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Jakobsen P, Côté-Allard U, Riegler MA, Stabell LA, Stautland A, Nordgreen T, Torresen J, Fasmer OB, Oedegaard KJ. Early warning signals observed in motor activity preceding mood state change in bipolar disorder. Bipolar Disord 2024. [PMID: 38639725 DOI: 10.1111/bdi.13430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Alterations in motor activity are well-established symptoms of bipolar disorder, and time series of motor activity can be considered complex dynamical systems. In such systems, early warning signals (EWS) occur in a critical transition period preceding a sudden shift (tipping point) in the system. EWS are statistical observations occurring due to a system's declining ability to maintain homeostasis when approaching a tipping point. The aim was to identify critical transition periods preceding bipolar mood state changes. METHODS Participants with a validated bipolar diagnosis were included to a one-year follow-up study, with repeated assessments of the participants' mood. Motor activity was recorded continuously by a wrist-worn actigraph. Participants assessed to have relapsed during follow-up were analyzed. Recognized EWS features were extracted from the motor activity data and analyzed by an unsupervised change point detection algorithm, capable of processing multi-dimensional data and developed to identify when the statistical property of a time series changes. RESULTS Of 49 participants, four depressive and four hypomanic/manic relapses among six individuals occurred, recording actigraphy for 23.8 ± 0.2 h/day, for 39.8 ± 4.6 days. The algorithm detected change points in the time series and identified critical transition periods spanning 13.5 ± 7.2 days. For depressions 11.4 ± 1.8, and hypomania/mania 15.6 ± 10.2 days. CONCLUSION The change point detection algorithm seems capable of recognizing impending mood episodes in continuous flowing data streams. Hence, we present an innovative method for forecasting approaching relapses to improve the clinical management of bipolar disorder.
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Affiliation(s)
- Petter Jakobsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | | | - Lena Antonsen Stabell
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Andrea Stautland
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jim Torresen
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Ole Bernt Fasmer
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ketil Joachim Oedegaard
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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2
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Niemsiri V, Rosenthal SB, Nievergelt CM, Maihofer AX, Marchetto MC, Santos R, Shekhtman T, Alliey-Rodriguez N, Anand A, Balaraman Y, Berrettini WH, Bertram H, Burdick KE, Calabrese JR, Calkin CV, Conroy C, Coryell WH, DeModena A, Eyler LT, Feeder S, Fisher C, Frazier N, Frye MA, Gao K, Garnham J, Gershon ES, Goes FS, Goto T, Harrington GJ, Jakobsen P, Kamali M, Kelly M, Leckband SG, Lohoff FW, McCarthy MJ, McInnis MG, Craig D, Millett CE, Mondimore F, Morken G, Nurnberger JI, Donovan CO, Øedegaard KJ, Ryan K, Schinagle M, Shilling PD, Slaney C, Stapp EK, Stautland A, Tarwater B, Zandi PP, Alda M, Fisch KM, Gage FH, Kelsoe JR. Focal adhesion is associated with lithium response in bipolar disorder: evidence from a network-based multi-omics analysis. Mol Psychiatry 2024; 29:6-19. [PMID: 36991131 PMCID: PMC11078741 DOI: 10.1038/s41380-022-01909-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 11/14/2022] [Accepted: 12/02/2022] [Indexed: 03/31/2023]
Abstract
Lithium (Li) is one of the most effective drugs for treating bipolar disorder (BD), however, there is presently no way to predict response to guide treatment. The aim of this study is to identify functional genes and pathways that distinguish BD Li responders (LR) from BD Li non-responders (NR). An initial Pharmacogenomics of Bipolar Disorder study (PGBD) GWAS of lithium response did not provide any significant results. As a result, we then employed network-based integrative analysis of transcriptomic and genomic data. In transcriptomic study of iPSC-derived neurons, 41 significantly differentially expressed (DE) genes were identified in LR vs NR regardless of lithium exposure. In the PGBD, post-GWAS gene prioritization using the GWA-boosting (GWAB) approach identified 1119 candidate genes. Following DE-derived network propagation, there was a highly significant overlap of genes between the top 500- and top 2000-proximal gene networks and the GWAB gene list (Phypergeometric = 1.28E-09 and 4.10E-18, respectively). Functional enrichment analyses of the top 500 proximal network genes identified focal adhesion and the extracellular matrix (ECM) as the most significant functions. Our findings suggest that the difference between LR and NR was a much greater effect than that of lithium. The direct impact of dysregulation of focal adhesion on axon guidance and neuronal circuits could underpin mechanisms of response to lithium, as well as underlying BD. It also highlights the power of integrative multi-omics analysis of transcriptomic and genomic profiling to gain molecular insights into lithium response in BD.
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Grants
- R01 MH095741 NIMH NIH HHS
- UL1 TR001442 NCATS NIH HHS
- U19 MH106434 NIMH NIH HHS
- U01 MH092758 NIMH NIH HHS
- T32 MH018399 NIMH NIH HHS
- U.S. Department of Health & Human Services | NIH | National Institute of Mental Health (NIMH)
- Department of Veterans Affairs | Veterans Affairs San Diego Healthcare System (VA San Diego Healthcare System)
- The Halifax group (MA, CVC, JG, CO, and CS) is supported by grants from Canadian Institutes of Health Research (#166098), ERA PerMed project PLOT-BD, Research Nova Scotia, Genome Atlantic, Nova Scotia Health Authority and Dalhousie Medical Research Foundation (Lindsay Family Fund).
- U.S. Department of Health & Human Services | NIH | National Center for Advancing Translational Sciences (NCATS)
- U19MH106434, part of the National Cooperative Reprogrammed Cell Research Groups (NCRCRG) to Study Mental Illness. AHA-Allen Initiative in Brain Health and Cognitive Impairment Award (19PABH134610000). The JPB Foundation, Bob and Mary Jane Engman, Annette C Merle-Smith, R01 MH095741, and Lynn and Edward Streim.
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Affiliation(s)
- Vipavee Niemsiri
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Sara Brin Rosenthal
- Center for Computational Biology and Bioinformatics, University of California, San Diego, La Jolla, CA, USA
| | | | - Adam X Maihofer
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Maria C Marchetto
- Department of Anthropology, University of California, San Diego, La Jolla, CA, USA
- Laboratory of Genetics, Salk Institute for Biological Studies, La Jolla, CA, USA
| | - Renata Santos
- Laboratory of Genetics, Salk Institute for Biological Studies, La Jolla, CA, USA
- University of Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1261266, Laboratory of Dynamics of Neuronal Structure in Health and Disease, Paris, France
| | - Tatyana Shekhtman
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Ney Alliey-Rodriguez
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Neuroscience, Northwestern University, Chicago, IL, USA
| | - Amit Anand
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yokesh Balaraman
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Wade H Berrettini
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Holli Bertram
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Calabrese
- Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Mood Disorders Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Cynthia V Calkin
- Department of Psychiatry and Medical Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Carla Conroy
- Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Mood Disorders Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Anna DeModena
- Psychiatry Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Scott Feeder
- Department of Psychiatry, The Mayo Clinic, Rochester, MN, USA
| | - Carrie Fisher
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicole Frazier
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mark A Frye
- Department of Psychiatry, The Mayo Clinic, Rochester, MN, USA
| | - Keming Gao
- Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Mood Disorders Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Julie Garnham
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Elliot S Gershon
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Toyomi Goto
- Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Petter Jakobsen
- Norment, Division of Psychiatry, Haukeland University Hospital and Department of Clinical medicine, University of Bergen, Bergen, Norway
| | - Masoud Kamali
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Marisa Kelly
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Susan G Leckband
- Psychiatry Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Falk W Lohoff
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael J McCarthy
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - David Craig
- Department of Translational Genomics, University of Southern California, Los Angeles, CA, USA
| | - Caitlin E Millett
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Francis Mondimore
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Gunnar Morken
- Division of Mental Health Care, St Olavs University Hospital, and Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - John I Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Medical and Molecular Genetics, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Ketil J Øedegaard
- Norment, Division of Psychiatry, Haukeland University Hospital and Department of Clinical medicine, University of Bergen, Bergen, Norway
| | - Kelly Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Martha Schinagle
- Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Paul D Shilling
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Claire Slaney
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Emma K Stapp
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea Stautland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bruce Tarwater
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Kathleen M Fisch
- Center for Computational Biology and Bioinformatics, University of California, San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Fred H Gage
- Laboratory of Genetics, Salk Institute for Biological Studies, La Jolla, CA, USA
| | - John R Kelsoe
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- Institute for Genomic Medicine, University of California, San Diego, La Jolla, CA, USA.
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3
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Frid LM, Kessler U, Ousdal OT, Hammar Å, Haavik J, Riemer F, Hirnstein M, Ersland L, Erchinger VJ, Ronold EH, Nygaard G, Jakobsen P, Craven AR, Osnes B, Alisauskiene R, Bartsch H, Le Hellard S, Stavrum AK, Oedegaard KJ, Oltedal L. Neurobiological mechanisms of ECT and TMS treatment in depression: study protocol of a multimodal magnetic resonance investigation. BMC Psychiatry 2023; 23:791. [PMID: 37904091 PMCID: PMC10617235 DOI: 10.1186/s12888-023-05239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/30/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Noninvasive neurostimulation treatments are increasingly being used to treat major depression, which is a common cause of disability worldwide. While electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are both effective in treating depressive episodes, their mechanisms of action are, however, not completely understood. ECT is given under general anesthesia, where an electrical pulse is administered through electrodes placed on the patient's head to trigger a seizure. ECT is used for the most severe cases of depression and is usually not prescribed before other options have failed. With TMS, brain stimulation is achieved through rapidly changing magnetic fields that induce electric currents underneath a ferromagnetic coil. Its efficacy in depressive episodes has been well documented. This project aims to identify the neurobiological underpinnings of both the effects and side effects of the neurostimulation techniques ECT and TMS. METHODS The study will utilize a pre-post case control longitudinal design. The sample will consist of 150 subjects: 100 patients (bipolar and major depressive disorder) who are treated with either ECT (N = 50) or TMS (N = 50) and matched healthy controls (N = 50) not receiving any treatment. All participants will undergo multimodal magnetic resonance imaging (MRI) as well as neuropsychological and clinical assessments at multiple time points before, during and after treatment. Arterial spin labeling MRI at baseline will be used to test whether brain perfusion can predict outcomes. Signs of brain disruption, potentiation and rewiring will be explored with resting-state functional MRI, magnetic resonance spectroscopy and multishell diffusion weighted imaging (DWI). Clinical outcome will be measured by clinician assessed and patient reported outcome measures. Memory-related side effects will be investigated, and specific tests of spatial navigation to test hippocampal function will be administered both before and after treatment. Blood samples will be stored in a biobank for future analyses. The observation time is 6 months. Data will be explored in light of the recently proposed disrupt, potentiate and rewire (DPR) hypothesis. DISCUSSION The study will contribute data and novel analyses important for our understanding of neurostimulation as well as for the development of enhanced and more personalized treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05135897.
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Affiliation(s)
- Leila Marie Frid
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Olga Therese Ousdal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, , Psychiatry Research Skåne, Region Skåne, Sweden
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Frank Riemer
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Marco Hirnstein
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Lars Ersland
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Vera Jane Erchinger
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Gyrid Nygaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Petter Jakobsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Alexander R Craven
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Berge Osnes
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | | | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Stephanie Le Hellard
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Anne-Kristin Stavrum
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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4
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Stautland A, Jakobsen P, Fasmer OB, Osnes B, Torresen J, Nordgreen T, Oedegaard KJ. Reduced heart rate variability during mania in a repeated naturalistic observational study. Front Psychiatry 2023; 14:1250925. [PMID: 37743991 PMCID: PMC10513449 DOI: 10.3389/fpsyt.2023.1250925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background Bipolar disorder (BD) is a chronic recurrent mood disorder associated with autonomic nervous system (ANS) dysfunction, indexed by heart rate variability (HRV). Changes in HRV between mood states are sparsely studied longitudinally. We aimed to compare HRV of hospitalized manic individuals with their own euthymic selves in a naturalistic observational study. Methods 34 individuals were included, of which 16 were lost to follow-up. Ultimately 15 patients provided reliable heart rate data in both a manic and euthymic state, using photoplethysmography (PPG) sensor wristbands overnight. We calculated HRV measures Root Mean Square of Successive Differences (RMSSD), High-frequency (HF: 0.15-0.40 Hz), Low-frequency (LF: 0.40-0.15 Hz), Very low-frequency (VLF: 0.0033-0.04 Hz), Total power and Sample Entropy in 5-min night-time resting samples. We compared HRV measures by mood state within individuals using paired t-tests and linear regression to control for age and sex. Results HRV was lower in the manic state when compared to the euthymic state for all HRV metrics (p ≤ 0.02), with large to medium effect sizes (g = 1.24 to 0.65). HRV changes were not significantly affected by age or sex. Conclusion This longitudinal study provides evidence of lower HRV in manic states compared to euthymia, indicating an association between ANS dysregulation and changes in bipolar mood state. This corroborates previous cross-sectional studies, although the association may be less clear or reversed in hypomanic states. Further investigation in larger longitudinal samples is warranted.
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Affiliation(s)
- Andrea Stautland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Petter Jakobsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ole Bernt Fasmer
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Berge Osnes
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Jim Torresen
- Department of Informatics and RITMO, University of Oslo, Oslo, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ketil J. Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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5
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Syrstad VEG, Mjeldheim K, Førland W, Jakobsen P, Gjestad R, Berle JØ, Merikangas KR, Oedegaard KJ, Fasmer OB. Objective assessment of motor activity in a clinical sample of adults with attention-deficit/hyperactivity disorder and/or cyclothymic temperament. BMC Psychiatry 2022; 22:609. [PMID: 36104774 PMCID: PMC9476590 DOI: 10.1186/s12888-022-04242-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 09/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Most research on patterns of motor activity has been conducted on adults with mood disorders, but few studies have investigated comorbid attention-deficit/hyperactivity disorder (ADHD) or temperamental factors that may influence the clinical course and symptoms. Cyclothymic temperament (CT) is particularly associated with functional impairment. Clinical features define both disorders, but objective, biological markers for these disorders could give important insights with regard to pathophysiology and classification. METHODS Seventy-six patients, requiring diagnostic evaluation of ADHD, mood or anxiety disorders were recruited. A comprehensive diagnostic evaluation, including the CT scale of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego - Auto-questionnaire (TEMPS-A), neuropsychological tests and actigraphy, was performed. ADHD was diagnosed according to the DSM-IV criteria. There was a range of different conditions in this clinical sample, but here we report on the presence of CT and ADHD in relation to motor activity. Twenty-nine healthy controls were recruited. We analyzed motor activity time series using linear and nonlinear mathematical methods, with a special focus on active and inactive periods in the actigraphic recordings. RESULTS Forty patients fulfilled the criteria for ADHD, with the remainder receiving other psychiatric diagnoses (clinical controls). Forty-two patients fulfilled the criteria for CT. Twenty-two patients fulfilled the criteria for ADHD and CT, 18 patients met the criteria for ADHD without CT, and 15 patients had neither. The ratio duration of active/inactive periods was significantly lower in patients with CT than in patients without CT, in both the total sample, and in the ADHD subsample. CONCLUSIONS CT is associated with objectively assessed changes in motor activity, implying that the systems regulating motor behavior in these patients are different from both healthy controls and clinical controls without CT. Findings suggest that actigraphy may supplement clinical assessments of CT and ADHD, and may provide an objective marker for CT.
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Affiliation(s)
- Vigdis Elin Giaever Syrstad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway. .,Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway.
| | | | | | - Petter Jakobsen
- grid.412008.f0000 0000 9753 1393Division of Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway
| | - Rolf Gjestad
- grid.412008.f0000 0000 9753 1393Division of Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443 Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Jan Øystein Berle
- grid.412008.f0000 0000 9753 1393Division of Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway
| | - Kathleen Ries Merikangas
- grid.416868.50000 0004 0464 0574Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland USA
| | - Ketil Joachim Oedegaard
- grid.412008.f0000 0000 9753 1393Division of Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway
| | - Ole Bernt Fasmer
- grid.412008.f0000 0000 9753 1393Division of Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway
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6
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Federoff M, McCarthy MJ, Anand A, Berrettini WH, Bertram H, Bhattacharjee A, Calkin CV, Conroy C, Coryell WH, D'Arcangelo N, DeModena A, Fisher C, Feeder S, Frazier N, Frye MA, Gao K, Garnham J, Gershon ES, Alliey-Rodriguez N, Glazer K, Goes F, Karberg T, Harrington G, Jakobsen P, Kamali M, Kelly M, Leckband SG, Lohoff F, Maihofer AX, McInnis MG, Mondimore F, Morken G, Nurnberger JI, Oedegaard KJ, Ritchey M, Ryan K, Schinagle M, Schoeyen H, Schwebel C, Shaw M, Shilling PD, Slaney C, Stautland A, Tarwater B, Calabrese JR, Alda M, Nievergelt CM, Zandi PP, Kelsoe JR. Correction of depression-associated circadian rhythm abnormalities is associated with lithium response in bipolar disorder. Bipolar Disord 2022; 24:521-529. [PMID: 34825444 DOI: 10.1111/bdi.13162] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is characterized by episodes of depression and mania and disrupted circadian rhythms. Lithium is an effective therapy for BD, but only 30%-40% of patients are fully responsive. Preclinical models show that lithium alters circadian rhythms. However, it is unknown if the circadian rhythm effects of lithium are essential to its therapeutic properties. METHODS In secondary analyses of a multi-center, prospective, trial of lithium for BD, we examined the relationship between circadian rhythms and therapeutic response to lithium. Using standardized instruments, we measured morningness, diurnal changes in mood, sleep, and energy (circadian rhythm disturbances) in a cross-sectional study of 386 BD subjects with varying lithium exposure histories. Next, we tracked symptoms of depression and mania prospectively over 12 weeks in a subset of 88 BD patients initiating treatment with lithium. Total, circadian, and affective mood symptoms were scored separately and analyzed. RESULTS Subjects with no prior lithium exposure had the most circadian disruption, while patients stable on lithium monotherapy had the least. Patients who were stable on lithium with another drug or unstable on lithium showed intermediate levels of disruption. Treatment with lithium for 12 weeks yielded significant reductions in total and affective depression symptoms. Lithium responders (Li-Rs) showed improvement in circadian symptoms of depression, but non-responders did not. There was no difference between Li-Rs and nonresponders in affective, circadian, or total symptoms of mania. CONCLUSIONS Exposure to lithium is associated with reduced circadian disruption. Lithium response at 12 weeks was selectively associated with the reduction of circadian depressive symptoms. We conclude that stabilization of circadian rhythms may be an important feature of lithium's therapeutic effects. CLINICAL TRIALS REGISTRY NCT0127253.
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Affiliation(s)
- Monica Federoff
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Michael J McCarthy
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Psychiatry, VA San Diego Healthcare System, La Jolla, California, USA
| | - Amit Anand
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | - Wade H Berrettini
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Abesh Bhattacharjee
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Psychiatry, VA San Diego Healthcare System, La Jolla, California, USA
| | | | - Carla Conroy
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Nicole D'Arcangelo
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | - Anna DeModena
- Department of Psychiatry, VA San Diego Healthcare System, La Jolla, California, USA
| | - Carrie Fisher
- Departments of Psychiatry and Medical and Molecular Genetics, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | | | - Keming Gao
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | - Kara Glazer
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Fernando Goes
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Toyomi Karberg
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Petter Jakobsen
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Norway
| | | | - Marisa Kelly
- University of Michigan, Ann Arbor, Michigan, USA
| | - Susan G Leckband
- Department of Psychiatry, VA San Diego Healthcare System, La Jolla, California, USA
| | - Falk Lohoff
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adam X Maihofer
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | | | - Francis Mondimore
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Gunnar Morken
- Division of Psychiatry, St. Olav University Hospital of Trondheim and Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - John I Nurnberger
- Departments of Psychiatry and Medical and Molecular Genetics, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ketil J Oedegaard
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Norway
| | - Megan Ritchey
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kelly Ryan
- University of Michigan, Ann Arbor, Michigan, USA
| | - Martha Schinagle
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | - Helle Schoeyen
- Department of Clinical Medicine, University of Bergen, Norway.,Clinic of Adult Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Candice Schwebel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Martha Shaw
- University of Chicago, Chicago, Illinois, USA
| | - Paul D Shilling
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | | | | | | | - Joseph R Calabrese
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Caroline M Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - John R Kelsoe
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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7
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Lamo Y, Mukhiya SK, Rabbi F, Aminifar A, Lillehaug SI, Tørresen J, H Pham M, Côtè-Allard U, Noori FM, Guribye F, Inal Y, Flobakk E, Wake JD, Myklebost S, Lundervold AJ, Hammar A, Nordby E, Kahlon S, Kenter R, Sekse RJT, Griffin KF, Jakobsen P, Ødegaard KJ, Skar YS, Nordgreen T. Towards adaptive technology in routine mental health care. Digit Health 2022; 8:20552076221128678. [PMID: 36386244 PMCID: PMC9661551 DOI: 10.1177/20552076221128678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This paper summarizes the information technology-related research findings after 5 years with the INTROducing Mental health through Adaptive Technology project. The aim was to improve mental healthcare by introducing new technologies for adaptive interventions in mental healthcare through interdisciplinary research and development. We focus on the challenges related to internet-delivered psychological treatments, emphasising artificial intelligence, human-computer interaction, and software engineering. We present the main research findings, the developed artefacts, and lessons learned from the project before outlining directions for future research. The main findings from this project are encapsulated in a reference architecture that is used for establishing an infrastructure for adaptive internet-delivered psychological treatment systems in clinical contexts. The infrastructure is developed by introducing an interdisciplinary design and development process inspired by domain-driven design, user-centred design, and the person based approach for intervention design. The process aligns the software development with the intervention design and illustrates their mutual dependencies. Finally, we present software artefacts produced within the project and discuss how they are related to the proposed reference architecture. Our results indicate that the proposed development process, the reference architecture and the produced software can be practical means of designing adaptive mental health care treatments in correspondence with the patients’ needs and preferences. In summary, we have created the initial version of an information technology infrastructure to support the development and deployment of Internet-delivered mental health interventions with inherent support for data sharing, data analysis, reusability of treatment content, and adaptation of intervention based on user needs and preferences.
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Affiliation(s)
- Yngve Lamo
- Department of Computer Science, Electrical Engineering, and Mathematical Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Suresh K Mukhiya
- Department of Computer Science, Electrical Engineering, and Mathematical Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Fazle Rabbi
- Department of Computer Science, Electrical Engineering, and Mathematical Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Information Science and Media Studies, Faculty of Social Science, University of Bergen, Bergen, Noway
| | - Amin Aminifar
- Department of Computer Science, Electrical Engineering, and Mathematical Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Svein I Lillehaug
- Department of Computer Science, Electrical Engineering, and Mathematical Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jim Tørresen
- Department of Informatics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Minh H Pham
- Department of Informatics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Ulysse Côtè-Allard
- Department of Informatics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Farzan M Noori
- Department of Informatics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Frode Guribye
- Department of Information Science and Media Studies, Faculty of Social Science, University of Bergen, Bergen, Noway
| | - Yavuz Inal
- Department of Information Science and Media Studies, Faculty of Social Science, University of Bergen, Bergen, Noway
| | - Eivind Flobakk
- Department of Information Science and Media Studies, Faculty of Social Science, University of Bergen, Bergen, Noway
| | - Jo D Wake
- NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Sunniva Myklebost
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Aasa Hammar
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Emilie Nordby
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Smiti Kahlon
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Robin Kenter
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Ragnhild JT Sekse
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | | | - Petter Jakobsen
- Norment, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ketil Joachim Ødegaard
- Norment, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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8
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Lin Y, Maihofer AX, Stapp E, Ritchey M, Alliey-Rodriguez N, Anand A, Balaraman Y, Berrettini WH, Bertram H, Bhattacharjee A, Calkin CV, Conroy C, Coryell W, D'Arcangelo N, DeModena A, Biernacka JM, Fisher C, Frazier N, Frye M, Gao K, Garnham J, Gershon E, Glazer K, Goes FS, Goto T, Karberg E, Harrington G, Jakobsen P, Kamali M, Kelly M, Leckband SG, Lohoff FW, Stautland A, McCarthy MJ, McInnis MG, Mondimore F, Morken G, Nurnberger JI, Oedegaard KJ, Syrstad VEG, Ryan K, Schinagle M, Schoeyen H, Andreassen OA, Shaw M, Shilling PD, Slaney C, Tarwater B, Calabrese JR, Alda M, Nievergelt CM, Zandi PP, Kelsoe JR. Clinical predictors of non-response to lithium treatment in the Pharmacogenomics of Bipolar Disorder (PGBD) study. Bipolar Disord 2021; 23:821-831. [PMID: 33797828 DOI: 10.1111/bdi.13078] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Lithium is regarded as a first-line treatment for bipolar disorder (BD), but partial response and non-response commonly occurs. There exists a need to identify lithium non-responders prior to initiating treatment. The Pharmacogenomics of Bipolar Disorder (PGBD) Study was designed to identify predictors of lithium response. METHODS The PGBD Study was an eleven site prospective trial of lithium treatment in bipolar I disorder. Subjects were stabilized on lithium monotherapy over 4 months and gradually discontinued from all other psychotropic medications. After ensuring a sustained clinical remission (defined by a score of ≤3 on the CGI for 4 weeks) had been achieved, subjects were followed for up to 2 years to monitor clinical response. Cox proportional hazard models were used to examine the relationship between clinical measures and time until failure to remit or relapse. RESULTS A total of 345 individuals were enrolled into the study and included in the analysis. Of these, 101 subjects failed to remit or relapsed, 88 achieved remission and continued to study completion, and 156 were terminated from the study for other reasons. Significant clinical predictors of treatment failure (p < 0.05) included baseline anxiety symptoms, functional impairments, negative life events and lifetime clinical features such as a history of migraine, suicidal ideation/attempts, and mixed episodes, as well as a chronic course of illness. CONCLUSIONS In this PGBD Study of lithium response, several clinical features were found to be associated with failure to respond to lithium. Future validation is needed to confirm these clinical predictors of treatment failure and their use clinically to distinguish who will do well on lithium before starting pharmacotherapy.
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Affiliation(s)
- Yian Lin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adam X Maihofer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Emma Stapp
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Megan Ritchey
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Amit Anand
- Center for Behavioral Health, Cleveland Clinic, Cleveland, OH, USA
| | - Yokesh Balaraman
- Department of Psychiatry, Indiana University, Indianapolis, IN, USA
| | - Wade H Berrettini
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | | | - Carla Conroy
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | | | - Nicole D'Arcangelo
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | - Anna DeModena
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | | | - Carrie Fisher
- Department of Psychiatry, Indiana University, Indianapolis, IN, USA
| | | | | | - Keming Gao
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Kara Glazer
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Toyomi Goto
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | - Elizabeth Karberg
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | | | - Petter Jakobsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Masoud Kamali
- University of Michigan, Ann Arbor, MI, USA.,Department of Psychiatry, Massachusetts General Hospital and Harvard University, Boston, MA, USA
| | | | - Susan G Leckband
- Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA, USA
| | - Falk W Lohoff
- National Institute of Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA
| | - Andrea Stautland
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen and Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Michael J McCarthy
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA, USA
| | | | - Francis Mondimore
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gunnar Morken
- Division of Psychiatry, St. Olav University Hospital of Trondheim and Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Ketil J Oedegaard
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen and Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Vigdis Elin Giever Syrstad
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen and Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kelly Ryan
- University of Michigan, Ann Arbor, MI, USA
| | - Martha Schinagle
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | - Helle Schoeyen
- Division of Psychiatry, Faculty of Medicine and Dentistry, Stavanger University Hospital, University of Bergen, Stavanger, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Paul D Shilling
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | | | | | - Joseph R Calabrese
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | - Martin Alda
- Dalhousie University, Halifax, Canada.,National Institute of Mental Health, Klecany, Czech Republic
| | | | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John R Kelsoe
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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9
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Nordgreen T, Rabbi F, Torresen J, Skar YS, Guribye F, Inal Y, Flobakk E, Wake JD, Mukhiya SK, Aminifar A, Myklebost S, Lundervold AJ, Kenter R, Hammar Å, Nordby E, Kahlon S, Tveit Sekse RJ, Griffin KF, Jakobsen P, Pham MH, Côté-Allard U, Noori FM, Lamo Y. Challenges and possible solutions in cross-disciplinary and cross-sectorial research teams within the domain of e-mental health. JET 2021. [DOI: 10.1108/jet-03-2021-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PurposeMental illness presents a huge individual, societal and economic challenges, currently accounting for 20% of the worldwide burden of disease. There is a gap between the need for and access to services. Digital technology has been proven effective in e-mental health for preventing and treating mental health problems. However, there is a need for cross-disciplinary efforts to increase the impact of e-mental health services. This paper aims to report key challenges and possible solutions for cross-disciplinary and cross-sectorial research teams within the domain of e-mental health.Design/methodology/approachThe key challenges and possible solutions will be discussed in light of the literature on effective cross-disciplinary research teams.FindingsSix topics have been key challenges in our cross-disciplinary and cross-sectorial research team: to develop a shared understanding of the domain; to establish a common understanding of key concepts among the project participants; to involve the end-users in the research and development process; to collaborate across sectors; to ensure privacy and security of health data; and to obtain the right timing of activities according to project dependencies.Research limitations/implicationsThis study focuses to increase knowledge and training in cross-disciplinary and cross-sectorial research, as this is often referred to as an important tool when developing sustainable solutions for major societal challenges.Practical implicationsThis study needs to include theory and skills training in cross-disciplinary research in research training.Social implicationsCross-disciplinary teams have the potential to address major societal challenges, including more perspectives and more stakeholders than single disciplinary research teams.Originality/valueMajor societal challenges require complex and sustainable solutions. However, there is a lack of knowledge about how cross-disciplinary and cross-sectorial research teams may work productively to solve these challenges. This paper shares experiences regarding the challenges and possible solutions for productive collaboration in cross-disciplinary and cross-sectorial research teams within the domain of e-mental health services.
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10
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Fasmer OB, Fasmer EE, Mjeldheim K, Førland W, Syrstad VEG, Jakobsen P, Berle JØ, Henriksen TEG, Sepasdar Z, Hauge ER, Oedegaard KJ. Diurnal variation of motor activity in adult ADHD patients analyzed with methods from graph theory. PLoS One 2020; 15:e0241991. [PMID: 33166350 PMCID: PMC7652335 DOI: 10.1371/journal.pone.0241991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/25/2020] [Indexed: 02/07/2023] Open
Abstract
Attention-deficit /hyperactivity disorder (ADHD) is a common neurodevelopmental syndrome characterized by age-inappropriate levels of motor activity, impulsivity and attention. The aim of the present study was to study diurnal variation of motor activity in adult ADHD patients, compared to healthy controls and clinical controls with mood and anxiety disorders. Wrist-worn actigraphs were used to record motor activity in a sample of 81 patients and 30 healthy controls. Time series from registrations in the morning and evening were analyzed using measures of variability, complexity and a newly developed method, the similarity algorithm, based on transforming time series into graphs. In healthy controls the evening registrations showed higher variability and lower complexity compared to morning registrations, however this was evident only in the female controls. In the two patient groups the same measures were not significantly different, with one exception, the graph measure bridges. This was the measure that most clearly separated morning and evening registrations and was significantly different both in healthy controls and in patients with a diagnosis of ADHD. These findings suggest that actigraph registrations, combined with mathematical methods based on graph theory, may be used to elucidate the mechanisms responsible for the diurnal regulation of motor activity.
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Affiliation(s)
- Ole Bernt Fasmer
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | | | | | | | - Vigdis Elin Giæver Syrstad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Petter Jakobsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jan Øystein Berle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tone E. G. Henriksen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Mental Health Care, Valen Hospital, Fonna Local Health Authority, Valen, Norway
| | - Zahra Sepasdar
- School of Electrical and Computer Engineering, Shiraz University, Shiraz, Iran
| | - Erik R. Hauge
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ketil J. Oedegaard
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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11
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Burdick KE, Millett CE, Russo M, Alda M, Alliey-Rodriguez N, Anand A, Balaraman Y, Berrettini W, Bertram H, Calabrese JR, Calkin C, Conroy C, Coryell W, DeModena A, Feeder S, Fisher C, Frazier N, Frye M, Gao K, Garnham J, Gershon ES, Glazer K, Goes FS, Goto T, Harrington GJ, Jakobsen P, Kamali M, Kelly M, Leckband S, Løberg EM, Lohoff FW, Maihofer AX, McCarthy MJ, McInnis M, Morken G, Nievergelt CM, Nurnberger J, Oedegaard KJ, Ortiz A, Ritchey M, Ryan K, Schinagle M, Schwebel C, Shaw M, Shilling P, Slaney C, Stapp E, Tarwater B, Zandi P, Kelsoe JR. The association between lithium use and neurocognitive performance in patients with bipolar disorder. Neuropsychopharmacology 2020; 45:1743-1749. [PMID: 32349118 PMCID: PMC7419515 DOI: 10.1038/s41386-020-0683-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/24/2020] [Accepted: 04/17/2020] [Indexed: 01/21/2023]
Abstract
Lithium remains the gold standard for the treatment of bipolar disorder (BD); however, its use has declined over the years mainly due to the side effects and the subjective experience of cognitive numbness reported by patients. In the present study, we aim to methodically test the effects of lithium on neurocognitive functioning in the largest single cohort (n = 262) of BD patients reported to date by harnessing the power of a multi-site, ongoing clinical trial of lithium monotherapy. At the cross-sectional level, multivariate analysis of covariance (MANCOVA) was conducted to examine potential group differences across neurocognitive tests [California Verbal Learning Test (CVLT trials 1-5,CVLT delayed recall), Wechsler Digit Symbol, Trail-making Test parts A and B (TMT-A; TMT-B), and a global cognition index]. At the longitudinal level, on a subset of patients (n = 88) who achieved mood stabilization with lithium monotherapy, we explored the effect of lithium treatment across time on neurocognitive functioning. There were no differences at baseline between BD patients that were taking lithium compared with those that were not. At follow-up a significant neurocognitive improvement in the global cognitive index score [F = 31.69; p < 0.001], CVLT trials 1-5 [F = 29.81; p < 0.001], CVLT delayed recall [F = 15.27; p < 0.001], and TMT-B [F = 6.64, p = 0.012] was detected. The cross-sectional and longitudinal (on a subset of 88 patients) investigations suggest that lithium may be beneficial to neurocognitive functioning in patients with BD and that at the very least it does not seem to significantly impair cognition when used therapeutically.
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Affiliation(s)
- Katherine E. Burdick
- grid.62560.370000 0004 0378 8294Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA ,James J Peters Veteran Administration (VA) Hospital, Bronx, NY USA
| | - Caitlin E. Millett
- grid.62560.370000 0004 0378 8294Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Manuela Russo
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Martin Alda
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | | | - Amit Anand
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Yokesh Balaraman
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Wade Berrettini
- grid.25879.310000 0004 1936 8972Center for Neurobiology and Behavior, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Holli Bertram
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Joseph R. Calabrese
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Cynthia Calkin
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | - Carla Conroy
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - William Coryell
- grid.214572.70000 0004 1936 8294University of Iowa, Iowa City, IA USA
| | - Anna DeModena
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Scott Feeder
- grid.66875.3a0000 0004 0459 167XMayo Clinic, Rochester, MN USA
| | - Carrie Fisher
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Nicole Frazier
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Mark Frye
- grid.66875.3a0000 0004 0459 167XMayo Clinic, Rochester, MN USA
| | - Keming Gao
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Julie Garnham
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | - Elliot S. Gershon
- grid.170205.10000 0004 1936 7822University of Chicago, Chicago, IL 60637 USA
| | - Kara Glazer
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Fernando S. Goes
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Toyomi Goto
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | | | - Petter Jakobsen
- grid.7914.b0000 0004 1936 7443NORMENT, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Masoud Kamali
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Marisa Kelly
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Susan Leckband
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Else Marie Løberg
- grid.7914.b0000 0004 1936 7443NORMENT, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Addiction Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Falk W. Lohoff
- grid.420085.b0000 0004 0481 4802National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, MD USA
| | - Adam X. Maihofer
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Michael J. McCarthy
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Melvin McInnis
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Gunnar Morken
- grid.412835.90000 0004 0627 2891Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | | | - John Nurnberger
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Ketil J. Oedegaard
- grid.7914.b0000 0004 1936 7443NORMENT, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Abigail Ortiz
- grid.17063.330000 0001 2157 2938Centre for Addiction and Mental Health, University of Toronto, Toronto, ON Canada
| | - Megan Ritchey
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Kelly Ryan
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Martha Schinagle
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Candice Schwebel
- grid.25879.310000 0004 1936 8972Center for Neurobiology and Behavior, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Martha Shaw
- grid.214572.70000 0004 1936 8294University of Iowa, Iowa City, IA USA
| | - Paul Shilling
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Claire Slaney
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | - Emma Stapp
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Bruce Tarwater
- grid.214572.70000 0004 1936 8294University of Iowa, Iowa City, IA USA
| | - Peter Zandi
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - John R. Kelsoe
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
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12
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Jakobsen P, Garcia-Ceja E, Riegler M, Stabell LA, Nordgreen T, Torresen J, Fasmer OB, Oedegaard KJ. Applying machine learning in motor activity time series of depressed bipolar and unipolar patients compared to healthy controls. PLoS One 2020; 15:e0231995. [PMID: 32833958 PMCID: PMC7446864 DOI: 10.1371/journal.pone.0231995] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/09/2020] [Indexed: 11/18/2022] Open
Abstract
Current practice of assessing mood episodes in affective disorders largely depends on subjective observations combined with semi-structured clinical rating scales. Motor activity is an objective observation of the inner physiological state expressed in behavior patterns. Alterations of motor activity are essential features of bipolar and unipolar depression. The aim was to investigate if objective measures of motor activity can aid existing diagnostic practice, by applying machine-learning techniques to analyze activity patterns in depressed patients and healthy controls. Random Forrest, Deep Neural Network and Convolutional Neural Network algorithms were used to analyze 14 days of actigraph recorded motor activity from 23 depressed patients and 32 healthy controls. Statistical features analyzed in the dataset were mean activity, standard deviation of mean activity and proportion of zero activity. Various techniques to handle data imbalance were applied, and to ensure generalizability and avoid overfitting a Leave-One-User-Out validation strategy was utilized. All outcomes reports as measures of accuracy for binary tests. A Deep Neural Network combined with SMOTE class balancing technique performed a cut above the rest with a true positive rate of 0.82 (sensitivity) and a true negative rate of 0.84 (specificity). Accuracy was 0.84 and the Matthews Correlation Coefficient 0.65. Misclassifications appear related to data overlapping among the classes, so an appropriate future approach will be to compare mood states intra-individualistically. In summary, machine-learning techniques present promising abilities in discriminating between depressed patients and healthy controls in motor activity time series.
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Affiliation(s)
- Petter Jakobsen
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- * E-mail:
| | | | - Michael Riegler
- Simula Metropolitan Center for Digitalisation, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Lena Antonsen Stabell
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Jim Torresen
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Ole Bernt Fasmer
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ketil Joachim Oedegaard
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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13
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Bjaastad JF, Jensen-Doss A, Moltu C, Jakobsen P, Hagenberg H, Joa I. Attitudes toward standardized assessment tools and their use among clinicians in a public mental health service. Nord J Psychiatry 2019; 73:387-396. [PMID: 31322010 DOI: 10.1080/08039488.2019.1642383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of the present study was to investigate the use and attitudes toward standardized assessment tools among clinicians in a public mental health service in Norway. A total of 606 clinicians provided feedback on their use and attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone using the Attitudes toward Standardized Assessment (ASA) Scales. Clinicians working in the adult mental health field scored significantly higher on use of diagnostic interviews, pre-post evaluations, and ongoing evaluations, whereas clinicians working in the child/adolescent mental health field scored significantly higher on use of screening instruments and held more positive attitudes towards using standardized assessment tools. Attitudes toward standardized assessment tools predicted use of such tools, and results were found to be similar to a study on US clinicians. Whereas the US study only found attitudes regarding the practicality of using such instrument as an independent predictor of assessment use, the current study found that attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone were independent predictors of use.
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Affiliation(s)
- Jon Fauskanger Bjaastad
- Division of Psychiatry, Stavanger University Hospital , Stavanger , Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre , Bergen , Norway
| | | | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde , Førde , Norway
| | - Petter Jakobsen
- Division of Psychiatry, Haukeland University Hospital , Bergen , Norway.,Department of Clinical Medicine, University of Bergen , Bergen , Norway
| | - Heine Hagenberg
- Division of Psychiatry, District General Hospital of Fonna , Haugesund , Norway
| | - Inge Joa
- TIPS - Network for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital , Stavanger , Norway.,The Interprofessional Network for Medical Sciences, Department of Public Health, Faculty of Health Sciences, University of Stavanger , Stavanger , Norway
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14
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Scott J, Hidalgo-Mazzei D, Strawbridge R, Young A, Resche-Rigon M, Etain B, Andreassen OA, Bauer M, Bennabi D, Blamire AM, Boumezbeur F, Brambilla P, Cattane N, Cattaneo A, Chupin M, Coello K, Cointepas Y, Colom F, Cousins DA, Dubertret C, Duchesnay E, Ferro A, Garcia-Estela A, Goikolea J, Grigis A, Haffen E, Høegh MC, Jakobsen P, Kalman JL, Kessing LV, Klohn-Saghatolislam F, Lagerberg TV, Landén M, Lewitzka U, Lutticke A, Mazer N, Mazzelli M, Mora C, Muller T, Mur-Mila E, Oedegaard KJ, Oltedal L, Pålsson E, Papadopoulos Orfanos D, Papiol S, Perez-Sola V, Reif A, Ritter P, Rossi R, Schulze T, Senner F, Smith FE, Squarcina L, Steen NE, Thelwall PE, Varo C, Vieta E, Vinberg M, Wessa M, Westlye LT, Bellivier F. Prospective cohort study of early biosignatures of response to lithium in bipolar-I-disorders: overview of the H2020-funded R-LiNK initiative. Int J Bipolar Disord 2019; 7:20. [PMID: 31552554 PMCID: PMC6760458 DOI: 10.1186/s40345-019-0156-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/24/2019] [Indexed: 01/01/2023] Open
Abstract
Background Lithium is recommended as a first line treatment for bipolar disorders. However, only 30% of patients show an optimal outcome and variability in lithium response and tolerability is poorly understood. It remains difficult for clinicians to reliably predict which patients will benefit without recourse to a lengthy treatment trial. Greater precision in the early identification of individuals who are likely to respond to lithium is a significant unmet clinical need. Structure The H2020-funded Response to Lithium Network (R-LiNK; http://www.r-link.eu.com/) will undertake a prospective cohort study of over 300 individuals with bipolar-I-disorder who have agreed to commence a trial of lithium treatment following a recommendation by their treating clinician. The study aims to examine the early prediction of lithium response, non-response and tolerability by combining systematic clinical syndrome subtyping with examination of multi-modal biomarkers (or biosignatures), including omics, neuroimaging, and actigraphy, etc. Individuals will be followed up for 24 months and an independent panel will assess and classify each participants’ response to lithium according to predefined criteria that consider evidence of relapse, recurrence, remission, changes in illness activity or treatment failure (e.g. stopping lithium; new prescriptions of other mood stabilizers) and exposure to lithium. Novel elements of this study include the recruitment of a large, multinational, clinically representative sample specifically for the purpose of studying candidate biomarkers and biosignatures; the application of lithium-7 magnetic resonance imaging to explore the distribution of lithium in the brain; development of a digital phenotype (using actigraphy and ecological momentary assessment) to monitor daily variability in symptoms; and economic modelling of the cost-effectiveness of introducing biomarker tests for the customisation of lithium treatment into clinical practice. Also, study participants with sub-optimal medication adherence will be offered brief interventions (which can be delivered via a clinician or smartphone app) to enhance treatment engagement and to minimize confounding of lithium non-response with non-adherence. Conclusions The paper outlines the rationale, design and methodology of the first study being undertaken by the newly established R-LiNK collaboration and describes how the project may help to refine the clinical response phenotype and could translate into the personalization of lithium treatment. Electronic supplementary material The online version of this article (10.1186/s40345-019-0156-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Université Paris Diderot, 75013, Paris, France
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Villaroel 170, 08036, Barcelona, Catalonia, Spain
| | - Rebecca Strawbridge
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Allan Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthieu Resche-Rigon
- Université Paris Diderot, 75013, Paris, France.,Service de Biostatistique et Information Médicale, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm, UMR 1153, Equipe ECSTRA, Paris, France
| | - Bruno Etain
- Université Paris Diderot, 75013, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, 75475, Paris, France.,Inserm, U1144, Team 1, 75006, Paris, France
| | - Ole A Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Djamila Bennabi
- Department of Clinical Psychiatry, Inserm CIC 1431, CHU Besançon, 25000, Besançon, France.,Laboratoire de Neurosciences, Université Bourgogne Franche-Comté, 25000, Besançon, France
| | - Andrew M Blamire
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.,Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Fawzi Boumezbeur
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-sur-Yvette, France
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioural Neurosciences, University of Texas at Houston, Houston, TX, USA
| | - Nadia Cattane
- IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Annamaria Cattaneo
- IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Marie Chupin
- CATI Neuroimaging Platform, ICM, Pitié Salpétrière Hospital, 75013, Paris, France.,Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France.,Inserm, U1127, 75013, Paris, France.,CNRS, UMR 7225, 75013, Paris, France.,Sorbonne Université, 75013, Paris, France
| | - Klara Coello
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Yann Cointepas
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-sur-Yvette, France.,CATI Neuroimaging Platform, ICM, Pitié Salpétrière Hospital, 75013, Paris, France
| | - Francesc Colom
- Mental Health Research Program, IMIM, Hospital del Mar, CIBERSAM, Barcelona, Catalonia, Spain
| | - David A Cousins
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, NE3 3XT, UK
| | - Caroline Dubertret
- Université Paris Diderot, 75013, Paris, France.,APHP; Psychiatry Department, University Hospital Louis Mourier, Colombes, France.,INSERM U894, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Edouard Duchesnay
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-sur-Yvette, France
| | - Adele Ferro
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Aitana Garcia-Estela
- Mental Health Research Program, IMIM, Hospital del Mar, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jose Goikolea
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Villaroel 170, 08036, Barcelona, Catalonia, Spain
| | - Antoine Grigis
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-sur-Yvette, France
| | - Emmanuel Haffen
- Department of Clinical Psychiatry, Inserm CIC 1431, CHU Besançon, 25000, Besançon, France.,Laboratoire de Neurosciences, Université Bourgogne Franche-Comté, 25000, Besançon, France
| | - Margrethe C Høegh
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Petter Jakobsen
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Janos L Kalman
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Farah Klohn-Saghatolislam
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Trine V Lagerberg
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Mikael Landén
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ute Lewitzka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ashley Lutticke
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Nicolas Mazer
- APHP; Psychiatry Department, University Hospital Louis Mourier, Colombes, France.,INSERM U894, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Monica Mazzelli
- IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Cristina Mora
- IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Thorsten Muller
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Estanislao Mur-Mila
- Mental Health Research Program, IMIM, Hospital del Mar, CIBERSAM, Barcelona, Catalonia, Spain
| | - Ketil Joachim Oedegaard
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Erik Pålsson
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Victor Perez-Sola
- Mental Health Research Program, IMIM, Hospital del Mar, CIBERSAM, Barcelona, Catalonia, Spain
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Roberto Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Thomas Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Fanny Senner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Fiona E Smith
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.,Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Letizia Squarcina
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Nils Eiel Steen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pete E Thelwall
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.,Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Cristina Varo
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Villaroel 170, 08036, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Villaroel 170, 08036, Barcelona, Catalonia, Spain
| | - Maj Vinberg
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Michele Wessa
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg-University Mainz, Wallstraße 3, 55122, Mainz, Germany
| | - Lars T Westlye
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Frank Bellivier
- Université Paris Diderot, 75013, Paris, France. .,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, 75475, Paris, France. .,Inserm, U1144, Team 1, 75006, Paris, France.
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15
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McCarthy MJ, Wei H, Nievergelt CM, Stautland A, Maihofer AX, Welsh DK, Shilling P, Alda M, Alliey-Rodriguez N, Anand A, Andreasson OA, Balaraman Y, Berrettini WH, Bertram H, Brennand KJ, Calabrese JR, Calkin CV, Claasen A, Conroy C, Coryell WH, Craig DW, D’Arcangelo N, Demodena A, Djurovic S, Feeder S, Fisher C, Frazier N, Frye MA, Gage FH, Gao K, Garnham J, Gershon ES, Glazer K, Goes F, Goto T, Harrington G, Jakobsen P, Kamali M, Karberg E, Kelly M, Leckband SG, Lohoff F, McInnis MG, Mondimore F, Morken G, Nurnberger JI, Obral S, Oedegaard KJ, Ortiz A, Ritchey M, Ryan K, Schinagle M, Schoeyen H, Schwebel C, Shaw M, Shekhtman T, Slaney C, Stapp E, Szelinger S, Tarwater B, Zandi PP, Kelsoe JR. Chronotype and cellular circadian rhythms predict the clinical response to lithium maintenance treatment in patients with bipolar disorder. Neuropsychopharmacology 2019; 44:620-628. [PMID: 30487653 PMCID: PMC6333516 DOI: 10.1038/s41386-018-0273-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 12/12/2022]
Abstract
Bipolar disorder (BD) is a serious mood disorder associated with circadian rhythm abnormalities. Risk for BD is genetically encoded and overlaps with systems that maintain circadian rhythms. Lithium is an effective mood stabilizer treatment for BD, but only a minority of patients fully respond to monotherapy. Presently, we hypothesized that lithium-responsive BD patients (Li-R) would show characteristic differences in chronotype and cellular circadian rhythms compared to lithium non-responders (Li-NR). Selecting patients from a prospective, multi-center, clinical trial of lithium monotherapy, we examined morning vs. evening preference (chronotype) as a dimension of circadian rhythm function in 193 Li-R and Li-NR BD patients. From a subset of 59 patient donors, we measured circadian rhythms in skin fibroblasts longitudinally over 5 days using a bioluminescent reporter (Per2-luc). We then estimated circadian rhythm parameters (amplitude, period, phase) and the pharmacological effects of lithium on rhythms in cells from Li-R and Li-NR donors. Compared to Li-NRs, Li-Rs showed a difference in chronotype, with higher levels of morningness. Evening chronotype was associated with increased mood symptoms at baseline, including depression, mania, and insomnia. Cells from Li-Rs were more likely to exhibit a short circadian period, a linear relationship between period and phase, and period shortening effects of lithium. Common genetic variation in the IP3 signaling pathway may account for some of the individual differences in the effects of lithium on cellular rhythms. We conclude that circadian rhythms may influence response to lithium in maintenance treatment of BD.
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Affiliation(s)
- Michael J. McCarthy
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA ,0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
| | - Heather Wei
- 0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
| | - Caroline M. Nievergelt
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA
| | - Andrea Stautland
- 0000 0004 1936 7443grid.7914.bDepartment of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway
| | - Adam X. Maihofer
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA
| | - David K. Welsh
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA ,0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
| | - Paul Shilling
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA
| | - Martin Alda
- 0000 0004 1936 8200grid.55602.34Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Ney Alliey-Rodriguez
- 0000 0004 1936 7822grid.170205.1Department of Psychiatry, University of Chicago, Chicago, USA
| | - Amit Anand
- 0000 0001 0790 959Xgrid.411377.7Department of Psychiatry, Indiana University, Bloomington, USA
| | - Ole A. Andreasson
- 0000 0004 1936 8921grid.5510.1Jebsen Centre for Psychosis Research, University of Oslo, Oslo, Norway
| | - Yokesh Balaraman
- 0000 0001 0790 959Xgrid.411377.7Department of Psychiatry, Indiana University, Bloomington, USA
| | - Wade H. Berrettini
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Holli Bertram
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Kristen J. Brennand
- 0000 0001 0670 2351grid.59734.3cDepartments of Neuroscience and Psychiatry, Icahn School of Medicine at Mt Sinai, New York, USA
| | - Joseph R. Calabrese
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Cynthia V. Calkin
- 0000 0004 1936 8200grid.55602.34Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Ana Claasen
- 0000 0004 0507 3225grid.250942.8Neurogenomics Division, Translational Genomics Research Institute, Phoenix, USA
| | - Clara Conroy
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - William H. Coryell
- 0000 0004 1936 8294grid.214572.7Department of Psychiatry, University of Iowa, Iowa City, USA
| | - David W. Craig
- 0000 0004 0507 3225grid.250942.8Neurogenomics Division, Translational Genomics Research Institute, Phoenix, USA
| | - Nicole D’Arcangelo
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Anna Demodena
- 0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
| | - Srdjan Djurovic
- 0000 0004 1936 8921grid.5510.1Jebsen Centre for Psychosis Research, University of Oslo, Oslo, Norway
| | - Scott Feeder
- 0000 0004 0459 167Xgrid.66875.3aDepartment of Psychiatry, The Mayo Clinic, Rochester, USA
| | - Carrie Fisher
- 0000 0001 0790 959Xgrid.411377.7Department of Psychiatry, Indiana University, Bloomington, USA
| | - Nicole Frazier
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Mark A. Frye
- 0000 0004 0459 167Xgrid.66875.3aDepartment of Psychiatry, The Mayo Clinic, Rochester, USA
| | - Fred H. Gage
- 0000 0001 0662 7144grid.250671.7Laboratory of Genetics, Salk Institute for Biological Studies, La Jolla, USA
| | - Keming Gao
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Julie Garnham
- 0000 0004 1936 8200grid.55602.34Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Elliot S. Gershon
- 0000 0004 1936 7822grid.170205.1Department of Psychiatry, University of Chicago, Chicago, USA
| | - Kara Glazer
- 0000 0001 2171 9311grid.21107.35Department of Psychiatry, Johns Hopkins University, Baltimore, USA
| | - Fernando Goes
- 0000 0001 2171 9311grid.21107.35Department of Psychiatry, Johns Hopkins University, Baltimore, USA
| | - Toyomi Goto
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Gloria Harrington
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Petter Jakobsen
- 0000 0000 9753 1393grid.412008.fNorment and KG Jebsen Centre for Neuropsychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Masoud Kamali
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Elizabeth Karberg
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Marisa Kelly
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Susan G. Leckband
- 0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
| | - Falk Lohoff
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Melvin G. McInnis
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Francis Mondimore
- 0000 0001 2171 9311grid.21107.35Department of Psychiatry, Johns Hopkins University, Baltimore, USA
| | - Gunnar Morken
- 0000 0001 1516 2393grid.5947.fDivision of Psychiatry, St. Olav University Hospital of Trondheim and Department of Mental Health Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - John I. Nurnberger
- 0000 0001 0790 959Xgrid.411377.7Department of Psychiatry, Indiana University, Bloomington, USA
| | - Sarah Obral
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Ketil J. Oedegaard
- 0000 0004 1936 7443grid.7914.bDepartment of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway ,0000 0000 9753 1393grid.412008.fNorment and KG Jebsen Centre for Neuropsychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Abigail Ortiz
- 0000 0001 2182 2255grid.28046.38Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
| | - Megan Ritchey
- 0000 0001 2171 9311grid.21107.35Department of Psychiatry, Johns Hopkins University, Baltimore, USA
| | - Kelly Ryan
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Martha Schinagle
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Helle Schoeyen
- 0000 0004 1936 7443grid.7914.bDepartment of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway
| | - Candice Schwebel
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Martha Shaw
- 0000 0004 1936 7822grid.170205.1Department of Psychiatry, University of Chicago, Chicago, USA
| | - Tatyana Shekhtman
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA ,0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
| | - Claire Slaney
- 0000 0004 1936 8200grid.55602.34Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Emma Stapp
- 0000 0001 2171 9311grid.21107.35Department of Psychiatry, Johns Hopkins University, Baltimore, USA
| | - Szabolcs Szelinger
- 0000 0004 0507 3225grid.250942.8Neurogenomics Division, Translational Genomics Research Institute, Phoenix, USA
| | - Bruce Tarwater
- 0000 0004 0507 3225grid.250942.8Neurogenomics Division, Translational Genomics Research Institute, Phoenix, USA
| | - Peter P. Zandi
- 0000 0001 2171 9311grid.21107.35Department of Psychiatry, Johns Hopkins University, Baltimore, USA
| | - John R. Kelsoe
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA ,0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
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Oedegaard KJ, Alda M, Anand A, Andreassen OA, Balaraman Y, Berrettini WH, Bhattacharjee A, Brennand KJ, Burdick KE, Calabrese JR, Calkin CV, Claasen A, Coryell WH, Craig D, DeModena A, Frye M, Gage FH, Gao K, Garnham J, Gershon E, Jakobsen P, Leckband SG, McCarthy MJ, McInnis MG, Maihofer AX, Mertens J, Morken G, Nievergelt CM, Nurnberger J, Pham S, Schoeyen H, Shekhtman T, Shilling PD, Szelinger S, Tarwater B, Yao J, Zandi PP, Kelsoe JR. The Pharmacogenomics of Bipolar Disorder study (PGBD): identification of genes for lithium response in a prospective sample. BMC Psychiatry 2016; 16:129. [PMID: 27150464 PMCID: PMC4857276 DOI: 10.1186/s12888-016-0732-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/01/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Bipolar disorder is a serious and common psychiatric disorder characterized by manic and depressive mood switches and a relapsing and remitting course. The cornerstone of clinical management is stabilization and prophylaxis using mood-stabilizing medications to reduce both manic and depressive symptoms. Lithium remains the gold standard of treatment with the strongest data for both efficacy and suicide prevention. However, many patients do not respond to this medication, and clinically there is a great need for tools to aid the clinician in selecting the correct treatment. Large genome wide association studies (GWAS) investigating retrospectively the effect of lithium response are in the pipeline; however, few large prospective studies on genetic predictors to of lithium response have yet been conducted. The purpose of this project is to identify genes that are associated with lithium response in a large prospective cohort of bipolar patients and to better understand the mechanism of action of lithium and the variation in the genome that influences clinical response. METHODS/DESIGN This study is an 11-site prospective non-randomized open trial of lithium designed to ascertain a cohort of 700 subjects with bipolar I disorder who experience protocol-defined relapse prevention as a result of treatment with lithium monotherapy. All patients will be diagnosed using the Diagnostic Interview for Genetic Studies (DIGS) and will then enter a 2-year follow-up period on lithium monotherapy if and when they exhibit a score of 1 (normal, not ill), 2 (minimally ill) or 3 (mildly ill) on the Clinical Global Impressions of Severity Scale for Bipolar Disorder (CGI-S-BP Overall Bipolar Illness) for 4 of the 5 preceding weeks. Lithium will be titrated as clinically appropriate, not to exceed serum levels of 1.2 mEq/L. The sample will be evaluated longitudinally using a wide range of clinical scales, cognitive assessments and laboratory tests. On relapse, patients will be discontinued or crossed-over to treatment with valproic acid (VPA) or treatment as usual (TAU). Relapse is defined as a DSM-IV manic, major depressive or mixed episode or if the treating physician decides a change in medication is clinically necessary. The sample will be genotyped for GWAS. The outcome for lithium response will be analyzed as a time to event, where the event is defined as clinical relapse, using a Cox Proportional Hazards model. Positive single nucleotide polymorphisms (SNPs) from past genetic retrospective studies of lithium response, the Consortium on Lithium Genetics (ConLiGen), will be tested in this prospective study sample; a meta-analysis of these samples will then be performed. Finally, neurons will be derived from pluripotent stem cells from lithium responders and non-responders and tested in vivo for response to lithium by gene expression studies. SNPs in genes identified in these cellular studies will also be tested for association to response. DISCUSSION Lithium is an extraordinarily important therapeutic drug in the clinical management of patients suffering from bipolar disorder. However, a significant proportion of patients, 30-40 %, fail to respond, and there is currently no method to identify the good lithium responders before initiation of treatment. Converging evidence suggests that genetic factors play a strong role in the variation of response to lithium, but only a few genes have been tested and the samples have largely been retrospective or quite small. The current study will collect an entirely unique sample of 700 patients with bipolar disorder to be stabilized on lithium monotherapy and followed for up to 2 years. This study will produce useful information to improve the understanding of the mechanism of action of lithium and will add to the development of a method to predict individual response to lithium, thereby accelerating recovery and reducing suffering and cost. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01272531 Registered: January 6, 2011.
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Affiliation(s)
- Ketil J. Oedegaard
- Department of Clinical Medicine, Section for Psychiatry, Faculty of Medicine, University of Bergen, Bergen, Norway ,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Anit Anand
- Department of Psychiatry, Indiana University, Indianapolis, IN USA
| | - Ole A. Andreassen
- NORMENT, KB Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Yokesh Balaraman
- Department of Psychiatry, Indiana University, Indianapolis, IN USA
| | - Wade H. Berrettini
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
| | - Abesh Bhattacharjee
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093 USA ,Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA USA
| | - Kristen J. Brennand
- Department of Psychiatry, Icahn School of Medicine at Mt Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA ,Department of Neuroscience, Icahn School of Medicine at Mt Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Katherine E. Burdick
- Department of Psychiatry, Icahn School of Medicine at Mt Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA ,Department of Neuroscience, Icahn School of Medicine at Mt Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Joseph R. Calabrese
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH USA
| | | | - Ana Claasen
- Neurogenomics Division, The Translational Genomics Research Institute, Phoenix, AZ USA
| | | | - David Craig
- Neurogenomics Division, The Translational Genomics Research Institute, Phoenix, AZ USA
| | - Anna DeModena
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093 USA ,Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA USA
| | - Mark Frye
- Department of Psychiatry, The Mayo Clinic, Rochester, MN USA
| | - Fred H. Gage
- Laboratory of Genetics, The Salk Institute for Biological Studies, La Jolla, CA USA
| | - Keming Gao
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Julie Garnham
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Elliot Gershon
- Department of Psychiatry, University of Chicago, Chicago, IL USA
| | - Petter Jakobsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Susan G. Leckband
- Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA USA
| | - Michael J. McCarthy
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093 USA ,Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA USA
| | | | - Adam X. Maihofer
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093 USA
| | - Jerome Mertens
- Laboratory of Genetics, The Salk Institute for Biological Studies, La Jolla, CA USA
| | - Gunnar Morken
- St. Olav University Hospital of Trondheim and Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Caroline M. Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093 USA ,Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA USA
| | - John Nurnberger
- Department of Psychiatry, Indiana University, Indianapolis, IN USA
| | - Son Pham
- Laboratory of Genetics, The Salk Institute for Biological Studies, La Jolla, CA USA
| | - Helle Schoeyen
- University of Bergen, Faculty of Medicine and Dentistry, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Tatyana Shekhtman
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093 USA ,Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA USA
| | - Paul D. Shilling
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093 USA
| | - Szabolcs Szelinger
- Neurogenomics Division, The Translational Genomics Research Institute, Phoenix, AZ USA
| | - Bruce Tarwater
- Department of Psychiatry, University of Iowa, Iowa City, IA USA
| | - Jun Yao
- Laboratory of Genetics, The Salk Institute for Biological Studies, La Jolla, CA USA
| | - Peter P. Zandi
- Department of Psychiatry, University of Chicago, Chicago, IL USA ,Department of Psychiatry, Johns Hopkins University, Baltimore, MD USA
| | - John R. Kelsoe
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093 USA ,Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA USA
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Thyssen J, Vester L, Grønhøj Larsen C, Smidt K, Jakobsen P, Hansen S, Vind‐Kezunovic D, Gluud L, Grønhøj Larsen F. The single‐dose pharmacokinetics of alitretinoin and its metabolites are not significantly altered in patients with cirrhosis. Br J Dermatol 2014; 170:408-14. [DOI: 10.1111/bjd.12546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J.P. Thyssen
- Department of Dermato‐allergology Copenhagen University Hospital Gentofte Hellerup Denmark
| | - L. Vester
- Department of Dermato‐allergology Copenhagen University Hospital Gentofte Hellerup Denmark
| | - C. Grønhøj Larsen
- Department of Otolaryngology, Head and Neck Surgery Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - K. Smidt
- Department of Biomedicine‐Pharmacology Aarhus University Aarhus Denmark
| | - P. Jakobsen
- Department of Biomedicine‐Pharmacology Aarhus University Aarhus Denmark
| | - S.H. Hansen
- Department of Pharmacy University of Copenhagen Copenhagen Denmark
| | - D. Vind‐Kezunovic
- Department of Dermato‐allergology Copenhagen University Hospital Gentofte Hellerup Denmark
| | - L.L. Gluud
- Department of Internal Medicine Copenhagen University Hospital Gentofte Hellerup Denmark
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Hansen J, Christensen J, Solling T, Jakobsen P, Hoeg-Jensen T. Ortho-substituted aryl monoboronic acids have improved selectivity for d-glucose relative to d-fructose and l-lactate. Tetrahedron 2011. [DOI: 10.1016/j.tet.2010.11.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grønhøj Larsen F, Jakobsen P, Grønhøj Larsen C, Heidenheim M, Held E, Nielsen-Kudsk F. The metabolism and pharmacokinetics of isotretinoin in patients with acne and rosacea are not influenced by ethanol. Br J Dermatol 2009; 161:664-70. [PMID: 19563582 DOI: 10.1111/j.1365-2133.2009.09241.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- F Grønhøj Larsen
- Department of Dermatology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
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Jakobsen JS, Holst U, Jakobsen P, Steen W, Mortensen J. Local and systemic effects of endoluminal pelvic perfusion of isoproterenol: a dose response investigation in pigs. J Urol 2007; 177:1934-8. [PMID: 17437851 DOI: 10.1016/j.juro.2007.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Isoproterenol (Sygehus Apotekerne Danmark, Copenhagen, Denmark) is a beta-adrenergic agonist known to cause upper urinary tract relaxation. We studied the local effect on pelvic pressure and the systemic effects of endoluminal perfusion with isoproterenol in a porcine model. MATERIALS AND METHODS Pigs weighing 40 kg were studied. Catheters were placed in the renal pelvis for pressure measurement and perfusion, and a catheter was used to drain the bladder. Blood pressure and heart rate were recorded. In 6 pigs in group 1 the pelvic pressure increase was examined at increasing flow rates of 0, 2, 5, 8, 10 and 15 ml per minute with saline containing 0, 10(-3), 10(-2), 10(-1), 1 and 10 microg/ml isoproterenol. Blood values of isoproterenol were analyzed. In 6 pigs in group 2 the pelvis was perfused at a flow rate of 8 ml per minute with saline containing 0, 10(-5), 10(-4), 10(-3), 10(-2), 10(-1), 1 and 10 microg/ml isoproterenol. RESULTS In group 1 endoluminal perfusion with isoproterenol inhibited the pelvic pressure increase due to perfusion at all concentrations of isoproterenol. At a perfusion rate of 8 ml per minute the maximal effect (a 78% decrease) was achieved using 0.1 microg/ml isoproterenol without cardiovascular side effects. In group 2 all isoproterenol concentrations caused significant inhibition of the pressure-flow relationship in a dose dependent matter. A 64% decrease in the pressure increase due to saline perfusion was achieved at 0.1 microg/ml isoproterenol without concomitant significant cardiovascular side effects. Isoproterenol was only detected in plasma during perfusion with 1 and 10 microg/ml isoproterenol, which caused significant cardiovascular side effects in the latter case. CONCLUSIONS Isoproterenol significantly inhibits the pressure increase due to perfusion in the normal porcine renal pelvis without concomitant cardiovascular side effects. Isoproterenol is a safe drug in this porcine model and, hence, it is potentially useful during endourological procedures.
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Affiliation(s)
- J S Jakobsen
- Department of Urology L, Odense University Hospital, Odense, Denmark.
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Larsen UL, Hyldahl Olesen L, Guldborg Nyvold C, Eriksen J, Jakobsen P, Østergaard M, Autrup H, Andersen V. Human intestinal P-glycoprotein activity estimated by the model substrate digoxin. Scand J Clin Lab Invest 2007; 67:123-34. [PMID: 17365992 DOI: 10.1080/00365510600986084] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE P-glycoprotein (Pgp) plays a part in the intestinal uptake of xenobiotics and has been associated with susceptibility to ulcerative colitis. The aim of this study was to examine Pgp activity in relation to age, gender, medical treatment (rifampicin or ketoconazole) and the multidrug resistance (MDR1) gene single nucleotide polymorphisms (SNPs) G2677T and C3435T using the model drug digoxin. MATERIAL AND METHODS Pgp activity was estimated from the pharmacokinetics of orally administered digoxin in blood samples from 32 healthy subjects. MDR1 gene expression in duodenal biopsies was monitored by real-time quantitative RT-PCR (RQ-PCR) and Western blot analyses. MDR1 SNPs were determined by PCR-restriction fragment length polymorphism (PCR-RFLP). The effect of medical treatment was tested by open, randomized, cross-over treatment with rifampicin and ketoconazole. RESULTS Rifampicin treatment resulted in increased Pgp activity, duodenal MDR1 mRNA expression and Pgp detection compared with that in the control group (p<0.05 for all), Pgp activity being associated with duodenal MDR1 mRNA level (p<0.05). Individuals homozygous for the 3435 wild-type allele (CC) showed higher Pgp activity (p<0.05), whereas SNP 2677 apparently did not affect Pgp activity. No variation in Pgp in relation to age or gender was found. CONCLUSIONS Our data confirm that rifampicin increases Pgp activity, by increasing MDR1 mRNA and Pgp levels. Moreover, we found that the wild-type allele of the synonymous polymorphism of MDR1 position 3435 confers a higher Pgp activity. These data support other findings suggesting an effect of Pgp on treatment response and disease susceptibility.
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Affiliation(s)
- U L Larsen
- Department of Internal Medicine, Viborg County Hospital, Viborg, Denmark
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Mortensen UM, Nielsen-Kudsk JE, Sondergaard HM, Jakobsen P, Jensen BS, Schmitz O, Nielsen TT. Effect of the oral hypoglycaemic sulphonylurea glibenclamide, a blocker of ATP-sensitive potassium channels, on walking distance in patients with intermittent claudication. Diabet Med 2006; 23:327-30. [PMID: 16492219 DOI: 10.1111/j.1464-5491.2006.01797.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The oral hypoglycaemic sulphonylurea glibenclamide stimulates endogenous insulin secretion through blockade of ATP-sensitive potassium (KATP) channels on pancreatic beta cells, but also blocks cardiovascular KATP channels, leading to increased peripheral vascular resistance and reduced peripheral blood flow in non-diabetic subjects. Therefore, this study examined whether a single oral dose of glibenclamide adversely affected the pain-free or maximal walking distance in patients with intermittent claudication. METHODS In a double-blind, randomized crossover study, 12 non-diabetic patients with intermittent claudication were given a single oral dose of glibenclamide (5.25 mg) or placebo separated by a washout period of 1 week. A treadmill test was carried out 180 min after glibenclamide/placebo intake for determination of pain-free and maximal walking distance. Plasma glucose concentrations were kept constant by an euglycemic clamp. Changes in ankle/brachial blood pressure index (ABI), serum insulin, and serum glibenclamide were also assessed. RESULTS The pain-free walking distance was 62.8 +/- 9.8 metres (mean +/- sem) after glibenclamide and 52.6 +/- 5.9 metres after placebo (P = 0.52). The maximal walking distance was 142.7 +/- 18.7 metres after glibenclamide and 132.6 +/- 16.6 metres after placebo (P = 0.23). The ABI was not significantly changed by glibenclamide compared with placebo. Serum glibenclamide was 0.51 +/- 0.08 microm 180 min after administration of the drug. Glibenclamide produced an 8-fold increase in circulating insulin compared with placebo (P < 0.001). CONCLUSIONS Glibenclamide given as a single oral dose commonly used in glucose-lowering drug therapy does not reduce pain-free or maximal walking distance in non-diabetic patients with intermittent claudication.
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Affiliation(s)
- U M Mortensen
- Department of Cardiology B, Aarhus University Hospital, Aarhus, Denmark
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Westergaard N, Madsen P, Lundbeck JM, Jakobsen P, Varming A, Andersen B. Identification of two novel and potent competitive inhibitors of the glucose-6-phosphatase catalytic protein. Diabetes Obes Metab 2002; 4:96-105. [PMID: 11940106 DOI: 10.1046/j.1463-1326.2002.00179.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM In this study, we show that inhibitors of the glucose-6-phosphatase (G-6-Pase) catalytic protein could be an alternative approach to the recent G-6-Pase T1-translocase inhibitors to target this enzyme for the treatment of type 2 diabetes. METHOD The active enantiomers of 4-methoxyphenyl-[4-(4-methoxyphenyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridin-5-yl]methanone (Compound A-1) and 4-methoxyphenyl-[4-(4-trifluoromethoxyphenyl)-4,5,6,7-tetrahydrothieno[3,2-c]pyridin-5-yl]methanone (Compound B-1) were characterized as inhibitors of the G-6-Pase catalytic protein using pig and rat liver microsomes and cultured rat hepatocytes. RESULTS Both compounds were found to be potent competitive inhibitors of the G-6-Pase catalytic protein obtained from pig and rat liver microsomes. The K(i) values (microM) were calculated to be 0.61 +/- 0.02 and 0.63 +/- 0.08 for compound A-1 and B-1 on intact pig microsomes, and 0.27 +/- 0.02 and 0.29 +/- 0.06 on disrupted pig microsomes. The corresponding values for rat liver microsomes were found to be 3.3 +/- 0.6 and 4.0 +/- 1.2 for compound A-1 and B-1 on intact microsomes, and 1.54 +/- 0.1 and 1.21 +/- 0.1 on disrupted microsomes. Compound A-1 was also able to inhibit pyrophosphatase activities from both intact and disrupted microsomes with equal potency (IC50; 0.43-0.55 microm). Using cultured rat hepatocytes and glycerol as the substrate, these compounds were able to prevent glucose production up to 60% with a concomitant increase in the G-6-P content (2.3-fold) using compound A-1. No increase in glycogen levels was seen. CONCLUSION These data demonstrated that these compounds were more potent inhibitors on G-6-Pase obtained from pig microsomes and were able to penetrate the microsomal membrane. The hepatocyte data further support the kinetic data, and are also consistent with the evoked mechanism of action.
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Affiliation(s)
- N Westergaard
- Department of Diabetes Biochemistry and Metabolism, Novo Nordisk A/S, DK-2760 Måløv, Denmark
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24
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Albertsen BK, Schrøder H, Ingerslev J, Jakobsen P, Avramis VI, Müller HJ, Carlsen NT, Schmiegelow K. Comparison of intramuscular therapy with Erwinia asparaginase and asparaginase Medac: pharmacokinetics, pharmacodynamics, formation of antibodies and influence on the coagulation system. Br J Haematol 2001; 115:983-90. [PMID: 11843837 DOI: 10.1046/j.1365-2141.2001.03148.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Asparaginase comes from different biological sources and the various preparations have different pharmacokinetic properties, and their tendency to induce side-effects is different. Erwinia asparaginase (ASNase) has a shorter half-life than the Escherichia coli preparations, and it has been reported to be less immunogenic than the E. coli preparations and to induce fewer coagulation disorders. Children with newly diagnosed acute lymphoblastic leukaemia (ALL) were included in this study. Twenty-seven patients were treated with Erwinia ASNase (induction therapy 30.000 IU/m2/d i.m. for 10 d, and re-induction therapy 30.000 IU/m2 twice a week for 2 weeks) and 15 were treated with ASNase Medac (induction therapy 1.000 IU/m2/d i.m. for 10 d, and re-induction therapy 5.000 IU/m2 i.m. twice a week for 2 weeks). Blood samples were drawn to determine enzyme activity, l-asparagine, anti-asparaginase antibodies, and coagulation parameters. After i.m. administration, Erwinia ASNase displayed a protracted absorption phase compared to ASNase Medac. The mean bioavailability after i.m. administration was 27% for Erwinia ASNase and 45% for ASNase Medac respectively. Mean trough enzyme activities during induction therapy were Erwinia ASNase 1748 IU/l and ASNase Medac 272 IU/l, and during re-induction therapy Erwinia ASNase 83 IU/l and ASNase Medac 147 IU/l. We conclude that in this setting, therapy with ASNase Medac resulted in sufficient treatment during both phases of therapy, whereas treatment with Erwinia ASNase resulted in unnecessarily intense therapy during the induction phase and insufficient treatment during the re-induction phase. There was no significant difference in the incidence of antibody formation, and therapy with Erwinia ASNase resulted in a more pronounced influence on the coagulation parameters than therapy with ASNase Medac.
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Affiliation(s)
- B K Albertsen
- Centre for Clinical Pharmacology, Department of Pharmacology, The Bartholin Building, University of Aarhus, 8000 Aarhus C, Denmark.
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25
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Albertsen BK, Schrøder H, Jakobsen P, Müller HJ, Carlsen NT, Schmiegelow K. Monitoring of Erwinia asparaginase therapy in childhood ALL in the Nordic countries. Br J Clin Pharmacol 2001; 52:433-7. [PMID: 11678787 PMCID: PMC2014586 DOI: 10.1046/j.0306-5251.2001.01464.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AIMS Evaluation of L-asparaginase therapy in the NOPHO-92 ALL-protocol (treatment protocol of acute lymphoblastic leukaemia of the Nordic Society of Paediatric Haematology and Oncology, initiated in 1992) after intravenous and intramuscular administration of Erwinia asparaginase during induction and re-induction therapy. METHODS Forty children with newly diagnosed acute lymphoblastic leukaemia received Erwinia asparaginase (30 000 IU/m2 i.v. or i.m.) during induction therapy (every day for 10 days), and 19 children received Erwinia asparaginase (30 000 IU/m2 i.v. or i.m.) during re-induction therapy (twice a week for 2 weeks). Within the treatment periods asparaginase trough activity (using a spectrophotometric assay) was determined on specific days. The goal of therapy is complete L-asparagine depletion, which asparaginase activities above 100 IU l(-1) have been shown to ensure. Therefore determination of L-asparagine (using a h.p.l.c. method) was performed only in plasma samples with asparaginase activities below 100 IU l(-1). RESULTS During induction therapy 92.2% of the trough enzyme activities were above 500 IU l(-1) for the i.v.-treated patients, and 92.4% of the trough enzyme activities were above 500 IU l(-1) for the i.m.-treated patients. During re-induction therapy 64.7% of the trough enzyme activities were below 100 IU l(-1) in the i.v.-treated group, and 73.3% of the trough enzyme activities were below 100 IU l(-1) in the i.m.-treated group. For trough enzyme activities below 100 IU l(-1) L-asparagine depletion was complete in two thirds of the samples. CONCLUSIONS In the NOPHO-92 ALL-protocol L-asparaginase treatment during induction therapy was unnecessarily intense, but during the re-induction phase it appeared inadequate.
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Affiliation(s)
- B K Albertsen
- Centre for Clinical Pharmacology, University of Aarhus, Aarhus, Denmark.
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Friedrichsen GM, Jakobsen P, Taub M, Begtrup M. Application of enzymatically stable dipeptides for enhancement of intestinal permeability. Synthesis and in vitro evaluation of dipeptide-coupled compounds. Bioorg Med Chem 2001; 9:2625-32. [PMID: 11557350 DOI: 10.1016/s0968-0896(01)00066-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Transport across the intestinal barrier of compounds with low permeability may be facilitated by targeting the human oligopeptide transporter, hPepT1. A flexible synthetic pathway for attaching compounds to dipeptides through ester or amide bonds was developed. Furthermore, a synthetic approach to functionalize model drugs from one key intermediate was generated and applied to a glucose-6-phosphatase active model drug. The model drug was coupled to D-Glu-Ala through various linkers, and the G-6-Pase activity as well as the aqueous solubility and transport properties of these prodrugs, as compared to those of the parent drugs, were examined. None of the peptide-coupled compounds seemed to be transported by hPepT1, though one of the peptide-coupled compounds had affinity for hPepT1. Interestingly, in one case the parent drug was actively effluxed, while the corresponding peptide-coupled prodrug was not. The low aqueous solubility of the parent compounds was not increased after attachment to a dipeptide. This suggests that only compounds with a certain intrinsic aqueous solubility should be targeted to hPepT1 by attachment to a dipeptide. Important information about the design of peptide-coupled drugs targeted for hPepT1 is presented.
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Affiliation(s)
- G M Friedrichsen
- Department of Medicinal Chemistry, The Royal Danish School of Pharmacy, Universitetsparken 2, DK-2100, Copenhagen, Denmark
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27
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Madsen P, Jakobsen P, Westergaard N. N,N-dibenzyl-N'-benzylidenehydrazines: potent competitive glucose-6-phosphatase catalytic enzyme inhibitors. Bioorg Med Chem Lett 2001; 11:2165-7. [PMID: 11514161 DOI: 10.1016/s0960-894x(01)00395-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A novel class of N,N-dibenzyl-N'-benzylidenehydrazines as potent and competitive glucose-6-phosphatase catalytic site inhibitors are described. Optimisation of this series identified compounds with IC(50) values as low as 170 nM.
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Affiliation(s)
- P Madsen
- Medicinal Chemistry Research, Novo Nordisk A/S, Novo Nordisk Discovery, Novo Nordisk Park, DK-2760, Maaloev, Denmark.
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28
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Albertsen BK, Jakobsen P, Schrøder H, Schmiegelow K, Carlsen NT. Pharmacokinetics of Erwinia asparaginase after intravenous and intramuscular administration. Cancer Chemother Pharmacol 2001; 48:77-82. [PMID: 11488528 DOI: 10.1007/s002800100286] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the pharmacokinetics of Erwinia asparaginase (ASNase) after intravenous (i.v.) and intramuscular (i.m.) administration. METHODS A group of 29 children with newly diagnosed acute lymphoblastic leukemia (ALL) received Erwinia ASNase 30,000 IU/m2 every day for 10 days during multiagent induction therapy. Of these patients. 13 received i.v. therapy and 16 received i.m. therapy. During the reinduction phase the patients received Erwinia ASNase 30,000 IU/m2 twice a week for 2 weeks (Mondays and Thursdays) (8 patients in the i.v.-treated group and 11 patients in the i.m.-treated group). ASNase activity (spectrophotometric assay) was measured in plasma samples obtained from the patients at various times during therapy. RESULTS The estimated half-life was 6.4 +/- 0.5 h (n = 13), the absorption rate after i.m. administration was found to limit elimination. The apparent volume of distribution corresponded well with the volume of plasma. The estimated clearance suggested that Erwinia ASNase is a low-clearance drug. Bioavailability after i.m. administration was (mean +/- SEM) 27.0 +/- 4.5% (range 11-61%; n = 12). CONCLUSIONS In this study the pharmacokinetic parameters after i.v. and i.m. administration of Erwinia ASNase were determined based on a substantial number of patients. The present findings emphasize the importance of conducting proper pharmacokinetic studies before a new drug or a new preparation of a drug is introduced in a different schedule.
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Affiliation(s)
- B K Albertsen
- Department of Pharmacology, University of Aarhus, Denmark.
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Pawlas J, Vedsø P, Jakobsen P, Huusfeldt PO, Begtrup M. Novel anionic annelation tactics for construction of fused heteroaromatic frameworks. 1. Synthesis of 4-substituted pyrazolo[3,4-c]quinolines, 9-substituted pyrazolo[3,4-c]quinolines, and 1,4-dihydrochromeno[4,3-c]pyrazoles. J Org Chem 2001; 66:4214-9. [PMID: 11397156 DOI: 10.1021/jo001422u] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
4-Substituted pyrazolo[4,3-c]quinolines 4a-i and 6a-b were prepared from pyrazole 3 whereas 9-substituted pyrazolo[3,4-c]quinolines 9a-d and 17 were prepared from pyrazole 13 utilizing anionic annelation techniques. 1,4-dihydrochromeno[4,3-c]pyrazoles 7a-c were accessed from pyrazole 3, extending the method for the synthesis of 4a-i.
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Affiliation(s)
- J Pawlas
- Department of Medicinal Chemistry, The Royal Danish School of Pharmacy, Universitetsparken 2, DK-2100 Copenhagen, Denmark
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30
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Jakobsen P, Lundbeck JM, Kristiansen M, Breinholt J, Demuth H, Pawlas J, Candela MP, Andersen B, Westergaard N, Lundgren K, Asano N. Iminosugars: potential inhibitors of liver glycogen phosphorylase. Bioorg Med Chem 2001; 9:733-44. [PMID: 11310609 DOI: 10.1016/s0968-0896(00)00291-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The first synthesis of the single isomers (3R,4R,5R); (3S,4S,5S): (3R,4R,5S) and (3S,4S,5R) of 5-hydroxymethyl-piperidine-3,4-diol from Arecolin is reported, including the synthesis of a series of N-substituted derivatives of the (3R,4R,5R)-isomer (Isofagomine). The inhibitory effect of these isomers as well as of a series of N-substituted derivatives of the (3R,4R,5R)-isomer and selected hydroxypiperidine analogues on liver glycogen phosphorylase (GP) showed that the (3R,4R,5R) configuration was essential for obtaining an inhibitory effect at submicromolar concentration. The results also showed that all three hydroxy groups should be present and could not be substituted, nor were extra OH groups allowed if sub-micromolar inhibition should be obtained. Some inhibitory effect was retained for N-substituted derivatives of Isofagomine; however, N-substitution always resulted in a loss of activity compared to the parent compound, IC50 values ranging from 1 to 100 microM were obtained for simple alkyl, arylalkyl and benzoylmethyl substituents. Furthermore, we found that it was not enough to assure inhibitory effect to have the (R,R,R) configuration. Fagomine, the (2R,3R,4R)-2-hydroxymethylpiperidine-3,4-diol analogue, showed an IC50 value of 200 microM compared to 0.7 microM for Isofagomine. In addition, Isofagomine was able to prevent basal and glucagon stimulated glycogen degradation in cultured hepatocytes with IC50 values of 2-3 microM.
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Affiliation(s)
- P Jakobsen
- Medicinal Chemistry Research, Novo Nordisk A/S, Health Care Discovery, Maaloev, Denmark
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31
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Pawlas J, Vedsø P, Jakobsen P, Huusfeldt PO, Begtrup M. Synthesis of 1-hydroxy-substituted pyrazolo[3,4-c]- and pyrazolo[4, 3-c]quinolines and -isoquinolines from 4- and 5-aryl-substituted 1-benzyloxypyrazoles. J Org Chem 2000; 65:9001-6. [PMID: 11149843 DOI: 10.1021/jo000986v] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
1-Hydroxypyrazolo[3,4-c]quinoline (22), 1-hydroxypyrazolo[4, 3-c]quinoline (21), 1-hydroxypyrazolo[3,4-c]isoquinoline (20), and 1-hydroxypyrazolo[4,3-c]isoquinoline (19) were prepared from 1-benzyloxypyrazole (6), establishing the pyridine B-ring in the terminal step. The pyridine ring of pyrazoloquinolines 14 and 18 was formed via cyclization of a formyl group at C-4 or C-5 and an amino group of a 2-aminophenyl substituent at C-5 or C-4 in 1-benzyloxypyrazole. The pyridine ring of pyrazoloisoquinolines 5 and 9 was created via cyclization of a formyl group in a 2-formylphenyl substituent at C-4 or C-5 with an iminophosphorane group installed at C-5 or C-4 of 1-benzyloxypyrazole by lithiation followed by reaction with tosyl azide and then with tributylphoshine utilizing the Staudinger/aza-Wittig protocol. The 2-aminophenyl and the 2-formylphenyl substituent were introduced at C-5 or C-4 by regioselective metalation followed by transmetalation to the pyrazolylzinc halide and subsequent palladium-catalyzed cross-coupling with 2-iodoaniline or 2-bromobenzaldehyde. The order of reactions and use of protecting groups in the individual sequences have been optimized. The 1-benzyloxy-substituted pyrazoloquinolines and isoquinolines thus obtained were debenzylated by strong acid to the corresponding 1-hydroxy-substituted pyrazoloquinolines and isoquinolines 19-22.
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Affiliation(s)
- J Pawlas
- Department of Medicinal Chemistry, The Royal Danish School of Pharmacy, Universitetsparken 2, DK-2100 Copenhagen, Denmark
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Grønhøj Larsen F, Steinkjer B, Jakobsen P, Hjorter A, Brockhoff PB, Nielsen-Kudsk F. Acitretin is converted to etretinate only during concomitant alcohol intake. Br J Dermatol 2000; 143:1164-9. [PMID: 11122016 DOI: 10.1046/j.1365-2133.2000.03883.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acitretin has replaced etretinate in the treatment of various disorders of keratinization due to a considerably shorter terminal half-life. Possible esterification of acitretin to etretinate in the presence of ethanol has been reported. OBJECTIVES To determine the plasma concentrations of etretinate as a metabolite in patients with various disorders of keratinization after multiple acitretin dosing, and to assess the influence of alcohol consumption using a questionnaire. In addition, to study the influence of alcohol consumption on the risk of metabolic formation of etretinate. PATIENTS/METHODS Eighty-six acitretin (Neotigason(R), Roche)-treated outpatients from three centres provided pre-dose (trough) samples for determining plasma concentrations of acitretin and its metabolites 13-cis-acitretin and etretinate. Patients received acitretin doses of between 0.1 and 1.3 mg kg-1 daily. The concentrations of etretinate, acitretin and 13-cis-acitretin were determined by reverse-phase high-performance liquid chromatography. RESULTS Of the 86 patients, 30 had detectable plasma etretinate levels. No etretinate was found in 20 patients who reported that they never drank alcohol, while etretinate was found in all 16 patients with an average weekly alcohol consumption of > 200 g ethanol, corresponding to about 15 U (1 U equals half a pint of standard beer or a wine glass of non-fortified wine). Etretinate was detected in 14 of 50 patients with a moderate weekly alcohol intake of up to 200 g ethanol. A trend linking higher alcohol intake with both higher risk of etretinate formation and higher etretinate levels was observed. The study also revealed that the ethylesterification only relates to acitretin (13-trans-) and not to the main metabolite 13-cis-acitretin, although the latter compound showed higher plasma trough concentration levels at steady state. CONCLUSIONS Owing to the teratogenic potential and possible side-effects of oral retinoids, fertile women especially should be informed about the importance of strict alcohol abstinence during treatment and for at least 2 months after stopping therapy. In case of non-compliance with alcohol abstinence a post-therapy contraceptive period of 2-3 years should be recommended.
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Affiliation(s)
- F Grønhøj Larsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
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Jakobsen P, Horneman AM, Persson E. Inhibitors of the tissue factor/factor VIIa-induced coagulation: synthesis and in vitro evaluation of novel 2-aryl substituted pyrid. Bioorg Med Chem 2000; 8:2803-12. [PMID: 11131171 DOI: 10.1016/s0968-0896(00)00207-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The synthesis of a series of 2-aryl substituted hetero annulated 1,3-oxazin-4-ones and their evaluation as specific inhibitors of the tissue factor (TF)/factor VIIa (FVIIa)-induced pathway of coagulation is reported. Inhibitory activities (IC50 values) in the range 0.64 to > 40 microM on the activation of factor X (FX) by the TF/FVIIa complex were found for compounds having one or two electronegative substituents such as F and NO2 in the 2-aryl substituent. Some of the compounds showed a selectivity ratio towards FX and thrombin of > 50, thus being similar in specificity to 2-aryl substituted 4H-3,1-benzoxazin-4-ones described as potential drugs for oral antithrombotic treatment without side effects, such as bleeding, which is observed especially with thrombin inhibitors.
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Affiliation(s)
- P Jakobsen
- Medicinal Chemistry Research, Novo Nordisk A/S, Novo Nordisk Park, Maaloev, Denmark.
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Wanner-Olsen H, Gaarskaer FB, Mikkelsen EO, Jakobsen P, Voldby B. Studies on concentration-time profiles of nimodipine enantiomers following intravenous and oral administration of nimodipine in patients with subarachnoid hemorrhage. Chirality 2000; 12:660-4. [PMID: 10984739 DOI: 10.1002/1520-636x(2000)12:9<660::aid-chir3>3.0.co;2-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
After i.v. and oral administration of nimodipine the concentration-time profiles of the drug and its enantiomers were studied in seven patients with subarachnoid hemorrhage. Concentrations of nimodipine, (+)-(R)-, and (-)-(S)-nimodipine were analyzed using a new stereoselective high-performance liquid chromatographic method. During the first 3 h after oral administration the concentrations of (+)-(R)- and (-)-(S)-nimodipine were significantly different, the (-)-(S)-enantiomer being found in much lesser concentrations compared to the (+)-(R)-enantiomer. The results indicate that if uptake from the gastrointestinal system is equal for the two enantiomers, then (-)-(S)-nimodipine is metabolized at a much faster rate compared to (+)-(R)-nimodipine after oral administration of the drug in patients with subarachnoid bleeding. After i.v. administration; no significant differences between the concentrations of the (-)-(S) and the (+)-(R) isomers were demonstrated.
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Affiliation(s)
- H Wanner-Olsen
- Department of Anaestesiology, Aarhus Kommunehospital, DK-8000 Aarhus C, Denmark
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35
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Madsen P, Lundbeck JM, Jakobsen P, Varming AR, Westergaard N. Glucose-6-phosphatase catalytic enzyme inhibitors: synthesis and in vitro evaluation of novel 4,5,6,7-tetrahydrothieno[3,2-c]- and -[2,3-c]pyridines. Bioorg Med Chem 2000; 8:2277-89. [PMID: 11026540 DOI: 10.1016/s0968-0896(00)00153-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The discovery of the first class of potent glucose-6-phosphatase catalytic site inhibitors, substituted 4,5,6,7-tetrahydrothieno[3,2-c]- and -[2,3-c]pyridines, is described. Optimisation of this series involved solution phase combinatorial synthesis and very potent compounds were prepared with IC50 values down to 140 nM. The structure activity relationship (SAR) of these compounds indicates that: a tetrahydrothieno[3,2-c]pyridine core ring system and the isomeric [2,3-c] system are equipotent and much better than the corresponding benzo analogue, 1,2,3,4-tetrahydro-isoquinoline. The 4-substituent of the tetrahydrothieno[3,2-c]pyridine ring has to be a phenyl group, optionally substituted with a lipophilic 4-substituent, such as trifluoromethoxy or chloro. The 5-substituent of the tetrahydrothieno[3,2-c]pyridine ring has to be a substituted benzoyl; anisoyl and (E)-3-furan-3-ylacryloyl are the best of the investigated groups. Substitution in the benzoyl ortho position seems to be forbidden, whereas substitution in the meta position is tolerated only if a methoxy para substituent is present. These SAR findings were parallel to those obtained in the 4,5,6,7-tetrahydrothieno[2,3-c]pyridine system. Enantioselectivity in enzyme recognition was observed and the activity resided in all cases only in one of the enantiomers.
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Affiliation(s)
- P Madsen
- Medicinal Chemistry Research, Novo Nordisk A/S, Health Care Discovery, Målov, Denmark.
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Jakobsen P, Pedersen BR, Persson E. Inhibitors of the tissue factor/factor VIIa-induced coagulation: synthesis and in vitro evaluation of novel specific 2-aryl substituted 4H-3,1-benzoxazin-4-ones. Bioorg Med Chem 2000; 8:2095-103. [PMID: 11003155 DOI: 10.1016/s0968-0896(00)00129-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The synthesis of a series of novel 2-aryl substituted 4H-3,1-benzoxazin-4-ones and their evaluation as specific inhibitors of the Tissue Factor (TF)/Factor VIIa (FVIIa)-induced pathway of coagulation is reported. Inhibitory activities (IC50 values) in the range 0.17 to > 40 microM on the activation of Factor X (FX) by the TF/FVIIa complex were found for compounds having one or two electronegative substituents such as F, Cl and NO2 in the 2-aryl substituent. Different substitutions both electron-attracting and donating groups were allowed in the 5, 6, 7 and 8 positions. Several of the compounds showed a selectivity ratio towards FX and thrombin of > 50, thus being the first small molecules described as potential drugs for oral antithrombotic treatment without side effects such as bleeding which is observed especially with thrombin inhibitors. The best substituent pattern being the 2-aryl group substituted with: 2-F; 2,6-F2; or 2-FX; 6-Cl; together with electronegative substitution in the 5, 6, 7, or 8 positions. 2-Heteroaryl substituents like thienyl and furanyl were of low activity while some 2-(2-chloro-3-pyridyl) derivatives had inhibitory activity < 10 microM and a good selectivity.
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Affiliation(s)
- P Jakobsen
- Medicinal Chemistry Research, Novo Nordisk A/S, Maaloev, Denmark
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Abstract
BACKGROUND/AIM The aim of the study was to evaluate the pharmacokinetics of octreotide in patients with cirrhosis compared to healthy volunteers. METHODS Seventeen patients with cirrhosis and nine normals received an intravenous bolus of octreotide (0.75 microgram/kg), followed by a continuous infusion of 0.75 microgram.kg-1.h-1 for 12 h. Eight patients were decompensated with ascites, while nine were without signs of decompensation. Serum octreotide levels were followed by blood sampling during the infusion period and for 24 h afterwards. RESULTS The average clearance (+/-SEM) was 151 +/- 15 ml/min in normals compared to 102 +/- 9 (p < 0.05) and 105 +/- 9 (p < 0.05) in patients with compensated and decompensated cirrhosis, respectively. The average area under the serum octreotide curve was significantly increased by 53% (p < 0.05) in decompensated and 46% (p < 0.05) in compensated cirrhosis compared to healthy volunteers, while no difference was observed between the groups with cirrhosis. This difference was also reflected by an increased maximum serum concentration during the infusion period of 9797 +/- 580 ng/l in the patients with cirrhosis compared to 7081 +/- 547 ng/l (p = 0.006) in normals. The serum half-life for the beta-phase (T1/2 beta) was 165 +/- 26 min in normals, 200 +/- 21 min in the compensated and 216 +/- 26 min in the decompensated group (NS). The volume of distribution (Vd beta) showed no difference between the three groups. Because of the slow equilibration between plasma and ascitic fluid in decompensated cirrhosis, the calculated clearance may have been overestimated and T1/2 beta and Vd beta underestimated in these patients. CONCLUSIONS The present study demonstrates that the pharmacokinetics of octreotide in cirrhosis is substantially different from that found in normals.
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Affiliation(s)
- L H Ottesen
- Surgical Department L, Aarhus University Hospital, Denmark
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Jakobsen A, Bertelsen K, Andersen JE, Havsteen H, Jakobsen P, Moeller KA, Nielsen K, Sandberg E, Stroeyer I. Dose-effect study of carboplatin in ovarian cancer: a Danish Ovarian Cancer Group study. J Clin Oncol 1997; 15:193-8. [PMID: 8996142 DOI: 10.1200/jco.1997.15.1.193] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To elucidate the effect of a doubled carboplatin dose-intensity in epithelial ovarian cancer in combination with a fixed dose of cyclophosphamide. PATIENTS AND METHODS A total of 222 patients with epithelial ovarian cancer stages II to IV were included in the study. Following surgery, patients were randomly assigned to receive carboplatin at an area under the concentration-versus-time curve (AUC) of 4 (AUC4) or carboplatin at an AUC of 8 (AUC8) and cyclophosphamide 500 mg/m2 given every 4 weeks for six courses. The AUC was calculated according to Calvert's formula. In 123 patients, the carboplatin AUC was also measured based on a single-sample method and the results were compared with the calculated AUC. The end points of the trial were complete pathologic remission (CPR) and crude survival. RESULTS Approximately 50% of patients in both arms underwent second-look surgery. The frequency of CPR was 32% and 30%, respectively. The survival curves showed no significant difference (P = .84). The dose-intensity of cyclophosphamide was almost identical in the two arms, whereas that of carboplatin was different. In the AUC8 arm, the dose-intensity was 1.86 times that of the AUC4 arm. The results also demonstrated good agreement between the calculated and the measured AUC in most patients. Bone marrow toxicity was significantly higher in the AUC8 arm. CONCLUSION A doubling of the carboplatin dose-intensity did not result in any significant improvement of pathologic remission or survival. Calvert's formula can be used to give a fairly accurate estimate of the carboplatin AUC. Bone marrow toxicity increased with higher dose-intensity, and a further increase of dose is only feasible with growth-factor or stem-cell support.
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Affiliation(s)
- A Jakobsen
- Department of Oncology, Odense University Hospital, Denmark
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39
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Bastholt L, Dalmark M, Gjedde SB, Pfeiffer P, Pedersen D, Sandberg E, Kjaer M, Mouridsen HT, Rose C, Nielsen OS, Jakobsen P, Bentzen SM. Dose-response relationship of epirubicin in the treatment of postmenopausal patients with metastatic breast cancer: a randomized study of epirubicin at four different dose levels performed by the Danish Breast Cancer Cooperative Group. J Clin Oncol 1996; 14:1146-55. [PMID: 8648369 DOI: 10.1200/jco.1996.14.4.1146] [Citation(s) in RCA: 135] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To test for possible correlations between dose of single-drug epirubicin and efficacy/toxicity in postmenopausal women with metastatic breast cancer. The study also included analysis of a correlation between pharmacokinetic and pharmacodynamic parameters. PATIENTS AND METHODS Two hundred eighty-seven women were randomized to receive either 40, 60, 90, or 135 mg/m2 of epirubicin intravenously (IV) every 3 weeks. Treatment consisted of first-line cytotoxic therapy for metastatic disease. In patients with early progressive disease after either 40 or 60 mg/m2, dose escalation to 135 mg/m2 was performed. A full pharmacokinetic analysis was performed in 78 patients. RESULTS Among 263 eligible patients, an increase in response rate and time to progression was found with an increase in dose from 40 to 90 mg/m2, while no increase in efficacy was found from 90 to 135 mg/m2. Multivariate analysis, using the Cox proportional hazards model with time to progression as the end point, confirmed that epirubicin dose more than 60 mg/m2 was an independent prognostic covariate. Furthermore, a significant association was established between randomized dose and both hematologic and nonhematologic toxicity. No association between pharmacokinetic parameters and efficacy parameters was demonstrated. On the other hand, a significant correlation between pharmacokinetic parameters and both hematologic and nonhematologic toxicity was found. CONCLUSION An increase in dose of epirubicin from 40 to 90 mg/m2 is accompanied by increased efficacy. Further increases in dose do not yield increased efficacy. A positive correlation between epirubicin dose and toxicity, as well as a correlation between pharmacokinetic parameters and toxicity, was also established.
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Affiliation(s)
- L Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
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40
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Pellicciari R, Luneia R, Costantino G, Marinozzi M, Natalini B, Jakobsen P, Kanstrup A, Lombardi G, Moroni F, Thomsen C. 1-Aminoindan-1,5-dicarboxylic acid: a novel antagonist at phospholipase C-linked metabotropic glutamate receptors. J Med Chem 1995; 38:3717-9. [PMID: 7562903 DOI: 10.1021/jm00019a002] [Citation(s) in RCA: 156] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- R Pellicciari
- Istituto di Chimica e Tecnologia del Farmaco, Università di Perugia, Italy
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41
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Jakobsen P, Boksenberg A, Deharveng J, Greenfield P, Jedrzejewski R, Paresce F. Detection of intergalactic ionized helium absorption in a high-redshift quasar. Nature 1994. [DOI: 10.1038/370035a0] [Citation(s) in RCA: 168] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Barone FC, Price WJ, Jakobsen P, Sheardown MJ, Feuerstein G. Pharmacological profile of a novel neuronal calcium channel blocker includes reduced cerebral damage and neurological deficits in rat focal ischemia. Pharmacol Biochem Behav 1994; 48:77-85. [PMID: 8029306 DOI: 10.1016/0091-3057(94)90501-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Excessive calcium entry into depolarized neurons contributes significantly to cerebral tissue damage following ischemia. Therefore, blocking voltage-operated calcium channels on nerve cells should provide significant neuroprotection in ischemia. We now report on a novel neuronal calcium channel blocker, NNC 09-0026, in terms of its selective effects on neuronal calcium current and its efficacy in reducing infarct size and neurological deficits in a rat model of focal stroke. In the present studies, the effects of NNC 09-0026 on neuronal calcium influx, calcium channel binding, and cardiovascular parameters were determined. Also, phencyclidine, NNC 09-0026, or vehicle were administered i.v. to rats subjected to permanent middle cerebral and common carotid artery occlusions. Infarct volumes and contralateral forepaw and hindlimb neurological deficits were assessed at 24 and 48 h after onset of stroke. NNC 09-0026 exhibited a pharmacological profile suggesting selectivity at neuronal calcium channels. It inhibited potassium-stimulated calcium uptake into rat synaptosomes with an IC50 of 13 microM. Voltage-operated calcium currents measured from cultured rat dorsal root ganglion cells using the patch clamp technique were blocked by 43% at 10 microM (p < 0.05). The compound showed only weak effects on smooth muscle from the guinea pig taenia coli and was relatively inactive at displacing nitrendipine and omega-conotoxin in receptor-binding studies. Single, bolus injections of NNC 09-0026 as high as 10 mg/kg i.v. produced only 12% reduction in heart rate and a 28% decrease in blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F C Barone
- Department of Cardiovascular Pharmacology, SmithKline Beecham Pharmaceuticals, King of Prussia, PA 19406
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43
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Sørensen B, Bastholt L, Mirza MR, Gjedde SB, Jakobsen P, Mouridsen HT, Rose C. The cardioprotector ADR-529 and high-dose epirubicin given in combination with cyclophosphamide, 5-fluorouracil, and tamoxifen: a phase I study in metastatic breast cancer. Cancer Chemother Pharmacol 1994; 34:439-43. [PMID: 8070013 DOI: 10.1007/bf00685571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of this study was to determine the maximal tolerable dose (MTD) of epirubicin and ADR-529 given in combination with cyclophosphamide, 5-fluorouracil, and tamoxifen. A total of 64 breast cancer patients with locally advanced disease or a first metastatic event were included. Using fixed doses of cyclophosphamide, 5-fluorouracil, and tamoxifen, cohorts of ten patients were treated with escalating doses of epirubicin and ADR-529. With the use of protocol criteria specifying evaluation after the first course, the MTD was not reached. Dose reductions carried out due to hematologic toxicity during the first four courses made it impossible to escalate doses of epirubicin beyond 80 mg/m2 given together with ADR-529 600 mg/m2. The vascular toxicity of ADR-529 necessitated central venous access in a number of patients. For phase III evaluation of ADR-529 given together with cyclophosphamide, epirubicin, 5-fluorouracil, and tamoxifen (CEF/TAM) we recommend using epirubicin/ADR-529 at 60/600 mg/m2. Together with evaluation of the cardioprotective properties of ADR-529, we recommend evaluating the impact of ADR-529 on the efficacy of cytotoxic therapy and investigating further the toxicity of ADR-529.
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Affiliation(s)
- B Sørensen
- Department of Oncology, Odense University Hospital, Denmark
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44
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Jakobsen P, Sørensen B, Bastholt L, Mirza MR, Gjedde SB, Mouridsen HT, Rose C. The pharmacokinetics of high-dose epirubicin and of the cardioprotector ADR-529 given together with cyclophosphamide, 5-fluorouracil, and tamoxifen in metastatic breast-cancer patients. Cancer Chemother Pharmacol 1994; 35:45-52. [PMID: 7987976 DOI: 10.1007/bf00686283] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A high-pressure liquid chromatographic method for determination of the bisdioxopiperazine derivative ADR-529 (ICRF-187), a compound proven effective in protection against anthracycline-induced cardiotoxicity, has been developed. The limit of quantitation was 5 ng/ml using a narrow-bore 5-microns silica column and UV detection. The method was used for determination of pharmacokinetic profiles of ADR-529 after a 3-weekly i.v. administration of different doses of ADR-529 (600-1000 mg/m2) together with different doses of epirubicin (E, 60-100 mg/m2), fixed-dose cyclophosphamide (C, 600 mg/m2), fixed-dose 5-fluorouracil (F, 600 mg/m2), and daily administration of tamoxifen (T, 30 mg; CEF-T) in the treatment of patients with metastatic breast cancer. Pharmacokinetic parameters for epirubicin were also determined. The aim of the study was to determine (1) whether the pharmacokinetics of ADR-529 as part of a combination with CEF-T changes with increasing doses of ADR-529 and increasing doses of epirubicin and (2) whether the pharmacokinetics of epirubicin in the same combinations is altered with the administration of increasing doses of ADR-529. A total of 82 patients were included. A crossover study including 16 of the patients showed no significant difference in epirubicin pharmacokinetic parameters when epirubicin was given with or without concomitant administration of ADR-529. Apart from minor changes in the distributional half-lives, the pharmacokinetic parameters of epirubicin were not altered with increasing doses of ADR-529, nor were the pharmacokinetic parameters of ADR-529 itself. Escalating doses of epirubicin did not significantly alter the pharmacokinetic parameters of ADR-529 with the exception of a 30% increase in the terminal half-life and a decrease in total body clearance when the epirubicin dose was raised from 60 to 100 mg/m2. We conclude that concomitant administration of ADR-529 does not alter the distribution and elimination of epirubicin in doses suitable for preventing the anthracycline-induced cardiotoxicity.
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Affiliation(s)
- P Jakobsen
- Institute of Pharmacology, University of Aarhus, Denmark
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45
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Kjaer M, Brunsgaard N, Jakobsen P, Edwards DM, Strolin-Benedetti M. Bioavailability of a new oral formulation of medroxyprogesterone acetate compared with the standard formulation: a single dose randomized study. Anticancer Drugs 1993; 4:437-41. [PMID: 8400345 DOI: 10.1097/00001813-199308000-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Twenty-six female patients with breast cancer participated in an open, randomized, cross-over study comparing single dose bioavailability of a recently developed oral medroxyprogesterone acetate (MPA) formulation (200 mg sachet where MPA is loaded in a polyvinylpyrrolidone cross-linked polymer, MPA/PVP) with the standard formulation (500 mg tablet). Blood tests were performed under standardized conditions for 120 h in all patients and MPA plasma concentrations determined by means of HPLC. Dose-normalized AUC(0-tz), AUC (0-infinity) and Cmax were all significantly higher for the MPA/PVP formulation than for the standard formulation. The relative bioavailability of the MPA/PVP formulation was on average three times superior to that of the standard formulation. This new MPA formulation might have important clinical implications for the treatment of hormone-sensitive cancer.
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Affiliation(s)
- M Kjaer
- Department of Oncology, Aalborg Hospital, Denmark
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46
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Larsen FG, Jakobsen P, Knudsen J, Weismann K, Kragballe K, Nielsen-Kudsk F. Conversion of acitretin to etretinate in psoriatic patients is influenced by ethanol. J Invest Dermatol 1993; 100:623-7. [PMID: 8491984 DOI: 10.1111/1523-1747.ep12472293] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Acitretin has recently been introduced to replace etretinate in the treatment of severe psoriasis due to a considerable shorter terminal half-life. The previously recommended 2-month anticonceptive period after acitretin treatment has been extended to 2 years after the detection of etretinate in certain acitretin recipients. In the present study, 10 patients with severe psoriasis were treated with 30 mg acitretin daily for 3 months. Seven patients had detectable mean steady-state plasma etretinate concentrations in the range of 2.5 to 56.7 ng/ml. Four of the patients showed teratogenic levels of plasma etretinate. Consumption of alcohol appeared to be an important contributing factor for the formation of etretinate. As judged from the dose- and body-weight-normalized AUC values (AUCcor) there was a great inter-individual variation (sixfold) in the systemic availability of acitretin. After discontinuation of therapy, the rate of elimination of both acitretin (t1/2 range 1.0 to 25.4 d) and 13-cis-acitretin (t1/2 range 1.5 to 25.7 d) was found to be related to the observed mean steady-state level of etretinate as evidenced by a longer terminal t1/2 of patients with high levels of etretinate in plasma. A mean terminal elimination half-life of etretinate was found to be 45.7 d +/- 10.6 (mean +/- SD; range 27.0 to 59.3 d). The risk of metabolic formation of etretinate in acitretin recipients makes it impossible to draw any definite conclusion with regard to recommendation of length of anticonceptive period following acitretin therapy in psoriatics. Monitoring of plasma etretinate levels in acitretin-treated fertile women is advisable.
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Affiliation(s)
- F G Larsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
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47
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Strömgren AS, Sørensen BT, Jakobsen P, Jakobsen A. A limited sampling method for estimation of the etoposide area under the curve. Cancer Chemother Pharmacol 1993; 32:226-30. [PMID: 7684658 DOI: 10.1007/bf00685840] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A limited sampling method for estimation of the etoposide area under the curve (AUC) is presented. The method was developed and validated in 23 patients (42 pharmacokinetic studies) with small-cell lung cancer (SCLC), limited disease. The patients received 100 mg/m2 etoposide as a 90-min intravenous infusion in combination with carboplatin, allowing for etoposide dose modification at a following course (25% increase or decrease) due to high or low nadir values for leukocytes or thrombocytes. Of the 42 pharmacokinetic studies, 27 were used in the model development and 15 were used in the model validation. Single regression analyses of the AUC versus the fitted concentrations for the model data set were performed at several time points. The analyses demonstrated high and essentially identical correlation coefficients in the interval between 2 and 21 h, with a maximal value of 0.96 being recorded at 4 h. Multiple regression analysis was then performed using fitted concentrations corresponding to 0.08-21 h. The best model for one sample was AUC = 1.01 x (dose level divided by 100 mg/m2) + 799 x C4 h, that for two samples was AUC = 1.43 x (dose level divided by 100 mg/m2) + 544 x C4 h + 1756 x C21 h, and that for three samples was AUC = 0.07 x (dose level divided by 100 mg/m2) + 110 x C5 min + 474 x C4 h + 1759 x C21 h. Not unexpectedly, the model validation revealed that the one-sample model was less precise than the two- or three-sample model [percentage of root mean squared error (RMSE%) = 11.6%, 7.1%, and 5.4%, respectively]. All models proved to be unbiased in the validation [percentage of mean predictive error (MPE%) +/- SE = 4.2% +/- 11.0%, 7.9% +/- 6.1%, and 6.3% +/- 5.3%, respectively]. The models were subsequently validated in 14 pharmacokinetic studies of patients with metastatic germ-cell tumours who were receiving combination chemotherapy with cisplatin and bleomycin plus 100 mg/m2 etoposide as a 90-min infusion. The RMSE% was 13.4%, 10.8%, and 9.0% and the MPE% +/- SE was -1.0% +/- 11.9%, 1.7% +/- 10.5%, and 2.7% +/- 7.9% for the one-, two-, and three-sample models, respectively. The limited sampling methods presented herein may prove to be a most valuable tool for therapeutic drug monitoring in regimens in which etoposide is given in combination with carboplatin or with cisplatin and bleomycin.
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Affiliation(s)
- A S Strömgren
- Department of Oncology, Aarhus University Hospital, Denmark
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48
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Strömgren A, Sørensen BT, Jakobsen P, Jakobsen A. Pharmacokinetics and toxicity of etoposide in combination with carboplatin in patients with small cell lung cancer (SCLC). Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)91216-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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49
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Sørensen BT, Strömgren A, Jakobsen P, Jakobsen A. A limited sampling method for estimation of the carboplatin area under the curve. Cancer Chemother Pharmacol 1993; 31:324-7. [PMID: 8422698 DOI: 10.1007/bf00685679] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A limited sampling method for estimation of the carboplatin area under the curve (AUC) from one or two plasma concentration determination is presented. The model was conceived and developed using 43 pharmacokinetic studies in 15 patients with ovarian cancer (model data set) who received carboplatin in combination with cyclophosphamide. Linear regression analyses comparing the AUC and the drug concentration at a single time point (0.25-10 h after the end of the infusion) as calculated from the fitted exponential equations gave correlation coefficients as high as 0.97, with maximal correlations falling within the interval of 2-3.25 h. The model was validated prospectively in 9 patients with ovarian cancer (validation data set) who received the same treatment as did the model data set (21 pharmacokinetic studies), testing the equation AUC = 0.52 x C2.75 h + 0.92. Observed and estimated AUCs were correlated in the validation data set (r = 0.91). The mean predictive error (MPE% +/- SE) was -4.4% +/- 3.1% and the root mean squared error (RMSE%) was 13.9%. Multiple regression analysis revealed that adding a second sample drawn at 0.25 h (AUC = 0.053 x C0.25h + 0.401 x C2.75h + 0.628) improved the MPE% to -2.2% +/- 2.1% and the RMSE% to 9.4% (r = 0.96). We conclude that the carboplatin AUC can be estimated from a single plasma sample at 2.75 h or, more precisely, from two plasma samples at 0.25 and 2.75 h. The methods described may prove to be a handy tool for the calculation of approximate AUCs in trials of a size that would discourage detailed pharmacokinetic studies.
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Affiliation(s)
- B T Sørensen
- Danish Cancer Society, Department of Oncology, Aarhus University Hospital
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50
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Abstract
The Royal Dental College, Copenhagen, houses an extensive collection of human teeth extracted in Denmark. The collection currently contains 104 one-rooted, permanent maxillary second molars. The root complex on these teeth was sectioned at the junction between the coronal and the apical halves, i.e. mid-root, and at the junction between the middle and the apical thirds, i.e. apically. Using a stereomicroscope we then registered, mid-root and apically, the following variables: canal number, canal position, and canal cross-section. Mid-root there was 1 centrally located root canal in 25.96% of the teeth examined; 2 canals were observed either mesially and distofacially, mesiofacially and distally, or facially and lingually in 34.62%; 3 canals positioned mesiofacially, distofacially, and lingually were found in 39.42%. At the same level 63.51% of the canal cross-sections were non-circular, whereas 36.49% of the canals had a circular cross-section image. The non-circular canal cross-sections could more specifically be characterized as C-shaped, Y-shaped, hourglass-shaped or the root canal had a greater faciolingual than mesiodistal extension or, respectively, a greater mesiodistal than faciolingual extension. Apically there was 1 centrally located root canal in 35.58%; 2 canals were observed with a position either mesially and distofacially, mesiofacially and distally, or facially and lingually in 37.49%; 3 canals located mesiofacially, distofacially, and lingually were found in 26.92%. At the apical level, 64.32% of the root canal cross-sections were non-circular, whereas 35.68% of the canals showed a circular cross-section. The results presented here are aimed at: clinical dentists, endodontists, and dental morphologists.
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Affiliation(s)
- O Carlsen
- Department of Dental Morphology, Royal Dental College, Copenhagen, Denmark
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