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Moody OA, Talwar S, Jenkins MA, Freeman AA, Trotti LM, García PS, Bliwise D, Lynch JW, Cherson B, Hernandez EM, Feldman N, Saini P, Rye DB, Jenkins A. Rigor, reproducibility, and in vitro cerebrospinal fluid assays: The devil in the details. Ann Neurol 2017; 81:904-907. [PMID: 28440033 DOI: 10.1002/ana.24940] [Citation(s) in RCA: 2] [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] [Received: 12/22/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Olivia A Moody
- Program in Neuroscience, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA
| | - Sahil Talwar
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | | | - Amanda A Freeman
- Center for the Study of Human Health, Emory College, Atlanta, GA
| | - Lynn Marie Trotti
- Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA
| | - Paul S García
- Program in Neuroscience, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA.,Anesthesiology and Research Divisions, Atlanta VA Medical Center, Atlanta, GA.,Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - Donald Bliwise
- Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA
| | - Joseph W Lynch
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia.,School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | | | | | - Neil Feldman
- St Petersburg Sleep Disorders Center, St Petersburg, FL
| | - Prabhjyot Saini
- Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA
| | - David B Rye
- Program in Neuroscience, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA.,Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA
| | - Andrew Jenkins
- Program in Neuroscience, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA.,Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA.,Department of Pharmacology, Emory University School of Medicine, Atlanta, GA
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Trotti LM, Saini P, Bliwise DL, Freeman AA, Jenkins A, Rye DB. Clarithromycin in γ-aminobutyric acid-Related hypersomnolence: A randomized, crossover trial. Ann Neurol 2015; 78:454-65. [PMID: 26094838 DOI: 10.1002/ana.24459] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 05/22/2015] [Accepted: 05/31/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Some central hypersomnolence syndromes are associated with a positive allosteric modulator of γ-aminobutyric acid (GABA)-A receptors in cerebrospinal fluid. Negative allosteric modulators of GABA-A receptors, including clarithromycin, have been reported to reduce sleepiness in these patients. We sought to systematically assess the effects of clarithromycin on objective vigilance and subjective sleepiness. METHODS This was a 5-week, randomized, placebo-controlled, double-blind, crossover trial of clarithromycin 500mg with breakfast and lunch, in patients with hypersomnolence syndromes (excluding narcolepsy with cataplexy) and evidence for abnormal cerebrospinal fluid potentiation of GABA-A receptors. The study occurred at a university-affiliated medical center. The primary outcome measure was median reaction time on the psychomotor vigilance task (PVT) at week 2 in each condition. Secondary outcomes included the Epworth Sleepiness Scale, Stanford Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Pittsburgh Sleep Quality Index, SF-36, and additional PVT measures. RESULTS Twenty-three patients began treatment. Three patients dropped out, and final analyses were performed on 20 complete cases. Median reaction time was not significantly different between clarithromycin and placebo. Subjective measures of sleepiness were significantly improved on clarithromycin versus placebo. Altered taste perception occurred, but was the only side effect more common on clarithromycin than placebo. No serious adverse events occurred. INTERPRETATION Subjective sleepiness, but not psychomotor vigilance, improved during a 2-week course of clarithromycin. Although additional studies are needed, this suggests that clarithromycin may be a reasonable treatment option in patients with treatment-refractory hypersomnolence. This trial was registered at ClinicalTrials.gov (NCT01146600) and supported by the American Sleep Medicine Foundation.
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Affiliation(s)
| | | | | | | | - Andrew Jenkins
- Department of Anesthesia, Emory University School of Medicine, Atlanta, GA
| | - David B Rye
- Department of Neurology and Emory Sleep Center
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Trotti LM, Saini P, Freeman AA, Bliwise DL, García PS, Jenkins A, Rye DB. Improvement in daytime sleepiness with clarithromycin in patients with GABA-related hypersomnia: Clinical experience. J Psychopharmacol 2014; 28:697-702. [PMID: 24306133 DOI: 10.1177/0269881113515062] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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: 12/20/2022]
Abstract
The macrolide antibiotic clarithromycin can enhance central nervous system excitability, possibly by antagonism of GABA-A receptors. Enhancement of GABA signaling has recently been demonstrated in a significant proportion of patients with central nervous system hypersomnias, so we sought to determine whether clarithromycin might provide symptomatic benefit in these patients. We performed a retrospective review of all patients treated with clarithromycin for hypersomnia, in whom cerebrospinal fluid enhanced GABA-A receptor activity in vitro in excess of controls, excluding those with hypocretin deficiency or definite cataplexy. Subjective reports of benefit and objective measures of psychomotor vigilance were collected to assess clarithromycin's effects. Clinical and demographic characteristics were compared in responders and non-responders. In total, 53 patients (38 women, mean age 35.2 (SD 12.8 years)) were prescribed clarithromycin. Of these, 34 (64%) reported improvement in daytime sleepiness, while 10 (19%) did not tolerate its side effects, and nine (17%) found it tolerable but without symptomatic benefit. In those who reported subjective benefit, objective corroboration of improved vigilance was evident on the psychomotor vigilance task. Twenty patients (38%) elected to continue clarithromycin therapy. Clarithromycin responders were significantly younger than non-responders. Clarithromycin may be useful in the treatment of hypersomnia associated with enhancement of GABA-A receptor function. Further evaluation of this novel therapy is needed.
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Affiliation(s)
- Lynn Marie Trotti
- Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA, USA
| | - Prabhjyot Saini
- Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA, USA
| | - Amanda A Freeman
- Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA, USA
| | - Donald L Bliwise
- Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA, USA
| | - Paul S García
- Department of Anesthesia, Emory University School of Medicine, Atlanta, GA, USA Atlanta VA Medical Center, Atlanta, GA, USA
| | - Andrew Jenkins
- Department of Anesthesia, Emory University School of Medicine, Atlanta, GA, USA
| | - David B Rye
- Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA, USA
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Felger JC, Alagbe O, Hu F, Mook D, Freeman AA, Sanchez MM, Kalin NH, Ratti E, Nemeroff CB, Miller AH. Effects of interferon-alpha on rhesus monkeys: a nonhuman primate model of cytokine-induced depression. Biol Psychiatry 2007; 62:1324-33. [PMID: 17678633 PMCID: PMC2149847 DOI: 10.1016/j.biopsych.2007.05.026] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [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: 02/23/2007] [Revised: 05/04/2007] [Accepted: 05/17/2007] [Indexed: 12/29/2022]
Abstract
BACKGROUND Interferon (IFN)-alpha is an innate immune cytokine that causes high rates of depression in humans and therefore has been used to study the impact of cytokines on the brain and behavior. To establish a nonhuman primate model of cytokine-induced depression, we examined the effects of IFN-alpha on rhesus monkeys. METHODS Eight rhesus monkeys were administered recombinant human (rHu)-IFN-alpha (20 MIU/m(2)) or saline for 4 weeks in counterbalanced fashion, and videotaped behavior, as well as plasma and cerebrospinal fluid (CSF), were obtained at regular intervals to assess behavioral, neuroendocrine, immune, and neurotransmitter parameters. Additionally, expression and activity of IFN-alpha/beta receptors in monkey peripheral blood mononuclear cells (PBMCs) were assessed. RESULTS Compared with saline treatment, IFN-alpha administration was associated with persistent increases in anxiety-like behaviors and decreases in environmental exploration. In addition, IFN-alpha induced significant increases in plasma concentrations of corticotropin (ACTH), cortisol, and interleukin-6 that tended to diminish after chronic administration, especially in dominant animals. Interestingly, in three animals, depressive-like, huddling behavior was observed. Monkeys that displayed huddling behavior exhibited significantly higher plasma concentrations of ACTH and lower CSF concentrations of the dopamine metabolite homovanillic acid. Rhesus monkey PBMCs were found to express mRNA and protein for the IFN-alpha/beta receptor. Moreover, treatment of PBMCs with rHu-IFN-alpha led to induction of STAT1, one of the primary IFN-alpha-induced signaling molecules. CONCLUSIONS IFN-alpha evoked behavioral, neuroendocrine, and immune responses in rhesus monkeys that are similar to humans. Moreover, alterations in hypothalamic-pituitary-adrenal axis responses and dopamine metabolism may contribute to IFN-alpha-induced depressive-like huddling behavior.
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Affiliation(s)
- Jennifer C Felger
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Winship Cancer Institute, 1365-C Clifton Road, Atlanta, GA 30322, USA
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Edmonds KW, van der Laan G, Freeman AA, Farley NRS, Johal TK, Campion RP, Foxon CT, Gallagher BL, Arenholz E. Angle-dependent x-ray magnetic circular dichroism from (Ga,Mn)As: anisotropy and identification of hybridized states. Phys Rev Lett 2006; 96:117207. [PMID: 16605863 DOI: 10.1103/physrevlett.96.117207] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Indexed: 05/08/2023]
Abstract
Remarkably anisotropic Mn L2,3 x-ray magnetic circular dichroism spectra from the ferromagnetic semiconductor (Ga,Mn)As are reported. States with cubic and uniaxial symmetry are distinguished by careful analysis of the angle dependence of the spectra. The multiplet structures with cubic symmetry are qualitatively reproduced by calculations for an atomiclike d5 configuration in tetrahedral environment, and show zero anisotropy in the orbital and spin moments within the experimental uncertainty. However, hybridization with the host valence bands is reflected by the presence of a preedge feature with a uniaxial anisotropy and a marked dependence on the hole density.
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Affiliation(s)
- K W Edmonds
- School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2RD, United Kingdom
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Hagiwara K, Freeman AA, McMenamin MG, Harris CC. Screening cloned PCR fragments by restriction endonuclease finger-printing to obtain wild-type sequences. Biotechniques 1998; 25:554-5, 558. [PMID: 9793631 DOI: 10.2144/98254bm01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- K Hagiwara
- Laboratory of Human Carcinogenesis, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-4255, USA
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Baer JC, Freeman AA, Newlands ES, Watson AJ, Rafferty JA, Margison GP. Depletion of O6-alkylguanine-DNA alkyltransferase correlates with potentiation of temozolomide and CCNU toxicity in human tumour cells. Br J Cancer 1993; 67:1299-302. [PMID: 8512814 PMCID: PMC1968485 DOI: 10.1038/bjc.1993.241] [Citation(s) in RCA: 142] [Impact Index Per Article: 4.6] [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] [Indexed: 01/31/2023] Open
Abstract
Temozolomide (8-carbamoyl-3-methylimidazo[5,1-d]-1,2,3,5-tetrazin-4-(3H)-one) has shown promising activity in Phase I trials against some brain (glioma) and skin (melanoma, mycosis fungoides) cancers. Temozolomide and lomustine (CCNU) showed parallel toxicity in seven human tumour cell lines and this generally correlated (correlation coefficients 0.87 and 0.92 respectively) with the level of expression of the DNA repair protein O6-alkylguanine-DNA alkyltransferase (ATase, EC 2.1.1.63). Pretreating cells with the ATase inhibitor, O6-benzylguanine (BG), potentiated cytotoxicity to a similar degree with both drugs, but did not sensitise a cell line (ZR-75-1) expressing very low levels of this protein. When BG pretreatment was combined with repeat doses of temozolomide a dramatic potentiation (300 fold) was seen in MAWI cells, which express high levels of ATase, but not in a cell line (U373) expressing lower levels of ATase. [14C]-labelled temozolomide uptake was similar in sensitive and resistant lines. Human ATase-cDNA transfected xeroderma pigmentosum (XP) fibroblasts were more resistant than XP control cells to temozolomide and the related chloroethylating agent mitozolomide and although BG completely suppressed ATase activity in these cells, resistance was still greater than in control cells.
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Affiliation(s)
- J C Baer
- CRC Department of Medical Oncology, Charing Cross Hospital, London, UK
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Freeman AA. Hospital Integration in Columbus, Ohio. J Natl Med Assoc 1959; 51:301-302. [PMID: 20893918 PMCID: PMC2641548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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