy, oxidative stress, inflammation, and mitochondrial function. Such a wide range of intracellular responses may be secondary to two key effects, that is, the inhibition of glycogen synthase kinase-3 beta (GSK-3β) and inositol monophosphatase (IMP) by lithium. In the present review, we revisit the neurobiological properties of lithium in light of the available evidence of its neurotrophic and neuroprotective properties, and discuss the rationale for its use in the treatment and prevention of neurodegenerative diseases.
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Affiliation(s)
- O. V. Forlenza
- Laboratory
of Neuroscience (LIM-27), Department and Institute of Psychiatry,
Faculty of Medicine, University of Sao Paulo, SP, Brazil
| | - V. J. R. De-Paula
- Laboratory
of Neuroscience (LIM-27), Department and Institute of Psychiatry,
Faculty of Medicine, University of Sao Paulo, SP, Brazil
| | - B. S. O. Diniz
- Department
of Mental Health and National Institute of Science and Technology,
Molecular Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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25
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Marlinge E, Bellivier F, Houenou J. White matter alterations in bipolar disorder: potential for drug discovery and development. Bipolar Disord 2014; 16:97-112. [PMID: 24571279 DOI: 10.1111/bdi.12135] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 05/24/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Brain white matter (WM) alterations have recently emerged as potentially relevant in bipolar disorder. New techniques such as diffusion tensor imaging allow precise exploration of these WM microstructural alterations in bipolar disorder. Our objective was to critically review WM alterations in bipolar disorder, using neuroimaging and neuropathological studies, in the context of neural models and the potential for drug discovery and development. METHODS We conducted a systematic PubMed and Google Scholar search of the WM and bipolar disorder literature up to and including January 2013. RESULTS Findings relating to WM alterations are consistent in neuroimaging and neuropathology studies of bipolar disorder, especially in regions involved in emotional processing such as the anterior frontal lobe, corpus callosum, cingulate cortex, and in fronto-limbic connections. Some of the structural alterations are related to genetic risk factors for bipolar disorder and may underlie the dysfunctional emotional processing described in recent neurobiological models of bipolar disorder. Medication effects in bipolar disorder, from lithium and other mood stabilizers, might impact myelinating processes, particularly by inhibition of glycogen synthase kinase-3 beta. CONCLUSIONS Pathways leading to WM alterations in bipolar disorder represent potential targets for the development and discovery of new drugs. Myelin damage in bipolar disorder suggests that the effects of existing pro-myelinating drugs should also be evaluated to improve our understanding and treatment of this disease.
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Affiliation(s)
- Emeline Marlinge
- AP-HP, Groupe Henri Mondor-Albert Chenevier, Pôle de Psychiatrie, Paris, France; Inserm, U955, Equipe 15 (Psychiatrie Génétique), Paris, France; Fondation Fondamental, Créteil, France; Neurospin, I2BM, CEA, Gif-Sur-Yvette, France
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Abstract
OBJECTIVES The investigation of the pathophysiology of bipolar disorder in patients at disease onset is a strategy to avoid the confounding effect of progression of disease or duration of treatment. Our purpose was to investigate in vivo neuronal metabolites in the hippocampus of bipolar disorder patients using proton magnetic resonance spectroscopy ((1)H-MRS) within 3 months after their first manic episode. METHODS Fifty-eight BD I patients meeting DSM-IV criteria following their first episode of mania and 27 healthy subjects were studied using (1)H-MRS with a 3.0 T Philips Achieva scanner. Voxels with 30 × 15 × 15 mm were placed in the hippocampus on both sides of the brain and the signal was collected using a PRESS sequence with TE = 35 ms and TR = 2000 ms. Data analysis was performed using the LC Model software. RESULTS N-Acetyl-aspartate (NAA), choline (Cho), myo-inositol (mI), creatine (Cre) and glutamine + glutamate (Glx) levels were compared between the groups and no statistically significant differences were found. CONCLUSIONS Our results suggest that early in the course of BD there are no alterations in neuronal metabolism or vulnerability in the hippocampus after the first manic episode.
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Affiliation(s)
- Alexandre Duarte Gigante
- Bipolar Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School , São Paulo - SP , Brazil
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27
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Hajek T, Bauer M, Simhandl C, Rybakowski J, O'Donovan C, Pfennig A, König B, Suwalska A, Yucel K, Uher R, Young LT, MacQueen G, Alda M. Neuroprotective effect of lithium on hippocampal volumes in bipolar disorder independent of long-term treatment response. Psychol Med 2014; 44:507-517. [PMID: 23721695 DOI: 10.1017/s0033291713001165] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neuroimaging studies have demonstrated an association between lithium (Li) treatment and brain structure in human subjects. A crucial unresolved question is whether this association reflects direct neurochemical effects of Li or indirect effects secondary to treatment or prevention of episodes of bipolar disorder (BD). METHOD To address this knowledge gap, we compared manually traced hippocampal volumes in 37 BD patients with at least 2 years of Li treatment (Li group), 19 BD patients with <3 months of lifetime Li exposure over 2 years ago (non-Li group) and 50 healthy controls. All BD participants were followed prospectively and had at least 10 years of illness and a minimum of five episodes. We established illness course and long-term treatment response to Li using National Institute of Mental Health (NIMH) life charts. RESULTS The non-Li group had smaller hippocampal volumes than the controls or the Li group (F 2,102 = 4.97, p = 0.009). However, the time spent in a mood episode on the current mood stabilizer was more than three times longer in the Li than in the non-Li group (t(51) = 2.00, p = 0.05). Even Li-treated patients with BD episodes while on Li had hippocampal volumes comparable to healthy controls and significantly larger than non-Li patients (t(43) = 2.62, corrected p = 0.02). CONCLUSIONS Our findings support the neuroprotective effects of Li. The association between Li treatment and hippocampal volume seems to be independent of long-term treatment response and occurred even in subjects with episodes of BD while on Li. Consequently, these effects of Li on brain structure may generalize to patients with neuropsychiatric illnesses other than BD.
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Affiliation(s)
- T Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - M Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - C Simhandl
- Psychiatrische Abteilung, Krankenhaus Neunkirchen, Austria
| | - J Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poland
| | - C O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - A Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - B König
- Psychiatrische Abteilung, Krankenhaus Neunkirchen, Austria
| | - A Suwalska
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poland
| | - K Yucel
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - R Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - L T Young
- Department of Psychiatry, University of Toronto, ON, Canada
| | - G MacQueen
- Department of Psychiatry, University of Calgary, AB, Canada
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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28
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Vernon AC, Hajek T. Effects of lithium on magnetic resonance imaging signal might not preclude increases in brain volume after chronic lithium treatment. Biol Psychiatry 2013; 74:e39-40. [PMID: 23998561 DOI: 10.1016/j.biopsych.2012.12.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 12/19/2012] [Accepted: 12/20/2012] [Indexed: 02/03/2023]
Affiliation(s)
- Anthony C Vernon
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
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29
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Neurochemical effects of quetiapine in patients with bipolar mania: a proton magnetic resonance spectroscopy study. J Clin Psychopharmacol 2013; 33:528-32. [PMID: 23764689 DOI: 10.1097/jcp.0b013e3182905b77] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although the neurophysiology underlying pharmacotherapy for bipolar disorder remains poorly understood, recent studies suggest that therapeutic mechanisms may be reflected in changes in concentrations of N-acetylaspartate (NAA), a putative measure of neuronal integrity and metabolism. In this study, we used magnetic resonance spectroscopy (MRS) to examine prefrontal NAA in patients receiving quetiapine for bipolar mania. On the basis of previous findings, we hypothesized that remission would be associated with increased NAA concentrations in the prefrontal cortex. Thirty-one manic bipolar patients and 13 healthy subjects were recruited to participate in this prospective study. All subjects participated in MRS at baseline and after 8 weeks of treatment. Bipolar subjects received open-label quetiapine monotherapy (mean dose [SD], 584 [191] mg). Fourteen patients remitted (Young Mania Rating Scale ≤ 12) ("remitters"), 11 patients did not ("nonremitters"), and 6 patients were lost to follow-up. Bipolar and healthy subjects did not significantly differ in baseline NAA or degree of change during the 8 weeks. Remitters showed greater mean baseline NAA concentrations in the right ventrolateral prefrontal cortex compared with nonremitters (P < 0.05). In the anterior cingulate, remitters showed near significantly decreased baseline NAA concentrations at baseline (P < 0.06), and significant differences in NAA change during the 8 weeks of treatment (P < 0.03). Manic patients who remitted with quetiapine treatment in the course of this study exhibited distinct patterns of baseline prefrontal NAA concentration, coupled with decreased NAA in the anterior cingulate with treatment; the latter possibly reflecting disparate effects of quetiapine on neuronal metabolism. These data support suggestions that therapeutic effects of quetiapine involve metabolic effects on specific prefrontal regions.
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30
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Howells FM, Ives-Deliperi VL, Horn NR, Stein DJ. Increased thalamic phospholipid concentration evident in bipolar I disorder. Prog Neuropsychopharmacol Biol Psychiatry 2013; 41:1-5. [PMID: 23142769 DOI: 10.1016/j.pnpbp.2012.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/19/2012] [Accepted: 10/31/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bipolar disorder is characterised by changes in brain metabolites, as measured by (1)H-MRS. However, there is no consistent metabolic profile for bipolar disorder, which includes changes in N-acetyl-aspartate (NAA), choline metabolites and myo-inositol. The aim of the present paper is to add to this literature of (1)H-MRS, the metabolite profiles in bipolar disorder. METHODOLOGY Nineteen individuals with euthymic bipolar I disorder and eight control participants were recruited for the present study. (1)H-MRS chemical shift imaging (CSI) was used to measure NAA, choline metabolites and myo-inositol of several bilateral brain areas potentially involved in bipolar disorder: hippocampal complexes, brain stem including the locus coeruleus, and thalami. RESULTS Compared with healthy controls, individuals with bipolar I disorder showed increased choline metabolites in bilateral thalami and increased NAA in left hippocampus. The (1)H-MRS data were not influenced by age, symptom severity, or medication status. CONCLUSIONS Our present findings suggest that individuals with bipolar I disorder have increased phospholipid concentration in the thalami and increased NAA concentration in the left hippocampus. While MRS data on bipolar data remain somewhat inconsistent, the findings here are consistent with other evidence supporting the hypothesis that dysfunctional thalamocortical gating plays a role in bipolar disorder.
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Affiliation(s)
- Fleur M Howells
- Department of Psychiatry, Faculty of Health Sciences, University of Cape Town, Observatory 7925, South Africa.
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31
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Diniz BS, Machado-Vieira R, Forlenza OV. Lithium and neuroprotection: translational evidence and implications for the treatment of neuropsychiatric disorders. Neuropsychiatr Dis Treat 2013; 9:493-500. [PMID: 23596350 PMCID: PMC3627470 DOI: 10.2147/ndt.s33086] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In the last two decades, a growing body of evidence has shown that lithium has several neuroprotective effects. Several neurobiological mechanisms have been proposed to underlie these clinical effects. Evidence from preclinical studies suggests that neuroprotection induced by lithium is mainly related to its potent inhibition of the enzyme glycogen synthase kinase-3β (GSK-3β) and its downstream effects, ie, reduction of both tau protein phosphorylation and amyloid-β42 production. Additional neuroprotective effects include increased neurotrophic support, reduced proinflammatory status, and decreased oxidative stress. More recently, neuroimaging studies in humans have demonstrated that chronic use is associated with cortical thickening, higher volume of the hippocampus and amygdala, and neuronal viability in bipolar patients on lithium treatment. In line with this evidence, observational and case registry studies have shown that chronic lithium intake is associated with a reduced risk of Alzheimer's disease in subjects with bipolar disorder. Evidence from recent clinical trials in patients with mild cognitive impairment suggests that chronic lithium treatment at subtherapeutic doses can reduce cerebral spinal fluid phosphorylated tau protein. Overall, convergent lines of evidence point to the potential of lithium as an agent with disease modifying properties in Alzheimer's disease. However, additional long-term studies are necessary to confirm its efficacy and safety for these patients, particularly as chronic intake is necessary to achieve the best therapeutic results.
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Affiliation(s)
- Breno Satler Diniz
- Department of Mental Health, National Institute of Science and Technology - Molecular Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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32
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Özdel O, Kalayci D, Sözeri-Varma G, Kiroğlu Y, Tümkaya S, Toker-Uğurlu T. Neurochemical metabolites in the medial prefrontal cortex in bipolar disorder: A proton magnetic resonance spectroscopy study. Neural Regen Res 2012; 7:2929-36. [PMID: 25317146 PMCID: PMC4190952 DOI: 10.3969/j.issn.1673-5374.2012.36.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 11/04/2012] [Indexed: 12/30/2022] Open
Abstract
The aim of this study was to investigate proton magnetic resonance spectroscopy metabolite values in the medial prefrontal cortex of individuals with euthymic bipolar disorder. The subjects consisted of 15 patients with euthymic bipolar disorder type I and 15 healthy controls. We performed proton magnetic resonance spectroscopy of the bilateral medial prefrontal cortex and measured levels of N-acetyl aspartate, choline and creatine. Levels of these three metabolites in the medial prefrontal cortex were found to be lower in patients with bipolar disorder compared with healthy controls. A positive correlation was found between illness duration and choline levels in the right medial prefrontal cortex. Our study suggests that during the euthymic period, there are abnormalities in cellular energy and membrane phospholipid metabolism in the medial prefrontal cortex, and that this may impair neuronal activity and integrity.
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Affiliation(s)
- Osman Özdel
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli 20100, Turkey
| | - Demet Kalayci
- Department of Psychiatry, Antalya Training and Research Hospital, Antalya 07050, Turkey
| | - Gülfizar Sözeri-Varma
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli 20100, Turkey
| | - Yilmaz Kiroğlu
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli 20100, Turkey
| | - Selim Tümkaya
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli 20100, Turkey
| | - Tugçe Toker-Uğurlu
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli 20100, Turkey
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Wu RH, Lin R, Li H, Xiao ZW, Rao HB, Luo WH, Guo G, Huang K, Zhang XG, Lang ZJ. Accuracy of noninvasive quantification of brain NAA concentrations using PRESS sequence: verification in a swine model with external standard. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2012; 2005:1396-9. [PMID: 17282459 DOI: 10.1109/iembs.2005.1616690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The metabolite ratios had been employed in the field of MR spectroscopy (MRS) for a long period. The main drawback of metabolite ratio is that ratio results are not comparable with absolute metabolite concentration in vivo. The purpose of this study was to examine the accuracy of noninvasive quantification of brain N-acetylaspartate (NAA) concentrations using previously reported MR external standard method. Eight swine were scanned on a GE 1.5 T scanner with a standard head coil. The external standard method was utilized with a sphere filled with NAA, GABA, glutamine, glutamate, creatine, choline chloride, and myo-inositol. The position resolved spectroscopy (PRESS) sequence was used with TE=135 msec, TR=1500 msec, and 128 scan averages. The analysis of MRS was done with SAGE/IDL program. In vivo NAA concentration was obtained using the equation S=N * e(-TE/T<sub>2</sub>) * [1-e(-TR/T<sub>1</sub>). In vitro NAA concentration was measured by high performance liquid chromatography (HPLC). In the MRS group, the mean concentration of NAA was 10.03 plusmn 0.74 mmol/kg. In the HPLC group, the mean concentration of NAA was 9.22 plusmn 0.55 mmol/kg. There was no significant difference between the two groups (p = 0.46). However, slightly higher value was observed in the MRS group (7/8 swine), compared with HPLC group. The range of differences was between 0.02~2.05 mmol/kg. MRS external reference method could be more accurate than internal reference method. <sup>1</sup>H MRS does not distinguish between N-acetyl resonance frequencies and other N-acetylated amino acids.
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Affiliation(s)
- R H Wu
- Med. Imaging & Central Lab., Shantou Univ. Med. Coll
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34
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Forlenza OV, de Paula VJ, Machado-Vieira R, Diniz BS, Gattaz WF. Does lithium prevent Alzheimer's disease? Drugs Aging 2012; 29:335-42. [PMID: 22500970 DOI: 10.2165/11599180-000000000-00000] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Lithium salts have a well-established role in the treatment of major affective disorders. More recently, experimental and clinical studies have provided evidence that lithium may also exert neuroprotective effects. In animal and cell culture models, lithium has been shown to increase neuronal viability through a combination of mechanisms that includes the inhibition of apoptosis, regulation of autophagy, increased mitochondrial function, and synthesis of neurotrophic factors. In humans, lithium treatment has been associated with humoral and structural evidence of neuroprotection, such as increased expression of anti-apoptotic genes, inhibition of cellular oxidative stress, synthesis of brain-derived neurotrophic factor (BDNF), cortical thickening, increased grey matter density, and hippocampal enlargement. Recent studies addressing the inhibition of glycogen synthase kinase-3 beta (GSK3B) by lithium have further suggested the modification of biological cascades that pertain to the pathophysiology of Alzheimer's disease (AD). A recent placebo-controlled clinical trial in patients with amnestic mild cognitive impairment (MCI) showed that long-term lithium treatment may actually slow the progression of cognitive and functional deficits, and also attenuate Tau hyperphosphorylation in the MCI-AD continuum. Therefore, lithium treatment may yield disease-modifying effects in AD, both by the specific modification of its pathophysiology via inhibition of overactive GSK3B, and by the unspecific provision of neurotrophic and neuroprotective support. Although the clinical evidence available so far is promising, further experimentation and replication of the evidence in large scale clinical trials is still required to assess the benefit of lithium in the treatment or prevention of cognitive decline in the elderly.
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Affiliation(s)
- Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
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35
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Neurometabolites in schizophrenia and bipolar disorder - a systematic review and meta-analysis. Psychiatry Res 2012; 203:111-25. [PMID: 22981426 PMCID: PMC3466386 DOI: 10.1016/j.pscychresns.2012.02.003] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/02/2012] [Accepted: 02/08/2012] [Indexed: 01/10/2023]
Abstract
This meta-analysis evaluates alterations of neurometabolites in schizophrenia and bipolar disorder. PubMed was searched to find controlled studies evaluating N-acetylaspartate (NAA), Choline (Cho) and Creatine (Cr) assessed with ((1))H-MRS (proton magnetic resonance spectroscopy) in patients with schizophrenia and bipolar disorder up to September 2010. Random effects meta-analyses were conducted to estimate pooled standardized mean differences. The statistic was used to quantify inconsistencies. Subgroup analyses were conducted to explore potential explanations for inconsistencies. The systematic review included 146 studies with 5643 participants. NAA levels were affected in schizophrenia and bipolar disorder. Decreased levels in the basal ganglia and frontal lobe were the most consistent findings in schizophrenia; decreased levels in the basal ganglia were the most consistent findings in bipolar disorder. Cho and Cr levels were not altered in either disorder. Findings for Cr were most consistent in the thalamus, frontal lobe and dorsolateral prefrontal cortex in schizophrenia and the basal ganglia and frontal lobe in bipolar disorder. Findings for Cho were most consistent in the thalamus, frontal lobe and anterior cingulate cortex in schizophrenia and basal ganglia in bipolar disorder. Large, carefully designed studies are needed to better estimate the extent of alterations in neurometabolites.
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Chang K, DelBello M, Chu WJ, Garrett A, Kelley R, Mills N, Howe M, Bryan H, Adler C, Eliassen J, Spielman D, Strakowski SM. Neurometabolite effects of response to quetiapine and placebo in adolescents with bipolar depression. J Child Adolesc Psychopharmacol 2012; 22:261-8. [PMID: 22849427 PMCID: PMC3472676 DOI: 10.1089/cap.2011.0153] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Mood stabilizers have been reported to affect brain concentrations of myo-inositol (mI) and N-acetylaspartate (NAA). We examined the effects of quetiapine (QUET), an atypical antipsychotic, on these neurochemicals, and potential predictors of response to QUET in adolescents with bipolar depression. METHODS Twenty-six adolescents with bipolar depression participated in an 8-week placebo-controlled trial of QUET monotherapy. Subjects were scanned at baseline and after 8 weeks with proton magnetic resonance spectroscopy (1H-MRS) at 3T and 4T at two sites, with 8 cm(3) voxels placed in the right and left dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC). LCModel was used to calculate absolute concentrations of NAA and mI. RESULTS Twenty-six subjects had pre- and posttreatment scans (mean age=15.6 years, 9 boys). Of these subjects, 5 out of 16 subjects receiving QUET and 5 out of 10 receiving placebo (PBO) were responders (50% decrease in Children's Depression Rating Scale [CDRS] score). Although baseline ACC mI did not predict responder status, responders had significantly lower posttreatment ACC mI values than did nonresponders (3.27±.71 vs. 4.23±.70; p=0.004). There were no significant differences in the changes in ACC and DLPFC NAA levels in the QUET group compared with the PBO group (ACC: -0.55±1.3 vs.+0.25±1.5, p=0.23; right-DLPFC: -0.55±1.3 vs. 0.33±0.89, p=0.13; left-DLPFC: -0.04±0.91 vs.+0.29±0.61, p=0.41). CONCLUSION We found that posttreatment, not baseline, ACC mI levels were associated with response to QUET in adolescents with bipolar depression. There were no differences in NAA concentration changes between the QUET and PBO groups. Larger studies including different brain regions would help to clarify the effects of QUET on neurochemistry in patients with bipolar disorder.
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Affiliation(s)
- Kiki Chang
- Pediatric Bipolar Disorders Program, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94305-5540, USA.
| | - Melissa DelBello
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Wen-Jang Chu
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amy Garrett
- Pediatric Bipolar Disorders Program, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Ryan Kelley
- Pediatric Bipolar Disorders Program, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Neil Mills
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Meghan Howe
- Pediatric Bipolar Disorders Program, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Holly Bryan
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Cal Adler
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jim Eliassen
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Daniel Spielman
- Pediatric Bipolar Disorders Program, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Stephen M. Strakowski
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Hajek T, Bauer M, Pfennig A, Cullis J, Ploch J, O’Donovan C, Bohner G, Klingebiel R, Young LT, MacQueen GM, Alda M. Large positive effect of lithium on prefrontal cortex N-acetylaspartate in patients with bipolar disorder: 2-centre study. J Psychiatry Neurosci 2012; 37:185-92. [PMID: 22353634 PMCID: PMC3341410 DOI: 10.1503/jpn.110097] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Neuroprotective effects of lithium (Li) have been well documented in tissue cultures and animal models, whereas human data continue to be limited. Previous studies investigating the association between Li treatment and brain N-acetylaspartate (NAA), a putative neuronal marker, showed mixed results because of methodological heterogeneity. METHODS To investigate the effects of Li on prefrontal cortex NAA levels, we compared patients with bipolar disorder from specialized Li clinics in Berlin and Halifax with at least 2 years of ongoing Li treatment (Li group), patients with lifetime Li exposure of less than 3 months more than 2 years ago (non-Li group) and healthy controls. Participants in both patient groups had at least 10 years of illness and 5 episodes. We measured left prefrontal NAA levels using 1.5-T magnetic resonance spectroscopy. RESULTS We enrolled 27 participants in the Li, 16 in the non-Li and 21 in the healthy control groups. The non-Li group had lower prefrontal NAA levels than the Li group (t41 = -3.44, corrected p < 0.01) or control participants (t35 = -2.91, corrected p < 0.05), who did not differ from the Li group (t46 = -0.14, p = 0.89). The same pattern of prefrontal NAA differences was replicated in both sites. In addition, there was a negative correlation between prefrontal NAA and duration of illness in the non-Li group (r = -0.60, p = 0.019) but not in the Li group (r = 0.07, p = 0.74). LIMITATIONS Study limitations include the crosssectional design and exposure to other medications. CONCLUSION Whereas patients with bipolar disorder, substantial illness burden and limited lifetime Li exposure had significantly lower prefrontal NAA levels than controls, Li-treated patients with similar illness burden showed prefrontal NAA levels comparable to those of healthy controls. These findings provide indirect support for neuroprotective effects of Li and for negative effects of illness burden on prefrontal NAA levels in patients with bipolar disorder.
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Affiliation(s)
- Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS.
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Hajek T, Cullis J, Novak T, Kopecek M, Höschl C, Blagdon R, O’Donovan C, Bauer M, Young LT, MacQueen G, Alda M. Hippocampal volumes in bipolar disorders: opposing effects of illness burden and lithium treatment. Bipolar Disord 2012; 14:261-70. [PMID: 22548899 PMCID: PMC3525647 DOI: 10.1111/j.1399-5618.2012.01013.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hippocampal volume decrease associated with illness burden is among the most replicated findings in unipolar depression. The absence of hippocampal volume changes in most studies of individuals with bipolar disorder (BD) may reflect neuroprotective effects of lithium (Li). METHODS We recruited 17 BD patients from specialized Li clinics, with at least two years of regularly monitored Li treatment (Li group), and compared them to 12 BD participants with < 3 months of lifetime Li exposure and no Li treatment within two years prior to the scanning (non-Li group) and 11 healthy controls. All BD patients had at least 10 years of illness and five episodes. We also recruited 13 Li-naïve, young BD participants (15-30 years of age) and 18 sex- and age-matched healthy controls. We compared hippocampal volumes obtained from 1.5-T magnetic resonance imaging (MRI) scans using optimized voxel-based morphometry with small volume correction. RESULTS The non-Li group had smaller left hippocampal volumes than controls (corrected p < 0.05), with a trend for lower volumes than the Li group (corrected p < 0.1), which did not differ from controls. Young, Li-naïve BD patients close to the typical age of onset had comparable hippocampal volumes to controls. CONCLUSIONS Whereas patients with limited lifetime Li exposure had significantly lower hippocampal volumes than controls, patients with comparable illness burden, but with over two years of Li treatment, or young Li-naïve BD patients, showed hippocampal volumes comparable to controls. These results provide indirect support for neuroprotective effects of Li and negative effects of illness burden on hippocampal volumes in bipolar disorders.
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Affiliation(s)
- Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
| | - Jeffrey Cullis
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Tomas Novak
- Department of Psychiatry and Medical Psychology, Prague Psychiatric Centre, 3rd School of Medicine, Charles University, Prague, Czech Republic
| | - Miloslav Kopecek
- Department of Psychiatry and Medical Psychology, Prague Psychiatric Centre, 3rd School of Medicine, Charles University, Prague, Czech Republic
| | - Cyril Höschl
- Department of Psychiatry and Medical Psychology, Prague Psychiatric Centre, 3rd School of Medicine, Charles University, Prague, Czech Republic
| | - Ryan Blagdon
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Claire O’Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - L Trevor Young
- Department of Psychiatry, University of Toronto, Toronto, ON
| | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Department of Psychiatry and Medical Psychology, Prague Psychiatric Centre, 3rd School of Medicine, Charles University, Prague, Czech Republic
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Abstract
Bipolar disorder is a serious disorder of mood that is associated with considerable psychosocial and economic morbidity. Even though it is more common than previously thought, it has until relatively recently been somewhat neglected in terms of research when compared to disorders such as schizophrenia and major depression. Recent advances in the fields of nosology, epidemiology, and molecular genetics in particular have begun to unravel some of the complexity of this disorder and the next few years are likely to witness substantial changes to the ways in which the broad spectrum of bipolar disorders is diagnosed and managed.
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Affiliation(s)
- Daniel J Smith
- Department of Psychological Medicine, Cardiff University, Cardiff, UK
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Involvement of the glycogen synthase kinase-3 signaling pathway in TBI pathology and neurocognitive outcome. PLoS One 2011; 6:e24648. [PMID: 21935433 PMCID: PMC3174188 DOI: 10.1371/journal.pone.0024648] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 08/17/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) sets in motion cascades of biochemical changes that result in delayed cell death and altered neuronal architecture. Studies have demonstrated that inhibition of glycogen synthase kinase-3 (GSK-3) effectively reduces apoptosis following a number of stimuli. The Wnt family of proteins, and growth factors are two major factors that regulate GSK-3 activity. In the absence of stimuli, GSK-3 is constitutively active and is complexed with Axin, adenomatous polyposis coli (APC), and casein kinase Iα (CK1α) and phosphorylates ß-Catenin leading to its degradation. Binding of Wnt to Frizzled receptors causes the translocation of GSK-3 to the plasma membrane, where it phosphorylates and inactivates the Frizzled co-receptor lipoprotein-related protein 6 (LRP6). Furthermore, the translocation of GSK-3 reduces ß-Catenin phosphorylation and degradation, leading to ß-Catenin accumulation and gene expression. Growth factors activate Akt, which in turn inhibits GSK-3 activity by direct phosphorylation, leading to a reduction in apoptosis. METHODOLOGY/PRINCIPAL FINDINGS Using a rodent model, we found that TBI caused a rapid, but transient, increase in LRP6 phosphorylation that is followed by a modest decrease in ß-Catenin phosphorylation. Phospho-GSK-3β immunoreactivity was found to increase three days post injury, a time point at which increased Akt activity following TBI has been observed. Lithium influences several neurochemical cascades, including inhibiting GSK-3. When the efficacy of daily lithium was assessed, reduced hippocampal neuronal cell loss and learning and memory improvements were observed. These influences were partially mimicked by administration of the GSK-3-selective inhibitor SB-216763, as this drug resulted in improved motor function, but only a modest improvement in memory retention and no overt neuroprotection. CONCLUSION/SIGNIFICANCE Taken together, our findings suggest that selective inhibition of GSK-3 may offer partial cognitive improvement. As a broad spectrum inhibitor of GSK-3, lithium offers neuroprotection and robust cognitive improvement, supporting its clinical testing as a treatment for TBI.
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Germaná C, Kempton MJ, Sarnicola A, Christodoulou T, Haldane M, Hadjulis M, Girardi P, Tatarelli R, Frangou S. The effects of lithium and anticonvulsants on brain structure in bipolar disorder. Acta Psychiatr Scand 2010; 122:481-7. [PMID: 20560901 DOI: 10.1111/j.1600-0447.2010.01582.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the effect of lithium, anticonvulsants and antipsychotics on brain structure in bipolar disorder (BD). METHOD A cross-sectional structural brain magnetic resonance imaging study of 74 remitted patients with BD, aged 18-65, who were receiving long-term prophylactic treatment with lithium or anticonvulsants or antipsychotics. Global and regional grey matter, white matter, and cerebrospinal fluid volumes were compared between treatment groups. RESULTS Grey matter in the subgenual anterior cingulate gyrus on the right (extending into the hypothalamus) and in the postcentral gyrus, the hippocampus/amygdale complex and the insula on the left was greater in BD patients on lithium treatment compared to all other treatment groups. CONCLUSION Lithium treatment in BD has a significant effect on brain structure particularly in limbic/paralimbic regions associated with emotional processing.
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Affiliation(s)
- C Germaná
- Institute of Psychiatry King's College London, UK
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Yu K, Cheung C, Leung M, Li Q, Chua S, McAlonan G. Are Bipolar Disorder and Schizophrenia Neuroanatomically Distinct? An Anatomical Likelihood Meta-analysis. Front Hum Neurosci 2010; 4:189. [PMID: 21103008 PMCID: PMC2987512 DOI: 10.3389/fnhum.2010.00189] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 09/22/2010] [Indexed: 11/13/2022] Open
Abstract
Objective: There is renewed debate on whether modern diagnostic classification should adopt a dichotomous or dimensional approach to schizophrenia and bipolar disorder. This study synthesizes data from voxel-based studies of schizophrenia and bipolar disorder to estimate the extent to which these conditions have a common neuroanatomical phenotype. Methods: A post-hoc meta-analytic estimation of the extent to which bipolar disorder, schizophrenia, or both conditions contribute to brain gray matter differences compared to controls was achieved using a novel application of the conventional anatomical likelihood estimation (ALE) method. 19 schizophrenia studies (651 patients and 693 controls) were matched as closely as possible to 19 bipolar studies (540 patients and 745 controls). Result: Substantial overlaps in the regions affected by schizophrenia and bipolar disorder included regions in prefrontal cortex, thalamus, left caudate, left medial temporal lobe, and right insula. Bipolar disorder and schizophrenia jointly contributed to clusters in the right hemisphere, but schizophrenia was almost exclusively associated with additional gray matter deficits (left insula and amygdala) in the left hemisphere. Limitation: The current meta-analytic method has a number of constraints. Importantly, only studies identifying differences between controls and patient groups could be included in this analysis. Conclusion: Bipolar disorder shares many of the same brain regions as schizophrenia. However, relative to neurotypical controls, lower gray matter volume in schizophrenia is more extensive and includes the amygdala. This fresh application of ALE accommodates multiple studies in a relatively unbiased comparison. Common biological mechanisms may explain the neuroanatomical overlap between these major disorders, but explaining why brain differences are more extensive in schizophrenia remains challenging.
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Affiliation(s)
- Kevin Yu
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong Pokfulam, Hong Kong
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Scaglia F. The role of mitochondrial dysfunction in psychiatric disease. ACTA ACUST UNITED AC 2010; 16:136-43. [DOI: 10.1002/ddrr.115] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Lyoo IK, Dager SR, Kim JE, Yoon SJ, Friedman SD, Dunner DL, Renshaw PF. Lithium-induced gray matter volume increase as a neural correlate of treatment response in bipolar disorder: a longitudinal brain imaging study. Neuropsychopharmacology 2010; 35:1743-50. [PMID: 20357761 PMCID: PMC3055479 DOI: 10.1038/npp.2010.41] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Preclinical studies suggest that lithium may exert neurotrophic effects that counteract pathological processes in the brain of patients with bipolar disorder (BD). To describe and compare the course and magnitude of gray matter volume changes in patients with BD who are treated with lithium or valproic acid (VPA) compared to healthy comparison subjects, and to assess clinical relationships to gray matter volume changes induced by lithium in patients with BD, we conducted longitudinal brain imaging and clinical evaluations of treatment response in 22 mood-stabilizing and antipsychotic medications-naive patients with BD who were randomly assigned to either lithium or VPA treatment after baseline assessment. Fourteen healthy comparison subjects did not take any psychotropic medications during follow-up. Longitudinal data analyses of 93 serial magnetic resonance images revealed lithium-induced increases in gray matter volume, which peaked at week 10-12 and were maintained through 16 weeks of treatment. This increase was associated with positive clinical response. In contrast, VPA-treated patients with BD or healthy comparison subjects did not show gray matter volume changes over time. Results suggest that lithium induces sustained increases in cerebral gray matter volume in patients with BD and that these changes are related to the therapeutic efficacy of lithium.
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Affiliation(s)
- In Kyoon Lyoo
- Department of Psychiatry, Seoul National University, Seoul, South Korea.
| | - Stephen R Dager
- Department of Radiology, University of Washington, Seattle, WA, USA,Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Jieun E Kim
- Department of Psychiatry, Seoul National University, Seoul, South Korea
| | - Sujung J Yoon
- Department of Psychiatry, Catholic University of Korea School of Medicine, Seoul, South Korea
| | - Seth D Friedman
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - David L Dunner
- Center for Anxiety and Depression, Mercer Island, WA, USA
| | - Perry F Renshaw
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA,The Brain Institute, University of Utah, Salt Lake City, UT, USA,Department of Veterans Affairs VISN 19 MIRECC, Salt Lake City, UT, USA
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Assadi M, Janson C, Wang DJ, Goldfarb O, Suri N, Bilaniuk L, Leone P. Lithium citrate reduces excessive intra-cerebral N-acetyl aspartate in Canavan disease. Eur J Paediatr Neurol 2010; 14:354-9. [PMID: 20034825 DOI: 10.1016/j.ejpn.2009.11.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 10/27/2009] [Accepted: 11/26/2009] [Indexed: 11/18/2022]
Abstract
Our group has previously reported the first clinical application of lithium in a child affected by Canavan disease. In this study, we aimed to assess the effects of lithium on N-acetyl aspartate (NAA) as well as other end points in a larger cohort. Six patients with clinical, laboratory and genetic confirmation of Canavan disease were recruited and underwent treatment with lithium. The battery of safety and efficacy testing performed before and after sixty days of treatment included Gross Motor Function Testing (GMFM), Magnetic Resonance Imaging (MRI) Proton Magnetic Spectroscopy (H-MRS) as well as blood work. The medication was safe without any clinical or laboratory evidence for toxicity. Parental reports indicated improvement in alertness and social interactions. GMFM did not show statistically significant improvement in motor development. H-MRS documented an overall drop in NAA which was statistically significant in the basal ganglia. T1 measurements recorded on MRI studies suggested a mild improvement in myelination in the frontal white matter after treatment. Diffusion Tensor Imaging was available in two patients and suggested micro-structural improvement in the corpus callosum. The results suggest that lithium administration may be beneficial in patients with Canavan disease.
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Affiliation(s)
- Mitra Assadi
- Robert Wood Johnson Medical School, Neurology, 3 Cooper Plaza, Suite 320, Camden, NJ 08103, USA.
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Bipolar disorder comorbid with alcoholism: a 1H magnetic resonance spectroscopy study. J Psychiatr Res 2010; 44:278-85. [PMID: 19818454 PMCID: PMC2836426 DOI: 10.1016/j.jpsychires.2009.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 09/05/2009] [Accepted: 09/08/2009] [Indexed: 01/11/2023]
Abstract
Alcoholism is highly prevalent among bipolar disorder (BD) patients, and its presence is associated with a worse outcome and refractoriness to treatment of the mood disorder. The neurobiological underpinnings that characterize this comorbidity are unknown. We sought to investigate the neurochemical profile of the dorsolateral prefrontal cortex (DLPFC) of BD patients with comorbid alcoholism. A short-TE, single-voxel (1)H spectroscopy acquisition at 1.5T from the left DLFPC of 22 alcoholic BD patients, 26 non-alcoholic BD patients and 54 healthy comparison subjects (HC) were obtained. Absolute levels of N-acetyl aspartate, phosphocreatine plus creatine, choline-containing compounds, myo-inositol, glutamate plus glutamine (Glu+Gln) and glutamate were obtained using the water signal as an internal reference. Analysis of co-variance was used to compare metabolite levels among the three groups. In the primary comparison, non-alcoholic BD patients had higher glutamate concentrations compared to alcoholic BD patients. In secondary comparisons integrating interactions between gender and alcoholism, non-alcoholic BD patients presented significantly higher glutamate plus glutamine (Glu+Gln) than alcoholic BD patients and HC. These results appeared to be driven by differences in male subjects. Alcoholic BD patients with additional drug use disorders presented significantly lower myo-inositol than BD patients with alcoholism alone. The co-occurrence of BD and alcoholism may be characterized by neurochemical abnormalities related to the glutamatergic system and to the inositol second messenger system and/or in glial pathology. These abnormalities may be the neurochemical correlate of an increased risk to develop alcoholism in BD, or of a persistently worse clinical and functional status in BD patients in remission from alcoholism, supporting the clinical recommendation that efforts should be made to prevent or early diagnose and treat alcoholism in BD patients.
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Nery-Fernandes F, Quarantini LC, Galvão-De-Almeida A, Rocha MV, Kapczinski F, Miranda-Scippa A. Lower rates of comorbidities in euthymic bipolar patients. World J Biol Psychiatry 2010; 10:474-9. [PMID: 19401946 DOI: 10.1080/15622970802688929] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study assessed the frequency of axis I psychiatric comorbidities in euthymic bipolar patients and the clinical differences between patients with and without comorbidities. METHOD In this study, 62 euthymic bipolar outpatients assessed using a clinical questionnaire underwent a structured diagnostic interview (SCID/CV-DSM-IV) as well as a symptoms evaluation (YMRS and HAM-D-17). RESULTS The lifetime frequency of patients with comorbidities was 27.4%. The most frequent comorbidities were anxiety disorders (33.7%), and the positive associated variables were more advanced age, the presence of a steady partner, a first episode of the depressive type and lifetime attempted suicide. CONCLUSIONS The lower frequency of comorbidities found in our study in comparison with those described in the literature may be due to the evaluation restricted only to euthymic patients. This suggests the importance of assessing psychiatric comorbidity in bipolar individuals while not in acute phases of the disorder.
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Affiliation(s)
- Fabiana Nery-Fernandes
- Center for Study and Treatment of Affective Disorders (CETTA), Universidade Federal da Bahia, Salvador-Ba, Brazil.
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Nery FG, Stanley JA, Chen HH, Hatch JP, Nicoletti MA, Monkul ES, Matsuo K, Caetano SC, Peluso MA, Najt P, Soares JC. Normal metabolite levels in the left dorsolateral prefrontal cortex of unmedicated major depressive disorder patients: a single voxel (1)H spectroscopy study. Psychiatry Res 2009; 174:177-83. [PMID: 19910168 DOI: 10.1016/j.pscychresns.2009.05.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 05/06/2009] [Accepted: 05/15/2009] [Indexed: 02/02/2023]
Abstract
Few proton magnetic resonance spectroscopy ((1)H spectroscopy) studies have investigated the dorsolateral prefrontal cortex (DLPFC), a key region in the pathophysiology of major depressive disorder (MDD). We used (1)H spectroscopy to verify whether MDD patients differ from healthy controls (HC) in metabolite levels in this brain area. Thirty-seven unmedicated DSM-IV MDD patients were compared with 40 HC. Subjects underwent a short echo-time (1)H spectroscopy examination at 1.5 T, with an 8-cm(3) single voxel placed in the left DLPFC. Reliable absolute metabolite levels of N-acetyl aspartate (NAA), phosphocreatine plus creatine (PCr+Cr), choline-containing compounds (GPC+PC), myo-inositol, glutamate plus glutamine (Glu+Gln), and glutamate were obtained using the unsuppressed water signal as an internal reference. Metabolite levels in the left DLPFC did not statistically differ between MDD patients and HC. We found an interaction between gender and diagnosis on PCr+Cr levels. Male MDD patients presented lower levels of PCr+Cr than male HC, and female MDD patients presented higher levels of PCr+Cr than female HC. Moreover, length of illness was inversely correlated with NAA levels. These findings suggest that there is not an effect of diagnosis on the left DLPFC neurochemistry. Possible effects of gender on PCr+Cr levels of MDD patients need to be further investigated.
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Affiliation(s)
- Fabiano G Nery
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Hunsberger J, Austin DR, Henter ID, Chen G. The neurotrophic and neuroprotective effects of psychotropic agents. DIALOGUES IN CLINICAL NEUROSCIENCE 2009. [PMID: 19877500 PMCID: PMC2804881 DOI: 10.31887/dcns.2009.11.3/jhunsberger] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Accumulating evidence suggests that psychotropic agents such as mood stabilizers, antidepressants, and antipsychotics realize their neurotrophic/neuroprotective effects by activating the mitogen activated protein kinaselextracellular signal-related kinase, PI3-kinase, and winglesslglycogen synthase kinase (GSK) 3 signaling pathways. These agents also upregulate the expression of trophic/protective molecules such as brain-derived neurotrophic factor, nerve growth factor, B-cell lymphoma 2, serine-threonine kinase, and Bcl-2 associated athanogene 1, and inactivate proapoptotic molecules such as GSK-3, They also promote neurogenesis and are protective in models of neurodegenerative diseases and ischemia. Most if not all, of this evidence was collected from animal studies that used clinically relevant treatment regimens. Furthermore, human imaging studies have found that these agents increase the volume and density of brain tissue, as well as levels of N-acetyl aspartate and glutamate in selected brain regions. Taken together, these data suggest that the neurotrophic/neuroprotective effects of these agents have broad therapeutic potential in the treatment, not only of mood disorders and schizophrenia, but also neurodegenerative diseases and ischemia.
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Affiliation(s)
- Joshua Hunsberger
- Laboratory of Molecular Pathophysiology and Experimental Therapeutics, Mood and Anxiety Disorders Program, NIMH, NIH, Bethesda, MD, 20892, USA
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McLoughlin GA, Ma D, Tsang TM, Jones DNC, Cilia J, Hill MD, Robbins MJ, Benzel IM, Maycox PR, Holmes E, Bahn S. Analyzing the effects of psychotropic drugs on metabolite profiles in rat brain using 1H NMR spectroscopy. J Proteome Res 2009; 8:1943-52. [PMID: 19714815 DOI: 10.1021/pr800892u] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The mechanism of action of standard drug treatments for psychiatric disorders remains fundamentally unknown, despite intensive investigation in academia and the pharmaceutical industry. So far, little is known about the effects of psychotropic medications on brain metabolism in either humans or animals. In this study, we investigated the effects of a range of psychotropic drugs on rat brain metabolites. The drugs investigated were haloperidol, clozapine, olanzapine, risperidone, aripiprazole (antipsychotics); valproate, carbamazapine (mood stabilizers) and phenytoin (antiepileptic drug). The relative concentrations of endogenous metabolites were determined using high-resolution proton nuclear magnetic resonance (1H NMR) spectroscopy. The results revealed that different classes of psychotropic drugs modulated a range of metabolites, where each drug induced a distinct neurometabolic profile. Some common responses across several drugs or within a class of drug were also observed. Antipsychotic drugs and mood stabilizers, with the exception of olanzapine, consistently increased N-acetylaspartate (NAA) levels in at least one brain area, suggesting a common therapeutic response on increased neuronal viability. Most drugs also altered the levels of several metabolites associated with glucose metabolism, neurotransmission (including glutamate and aspartate) and inositols. The heterogenic pharmacological response reflects the functional and physiological diversity of the therapeutic interventions, including side effects. Further study of these metabolites in preclinical models should facilitate the development of novel drug treatments for psychiatric disorders with improved efficacy and side effect profiles.
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Affiliation(s)
- Gerard A McLoughlin
- Department of Biomolecular Medicine, Division of SORA, Faculty of Medicine, Imperial College, London SW7 2AZ, UK
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