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Cellular targets of mefloquine. Toxicology 2021; 464:152995. [PMID: 34678321 DOI: 10.1016/j.tox.2021.152995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022]
Abstract
Mefloquine is a quinoline-based compound widely used as an antimalarial drug, particularly in chemoprophylaxis. Although decades of research have identified various aspects of mefloquine's anti-Plasmodium properties, toxic effects offset its robust use in humans. Mefloquine exerts harmful effects in several types of human cells by targeting many of the cellular lipids, proteins, and complexes, thereby blocking a number of downstream signaling cascades. In general, mefloquine modulates several cellular phenomena, such as alteration of membrane potential, induction of oxidative stress, imbalance of ion homeostasis, disruption of metabolism, failure of organelle function, etc., leading to cell cycle arrest and programmed cell death. This review aims to summarize the information on functional and mechanistic findings related to the cytotoxic effects of mefloquine.
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Martins AC, Paoliello MMB, Docea AO, Santamaria A, Tinkov AA, Skalny AV, Aschner M. Review of the mechanism underlying mefloquine-induced neurotoxicity. Crit Rev Toxicol 2021; 51:209-216. [PMID: 33905310 DOI: 10.1080/10408444.2021.1901258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mefloquine, a potent blood schizontocide, is effective against drug-resistant Plasmodium falciparum. This property, along with its unique pharmacokinetic profile, makes mefloquine a widely prescribed antimalarial drug. However, several epidemiological studies have raised concerns on the safety of mefloquine as prophylaxis for malaria. Well-documented side-effects of mefloquine include abnormal dreams, insomnia, anxiety, and depressed mood, as well as nausea and dizziness (the last two most frequent effects). The mechanisms that underlie the neurological/psychiatric complications of mefloquine are poorly understood. The aim of this study was to review the literature on the neurotoxic mechanisms of action of mefloquine to better understand its potential toxicity in the central nervous system, highlighting the mechanisms that lead to its psychiatric disorders. Experimental studies on the neurotoxic effects of mefloquine discussed herein include brain transporters of mefloquine, alteration in neurotransmitters, disruption on calcium (Ca2+) homeostasis and neuroinflammation, generation of oxidative stress response in neurons (involving glutathione, increased F2-isoprostanes, accumulation of cytosolic lipid globules), and alteration of voltage-dependent channels, as well as gap junction intercellular communications. Although several hypotheses have been proposed for the mechanisms that mediate mefloquine-induced brain damage, they are not fully understood, necessitating additional studies in the future.
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Affiliation(s)
- Airton C Martins
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Monica M B Paoliello
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anca O Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Abel Santamaria
- Laboratorio de Aminoacidos Excitadores, Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico
| | - Alexey A Tinkov
- I.M. Sechenov First, Moscow State Medical University (Sechenov University), Moscow, Russia.,KG Razumovsky Moscow State University of Technologies and Management, Moscow, Russia
| | - Anatoly V Skalny
- I.M. Sechenov First, Moscow State Medical University (Sechenov University), Moscow, Russia.,KG Razumovsky Moscow State University of Technologies and Management, Moscow, Russia
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, USA.,I.M. Sechenov First, Moscow State Medical University (Sechenov University), Moscow, Russia
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Pedrioli G, Patani R, Paganetti P. Chloroquine, the Coronavirus Crisis, and Neurodegeneration: A Perspective. Front Neurol 2020; 11:596528. [PMID: 33281734 PMCID: PMC7691290 DOI: 10.3389/fneur.2020.596528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
On the verge of the ongoing coronavirus pandemic, in vitro data suggested that chloroquine, and its analog hydroxychloroquine, may be useful in controlling SARS-CoV-2 infection. Efforts are ongoing in order to test this hypothesis in clinical trials. Some studies demonstrated no evidence of efficacy, whereas in some cases results were retracted after reporting. Despite the lack of scientific validation, support for the use of these compounds continues from various influencers. At the cellular level, the lysosomotropic drug chloroquine accumulates in acidic organelles where it acts as an alkalizing agent with possible downstream effects on several cellular pathways. In this perspective, we discuss a possible modulatory role of these drugs in two shared features of neurodegenerative diseases, the cellular accumulation of aberrantly folded proteins and the contribution of neuroinflammation in this pathogenic process. Certainly, the decision on the use of chloroquine must be determined by its efficacy in the specific clinical situation. However, at an unprecedented time of a potential widespread use of chloroquine, we seek to raise awareness of its potential impact in ongoing clinical trials evaluating disease-modifying therapies in neurodegeneration.
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Affiliation(s)
- Giona Pedrioli
- Neurodegeneration Research Group, Laboratory for Biomedical Neurosciences, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Torricella-Taverne, Switzerland.,International PhD Program of the Biozentrum, University of Basel, Basel, Switzerland
| | - Rickie Patani
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, London, United Kingdom.,The Francis Crick Institute, London, United Kingdom
| | - Paolo Paganetti
- Neurodegeneration Research Group, Laboratory for Biomedical Neurosciences, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Torricella-Taverne, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Ouachikh O, Hafidi A, Boucher Y, Dieb W. Electrical Synapses are Involved in Orofacial Neuropathic Pain. Neuroscience 2018; 382:69-79. [PMID: 29746991 DOI: 10.1016/j.neuroscience.2018.04.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/24/2018] [Accepted: 04/26/2018] [Indexed: 12/28/2022]
Abstract
Accumulated evidences suggest important roles of glial GAP-junctions in pain. However, only a few studies have explored the role of neuronal GAP-junctions or electrical synapses in neuropathic pain (NP). Therefore, the present study explores the role of connexin 36 (Cx36) in NP using the chronic constriction injury of the infraorbital nerve (CCI-IoN) model in rat. A significant increase in Cx36 labeling was observed in the medullary dorsal horn (MDH) of CCI-IoN-lesioned compared to sham rats. The expression of Cx36 in CCI-IoN-lesioned rats revealed a rostroventral gradient of punctuate labeling within lamina IIo of the MDH. Cx36-positive somata and processes were also observed in MDH laminae IIi and III-V. These somata were mostly of the Gamma aminobutyric acid (GABA) and occasionally Glycine transporter 2 (GlyT2) cell subtypes. Moreover the GABA cell subtypes are highly coupled in lamina IIo as revealed by the intense Cx36 staining in this lamina. Pharmacological Cx36 blockade by intracisternal administration of mefloquine decreased significantly the mechanical allodynia observed in CCI-IoN-lesioned rats. Altogether, our findings demonstrated that Cx36 play an important role in mechanical allodynia by coupling GABA cells. Increasing cell coupling by enhancing Cx36 expression favors neuropathic pain while disrupting this coupling alleviates it. This mechanism may constitute a novel target for the treatment of orofacial mechanical allodynia.
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Affiliation(s)
- Omar Ouachikh
- EA 7280 - Neuro-psycho-pharmacologie des systèmes dopaminergiques sous corticaux, Université Clermont Auvergne, Clermont-Ferrand 63000, France
| | - Aziz Hafidi
- EA 7280 - Neuro-psycho-pharmacologie des systèmes dopaminergiques sous corticaux, Université Clermont Auvergne, Clermont-Ferrand 63000, France.
| | - Yves Boucher
- Faculté d'odontologie (Garançière), Université Paris-Diderot, Paris, France; Hôpital Pitié-Salpétrière, AP-HP, Paris, France
| | - Wisam Dieb
- EA 7280 - Neuro-psycho-pharmacologie des systèmes dopaminergiques sous corticaux, Université Clermont Auvergne, Clermont-Ferrand 63000, France; Faculté d'odontologie (Garançière), Université Paris-Diderot, Paris, France; Hôpital Pitié-Salpétrière, AP-HP, Paris, France
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Abadie D, Essilini A, Fulda V, Gouraud A, Yéléhé-Okouma M, Micallef J, Montastruc F, Montastruc JL. Drug-induced panic attacks: Analysis of cases registered in the French pharmacovigilance database. J Psychiatr Res 2017; 90:60-66. [PMID: 28231495 DOI: 10.1016/j.jpsychires.2017.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 02/03/2017] [Accepted: 02/08/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The potential role of drugs in the onset of panic attacks (PAs) is poorly understood. AIM The objective of our study was to characterize drug-induced PAs. METHOD We performed an analysis of PAs registered in the French pharmacovigilance database between 01/01/1985 and 05/11/2014. RESULTS Among the 163 recorded cases, 136 (83.4%) were directly related to drugs, mainly antidepressants (11.3%, mainly serotonin reuptake inhibitors), mefloquine (7.2%), isotretinoin (5.2%), rimonabant (3.6%) and corticosteroids (4.7%). PAs are labelled in the Summary of Product Characteristics (SmPC) for a minority (8.6%) of these drugs. In 31.4% of these cases, withdrawal of the suspected drug was performed more than a week after the onset of PAs. PAs could also be secondary to another adverse drug reaction (ADR; n = 14, 8.6%), mainly an allergy to antineoplastic or immunomodulating agents. In 13 cases (8.0%), PAs occurred during a drug-withdrawal syndrome, mainly after benzodiazepines or opioids. Most cases (73%) involved patients without any previous psychiatric disorder. CONCLUSION This is the first pharmacoepidemiological study about iatrogenic PAs. Beside antidepressants, the most often encountered drugs are not indicated for psychiatric diseases. This study also reveals that iatrogenic PAs mostly occur in patients without any psychiatric medical history and that PAs can be triggered by another ADR. Lastly, the many cases with delayed management underline the need to raise awareness of this relatively unknown ADR among physicians, especially since PAs are generally not labelled in SmPCs of the suspected drugs.
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Affiliation(s)
- Delphine Abadie
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Faculty of Medicine, 37 allées Jules Guesde, 31000 Toulouse, France.
| | - Anaïs Essilini
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Faculty of Medicine, 37 allées Jules Guesde, 31000 Toulouse, France
| | - Virginie Fulda
- Regional Pharmacovigilance Center, Hôpital Européen Georges Pompidou, 20-40 rue Leblanc, 75015 Paris, France
| | - Aurore Gouraud
- Regional Pharmacovigilance Center, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424 Lyon, France
| | - Mélissa Yéléhé-Okouma
- Regional Pharmacovigilance Center, Hôpitaux de Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Joëlle Micallef
- Regional Pharmacovigilance Center, Department of Medical and Clinical Pharmacology, Hôpital Sainte-Marguerite AP-HM, 270 boulevard de Saint-Marguerite, 13009 Marseille, France
| | - François Montastruc
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Faculty of Medicine, 37 allées Jules Guesde, 31000 Toulouse, France
| | - Jean Louis Montastruc
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Faculty of Medicine, 37 allées Jules Guesde, 31000 Toulouse, France
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Paiz-Candia B, Islas AA, Sánchez-Solano A, Mancilla-Simbro C, Scior T, Millan-PerezPeña L, Salinas-Stefanon EM. Mefloquine inhibits voltage dependent Nav1.4 channel by overlapping the local anaesthetic binding site. Eur J Pharmacol 2017; 796:215-223. [DOI: 10.1016/j.ejphar.2017.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/21/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
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Neuropsychiatric Adverse Reactions to Mefloquine: a Systematic Comparison of Prescribing and Patient Safety Guidance in the US, UK, Ireland, Australia, New Zealand, and Canada. Neurol Ther 2016; 5:69-83. [PMID: 27240849 PMCID: PMC4919134 DOI: 10.1007/s40120-016-0045-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction The antimalarial drug mefloquine (MQ) is associated with neuropsychiatric adverse reactions, some of which may predict the development of more serious effects. Although prescribing guidance in the United States drug label (DL) recommends to discontinue MQ at the onset of neuropsychiatric symptoms, only certain reactions are listed in both the DL and the corresponding patient medication guide with a recommendation to discontinue or to consult a physician should they occur. To identify possible prodromal reactions for which there is complete or partial agreement in prescribing and patient recommendations, a systematic comparison of international drug safety labeling was performed. Methods The full text of each DL and medication guide (or equivalent) from six primarily English-speaking countries was reviewed to identify specific reactions with corresponding recommendations in drug safety labeling. Percentage agreement across the countries in corresponding recommendations was determined by MedDRA® high level group term (HLGT). Results Recommendations were found for reactions in 22 neuropsychiatric HLGTs. Complete or partial international agreement was found for reactions in 11 (50%) HLGTs. Conclusion This analysis suggests opportunities for physicians to improve patient counseling and for international drug regulators to clarify language in MQ safety labeling to reflect national risk–benefit considerations.
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