Relevance of pharmacogenetic analyses and therapeutic drug monitoring of antidepressants for an individualized treatment of peripartum psychopathology

OBJECTIVE

Psychiatric disorders burden the peripartum period, often requiring psychopharmacological treatment, including antidepressants. Efficacy and tolerability of antidepressants are influenced by the physiological changes of the peripartum and individual metabolic profiles, which in turn can be modified by pregnancy. The objective of this study is to assess the relationship between antidepressants' pharmacokinetic profiles during pregnancy and individual metabolic profiles, along with the efficacy of the treatment.

METHODS

In total 87 outpatients with diagnoses of bipolar disorder, major depression, anxiety, obsessive-compulsive disorder and post-traumatic stress disorder who required antidepressant treatment during pregnancy were recruited. Genotyping analysis of hepatic cytochrome P450 (CYPs) individual isoforms was performed. Antidepressants' blood concentrations and psychometric assessments were collected at five time points. Antidepressants' cord blood concentrations were assessed at birth.

RESULTS

Sertraline showed greater stability in plasma concentrations and a lower placental penetrance index. Most of the antidepressants' concentrations below the therapeutic range were found in women with an extensive/ultrarapid metabolic profile. Antidepressants mainly metabolized by CYP2C19 were less frequently below the therapeutic range compared with antidepressants metabolized by CYP2D6.

CONCLUSIONS

Pregnancy modulates cytochrome activity and drugs' pharmacokinetics. Genotyping analysis of CYPs isoforms and therapeutic drug monitoring might be used to guide clinicians in a well-tolerated treatment of psychiatric symptoms in pregnant women.

Extracapillary glomerulonephritis and renal amyloidosis

We report three patients with well-documented renal amyloidosis who developed rapidly progressive renal failure. Renal biopsies from all three patients showed crescentic glomerulonephritis imposed on renal amyloidosis. All patients were treated with intravenous high-dose methylprednisolone pulses combined with immunosuppressive agents and oral corticosteroids. Partial recovery of renal function was obtained in two patients. For the third patient, treatment had to be stopped after a few days because of a septic arthritis. Renal function continued to deteriorate, and the patient had to be placed on regular hemodialysis. We conclude that extracapillary glomerulonephritis may occasionally complicate a preexisting renal amyloidosis and may be reversible if recognized early and treated appropriately.

Antiparallel expression of the sense and antisense transcripts of maize alpha-tubulin genes

In all eukaryotes alpha- and beta-tubulins are encoded by small families of closely related genes and are highly conserved. In Zea mays, at least six different alpha-tubulin coding sequences are known. We describe the isolation from scutellar nodes of the maize inbred line W22 of a clone (CTM5) coding for an alpha-tubulin. On the basis of the 3' end nucleotide sequence, this clone can be assigned to the already reported tua4 gene. Northern analysis demonstrates that CTM5 encodes a 1.5 kb transcript, which is expressed in different tissues of the seed and of the seedling. In order to define the spatial and temporal expression of alpha-tubulin genes, in situ hybridization experiments were performed on these tissues. Unexpectedly, a specific signal was detected with both antisense and sense RNA strands. Temporal and spatial distribution of the two RNAs, however, shows that high levels of the two transcripts are always discordant. In tissues where sense transcripts are highly abundant (embryos at various developmental stages, root tips, pollen grains), the antisense transcripts are expressed in relatively small amounts, while in pericarp, coleoptile, leaves, and scutellar node, where antisense transcripts accumulate, the sense transcript only reaches a very low level. Northern analysis using single-stranded DNA probes confirmed the presence of an antisense transcript of 1.5 kb, prompting speculation about the role of this transcript in the regulation of the expression of alpha-tubulin genes.

Sn, a light-dependent and tissue-specific gene of maize: the genetic basis of its instability

The genetic system under investigation is defined by three major components: a gene, Sn, conferring tissue specific anthocyanin accumulation in different plant regions, light, required for color development in competent tissues, and another gene, Pl, substituting for light in its capacity to elicit pigment production. Attention is given in this paper to an Sn allele, symbolized Sn:bol3, capable of some constitutive pigmentation in seedlings and seed integuments. Sn:bol3 confers a higher pigment potential than the other alleles and is unstable. Its instability relates to its frequent changes from an original condition, indicated as Sn-s, to Sn-w, where -s and -w stand for strong and weak and refer to the two levels of seedling pigmentation. Weak derivatives arise spontaneously at a high frequency in homo- and heterozygous Sn:bol3 genotypes. In the latter, weak derivatives are also recovered on the chromosome originally devoid of Sn as if the heterozygous association had promoted "contamination" of one chromosome (recipient) with Sn coming from the other (donor). If the two chromosomes in the heterozygote are marked with contrasting alleles of R, a gene lying about two crossover units proximal to Sn, it appears that the R constitution of the recipient chromosome affects their constitution. Presence of R-r in fact leads to changes of both chromosomes in terms of Sn constitution, resulting in a majority of nonparental chromosomes, R-r Sn and r Sn-w or r sn, while replacement of R-r with R-g, a mutant derivative of R-r, leads to a drastic reduction in the yield of nonparental chromosomes.(ABSTRACT TRUNCATED AT 250 WORDS)