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Pin JN, Leonardi L, Nosadini M, Cavicchiolo ME, Guariento C, Zarpellon A, Perilongo G, Raffagnato A, Toldo I, Baraldi E, Sartori S. Efficacy and safety of ketamine for neonatal refractory status epilepticus: case report and systematic review. Front Pediatr 2023; 11:1189478. [PMID: 37334223 PMCID: PMC10275409 DOI: 10.3389/fped.2023.1189478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Background Evidence-based data on treatment of neonatal status epilepticus (SE) are scarce. We aimed to collect data on the efficacy and safety of ketamine for the treatment of neonatal SE and to assess its possible role in the treatment of neonatal SE. Methods We described a novel case and conducted a systematic literature review on neonatal SE treated with ketamine. The search was carried out in Pubmed, Cochrane, Clinical Trial Gov, Scopus and Web of Science. Results Seven published cases of neonatal SE treated with ketamine were identified and analyzed together with our novel case. Seizures typically presented during the first 24 h of life (6/8). Seizures were resistant to a mean of five antiseizure medications. Ketamine, a NMDA receptor antagonist, appeared to be safe and effective in all neonates treated. Neurologic sequelae including hypotonia and spasticity were reported for 4/5 of the surviving children (5/8). 3/5 of them were seizure free at 1-17 months of life. Discussion Neonatal brain is more susceptible to seizures due to a shift towards increased excitation because of a paradoxical excitatory effect of GABA, a greater density of NMDA receptors and higher extracellular concentrations of glutamate. Status epilepticus and neonatal encephalopathy could further enhance these mechanisms, providing a rationale for the use of ketamine in this setting. Conclusions Ketamine in the treatment of neonatal SE showed a promising efficacy and safety profile. However, further in-depth studies and clinical trials on larger populations are needed.
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Affiliation(s)
- Jacopo Norberto Pin
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
- Master in Pediatrics and Pediatric Subspecialties, University Hospital of Padua, Padova, Italy
| | - Letizia Leonardi
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Margherita Nosadini
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
- Neuroimmunology Group, Paediatric Research Institute “Città della Speranza”, Padova, Italy
| | - Maria Elena Cavicchiolo
- Department of Women’s and Children’s Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padova, Italy
| | - Chiara Guariento
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Anna Zarpellon
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Giorgio Perilongo
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Alessia Raffagnato
- Department of Women’s and Children’s Health, Child and Adolescent Neuropsychiatric Unit, University Hospital of Padua, Padova, Italy
| | - Irene Toldo
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Eugenio Baraldi
- Department of Women’s and Children’s Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padova, Italy
| | - Stefano Sartori
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
- Master in Pediatrics and Pediatric Subspecialties, University Hospital of Padua, Padova, Italy
- Neuroimmunology Group, Paediatric Research Institute “Città della Speranza”, Padova, Italy
- Department of Neuroscience, University Hospital of Padua, Padova, Italy
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Vines L, Sotelo D, Johnson A, Dennis E, Manza P, Volkow ND, Wang GJ. Ketamine use disorder: preclinical, clinical, and neuroimaging evidence to support proposed mechanisms of actions. INTELLIGENT MEDICINE 2022; 2:61-68. [PMID: 35783539 PMCID: PMC9249268 DOI: 10.1016/j.imed.2022.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Ketamine, a noncompetitive NMDA receptor antagonist, has been exclusively used as an anesthetic in medicine and has led to new insights into the pathophysiology of neuropsychiatric disorders. Clinical studies have shown that low subanesthetic doses of ketamine produce antidepressant effects for individuals with depression. However, its use as a treatment for psychiatric disorders has been limited due to its reinforcing effects and high potential for diversion and misuse. Preclinical studies have focused on understanding the molecular mechanisms underlying ketamine's antidepressant effects, but a precise mechanism had yet to be elucidated. Here we review different hypotheses for ketamine's mechanism of action including the direct inhibition and disinhibition of NMDA receptors, AMPAR activation, and heightened activation of monoaminergic systems. The proposed mechanisms are not mutually exclusive, and their combined influence may exert the observed structural and functional neural impairments. Long term use of ketamine induces brain structural, functional impairments, and neurodevelopmental effects in both rodents and humans. Its misuse has increased rapidly in the past 20 years and is one of the most common addictive drugs used in Asia. The proposed mechanisms of action and supporting neuroimaging data allow for the development of tools to identify 'biotypes' of ketamine use disorder (KUD) using machine learning approaches, which could inform intervention and treatment.
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Affiliation(s)
| | | | | | | | | | | | - Gene-Jack Wang
- Corresponding author: Gene-Jack Wang, Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 10 Center Dr, Rm B2L124, Bethesda, Maryland, United States ()
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Alexander L, Jelen LA, Mehta MA, Young AH. The anterior cingulate cortex as a key locus of ketamine's antidepressant action. Neurosci Biobehav Rev 2021; 127:531-554. [PMID: 33984391 DOI: 10.1016/j.neubiorev.2021.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 12/30/2022]
Abstract
The subdivisions of the anterior cingulate cortex (ACC) - including subgenual, perigenual and dorsal zones - are implicated in the etiology, pathogenesis and treatment of major depression. We review an emerging body of evidence which suggests that changes in ACC activity are critically important in mediating the antidepressant effects of ketamine, the prototypical member of an emerging class of rapidly acting antidepressants. Infusions of ketamine induce acute (over minutes) and post-acute (over hours to days) modulations in subgenual and perigenual activity, and importantly, these changes can correlate with antidepressant efficacy. The subgenual and dorsal zones of the ACC have been specifically implicated in ketamine's anti-anhedonic effects. We emphasize the synergistic relationship between neuroimaging studies in humans and brain manipulations in animals to understand the causal relationship between changes in brain activity and therapeutic efficacy. We conclude with circuit-based perspectives on ketamine's action: first, related to ACC function in a central network mediating affective pain, and second, related to its role as the anterior node of the default mode network.
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Affiliation(s)
- Laith Alexander
- Department of Psychological Medicine, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; St Thomas' Hospital, London, United Kingdom.
| | - Luke A Jelen
- Department of Psychological Medicine, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mitul A Mehta
- Department of Psychological Medicine, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Allan H Young
- Department of Psychological Medicine, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Protective Effects of Xenon on Propofol-Induced Neurotoxicity in Human Neural Stem Cell-Derived Models. Mol Neurobiol 2020; 57:200-207. [PMID: 31578707 DOI: 10.1007/s12035-019-01769-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Early life exposure to general anesthetics can have neurotoxic consequences. Evidence indicates that xenon, a rare noble gas with anesthetic properties, may lessen neuronal damage under certain conditions. However, its potential neuroprotective properties, when used alone or in combination with other anesthetics, remain largely unknown. While it is difficult to verify the adverse effects of long duration anesthetic exposure in infants and children, the utilization of relevant non-clinical models (i.e., human-derived neural stem cells) may serve as a "bridging" model for evaluating the vulnerability of the nervous system. Neural stem cells, purchased from PhoenixSongs Biologicals, Inc., were guided to differentiate into neurons, astrocytes, and oligodendrocytes, which were then exposed to propofol (50 μM) for 16 h in the presence or absence of xenon (33%). Differentiation into cells of the neural lineage was confirmed by labelling with cell-specific markers, β-tubulin for neurons, glial fibrillary acidic protein (GFAP) for astrocytes, and galactocerebroside (GALC) for oligodendrocytes after 5 days of differentiation. The presence and severity of neural damage induced by anesthetic exposures were assessed by several methods, including the TUNEL assay, and immuno-histochemical measurements. Our data demonstrate that prolonged exposure to propofol results in a significant increase in the number of TUNEL-positive cells, indicating increased neural apoptosis. No significant changes were detected in the number of GFAP-positive astrocytes or GALC-positive oligodendrocytes. However, the number of β-tubulin-positive neurons was substantially reduced in the propofol-exposed cultures. Co-administration of xenon effectively blocked the propofol-induced neuronal damage/loss. No significant effects were observed when xenon was administered alone. The data indicate that prolonged exposure to propofol during development produces elevated levels of neuronal apoptosis in a human neural stem cell-derived model. However, sub-clinical, non-anesthetic concentrations of xenon, when used in combination with propofol, can prevent or ameliorate the toxic effects associated with prolonged anesthetic exposure. This is important as a more complete understanding of the neurotoxic mechanisms associated with a variety of clinically relevant anesthetic combinations becomes available. Protective approaches are critical for developing sound guidance on best practices for the use of these agents in the pediatric setting.
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Huntsman RJ, Strueby L, Bingham W. Are Ketamine Infusions a Viable Therapeutic Option for Refractory Neonatal Seizures? Pediatr Neurol 2020; 103:8-11. [PMID: 31601453 DOI: 10.1016/j.pediatrneurol.2019.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/22/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023]
Abstract
Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that works by binding to the phencyclidine-binding site, thereby blocking influx of cations through the NMDA receptor channel. The use of ketamine to treat refractory status epilepticus in adults and older children is well documented. Maturational changes in neonatal NMDA and γ-aminobutyric acid receptor expression and function make NMDA receptor antagonists, like ketamine, attractive potential therapeutic agents for treatment of refractory seizures in the newborn. However, descriptions of its use in this age group are limited to two case reports. Concerns regarding potential ketamine-mediated neurotoxicity in the immature brain require further investigation.
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Affiliation(s)
- Richard J Huntsman
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Lannae Strueby
- Division of Neonatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - William Bingham
- Division of Neonatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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6
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Wang C, Inselman A, Liu S, Liu F. Potential mechanisms for phencyclidine/ketamine-induced brain structural alterations and behavioral consequences. Neurotoxicology 2019; 76:213-219. [PMID: 31812709 DOI: 10.1016/j.neuro.2019.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/24/2019] [Accepted: 12/04/2019] [Indexed: 01/30/2023]
Abstract
Evidence of structural abnormalities in the nervous system of recreational drug [e.g., phencyclidine (PCP) or ketamine] users and/or preclinical animal research models suggests interference with the activity of multiple neurotransmitters, particularly glutamate neurotransmission. The damage to the central nervous system (CNS) may include neuronal loss, synaptic changes, disturbed neural network formation and reduced projections to subcortical fields. Notably, the reduced projections may considerably compromise the establishment of the subcortical areas, such as the nucleus accumbens located in the basal forebrain. With its abundant dopaminergic innervation, the nucleus accumbens is believed to be directly associated with addictive behaviors and mental disorders. This review seeks to delineate the relationship between PCP/ketamine-induced loss of cortical neurons and the reduced level of polysialic acid neural cell adhesion molecule (PSA-NCAM) in the striatum, and the likely changes in striatal synaptogenesis during development. The basic mechanism of how PSA-NCAM cell surface expression may be regulated will also be discussed, as well as the hypothesis that PSA-NCAM activity is critical to the regulation of synaptic protein expression. Overall, the present review will address the general hypothesis that damage/interruption of cortico-striatal communication and subcortical synaptogenesis could underlie the erratic/sensitization or addictive states produced by chronic or prolonged PCP/ketamine usage.
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Affiliation(s)
- Cheng Wang
- Division of Neurotoxicology, National Center for Toxicological Research/U.S. Food & Drug Administration, Jefferson, AR, United States.
| | - Amy Inselman
- Division of Systems Biology, National Center for Toxicological Research/U.S. Food & Drug Administration, Jefferson, AR, United States
| | - Shuliang Liu
- Division of Neurotoxicology, National Center for Toxicological Research/U.S. Food & Drug Administration, Jefferson, AR, United States
| | - Fang Liu
- Division of Neurotoxicology, National Center for Toxicological Research/U.S. Food & Drug Administration, Jefferson, AR, United States.
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Niu D, Wang L, Cui J, Zhou B, Yao L. Inhibition of long noncoding RNA BLACAT1 protects anesthesia-induced neural cytotoxicity in human induced pluripotent stem cells derived neurons. Eur J Pharmacol 2019; 865:172737. [DOI: 10.1016/j.ejphar.2019.172737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 12/16/2022]
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8
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Additive and subadditive antiallodynic interactions between μ-opioid agonists and N-methyl D-aspartate antagonists in male rhesus monkeys. Behav Pharmacol 2019; 29:41-52. [PMID: 29239974 DOI: 10.1097/fbp.0000000000000336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
μ-Opioid agonists are clinically effective analgesics, but also produce undesirable effects such as sedation and abuse potential that limit their clinical utility. Glutamatergic systems also modulate nociception and N-methyl D-aspartate (NMDA) receptor antagonists have been proposed as one useful adjunct to enhance the therapeutic effects and/or attenuate the undesirable effects of μ-opioid agonists. Whether NMDA antagonists enhance the antiallodynic effects of μ-agonists in preclinical models of thermal hypersensitivity (i.e. capsaicin-induced thermal allodynia) are unknown. The present study determined the behavioral effects of racemic ketamine, (+)-MK-801, (-)-nalbuphine, and (-)-oxycodone alone and in fixed proportion mixtures in assays of capsaicin-induced thermal allodynia and schedule-controlled responding in rhesus monkeys. Ketamine, nalbuphine, and oxycodone produced dose-dependent antiallodynia. MK-801 was inactive up to doses that produced undesirable effects. Ketamine, but not MK-801, enhanced the potency of μ-agonists to decrease rates of operant responding. Ketamine and nalbuphine interactions were additive in both procedures. Ketamine and oxycodone interactions were additive or subadditive depending on the mixture. Furthermore, oxycodone and MK-801 interactions were subadditive on antiallodynia and additive on rate suppression. These results do not support the broad clinical utility of NMDA receptor antagonists as adjuncts to μ-opioid agonists for thermal allodynic pain states.
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9
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Eustaquio T, Wang C, Dugard CK, George NI, Liu F, Slikker W, Paule MG, Howard PC, Paredes AM. Electron microscopy techniques employed to explore mitochondrial defects in the developing rat brain following ketamine treatment. Exp Cell Res 2018; 373:164-170. [PMID: 30342004 DOI: 10.1016/j.yexcr.2018.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 01/12/2023]
Abstract
Ketamine, an FDA-approved N-methyl-D-aspartate (NMDA) receptor antagonist, is commonly used for general pediatric anesthesia. Accumulating evidence has indicated that prolonged exposure to ketamine induces widespread apoptotic cell death in the developing brains of experimental animals. Although mitochondria are known to play a pivotal role in cell death, little is known about the alterations in mitochondrial ultrastructure that occur during ketamine-induced neurotoxicity. The objective of this pilot study was to utilize classic and contemporary methods in electron microscopy to study the impact of ketamine on the structure of mitochondria in the developing rat brain. While transmission electron microscopy (TEM) was employed to comprehensively study mitochondrial inner membrane topology, serial block-face scanning electron microscopy (SBF-SEM) was used as a complementary technique to compare the overall mitochondrial morphology from a representative treated and untreated neuron. In this study, postnatal day 7 (PND-7) Sprague-Dawley rats were treated with ketamine or saline (6 subcutaneous injections × 20 mg/kg or 10 ml/kg, respectively, at 2-h intervals with a 6-h withdrawal period after the last injection, n=6 each group). Samples from the frontal cortex were harvested and analyzed using TEM or SBF-SEM. While classic TEM revealed that repeated ketamine exposure induces significant mitochondrial swelling in neurons, the newer technique of SBF-SEM confirmed the mitochondrial swelling in three dimensions (3D) and showed that ketamine exposure may also induce mitochondrial fission, which was not observable in the two dimensions (2D) of TEM. Furthermore, 3D statistical analysis of these reconstructed mitochondria appeared to show that ketamine-treated mitochondria had significantly larger volumes per unit surface area than mitochondria from the untreated neuron. The ultrastructural mitochondrial alterations demonstrated here by TEM and SBF-SEM support ketamine's proposed mechanism of neurotoxicity in the developing rat brain.
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Affiliation(s)
- Trisha Eustaquio
- NCTR/ORA Nanotechnology Core Facility, Office of Scientific Coordination, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Cheng Wang
- Division of Neurotoxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Christopher K Dugard
- NCTR/ORA Nanotechnology Core Facility, Office of Scientific Coordination, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Nysia I George
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Fang Liu
- Division of Neurotoxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - William Slikker
- Office of the Center Director, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Merle G Paule
- Division of Neurotoxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Paul C Howard
- NCTR/ORA Nanotechnology Core Facility, Office of Scientific Coordination, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Angel M Paredes
- NCTR/ORA Nanotechnology Core Facility, Office of Scientific Coordination, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States.
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Wu ZG, Chen F, Wu H, Chen JX, Wei QT, Fu YQ, Lu X, Ye Y, Yan YY, Liao LC. Urinary metabonomics of rats with ketamine-induced cystitis using GC-MS spectroscopy. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:558-567. [PMID: 31938141 PMCID: PMC6958055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 12/27/2017] [Indexed: 06/10/2023]
Abstract
Ketamine abuse has dramatically increased in recently years. With the widely application of ketamine, its side effects, especially cystitis induced by long-term use, have attracted more and more attention from the public. In the present study, we aimed to explore the potential generative mechanism of ketamine-induced cystitis by determining the endogenous metabolites at different time points after ketamine treatment. Body weight, bladder/body coefficient, urinary frequency, urinary potassium, serum IL-6, and TNF-α were determined at different time points after ketamine treatment. H&E staining was used to observe the changes of histopathology. Metabonomics was performed to determine the changes of endogenous metabolites. After 12 weeks of treatment, obvious inflammatory reaction was noticed in the KET group; the body weight and urinary potassium of the KET group were significantly lower than the NS group (P < 0.05) and other factors, such as urinary frequency, bladder/body coefficient, serum TNF-α and IL-6 were higher than the NS group (P < 0.05). A total of 30, 28, and 32 significantly changed metabolites were identified at the 1st week, 4th week and 12th week, respectively. Metabolic pathway analysis showed that different metabolic pathways were affected during the treatment process. Linoleic acid metabolism, beta-alanine metabolism, glyoxylate and dicarboxylate metabolism were only affected following long-term administration of ketamine. Those metabolic pathways may have a close relationship with cystitis induced by ketamine.
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Affiliation(s)
- Zhi-Gui Wu
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan UniversityChengdu 610041, Sichuan, China
- Department of Pharmacy, Affiliated Hospital of Southwest Medical UniversityLuzhou, Sichuan, China
| | - Fan Chen
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan UniversityChengdu 610041, Sichuan, China
| | - Hao Wu
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan UniversityChengdu 610041, Sichuan, China
| | - Jian-Xia Chen
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan UniversityChengdu 610041, Sichuan, China
| | - Qing-Tao Wei
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan UniversityChengdu 610041, Sichuan, China
| | - Ying-Qiang Fu
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan UniversityChengdu 610041, Sichuan, China
| | - Xiang Lu
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan UniversityChengdu 610041, Sichuan, China
| | - Yi Ye
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan UniversityChengdu 610041, Sichuan, China
| | - You-Yi Yan
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan UniversityChengdu 610041, Sichuan, China
| | - Lin-Chuan Liao
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan UniversityChengdu 610041, Sichuan, China
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12
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Lu Y, Lei S, Wang N, Lu P, Li W, Zheng J, Giri PK, Lu H, Chen X, Zuo Z, Liu Y, Zhang P. Protective Effect of Minocycline Against Ketamine-Induced Injury in Neural Stem Cell: Involvement of PI3K/Akt and Gsk-3 Beta Pathway. Front Mol Neurosci 2016; 9:135. [PMID: 28066173 PMCID: PMC5167749 DOI: 10.3389/fnmol.2016.00135] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/22/2016] [Indexed: 01/14/2023] Open
Abstract
It has been suggested that ketamine cause injury during developing brain. Minocycline (MC) could prevent neuronal cell death through the activation of cell survival signals and the inhibition of apoptotic signals in models of neurodegenerative diseases. Here we investigated the protective effect of MC against ketamine-induced injury in neural stem cells (NSCs) from neonatal rat. Ketamine (100 μM/L) significantly inhibited NSC proliferation, promoted their differentiation into astrocytes and suppressed neuronal differentiation of NSCs. Moreover, the apoptotic level was increased following ketamine exposure. MC pretreatment greatly enhanced cell viability, decreased caspase-3-like activity, even reversed the differentiation changes caused by ketamine. To elucidate a possible mechanism of MC' neuroprotective effect, we investigated the phosphatidylinositol 3-kinase (PI3K) pathway using LY294002, a specific PI3K inhibitor. Immunoblotting revealed that MC enhanced the phosphorylation/activation of Akt and phosphorylation/inactivation of glycogen synthase kinase-3beta (Gsk-3β). Our results suggest that PI3K/Akt and Gsk-3β pathway are involved in the neuroprotective effect of MC.
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Affiliation(s)
- Yang Lu
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Shan Lei
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Ning Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Pan Lu
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Weisong Li
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Juan Zheng
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Praveen K Giri
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
| | - Haixia Lu
- Institute of Neurobiology, National Key Academic Subject of Physiology of Xi'an Jiaotong University Xi'an, China
| | - Xinlin Chen
- Institute of Neurobiology, National Key Academic Subject of Physiology of Xi'an Jiaotong University Xi'an, China
| | - Zhiyi Zuo
- Department of Anesthesiology, University of Virginia Charlottesville, VA, USA
| | - Yong Liu
- Institute of Neurobiology, National Key Academic Subject of Physiology of Xi'an Jiaotong University Xi'an, China
| | - Pengbo Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, China
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Lee EN, Lee JH. The Effects of Low-Dose Ketamine on Acute Pain in an Emergency Setting: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0165461. [PMID: 27788221 PMCID: PMC5082866 DOI: 10.1371/journal.pone.0165461] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 10/12/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Currently ketamine is not used often as an analgesic in the emergency department (ED). Nonetheless, it can increase the efficiency of opioids and decrease their side effects. The purpose of this systematic review and meta-analysis was to evaluate whether low-dose ketamine in the ED provides better analgesia with fewer adverse effects. METHODS The PubMed, EMBASE, and Cochrane Library databases were searched by two reviewers independently (last search performed on January 2016). Data were also extracted independently. RESULTS A total of 6 trials involving 438 patients were included in the current analysis. Our subgroup analysis of pain reduction indicates that the favorable effects of ketamine were similar or superior to those of placebo or opioids, although these effects were heterogeneous. However, low-dose ketamine was associated with a higher risk of neurological (relative risk [RR] = 2.17, 95% confidence interval [CI] = 1.37-3.42, P < 0.001) and psychological events (RR = 13.86, 95% CI = 4.85-39.58, P < 0.001). In contrast, the opioid group had a higher risk of major cardiopulmonary events (RR = 0.22, 95% CI = 0.05-1.01, P = 0.05). CONCLUSIONS The efficiency of ketamine varies depending on the pain site, but low-dose ketamine may be a key agent for pain control in the ED, as it has no side effects. It may also help to reduce the side effects of opioids.
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Affiliation(s)
- Eun Nam Lee
- Department of Nursing, Dong-A University, Daesin Gonwon-Ro, Seo-Gu, Busan, South Korea
| | - Jae Hoon Lee
- Department of Emergency Medicine, Dong-A university College of Medicine, Daesin Gonwon-Ro, Seo-Gu, Busan, South Korea
- * E-mail:
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Zhang YH, Zhang J, Song JN, Xu X, Cai JS, Zhou Y, Gao JG. The PI3K-AKT-mTOR pathway activates recovery from general anesthesia. Oncotarget 2016; 7:40939-40952. [PMID: 27340771 PMCID: PMC5173033 DOI: 10.18632/oncotarget.10172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/16/2016] [Indexed: 12/29/2022] Open
Abstract
We investigated roles of PI3K-AKT-mTOR pathway in recovery from general anesthesia. Sprague-Dawley rats divided into five groups: saline+artificial cerebrospinal fluid (ACSF; Group A), ketamine+ACSF (Group B), ketamine+IGF-1 (Group C), ketamine+PI3K inhibitor (Group D), and PI3K/Akt agonists (Group E). Proportion of δ waves on ECoGs was recorded. Rats were tested for duration of loss of righting reflex (LORR), ataxic period and behavior in Morris water maze. mRNA and protein expression of members of PI3K-AKT-mTOR pathway were measured by RT-qPCR and Western blots. Histopathologic changes in hippocampal tissues observed by HE staining. We found that the proportion of δ waves decreased in Group C, while increased in Group D compared with Group B; the durations of LORR and ataxic period were shorter in Group C, but longer in Group D. In Morris water maze, escape latency (EL) and duration and frequency of staying on platform was shorter in Group C and longer in Group D than in Group B. Group A exhibited low expression of proteins in PI3K-AKT-mTOR pathway, while p-AKT, p-mTOR and p-P70S6K expression increased in cerebral cortex, brain stem, and thalamus in Group C. By contrast, expression of those proteins was lower in Group D than Group B. Those proteins expressions were higher in Group E than in Group A. HE staining showed that anesthesia may induce cell apoptosis in rat hippocampal CA1 areas, and PI3K/Akt agonists could inhibit apoptosis. Our results suggest that activation of PI3K-AKT-mTOR pathway may promote recovery from general anesthesia and enhance spatial learning and memory.
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Affiliation(s)
- Yun-Hui Zhang
- Department of Anesthesia, the Second Hospital of Hebei Medical University, Shijiazhuang, P. R. China
| | - Jin Zhang
- Department of Anesthesia, Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, P. R. China
| | - Jian-Nan Song
- Department of Anesthesia, Chifeng Municipal Hospital, Chifeng, P. R. China
| | - Xue Xu
- Department of Anesthesia, the Second Hospital of Hebei Medical University, Shijiazhuang, P. R. China
| | - Jin-Song Cai
- Department of Anesthesia, the Second Hospital of Hebei Medical University, Shijiazhuang, P. R. China
| | - Yang Zhou
- Department of Anesthesia, Hebei Medical University, Shijiazhuang, P. R. China
| | - Jin-Gui Gao
- Department of Anesthesia, the Second Hospital of Hebei Medical University, Shijiazhuang, P. R. China
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15
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Zheng X, Zhou J, Xia Y. The role of TNF-α in regulating ketamine-induced hippocampal neurotoxicity. Arch Med Sci 2015; 11:1296-302. [PMID: 26788093 PMCID: PMC4697060 DOI: 10.5114/aoms.2015.56355] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 03/09/2014] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Ketamine is commonly used in pediatric anesthesia but recent studies have shown that it could induce neurotoxicity in the developing brain. The inflammatory cytokine, tumor necrosis factor α (TNF-α) is involved in the pathogenesis of various types of neurodegenerations. In the present study, we examined whether TNF-α may regulate ketamine-induced neurotoxicity in the hippocampus of neonatal mouse. MATERIAL AND METHODS The in vitro organotypic culture of hippocampal slices was used to investigate the gain-of-function and loss-of-function effect of TNF-α modulation on ketamine-induced hippocampal neurotoxicity. Also, western blotting analysis was used to examine the relative pathways associated with TNF-α modulation. In the in vivo Morris water maze test, TNF-α was genetically silenced to see if memory function was improved after anesthesia-induced memory impairment. RESULTS In in vitro experiments, adding TNF-α enhanced (112.99 ±5.4%, p = 0.015), whereas knocking down TNF-α ameliorated (46.8 ±11.6%, p = 0.003) ketamine-induced apoptosis in hippocampal CA1 neurons in the organotypic culture. Western blotting showed that addition of TNF-α reduced (67.1 ±3.7%, p = 0.022), whereas downregulation of TNF-α increased (126.87 ±8.5%, p = 0.004) the phosphorylation of PKC-ERK pathway in ketamine-treated hippocampus. In in vivo experiments, genetically silencing TNF-α markedly improved the ketamine-induced memory impairment through Morris water maze test. CONCLUSIONS Our results clearly demonstrated a protective mechanism of down-regulating TNF in ketamine-induced hippocampal neurotoxicity. This study may present a new target for pharmacological intervention to prevent anesthesia-related neurodegeneration in brain.
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Affiliation(s)
- Xiaozhu Zheng
- Department of Anesthesia, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Jiali Zhou
- Department of Anesthesia, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Yanfei Xia
- Department of Anesthesia, Zhejiang Hospital, Hangzhou, Zhejiang, China
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16
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Korpi ER, den Hollander B, Farooq U, Vashchinkina E, Rajkumar R, Nutt DJ, Hyytiä P, Dawe GS. Mechanisms of Action and Persistent Neuroplasticity by Drugs of Abuse. Pharmacol Rev 2015; 67:872-1004. [DOI: 10.1124/pr.115.010967] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Slikker W, Liu F, Rainosek SW, Patterson TA, Sadovova N, Hanig JP, Paule MG, Wang C. Ketamine-Induced Toxicity in Neurons Differentiated from Neural Stem Cells. Mol Neurobiol 2015; 52:959-69. [DOI: 10.1007/s12035-015-9248-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Indexed: 11/28/2022]
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Wang C, Liu F, Patterson TA, Paule MG, Slikker W. Anesthetic Drug-Induced Neurotoxicity and Compromised Neural Stem Cell Proliferation. ACTA ACUST UNITED AC 2015. [DOI: 10.4303/jdar/235905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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Johnson JW, Glasgow NG, Povysheva NV. Recent insights into the mode of action of memantine and ketamine. Curr Opin Pharmacol 2014; 20:54-63. [PMID: 25462293 DOI: 10.1016/j.coph.2014.11.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 01/21/2023]
Abstract
The clinical benefits of the glutamate receptor antagonists memantine and ketamine have helped sustain optimism that glutamate receptors represent viable targets for development of therapeutic drugs. Both memantine and ketamine antagonize N-methyl-D-aspartate receptors (NMDARs), a glutamate receptor subfamily, by blocking the receptor-associated ion channel. Although many of the basic characteristics of NMDAR inhibition by memantine and ketamine appear similar, their effects on humans and to a lesser extent on rodents are strongly divergent. Some recent research suggests that preferential inhibition by memantine and ketamine of distinct NMDAR subpopulations may contribute to the drugs' differential clinical effects. Here we review studies that shed light on possible explanations for differences between the effects of memantine and ketamine.
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Affiliation(s)
- Jon W Johnson
- Department of Neuroscience and Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15260, USA.
| | - Nathan G Glasgow
- Department of Neuroscience and Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Nadezhda V Povysheva
- Department of Neuroscience and Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15260, USA
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21
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Xu H, Zhang J, Zhou W, Feng Y, Teng S, Song X. The role of miR-124 in modulating hippocampal neurotoxicity induced by ketamine anesthesia. Int J Neurosci 2014; 125:213-20. [PMID: 24825585 DOI: 10.3109/00207454.2014.919915] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Ketamine is widely used in pediatric anesthesia. Recent studies have demonstrated that excessive application of ketamine leads to cortical neurodegeneration in neonatal brains. The present study aims to characterize the functional role of neuronal microRNA, miR-124, in regulating ketamine-induced neurotoxicity in mouse hippocampus. METHODS Real-time quantitative PCR (RT-PCR) was used to examine the effect of high-dosage ketamine on the expression of miR-124 in murine hippocampus in vitro. Downregulation of hippocampal miR-124 was achieved by lentivirual transfection, and its effects on protecting ketamine-induced hippocampal neurodegeneration were examined both in vitro and in vivo. RESULTS Hippocampal miR-124 was upregulated by ketamine treatment. Knocking down miR-124 in vitro reduced ketamine-induced apoptosis in hippocampal CA1 neurons, upregulated AMPA receptors phosphorylation and activated the protein kinase C/extracellular signal-regulated kinases (PKC/ERK) pathway. In the in vivo Morris water maze test, following ketamine-induced hippocampal neurodegeneration, mice subjected to hippocampal miR-124 inhibition showed improved memory performance. CONCLUSIONS Our study demonstrated that miR-124 played an important role in regulating ketamine-induced hippocampal neurodegeneration. Inhibiting miR-124 may provide a molecular target to improve memory performance in both human and animals suffering from overanesthetizing-related neurotoxicity.
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22
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Ding X, Jin S, Niu X, Wang T, Zhao X, Ren H, Tong Y, Li Q. Morphine with adjuvant ketamine versus higher dose of morphine alone for acute pain: a meta-analysis. Int J Clin Exp Med 2014; 7:2504-2510. [PMID: 25356103 PMCID: PMC4211753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/26/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE Ketamine is currently the N-methyl-D-aspartate receptor channel blocker in clinical use. Morphine in pain management is usually limited by adverse effect such as nausea and vomiting. Adjuvant treatment with ketamine may be value in giving better analgesia with fewer adverse effects. The purpose of this meta-analysis was to evaluate the differences when patients received morphine with adjuvant ketamine (MK) compared with higher dose of morphine (MO) for acute pain. METHODS The PubMed, EMBASE and the Cochrane Library databases were searched (Last search performed on July 1, 2014) by two reviewers independently. Data were extracted independently by the same two individuals who searched the studies. RESULTS A total of 7 trials involving 492 patients were included in the current analysis. We found pain scores were lower in the MK group compared to the MO group [MD 2.19, 95% CI (1.24, 3.13) P<0.00001]. And more patients in the MO required diclofenac [OR 1.97, 95% CI (1.06, 3.67) P=0.03]. Furthermore, morphine plus ketamine can reduced post-operative nausea and vomiting (PONV) [OR 3.71, 95% CI (2.37, 5.80) P<0.00001]. Importantly, the wakefulness scores for the MK group were consistently and significantly better than those for the MO group [MD -1.53, 95% CI (-2.67, -0.40) P=0.008]. CONCLUSION The use of ketamine plus 1/4~2/3 the dose of morphine is better than higher dose of morphine alone in reducing pain scores, and rescuing analgesic requirement. It also improved PONV and wakefulness.
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Affiliation(s)
- Xibing Ding
- Department of Anesthesiology, East Hospital, Tongji University School of MedicineShanghai, China
| | - Shuqing Jin
- Department of Anesthesiology, East Hospital, Tongji University School of MedicineShanghai, China
| | - Xiaoyin Niu
- Department of Anesthesiology, East Hospital, Tongji University School of MedicineShanghai, China
| | - Tingting Wang
- Department of Anesthesiology, Shanghai Huashan Hospital, Fudan University School of MedicineShanghai, China
| | - Xiang Zhao
- Department of Anesthesiology, East Hospital, Tongji University School of MedicineShanghai, China
| | - Hao Ren
- Department of Anesthesiology, East Hospital, Tongji University School of MedicineShanghai, China
| | - Yao Tong
- Department of Anesthesiology, East Hospital, Tongji University School of MedicineShanghai, China
| | - Quan Li
- Department of Anesthesiology, East Hospital, Tongji University School of MedicineShanghai, China
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Jiang XL, Du BX, Chen J, Liu L, Shao WB, Song J. MicroRNA-34a negatively regulates anesthesia-induced hippocampal apoptosis and memory impairment through FGFR1. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:6760-6767. [PMID: 25400756 PMCID: PMC4230107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/23/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Mounting evidence has shown the toxic effects of anesthesia to neonatal hippocampus. We used an in vivo mouse model to explore the role of microRNA 34a (miR-34a) in regulating anesthesia-induced hippocampal neurotoxicity. METHODS One-month old C57/BL6 mice received daily intraperitoneal injection of anesthesia (ketamine, 50 mg/kg) for 7 days. One day after, apoptosis was evaluated by TUNEL staining in hippocampal CA1 region, and expression level of miR-34a assessed by real-time quantitative PCR (qPCR). Hippocampal miR-34a was then down-regulated through lentivirus mediated cortical injection prior to anesthesia. The effects of inhibiting hippocampal miR-34a on anesthesia-induced hippocampal apoptosis and memory impairment were further investigated by TUNEL staining and Morris water maze (MWM) test. The predicted molecular target of miR-34a, fibroblast growth factor receptor 1 (FGFR1) was down-regulated in hippocampus through siRNA-mediated cortical injection and its effect on hippocampal apoptosis was also examined. RESULTS Anesthesia caused severe apoptosis among hippocampal CA1 neurons and upregulated hippocampal miR-34a. On the other hand, lentivirual inhibition of miR-34a protected anesthesia-induced hippocampal apoptosis and memory impairment. Luciferase essay demonstrated FGFR1 was directly regulated by miR-34a in hippocampus. siRNA-induced FGFR1 downregulation further exaggerated anesthesia-induced apoptosis in hippocampus. CONCLUSIONS Overall, we showed that miR-34a negatively modulated anesthesia-induced hippocampal neurotoxicity.
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MESH Headings
- Anesthetics, Dissociative/toxicity
- Animals
- Animals, Newborn
- Apoptosis/drug effects
- Behavior, Animal/drug effects
- CA1 Region, Hippocampal/drug effects
- CA1 Region, Hippocampal/metabolism
- CA1 Region, Hippocampal/pathology
- CA1 Region, Hippocampal/physiopathology
- Gene Expression Regulation
- Gene Transfer Techniques
- Ketamine/toxicity
- Maze Learning/drug effects
- Memory/drug effects
- Memory Disorders/chemically induced
- Memory Disorders/genetics
- Memory Disorders/metabolism
- Memory Disorders/pathology
- Memory Disorders/physiopathology
- Mice, Inbred C57BL
- MicroRNAs/genetics
- MicroRNAs/metabolism
- RNA Interference
- Receptor, Fibroblast Growth Factor, Type 1/drug effects
- Receptor, Fibroblast Growth Factor, Type 1/genetics
- Receptor, Fibroblast Growth Factor, Type 1/metabolism
- Signal Transduction/drug effects
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Affiliation(s)
- Xiu-Li Jiang
- Department of Anesthesiology, The Second Affiliated Hospital of Nantong UniversityNantong 226001, Jiangsu Province, China
| | - Bo-Xiang Du
- Department of Anesthesiology, The Second Affiliated Hospital of Nantong UniversityNantong 226001, Jiangsu Province, China
| | - Jie Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nantong UniversityNantong 226001, Jiangsu Province, China
| | - Lin Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Nantong UniversityNantong 226001, Jiangsu Province, China
| | - Wei-Bin Shao
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nantong UniversityNantong 226001, Jiangsu Province, China
| | - Jie Song
- Department of Anesthesiology, The Second Affiliated Hospital of Nantong UniversityNantong 226001, Jiangsu Province, China
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Liu F, Rainosek SW, Sadovova N, Fogle CM, Patterson TA, Hanig JP, Paule MG, Slikker W, Wang C. Protective effect of acetyl-l-carnitine on propofol-induced toxicity in embryonic neural stem cells. Neurotoxicology 2014; 42:49-57. [DOI: 10.1016/j.neuro.2014.03.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 03/21/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
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Cuevas E, Trickler WJ, Guo X, Ali SF, Paule MG, Kanungo J. Acetyl L-carnitine protects motor neurons and Rohon-Beard sensory neurons against ketamine-induced neurotoxicity in zebrafish embryos. Neurotoxicol Teratol 2013; 39:69-76. [PMID: 23896048 DOI: 10.1016/j.ntt.2013.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/15/2013] [Accepted: 07/16/2013] [Indexed: 12/13/2022]
Abstract
Ketamine, a non-competitive antagonist of N-methyl-D-aspartate (NMDA) type glutamate receptors is commonly used as a pediatric anesthetic. Multiple studies have shown ketamine to be neurotoxic, particularly when administered during the brain growth spurt. Previously, we have shown that ketamine is detrimental to motor neuron development in the zebrafish embryos. Here, using both wild type (WT) and transgenic (hb9:GFP) zebrafish embryos, we demonstrate that ketamine is neurotoxic to both motor and sensory neurons. Drug absorption studies showed that in the WT embryos, ketamine accumulation was approximately 0.4% of the original dose added to the exposure medium. The transgenic embryos express green fluorescent protein (GFP) localized in the motor neurons making them ideal for evaluating motor neuron development and toxicities in vivo. The hb9:GFP zebrafish embryos (28 h post fertilization) treated with 2 mM ketamine for 20 h demonstrated significant reductions in spinal motor neuron numbers, while co-treatment with acetyl L-carnitine proved to be neuroprotective. In whole mount immunohistochemical studies using WT embryos, a similar effect was observed for the primary sensory neurons. In the ketamine-treated WT embryos, the number of primary sensory Rohon-Beard (RB) neurons was significantly reduced compared to that in controls. However, acetyl L-carnitine co-treatment prevented ketamine-induced adverse effects on the RB neurons. These results suggest that acetyl L-carnitine protects both motor and sensory neurons from ketamine-induced neurotoxicity.
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Affiliation(s)
- Elvis Cuevas
- Division of Neurotoxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, USA
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Dorandeu F, Dhote F, Barbier L, Baccus B, Testylier G. Treatment of status epilepticus with ketamine, are we there yet? CNS Neurosci Ther 2013; 19:411-27. [PMID: 23601960 PMCID: PMC6493567 DOI: 10.1111/cns.12096] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 02/23/2013] [Accepted: 02/23/2013] [Indexed: 12/24/2022] Open
Abstract
Status epilepticus (SE), a neurological emergency both in adults and in children, could lead to brain damage and even death if untreated. Generalized convulsive SE (GCSE) is the most common and severe form, an example of which is that induced by organophosphorus nerve agents. First- and second-line pharmacotherapies are relatively consensual, but if seizures are still not controlled, there is currently no definitive data to guide the optimal choice of therapy. The medical community seems largely reluctant to use ketamine, a noncompetitive antagonist of the N-methyl-d-aspartate glutamate receptor. However, a review of the literature clearly shows that ketamine possesses, in preclinical studies, antiepileptic properties and provides neuroprotection. Clinical evidences are scarcer and more difficult to analyze, owing to a use in situations of polytherapy. In absence of existing or planned randomized clinical trials, the medical community should make up its mind from well-conducted preclinical studies performed on appropriate models. Although potentially active, ketamine has no real place for the treatment of isolated seizures, better accepted drugs being used. Its best usage should be during GCSE, but not waiting for SE to become totally refractory. Concerns about possible developmental neurotoxicity might limit its pediatric use for refractory SE.
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Affiliation(s)
- Frederic Dorandeu
- Département de Toxicologie et risques chimiques, Institut de Recherche Biomédicale des Armées - Centre de Recherches du Service de Santé des Armées (IRBA-CRSSA), La Tronche Cedex, France.
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