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Müller T, Riederer P. The vicious circle between homocysteine, methyl group-donating vitamins and chronic levodopa intake in Parkinson's disease. J Neural Transm (Vienna) 2024; 131:631-638. [PMID: 37329350 DOI: 10.1007/s00702-023-02666-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/19/2023]
Abstract
A biomarker for declined methylation capacity is elevation of homocysteine levels. They increase the risk for onset of vascular disease and contribute to progression of chronic neurodegeneration and aging. This narrative review discusses associations between homocysteine, consumption of methyl group-donating vitamins and impact on disease-generating mechanisms in levodopa-treated patients with Parkinson's disease. We conclude to recommend levodopa-treated patients to substitute themselves with methyl group-donating vitamins. This is harmless in terms of application of folic acid, methylcobalamin or hydroxocobalamin. Moreover, we suggest a crucial discussion on the value of the various popular hypotheses on Parkinson's disease-generating mechanisms. Findings from studies with acute levodopa exposure describe oxidative stress generation and impaired methylation capacity, which causes gene dysfunction. Their repeated occurrences contribute to onset of mitochondrial dysfunction, iron enrichment and pathologic protein accumulation in the long term. Current research underestimates these epigenetic, metabolic consequences of chronic levodopa application. Supplementary treatment strategies are recommended to avoid levodopa-related side effects.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weissensee, Gartenstr. 1, 13088, Berlin, Germany.
| | - Peter Riederer
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Margarete-Höppel Platz 1, 97080, Würzburg, Germany
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Zhu J, Wang Z, Sun X, Wang D, Xu X, Yang L, Du J, Zhou Z, Qi Y, Ma L. Associations between one-carbon metabolism and valproic acid-induced liver dysfunction in epileptic patients. Front Pharmacol 2024; 15:1358262. [PMID: 38464726 PMCID: PMC10924308 DOI: 10.3389/fphar.2024.1358262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Valproic acid (VPA) has been widely used as an antiepileptic drug for decades. Although VPA is effective and well-tolerated, long-term VPA treatment is usually associated with hepatotoxicity. However, the underlying mechanisms of VPA-caused hepatotoxicity remain unclear. In this study, a total of 157 pediatric patients with epilepsy were recruited and divided into normal liver function (NLF, 112 subjects) group and abnormal liver function (ABLF, 45 subjects) group. We observed that MTHFR A1298C and MTHFR C677T variants may be linked to VPA-induced liver dysfunction (p = 0.001; p = 0.023, respectively). We also found that the MTHFR A1298C polymorphism was associated with a higher serum Hcy level (p = 0.001) and a lower FA level (p = 0.001). Moreover, the serum Hcy levels was strongly correlated with the GSH and TBARS concentrations (r = -0.6065, P < 0.001; r = 0.6564, P < 0.001, respectively). Furthermore, logistic analysis indicated that MTHFR A1298C/C677T polymorphisms and increased Hcy concentrations may be risk factors for VPA-induced liver dysfunction. These results suggested that individual susceptibility to VPA-induced liver dysfunction may result from MTHFR A1298C/C677T polymorphisms and increased Hcy levels. This study may be helpful for the prevention and guidance of VPA-induced liver dysfunction.
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Affiliation(s)
- Jingwei Zhu
- Department of Clinical Laboratory, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Zhe Wang
- Department of Clinical Laboratory, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Xiaotong Sun
- Department of Clinical Laboratory, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Dan Wang
- School of Life Science, Jilin University, Changchun, China
| | - Xinbo Xu
- Department of Clinical Laboratory, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Liping Yang
- Department of Clinical Laboratory, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Jiangdong Du
- Department of Clinical Laboratory, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Zhimei Zhou
- Department of Clinical Laboratory, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Yanhua Qi
- Department of Clinical Laboratory, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Linfeng Ma
- Department of Clinical Laboratory, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
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Husebye ESN, Romanowska J, Bjørke-Monsen AL, Gilhus NE, Selmer K, Gervin K, Riedel B, Bjørk MH. Does maternal genetic liability to folate deficiency influence the risk of antiseizure medication-associated language impairment and autistic traits in children of women with epilepsy? Am J Clin Nutr 2023:S0002-9165(23)63922-X. [PMID: 37217097 PMCID: PMC10375495 DOI: 10.1016/j.ajcnut.2023.05.023] [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: 01/26/2023] [Revised: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Prenatal exposure to antiseizure medication (ASM) may lead to low plasma folate concentrations and is associated with impaired neurodevelopment. OBJECTIVE To examine whether maternal genetic liability to folate deficiency interacts with ASM-associated risk of language impairment and autistic traits in children of women with epilepsy. METHODS We included children of women with and without epilepsy and with available genetic data enrolled in the Norwegian Mother, Father, and Child Cohort Study (MoBa). Information on ASM use, folic acid supplement use and dose, dietary folate intake, child autistic traits, and child language impairment was obtained from parent-reported questionnaires. Using logistic regression, we examined the interaction between prenatal ASM exposure and maternal genetic liability to folate deficiency expressed as polygenic risk score (PRS) of low folate concentrations or maternal rs1801133 genotype (CC or CT/TT) on risk of language impairment or autistic traits. RESULTS We included 96 children of women with ASM-treated epilepsy, 131 children of women with ASM-untreated epilepsy, and 37,249 children of women without epilepsy. The PRS of low folate concentrations or the maternal rs1801133 genotype did not interact with the ASM-associated risk of language impairment or autistic traits in ASM-exposed children of women with epilepsy compared to ASM-unexposed children aged 1.5-8 years. ASM-exposed children had increased risk of adverse neurodevelopment regardless of maternal rs1801133 genotype (adjusted odds ratio (aOR) for language impairment age 8 years was 2.88 (95% confidence interval (CI) 1.00-8.26) if CC and aOR 2.88 (CI 1.10-7.53) if CT/TT genotypes). In children of women without epilepsy aged 3 years, those with maternal rs1801133 CT/TT compared to CC genotype had increased risk of language impairment (aOR 1.18, CI 1.05-1.34). CONCLUSIONS In this cohort of pregnant women reporting widespread use of folic acid supplements, maternal genetic liability to folate deficiency did not significantly influence the ASM-associated risk of impaired neurodevelopment.
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Affiliation(s)
| | - Julia Romanowska
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Anne-Lise Bjørke-Monsen
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Norway; Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Kaja Selmer
- National Center for Epilepsy, Oslo University Hospital, Oslo; Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo
| | - Kristina Gervin
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo; Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo
| | - Bettina Riedel
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Marte Helene Bjørk
- Department of Clinical Medicine, University of Bergen, Norway; Department of Neurology, Haukeland University Hospital, Bergen, Norway
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Pedersen S, Kverneland M, Nakken KO, Rudi K, Iversen PO, Gervin K, Selmer KK. Genome-wide decrease in DNA methylation in adults with epilepsy treated with modified ketogenic diet: A prospective study. Epilepsia 2022; 63:2413-2426. [PMID: 35762681 PMCID: PMC9796519 DOI: 10.1111/epi.17351] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of the modified ketogenic diet on DNA methylation in adults with epilepsy. METHODS In this prospective study, we investigated the genome-wide DNA methylation in whole blood in 58 adults with epilepsy treated with the modified ketogenic for 12 weeks. Patients were recruited from the National Center for Epilepsy, Norway, from March 1, 2011 to February 28, 2017. DNA methylation was analyzed using the Illumina Infinium MethylationEPIC BeadChip array. Analysis of variance and paired t-test were used to identify differentially methylated loci after 4 and 12 weeks of dietary treatment. A false discovery rate approach with a significance threshold of <5% was used to adjust for multiple comparisons. RESULTS We observed a genome-wide decrease in DNA methylation, both globally and at specific sites, after 4 and 12 weeks of dietary treatment. A substantial share of the differentially methylated positions (CpGs) were annotated to genes associated with epilepsy (n = 7), lipid metabolism (n = 8), and transcriptional regulation (n = 10). Furthermore, five of the identified genes were related to inositol phosphate metabolism, which may represent a possible mechanism by which the ketogenic diet attenuates seizures. SIGNIFICANCE A better understanding of the modified ketogenic diet's influence at the molecular level may be the key to unraveling the mechanisms by which the diet can ameliorate seizures and possibly to identifying novel therapeutic targets for epilepsy.
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Affiliation(s)
- Sigrid Pedersen
- National Center for EpilepsyOslo University HospitalOsloNorway
| | | | | | - Knut Rudi
- Department of Chemistry, Biotechnology, and Food ScienceNorwegian University of Life SciencesÅsNorway
| | - Per Ole Iversen
- Department of NutritionUniversity of OsloOsloNorway,Department of HematologyOslo University HospitalOsloNorway
| | - Kristina Gervin
- Department of Research and InnovationOslo University HospitalOsloNorway
| | - Kaja Kristine Selmer
- National Center for EpilepsyOslo University HospitalOsloNorway,Department of Research and InnovationOslo University HospitalOsloNorway
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Alvestad S, Husebye ESN, Christensen J, Dreier JW, Sun Y, Igland J, Leinonen MK, Gissler M, Gilhus NE, Tomson T, Bjørk M. Folic Acid and Risk of Preterm Birth, Preeclampsia, and Fetal Growth Restriction Among Women With Epilepsy: A Prospective Cohort Study. Neurology 2022; 99:e605-e615. [PMID: 35577577 PMCID: PMC9442624 DOI: 10.1212/wnl.0000000000200669] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Women with epilepsy treated with antiseizure medication (ASM) have increased risk of pregnancy complications including preterm birth, fetal growth restriction, and preeclampsia. We aimed to investigate whether folic acid supplementation is associated with these pregnancy complications in women with epilepsy using ASM. METHODS Singleton pregnancies in the prospective Norwegian Mother and Child Cohort Study (MoBa) (1999-2008) were included. Information on maternal epilepsy, ASM, folic acid supplementation, and pregnancy outcomes was obtained from the MoBa questionnaires and the Norwegian Medical Birth Registry. The main exposure, periconceptional folic acid supplementation, was defined as intake between 4 weeks before pregnancy and 12 weeks into pregnancy, retrospectively collected by recall of the mothers in weeks 17-19. The primary outcomes were preterm birth (gestational age <37 weeks at birth), small for gestational age (SGA), and preeclampsia. RESULTS The study included 100,105 pregnancies: 99,431 without maternal epilepsy, 316 with maternal epilepsy and ASM exposure in pregnancy, and 358 with untreated maternal epilepsy. Among ASM-treated women with epilepsy, the risk of preterm birth was higher in those who did not use periconceptional folic acid (n = 64) compared with those who did (n = 245, the reference) (adjusted odds ratio [aOR] 3.3, 95% CI 1.2-9.2), while the risk of preterm birth among the reference was similar to the risk among women without epilepsy using folic acid periconceptionally (aOR 0.9, 95% CI 0.5-1.6). ASM-treated women with epilepsy starting folic acid after the first trimester had a higher risk compared with women without epilepsy with similar timing of folic acid (aOR 2.6, 95% CI 1.1-6.5), and even higher if not using folic acid (aOR 9.4, 95% CI 2.6-34.8). Folic acid was not associated with risk of preterm birth among women with epilepsy without ASM or among women without epilepsy. Folic acid was not associated with risk of preeclampsia or SGA among women with epilepsy. DISCUSSION In women with epilepsy using ASM, periconceptional folic acid was associated with a lower risk of preterm birth. This finding supports the recommendation that ASM-treated women with epilepsy of childbearing potential should use folic acid supplementation on a regular basis. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for women with epilepsy using ASM, periconceptional folic acid supplementation decreases the risk of preterm birth.
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Affiliation(s)
- Silje Alvestad
- From the Department of Clinical Medicine (S.A., E.S.N.H., J.W.D., N.E.G., M.B.), University of Bergen; National Center for Epilepsy (S.A.), Oslo; Department of Neurology (E.S.N.H., N.E.G., M.B.), Haukeland University Hospital, Bergen, Norway; Department of Neurology (J.C., Y.S.), and National Centre for Register-Based Research (J.C., J.W.D., Y.S.), Aarhus University, Denmark; Core Facility for Biostatistics and Data Analysis (J.I.), Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Departments of Molecular Medicine and Surgery (M.G.), Clinical Neuroscience (T.T.), and Department of Neurology (T.T.), Karolinska University Hospital, Stockholm, Sweden.
| | - Elisabeth Synnøve Nilsen Husebye
- From the Department of Clinical Medicine (S.A., E.S.N.H., J.W.D., N.E.G., M.B.), University of Bergen; National Center for Epilepsy (S.A.), Oslo; Department of Neurology (E.S.N.H., N.E.G., M.B.), Haukeland University Hospital, Bergen, Norway; Department of Neurology (J.C., Y.S.), and National Centre for Register-Based Research (J.C., J.W.D., Y.S.), Aarhus University, Denmark; Core Facility for Biostatistics and Data Analysis (J.I.), Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Departments of Molecular Medicine and Surgery (M.G.), Clinical Neuroscience (T.T.), and Department of Neurology (T.T.), Karolinska University Hospital, Stockholm, Sweden
| | - Jakob Christensen
- From the Department of Clinical Medicine (S.A., E.S.N.H., J.W.D., N.E.G., M.B.), University of Bergen; National Center for Epilepsy (S.A.), Oslo; Department of Neurology (E.S.N.H., N.E.G., M.B.), Haukeland University Hospital, Bergen, Norway; Department of Neurology (J.C., Y.S.), and National Centre for Register-Based Research (J.C., J.W.D., Y.S.), Aarhus University, Denmark; Core Facility for Biostatistics and Data Analysis (J.I.), Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Departments of Molecular Medicine and Surgery (M.G.), Clinical Neuroscience (T.T.), and Department of Neurology (T.T.), Karolinska University Hospital, Stockholm, Sweden
| | - Julie Werenberg Dreier
- From the Department of Clinical Medicine (S.A., E.S.N.H., J.W.D., N.E.G., M.B.), University of Bergen; National Center for Epilepsy (S.A.), Oslo; Department of Neurology (E.S.N.H., N.E.G., M.B.), Haukeland University Hospital, Bergen, Norway; Department of Neurology (J.C., Y.S.), and National Centre for Register-Based Research (J.C., J.W.D., Y.S.), Aarhus University, Denmark; Core Facility for Biostatistics and Data Analysis (J.I.), Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Departments of Molecular Medicine and Surgery (M.G.), Clinical Neuroscience (T.T.), and Department of Neurology (T.T.), Karolinska University Hospital, Stockholm, Sweden
| | - Yuelian Sun
- From the Department of Clinical Medicine (S.A., E.S.N.H., J.W.D., N.E.G., M.B.), University of Bergen; National Center for Epilepsy (S.A.), Oslo; Department of Neurology (E.S.N.H., N.E.G., M.B.), Haukeland University Hospital, Bergen, Norway; Department of Neurology (J.C., Y.S.), and National Centre for Register-Based Research (J.C., J.W.D., Y.S.), Aarhus University, Denmark; Core Facility for Biostatistics and Data Analysis (J.I.), Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Departments of Molecular Medicine and Surgery (M.G.), Clinical Neuroscience (T.T.), and Department of Neurology (T.T.), Karolinska University Hospital, Stockholm, Sweden
| | - Jannicke Igland
- From the Department of Clinical Medicine (S.A., E.S.N.H., J.W.D., N.E.G., M.B.), University of Bergen; National Center for Epilepsy (S.A.), Oslo; Department of Neurology (E.S.N.H., N.E.G., M.B.), Haukeland University Hospital, Bergen, Norway; Department of Neurology (J.C., Y.S.), and National Centre for Register-Based Research (J.C., J.W.D., Y.S.), Aarhus University, Denmark; Core Facility for Biostatistics and Data Analysis (J.I.), Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Departments of Molecular Medicine and Surgery (M.G.), Clinical Neuroscience (T.T.), and Department of Neurology (T.T.), Karolinska University Hospital, Stockholm, Sweden
| | - Maarit K Leinonen
- From the Department of Clinical Medicine (S.A., E.S.N.H., J.W.D., N.E.G., M.B.), University of Bergen; National Center for Epilepsy (S.A.), Oslo; Department of Neurology (E.S.N.H., N.E.G., M.B.), Haukeland University Hospital, Bergen, Norway; Department of Neurology (J.C., Y.S.), and National Centre for Register-Based Research (J.C., J.W.D., Y.S.), Aarhus University, Denmark; Core Facility for Biostatistics and Data Analysis (J.I.), Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Departments of Molecular Medicine and Surgery (M.G.), Clinical Neuroscience (T.T.), and Department of Neurology (T.T.), Karolinska University Hospital, Stockholm, Sweden
| | - Mika Gissler
- From the Department of Clinical Medicine (S.A., E.S.N.H., J.W.D., N.E.G., M.B.), University of Bergen; National Center for Epilepsy (S.A.), Oslo; Department of Neurology (E.S.N.H., N.E.G., M.B.), Haukeland University Hospital, Bergen, Norway; Department of Neurology (J.C., Y.S.), and National Centre for Register-Based Research (J.C., J.W.D., Y.S.), Aarhus University, Denmark; Core Facility for Biostatistics and Data Analysis (J.I.), Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Departments of Molecular Medicine and Surgery (M.G.), Clinical Neuroscience (T.T.), and Department of Neurology (T.T.), Karolinska University Hospital, Stockholm, Sweden
| | - Nils Erik Gilhus
- From the Department of Clinical Medicine (S.A., E.S.N.H., J.W.D., N.E.G., M.B.), University of Bergen; National Center for Epilepsy (S.A.), Oslo; Department of Neurology (E.S.N.H., N.E.G., M.B.), Haukeland University Hospital, Bergen, Norway; Department of Neurology (J.C., Y.S.), and National Centre for Register-Based Research (J.C., J.W.D., Y.S.), Aarhus University, Denmark; Core Facility for Biostatistics and Data Analysis (J.I.), Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Departments of Molecular Medicine and Surgery (M.G.), Clinical Neuroscience (T.T.), and Department of Neurology (T.T.), Karolinska University Hospital, Stockholm, Sweden
| | - Torbjörn Tomson
- From the Department of Clinical Medicine (S.A., E.S.N.H., J.W.D., N.E.G., M.B.), University of Bergen; National Center for Epilepsy (S.A.), Oslo; Department of Neurology (E.S.N.H., N.E.G., M.B.), Haukeland University Hospital, Bergen, Norway; Department of Neurology (J.C., Y.S.), and National Centre for Register-Based Research (J.C., J.W.D., Y.S.), Aarhus University, Denmark; Core Facility for Biostatistics and Data Analysis (J.I.), Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Departments of Molecular Medicine and Surgery (M.G.), Clinical Neuroscience (T.T.), and Department of Neurology (T.T.), Karolinska University Hospital, Stockholm, Sweden
| | - Marte Bjørk
- From the Department of Clinical Medicine (S.A., E.S.N.H., J.W.D., N.E.G., M.B.), University of Bergen; National Center for Epilepsy (S.A.), Oslo; Department of Neurology (E.S.N.H., N.E.G., M.B.), Haukeland University Hospital, Bergen, Norway; Department of Neurology (J.C., Y.S.), and National Centre for Register-Based Research (J.C., J.W.D., Y.S.), Aarhus University, Denmark; Core Facility for Biostatistics and Data Analysis (J.I.), Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Departments of Molecular Medicine and Surgery (M.G.), Clinical Neuroscience (T.T.), and Department of Neurology (T.T.), Karolinska University Hospital, Stockholm, Sweden
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Mahmoud AA, Aboelghar HM, Abdelmageed SM, Abdallah HM, Garib MI, Abd El Hady NMS. Assessment of asymmetric dimethylarginine and homocysteine in epileptic children receiving antiepileptic drugs. Pediatr Res 2022; 92:1606-1612. [PMID: 35688962 PMCID: PMC9771805 DOI: 10.1038/s41390-022-02132-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/13/2022] [Accepted: 05/08/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Epilepsy is a neurological disease that requires long-term antiepileptic drugs (AEDs). The old generation of AEDs may affect serum homocysteine and asymmetric dimethylarginine (ADMA) and disturb lipid levels. The aim of the study was to evaluate serum ADMA, homocysteine, lipid profile, and carotid intima-media thickness (CIMT) in epileptic children. METHODS This study was implemented on 159 epileptic children who were subdivided into 3 subgroups, with 53 receiving sodium valproate, 53 receiving levetiracetam, and 53 receiving polytherapy, for over 6 months and 53 healthy children. RESULTS Low-density lipoprotein, triglycerides, and cholesterol levels were increased in epileptic children (p < 0.001), which were higher in those receiving multidrug followed by a valproate receiver. While high-density lipoprotein was lower in those receiving multidrug more than those receiving valproate. ADMA and homocysteine levels increased in epileptic patients than in controls (p < 0.001). Higher ADMA was also observed in the multidrug receiver (5.78 ± 0.62), followed by the levetiracetam group (5.56 ± 0.61). Homocysteine levels were significantly higher in multidrug and valproate-treated children than those treated with levetiracetam. CIMT was significantly higher in multidrug and valproate-treated patients (p < 0.001). CONCLUSIONS Long-term use of AEDs, especially old-generation polytherapy, can elevate lipid profiles, homocysteine, ADMA levels, and carotid intima-media thickness compared to the minimal effect of new AEDs. IMPACT The long-term use of antiepileptic drugs, especially old-generation polytherapy, can increase lipid profiles, homocysteine levels, ADMA, and carotid intima thickness compared to the minimal effect of new antiepileptic generation. A routine follow-up of these markers and a lifestyle modification are recommended to avoid cerebrovascular events as much as possible.
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Affiliation(s)
- Asmaa A. Mahmoud
- grid.411775.10000 0004 0621 4712Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Hesham M. Aboelghar
- grid.411775.10000 0004 0621 4712Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Sabry Moawad Abdelmageed
- grid.411775.10000 0004 0621 4712Department of Clinical Biochemistry and Molecular Diagnostics, National Liver Institute, Menoufia University, Shebin Elkom, Egypt
| | - Heba M. Abdallah
- grid.411775.10000 0004 0621 4712Department of Clinical Pathology, National Liver Institute, Menoufia University, Shebin Elkom, Egypt
| | - Mohamed I. Garib
- grid.411775.10000 0004 0621 4712Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Nahla M. S. Abd El Hady
- grid.411775.10000 0004 0621 4712Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
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Husebye ESN, Riedel B, Bjørke-Monsen AL, Spigset O, Daltveit AK, Gilhus NE, Bjørk MH. Vitamin B status and association with antiseizure medication in pregnant women with epilepsy. Epilepsia 2021; 62:2968-2980. [PMID: 34590314 DOI: 10.1111/epi.17076] [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] [Received: 06/09/2021] [Revised: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Antiseizure medication (ASM) use interacts with vitamin B status in nonpregnant epilepsy populations. We aimed to examine the association between ASM and vitamin B status in pregnant women with epilepsy. METHODS We performed a cross-sectional study of pregnancies in women with epilepsy enrolled in the Norwegian Mother, Father and Child Cohort Study from 1999 to 2008. Data on ASM and vitamin supplement use were collected from questionnaires. We analyzed maternal plasma concentrations of ASM and metabolites of folate, including unmetabolized folic acid (UMFA), riboflavin (vitamin B2), pyridoxine (vitamin B6), and niacin (vitamin B3) during gestational weeks 17-19. RESULTS We included 227 singleton pregnancies exposed to ASM with available plasma samples (median maternal age 29 years, range 18 to 41 years). From the preconception period to gestational week 20, any supplement of folic acid was reported in 208 of pregnancies (94%), riboflavin in 72 (33%), pyridoxine in 77 (35%), and niacin in 45 (20%). High ASM concentrations correlated with high concentrations of UMFA and inactive folate metabolites, and with low concentrations of riboflavin and metabolically active pyridoxine. There was no association between ASM and niacin status. SIGNIFICANCE ASM concentrations during pregnancy were associated with vitamin B status in pregnant women with epilepsy. Additional studies are needed to determine the clinical impact of these findings, and to define the optimal vitamin doses that should be recommended to improve pregnancy outcomes.
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Affiliation(s)
- Elisabeth Synnøve Nilsen Husebye
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Bettina Riedel
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anne-Lise Bjørke-Monsen
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Kjersti Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
| | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Marte Helene Bjørk
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
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8
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Zhu S, Ni G, Sui L, Zhao Y, Zhang X, Dai Q, Chen A, Lin W, Li Y, Huang M, Zhou L. Genetic Polymorphisms in Enzymes Involved in One-Carbon Metabolism and Anti-epileptic Drug Monotherapy on Homocysteine Metabolism in Patients With Epilepsy. Front Neurol 2021; 12:683275. [PMID: 34177787 PMCID: PMC8220895 DOI: 10.3389/fneur.2021.683275] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/10/2021] [Indexed: 11/14/2022] Open
Abstract
Aims: To investigate the effects of single nucleotide polymorphisms (SNPs) in genes of one-carbon metabolism (OCM) related enzymes and anti-epileptic drug (AED) monotherapy on homocysteine (Hcy) metabolism in patients with epilepsy, and to further explore specific SNPs that may increase patients' susceptibility to the effects of AEDs on the Hcy imbalance. Method: This case-control study analyzed 279 patients with epilepsy, including patients receiving monotherapy with valproate (VPA) (n = 53), oxcarbazepine (OXC) (n = 71), lamotrigine (LTG) (n = 55), or levetiracetam (LEV) (n = 35) and patients who had not taken any AEDs (controls, n = 65) for at least 6 months. Serum levels of vitamin B12 (vit B12), folate (FA) and Hcy were measured, and 23 SNPs in 13 genes of OCM-related enzymes were genotyped in all patients. Results: Methylenetetrahydrofolate reductase (MTHFR) rs1801133 was associated with elevated serum Hcy levels in patients with epilepsy (P < 0.001), and patients presenting the TT genotype exhibited higher serum Hcy levels than patients with the CC (P < 0.001) or CT (P < 0.001) genotype. A subsequent multiple linear regression analysis showed that AED monotherapy with VPA (vs. control: P = 0.023) or OXC (vs. control: P = 0.041), and genotypes of MTHFR rs1801133 TT (vs. CC: P < 0.001; vs. CT: P < 0.001), transcobalamin 2 (TCN2) rs1801198 CC (vs. GC: P = 0.039) and folate receptor 1 (FOLR1) rs2071010 AA (vs. GA: P = 0.031) were independent risk factors for higher Hcy levels. In the subgroup analysis of patients taking OXC, we found that patients with genotypes of MTHFR rs1801133 TT (vs. CC: P = 0.001; vs. CT: P < 0.001) and TCN2 rs1801198 CC (vs. GC: P = 0.021; vs. GG: P = 0.018) exhibited higher serum Hcy levels. Conclusions: VPA, OXC, and genotypes of MTHFR rs1801133 TT, TCN2 rs1801198 CC, and FOLR1 rs2071010 AA are all independent risk factors for elevated Hcy levels in patients with epilepsy. Moreover, genotypes of MTHFR rs1801133 TT and TCN2 rs1801198 CC may increase patients' susceptibility to the effect of OXC on disrupting Hcy homeostasis.
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Affiliation(s)
- Shaofang Zhu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guanzhong Ni
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lisen Sui
- Department of Epilepsy Center, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yiran Zhao
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xiaoxu Zhang
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - Qilin Dai
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Aohan Chen
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Wanrong Lin
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yinchao Li
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Min Huang
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - Liemin Zhou
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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9
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Kong FC, Ma CL, Zhong MK. Epigenetic Effects Mediated by Antiepileptic Drugs and their Potential Application. Curr Neuropharmacol 2020; 18:153-166. [PMID: 31660836 PMCID: PMC7324883 DOI: 10.2174/1570159x17666191010094849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/01/2019] [Accepted: 10/03/2019] [Indexed: 12/20/2022] Open
Abstract
An epigenetic effect mainly refers to a heritable modulation in gene expression in the short term but does not involve alterations in the DNA itself. Epigenetic molecular mechanisms include DNA methylation, histone modification, and untranslated RNA regulation. Antiepileptic drugs have drawn attention to biological and translational medicine because their impact on epigenetic mechanisms will lead to the identification of novel biomarkers and possible therapeutic strategies for the prevention and treatment of various diseases ranging from neuropsychological disorders to cancers and other chronic conditions. However, these transcriptional and posttranscriptional alterations can also result in adverse reactions and toxicity in vitro and in vivo. Hence, in this review, we focus on recent findings showing epigenetic processes mediated by antiepileptic drugs to elucidate their application in medical experiments and shed light on epigenetic research for medicinal purposes.
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Affiliation(s)
- Fan-Cheng Kong
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Chun-Lai Ma
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Ming-Kang Zhong
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
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10
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Reynolds EH. Antiepileptic drugs, folate and one carbon metabolism revisited. Epilepsy Behav 2020; 112:107336. [PMID: 32871500 DOI: 10.1016/j.yebeh.2020.107336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022]
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11
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Reynolds EH, Green R. Valproate and folate: Congenital and developmental risks. Epilepsy Behav 2020; 108:107068. [PMID: 32375098 DOI: 10.1016/j.yebeh.2020.107068] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 01/08/2023]
Abstract
Increasing awareness of the congenital and developmental risks associated with the use of sodium valproate (VPA) has led to recent European guidelines designed to avoid the use of this drug in pregnancy if effective alternative treatments are available. In the general population, it is well established that periconceptual folic acid reduces the risk of neural tube defects (NTDs) and possibly other congenital abnormalities. We here review the evidence 1) that VPA interferes with one-carbon metabolism, including the transport of methylfolate into the brain and the placenta by targeting folate receptors; 2) that VPA effects on the folate metabolic system contribute to congenital and developmental problems associated with VPA exposure; and 3) that genetic factors, notably polymorphisms related to one-carbon metabolism, contribute to the vulnerability to these VPA-induced risks. Based on these facts, we propose that the standard periconceptual use of 400 μg of folic acid may not adequately protect against VPA or other antiepileptic drug (AED)-induced congenital or developmental risks. Pending definitive studies to determine appropriate dose, we recommend up to 5 mg of folic acid periconceptually in at-risk women with the caveat that the addition of supplementary vitamin B12 may also be prudent because vitamin B12 deficiency is common in pregnancy in some countries and is an additional risk factor for developmental abnormalities.
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Affiliation(s)
| | - Ralph Green
- Department of Pathology and Laboratory Medicine, University of California Davis, USA
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12
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Coppedè F, Stoccoro A, Tannorella P, Gallo R, Nicolì V, Migliore L. Association of Polymorphisms in Genes Involved in One-Carbon Metabolism with MTHFR Methylation Levels. Int J Mol Sci 2019; 20:E3754. [PMID: 31370354 PMCID: PMC6696388 DOI: 10.3390/ijms20153754] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 12/11/2022] Open
Abstract
Methylenetetrahydrofolate reductase (MTHFR) is a pivotal enzyme in the one-carbon metabolism, a metabolic pathway required for DNA synthesis and methylation reactions. MTHFR hypermethylation, resulting in reduced gene expression, can contribute to several human disorders, but little is still known about the factors that regulate MTHFR methylation levels. We performed the present study to investigate if common polymorphisms in one-carbon metabolism genes contribute to MTHFR methylation levels. MTHFR methylation was assessed in peripheral blood DNA samples from 206 healthy subjects with methylation-sensitive high-resolution melting (MS-HRM); genotyping was performed for MTHFR 677C>T (rs1801133) and 1298A>C (rs1801131), MTRR 66A>G (rs1801394), MTR 2756A>G (rs1805087), SLC19A1 (RFC1) 80G>A (rs1051266), TYMS 28-bp tandem repeats (rs34743033) and 1494 6-bp ins/del (rs34489327), DNMT3A -448A>G (rs1550117), and DNMT3B -149C>T (rs2424913) polymorphisms. We observed a statistically significant effect of the DNMT3B -149C>T polymorphism on mean MTHFR methylation levels, and particularly CT and TT carriers showed increased methylation levels than CC carriers. The present study revealed an association between a functional polymorphism of DNMT3B and MTHFR methylation levels that could be of relevance in those disorders, such as inborn defects, metabolic disorders and cancer, that have been linked to impaired DNA methylation.
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Affiliation(s)
- Fabio Coppedè
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
| | - Andrea Stoccoro
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | - Pierpaola Tannorella
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Unit of Genetics of Neurodegenerative and Metabolic Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Roberta Gallo
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Doctoral School in Genetics, Oncology and Clinical Medicine, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Vanessa Nicolì
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Doctoral School in Genetics, Oncology and Clinical Medicine, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Lucia Migliore
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Via Roma 55, 56126 Pisa, Italy
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13
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Sarecka-Hujar B, Szołtysek-Bołdys I, Kopyta I, Dolińska B, Sobczak A. Concentrations of the Selected Biomarkers of Endothelial Dysfunction in Response to Antiepileptic Drugs: A Literature Review. Clin Appl Thromb Hemost 2019; 25:1076029619859429. [PMID: 31238702 PMCID: PMC6714895 DOI: 10.1177/1076029619859429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Epilepsy is a disease arising from morphological and metabolic changes in the brain. Approximately 60% of patients with seizures can be controlled with 1 antiepileptic drug (AED), while in others, polytherapy is required. The AED treatment affects a number of biochemical processes in the body, including increasing the risk of cardiovascular diseases (CVDs). It is indicated that the duration of AED therapy with some AEDs significantly accelerates the process of atherosclerosis. Most of AEDs increase levels of homocysteine (HCys) as well as may affect concentrations of new, nonclassical risk factors for atherosclerosis, that is, asymmetric dimethylarginine (ADMA) and homoarginine (hArg). Because of the role of these parameters in the pathogenesis of CVD, knowledge of HCys, ADMA, and hArg concentrations in patients with epilepsia treated with AED, both pediatric and adult, appears to be of significant importance.
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Affiliation(s)
- Beata Sarecka-Hujar
- 1 Department of Pharmaceutical Technology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Izabela Szołtysek-Bołdys
- 2 Department of General and Inorganic Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Ilona Kopyta
- 3 Department of Pediatric Neurology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Barbara Dolińska
- 1 Department of Pharmaceutical Technology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Andrzej Sobczak
- 2 Department of General and Inorganic Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
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14
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El-Aziz Hammad D, Mahmoud A, Tawfik M, Abd-El-Naby S. A study of DNA damage in epileptic children treated with valproic acid or carbamazepine. MENOUFIA MEDICAL JOURNAL 2019; 32:1078. [DOI: 10.4103/mmj.mmj_41_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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15
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Navarrete-Modesto V, Orozco-Suárez S, Feria-Romero IA, Rocha L. The molecular hallmarks of epigenetic effects mediated by antiepileptic drugs. Epilepsy Res 2019; 149:53-65. [DOI: 10.1016/j.eplepsyres.2018.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 10/16/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023]
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16
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Vidmar M, Grželj J, Mlinarič-Raščan I, Geršak K, Dolenc MS. Medicines associated with folate-homocysteine-methionine pathway disruption. Arch Toxicol 2018; 93:227-251. [PMID: 30499019 DOI: 10.1007/s00204-018-2364-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022]
Abstract
Folate is vital for cell development and growth. It is involved in one-carbon transfer reactions essential for the synthesis of purines and pyrimidines. It also acts in conjunction with cobalamin (vitamin B12) as a fundamental cofactor in the remethylation cycle that converts homocysteine to methionine. A deficiency in folate or vitamin B12 can lead to elevated homocysteine level, which has been identified as an independent risk factor in several health-related conditions. Adequate folate levels are essential in women of childbearing age and in pregnant women, and folate deficiency is associated with several congenital malformations. Low folate levels can be caused by dietary deficiencies, a genetic predisposition or treatment with medicines that affect folate concentration. Women who are pregnant or of child-bearing age commonly use medicines, so it is important to identify the basic biochemical mechanisms by which medicines interfere with the folate-homocysteine-methionine pathway. This review focuses on prescription medicines associated with folate disruption. It also summarizes their undesirable/toxic effects. Recommendations regarding folate supplementation during medical therapy are also reviewed.
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Affiliation(s)
- M Vidmar
- Research Unit, Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, Šlajmarjeva 3, Ljubljana, Slovenia.,University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, Ljubljana, Slovenia
| | - J Grželj
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, Ljubljana, Slovenia.,Krka, d.d., Novo mesto, Šmarješka 6, Novo mesto, Slovenia
| | - I Mlinarič-Raščan
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, Ljubljana, Slovenia
| | - K Geršak
- Research Unit, Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, Šlajmarjeva 3, Ljubljana, Slovenia
| | - M Sollner Dolenc
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, Ljubljana, Slovenia.
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17
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Husebye ESN, Gilhus NE, Riedel B, Spigset O, Daltveit AK, Bjørk MH. Verbal abilities in children of mothers with epilepsy: Association to maternal folate status. Neurology 2018; 91:e811-e821. [PMID: 30068633 PMCID: PMC6133626 DOI: 10.1212/wnl.0000000000006073] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 05/24/2018] [Indexed: 12/12/2022] Open
Abstract
Objective To examine the effect of maternal folic acid supplementation and maternal plasma folate and antiepileptic drug (AED) concentrations on language delay in AED-exposed children of mothers with epilepsy. Methods Children of mothers with and without epilepsy enrolled from 1999 to 2008 in the Norwegian Mother and Child Cohort study were included. Information on medical history, AED use, and folic acid supplementation during pregnancy was collected from parent-completed questionnaires. Maternal plasma folate and maternal plasma and umbilical cord AED concentrations were measured in blood samples from gestational weeks 17 to 19 and immediately after birth, respectively. Language development at 18 and 36 months was evaluated by the Ages and Stages Questionnaires. Results A total of 335 AED-exposed children of mothers with epilepsy and 104,222 children of mothers without epilepsy were surveyed. For those with no maternal periconceptional folic acid supplementation, the fully adjusted odds ratio (OR) for language delay in AED-exposed children compared to the controls at 18 months was 3.9 (95% confidence interval [CI] 1.9–7.8, p < 0.001) and at 36 months was 4.7 (95% CI 2.0–10.6, p < 0.001). When folic supplementation was used, the corresponding ORs for language delay were 1.7 (95% CI 1.2–2.6, p = 0.01) and 1.7 (95% CI 0.9–3.2, p = 0.13), respectively. The positive effect of folic acid supplement use on language delay in AED-exposed children was significant only when supplement was used in the period from 4 weeks before the pregnancy and until the end of the first trimester. Conclusion Folic acid use early in pregnancy may have a preventive effect on language delay associated with in utero AED exposure.
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Affiliation(s)
- Elisabeth Synnøve Nilsen Husebye
- From the Department of Clinical Medicine (E.S.N.H., N.E.G., M.H.B.), Section for Neurology, Department of Clinical Science (B.R.), and Department of Global Public Health and Primary Care (A.K.D.), University of Bergen; Department of Neurology (E.S.N.H., N.E.G., M.H.B.) and Laboratory of Clinical Biochemistry (B.R.), Section of Clinical Pharmacology, Haukeland University Hospital, Bergen; Department of Clinical Pharmacology (O.S.), St. Olav University Hospital; Department of Clinical and Molecular Medicine (O.S.), Norwegian University of Science and Technology, Trondheim; and Department of Health Registries (A.K.D.), Norwegian Institute of Public Health, Bergen, Norway.
| | - Nils Erik Gilhus
- From the Department of Clinical Medicine (E.S.N.H., N.E.G., M.H.B.), Section for Neurology, Department of Clinical Science (B.R.), and Department of Global Public Health and Primary Care (A.K.D.), University of Bergen; Department of Neurology (E.S.N.H., N.E.G., M.H.B.) and Laboratory of Clinical Biochemistry (B.R.), Section of Clinical Pharmacology, Haukeland University Hospital, Bergen; Department of Clinical Pharmacology (O.S.), St. Olav University Hospital; Department of Clinical and Molecular Medicine (O.S.), Norwegian University of Science and Technology, Trondheim; and Department of Health Registries (A.K.D.), Norwegian Institute of Public Health, Bergen, Norway
| | - Bettina Riedel
- From the Department of Clinical Medicine (E.S.N.H., N.E.G., M.H.B.), Section for Neurology, Department of Clinical Science (B.R.), and Department of Global Public Health and Primary Care (A.K.D.), University of Bergen; Department of Neurology (E.S.N.H., N.E.G., M.H.B.) and Laboratory of Clinical Biochemistry (B.R.), Section of Clinical Pharmacology, Haukeland University Hospital, Bergen; Department of Clinical Pharmacology (O.S.), St. Olav University Hospital; Department of Clinical and Molecular Medicine (O.S.), Norwegian University of Science and Technology, Trondheim; and Department of Health Registries (A.K.D.), Norwegian Institute of Public Health, Bergen, Norway
| | - Olav Spigset
- From the Department of Clinical Medicine (E.S.N.H., N.E.G., M.H.B.), Section for Neurology, Department of Clinical Science (B.R.), and Department of Global Public Health and Primary Care (A.K.D.), University of Bergen; Department of Neurology (E.S.N.H., N.E.G., M.H.B.) and Laboratory of Clinical Biochemistry (B.R.), Section of Clinical Pharmacology, Haukeland University Hospital, Bergen; Department of Clinical Pharmacology (O.S.), St. Olav University Hospital; Department of Clinical and Molecular Medicine (O.S.), Norwegian University of Science and Technology, Trondheim; and Department of Health Registries (A.K.D.), Norwegian Institute of Public Health, Bergen, Norway
| | - Anne Kjersti Daltveit
- From the Department of Clinical Medicine (E.S.N.H., N.E.G., M.H.B.), Section for Neurology, Department of Clinical Science (B.R.), and Department of Global Public Health and Primary Care (A.K.D.), University of Bergen; Department of Neurology (E.S.N.H., N.E.G., M.H.B.) and Laboratory of Clinical Biochemistry (B.R.), Section of Clinical Pharmacology, Haukeland University Hospital, Bergen; Department of Clinical Pharmacology (O.S.), St. Olav University Hospital; Department of Clinical and Molecular Medicine (O.S.), Norwegian University of Science and Technology, Trondheim; and Department of Health Registries (A.K.D.), Norwegian Institute of Public Health, Bergen, Norway
| | - Marte Helene Bjørk
- From the Department of Clinical Medicine (E.S.N.H., N.E.G., M.H.B.), Section for Neurology, Department of Clinical Science (B.R.), and Department of Global Public Health and Primary Care (A.K.D.), University of Bergen; Department of Neurology (E.S.N.H., N.E.G., M.H.B.) and Laboratory of Clinical Biochemistry (B.R.), Section of Clinical Pharmacology, Haukeland University Hospital, Bergen; Department of Clinical Pharmacology (O.S.), St. Olav University Hospital; Department of Clinical and Molecular Medicine (O.S.), Norwegian University of Science and Technology, Trondheim; and Department of Health Registries (A.K.D.), Norwegian Institute of Public Health, Bergen, Norway
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18
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Chen X, Peng X, Wang L, Fu X, Zhou JX, Zhu B, Luo J, Wang X, Xiao Z. Association of RASgrf1 methylation with epileptic seizures. Oncotarget 2018; 8:46286-46297. [PMID: 28611277 PMCID: PMC5542267 DOI: 10.18632/oncotarget.18000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/11/2017] [Indexed: 11/25/2022] Open
Abstract
DNA methylation, one of the mechanisms of epigenetic regulation, has been suggested to be related with epilepsy. RASgrf1 is a paternally imprinted gene and has a differentially methylated region (DMR) at the promoter that can silence gene expression. We have previously observed the down-regulation of RASgrf1 in the temporal neocortex of epilepsy patients and in the hippocampus of epileptic animals. Here, we further explored the dynamic change (1-day acute period, 10-day latent period and 45-day chronic phase) of DNA methylation and RASgrf1 expression after acute epileptic seizures in kainic acid (KA)-treated mice, and we observed the impact of N-phthalyl-L-tryptophan (RG108), a DNA methyltransferase (DNMT) inhibitor, on an acute epileptic model by polymerase chain reaction (PCR), western blotting, and bisulfite sequencing PCR (BSP). The results directly showed that the methylation of the RASgrf1 promoter gradually increased and reached a maximal level at the latent period, with subsequent suppression of RASgrf1 mRNA and protein expression levels, which reached a minimum level in the chronic phase. RG108 inhibited the increased methylation of the RASgrf1 gene, with significant inhibition occurring at the latent period, and restored RASgrf1 expression levels in the chronic phase. In addition, we demonstrated that RG108 could suppress acute epileptic seizures in KA-treated mice and epileptic discharges in 4-aminopyridine (4-AP)-treated hippocampal slices. These findings demonstrate that RASgrf1 is closely associated with epilepsy via the aberrant methylation of RASgrf1, and regulating the methylation status of relevant genes might be an intriguing topic in future research on epilepsy.
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Affiliation(s)
- Xiaoni Chen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.,Department of Neurology, Xi'an Third Hospital, Shanxi 710000, China
| | - Xi Peng
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Liang Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xinwei Fu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.,Department of Neurology, The Third Hospital of Mianyang, Sichuan 621000, China
| | - Ji Xiu Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Binglin Zhu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jing Luo
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xuefeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zheng Xiao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Ni G, Qin J, Chen Z, Li H, Zhou J, Huang M, Zhou L. Associations between genetic variation in one-carbon metabolism and leukocyte DNA methylation in valproate-treated patients with epilepsy. Clin Nutr 2017; 37:308-312. [PMID: 28161091 DOI: 10.1016/j.clnu.2017.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 01/06/2017] [Accepted: 01/09/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Valproate (VPA) as a first-line antiepileptic drug is useful for the most types of epileptic seizure treatment. Previous studies observed that VPA influenced one-carbon metabolism (OCM), consequently, DNA methylation. However, other individual genetic variations, as well as VPA, modify DNA methylation. OBJECTIVE In this study, we investigated associations between genetic variations in OCM and leukocyte DNA methylation in VPA-treated patients with epilepsy. METHODS This was a cross-sectional study of 101 epileptic patients who underwent VPA monotherapy and 68 healthy controls. All subjects were measured OCM-related nutrients (folate, homocysteine and vitamin B12), and DNA methylation of specific regions were analyzed. Furthermore, we examined the associations between genetic variations in OCM and DNA methylation levels in epileptic patients. RESULTS VPA-treated patients with epilepsy exhibited both higher serum homocysteine and vitaminB12 levels and lower folate levels relative to controls (P = 0.018, P = 0.003, P < 0.001 respectively), the methylation level of the MTHFR amplicon was significantly lower in the VPA group compared with those in the controls (P = 0.043). VPA-treated epileptic patients carrying the T-allele of methylenetetrahydrofolate reductase (MTHFR) c.677C>T showed higher serum Hcy levels than those observed in the 677CC group (P < 0.01). Epileptic patients who carried G-allele of methionine synthase (MTR) c.2756A>G showed significantly lower MTHFR amplicon methylation levels compared to carriers of the wild-type MTR 2756AA genotype (P = 0.028). CONCLUSION Our study provided evidence that the MTR c.2756A>G polymorphism is associated with MTHFR amplicon hypomethylation in VPA-treated patients with epilepsy.
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Affiliation(s)
- Guanzhong Ni
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Jiaming Qin
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Ziyi Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Hongliang Li
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Jueqian Zhou
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Min Huang
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Liemin Zhou
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
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How to interpret epigenetic association studies: a guide for clinicians. BONEKEY REPORTS 2016; 5:797. [PMID: 27195108 DOI: 10.1038/bonekey.2016.24] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/15/2016] [Indexed: 01/23/2023]
Abstract
Epigenetic mechanisms are able to alter gene expression, without altering DNA sequence, in a stable manner through cell divisions. They include, among others, the methylation of DNA cytosines and microRNAs and allow the cells to adapt to changing environmental conditions. In recent years, epigenetic association studies are providing new insights into the pathogenesis of complex disorders including prevalent skeletal disorders. Unlike the genome, the epigenome is cell and tissue specific and may change with age and a number of acquired factors. This poses particular difficulties for the design and interpretation of epigenetic studies, particularly those exploring the association of genome-wide epigenetic marks with disease phenotypes. In this report, we propose a framework to help in the critical appraisal of epigenetic association studies. In line with previous suggestions, we focus on the questions critical to appraise the validity of the study, to interpret the results and to assess the generalizability and relevance of the information.
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Fuso A, Iyer AM, van Scheppingen J, Maccarrone M, Scholl T, Hainfellner JA, Feucht M, Jansen FE, Spliet WG, Krsek P, Zamecnik J, Mühlebner A, Aronica E. Promoter-Specific Hypomethylation Correlates with IL-1β Overexpression in Tuberous Sclerosis Complex (TSC). J Mol Neurosci 2016; 59:464-70. [PMID: 27122151 PMCID: PMC4972849 DOI: 10.1007/s12031-016-0750-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 03/24/2016] [Indexed: 01/04/2023]
Abstract
In tuberous sclerosis complex (TSC), overexpression of numerous genes associated with inflammation has been observed. Among different proinflammatory cytokines, interleukin-1β (IL-1β) has been shown to be significantly involved in epileptogenesis and maintenance of seizures. Recent evidence indicates that IL-1β gene expression can be regulated by DNA methylation of its promoter. In the present study, we hypothesized that hypomethylation in the promoter region of the IL-1β gene may underlie its overexpression observed in TSC brain tissue. Bisulfite sequencing was used to study the methylation status of the promoter region of the IL-1β gene in TSC and control samples. We identified hypomethylation in the promoter region of the IL-1β gene in TSC samples. IL-1β is overexpressed in tubers, and gene expression is correlated with promoter hypomethylation at CpG and non-CpG sites. Our results provide the first evidence of epigenetic modulation of the IL-1β signaling in TSC. Thus, strategies that target epigenetic alterations could offer new therapeutic avenues to control the persistent activation of interleukin-1β-mediated inflammatory signaling in TSC brain.
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Affiliation(s)
- A Fuso
- European Center for Brain Research (CERC)/IRCCS Santa Lucia Foundation, Via del Fosso di Fiorano 64-65, 00143, Rome, Italy
| | - A M Iyer
- Department of (Neuro)Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J van Scheppingen
- Department of (Neuro)Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M Maccarrone
- European Center for Brain Research (CERC)/IRCCS Santa Lucia Foundation, Via del Fosso di Fiorano 64-65, 00143, Rome, Italy.,Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - T Scholl
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - J A Hainfellner
- Institute of Neurology, Medical University Vienna, Vienna, Austria
| | - M Feucht
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - F E Jansen
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W G Spliet
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Krsek
- Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - J Zamecnik
- Department of Pathology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - A Mühlebner
- Department of (Neuro)Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - E Aronica
- Department of (Neuro)Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands. .,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
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