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Riaz S, Emam S, Wang T, Gniadecki R. Negative impact of comorbidities on all-cause mortality of patients with psoriasis is partially alleviated by biologic treatment: A real-world case-control study. J Am Acad Dermatol 2024; 91:43-50. [PMID: 38387852 DOI: 10.1016/j.jaad.2024.01.078] [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: 07/26/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Cardiovascular comorbidities are believed to cause higher mortality in psoriasis patients. Conversely, systemic therapy may improve overall survival. OBJECTIVE To evaluate the impact of different comorbidities and therapy on mortality risk of psoriasis patients in the entire population of Alberta, Canada (population 4.37 million). METHODS Cohorts of psoriasis cases (n = 18,618) and controls (ambulatory patients matched 1:3 by age and sex) were retrieved from Alberta Health Services Data Repository of Reporting database within the period 2012 to 2019. Cases were stratified according to Charlson Comorbidity Index, and the type of therapy. RESULTS Mortality in psoriasis cohort was significantly higher than in the controls (median age of death 72.0 years vs 74.4 years, respectively). Charlson Comorbidity Index and comorbidities were strong predictors of mortality, in particular drug induced liver injury (hazard ratio 1.8, affective bipolar disease, hazard ratio 1.6, and major cardiovascular diseases. Mortality was lower in patients treated with biologics (hazard ratio 0.54). LIMITATIONS Some factors (psoriasis type and severity, response to treatment, smoking, alcohol intake) could not be measured. CONCLUSIONS Hepatic injury, psychiatric affective disorders and cardiovascular disease were major determinants of overall survival in psoriasis. Biologic therapy was associated with a reduced mortality risk.
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Affiliation(s)
- Saba Riaz
- Division of Dermatology, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Sepideh Emam
- Division of Dermatology, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Ting Wang
- Provincial Research Data Services-Alberta Health Services, Edmonton, Alberta, Canada
| | - Robert Gniadecki
- Division of Dermatology, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada.
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Liang W, Zhong K, Lai T, Zeng Y, Huang Z, Zhou J, Huang J, Shi Z, Zhang J, Ding F. Causal relationship between depression and metabolic dysfunction-associated steatotic liver disease: a bidirectional Mendelian randomized study. Front Psychiatry 2024; 15:1384003. [PMID: 38903646 PMCID: PMC11187267 DOI: 10.3389/fpsyt.2024.1384003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/08/2024] [Indexed: 06/22/2024] Open
Abstract
Background With the global rise in obesity, metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the most common chronic liver disease. Concurrently, depression is a highly prevalent mental disorder. As the incidence of MASLD and depression continues to increase, a growing body of research indicates a potential association between the two conditions. However, the direction of causality between depression and MASLD remains uncertain. To address this gap, our study utilizes a two-sample Mendelian randomization (MR) approach to explore the bidirectional causal relationship between depression and MASLD. Methods We extracted single nucleotide polymorphisms (SNPs) associated with depression and MASLD from pooled data of genome-wide association studies (GWAS). A comprehensive assessment of possible causality was also performed. Possible mediating effects of liver enzymes on MASLD were also assessed. Results A total of three GWAS pooled data on depression as well as GWAS data related to MASLD and GWAS data on four liver enzymes were used in this study. Our findings indicated a strong causal relationship between depression and MASLD (OR, 1.557; 95% CI, 1.097-2.211; P = 0.016). And we found a mediating effect of gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST). ALT 10% (95% CI: 7% - 13%, P< 0.0002). AST, 4.14% (95% CI: 2.34% - 5.94%, P < 0.05). GGT 0.19% (95% CI: 0.15% - 0.22%, P< 0.000000002). However, we did not find a mediating effect of alkaline phosphatase (ALP). Our inverse MR analysis did not reveal any causal relationship between MASLD and depression. Conclusions The MR analysis revealed a positive causal relationship between depression and MASLD, while no reverse causal relationship was identified. Liver enzymes may mediate the role between depression and MASLD.
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Affiliation(s)
- Weiyu Liang
- Research Centre of Basic Integrative Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kunting Zhong
- Research Centre of Basic Integrative Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tingting Lai
- Research Centre of Basic Integrative Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuhao Zeng
- Research Centre of Basic Integrative Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhanhui Huang
- Traditional Chinese Medicine Department, Yihui Fund Hospital, Shanwei, China
| | - Jiqing Zhou
- Research Centre of Basic Integrative Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jin Huang
- Clinic Department of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhenni Shi
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jin Zhang
- Research Centre of Basic Integrative Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fuping Ding
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
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3
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Ran S, Peng R, Guo Q, Cui J, Chen G, Wang Z. Bupleurum in Treatment of Depression Disorder: A Comprehensive Review. Pharmaceuticals (Basel) 2024; 17:512. [PMID: 38675471 PMCID: PMC11054835 DOI: 10.3390/ph17040512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
The incidence of depression has been steadily rising in recent years, making it one of the most prevalent mental illnesses. As the pursuit of novel antidepressant drugs captivates the pharmaceutical field, the therapeutic efficacy of Traditional Chinese Medicine (TCM) has been widely explored. Chaihu (Bupleurum) has been traditionally used for liver conditions such as hepatitis, liver inflammation, liver fibrosis, and liver cancer. It is believed to have hepatoprotective effects, promoting liver cell regeneration and protecting against liver damage. In addition, Bupleurum has also been used as a Jie Yu (depression-relieving) medicine in China, Japan, Republic of Korea, and other Asian countries for centuries. This review article aims to summarize the research conducted on the antidepressant properties and mechanisms of Bupleurum, as well as discuss the potential of TCM formulas containing Bupleurum. This review highlights various antidepressant ingredients isolated from Bupleurum, including saikosaponin A, saikosaponin D, rutin, puerarin, and quercetin, each with distinct mechanisms of action. Additionally, Chinese herb prescriptions and extracts containing Bupleurum, such as Chaihu Shugansan, Xiaoyaosan, and Sinisan, are also included due to their demonstrated antidepressant effects. This review reveals that these Bupleurum compounds exhibit antidepressant effects through the regulation of neurotransmitter mechanisms (such as 5-HT and DA), the NMDA (N-methyl-D-aspartate) system, brain-derived neurotrophic factor (BDNF), and other intracellular signaling pathways. Collectively, this comprehensive review provides insights into the multiple applications of Bupleurum in the treatment of depression and highlights its potential as an alternative or complementary approach to traditional therapies. However, it is essential to consider the potential adverse effects and clinical restrictions of Bupleurum despite its promising potential. Further research is needed to elucidate its specific mechanisms of action and evaluate its effectiveness in human subjects.
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Affiliation(s)
| | | | | | | | - Gang Chen
- Interdisciplinary Institute for Personalized Medicine in Brain Disorders, School of Traditional Chinese Medicine, Jinan University, Guangzhou 510632, China; (S.R.); (R.P.); (Q.G.); (J.C.)
| | - Ziying Wang
- Interdisciplinary Institute for Personalized Medicine in Brain Disorders, School of Traditional Chinese Medicine, Jinan University, Guangzhou 510632, China; (S.R.); (R.P.); (Q.G.); (J.C.)
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Abegg VF, Panajatovic MV, Mancuso RV, Allard JA, Duthaler U, Odermatt A, Krähenbühl S, Bouitbir J. Mechanisms of hepatocellular toxicity associated with the components of St. John's Wort extract hypericin and hyperforin in HepG2 and HepaRG cells. Toxicol Lett 2024; 393:1-13. [PMID: 38219807 DOI: 10.1016/j.toxlet.2024.01.008] [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: 10/16/2023] [Revised: 12/19/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
St. John's Wort preparations are used for the treatment of mild to moderate depression. They are usually well tolerated but can cause adverse reactions including liver toxicity in rare cases. To date, the mechanism(s) underlying the hepatotoxicity of St. John's Wort extracts are poorly investigated. We studied the hepatocellular toxicity of hypericin and hyperforin as the two main ingredients of St. John's Wort extracts in HepG2 and HepaRG cells and compared the effects to citalopram (a synthetic serotonin uptake inhibitor) with a special focus on mitochondrial toxicity and oxidative stress. In HepG2 cells, hypericin was membrane-toxic at 100 µM and depleted ATP at 20 µM. In HepaRG cells, ATP depletion started at 5 µM. In comparison, hyperforin and citalopram were not toxic up to 100 µM. In HepG2 cells, hypericin decreased maximal respiration starting at 2 µM and mitochondrial ATP formation starting at 10 µM but did not affect glycolytic ATP production. Hypericin inhibited the activity of complex I, II and IV of the electron transfer system and caused mitochondrial superoxide accumulation in cells. The protein expression of mitochondrial superoxide dismutase 2 (SOD2) and thioredoxin 2 (TRX2) and total and reduced glutathione decreased in cells exposed to hypericin. Finally, hypericin diminished the mitochondrial DNA copy number and caused cell necrosis but not apoptosis. In conclusion, hypericin, but not hyperforin or citalopram, is a mitochondrial toxicant at low micromolar concentrations. This mechanism may contribute to the hepatotoxicity occasionally observed in susceptible patients treated with St. John's Wort preparations.
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Affiliation(s)
- Vanessa Fabienne Abegg
- Division of Pharmaceutical Biology, Department of Pharmaceutical Sciences, University of Basel, Switzerland
| | | | | | - Julien Arthur Allard
- Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Switzerland
| | - Urs Duthaler
- Division of Clinical Pharmacology & Toxicology, University Hospital, Basel, Switzerland
| | - Alex Odermatt
- Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Switzerland
| | - Stephan Krähenbühl
- Division of Clinical Pharmacology & Toxicology, University Hospital, Basel, Switzerland
| | - Jamal Bouitbir
- Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Switzerland.
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Khalil SM, MacKenzie KR, Maletic-Savatic M, Li F. Metabolic bioactivation of antidepressants: advance and underlying hepatotoxicity. Drug Metab Rev 2024; 56:97-126. [PMID: 38311829 PMCID: PMC11118075 DOI: 10.1080/03602532.2024.2313967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/30/2024] [Indexed: 02/06/2024]
Abstract
Many drugs that serve as first-line medications for the treatment of depression are associated with severe side effects, including liver injury. Of the 34 antidepressants discussed in this review, four have been withdrawn from the market due to severe hepatotoxicity, and others carry boxed warnings for idiosyncratic liver toxicity. The clinical and economic implications of antidepressant-induced liver injury are substantial, but the underlying mechanisms remain elusive. Drug-induced liver injury may involve the host immune system, the parent drug, or its metabolites, and reactive drug metabolites are one of the most commonly referenced risk factors. Although the precise mechanism by which toxicity is induced may be difficult to determine, identifying reactive metabolites that cause toxicity can offer valuable insights for decreasing the bioactivation potential of candidates during the drug discovery process. A comprehensive understanding of drug metabolic pathways can mitigate adverse drug-drug interactions that may be caused by elevated formation of reactive metabolites. This review provides a comprehensive overview of the current state of knowledge on antidepressant bioactivation, the metabolizing enzymes responsible for the formation of reactive metabolites, and their potential implication in hepatotoxicity. This information can be a valuable resource for medicinal chemists, toxicologists, and clinicians engaged in the fields of antidepressant development, toxicity, and depression treatment.
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Affiliation(s)
- Saleh M. Khalil
- Center for Drug Discovery, Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kevin R. MacKenzie
- Center for Drug Discovery, Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030, USA
- NMR and Drug Metabolism Core, Advanced Technology Cores, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mirjana Maletic-Savatic
- Department of Pediatrics, Baylor College of Medicine; Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Feng Li
- Center for Drug Discovery, Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030, USA
- NMR and Drug Metabolism Core, Advanced Technology Cores, Baylor College of Medicine, Houston, TX 77030, USA
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Mu W, Xu G, Wang Z, Li Q, Sun S, Qin Q, Li Z, Shi W, Dai W, Zhan X, Wang J, Bai Z, Xiao X. Tricyclic antidepressants induce liver inflammation by targeting NLRP3 inflammasome activation. Cell Commun Signal 2023; 21:123. [PMID: 37231437 DOI: 10.1186/s12964-023-01128-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 04/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Idiosyncratic drug-induced liver injury (IDILI) is common in hepatology practices and, in some cases, lethal. Increasing evidence show that tricyclic antidepressants (TCAs) can induce IDILI in clinical applications but the underlying mechanisms are still poorly understood. METHODS We assessed the specificity of several TCAs for NLRP3 inflammasome via MCC950 (a selective NLRP3 inhibitor) pretreatment and Nlrp3 knockout (Nlrp3-/-) BMDMs. Meanwhile, the role of NLRP3 inflammasome in the TCA nortriptyline-induced hepatotoxicity was demonstrated in Nlrp3-/- mice. RESULTS We reported here that nortriptyline, a common TCA, induced idiosyncratic hepatotoxicity in a NLRP3 inflammasome-dependent manner in mildly inflammatory states. In parallel in vitro studies, nortriptyline triggered the inflammasome activation, which was completely blocked by Nlrp3 deficiency or MCC950 pretreatment. Furthermore, nortriptyline treatment led to mitochondrial damage and subsequent mitochondrial reactive oxygen species (mtROS) production resulting in aberrant activation of the NLRP3 inflammasome; a selective mitochondrial ROS inhibitor pretreatment dramatically abrogated nortriptyline-triggered the NLRP3 inflammasome activation. Notably, exposure to other TCAs also induced aberrant activation of the NLRP3 inflammasome by triggering upstream signaling events. CONCLUSION Collectively, our findings revealed that the NLRP3 inflammasome may act as a crucial target for TCA agents and suggested that the core structures of TCAs may contribute to the aberrant activation of NLRP3 inflammasome induced by them, an important factor involved in the pathogenesis of TCA-induced liver injury. Video Abstract.
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Affiliation(s)
- Wenqing Mu
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, 100039, China
- State Key Laboratory of Radiation Medicine and Protection, Institutes for Translational Medicine, Soochow University, Suzhou, 215123, Jiangsu, China
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
| | - Guang Xu
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, 100039, China.
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China.
- Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.
| | - Zhilei Wang
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, 100039, China
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Qiang Li
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, 100039, China
- Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Siqiao Sun
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, 100039, China
- Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Qin Qin
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, 100039, China
- Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Zhiyong Li
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, 100039, China
- Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Wei Shi
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, 100039, China
- Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Wenzhang Dai
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, 100039, China
- Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Xiaoyan Zhan
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, 100039, China
- Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Jiabo Wang
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, 100039, China
- Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Zhaofang Bai
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, 100039, China.
- Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.
| | - Xiaohe Xiao
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, 100039, China.
- Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.
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Guo W, Yao X, Cui R, Yang W, Wang L. Mechanisms of paeoniaceae action as an antidepressant. Front Pharmacol 2023; 13:934199. [PMID: 36844911 PMCID: PMC9944447 DOI: 10.3389/fphar.2022.934199] [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: 05/02/2022] [Accepted: 08/05/2022] [Indexed: 02/10/2023] Open
Abstract
Paeoniflorin (PF) has been widely used for the treatment of depression in mice models, some Chinese herbal compound containing PF on treating depression, such as Xiaoyao San, Chaihu-Shugan-San, Danggui Shaoyao San etc. Many experiments are also verifying whether PF in these powders can be used as an effective component in the treatment of depression. Therefore, in this review the antidepressant effect of PF and its mechanism of action are outlined with particular focus on the following aspects: increasing the levels of monoamine neurotransmitters, inhibiting the HPA axis, promoting neuroprotection, enhancing neurogenesis in the hippocampus, and elevating levels of brain-derived neurotrophic factor (BDNF). This review may be helpful for the application of PF in the treatment of depression.
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Affiliation(s)
- Wanxu Guo
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, China
| | - Xiaoxiao Yao
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, China
| | - Ranji Cui
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, China
| | - Wei Yang
- *Correspondence: Wei Yang, ; Lei Wang,
| | - Lei Wang
- *Correspondence: Wei Yang, ; Lei Wang,
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González‐Muñoz M, Monserrat Villatoro J, Marín‐Serrano E, Stewart S, Bardón Rivera B, Marín J, Martínez de Soto L, Seco Meseguer E, Ramírez E. A case report of a drug-induced liver injury (DILI) caused by multiple antidepressants with causality established by the updated Roussel Uclaf causality assessment method (RUCAM) and in vitro testing. Clin Case Rep 2020; 8:3105-3109. [PMID: 33363890 PMCID: PMC7752543 DOI: 10.1002/ccr3.3348] [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: 01/17/2020] [Revised: 06/17/2020] [Accepted: 08/22/2020] [Indexed: 12/13/2022] Open
Abstract
A 56-year-old female patient was hospitalized because of a lack of response and poor tolerance to multiple antidepressants, which included an episode of DILI. During hospitalization, the patient suffered another episode of DILI. Causality was assessed both by RUCAM and Lymphocyte Transformation Test, allowing to identify a safer medication.
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Affiliation(s)
- Miguel González‐Muñoz
- Immunology DepartmentLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazMadridEspaña
| | - Jaime Monserrat Villatoro
- Clinical Pharmacology DepartmentFacultad de MedicinaLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazUniversidad Autónoma de MadridMadridEspaña
| | - Eva Marín‐Serrano
- Gastroenterology and Hepatology DepartmentLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazMadridEspaña
| | - Stefan Stewart
- Clinical Pharmacology DepartmentFacultad de MedicinaLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazUniversidad Autónoma de MadridMadridEspaña
| | - Belén Bardón Rivera
- Psiquiatry DepartmentLa Paz‐Cantoblanco‐Carlos III University Hospital, IdiPazMadridEspaña
| | - Jesús Marín
- Psiquiatry DepartmentLa Paz‐Cantoblanco‐Carlos III University Hospital, IdiPazMadridEspaña
| | - Lucía Martínez de Soto
- Clinical Pharmacology DepartmentFacultad de MedicinaLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazUniversidad Autónoma de MadridMadridEspaña
| | - Enrique Seco Meseguer
- Clinical Pharmacology DepartmentFacultad de MedicinaLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazUniversidad Autónoma de MadridMadridEspaña
| | - Elena Ramírez
- Clinical Pharmacology DepartmentFacultad de MedicinaLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazUniversidad Autónoma de MadridMadridEspaña
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Zhu YL, Li SL, Zhu CY, Wang W, Zuo WF, Qiu XJ. Metabolomics analysis of the antidepressant prescription Danzhi Xiaoyao Powder in a rat model of Chronic Unpredictable Mild Stress (CUMS). JOURNAL OF ETHNOPHARMACOLOGY 2020; 260:112832. [PMID: 32387465 DOI: 10.1016/j.jep.2020.112832] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/24/2020] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Danzhi Xiaoyao Powder (DZXY) is a classical prescription, that has been extensively used in traditional Chinese medicine (TMC) to treat depression for many years. However, the mechanism of DZXY is still unclear. AIM OF THE STUDY The aim was to investigate the mechanism of the antidepressant effect of DZXY on a rat model of chronic unpredictable mild stress (CUMS). MATERIALS AND METHODS Forty male SD (Sprague-Dawley) rats with similar open field test (OFT) results were randomLy divided into a control group (n = 10) and an experimental group (n = 30). A depression model was established in the experimental group using the CUMS method. After the CUMS model was established successfully, the rats were randomLy divided into a depression model group and a DZXY group. The DZXY group was fed DZXY, while the depression model group and control group were given an equal amount of 0.5% sodium carboxymethyl cellulose suspension. Intragastric administration was performed once daily for 14 consecutive days. Animal weight, the sugar preference test, the open field test and the forced swimming test were used to evaluate the modeling effect and the antidepressant effect of DZXY. After the experiment, the plasma of rats was collected and the changes in plasma metabolites were analyzed by UPLC/Q-TOF-MS. The UPLC/Q-TOF-MS spectra data were evaluated by pattern recognition analysis to determine the changes in endogenous metabolites in the rat plasma samples. RESULTS The results of the behavioral investigation showed that the rat model of depression was successfully replicated and that DZXY had an antidepressant effect. Using the UPLC-MS/MS metabolomics platform, partial least squares (PLS) and orthogonal partial least squares (OPLS), metabolic profile models (R2 and Q2 ≥ 0.5) of rat plasma were successfully constructed. The model could distinguish among the control group, the depression model group and the DZXY group. Finally, 38 differential metabolites were identified in the plasma. According to KEGG (http://www.kegg.jp) pathway analysis, amino acid metabolism, lipid metabolism, purine metabolism, the prolactin signaling pathway and bile secretion were enriched and represented the main metabolic pathways influenced in the plasma. CONCLUSIONS This study successfully established a CUMS depression model. A total of 38 differential metabolites associated with depression were identified in the plasma of rats, 24 of which were modulated by DZXY. These results suggest that DZXY can improve excitability and play an antidepressant role by regulating phenylalanine metabolism, arachidonic acid metabolism, porphyrin metabolism, D-arginine and D-ornithine metabolism, steroid hormone biosynthesis, unsaturated fatty acid biosynthesis and steroid biosynthesis.
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MESH Headings
- Animals
- Antidepressive Agents/pharmacology
- Behavior, Animal/drug effects
- Biomarkers/blood
- Chromatography, High Pressure Liquid
- Depression/blood
- Depression/drug therapy
- Depression/psychology
- Disease Models, Animal
- Drugs, Chinese Herbal/pharmacology
- Energy Metabolism/drug effects
- Exploratory Behavior/drug effects
- Food Preferences/drug effects
- Male
- Metabolomics
- Motor Activity/drug effects
- Powders
- Rats, Sprague-Dawley
- Spectrometry, Mass, Electrospray Ionization
- Stress, Psychological/blood
- Stress, Psychological/drug therapy
- Stress, Psychological/psychology
- Tandem Mass Spectrometry
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Affiliation(s)
- Yong-Liang Zhu
- Medical College of Henan University of Science and Technology, Luoyang, 471023, PR China.
| | - Shuang-Long Li
- Medical College of Henan University of Science and Technology, Luoyang, 471023, PR China.
| | - Chun-Yang Zhu
- Medical College of Henan University of Science and Technology, Luoyang, 471023, PR China.
| | - Wan Wang
- Medical College of Henan University of Science and Technology, Luoyang, 471023, PR China.
| | - Wen-Fei Zuo
- Medical College of Henan University of Science and Technology, Luoyang, 471023, PR China.
| | - Xiang-Jun Qiu
- Medical College of Henan University of Science and Technology, Luoyang, 471023, PR China.
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Dodd S, Mitchell PB, Bauer M, Yatham L, Young AH, Kennedy SH, Williams L, Suppes T, Lopez Jaramillo C, Trivedi MH, Fava M, Rush AJ, McIntyre RS, Thase ME, Lam RW, Severus E, Kasper S, Berk M. Monitoring for antidepressant-associated adverse events in the treatment of patients with major depressive disorder: An international consensus statement. World J Biol Psychiatry 2018; 19:330-348. [PMID: 28984491 DOI: 10.1080/15622975.2017.1379609] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES These recommendations were designed to ensure safety for patients with major depressive disorder (MDD) and to aid monitoring and management of adverse effects during treatment with approved antidepressant medications. The recommendations aim to inform prescribers about both the risks associated with these treatments and approaches for mitigating such risks. METHODS Expert contributors were sought internationally by contacting representatives of key stakeholder professional societies in the treatment of MDD (ASBDD, CANMAT, WFSBP and ISAD). The manuscript was drafted through iterative editing to ensure consensus. RESULTS Adequate risk assessment prior to commencing pharmacotherapy, and safety monitoring during pharmacotherapy are essential to mitigate adverse events, optimise the benefits of treatment, and detect and assess adverse events when they occur. Risk factors for pharmacotherapy vary with individual patient characteristics and medication regimens. Risk factors for each patient need to be carefully assessed prior to initiating pharmacotherapy, and appropriate individualised treatment choices need to be selected. Some antidepressants are associated with specific safety concerns which were addressed. CONCLUSIONS Risks of adverse outcomes with antidepressant treatment can be managed through appropriate assessment and monitoring to improve the risk benefit ratio and improve clinical outcomes.
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Affiliation(s)
- Seetal Dodd
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia.,b Department of Psychiatry , University of Melbourne , Melbourne , Australia.,c Mental Health Drug and Alcohol Services , University Hospital Geelong, Barwon Health , Geelong , Australia.,d Orygen The National Centre of Excellence in Youth Mental Health , Parkville , Australia
| | - Philip B Mitchell
- f School of Psychiatry , University of New South Wales, and Black Dog Institute , Sydney , Australia
| | - Michael Bauer
- g Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Technische, Universität Dresden , Dresden , Germany
| | - Lakshmi Yatham
- h Department of Psychiatry , University of British Columbia , British Columbia , BC , Canada
| | - Allan H Young
- i Department of Psychological Medicine , Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK & South London and Maudsley NHS Foundation Trust , London , UK
| | - Sidney H Kennedy
- j Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Lana Williams
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia
| | - Trisha Suppes
- k Department of Psychiatry & Behavioral Sciences , School of Medicine, Stanford University , Stanford , CA , USA
| | | | - Madhukar H Trivedi
- m Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Maurizio Fava
- n Division of Clinical Research , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA
| | - A John Rush
- o Duke-National University of Singapore Medical School , Singapore , Singapore
| | - Roger S McIntyre
- j Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,p Mood Disorders Psychopharmacology Unit, University of Toronto , Toronto , ON , Canada.,q Brain and Cognition Discovery Foundation , Toronto , ON , Canada
| | - Michael E Thase
- r Department of Psychiatry, Perelman School of Medicine , University of Pennsylvania , Pennsylvania , PA , USA
| | - Raymond W Lam
- h Department of Psychiatry , University of British Columbia , British Columbia , BC , Canada
| | - Emanuel Severus
- g Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Technische, Universität Dresden , Dresden , Germany
| | - Siegfried Kasper
- s Department of Psychiatry and Psychotherapy , Medical University of Vienna , Wien , Austria
| | - Michael Berk
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia.,b Department of Psychiatry , University of Melbourne , Melbourne , Australia.,c Mental Health Drug and Alcohol Services , University Hospital Geelong, Barwon Health , Geelong , Australia.,d Orygen The National Centre of Excellence in Youth Mental Health , Parkville , Australia.,e The Florey Institute of Neuroscience and Mental Health , Parkville , Australia
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Wang SM, Han C, Bahk WM, Lee SJ, Patkar AA, Masand PS, Pae CU. Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review. Chonnam Med J 2018; 54:101-112. [PMID: 29854675 PMCID: PMC5972123 DOI: 10.4068/cmj.2018.54.2.101] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 01/19/2023] Open
Abstract
Randomized trials have shown that selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have better safety profiles than classical tricyclic antidepressants (TCAs). However, an increasing number of studies, including meta-analyses, naturalistic studies, and longer-term studies suggested that SSRIs and SNRIs are no less safe than TCAs. We focused on comparing the common side effects of TCAs with those of newer generation antidepressants including SSRIs, SNRIs, mirtazapine, and bupropion. The main purpose was to investigate safety profile differences among drug classes rather than the individual antidepressants, so studies containing comparison data on drug groups were prioritized. In terms of safety after overdose, the common belief on newer generation antidepressants having fewer side effects than TCAs appears to be true. TCAs were also associated with higher drop-out rates, lower tolerability, and higher cardiac side-effects. However, evidence regarding side effects including dry mouth, gastrointestinal side effects, hepatotoxicity, seizure, and weight has been inconsistent, some studies demonstrated the superiority of SSRIs and SNRIs over TCAs, while others found the opposite. Some other side effects such as sexual dysfunction, bleeding, and hyponatremia were more prominent with either SSRIs or SNRIs.
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Affiliation(s)
- Sheng-Min Wang
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea.,International Health Care Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Changsu Han
- Department of Psychiatry, Korea University, College of Medicine, Seoul, Korea
| | - Won-Myoung Bahk
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soo-Jung Lee
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ashwin A Patkar
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Chi-Un Pae
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.,Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
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12
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He D, Sai X, Wang N, Li X, Wang L, Xu Y. Camellia euphlebia exerts its antidepressant-like effect via modulation of the hypothalamic-pituitary-adrenal axis and brain monoaminergic systems. Metab Brain Dis 2018; 33:301-312. [PMID: 29247282 DOI: 10.1007/s11011-017-0167-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 12/11/2017] [Indexed: 01/20/2023]
Abstract
Camellia euphlebia (family, Theaceae) is a Chinese folk medicine, known for its multiple pharmacological properties. The present study aimed to provide further insights into the therapeutic basis of C. euphlebia using several animal behavioral tests and physiological indexes. Tail suspension test, forced swimming test, open-field test, chronic unpredictable mild stress (CUMS), reversal of reserpine-induced hypothermia and palpebral ptosis, and 5-hydroxytryptophane-induced head-twitch response were used to evaluate the antidepressant effect of aqueous extract of Camellia euphlebia (AEC) on mice. The possible underlying mechanism was explored by investigating the changes associated with several parameters of animal behavior, as well as the changes in monoamine neurotransmitter and stress hormone levels in these animals during the tests. Mice administered AEC at 100 and 200 mg/kg/day doses for 7 days showed significantly reduced immobility duration in forced swimming test and tail suspension test, whilst exhibiting no apparent changes in locomotor activity. Additionally, administration of AEC also effectively antagonized reserpine-induced palpebral ptosis and hypothermia and enhanced 5-hydroxytryptophane-induced head-twitch response. AEC significantly elevated the levels of serotonin, noradrenaline and dopamine in the blood and brain compared to non-treated mice. After 28 days of administration, the maximum AEC dose (100 mg/kg/day) significantly reversed CUMS-induced inhibition of weight gain and sucrose intake, while decreasing the levels of plasma adrenocorticotropic hormone and serum corticosterone. The antidepressant effect of AEC appeared to involve the alteration of hypothalamic-pituitary-adrenal axis and monoaminergic systems.
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Affiliation(s)
- Dongye He
- School of Life Science and Biotechnology, Dalian University of Technology, Dalian, 116024, China
- Ministry of Education Center for Food Safety of Animal Origin, Dalian University of Technology, Dalian, 116620, China
| | - Xuan Sai
- School of Life Science and Biotechnology, Dalian University of Technology, Dalian, 116024, China
- Ministry of Education Center for Food Safety of Animal Origin, Dalian University of Technology, Dalian, 116620, China
| | - Ning Wang
- School of Life Science and Biotechnology, Dalian University of Technology, Dalian, 116024, China
- Ministry of Education Center for Food Safety of Animal Origin, Dalian University of Technology, Dalian, 116620, China
| | - Xiaoyu Li
- School of Life Science and Biotechnology, Dalian University of Technology, Dalian, 116024, China
- Ministry of Education Center for Food Safety of Animal Origin, Dalian University of Technology, Dalian, 116620, China
| | - Lili Wang
- School of Life Science and Biotechnology, Dalian University of Technology, Dalian, 116024, China
- Ministry of Education Center for Food Safety of Animal Origin, Dalian University of Technology, Dalian, 116620, China
| | - Yongping Xu
- School of Life Science and Biotechnology, Dalian University of Technology, Dalian, 116024, China.
- Ministry of Education Center for Food Safety of Animal Origin, Dalian University of Technology, Dalian, 116620, China.
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13
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Teschke R, Danan G. Causality Assessment Methods in Drug-Induced Liver Injury. METHODS IN PHARMACOLOGY AND TOXICOLOGY 2018. [DOI: 10.1007/978-1-4939-7677-5_27] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Violle N, Rozan P, Demais H, Nyvall Collen P, Bisson JF. Evaluation of the antidepressant- and anxiolytic-like effects of a hydrophilic extract from the green seaweed Ulva sp. in rats. Nutr Neurosci 2017; 21:248-256. [PMID: 28102110 DOI: 10.1080/1028415x.2016.1276704] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The green seaweed Ulva sp. contains a large amount of ulvans, a family of sulphated polysaccharides. The present study was designed to investigate in rats the antidepressant- and anxiolytic-like effects of a hydrophilic extract of Ulva sp. (MSP) containing about 45% of ulvans. METHODS After a 14-day administration of MSP at doses of 10, 20 and 40 mg/kg/day, 48 and 60 male adult Wistar rats were respectively tested in the elevated plus-maze (EPM) and the forced swimming test (FST). In the FST, MSP effects were compared to the reference antidepressant drug imipramine (IMI) (10 mg/kg/day). Acute and sub-chronic toxicities of the extract were also assessed in male and female rats following OECD guidelines. RESULTS MSP treatment did not modify anxiety-related behaviour in the EPM. In contrast, MSP induced a dose-dependent reduction of immobility behaviour in the FST. At the highest tested dose of 40 mg/kg, MSP displayed a significant antidepressant-like effect similar to IMI. MSP did not modify the exploratory behaviour of rats in the open field test and did not produce any toxic effect. DISCUSSION MSP may potentially represent a good adjunct or alternative to existing antidepressant therapeutics. Further studies are necessary to confirm the mechanism of action of MSP and its modulation of brain functioning.
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Affiliation(s)
- Nicolas Violle
- a ETAP-Lab, 13 rue du Bois de la Champelle , Vandœuvre-lès-Nancy 54500, France
| | - Pascale Rozan
- a ETAP-Lab, 13 rue du Bois de la Champelle , Vandœuvre-lès-Nancy 54500, France
| | - Hervé Demais
- b BIOVET-CONSEIL , 1 rte du Linès, Merlevenez 56700, France
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15
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Abstract
Objective:To review principles of drug-induced liver injury (DILI), summarize characteristics of antidepressant-mediated liver Injury, and provide recommendations for monitoring and management.Data Sources:A search relating to antidepressant-induced liver injury was performed using MEDLINE (1966–March 2007). Search terms included antidepressant, cholestasis, hepatotoxicity, jaundice, liver injury, toxic hepatitis, and transaminases. Reference citations not Identified in the initial database search were also utilized.Study Selection and Data Extraction:All English-language case reports, letters, and review articles identified from the data sources were used. Case reports and letters relating to hepatotoxicity from antidepressant overdose were excluded.Data Synthesis:Antidepressant-induced liver injury described in published cases were of the idiopathic type and, by definition, cannot be predicted based on dose or specific risk factors. Paroxetine had the largest number of cases within the selective serotonin-reuptake inhibitor class. Nefazodone, a serotonin–norepinephrine reuptake inhibitor, appeared to have the most serious cases and is the only antidepressant agent that carries a Food and Drug Administration Black Box Warning regarding hepatotoxiciiy. The tricyclic antidepressants and monoamine oxidase Inhibitors are capable of producing hepatotoxicity, but fewer cases with these agents have been reported in the past 15 years, possibly due to a decline in their use. Causality has not been well established in all reports due to the concurrent use of other drugs and/or underlying liver disease.Conclusions:Most antidepressant agents have the potential to produce idiopathic liver injury. There is no way to prevent idiopathic DILI, but the severity of the reaction may be minimized with prompt recognition and early withdrawal of the agent. The clinician must be careful to provide ongoing therapy of the underlying depressive disorder and be aware of possible drug discontinuation syndromes should potential hepatotoxicity be suspected.
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16
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Pizzo F, Lombardo A, Manganaro A, Benfenati E. A New Structure-Activity Relationship (SAR) Model for Predicting Drug-Induced Liver Injury, Based on Statistical and Expert-Based Structural Alerts. Front Pharmacol 2016; 7:442. [PMID: 27920722 PMCID: PMC5118449 DOI: 10.3389/fphar.2016.00442] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 11/04/2016] [Indexed: 12/20/2022] Open
Abstract
The prompt identification of chemical molecules with potential effects on liver may help in drug discovery and in raising the levels of protection for human health. Besides in vitro approaches, computational methods in toxicology are drawing attention. We built a structure-activity relationship (SAR) model for evaluating hepatotoxicity. After compiling a data set of 950 compounds using data from the literature, we randomly split it into training (80%) and test sets (20%). We also compiled an external validation set (101 compounds) for evaluating the performance of the model. To extract structural alerts (SAs) related to hepatotoxicity and non-hepatotoxicity we used SARpy, a statistical application that automatically identifies and extracts chemical fragments related to a specific activity. We also applied the chemical grouping approach for manually identifying other SAs. We calculated accuracy, specificity, sensitivity and Matthews correlation coefficient (MCC) on the training, test and external validation sets. Considering the complexity of the endpoint, the model performed well. In the training, test and external validation sets the accuracy was respectively 81, 63, and 68%, specificity 89, 33, and 33%, sensitivity 93, 88, and 80% and MCC 0.63, 0.27, and 0.13. Since it is preferable to overestimate hepatotoxicity rather than not to recognize unsafe compounds, the model's architecture followed a conservative approach. As it was built using human data, it might be applied without any need for extrapolation from other species. This model will be freely available in the VEGA platform.
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Affiliation(s)
- Fabiola Pizzo
- Department of Environmental Health Sciences, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" Milan, Italy
| | - Anna Lombardo
- Department of Environmental Health Sciences, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" Milan, Italy
| | - Alberto Manganaro
- Department of Environmental Health Sciences, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" Milan, Italy
| | - Emilio Benfenati
- Department of Environmental Health Sciences, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" Milan, Italy
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17
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The Effect of Chronic Mild Stress and Imipramine on the Markers of Oxidative Stress and Antioxidant System in Rat Liver. Neurotox Res 2016; 30:173-84. [PMID: 26961706 PMCID: PMC4947122 DOI: 10.1007/s12640-016-9614-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 02/06/2023]
Abstract
Liver abnormalities have been reported to occur in up to 20 % of patients on a long-term therapy with the tricyclic antidepressant drug imipramine (IMI). The mechanism involved in this IMI-induced process is unknown but a contribution of oxidative stress is highly likely. Chronic mild stress (CMS) is widely used for modeling depressive-like behavior in rats. In the present study, we examined the effects of CMS and chronic IMI treatment, applied alone or in combination, on the levels of oxidative stress markers, such as reactive oxygen species (ROS), malondialdehyde (MDA), non-protein sulfhydryl groups, and sulfane sulfur as well as on activities of key antioxidant enzymes: catalase (CAT), glutathione peroxidase (GPx), and superoxide dismutase in the rat liver. Administration of IMI for 5 weeks to rats subjected to CMS resulted in a gradual significant reduction of anhedonia measured by sucrose intake, in a majority of animals (CMS IMI-reactive, CMS IMI-R), although about 20 % of rats did not respond to the IMI treatment (CMS IMI non-reactive, CMS IMI-NR). CMS-induced hepatic oxidative stress, estimated by increased ROS and MDA concentrations, was not prevented by the IMI administration, moreover, in CMS IMI-NR animals, the level of the marker of lipid peroxidation, i.e., MDA was increased in comparison to CMS-subjected rats and activity of antioxidant enzymes (GPx and CAT) was decreased compared to IMI-treated rats. The clinical significance of this observation remains to be established.
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18
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Chen M, Suzuki A, Thakkar S, Yu K, Hu C, Tong W. DILIrank: the largest reference drug list ranked by the risk for developing drug-induced liver injury in humans. Drug Discov Today 2016; 21:648-53. [PMID: 26948801 DOI: 10.1016/j.drudis.2016.02.015] [Citation(s) in RCA: 195] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/05/2016] [Accepted: 02/22/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Minjun Chen
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA
| | - Ayako Suzuki
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Shraddha Thakkar
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA
| | - Ke Yu
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA
| | - Chuchu Hu
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA
| | - Weida Tong
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA.
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Danan G, Teschke R. RUCAM in Drug and Herb Induced Liver Injury: The Update. Int J Mol Sci 2015; 17:E14. [PMID: 26712744 PMCID: PMC4730261 DOI: 10.3390/ijms17010014] [Citation(s) in RCA: 447] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 12/07/2015] [Accepted: 12/09/2015] [Indexed: 12/12/2022] Open
Abstract
RUCAM (Roussel Uclaf Causality Assessment Method) or its previous synonym CIOMS (Council for International Organizations of Medical Sciences) is a well established tool in common use to quantitatively assess causality in cases of suspected drug induced liver injury (DILI) and herb induced liver injury (HILI). Historical background and the original work confirm the use of RUCAM as single term for future cases, dismissing now the term CIOMS for reasons of simplicity and clarity. RUCAM represents a structured, standardized, validated, and hepatotoxicity specific diagnostic approach that attributes scores to individual key items, providing final quantitative gradings of causality for each suspect drug/herb in a case report. Experts from Europe and the United States had previously established in consensus meetings the first criteria of RUCAM to meet the requirements of clinicians and practitioners in care for their patients with suspected DILI and HILI. RUCAM was completed by additional criteria and validated, assisting to establish the timely diagnosis with a high degree of certainty. In many countries and for more than two decades, physicians, regulatory agencies, case report authors, and pharmaceutical companies successfully applied RUCAM for suspected DILI and HILI. Their practical experience, emerging new data on DILI and HILI characteristics, and few ambiguous questions in domains such alcohol use and exclusions of non-drug causes led to the present update of RUCAM. The aim was to reduce interobserver and intraobserver variability, to provide accurately defined, objective core elements, and to simplify the handling of the items. We now present the update of the well accepted original RUCAM scale and recommend its use for clinical, regulatory, publication, and expert purposes to validly establish causality in cases of suspected DILI and HILI, facilitating a straightforward application and an internationally harmonized approach of causality assessment as a common basic tool.
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Affiliation(s)
- Gaby Danan
- Pharmacovigilance Consultancy, rue des Ormeaux, 75020 Paris, France.
| | - Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/Main, Frankfurt am Main, D-63450 Hanau, Germany.
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Gahr M, Zeiss R, Lang D, Connemann BJ, Hiemke C, Schönfeldt-Lecuona C. Drug-Induced Liver Injury Associated With Antidepressive Psychopharmacotherapy: An Explorative Assessment Based on Quantitative Signal Detection Using Different MedDRA Terms. J Clin Pharmacol 2015; 56:769-78. [DOI: 10.1002/jcph.662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/13/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Maximilian Gahr
- University of Ulm; Department of Psychiatry and Psychotherapy III; Ulm Germany
| | - René Zeiss
- University of Ulm; Department of Psychiatry and Psychotherapy III; Ulm Germany
| | - Dirk Lang
- University of Ulm; Department of Psychosomatic Medicine and Psychotherapy; Ulm Germany
| | | | - Christoph Hiemke
- University Medical Center of Mainz; Department of Psychiatry and Psychotherapy; Mainz Germany
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21
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Chatterjee A, Acharya K. Include mushroom in daily diet—A strategy for better hepatic health. FOOD REVIEWS INTERNATIONAL 2015. [DOI: 10.1080/87559129.2015.1057839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Wu H, Wang P, Liu M, Tang L, Fang J, Zhao Y, Zhang Y, Li D, Xu H, Yang H. A 1H-NMR-Based Metabonomic Study on the Anti-Depressive Effect of the Total Alkaloid of Corydalis Rhizoma. Molecules 2015; 20:10047-64. [PMID: 26035102 PMCID: PMC6272534 DOI: 10.3390/molecules200610047] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/13/2015] [Accepted: 05/26/2015] [Indexed: 01/01/2023] Open
Abstract
Corydalis Rhizoma, named YuanHu in China, is the dried tuber of Corydalis yanhusuo W.T. Wang which is used in Traditional Chinese Medicine for pain relief and blood activation. Previous pharmacological studies showed that apart from analgesics, the alkaloids from YuanHu may be useful in the therapy of depression by acting on the GABA, dopamine and benzodiazepine receptors. In this study, the antidepressive effect of the total alkaloid of YuanHu (YHTA) was investigated in a chronic unpredictable mild stress (CUMS) rat model using 1H-NMR-based metabonomics. Plasma metabolic profiles were analyzed and multivariate data analysis was applied to discover the metabolic biomarkers in CUMS rats. Thirteen biomarkers of CUMS-introduced depression were identified, which are myo-inositol, glycerol, glycine, creatine, glutamine, glutamate, β-glucose, α-glucose, acetoacetate, 3-hydroxybutyrate, leucine and unsaturated lipids (L7, L9). Moreover, a metabolic network of the potential biomarkers in plasma perturbed by CUMS was detected. After YHTA treatment, clear separation between the model group and YHTA-treated group was achieved. The levels of all the abnormal metabolites mentioned above showed a tendency of restoration to normal levels. The results demonstrated the therapeutic efficacy of YHTA against depression and suggested that NMR-based metabolomics can provide a simple and easy tool for the evaluation of herbal therapeutics.
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Affiliation(s)
- Hongwei Wu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Dong Nei Nan Xiao Jie 16, Beijing 100700, China
| | - Peng Wang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Dong Nei Nan Xiao Jie 16, Beijing 100700, China
| | - Mengting Liu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Dong Nei Nan Xiao Jie 16, Beijing 100700, China
| | - Liying Tang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Dong Nei Nan Xiao Jie 16, Beijing 100700, China
| | - Jing Fang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Dong Nei Nan Xiao Jie 16, Beijing 100700, China
| | - Ye Zhao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Dong Nei Nan Xiao Jie 16, Beijing 100700, China
| | - Yi Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Dong Nei Nan Xiao Jie 16, Beijing 100700, China
| | - Defeng Li
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Dong Nei Nan Xiao Jie 16, Beijing 100700, China
| | - Haiyu Xu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Dong Nei Nan Xiao Jie 16, Beijing 100700, China.
| | - Hongjun Yang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Dong Nei Nan Xiao Jie 16, Beijing 100700, China.
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Abstract
Little is known about symptom preferences of clinical psychiatrists in the treatment of geriatric depression and preferences for avoiding adverse drug effects. Participants (board-certified psychiatrists) were recruited prior to a lecture on geriatric depression during a continuing education program. An analytic hierarchy process was performed and participants were asked for pairwise comparison of criteria guiding them in appraising therapeutic efficacy, and in avoiding toxicity and adverse events. Of the 61 participants from the continuing education program, 42 (69%) returned their data sheet. Avoidance of cardiotoxicity was regarded as more important than avoidance of hepatotoxicity or hematotoxicity. Concerning adverse events, highest preference was given to avoidance of falls and drug interactions, followed by avoidance of sedation, weight change, and impairment of sexual function. The most important preferences for appraisal of therapeutic efficacy were suicidality over ability to concentrate and sleep. Clinical psychiatrists have a hierarchy of preferences for treatment goals and avoidance of adverse events and toxicity. This raises the question for future research whether these preferences cause differences in prescription patterns in clinical practice even though a multitude of antidepressants are similarly effective when judged with instruments used in clinical trials.
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Affiliation(s)
- Matthias W Riepe
- Mental Health and Geriatric Psychiatry, Psychiatry II, Ulm University, Ulm, Germany
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Hepatotoxicity related to agomelatine and other new antidepressants: a case/noncase approach with information from the Portuguese, French, Spanish, and Italian pharmacovigilance systems. J Clin Psychopharmacol 2014; 34:327-30. [PMID: 24561328 DOI: 10.1097/jcp.0000000000000094] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Antidepressants have been associated with a low incidence of idiosyncratic hepatic injury. Some of them, nefazodone or amineptine, were observed to induce severe hepatic injury and withdrawn from the market. Recently, some cases of this severe condition have been reported in association with agomelatine use. Therefore, the objective of this study is to learn the risk of hepatic damage with agomelatine as compared with other new antidepressants. We took data from the Spanish, French, Italian, and Portuguese pharmacovigilance system databases. A case/noncase approach to assess the strength of the association between whichever antidepressant and hepatotoxicity was performed; cases were defined as reports of hepatotoxicity; noncases were reports of all reactions other than hepatotoxicity. Exposure was the recording of a new antidepressant in a report, whether or not it was suspected of causing the reaction. During the period surveyed, 3300 cases of hepatotoxicity were collected for the antidepressants assessed. They represent 10.3% of all cases collected for these drugs; the corresponding figure for all drugs was 6.0%. Meanwhile, 63 cases of hepatotoxicity associated with agomelatine were collected since its introduction until the end of the period studied; they account for a percentage of 14.6. Agomelatine was statistically associated with hepatotoxicity in Spain [reporting odds ratio (ROR), 4.9 (95% confidence interval [CI], 2.4-9.7)], France (ROR, 2.4 [95% CI, 1.5-3.7]), and Italy (ROR, 5.1 [95% CI, 1.7-14.0]). Current results support the idea of agomelatine to be related to a higher hepatotoxicity risk. Physicians should consider early discontinuation if the condition is suspected; health authorities should promptly explore the best regulatory actions to be taken.
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Zlatković J, Todorović N, Tomanović N, Bošković M, Djordjević S, Lazarević-Pašti T, Bernardi RE, Djurdjević A, Filipović D. Chronic administration of fluoxetine or clozapine induces oxidative stress in rat liver: a histopathological study. Eur J Pharm Sci 2014; 59:20-30. [PMID: 24768740 DOI: 10.1016/j.ejps.2014.04.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 02/28/2014] [Accepted: 04/13/2014] [Indexed: 12/16/2022]
Abstract
Chronic exposure to stress contributes to the etiology of mood disorders, and the liver as a target organ of antidepressant and antipsychotic drug metabolism is vulnerable to drug-induced toxicity. We investigated the effects of chronic administration of fluoxetine (15mg/kg/day) or clozapine (20mg/kg/day) on liver injury via the measurement of liver enzymes, oxidative stress and histopathology in rats exposed to chronic social isolation (21days), an animal model of depression, and controls. The activity of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST), the liver content of carbonyl groups, malonyldialdehyde (MDA), reduced glutathione (GSH), cytosolic glutathione S-transferase (GST) and nitric oxide (NO) metabolites were determined. We also characterized nuclear factor-κB (NF-κB), cyclooxygenase-2 (COX-2) and CuZn-superoxide dismutase (CuZnSOD) protein expression as well as histopathological changes. Increased serum ALT activity in chronically-isolated and control animals treated with both drugs was found while increased AST activity was observed only in fluoxetine-treated rats (chronically-isolated and controls). Increased carbonyl content, MDA, GST activity and decreased GSH levels in drug-treated controls/chronically-isolated animals suggest a link between drugs and hepatic oxidative stress. Increased NO levels associated with NF-κB activation and the concomitant increased COX-2 expression together with compromised CuZnSOD expression in clozapine-treated chronically-isolated rats likely reinforce oxidative stress, observed by increased lipid peroxidation and GSH depletion. In contrast, fluoxetine reduced NO levels in chronically-isolated rats. Isolation induced oxidative stress but histological changes were similar to those observed in vehicle-treated controls. Chronic administration of fluoxetine in both chronically-isolated and control animals resulted in more or less normal hepatic architecture, while clozapine in both groups resulted in liver injury. These data suggest that clozapine appears to have a higher potential to induce liver toxicity than fluoxetine.
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Affiliation(s)
- Jelena Zlatković
- Laboratory of Molecular Biology and Endocrinology, Institute of Nuclear Sciences "Vinča", University of Belgrade, Serbia
| | - Nevena Todorović
- Laboratory of Molecular Biology and Endocrinology, Institute of Nuclear Sciences "Vinča", University of Belgrade, Serbia
| | - Nada Tomanović
- Institute of Pathology, School of Medicine, University of Belgrade, Serbia
| | - Maja Bošković
- Laboratory of Molecular Biology and Endocrinology, Institute of Nuclear Sciences "Vinča", University of Belgrade, Serbia
| | | | - Tamara Lazarević-Pašti
- Department of Physical Chemistry, Institute of Nuclear Sciences "Vinča", University of Belgrade, Serbia
| | - Rick E Bernardi
- Central Institute of Mental Health, Institute of Psychopharmacology, Mannheim, Germany
| | | | - Dragana Filipović
- Laboratory of Molecular Biology and Endocrinology, Institute of Nuclear Sciences "Vinča", University of Belgrade, Serbia.
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Andrade RJ, López-Ortega S, López-Vega MC, Robles M, Cueto I, Lucena MI. Idiosyncratic drug hepatotoxicity: a 2008 update. Expert Rev Clin Pharmacol 2014; 1:261-76. [PMID: 24422651 DOI: 10.1586/17512433.1.2.261] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pharmaceutical preparations, and also herbal products and dietary supplements, are emerging contributors to severe forms of liver disease. Although acetaminophen intoxication is still the reason for many cases of drug-induced liver injury (DILI) in Western countries, the bulk of hepatic reactions to drugs are idiosyncratic. Only a small fraction of individuals exposed to a drug associated with liver injury will develop hepatotoxicity. Indeed, the rarity of this serious adverse event prevents its detection in clinical trials. The pathogenesis of idiosyncratic DILI is not well known because of a lack of reliable animal models, although it probably involves the metabolism of the drug and/or activation of the immune system. Different databases have described antibiotics, NSAIDs and anticonvulsants as the main group of drugs incriminated in DILI. Clinical presentation of DILI includes predominantly a hepatocellular type of damage, yet cholestatic and mixed types are also common; the determinants of the type of damage induced by a given drug are poorly understood. Analysis of pooled data has recently underlined the influence of older age in the cholestatic/mixed expression of liver injury, as well as the independent association of female gender, older age, aspartate aminotransferase levels with hepatocellular type of damage and high bilirubin levels with the risk of fulminant liver failure/death. In the long term (providing the patient survives the initial episode), persistent damage may occur in at least 6% of patients, with the cholestatic mixed type of damage more prone to becoming chronic, while in the hepatocellular pattern the severity is greater, with further likelihood of evolution to cirrhosis. Cardiovascular and CNS drugs are the main groups leading to chronic liver damage. The diagnosis of hepatotoxicity remains a difficult task owing to the lack of reliable markers for use in general clinical practice. Diagnostic algorithms may add consistency to clinical judgment by translating a suspicion into a quantitative score. Currently, the Council for International Organizations of Medical Sciences/Roussel Uclaf Causality Assessment Method instrument is considered the gold standard in causality assessment of hepatotoxicity, although there is probably room for improvement. Current efforts in collecting bona fide cases will make refinements of existing scales feasible. Efforts should also be directed towards the development of an abridged instrument for use in evaluating suspected drug-induced hepatotoxicity at the very beginning of the diagnosis and treatment process when clinical decisions need to be taken. The treatment of idiosyncratic DILI is largely supportive. Early suspicion and withdrawal of the offending agent is the most important therapeutic measure.
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Affiliation(s)
- Raúl J Andrade
- CIBERehd; Liver Unit, Gastroenterology Service, "Virgen de la Victoria" University Hospital and School of Medicine, Málaga, Spain.
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Weisler R, McIntyre RS, Bauer M. Extended-release quetiapine fumarate in the treatment of patients with major depressive disorder: adjunct therapy. Expert Rev Neurother 2014; 13:1183-200. [DOI: 10.1586/14737175.2013.846519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Messaoudi M, Bisson JF, Nejdi A, Rozan P, Javelot H. Antidepressant-like effects of a cocoa polyphenolic extract in Wistar–Unilever rats. Nutr Neurosci 2013; 11:269-76. [DOI: 10.1179/147683008x344165] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Sedky K, Nazir R, Joshi A, Kaur G, Lippmann S. Which psychotropic medications induce hepatotoxicity? Gen Hosp Psychiatry 2012; 34:53-61. [PMID: 22133982 DOI: 10.1016/j.genhosppsych.2011.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 10/15/2011] [Accepted: 10/18/2011] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Safe prescribing practices to minimize pharmaceutically induced liver damage or worsening of preexisting conditions require knowledge about medicines with hepatotoxic potential. This paper reviews psychotropic medications and their effects on the liver. METHODS A MEDLINE search was performed utilizing the phrase "drug-induced liver injury" with various categories of psychiatric drugs. Only articles written in English were utilized. RESULTS Hepatotoxicity can be acute or chronic in nature. Medication discontinuation is necessary in acute forms, while close monitoring is required in milder forms of medication-induced chronic liver damage. Nefazodone, pemoline and/or tacrine are the highest offenders. Carbamazepine and valproate products (e.g., divalproex) can lead to this adverse event and should be avoided in patients with liver disease, persons with alcohol misuse or those consuming high doses of acetaminophen. CONCLUSION Knowing the risk levels associated with various medicines is important; prescribing multiple drugs with hepatotoxic effects should be avoided. One should educate patients about early warning signs of liver injury. Always provide clinical and laboratory monitoring before and during the use of hepatotoxic drugs. Clinical features and laboratory results govern medication prescribing with ongoing risk-to-benefit ratio assessment during pharmacotherapy.
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Affiliation(s)
- Karim Sedky
- Department of Psychiatry, Drexel University, Philadelphia, PA 19124, USA.
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Lucena MI, Kaplowitz N, Hallal H, Castiella A, García-Bengoechea M, Otazua P, Berenguer M, Fernandez MC, Planas R, Andrade RJ. Recurrent drug-induced liver injury (DILI) with different drugs in the Spanish Registry: the dilemma of the relationship to autoimmune hepatitis. J Hepatol 2011; 55:820-7. [PMID: 21338638 DOI: 10.1016/j.jhep.2010.12.041] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 12/20/2010] [Accepted: 12/22/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Multiple instances of DILI in the same patient with drugs of similar structure or function as well as completely unrelated drugs are not well understood and poorly documented. We have sought evidence of the frequency and characteristics of patients who have experienced two DILI episodes due to different drugs. METHODS All cases of DILI systematically collected in the Spanish DILI Registry between 1994 and 2009 were retrieved. Data on demographics, clinical, laboratory and pathological findings, and outcome were analyzed. RESULTS Nine patients (mean age 67 years, four women) out of 742, 1.21%, had evidence of two DILI episodes caused by different drugs. In four cases DILI was associated with structurally related drugs and in an additional two cases the drugs had a common target. In another case, unrelated antibiotics were implicated. In only two cases, the two drugs/herbals were not related in structure or function. All but one patient exhibited hepatocellular damage. The type of damage was consistent in both DILI episodes. Four cases presented as autoimmune hepatitis (AIH) in the second episode. CONCLUSIONS Multiple episodes of DILI in association with different drugs occur infrequently. In each individual, the type of injury was similar during the two DILI episodes, regardless of the causative drug. Second episodes of DILI are more likely to be associated with features of AIH. It remains uncertain if this is drug-induced unmasking of true AIH or DILI with autoimmune features. These cases illustrate the dilemma faced by clinicians in distinguishing these possibilities.
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Affiliation(s)
- M I Lucena
- Servicio de Farmacología Clínica, Grupo de Estudio para las Hepatopatías Asociadas a Medicamentos, Co-ordinating Centre, Hospital Universitario Virgen de la Victoria, Facultad de Medicina, Campus Universitario de Teatinos s/n, Málaga, Spain.
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Dodd S, Malhi GS, Tiller J, Schweitzer I, Hickie I, Khoo JP, Bassett DL, Lyndon B, Mitchell PB, Parker G, Fitzgerald PB, Udina M, Singh A, Moylan S, Giorlando F, Doughty C, Davey CG, Theodoras M, Berk M. A consensus statement for safety monitoring guidelines of treatments for major depressive disorder. Aust N Z J Psychiatry 2011; 45:712-25. [PMID: 21888608 PMCID: PMC3190838 DOI: 10.3109/00048674.2011.595686] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This paper aims to present an overview of screening and safety considerations for the treatment of clinical depressive disorders and make recommendations for safety monitoring. METHOD Data were sourced by a literature search using MEDLINE and a manual search of scientific journals to identify relevant articles. Draft guidelines were prepared and serially revised in an iterative manner until all co-authors gave final approval of content. RESULTS Screening and monitoring can detect medical causes of depression. Specific adverse effects associated with antidepressant treatments may be reduced or identified earlier by baseline screening and agent-specific monitoring after commencing treatment. CONCLUSION The adoption of safety monitoring guidelines when treating clinical depression is likely to improve overall physical health status and treatment outcome. It is important to implement these guidelines in the routine management of clinical depression.
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Affiliation(s)
- Seetal Dodd
- School of Medicine, Deakin University, Geelong, Victoria, Australia; Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - John Tiller
- Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - Isaac Schweitzer
- Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - Ian Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Jon Paul Khoo
- Toowong Specialist Clinic, Level 2/54 Jephson St, Toowong, Brisbane, Queensland, Australia
| | - Darryl L Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia; School of Medicine, University of Notre Dame, Western Australia, Australia
| | - Bill Lyndon
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Alfred and Monash University School of Psychology and Psychiatry, Melbourne, Victoria, Australia
| | - Marc Udina
- Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Catalonia, Spain
| | - Ajeet Singh
- School of Medicine, Deakin University, Geelong, Victoria, Australia; Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - Steven Moylan
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | | | - Carolyn Doughty
- Child and Family Specialty Service, Canterbury District Health Board; Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand
| | | | - Michael Theodoras
- Eating Disorders Program, New Farm Clinic, Brisbane, Queensland, Australia
| | - Michael Berk
- School of Medicine, Deakin University, Geelong, Victoria; Department of Psychiatry, University of Melbourne, Victoria; Mental Health Research Institute, Parkville, Victoria; Orygen Youth Health Research Centre, Parkville, Victoria, Australia
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Waldman SD, Waldman CW. Role of Antidepressants in the Management of Pain. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00123-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Park YM, Lee BH, Lee HJ, Kang SG. Cholestatic jaundice induced by duloxetine in a patient with major depressive disorder. Psychiatry Investig 2010; 7:228-30. [PMID: 20927314 PMCID: PMC2947813 DOI: 10.4306/pi.2010.7.3.228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 06/30/2010] [Accepted: 08/11/2010] [Indexed: 12/17/2022] Open
Abstract
Duloxetine is a balanced and potent serotonin and noradrenaline reuptake inhibitor (SNRI) and has adverse effects that are commonly associated with such drugs, including nausea, dry mouth, constipation, insomnia, and dizziness. Recently, duloxetine-induced liver injury has also been observed in patients with preexisting liver disease or chronic alcohol use. We investigated the effects of duloxetine in a healthy young adult with major depressive disorder (MDD) but no risk factors, and found that his total bilirubin level increased to 3.3 mg/dL and he developed jaundice after 5 months of duloxetine treatment. Discontinuation of duloxetine treatment saw his total bilirubin level decrease to 1.8 mg/dL. Thus, the administration of duloxetine might induce liver injury in a patient with MDD. However, the limitations of this single case report must be acknowledged. Although the cause of hepatic dysfunction in this case remains to be elucidated, clinicians should monitor liver function carefully after duloxetine treatment. Further investigations with a larger sample are needed.
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Affiliation(s)
- Young-Min Park
- Department of Neuropsychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | | | - Heon-Jeong Lee
- Department of Psychiatry, Anam Hosipital, Korea University College of Medicine, Seoul, Korea
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Chalasani N, Björnsson E. Risk factors for idiosyncratic drug-induced liver injury. Gastroenterology 2010; 138:2246-59. [PMID: 20394749 PMCID: PMC3157241 DOI: 10.1053/j.gastro.2010.04.001] [Citation(s) in RCA: 227] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 04/02/2010] [Accepted: 04/08/2010] [Indexed: 12/13/2022]
Abstract
Idiosyncratic drug-induced liver injury (DILI) is a rare disorder that is not related directly to dosage and little is known about individuals who are at increased risk. There are no suitable preclinical models for the study of idiosyncratic DILI and its pathogenesis is poorly understood. It is likely to arise from complex interactions among genetic, nongenetic host susceptibility, and environmental factors. Nongenetic risk factors include age, sex, and other diseases (eg, chronic liver disease or human immunodeficiency virus infection). Compound-specific risk factors include daily dose, metabolism characteristics, and propensity for drug interactions. Alcohol consumption has been proposed as a risk factor for DILI from medications, but there is insufficient evidence to support this. Many studies have explored genetic defects that might be involved in pathogenesis and focused on genes involved in drug metabolism and the immune response. Multicenter databases of patients with DILI (the United States Drug Induced Liver Injury Network, DILIGEN, and the Spanish DILI registry) are important tools for clinical and genetic research. A genome-wide association study of flucloxacillin hepatotoxicity has yielded groundbreaking results and many similar studies are underway. Nonetheless, DILI is challenging to investigate because of its rarity, the lack of experimental models, the number of medications that might cause it, and challenges to diagnosis.
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Affiliation(s)
- Naga Chalasani
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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36
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Andrade RJ, Robles M, Lucena MI. Rechallenge in drug-induced liver injury: the attractive hazard. Expert Opin Drug Saf 2010; 8:709-14. [PMID: 19968572 DOI: 10.1517/14740330903397378] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Progress in the understanding of drug-induced liver injury (DILI) is clearly hampered by the lack of specific markers of the disease. In this scenario, recrudescence of the liver injury upon re-exposure to the suspicious drug is considered the more reliable evidence of DILI. On-purpose re-exposure, however, entails both practical and ethical issues because the bulk of situations in clinical practice are non-immunoallergic DILI in which a provocation test frequently would give negative results. Besides, deliberate re-exposure with a drug that is not considered vital or essential is potentially harmful and, hence, hardly justified in DILI, and rechallenge is more commonly described in an unintentional basis. The causes, characteristics and consequences of rechallenge have been specifically addressed recently. For causality assessment, a positive rechallenge test carries the strong value, and is accordingly scored by clinical algorithms. Such clinical scales, however, reward drugs that are associated with a positive rechallenge response, but might be considered biased against those where re-administration fails to elicit a response or, more commonly, for which no rechallenge is attempted.
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Affiliation(s)
- Raúl J Andrade
- University of Málaga, Vírgen de la Victoria University Hospital, Departamento de Medicina, Spain.
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Andrade RJ, Robles M, Ulzurrun E, Lucena MI. Drug-induced liver injury: insights from genetic studies. Pharmacogenomics 2009; 10:1467-87. [PMID: 19761370 DOI: 10.2217/pgs.09.111] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Drug-induced liver injury (DILI) is an increasing health problem and a challenge for physicians, regulatory bodies and the pharmaceutical industry, not only because of its potential severity and elusive pathogenesis but also because it is often inaccurately diagnosed, commonly missed entirely and more often not reported. The general view is that idiosyncratic DILI, which is not predictable whether based on the pharmacology of the drug or on the dose administered, is determined by the presence in the recipient of variants in, or expression of, genes coding for key metabolic pathways and/or the immune response, and the interaction of these genetic variants with environmental variables. Furthermore, idiosyncratic DILI is an example of a complex-trait disease with two or more susceptibility loci, as reflected by the frequency of genetic variants in the population often being higher than the occurrence of significant liver injury. Polymorphisms of bioactivation/toxification pathways via the CYP450 enzymes (Phase I), detoxification reactions (Phase II) and excretion/transport (Phase III), together with immunological factors that might determine DILI are reviewed. Challenges such as gene-trait association studies and whole-genome studies, and future approaches to the study of DILI are explored. Better knowledge of the candidate genes involved could provide further insight for the prospective identification of susceptible patients at risk of developing drug-induced hepatotoxicity, development of new diagnostic tools and new treatment strategies with safer drugs.
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Affiliation(s)
- Raúl J Andrade
- Unidad de Hepatología, Departamento de Medicina, Facultad de Medicina, Boulevard Louis Pasteur 32, 29071 Málaga, Spain.
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Tang W, Lu AY. Metabolic bioactivation and drug-related adverse effects: current status and future directions from a pharmaceutical research perspective. Drug Metab Rev 2009; 42:225-49. [DOI: 10.3109/03602530903401658] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Antoine DJ, Mercer AE, Williams DP, Park BK. Mechanism-based bioanalysis and biomarkers for hepatic chemical stress. Xenobiotica 2009; 39:565-77. [PMID: 19621999 DOI: 10.1080/00498250903046993] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Adverse drug reactions, in particular drug-induced hepatotoxicity, represent a major challenge for clinicians and an impediment to safe drug development. Novel blood or urinary biomarkers of chemically-induced hepatic stress also hold great potential to provide information about pathways leading to cell death within tissues. The earlier pre-clinical identification of potential hepatotoxins and non-invasive diagnosis of susceptible patients, prior to overt liver disease is an important goal. Moreover, the identification, validation and qualification of biomarkers that have in vitro, in vivo and clinical transferability can assist bridging studies and accelerate the pace of drug development. Drug-induced chemical stress is a multi-factorial process, the kinetics of the interaction between the hepatotoxin and the cellular macromolecules are crucially important as different biomarkers will appear over time. The sensitivity of the bioanalytical techniques used to detect biological and chemical biomarkers underpins the usefulness of the marker in question. An integrated analysis of the biochemical, molecular and cellular events provides an understanding of biological (host) factors which ultimately determine the balance between xenobiotic detoxification, adaptation and liver injury. The aim of this review is to summarise the potential of novel mechanism-based biomarkers of hepatic stress which provide information to connect the intracellular events (drug metabolism, organelle, cell and whole organ) ultimately leading to tissue damage (apoptosis, necrosis and inflammation). These biomarkers can provide both the means to inform the pharmacologist and chemist with respect to safe drug design, and provide clinicians with valuable tools for patient monitoring.
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Affiliation(s)
- D J Antoine
- Department of Pharmacology & Therapeutics, MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, UK.
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Abstract
The classic view on the pathogenesis of drug-induced liver injury is that the so-called parent compounds are made hepatotoxic by metabolism (formation of neo-substances that react abnormally), mainly by cytochromes P-450 (CYP), with further pathways, such as mitochondrial dysfunction and apoptosis, also playing a role. Risk factors for drug-induced liver injury include concomitant hepatic diseases, age and genetic polymorphisms of CYP. However, some susceptibility can today be predicted before drug administration, working on the common substrate, by phenotyping and genotyping studies and by taking in consideration patients’ health status. Physicians should always think of this adverse effect in the absence of other clear hepatic disease. Ethical and legal problems towards operators in the health care system are always matters to consider.
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Collados Arroyo V, Hallal H, Rodrigo Agudo JL, Plaza Aniorte J. Hepatitis colestásica por venlafaxina. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:382-3. [DOI: 10.1016/j.gastrohep.2008.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 11/18/2008] [Indexed: 10/20/2022]
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Collados Arroyo V, Plaza Aniorte J, Hallal H, Pérez-Cuadrado E. [Sertraline-induced hepatotoxicity]. FARMACIA HOSPITALARIA 2008; 32:60-1. [PMID: 18426707 DOI: 10.1016/s1130-6343(08)72814-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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44
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Isabel Lucena M, García-Cortés M, Cueto R, Lopez-Duran JL, Andrade RJ. Assessment of drug-induced liver injury in clinical practice. Fundam Clin Pharmacol 2008; 22:141-58. [DOI: 10.1111/j.1472-8206.2008.00566.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Rubio Barbón S, León Durán D, Arias Miranda I. [Antidepressant-induced toxic hepatitis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 31:48-49. [PMID: 18218282 DOI: 10.1157/13114570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Chapter 2 Drug-Induced Hepatotoxicity: Learning from Recent Cases of Drug Attrition. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1872-0854(07)02002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Zhang W, Davidson JR. Post-traumatic stress disorder: an evaluation of existing pharmacotherapies and new strategies. Expert Opin Pharmacother 2007; 8:1861-70. [PMID: 17696789 DOI: 10.1517/14656566.8.12.1861] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Post-traumatic stress disorder (PTSD) is often a chronic and disabling anxiety disorder that develops after exposure to a traumatic event. Researchers have demonstrated efficacy for both pharmacologic and psychosocial interventions in the treatment of PTSD. First-line pharmacotherapeutic options are the selective serotonin re-uptake inhibitors and serotonin noradrenaline re-uptake inhibitors. Older antidepressant agents, such as the tricyclic antidepressants and the monoamine oxidase inhibitor, phenelzine, have also proven efficacy in PTSD among more established agents. However, concerns for side effects have limited frequent use of these. Existing pharmacologic agents produce meaningful results and bear the advantage of treating depression and other co-morbid disorders, yet still fall short of being ideal due to limited response and remission rates and tolerability issues. The need for improving pharmacotherapy of PTSD remains compelling and directions for further research are discussed.
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Affiliation(s)
- Wei Zhang
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC 27710, USA.
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Role of Antidepressants in the Management of Pain. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50118-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hanje AJ, Pell LJ, Votolato NA, Frankel WL, Kirkpatrick RB. Case report: fulminant hepatic failure involving duloxetine hydrochloride. Clin Gastroenterol Hepatol 2006; 4:912-7. [PMID: 16797245 DOI: 10.1016/j.cgh.2006.04.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Duloxetine hydrochloride was approved by the Food and Drug Administration in August 2004 for the treatment of major depressive disorder and diabetic peripheral neuropathic pain. Initial product labeling contained a precaution regarding the risk for increases in liver function test results. Recently, postmarketing research has revealed episodes of cholestatic jaundice and increases in transaminase levels to greater than 20 times normal in patients with chronic liver disease. METHODS In this case report, we describe a patient with non-Hodgkin's lymphoma in remission and depression treated with duloxetine and mirtazapine. RESULTS Approximately 6 weeks after increasing her duloxetine dose from 30 to 60 mg daily, she became jaundiced and presented with fulminant hepatic failure. Liver function tests immediately before initiating duloxetine were not available, although the patient carried no prior history of chronic liver disease. A complete work-up for alternate causes failed to reveal another explanation for the patient's clinical presentation. A liver biopsy examination showed histologic changes of subacute injury and the patient's clinical course was consistent with drug-induced liver injury. Despite aggressive measures, the patient's condition deteriorated and the decision was made to withdraw care. CONCLUSIONS This report shows a case of fulminant hepatic failure and death involving duloxetine use. Given recent reports of severe hepatotoxicity associated with the use of duloxetine in patients with pre-existing liver disease, further investigation into the safety of this compound is warranted.
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Affiliation(s)
- A James Hanje
- Department of Internal Medicine, Division of Digestive Health, The Ohio State University, Columbus, Ohio 43210, USA.
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Grajower MM. Medical management of depression. N Engl J Med 2006; 354:646-8; author reply 646-8. [PMID: 16467558 DOI: 10.1056/nejmc053231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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