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Orsolini L, Pompili S, Volpe U. The ‘collateral side’ of mood stabilizers: safety and evidence-based strategies for managing side effects. Expert Opin Drug Saf 2020; 19:1461-1495. [DOI: 10.1080/14740338.2020.1820984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Simone Pompili
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
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Zavala-Tecuapetla C, Orozco-Suarez S, Manjarrez J, Cuellar-Herrera M, Vega-Garcia A, Buzoianu-Anguiano V. Activation of adenosine receptors modulates the efflux transporters in brain capillaries and restores the anticonvulsant effect of carbamazepine in carbamazepine resistant rats developed by window-pentylenetetrazole kindling. Brain Res 2019; 1726:146516. [PMID: 31634453 DOI: 10.1016/j.brainres.2019.146516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 01/14/2023]
Abstract
Up-regulation of efflux transporters in brain capillaries may lead to the decreased therapeutic efficacy of antiepileptic drugs in patients with Drug Resistant Epilepsy. Adenosine receptor activation in brain capillaries can modulate blood-brain barrier permeability by decreasing the protein levels and function of efflux transporters. Therefore, we aimed to investigate whether the activation of adenosine receptors improves convulsions outcome in carbamazepine (CBZ) resistant animals and modulates the protein levels of efflux transporters (P-GP, MRP1, MRP2) in brain capillaries. We employed the window-pentylenetetrazol (PTZ) kindling model to develop CBZ resistant rats by CBZ administration during the post-kindling phase, and tested if these animals displayed subsequent resistance to other antiepileptic drugs. Crucially, we investigated if the administration of a broad-spectrum adenosine agonist (NECA) improves convulsions control in CBZ resistant rats. Of potential therapeutic relevance, in CBZ resistant rats NECA restored the anticonvulsant effect of CBZ. We also evaluated how the resistance to CBZ and the activation of adenosine receptors with NECA affect protein levels of efflux transporters in brain capillaries, as quantified by western blot. While CBZ resistance was associated with the up-regulation of both P-GP/MRP2 in brain capillaries, with the administration of NECA in CBZ resistant rats, we observed a decrease of P-GP and an increase of MRP2 levels, in brain capillaries. Since the activation of adenosine receptors improves the outcome of convulsions probably through the modulation of the efflux transporters protein levels in brain capillaries, adenosine agonists could be useful as an adjunct therapy for the control of Drug Resistant Epilepsy.
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Affiliation(s)
- C Zavala-Tecuapetla
- Laboratory of Physiology of Reticular Formation, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, La Fama, 14269 Mexico City, Mexico.
| | - S Orozco-Suarez
- Medical Research Unit in Neurological Diseases, Specialty Hospital, National Medical Center XXI Century, IMSS, Cuauhtemoc 330, Doctores, 06720 Mexico City, Mexico
| | - J Manjarrez
- Laboratory of Physiology of Reticular Formation, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, La Fama, 14269 Mexico City, Mexico
| | - M Cuellar-Herrera
- Epilepsy Clinic, Hospital General de México, Dr. Eduardo Liceaga, Dr. Balmis 148, Doctores, 06720 Mexico City, Mexico
| | - A Vega-Garcia
- Medical Research Unit in Neurological Diseases, Specialty Hospital, National Medical Center XXI Century, IMSS, Cuauhtemoc 330, Doctores, 06720 Mexico City, Mexico; Department of Physiology, Faculty of Medicine, National Autonomous University of Mexico, Av. Universidad 3000, C.U., 04510 Mexico City, Mexico
| | - V Buzoianu-Anguiano
- Medical Research Unit in Neurological Diseases, Specialty Hospital, National Medical Center XXI Century, IMSS, Cuauhtemoc 330, Doctores, 06720 Mexico City, Mexico
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Booker SA, Pires N, Cobb S, Soares-da-Silva P, Vida I. Carbamazepine and oxcarbazepine, but not eslicarbazepine, enhance excitatory synaptic transmission onto hippocampal CA1 pyramidal cells through an antagonist action at adenosine A1 receptors. Neuropharmacology 2015; 93:103-15. [DOI: 10.1016/j.neuropharm.2015.01.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/29/2014] [Accepted: 01/22/2015] [Indexed: 01/24/2023]
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Gomes CV, Kaster MP, Tomé AR, Agostinho PM, Cunha RA. Adenosine receptors and brain diseases: neuroprotection and neurodegeneration. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2010; 1808:1380-99. [PMID: 21145878 DOI: 10.1016/j.bbamem.2010.12.001] [Citation(s) in RCA: 303] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 11/30/2010] [Accepted: 12/01/2010] [Indexed: 02/06/2023]
Abstract
Adenosine acts in parallel as a neuromodulator and as a homeostatic modulator in the central nervous system. Its neuromodulatory role relies on a balanced activation of inhibitory A(1) receptors (A1R) and facilitatory A(2A) receptors (A2AR), mostly controlling excitatory glutamatergic synapses: A1R impose a tonic brake on excitatory transmission, whereas A2AR are selectively engaged to promote synaptic plasticity phenomena. This neuromodulatory role of adenosine is strikingly similar to the role of adenosine in the control of brain disorders; thus, A1R mostly act as a hurdle that needs to be overcame to begin neurodegeneration and, accordingly, A1R only effectively control neurodegeneration if activated in the temporal vicinity of brain insults; in contrast, the blockade of A2AR alleviates the long-term burden of brain disorders in different neurodegenerative conditions such as ischemia, epilepsy, Parkinson's or Alzheimer's disease and also seem to afford benefits in some psychiatric conditions. In spite of this qualitative agreement between neuromodulation and neuroprotection by A1R and A2AR, it is still unclear if the role of A1R and A2AR in the control of neuroprotection is mostly due to the control of glutamatergic transmission, or if it is instead due to the different homeostatic roles of these receptors related with the control of metabolism, of neuron-glia communication, of neuroinflammation, of neurogenesis or of the control of action of growth factors. In spite of this current mechanistic uncertainty, it seems evident that targeting adenosine receptors might indeed constitute a novel strategy to control the demise of different neurological and psychiatric disorders.
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Affiliation(s)
- Catarina V Gomes
- Center for Neurosciences of Coimbra, University of Coimbra, Coimbra, Portugal
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Theophylline, a methylxanthine derivative, suppresses absence epileptic seizures in WAG/Rij rats. Epilepsy Behav 2004; 5:645-8. [PMID: 15380114 DOI: 10.1016/j.yebeh.2004.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Revised: 06/02/2004] [Accepted: 06/08/2004] [Indexed: 11/28/2022]
Abstract
The effects of systemic theophylline administration on spike-wave discharge (SWD) frequency in genetically absence epileptic Wistar Albino Glaxo/Rijswijk (WAG/Rij) rats are investigated. After an hour of baseline recording, animals were injected intraperitoneally (ip) with 5, 10, and 20mg/kg theophylline and electroencephalograms (EEGs) were recorded for 2h postinjection. Then, the number and total duration of SWDs were analyzed. Spontaneous behaviors of the animals was also observed before and after drug administration. Our results show that systemic administration of theophylline suppresses the occurrence of SWDs in a dose-dependent manner. The greatest suppression was seen in the group administered 20mg/kg theophylline. Theophylline also induced a mild increase in exploratory and automatic behavior. These results indicate that blockage of adenosinergic receptors via the methylxanthine derivative theophylline decreases the occurrence of SWDs, probably by augmenting the efficacy of excitator neurotransmission and increasing vigilance and arousal levels.
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Spiller HA, Carlisle RD. Status epilepticus after massive carbamazepine overdose. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 2002; 40:81-90. [PMID: 11990208 DOI: 10.1081/clt-120002889] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We report two patients who experienced status epilepticus after carbamazepine overdose. The first patient was an 18-year-old female with a history of epilepsy. She experienced 4 hour of persistent and prolonged seizures resistant to sodium amytal therapy. The status epilepticus ended with her death. The second patient was an 18-year-old male with a history of bipolar disorder. He experienced 5 hour of persistent and prolonged seizures that appeared to be resistant to diazepam, phenytoin, and phenobarbital. The seizures abated with the infusion of midazolam. This is a report of status epilepticus associated with wide complex tachycardia after carbamazepine overdose, which may be resistant to conventional therapy.
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Affiliation(s)
- Henry A Spiller
- Kentucky Regional Poison Center of Kosair Children's Hospital, Louisville 40232-5070, USA.
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Machado-Vieira R, Lara DR, Souza DO, Kapczinski F. Purinergic dysfunction in mania: an integrative model. Med Hypotheses 2002; 58:297-304. [PMID: 12027524 DOI: 10.1054/mehy.2001.1543] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purinergic system, which includes the anticonvulsant and antikindling neuromodulator adenosine and the neurotransmitter ATP, modulates second messenger systems, neurotransmitters, energy metabolism and different behaviors, such as sleep, motor activity, cognition, memory, aggressive behavior and social interaction. At the same time, mania is characterized by similar behavioral changes and a molecular basis to explain the pathological activation observed during manic episodes has been also associated with second messenger systems dysfunction and kindling. This hypothesis put forward an integrative model of neuronal communication, associating a reduced adenosinergic activity, mostly at A1 receptors, with the complex network of changes on neurotransmitters pathways related to manic behavior.
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Ambrósio AF, Soares-Da-Silva P, Carvalho CM, Carvalho AP. Mechanisms of action of carbamazepine and its derivatives, oxcarbazepine, BIA 2-093, and BIA 2-024. Neurochem Res 2002; 27:121-30. [PMID: 11926264 DOI: 10.1023/a:1014814924965] [Citation(s) in RCA: 216] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Carbamazepine (CBZ) has been extensively used in the treatment of epilepsy, as well as in the treatment of neuropathic pain and affective disorders. However, the mechanisms of action of this drug are not completely elucidated and are still a matter of debate. Since CBZ is not very effective in some epileptic patients and may cause several adverse effects, several antiepileptic drugs have been developed by structural variation of CBZ, such as oxcarbazepine (OXC), which is used in the treatment of epilepsy since 1990. (S)-(-)-10-acetoxy-10,11-dihydro-5H-dibenz [b,f]azepine-5-carboxamide (BIA 2-093) and 10,11-dihydro-10-hydroxyimino-5H-dibenz[b,f] azepine-5-carboxamide (BIA 2-024), which were recently developed by BIAL, are new putative antiepileptic drugs, with some improved properties. In this review, we will focus on the mechanisms of action of CBZ and its derivatives, OXC, BIA 2-093 and BIA 2-024. The available data indicate that the anticonvulsant efficacy of these AEDs is mainly due to the inhibition of sodium channel activity.
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Affiliation(s)
- António F Ambrósio
- Department of Cell Biology, Center for Neuroscience of Coimbra, Portugal
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