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Yokoyama S, Sugawara N, Maruo K, Yasui-Furukori N, Shimoda K. Blood Levels of Ammonia and Carnitine in Patients Treated with Valproic Acid: A Meta-analysis. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2022; 20:536-547. [PMID: 35879038 PMCID: PMC9329117 DOI: 10.9758/cpn.2022.20.3.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
Objective Long-term valproic acid (VPA) administration is associated with adverse metabolic effects, including hyperammonemia and hypocarnitinemia. However, the pathogeneses of these adverse events remain unclear, and not enough reviews have been performed. The aim of this study was to conduct a meta-analysis of studies examining blood levels of ammonia and carnitine in patients treated with VPA. Methods We conducted database searches (PubMed, Web of Science) to identify studies examining blood levels of ammonia and carnitine in patients treated with VPA. A meta-analysis was performed to conduct pre- and post-VPA treatment comparisons, cross-sectional comparisons between groups with and without VPA use, and estimations of the standardized correlations between blood levels of ammonia, carnitine, and VPA. Results According to the cross-sectional comparisons, the blood ammonia level in the VPA group was significantly higher than that in the non-VPA group. Compared to that in the non-VPA group, the blood carnitine level in the VPA group was significantly lower. In the meta-analysis of correlation coefficients, the blood VPA level was moderately correlated with blood ammonia and blood free carnitine levels in the random effects model. Furthermore, the blood ammonia level was moderately correlated with the blood free carnitine level. Conclusion Although the correlation between ammonia and free carnitine levels in blood was significant, the moderate strength of the correlation does not allow clinicians to infer free carnitine levels from the results of ammonia levels. Clinicians should measure both blood ammonia and free carnitine levels, especially in patients receiving high dosages of VPA.
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Affiliation(s)
- Saaya Yokoyama
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Norio Sugawara
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Kazushi Maruo
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
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Bene J, Szabo A, Komlósi K, Melegh B. Mass Spectrometric Analysis of L-carnitine and its Esters: Potential Biomarkers of Disturbances in Carnitine Homeostasis. Curr Mol Med 2020; 20:336-354. [PMID: 31729298 PMCID: PMC7231908 DOI: 10.2174/1566524019666191113120828] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE After a golden age of classic carnitine research three decades ago, the spread of mass spectrometry opened new perspectives and a much better understanding of the carnitine system is available nowadays. In the classic period, several human and animal studies were focused on various distinct physiological functions of this molecule and these revealed different aspects of carnitine homeostasis in normal and pathological conditions. Initially, the laboratory analyses were based on the classic or radioenzymatic assays, enabling only the determination of free and total carnitine levels and calculation of total carnitine esters' amount without any information on the composition of the acyl groups. The introduction of mass spectrometry allowed the measurement of free carnitine along with the specific and sensitive determination of different carnitine esters. Beyond basic research, mass spectrometry study of carnitine esters was introduced into the newborn screening program because of being capable to detect more than 30 metabolic disorders simultaneously. Furthermore, mass spectrometry measurements were performed to investigate different disease states affecting carnitine homeostasis, such as diabetes, chronic renal failure, celiac disease, cardiovascular diseases, autism spectrum disorder or inflammatory bowel diseases. RESULTS This article will review the recent advances in the field of carnitine research with respect to mass spectrometric analyses of acyl-carnitines in normal and various pathological states. CONCLUSION The growing number of publications using mass spectrometry as a tool to investigate normal physiological conditions or reveal potential biomarkers of primary and secondary carnitine deficiencies shows that this tool brought a new perspective to carnitine research.
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Affiliation(s)
- Judit Bene
- Department of Medical Genetics, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Andras Szabo
- Department of Medical Genetics, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Katalin Komlósi
- Department of Medical Genetics, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Bela Melegh
- Department of Medical Genetics, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
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El Mously S, Abdel Ghaffar H, Magdy R, Hamza S, Mansour M. Carnitine deficiency in epileptic children treated with a diversity of anti-epileptic regimens. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:37. [PMID: 30546248 PMCID: PMC6267633 DOI: 10.1186/s41983-018-0033-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 10/19/2018] [Indexed: 12/30/2022] Open
Abstract
Background Carnitine deficiency is relatively common in epileptic patients. The risk factors reported include the combination of valproic acid with other antiepileptic drugs (AEDs), young age, multiple neurologic disabilities, non-ambulatory status, and being underweight. Objectives To study the level of carnitine deficiency and its associated risk factors among a group of children with idiopathic epilepsy treated with different AEDs. Patients and methods Fifty children with idiopathic epilepsy and 40 age-matched controls were enrolled. For all, serum carnitine level was measured by enzyme-linked immune sorbent assay (ELISA). Results The mean carnitine level was lower in cases compared to controls (p = 0.04). Patients receiving monotherapy treatment had a high percentage of carnitine deficiency compared to controls (p = 0.04). Patients receiving valproate with other AEDs had a lower level of carnitine compared to controls (p = 0.03). The age of the patients, the duration of treatment, and the doses of different AEDs were not risk factors for carnitine deficiency. Conclusions Carnitine deficiency is common in our population, and the use of valproate with other AEDs is considered the most important risk factor for it in epileptic children.
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Affiliation(s)
| | | | - Remon Magdy
- Faculty of Medicine, Fayoum University, Fayoum City, 63611 Egypt
| | - Somaia Hamza
- Faculty of Medicine, Fayoum University, Fayoum City, 63611 Egypt
| | - Mohamed Mansour
- Faculty of Medicine, Fayoum University, Fayoum City, 63611 Egypt
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Kulhas Celik I, Tasdemir HA, Ince H, Celik H, Sungur M. Evaluation ofserum free carnitine/acylcarnitine levels and left ventricular systolic functions in children with idiopathic epilepsy receiving valproic acid. Clin Neurol Neurosurg 2018; 170:106-112. [DOI: 10.1016/j.clineuro.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/01/2018] [Accepted: 05/09/2018] [Indexed: 12/14/2022]
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Ando M, Amayasu H, Itai T, Yoshida H. Association between the blood concentrations of ammonia and carnitine/amino acid of schizophrenic patients treated with valproic acid. Biopsychosoc Med 2017; 11:19. [PMID: 28690671 PMCID: PMC5497353 DOI: 10.1186/s13030-017-0101-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/29/2017] [Indexed: 01/09/2023] Open
Abstract
Background Administration of valproic acid (VPA) is complicated with approximately 0.9% of patients developing hyperammonemia, but the pathogenesis of this adverse effect remains to be clarified. The aim of the present study was to search for mechanisms associated with VPA-induced hyperammonemia in the light of changes in serum amino acids concentrations associated with the urea cycle of schizophrenic patients. Method Blood samples (10 mL) were obtained from 37 schizophrenic patients receiving VPA for the prevention of violent behaviors in the morning after overnight fast. Blood concentrations of ammonia, VPA, free carnitine, acyl-carnitine, and 40 amino acids including glutamate and citrulline were measured for each patient. Univariate and multivariate regression analyses were performed to identify amino acids or concomitantly administered drugs that were associated with variability in the blood concentrations of ammonia. Result The blood ammonia level was positively correlated with the serum glutamate concentration (r = 0.44, p < 0.01) but negatively correlated with glutamine (r = −0.41, p = 0.01), citrulline (r = −0.42, p = 0.01), and glycine concentrations (r = −0.54, p < 0.01). It was also revealed that the concomitant administration of the mood stabilizers (p = 0.04) risperidone (p = 0.03) and blonanserin (p < 0.01) was positively associated with the elevation of the blood ammonia level. Conclusion We hypothisized that VPA would elevate the blood ammonia level of schizophrenic patients. The observed changes in serum amino acids are compatible with urea cycle dysfunction, possibly due to reduced carbamoyl-phosphate synthase 1 (CPS1) activity. We conclude that VPA should be prudently prescribed to schizophrenic patients, particularly those receiving mood stabilizers or certain antipsychotics.
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Affiliation(s)
- Masazumi Ando
- Department of Drug Metabolism and Disposition, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588 Japan.,Department of Pharmacy, Heartful Kawasaki Hospital, 2-1-3 Shimonoge, Takatsu-ku, Kawasaki, Kanagawa 213-0006 Japan.,Department of Pharmacy, the 2nd Totsuka Kyoritsu Hospital, 579-1 Yoshida-cho, Totsuka-ku, Yokohama, Kanagawa 244-0817 Japan
| | - Hideaki Amayasu
- Division of Psychiatry, Heartful Kawasaki Hospital, 2-1-3 Shimonoge, Takatsu-ku, Kawasaki, Kanagawa 213-0006 Japan
| | - Takahiro Itai
- Division of Psychiatry, Heartful Kawasaki Hospital, 2-1-3 Shimonoge, Takatsu-ku, Kawasaki, Kanagawa 213-0006 Japan
| | - Hisahiro Yoshida
- Department of Drug Metabolism and Disposition, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588 Japan
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Fukuda M, Kawabe M, Takehara M, Iwano S, Kuwabara K, Kikuchi C, Wakamoto H, Morimoto T, Suzuki Y, Ishii E. Carnitine deficiency: Risk factors and incidence in children with epilepsy. Brain Dev 2015; 37:790-6. [PMID: 25547040 DOI: 10.1016/j.braindev.2014.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/10/2014] [Accepted: 12/10/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Carnitine deficiency is relatively common in epilepsy; risk factors reportedly include combination antiepileptic drug (AED) therapy with valproic acid (VPA), young age, intellectual disability, diet and enteral or parenteral feeding. Few studies have examined the correlation between each risk factor and carnitine deficiency in children with epilepsy. We examined the influence of these risk factors on carnitine deficiency, and identified a formula to estimate plasma free carnitine concentration in children with epilepsy. METHODS Sixty-five children with epilepsy and 26 age-matched controls were enrolled. Plasma carnitine concentrations were measured using an enzyme cycling assay, and correlations were sought with patients' other clinical characteristics. RESULTS Carnitine deficiency was found in approximately 17% of patients with epilepsy and was significantly associated with carnitine-free enteral formula only by tube feeding, number of AEDs taken (independent of VPA use), body weight (BW), body height and Gross Motor Function Classification System (GMFCS) score. Stepwise multiple linear regression analysis indicated that carnitine concentration (in μmol/L) could be accurately estimated from a formula that does not require blood testing: 42.44+0.14×(BW in kg)-18.16×(feeding)-3.19×(number of AEDs), where feeding was allocated a score of 1 for carnitine-free enteral formula only by tube feeding and 0 for taking food orally (R(2)=0.504, P<0.001). CONCLUSIONS Carnitine-free enteral formula only by tube feeding, multiple AED treatment and low BW are risk factors for carnitine deficiency in children with epilepsy. l-carnitine should be administered to children at risk of deficiency to avoid complications. Treatment decisions can be informed using an estimation formula that does not require blood tests.
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Affiliation(s)
- Mitsumasa Fukuda
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
| | - Mika Kawabe
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Makoto Takehara
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Sachiko Iwano
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Kozue Kuwabara
- Ehime Rehabilitation Center for Children, Toon, Ehime, Japan
| | - Chiya Kikuchi
- Ehime Rehabilitation Center for Children, Toon, Ehime, Japan
| | | | | | - Yuka Suzuki
- Ehime Rehabilitation Center for Children, Toon, Ehime, Japan
| | - Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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Bhattacharyya S, Yan K, Pence L, Simpson PM, Gill P, Letzig LG, Beger RD, Sullivan JE, Kearns GL, Reed MD, Marshall JD, Van Den Anker JN, James LP. Targeted liquid chromatography-mass spectrometry analysis of serum acylcarnitines in acetaminophen toxicity in children. Biomark Med 2014; 8:147-59. [PMID: 24521011 DOI: 10.2217/bmm.13.150] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM Long-chain acylcarnitines have been postulated to be sensitive biomarkers of acetaminophen (APAP)-induced hepatotoxicity in mouse models. In the following study, the relationship of acylcarnitines with other known indicators of APAP toxicity was examined in children receiving low-dose (therapeutic) and high-dose ('overdose' or toxic ingestion) exposure to APAP. MATERIALS & METHODS The study included three subject groups: group A (therapeutic dose, n = 187); group B (healthy controls, n = 23); and group C (overdose, n = 62). Demographic, clinical and laboratory data were collected for each subject. Serum samples were used for measurement of APAP protein adducts, a biomarker of the oxidative metabolism of APAP and for targeted metabolomics analysis of serum acylcarnitines using ultra performance liquid chromatography-triple-quadrupole mass spectrometry. RESULTS Significant increases in oleoyl- and palmitoyl-carnitines were observed with APAP exposure (low dose and overdose) compared with controls. Significant increases in serum ALT, APAP protein adducts and acylcarnitines were observed in overdose children that received delayed treatment (time to treatment from overdose >24 h) with the antidote N-acetylcysteine. Time to peak APAP protein adducts in serum was shorter than that of the acylcarnitines and serum ALT. CONCLUSION Perturbations in long-chain acylcarnitines in children with APAP toxicity suggest that mitochrondrial injury and associated impairment in the β-oxidation of fatty acids are clinically relevant as biomarkers of APAP toxicity.
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Affiliation(s)
- Sudeepa Bhattacharyya
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA and Arkansas Children's Hospital Research Institute, Little Rock, AR 72202, USA
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Boullata JI. Drug and nutrition interactions: not just food for thought. J Clin Pharm Ther 2013; 38:269-71. [PMID: 23710968 DOI: 10.1111/jcpt.12075] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 05/07/2013] [Indexed: 01/01/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE The management of drug-drug interactions - from recognition of the interaction potential, to addressing the negative consequences - are well-recognized and avoided, or rapidly addressed when identified clinically. Drug-nutrition interactions are no less important than drug-drug interactions in patient care. Unfortunately, beyond those caused by food, these interactions are less commonly recognized or identified and managed. This article will re-introduce the topic of drug-nutrition interactions to clinicians. COMMENT Although many clinicians are acutely aware of and vigilant for potential drug-drug interactions, most are less aware of the possibility of drug-nutrition interactions beyond classic food-drug interactions. Interaction can occur between a drug and a nutrient, multiple nutrients, food in general, specific foods or components, or nutrition status. An interaction is considered clinically significant if it alters therapeutic drug response and/or compromises nutrition status. Mechanistically the interactions may be physicochemical reactions, actions at membrane transporters or metabolizing enzymes, or an influence on physiologic function. Appreciating the many types of drug-nutrition interactions will aid the clinician and have the potential to influence patient outcome. WHAT IS NEW AND CONCLUSION Ongoing advances in knowledge about drug and nutrition interactions have potential to improve patient care. Drug-nutrition interactions need to be better recognized, understood on a mechanistic basis, predicted, and managed as necessary.
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Affiliation(s)
- J I Boullata
- University of Pennsylvania, Philadelphia, PA, USA.
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Abstract
There has been important progress in the identification of antiepileptic compounds and their indications in children over the past 15 years: their number has doubled and specific pediatric trials are being performed to document their effect according to seizures and syndromes as well as their tolerability in pediatrics. The improved understanding of pharmacokinetics and drug-drug interactions has helped to optimize treatment. Specific issues specific of infants have also been studied although new antiepileptic drugs are still dramatically lacking for this age group. Before reaching a syndromic diagnosis, the choice of a first- line agent goes to compounds with the largest range of efficacy and least identified risks. Subsequent choices are mainly based on the epilepsy syndrome and seizure type in addition to good clinical practice to determine dose, adverse effect profile, risk of aggravating seizures and drug interactions, clinician's experience, cultural habits, and availability of drugs. If there are several options, preference is given to the compound that exhibits the best risk/benefit ratio, or the most rapid titration when seizure frequency is the major issue. For new antiepileptic compounds, price is often a limiting factor in countries with poor insurance coverage. Third generation anti-epileptic drugs are emerging which also seem to be promising.
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Affiliation(s)
- C Chiron
- INSERM UMR663, Université Paris Descartes, Paris and CEA, France.
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Boullata JI, Hudson LM. Drug-nutrient interactions: a broad view with implications for practice. J Acad Nutr Diet 2012; 112:506-17. [PMID: 22717215 DOI: 10.1016/j.jada.2011.09.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 09/03/2011] [Indexed: 01/03/2023]
Abstract
The relevance of drug?nutrient interactions in daily practice continues to grow with the widespread use of medication. Interactions can involve a single nutrient, multiple nutrients, food in general, or nutrition status. Mechanistically, drug?nutrient interactions occur because of altered intestinal transport and metabolism, or systemic distribution, metabolism and excretion, as well as additive or antagonistic effects. Optimal patient care includes identifying, evaluating, and managing these interactions. This task can be supported by a systematic approach for categorizing interactions and rating their clinical significance. This review provides such a broad framework using recent examples, as well as some classic drug?nutrient interactions. Pertinent definitions are presented, as is a suggested approach for clinicians. This important and expanding subject will benefit tremendously from further clinician involvement.
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Affiliation(s)
- Joseph I Boullata
- Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104, USA.
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Nakajima Y, Ito T, Maeda Y, Ichiki S, Kobayashi S, Ando N, Hussein MH, Kurono Y, Sugiyama N, Togari H. Evaluation of valproate effects on acylcarnitine in epileptic children by LC-MS/MS. Brain Dev 2011; 33:816-23. [PMID: 21196091 DOI: 10.1016/j.braindev.2010.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 11/08/2010] [Accepted: 12/01/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Valproate (VPA) is a simple fatty acid and a substrate for the fatty acid β-oxidation pathway. Previous data suggested that the toxicity of VPA may be provoked by carnitine deficiency and the inhibition of mitochondrial β-oxidation. OBJECTIVE The aim of the present study was to elucidate the effect of VPA treatment on carnitine and isomer-differentiated acylcarnitine disposition, and determined the relationships between acylcarnitines and blood VPA levels in long-term treated patients with VPA and/or other antiepileptic drugs. METHODS Serum samples were obtained from children aged 1-15 years old treated for at least 6 months with VPA alone (n=28) or VPA combined with other anticonvulsants (n=23) and untreated controls (n=23). Serum acylcarnitines were separated from their isomers and quantified using high-performance liquid chromatography-tandem mass spectrometry. RESULTS We found higher 3-hydroxyisovalerylcarnitine levels and trace amounts of valproylcarnitine in both VPA monotherapy and polytherapy patients. Other acylcarnitines, hexanoylcarnitine, C12, C14:1-carnitines and the ratio of long-chain acylcarnitine to free carnitine were also higher in VPA polytherapy individuals than in controls. VPA monotherapy does not result in decreases in free carnitine or in the accumulation of long-chain acylcarnitines. Blood VPA concentrations correlated positively with hexanoylcarnitine, C12, C14:1, C16:1, C18:1-carnitines in all VPA-treated children (n=51). CONCLUSION Long-term VPA treatment in pediatric patients could affect some specific acylcarnitines, which is enhanced by the concomitant use of other anticonvulsants, and the formation of valproylcarnitine alone seems insufficient to develop severe carnitine deficiency at therapeutic doses of VPA.
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Affiliation(s)
- Yoko Nakajima
- Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Sciences, Mizuho-cho, Nagoya, Japan
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Mastrangelo M, Mariani R, Spalice A, Rocchi V, Iannetti P. Stupor and fast activity on electroencephalography in a child treated with valproate. Pediatr Neurol 2009; 41:53-6. [PMID: 19520277 DOI: 10.1016/j.pediatrneurol.2009.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 01/26/2009] [Accepted: 02/04/2009] [Indexed: 10/20/2022]
Abstract
The case of a 4-year-old girl with valproate-induced stupor and electroencephalographic pattern of increased fast activity is reported. Stupor and fast activity have been related to the effects on gamma-aminobutyric acid type A (GABA(A)) receptors mediated by endozepines or by exogenous drugs such as benzodiazepines or barbiturates. The action of valproate in GABA metabolism and in GABA neuronal networks could produce a similar result through a hyperrecruitment of GABA-mediated postsynaptic transmission.
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Affiliation(s)
- Mario Mastrangelo
- Pediatric Neurology Division, Department of Pediatrics, La Sapienza University of Rome, Rome, Italy
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13
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Silva MFB, Aires CCP, Luis PBM, Ruiter JPN, IJlst L, Duran M, Wanders RJA, Tavares de Almeida I. Valproic acid metabolism and its effects on mitochondrial fatty acid oxidation: a review. J Inherit Metab Dis 2008; 31:205-16. [PMID: 18392741 DOI: 10.1007/s10545-008-0841-x] [Citation(s) in RCA: 253] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 02/12/2008] [Accepted: 02/15/2008] [Indexed: 12/25/2022]
Abstract
Valproic acid (VPA; 2-n-propylpentanoic acid) is widely used as a major drug in the treatment of epilepsy and in the control of several types of seizures. Being a simple fatty acid, VPA is a substrate for the fatty acid beta-oxidation (FAO) pathway, which takes place primarily in mitochondria. The toxicity of valproate has long been considered to be due primarily to its interference with mitochondrial beta-oxidation. The metabolism of the drug, its effects on enzymes of FAO and their cofactors such as CoA and/or carnitine will be reviewed. The cumulative consequences of VPA therapy in inborn errors of metabolism (IEMs) and the importance of recognizing an underlying IEM in cases of VPA-induced steatosis and acute liver toxicity are two different concepts that will be emphasized.
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Affiliation(s)
- M F B Silva
- Centro de Patogénese Molecular-UBMBE, iMed.UL, Faculdade de Farmácia da Universidade de Lisboa, Lisboa, Portugal.
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