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Parveen B, Penumallu NR, Shaik AR, Parveen A, Parveen R, Vohora D. The impact of antiseizure medication on bone heath: A systematic review of animal studies. Epilepsy Res 2024; 200:107302. [PMID: 38280331 DOI: 10.1016/j.eplepsyres.2024.107302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/01/2023] [Accepted: 01/11/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Antiseizure medications (ASMs) are known to potentially impact bone health, but existing literature presents conflicting results regarding their specific effects on bone mineralization, metabolism, and quality. OBJECTIVE This systematic review aims to establish a consensus regarding the influence of ASMs on bone health based on existing preclinical studies. METHODS Following SYRCLE and PRISMA guidelines, we conducted a systematic search in PubMed, Science Direct, and Google Scholar to identify relevant studies. Ultimately, 21 articles were selected for inclusion in this review. RESULTS Among the chosen studies, approximately half involved Wistar rats as experimental subjects. Levetiracetam and sodium valproate were the most frequently investigated drugs, with a typical treatment duration of 10-12 weeks. These studies exhibited a low risk of bias in aspects like sequence generation, random housing, random outcome assessment, and reporting bias. However, blinding in performance, allocation concealment, and detection were often rated as having a high risk of bias. The collective findings suggest that prolonged ASM use leads to reduced bone mineral density, altered bone turnover marker levels (including hypovitaminosis D, hypocalcemia, and secondary hyperparathyroidism), deterioration of bone microarchitecture, and decreased mechanical strength. CONCLUSION The adverse effects on bone associated with ASMs are not limited to enzyme-inducing drugs, as newer generation ASMs may also contribute to these effects. Hypovitaminosis D alone may not be solely responsible for ASM-induced bone issues, suggesting the involvement of other mechanisms. Furthermore, substantial variations were observed in the results of different preclinical studies on individual ASMs, highlighting the need to standardize animal study methodologies to enhance reproducibility and reduce variation.
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Affiliation(s)
- Bushra Parveen
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India; Centre of Excellence in Unani Medicine (Pharmacognosy & Pharmacology), Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India.
| | - Naveen Reddy Penumallu
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India; Centre of Excellence in Unani Medicine (Pharmacognosy & Pharmacology), Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Abdul Rahaman Shaik
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Abida Parveen
- Centre of Excellence in Unani Medicine (Pharmacognosy & Pharmacology), Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Rabea Parveen
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Divya Vohora
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India.
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Kim KM, Son HE, Lim YJ, Jang WG. Topiramate promotes osteogenic differentiation through AMPK-dependent phosphorylation of Smad1/5/9. Acta Histochem 2023; 125:152095. [PMID: 37757516 DOI: 10.1016/j.acthis.2023.152095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 09/29/2023]
Abstract
Topiramate [2,3:4,5-bis-o-(1-methylethylidene) β-D-fructo-pyranose sulfamate; TPM] is one of the most used new-generation antiepileptic drugs. It has been reported to regulate the differentiation of human bone cells. However, the molecular mechanism of TPM in osteoblast differentiation is not fully elucidated. In the present study, we examined the effect of TPM on osteogenic differentiation of C3H10T1/2, MC3T3-E1, primary mouse calvarial cells, and primary bone marrow stem cells (BMSCs). Primary cells were isolated from mice calvaria and bone marrow respectively. Expression of the osteogenic gene was determined by RT-PCR. The osteogenic protein levels were measured by Western blot analysis. Alkaline phosphatase (ALP) staining experiment was performed to evaluate ALP activity. Alizarin red s (ARS) staining was performed to measure zebrafish caudal fin regeneration. Treatment of TPM up-regulated the osteogenic genes including distal-less homeobox 5 (Dlx5) and runt-related transcription factor 2 (Runx2). In addition, TPM also increased the Dlx5 and Runx2 protein levels, Smad1/5/9 phosphorylation, and alkaline phosphatase (ALP) activity. Furthermore, TPM activated AMPK, and inhibition of AMPK decreased TPM-induced osteogenic differentiation. In the zebrafish model, osteogenic effect of TPM was identified. TPM was increased amputated caudal fin rays of zebrafish. These results demonstrate that TPM enhances osteogenic differentiation via AMPK-mediated Smad1/5/9 phosphorylation.
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Affiliation(s)
- Kyeong-Min Kim
- Department of Biotechnology, School of Engineering, Daegu University, Gyeongbuk 38453, Republic of Korea; Research Institute of Anti-Aging, Daegu University, Gyeongbuk 38453, Republic of Korea
| | - Hyo-Eun Son
- Department of Biotechnology, School of Engineering, Daegu University, Gyeongbuk 38453, Republic of Korea; Research Institute of Anti-Aging, Daegu University, Gyeongbuk 38453, Republic of Korea
| | - Young-Ju Lim
- Department of Biotechnology, School of Engineering, Daegu University, Gyeongbuk 38453, Republic of Korea; Research Institute of Anti-Aging, Daegu University, Gyeongbuk 38453, Republic of Korea
| | - Won-Gu Jang
- Department of Biotechnology, School of Engineering, Daegu University, Gyeongbuk 38453, Republic of Korea; Research Institute of Anti-Aging, Daegu University, Gyeongbuk 38453, Republic of Korea.
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Reyes Fernandez PC, Wright CS, Masterson AN, Yi X, Tellman TV, Bonteanu A, Rust K, Noonan ML, White KE, Lewis KJ, Sankar U, Hum JM, Bix G, Wu D, Robling AG, Sardar R, Farach-Carson MC, Thompson WR. Gabapentin Disrupts Binding of Perlecan to the α 2δ 1 Voltage Sensitive Calcium Channel Subunit and Impairs Skeletal Mechanosensation. Biomolecules 2022; 12:biom12121857. [PMID: 36551284 PMCID: PMC9776037 DOI: 10.3390/biom12121857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/04/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Our understanding of how osteocytes, the principal mechanosensors within bone, sense and perceive force remains unclear. Previous work identified "tethering elements" (TEs) spanning the pericellular space of osteocytes and transmitting mechanical information into biochemical signals. While we identified the heparan sulfate proteoglycan perlecan (PLN) as a component of these TEs, PLN must attach to the cell surface to induce biochemical responses. As voltage-sensitive calcium channels (VSCCs) are critical for bone mechanotransduction, we hypothesized that PLN binds the extracellular α2δ1 subunit of VSCCs to couple the bone matrix to the osteocyte membrane. Here, we showed co-localization of PLN and α2δ1 along osteocyte dendritic processes. Additionally, we quantified the molecular interactions between α2δ1 and PLN domains and demonstrated for the first time that α2δ1 strongly associates with PLN via its domain III. Furthermore, α2δ1 is the binding site for the commonly used pain drug, gabapentin (GBP), which is associated with adverse skeletal effects when used chronically. We found that GBP disrupts PLN::α2δ1 binding in vitro, and GBP treatment in vivo results in impaired bone mechanosensation. Our work identified a novel mechanosensory complex within osteocytes composed of PLN and α2δ1, necessary for bone force transmission and sensitive to the drug GBP.
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Affiliation(s)
- Perla C. Reyes Fernandez
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - Christian S. Wright
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - Adrianna N. Masterson
- Department of Chemistry and Chemical Biology, School of Science, Indiana University, Indianapolis, IN 46202, USA
| | - Xin Yi
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - Tristen V. Tellman
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA
| | - Andrei Bonteanu
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA
- Department of Bioengineering, George R. Brown School of Engineering, Rice University, Houston, TX 77005, USA
| | - Katie Rust
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - Megan L. Noonan
- Department of Medical and Molecular Genetics, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Kenneth E. White
- Department of Medical and Molecular Genetics, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Karl J. Lewis
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Uma Sankar
- Department of Anatomy, Cell Biology and Physiology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Julia M. Hum
- Division of Biomedical Science, College of Osteopathic Medicine, Marian University, Indianapolis, IN 46222, USA
| | - Gregory Bix
- Departments of Neurosurgery and Neurology, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Danielle Wu
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA
- Department of Bioengineering, George R. Brown School of Engineering, Rice University, Houston, TX 77005, USA
| | - Alexander G. Robling
- Department of Anatomy, Cell Biology and Physiology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Rajesh Sardar
- Department of Chemistry and Chemical Biology, School of Science, Indiana University, Indianapolis, IN 46202, USA
| | - Mary C. Farach-Carson
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA
- Department of Bioengineering, George R. Brown School of Engineering, Rice University, Houston, TX 77005, USA
| | - William R. Thompson
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN 46202, USA
- Department of Anatomy, Cell Biology and Physiology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
- Division of Biomedical Science, College of Osteopathic Medicine, Marian University, Indianapolis, IN 46222, USA
- Correspondence:
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Reyes Fernandez PC, Wright CS, Warden SJ, Hum J, Farach-Carson MC, Thompson WR. Effects of Gabapentin and Pregabalin on Calcium Homeostasis: Implications for Physical Rehabilitation of Musculoskeletal Tissues. Curr Osteoporos Rep 2022; 20:365-378. [PMID: 36149592 PMCID: PMC10108402 DOI: 10.1007/s11914-022-00750-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW In this review, we discuss the mechanism of action of gabapentinoids and the potential consequences of long-term treatment with these drugs on the musculoskeletal system. RECENT FINDINGS Gabapentinoids, such as gabapentin (GBP) and pregabalin (PGB) were designed as antiepileptic reagents and are now commonly used as first-line treatment for neuropathic pain and increasingly prescribed off-label for other pain disorders such as migraines and back pain. GBP and PGB exert their analgesic actions by selectively binding the α2δ1 auxiliary subunit of voltage-sensitive calcium channels, thereby inhibiting channel function. Numerous tissues express the α2δ1 subunit where GBP and PGB can alter calcium-mediated signaling events. In tissues such as bone, muscle, and cartilage, α2δ1 has important roles in skeletal formation, mechanosensation, and normal tissue function/repair that may be affected by chronic use of gabapentinoids. Long-term use of gabapentinoids is associated with detrimental musculoskeletal outcomes, including increased fracture risk. Therefore, understanding potential complications is essential for clinicians to guide appropriate treatments.
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Affiliation(s)
- Perla C Reyes Fernandez
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, 46202, USA
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, 46202, USA
| | - Christian S Wright
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, 46202, USA
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, 46202, USA
| | - Stuart J Warden
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, 46202, USA
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, 46202, USA
| | - Julia Hum
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, 46202, USA
- College of Osteopathic Medicine, Marian University, Indianapolis, IN, 4622, USA
| | - Mary C Farach-Carson
- Department of Diagnostic & Biomedical Sciences, University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, 77054, USA
| | - William R Thompson
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, 46202, USA.
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, 46202, USA.
- College of Osteopathic Medicine, Marian University, Indianapolis, IN, 4622, USA.
- Department of Anatomy and Cell Biology, Indiana University, Indianapolis, IN, 46202, USA.
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Li X, Wang Q, Zhang D, Wu D, Liu N, Chen T. Effects of long-term administration of Q808 on hippocampal transcriptome in healthy rats. Chem Pharm Bull (Tokyo) 2022; 70:642-649. [PMID: 35831127 DOI: 10.1248/cpb.c22-00357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Epilepsy treatment with antiepileptic drugs (AEDs) is usually requires for many years. Q808 is an innovative antiepileptic chemical. It exerts effective antiepileptic effect against various epilepsy models. Exploring the gene transcriptomic profile of long-term treatment of Q808 is necessary. In the present study, hippocampus RNA-sequencing was performed to reveal the transcriptome profile of rats before and after treatment of Q808 for 28 days. Results confirmed 51 differentially expressed genes (DEGs) between Q808 and healthy control groups. Gene cluster analysis showed that most upregulated DEGs linked to response to drug and nucleus, most downregulated DEGs linked to locomotory, neuronal cell body, and drug binding. Most of DEGs were enriched in the signaling transduction, substance dependence, nervous system, and neurodegenerative disease pathways. Furthermore, quantitative real-time PCR analysis confirmed that Q808 significantly increased the expression of neuroprotective genes, such as Mdk, and decreased the mRNA levels of Penk, Drd1, and Adora2a, which are highly expressed in epilepsy models. In addition, Q808 decreased the mRNA expression of Pde10A and Drd2, which are known to be closely associated with schizophrenia. Our study may provide a theoretical basis to explore the effect of Q808 on the susceptibility to epilepsy and other neurological diseases.
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Affiliation(s)
- Xiang Li
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University
| | - Qing Wang
- Jilin Provincial Academy of Traditional Chinese Medicine
| | - Dianwen Zhang
- Jilin Provincial Academy of Traditional Chinese Medicine
| | - Di Wu
- Jilin Provincial Academy of Traditional Chinese Medicine
| | - Ning Liu
- Jilin Provincial Academy of Traditional Chinese Medicine
| | - Tianli Chen
- School of Pharmacy, Changchun University of Chinese Medicine
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Cheng J, Zhong WL, Zhao JW, Zhai JH, Chen C, Chao AJ, Ren Z, Zhou L, Wang BM. Alterations in the composition of the gut microbiota affect absorption of cholecalciferol in severe osteoporosis. J Bone Miner Metab 2022; 40:478-486. [PMID: 35103840 DOI: 10.1007/s00774-021-01303-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION To evaluate the relationship between the gut microbial composition and intestinal cholecalciferol absorption in patients with severe osteoporosis (SOP). MATERIALS AND METHODS Eighteen patients with primary osteoporosis (OP) and 18 with SOP were included. Their clinical data were collected and their circulating concentrations of cholecalciferol and 25(OH)D3 were measured. Fecal samples were collected and their microbial contents were analyzed using 16S rDNA sequencing. RESULTS The age, sex, body mass index, and body mass of the participants did not differ between the groups. The prevalence of gastrointestinal symptoms in the participants with SOP was significantly higher than that in the participants with OP. There were significant differences in the 25(OH)D3 and cholecalciferol concentrations between participants with SOP or OP and there was a significant positive correlation between the concentrations of these substance. The diversity of the gut microbiota in participants with SOP was significantly higher than that in participants with OP. Firmicutes was more abundant in the SOP group and the ratio of Firmicutes/Bacteroidetes in participants with SOP was higher. Conversely, Bifidobacterium was significantly less abundant, as were the order and family it belongs to. At the species level, Bifidobacterium was the most significant difference between the two groups. CONCLUSION Differences in the intestinal microecology, especially Bifidobacterium, are associated with differences in the absorption of cholecalciferol and in the circulating 25(OH)D3 concentration, which may influence the progression of OP to SOP.
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Affiliation(s)
- Jing Cheng
- Gastroenterology Department, Tianjin Medical University General Hospital, Tianjin, China
- Department of Orthointernal, Tianjin Hospital, Tianjin, China
| | - Wei-Long Zhong
- Gastroenterology Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Jing-Wen Zhao
- Gastroenterology Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Jian-Hua Zhai
- Gastroenterology Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Chen Chen
- Gastroenterology Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Ai-Jun Chao
- Department of Orthointernal, Tianjin Hospital, Tianjin, China
| | - Zhe Ren
- Department of Orthointernal, Tianjin Hospital, Tianjin, China
| | - Lu Zhou
- Gastroenterology Department, Tianjin Medical University General Hospital, Tianjin, China.
| | - Bang-Mao Wang
- Gastroenterology Department, Tianjin Medical University General Hospital, Tianjin, China.
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Akin B, Kelle B, Kozanoglu E. The Effect of Pregabalin on Bone Metabolism. J Clin Densitom 2022; 25:223-229. [PMID: 34120834 DOI: 10.1016/j.jocd.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 12/26/2022]
Abstract
The aim of the study was to determine the effect of pregabalin as monotherapy on biochemical markers and bone mineral density. 40 patients diagnosed with neuropathic pain or fibromyalgia syndrome who were using pregabalin for at least 6 months and age and sex matched 40 healthy individuals were recruited for this cross-sectional study. Bone mineral density of both groups were measured by dual energy x ray absorbsiometry(DXA), bone biochemical markers, serum calcium, and vitamin D levels were investigated. Association between pregabalin use and bone biochemical markers, serum calcium, vitamin D levels were evaluated. The mean age of 40 patients (27 females, 13 males) was 40.6 ± 7.1 years and the mean age of 40 healthy individuals (27 females, 13 males) was 40.4 ± 7.3 years. The other demographic data were similar. There were no significant differences in lumbar and femur neck BMD scores between 2 groups. Also, there were no associations neither between pregabalin use and biochemical markers including serum calcium levels nor between pregabalin use and vitamin D levels. However, the patients who had been used pregabalin less than 24 months had low lumbar t and z scores than patients who had been used pregabalin more than 24 months. This effect was more prominent in male patients. Although no negative effect of pregabalin was found on bone metabolism in these group of patients, we have suggested that further prospective controlled studies with large sample size in different age groups could provide new data about the effects of pregabalin on bone metabolism. We suggest to investigate the bone metabolism especially in male patients on pregabalin treatment who had been used pregabalin treatment less than 24 months.
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Affiliation(s)
| | - Bayram Kelle
- Department of Physical Medicine and Rehabilitation, Cukurova University Faculty of Medicine, Adana, Turkey.
| | - Erkan Kozanoglu
- Department of Physical Medicine and Rehabilitation, Cukurova University Faculty of Medicine, Adana, Turkey
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Whitney DG, Kalia V, Rajapakse CS, Fedak Romanowski EM, Caird MS, Hurvitz EA, Jepsen KJ. The effect of age when initiating anti-seizure medication therapy on fragility fracture risk for children with epilepsy. Bone 2021; 149:115996. [PMID: 33962082 DOI: 10.1016/j.bone.2021.115996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anti-seizure medication (ASM) is necessary to manage epilepsy and often prescribed to children and adolescents, but can lead to iatrogenic effects, including bone fragility by altering bone metabolism. Disrupting bone metabolism during crucial developmental stages could have a lasting adverse effect on bone health. Therefore, the objective of this propensity score-matched, observational cohort study was to determine if age when initiating ASM therapy across developmental stages (from pre- to post-puberty) for individuals with epilepsy was associated with an increased risk of fragility fracture. METHODS Data from 01/01/2011 to 12/31/2018 were extracted from Optum Clinformatics® Data Mart. Children aged 4-21 years at baseline with at least 5 years of continuous health plan enrollment were included to allow for a 1-year baseline and 4-years of follow-up. The primary group of interest included new ASM users (i.e., treatment naïve) with epilepsy. The comparison group, no ASM users without epilepsy, was matched 1:14 to new ASM users with epilepsy for demographics and baseline fracture. To provide a proxy for developmental stages, age was categorized as 4-6 (pre-puberty), 7-10 (early puberty), 11-13 (mid-puberty), 14-17 (late puberty), and 18-21 (post-puberty). Crude incidence rate (IR; per 1000 person years) and IR ratio (IRR and 95% confidence intervals [CI]) were estimated for non-trauma fracture (NTFx) for up to 4-years of follow-up. RESULTS Prior to stratifying by age group, the crude NTFx IR (95% CI) of 20.6 (16.5-24.8) for new ASM users with epilepsy (n = 1205) was 34% higher (IRR = 1.34; 95% CI = 1.09-1.66) than the crude NTFx IR (95% CI) of 15.4 (14.4-16.3) for no ASM users without epilepsy. The groups exhibited a different pattern of NTFx incidence with age, with new ASM users showing a more dramatic increase and peaking at 11-13 years, then decreasing with the older age groups. The crude IR and IRR were elevated for new ASM users with epilepsy compared to no ASM users without epilepsy for each age group (10% to 55% higher), but was only statistically significant for 11-13 years (IRR = 1.55; 95% CI = 1.02-2.36). CONCLUSIONS Children with epilepsy initiating ASM therapy may be vulnerable to fragility fracture, especially when initiating ASM around the time of puberty. Clinicians should be aware of this age-related association and consider age-appropriate adjunct bone fragility therapies.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Vivek Kalia
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Chamith S Rajapakse
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Erin M Fedak Romanowski
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Michelle S Caird
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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Matuszewska A, Nowak B, Nikodem A, Merwid-Ląd A, Wiatrak B, Tomkalski T, Jędrzejuk D, Szeląg E, Sozański T, Danielewski M, Jawień P, Ceremuga I, Szandruk-Bender M, Bolanowski M, Filipiak J, Szeląg A. Antiepileptic Stiripentol May Influence Bones. Int J Mol Sci 2021; 22:7162. [PMID: 34281215 PMCID: PMC8269345 DOI: 10.3390/ijms22137162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 12/12/2022] Open
Abstract
Bone structure abnormalities are increasingly observed in patients chronically treated with antiepileptic drugs (AEDs). The majority of the available data concern older conventional AEDs, while the amount of information regarding newer AEDs, including stiripentol, is limited. The aim of the study was to assess the effect of stiripentol on bones. For 24 weeks, male Wistar rats, received 0.9% sodium chloride (control group) or stiripentol (200 mg/kg/day) (STP group). In the 16th week of the study, we detected lower serum PINP levels in the STP group compared to the control group. In the 24th week, a statistically significant lower 1,25-dihydroxyvitamin D3 level, higher inorganic phosphate level and higher neutrophil gelatinase-associated lipocalin (NGAL) levels in serum were found in the STP group compared to the control. Micro X-ray computed tomography of the tibias demonstrated lower bone volume fraction, lower trabecular thickness, higher trabecular pattern factor and a higher structure model index in the stiripentol group. Considering the results of this experiment on rats which suggests that long-term administration of stiripentol may impair the cancellous bone microarchitecture, further prospective human studies seem to be justified. However, monitoring plasma vitamin D, calcium, inorganic phosphate and kidney function in patients on long-term stiripentol therapy may be suggested.
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Affiliation(s)
- Agnieszka Matuszewska
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Beata Nowak
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Anna Nikodem
- Department of Mechanics, Materials and Biomedical Engineering, Wroclaw University of Science and Technology, ul. Ignacego Łukasiewicza 7/9, 50-371 Wrocław, Poland; (A.N.); (J.F.)
| | - Anna Merwid-Ląd
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Benita Wiatrak
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Tomasz Tomkalski
- Department of Endocrinology, Diabetology and Internal Medicine, Tadeusz Marciniak Lower Silesia Specialist Hospital—Centre for Medical Emergency, ul. Gen. Augusta Emila Fieldorfa 2, 54-049 Wrocław, Poland;
| | - Diana Jędrzejuk
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, wyb. Ludwika Pasteura 4, 50-367 Wrocław, Poland; (D.J.); (M.B.)
| | - Ewa Szeląg
- Department of Maxillofacial Orthopedics and Orthodontics Institute, Wroclaw University of Science and Technology, ul. Krakowska 26, 50-425 Wrocław, Poland;
| | - Tomasz Sozański
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Maciej Danielewski
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Paulina Jawień
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Ireneusz Ceremuga
- Department of Medical Biochemistry, Wroclaw Medical University, ul. Tytusa Chałubińskiego 10, 50-368 Wrocław, Poland;
| | - Marta Szandruk-Bender
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, wyb. Ludwika Pasteura 4, 50-367 Wrocław, Poland; (D.J.); (M.B.)
| | - Jarosław Filipiak
- Department of Mechanics, Materials and Biomedical Engineering, Wroclaw University of Science and Technology, ul. Ignacego Łukasiewicza 7/9, 50-371 Wrocław, Poland; (A.N.); (J.F.)
| | - Adam Szeląg
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
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Wang M, Liu J. Study on the Antiepileptic Effect of Brain Targeting Electric Field on Nano Hydrogel and miR-181. JOURNAL OF NANOSCIENCE AND NANOTECHNOLOGY 2021; 21:1018-1024. [PMID: 33183438 DOI: 10.1166/jnn.2021.18673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Epilepsy, as a kind of neurological disease, is harmful to human mental health. There are many problems in the corresponding drugs and treatment methods, such as poor targeting, side effects and drug resistance. The conventional treatment of epilepsy is mainly focused on its corresponding electrophysiological mechanism to limit the discharge of epileptic focus. However, in the clinical and experimental observation process, this method finds that its corresponding target and direction are easily interfered, and its targeting shows poor directionality. Therefore, based on this, this paper will fully combine the electrophysiological mechanism of epilepsy and brain targeting technology, fully analyze the correlation between miR-181 and epilepsy and other nervous system diseases, and construct the epilepsy cell model to provide new ideas for the target and direction. Finally, we will construct a nanoscale hydrogel targeting the electric field, which can rapidly suppress the discharge and release the therapeutic drugs in epileptic seizures, so as to achieve effective treatment for epilepsy. The experimental results show that the new targeting technology proposed in this paper has obvious effect on the treatment of epilepsy.
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Affiliation(s)
- Min Wang
- Department of Neurology, The Second Hospital of Shandong University, Jinan, 250033, Shandong, China
| | - Jianguo Liu
- Department of Neurology, The Sixth Medical Center, PLA General Hospital, Beijing 100048, China
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Guo Y, Lin Z, Huang Y, Yu L. Effects of valproate, lamotrigine, and levetiracetam monotherapy on bone health in newly diagnosed adult patients with epilepsy. Epilepsy Behav 2020; 113:107489. [PMID: 33220583 DOI: 10.1016/j.yebeh.2020.107489] [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: 07/01/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects of valproate (VPA), lamotrigine (LTG), and levetiracetam (LEV) on bone turnover and bone mineral density (BMD) in newly diagnosed adult patients with epilepsy. METHODS Eligible adult patients who were newly diagnosed with epilepsy were treated with VPA, LTG, and LEV. The chemical indicators of bone metabolism and BMD were measured before treatment and 2 years after treatment with different antiseizure medication (ASM) monotherapies. Then, the differences in these parameters before and after treatment were analyzed. RESULTS One hundred twenty-four patients completed the 2 years follow-up; 43 received monotherapy with VPA, 32 received LTG, and 49 received LEV. Serum parathyroid hormone (PTH), bone alkaline phosphatase (B-ALP), and β-cross-linked C-telopeptide of type I collagen (β-CTX) levels were elevated in adult patients after 2 years of VPA administration; the serum procollagen I intact N-terminal peptide (PINP) level was noticeably higher in patients after LEV treatment than before treatment. Meanwhile, the BMD of the lumbar spine and femoral neck did not change in patients treated with VPA, LTG, and LEV. CONCLUSIONS Valproate altered bone turnover in adult patients with epilepsy, while LTG and LEV did not exert harmful effects on bone health in adult patients.
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Affiliation(s)
- Yi Guo
- Department of Neurology, The Sixth People's Hospital of Chengdu, No. 16 South Jianshe Road, Chengdu, Sichuan 610051, People's Republic of China
| | - Zhonghua Lin
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32# W. Sec 2, 1st Ring Rd, Chengdu, Sichuan 610072, People's Republic of China
| | - Yulan Huang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32# W. Sec 2, 1st Ring Rd, Chengdu, Sichuan 610072, People's Republic of China.
| | - Liang Yu
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32# W. Sec 2, 1st Ring Rd, Chengdu, Sichuan 610072, People's Republic of China.
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12
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Xu Z, Xie Z, Sun J, Huang S, Chen Y, Li C, Sun X, Xia B, Tian L, Guo C, Li F, Pi G. Gut Microbiome Reveals Specific Dysbiosis in Primary Osteoporosis. Front Cell Infect Microbiol 2020; 10:160. [PMID: 32373553 PMCID: PMC7186314 DOI: 10.3389/fcimb.2020.00160] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/25/2020] [Indexed: 12/14/2022] Open
Abstract
Object: Primary osteoporosis (PO) is the most common bone disease, which is characterized by decreased bone mass, damage of bone tissue microstructure, increased bone fragility, and is prone to fracture. Gut microbiome may be involved in bone metabolism of PO through gut-brain axis regulation of immune system and endocrine system, however, the specific mechanism is still unclear. The purpose of this study was to characterize the gut microbiome of patients with PO and its possible role in the occurrence and development of the disease. Methods: Fecal samples were collected from 48 PO patients and 48 healthy controls (HC). The composition of gut microbiome community was analyzed by 16s rDNA amplification sequencing, and the difference of gut microbiome composition between PO patients and HC individuals was compared. PICRUSt was also used to predict the biological function of gut microbiome in patients with PO, and to explore its possible role in the occurrence and development of this disease. The classification model is constructed by random forest algorithm so as to screen the key biomarkers. Result: The diversity of gut microorganisms in PO patients was significantly higher than that in HC group (p < 0.05) and there was significant difference in microbial composition in PO group. The abundance of Dialister (0.036 vs. 0.004, p < 0.001) and Faecalibacterium (0.331 vs. 0.132, p < 0.001) were significantly enriched which were the key flora related to PO. Although no significant correlation between bone mineral density and the richness of microbial communities are found, PICRUST results show that there are a wide range of potential pathways between gut microbiome and PO patients, including genetic information processing, metabolism, environmental information processing, cellular processes, human diseases, and organic systems. Notably, the discriminant model based on dominant microflora can effectively distinguish PO from HC (AUC = 93.56). Conclusions: The findings show that PO is related to the change of gut microbiome, especially the enriched Dialister and Faecalibacterium genera, which give new clues to understand the disease and provide markers for the diagnosis and new strategies for intervention treatment of the disease.
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Affiliation(s)
- Zhiming Xu
- Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Zheng Xie
- Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Jianguang Sun
- Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Shilei Huang
- Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yangyang Chen
- Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Chengxiang Li
- Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xing Sun
- Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Bicheng Xia
- Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Lingyang Tian
- Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Caijuan Guo
- Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Feng Li
- Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Guofu Pi
- Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
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Effects of carbamazepine, eslicarbazepine, valproic acid and levetiracetam on bone microarchitecture in rats. Pharmacol Rep 2020; 72:1323-1333. [DOI: 10.1007/s43440-020-00087-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/24/2020] [Accepted: 03/09/2020] [Indexed: 12/28/2022]
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Simko J, Karesova I, Kremlacek J, Eva Z, Horacek J, Fekete S, Malakova J, Zivna H, Palicka V. The effect of gabapentin and pregabalin on bone turnover and bone strength: A prospective study in Wistar rats. Pharmacol Rep 2019; 71:1213-1218. [PMID: 31669885 DOI: 10.1016/j.pharep.2019.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/31/2019] [Accepted: 08/13/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are limited data on the effects of GBP on bone and no data for PGB. Some data suggest that there is a significant influence of sex hormone balance on the susceptibility of bone to antiepileptic drug-induced bone loss. METHODS Forty-eight male Wistar rats were divided into six groups that were subjected to two surgeries, sham (noORX) or real orchidectomy (ORX), and were fed three diets, a SLD, a SLD enriched with GBP or a SLD enriched with PGB. Dual energy X-ray absorptiometry was used to measure the bone mineral density. The concentrations of bone turnover markers were assayed. The femurs were biomechanically tested. RESULTS Significant reductions in bone mineral density, weight and biomechanical strength were observed in ORX animals. GBP or PGB exposure did not cause significant alterations in bone mineral density or biomechanical strength. No changes in bone turnover markers were observed, except for RANKL. A significant increase was found in the ORX GBP and ORX PGB groups. Within the orchidectomized animal group, RANKL levels were significantly higher in the ORX PGB group than in the ORX GBP group. CONCLUSIONS Because neither GBP nor PGB affected bone mineral density or mechanical bone strength, both of these antiepileptic drugs could be considered drugs with lower risks to bone health. A shift in RANKL levels indicates that the effects of GBP and PGB on osteoclast activity may be dependent on the hormonal status of animals.
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Affiliation(s)
- Julius Simko
- Department of Neurology, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic.
| | - Iva Karesova
- Institute of Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Jan Kremlacek
- Department of Pathophysiology, Charles University, Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Zimcikova Eva
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Jiri Horacek
- Department of Internal Medicine - Hematology, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Sona Fekete
- Institute of Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Jana Malakova
- Institute of Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Helena Zivna
- Radioisotope Laboratories and Vivarium, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Vladimir Palicka
- Institute of Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
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Effects of pregabalin on spinal fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:332-339. [DOI: 10.1007/s00586-019-06226-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 08/21/2019] [Accepted: 11/16/2019] [Indexed: 01/09/2023]
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Miziak B, Chrościńska-Krawczyk M, Czuczwar SJ. An update on the problem of osteoporosis in people with epilepsy taking antiepileptic drugs. Expert Opin Drug Saf 2019; 18:679-689. [PMID: 31159612 DOI: 10.1080/14740338.2019.1625887] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Antiepileptic drugs (AEDs) have been associated with a negative impact on bone health. Comorbid disorders in patients with epilepsy may require drugs exerting a pro-osteoporotic effect, so a possibility of untoward interactions with AEDs is probable. AREAS COVERED This review discusses evidence related to the deteriorating influence of AEDs on bone, demonstrating generally stronger negative effects of conventional AEDs. Lamotrigine seems to be a safer AED in this regard. Further, literature data indicate that generally AEDs can lower the serum concentration of vitamin D. Importantly, pediatric patients are of greater risk of bone problems during therapy with AEDs, which is probably due to their effects on bone-forming processes. EXPERT OPINION Supplementation with vitamin D and calcium is frequently recommended in patients taking AEDs chronically. Whether to add a bisphosphonate remains an open question due to the limited data on this issue. A possibility of negative interactions exists between AEDs and other pro-osteoporotic drugs: glucocorticoids, proton pump inhibitors and aromatase inhibitors. Depression is a frequent comorbidity in patients with epilepsy. Clinical data indicate that antidepressant drugs may also increase the risk of fractures. Again, patients with epilepsy and depression may be exposed to a greater risk of osteoporosis.
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Affiliation(s)
- Barbara Miziak
- a Department of Pathophysiology, Medical University of Lublin , Lublin , Poland
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Wang W, Gao Y, Zheng W, Li M, Zheng X. Phenobarbital inhibits osteoclast differentiation and function through NF-κB and MAPKs signaling pathway. Int Immunopharmacol 2019; 69:118-125. [PMID: 30703706 DOI: 10.1016/j.intimp.2019.01.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/05/2019] [Accepted: 01/22/2019] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to determine the direct effects of phenobarbital (PB) on receptor activator of nuclear factor kappa-B ligand (RANKL) induced osteoclast differentiation and function in vitro and in vivo. Here, PB significantly inhibited osteoclast formation and bone resorption ability induced by RANKL in vitro. Meanwhile, intracellular signaling transduction analysis revealed PB specifically decreasing the phosphorylation level of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and mitogen-activated protein kinase (MAPK), respectively. Besides, oral administration of PB at the dose of 60 mg/kg/day for 6 weeks led to improve the bone loss and to decrease the activity on both osteoblast and osteoclast. This suppression effect is more obvious in osteoblast-induced bone formation than that on osteoclast-induced bone resorption. Taken together, our findings demonstrated that PB down-regulate osteoclast differentiation and activity through modulation of NF-κB and MAPKs signaling pathway. The direct suppression effect on osteoclast can induce bone loss after long term oral administration. This bone loss is due to reducing bone turnover rate on both sides of bone formation and bone resorption.
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Affiliation(s)
- Wei Wang
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, China; School of Public Health, Shandong University, Jinan, China
| | - Yuan Gao
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, China
| | - Wenwen Zheng
- School of Public Health, Shandong University, Jinan, China
| | - Minqi Li
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, China.
| | - Xuexing Zheng
- School of Public Health, Shandong University, Jinan, China.
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Zhao XH, Tay FR, Fang YJ, Meng LY, Bian Z. Topical application of phenytoin or nifedipine-loaded PLGA microspheres promotes periodontal regeneration in vivo. Arch Oral Biol 2019; 97:42-51. [PMID: 30342306 DOI: 10.1016/j.archoralbio.2018.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/13/2018] [Accepted: 10/02/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Gingival recession and alveolar bone loss are common manifestations of periodontitis. Periodontal regeneration is the ideal strategy for rehabilitating periodontal tissue defects and preventing tooth loss. The present study examined whether localized, topical application of gingival overgrowth-inducing drugs, phenytoin, nifedipine or cyclosporine, induces periodontal regeneration. METHODS Polylactic-co-glycolic acid (PLGA) was used as the carrier for preparation of phenytoin, nifedipine or cyclosporine-loaded PLGA microspheres, using an oil-in-water emulsification technique. The drug-loaded microspheres were delivered to periodontal defects created on alveolar ridges mesial to the first maxillary molars of Sprague-Dawley rats. After eight weeks, the operation area in each rat, including the maxillary molars and periodontal tissues, was harvested and evaluated by micro-computed tomography, histochemical and immunohistochemical analyses. RESULTS Physical parameters representative of periodontal regeneration, including the length of new alveolar bone (p < 0.01) and the area of new alveolar bone (p < 0.01) were significantly improved in the phenytoin group. Compared to other groups, the phenytoin group demonstrated increased expression of COL-1, VEGF-A, osteoblast and osteoclast markers (BMP-2, TGF-β1, OCN and TRAP staining), as well as decreased expression of MMP-8. CONCLUSIONS Results of the present study provided new evidence that localized, controlled release of phenytoin confers therapeutic benefits toward gingival recession and alveolar bone loss. Phenytoin appears to be a promising drug that promotes periodontal regeneration.
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Affiliation(s)
- Xiao-Heng Zhao
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory for Oral Biomedicine of Ministry of Education (KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, PR China
| | - Franklin R Tay
- College of Graduate Studies, Augusta University, Augusta, GA, USA
| | - Yan-Jun Fang
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory for Oral Biomedicine of Ministry of Education (KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, PR China
| | - Liu-Yan Meng
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory for Oral Biomedicine of Ministry of Education (KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, PR China.
| | - Zhuan Bian
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory for Oral Biomedicine of Ministry of Education (KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, PR China.
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Kanda J, Izumo N, Furukawa M, Shimakura T, Yamamoto N, E Takahashi H, Asakura T, Wakabayashi H. Effects of the calcineurin inhibitors cyclosporine and tacrolimus on bone metabolism in rats. Biomed Res 2018; 39:131-139. [PMID: 29899188 DOI: 10.2220/biomedres.39.131] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Immunosuppressive therapy is considered as one of the factors inducing to the onset of osteoporosis after organ transplantation. Chronic immunosuppressive therapy after transplantation is required for organ transplant patients, and it is important to prevent the occurrence of osteoporotic fractures to maintain the quality of life in patients. In this study, we examined the effects of cyclosporine and tacrolimus on bone metabolism in rats. Five-week-old male Wistar rats were treated orally with 15 mg/kg cyclosporine or 1.5 mg/kg tacrolimus daily for 4 weeks. Each of cyclosporine and tacrolimus significantly reduced the bone strength of the femoral mid-diaphysis and bone mineral density of the tibia and femur. Bone histomorphometry showed that the administration of both drugs resulted in a decrease in bone volume, number and thickness of trabeculae, and an increase in trabecular separation. Bone formation parameters such as osteoid volume, osteoblast surface, mineralizing surface, mineral apposition rate, and bone formation rate significantly increased in the cyclosporine-treated group. Bone resorption parameters such as eroded surface, osteoclast surface, and osteoclast number significantly increased in both the cyclosporine- and the tacrolimus- treated groups. These results showed that cyclosporine increases both bone formation and bone resorption, leading to a high-turnover bone loss, and that tacrolimus increases bone resorption without affecting bone formation, leading to bone loss.
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Affiliation(s)
- Junkichi Kanda
- Department of Clinical Pharmacotherapy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences
| | - Nobuo Izumo
- General Health Medical Center Yokohama University of Pharmacy
| | - Megumi Furukawa
- General Health Medical Center Yokohama University of Pharmacy
| | | | - Noriaki Yamamoto
- Niigata Bone Science Institute, Niigata Rehabilitation Hospital.,Division of Orthopedic Surgery, Niigata Rehabilitation Hospital
| | | | - Toshinari Asakura
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences
| | - Hiroyuki Wakabayashi
- Department of Clinical Pharmacotherapy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences
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Parveen B, Tiwari AK, Jain M, Pal S, Chattopadhyay N, Tripathi M, Vohora D. The anti-epileptic drugs valproate, carbamazepine and levetiracetam cause bone loss and modulate Wnt inhibitors in normal and ovariectomised rats. Bone 2018; 113:57-67. [PMID: 29758362 DOI: 10.1016/j.bone.2018.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 01/21/2023]
Abstract
Secondary osteoporosis is the major concern associated with long term intake of antiepileptic drugs (AEDs). Women are the vulnerable targets owing to post-menopausal bone loss. In the present work, we evaluated the effect of 10 weeks of treatment with AED therapy (carbamazepine, CBZ, 75 mg/kg; sodium valproate, SVP, 300 mg/kg; levetiracetam, LTM, 150 mg/kg) on bone mineral density and microarchitecture at femoral epiphysis, lumbar vertebrae and proximal tibia of normal and ovariectomised Wistar rats. In addition, we measured serum levels of vitamin D, receptor activator of nuclear factor kappa β-ligand (RANKL), procollagen type 1 amino-terminal propeptide (P1NP) and wnt inhibitors (sclerostin and DKK-1) following AED therapy. Micro-computed tomography analysis of bones revealed significant reduction in BMD at femur epiphysis and lumbar vertebrae with all the three AEDs evaluated. At proximal tibia, only CBZ showed a significant decline. The reduction in BMD was more pronounced in ovariectomised rats. AEDs also resulted in alteration of micro-CT parameters. These changes were accompanied by an increased serum RANKL with all AEDs while vitamin D levels were reduced only with CBZ treatment and P1NP levels were reduced with SVP and CBZ. Serum sclerostin levels were elevated following all AEDs in normal and ovariectomised rats except with CBZ in normal rats. However, increase in DKK-1 levels was observed with only LTM. Ovariectomy itself resulted in increased RANKL, sclerostin and DKK-1 and reduced vitamin D and P1NP levels. Significant differences were discernible between normal and ovariectomised rats treated with AEDs in all the parameters. However, while sclerostin increased further upon AEDs treatment, P1NP decreased with SVP and CBZ and serum DKK-1 levels showed a declining trend with all the three AEDs studied. We confirm adverse effects on bone following AEDs in female rats. Further, our results demonstrate for the first time that these effects are more pronounced in ovariectomised rats as compared to normal rats and that this could be related to estrogen deficiency which in turn enhances bone resorption via increased RANKL and reduces bone formation via increased sclerostin and reduced P1NP. Finally, our study demonstrated for the first time that AED treatment displayed changes in the serum levels of wnt inhibitors and hence modulation of wnt inhibitors might be partly involved in their adverse effects on bone.
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Affiliation(s)
- Bushra Parveen
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | | | - Moon Jain
- Central Drug Research Institute, Division of Pharmacology, Lucknow 226031, Uttar Pradesh, India
| | - Subhashis Pal
- Central Drug Research Institute, Division of Endocrinology, Lucknow 226031, Uttar Pradesh, India
| | - Naibedya Chattopadhyay
- Central Drug Research Institute, Division of Endocrinology, Lucknow 226031, Uttar Pradesh, India
| | - Manjari Tripathi
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Divya Vohora
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India.
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Vellucci R, Terenzi R, Kanis JA, Kress HG, Mediati RD, Reginster JY, Rizzoli R, Brandi ML. Understanding osteoporotic pain and its pharmacological treatment. Osteoporos Int 2018; 29:1477-1491. [PMID: 29619540 DOI: 10.1007/s00198-018-4476-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/06/2018] [Indexed: 01/09/2023]
Abstract
Osteoporosis, a disorder that affects millions of people worldwide, is characterized by decreased bone mass and microstructural alterations giving rise to an increased risk of fractures. Osteoporotic fractures can cause acute and chronic pain that mainly affects elderly patients with multiple comorbidities and commonly on different drug regimens. The aim of this paper is to summarize the pathogenesis and systemic treatment of osteoporotic pain. This narrative review summarizes the main pathogenetic aspects of osteoporotic pain and the cornerstones of its treatment. Osteoporotic fractures induce both acute and chronic nociceptive and neuropathic pain. Central sensitization seems to play a pivotal role in developing and maintaining chronicity of post-fracture pain in osteoporosis. Antiosteoporosis drugs are able to partially control pain, but additional analgesics are always necessary for pain due to bone fractures. Nonsteroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors reduce acute pain but with a poor effect on the chronic neuropathic component of pain and with relevant side effects. Opioid drugs can control the whole spectrum of acute and chronic bone pain, but they differ with respect to their efficacy on neuropathic components, their tolerability and safety. Chronic pain after osteoporotic fractures requires a multifaceted approach, which includes a large spectrum of drugs (antiosteoporosis treatment, acetaminophen, NSAIDs, selective COX-2 inhibitors, weak and strong opioids) and non-pharmacological treatment. Based on a better understanding of the pathogenesis of osteoporotic and post-fracture pain, a guided stepwise approach to post-fracture osteoporotic pain will also better meet the needs of these patients.
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Affiliation(s)
- R Vellucci
- Palliative Care and Pain Therapy Unit, University Hospital of Careggi, Florence, Italy
| | - R Terenzi
- Department of Surgery and Translational Medicine, University of Florence, AOU Careggi Largo Brambilla n.3, 50134, Florence, Italy
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia
| | - H G Kress
- Department of Special Anaesthesia and Pain Medicine, Medical University/AKH of Vienna, Vienna, Austria
| | - R D Mediati
- Palliative Care and Pain Therapy Unit, University Hospital of Careggi, Florence, Italy
| | | | - R Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland
| | - M L Brandi
- Department of Surgery and Translational Medicine, University of Florence, AOU Careggi Largo Brambilla n.3, 50134, Florence, Italy.
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