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Barbieri M, Chiodini P, Di Gennaro P, Hafez G, Liabeuf S, Malyszko J, Mani LY, Mattace-Raso F, Pepin M, Perico N, Simeoni M, Zoccali C, Tortorella G, Capuano A, Remuzzi G, Capasso G, Paolisso G. Efficacy of erythropoietin as a neuroprotective agent in CKD-associated cognitive dysfunction: A literature systematic review. Pharmacol Res 2024; 203:107146. [PMID: 38493928 DOI: 10.1016/j.phrs.2024.107146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/19/2024]
Abstract
Patients with chronic kidney disease (CKD) often experience mild cognitive impairment and other neurocognitive disorders. Studies have shown that erythropoietin (EPO) and its receptor have neuroprotective effects in cell and animal models of nervous system disorders. Recombinant human EPO (rHuEPO), commonly used to treat anemia in CKD patients, could be a neuroprotective agent. In this systematic review, we aimed to assess the published studies investigating the cognitive benefits of rHuEPO treatment in individuals with reduced kidney function. We comprehensively searched Pubmed, Cochrane Library, Scopus, and Web of Science databases from 1990 to 2023. After selection, 24 studies were analyzed, considering study design, sample size, participant characteristics, intervention, and main findings. The collective results of these studies in CKD patients indicated that rHuEPO enhances brain function, improves performance on neuropsychological tests, and positively affects electroencephalography measurements. These findings suggest that rHuEPO could be a promising neuroprotective agent for managing CKD-related cognitive impairment.
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Affiliation(s)
- Michelangela Barbieri
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Paolo Chiodini
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Caserta 81100, Italy
| | - Piergiacomo Di Gennaro
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Caserta 81100, Italy
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Turkey
| | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France; MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Laila-Yasmin Mani
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Marion Pepin
- Clinical Epidemiology, CESP, INSERM, UMR 1018, Paris Saclay University, Villejuif, France; Department of Geriatrics, Ambroise Paré University Medical Center, APHP, Boulogne-Billancourt, France
| | - Norberto Perico
- Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Mariadelina Simeoni
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Carmine Zoccali
- Renal Research Institute, New York, USA; Institute of Biology and Molecular Biology (BIOGEM), Ariano Irpino, Italy; IPNET, Reggio Calabria, Italy
| | - Giovanni Tortorella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalisa Capuano
- Section of Pharmacology 'L. Donatelli', Department of Experimental Medicine, University of Campania 'Luigi Vanvitelli', Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | | | | | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; UniCamillus, International Medical University, Rome, Italy
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Macoveanu J, Petersen JZ, Mariegaard J, Jespersen AE, Cramer K, Bruun CF, Madsen HØ, Jørgensen MB, Vinberg M, Fisher PM, Knudsen GM, Hageman I, Ehrenreich H, Kessing LV, Miskowiak KW. Effects of erythropoietin on cognitive impairment and prefrontal cortex activity across affective disorders: A randomized, double-blinded, placebo-controlled trial. J Psychopharmacol 2024; 38:362-374. [PMID: 38519416 DOI: 10.1177/02698811241237869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND Persistent cognitive impairment is frequent across bipolar disorder (BD) and major depressive disorder (MDD), highlighting an urgent need for pro-cognitive treatments. AIM This study investigated effects of erythropoietin (EPO) on cognitive impairment and dorsal prefrontal cortex (dPFC) activity in affective disorders. METHODS In this randomized, double-blinded, placebo-controlled trial, cognitively impaired patients with remitted BD or MDD received 1 weekly recombinant human EPO (40,000 IU/mL) or saline infusion for a 12-week period. Assessments were conducted at baseline, after 2 weeks of treatment (week 3), immediately after treatment (week 13) and at 6-months follow-up. Participants underwent functional MRI during performance on a n-back working memory (WM) task at baseline and week 3, and for a subgroup 6 weeks post-treatment (week 18). The primary outcome was a cognitive composite score at week 13, whereas secondary outcomes comprised sustained attention and functioning. WM-related dPFC activity was a tertiary outcome. RESULTS Data were analysed for 101 of the 103 included patients (EPO, n = 58; saline, n = 43). There were no effects of EPO over saline on any cognitive or functional outcomes or on WM-related dPFC activity. CONCLUSIONS The absence of treatment-related changes in cognition and neural activity was unexpected and contrasts with multiple previous preclinical and clinical studies. It is possible that the lack of effects resulted from a recent change in the manufacturing process for EPO. Nevertheless, the findings support the validity of dPFC target engagement as a biomarker model for pro-cognitive effects, according to which treatments that do not improve cognition should not modulate dPFC activity. TRIAL REGISTRATIONS EudraCT no.: 2016-004023-24; ClinicalTrials.gov identifier: NCT03315897.
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Affiliation(s)
- Julian Macoveanu
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
| | - Jeff Zarp Petersen
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
| | - Johanna Mariegaard
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Elleby Jespersen
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Cramer
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
| | - Caroline Fussing Bruun
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
| | - Helle Østergaard Madsen
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maj Vinberg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Early Multimodular Prevention and Intervention Research Institution, Mental Health Centre, Northern Zealand, Mental Health Services CPH, Copenhagen, Denmark
| | - Patrick M Fisher
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ida Hageman
- Mental Health Services, Copenhagen University Hospital, Capital Region of Denmark, Copenhagen, Denmark
| | - Hannelore Ehrenreich
- Clinical Neuroscience, Max Planck Institute for Multidisciplinary Sciences (City Campus), Göttingen, Germany
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Petersen JZ, Macoveanu J, Ysbæk-Nielsen AT, Kessing LV, Jørgensen MB, Miskowiak KW. Neural correlates of episodic memory decline following electroconvulsive therapy: An exploratory functional magnetic resonance imaging study. J Psychopharmacol 2024; 38:168-177. [PMID: 38159102 DOI: 10.1177/02698811231221153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is an efficient and rapid-acting treatment indicated for severe depressive disorders. While ECT is commonly accompanied by transient memory decline, the brain mechanisms underlying these side effects remain unclear. AIMS In this exploratory functional magnetic resonance (fMRI) study, we aimed to compare effects of ECT versus pharmacological treatment on neural response during episodic memory encoding in patients with affective disorders. METHODS This study included 32 ECT-treated patients (major depressive disorder (MDD), n = 23; bipolar depression, n = 9) and 40 partially remitted patients in pharmacological treatment (MDD, n = 24; bipolar disorder, n = 16). Participants underwent neuropsychological assessment, a strategic picture encoding fMRI scan paradigm, and mood rating. The ECT group was assessed before ECT (pre-ECT) and 3 days after their eighth ECT session (post-ECT). RESULTS Groups were comparable on age, gender, and educational years (ps ⩾ 0.05). Within-group analyses revealed a selective reduction in verbal learning and episodic memory pre- to post-ECT (p = 0.012) but no decline in global cognitive performance (p = 0.3). Functional magnetic resonance imaging analyses adjusted for mood symptoms revealed greater activity in ECT-treated patients than pharmacologically treated No-ECT patients across left precentral gyrus (PCG), right dorsomedial prefrontal cortex (dmPFC), and left middle frontal gyrus (MFG). In ECT-treated patients, greater decline in verbal learning and memory performance from pre- to post-ECT correlated with higher PCG response (r = -0.46, p = 0.008), but not with dmPFC or MFG activity (ps ⩾ 0.1), post-ECT. CONCLUSIONS Episodic memory decline was related to greater neural activity in the left PCG, but unrelated to increased dmPFC and MFG activity, immediately after ECT.
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Affiliation(s)
- Jeff Zarp Petersen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Neurocogntion and Emotion in Affective Disorders (NEAD) Centre, Psychiatric Centre Copenhagen, and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Julian Macoveanu
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Neurocogntion and Emotion in Affective Disorders (NEAD) Centre, Psychiatric Centre Copenhagen, and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Tobias Ysbæk-Nielsen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Neurocogntion and Emotion in Affective Disorders (NEAD) Centre, Psychiatric Centre Copenhagen, and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, København Ø, Denmark
| | - Martin Balslev Jørgensen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, København Ø, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Neurocogntion and Emotion in Affective Disorders (NEAD) Centre, Psychiatric Centre Copenhagen, and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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