共济失调蛋白2结合蛋白1基因多态性与奥氮平所致体重增加的关联研究

目的:既往研究表明,共济失调蛋白2结合蛋白1(A2BP1)基因多态性可能与精神分裂症、孤独症及肥胖等复杂疾病关联,但目前尚无相关文献提示A2BP1基因多态性与抗精神病药所致体重增加的关联.本研究拟探讨A2BP1基因多态性与奥氮平治疗精神分裂症所致体重增加的关联.方法:本研究共入组350例精神分裂症患者,其中完成奥氮平(治疗剂量5～20 mg/d)治疗8周者为328例.采用阳性与阴性症状量表(PANSS)减分率评估药物疗效;分别于治疗前和治疗8周后测量并记录患者的清晨空腹体重并计算治疗前后体重增加率(％).提取患者外周血DNA,采用DNA测序基因分析方法,在328例汉族精神分裂症患者中,检测A2BP1基因4个单核苷酸多态性(SNP)位点(rs8048076,rs1478697,rs10500331,rs4786847)的基因型,并采用数量性状位点分析方法(QTL)探索A2BP1基因多态性与奥氮平治疗所致体重增加率的关联.结果:A2BP1基因rs8048076 (T=3.237;P=0.0012)及rs1478697 (T=2.956;P=0.0032)位点与奥氮平治疗精神分裂症8周后所致体重增加率关联(P＜0.05),经多重检验Bonferroni校正后仍有统计学意义;而rs10500331 (T=-0.293;P=0.769)与rs4786847(T=0.666; P=-0.505)在本样本中与奥氮平所致体重增加的关联无统计学意义(P＞0.05).结论:本研究结果提示在中国汉族人群中,A2BP1基因多态性可能与奥氮平治疗精神分裂症患者所致体重增加副反应关联,如能进一步验证及机制探索,则有望在精神科个体化治疗方面对药物所致体重增加的预测与防治提供线索依据.     

Determination of olanzapine in human blood by liquid chromatography-tandem mass spectrometry

A liquid chromatographic-tandem mass spectrometric (LC-MS-MS) assay was developed and validated to quantitatively determine olanzapine (OLZ) concentrations in human blood. Liquid-liquid extraction, using n-butanol:cyclohexane (3:47, v/v), was used to isolate OLZ and its internal standard, LY170158, from the biological matrix. Chromatographic resolution of OLZ from endogenous interferences and known metabolites was accomplished with a MetaChem Monochrom HPLC column (4.6 x 150 mm, d(p) 5 microm). Detection occurred using a Perkin-Elmer Sciex API III Plus triple quadrupole mass spectrometer using positive ion APCI and multiple reaction monitoring (MRM). The linear dynamic range was from 5 to 500 ng ml(-1) based on a 0.25-ml aliquot of human blood. The inter-day precision (%RSD) and accuracy (%RE) ranged from 3.65 to 10.64 and from -2.14 to 3.07, respectively. Modifications to an existing assay for the determination of OLZ in human plasma were necessary. A different structural analog was used as the internal standard due to instability observed for the original analog when using human blood as the matrix. A second modification was the addition of the anti-oxidant sodium ascorbate to inhibit degradation of OLZ in human blood, as has been noted by other investigators. Upon fortification of human blood with sodium ascorbate (final concentration, 0.33 mM), OLZ was found to be stable for at least 1 week at -70 degrees C as well as through two freeze-thaw cycles. This assay, which will be used to investigate the distribution of OLZ in human blood, grants insight into the proper sample handling conditions needed to perform valid determinations of OLZ in human blood.     

Brain neurotransmitter receptor-binding characteristics in rats after oral administration of haloperidol, risperidone and olanzapine

The present study was conducted to characterize the binding of neurotransmitter receptors (dopamine D(2), serotonin 5-HT(2), histamine H(1), adrenaline alpha(1) and muscarine M(l) receptors) in the rat's brain after the oral administration of haloperidol, risperidone, and olanzapine. Haloperidol at 1 and 3 mg/kg displayed significant activity to bind the D(2) receptor (increase in the Kd value for [(3)H]raclopride binding) in the corpus striatum with little change in the activity toward the 5-HT(2) receptor (binding parameters for [(3)H]ketanserin). In contrast, risperidone (0.1-3 mg/kg) showed roughly 30 times more affinity for the 5-HT(2) receptor than D(2) receptor. Also, olanzapine (1-10 mg/kg) was most active toward the H(1) receptor in the cerebral cortex, corpus striatum, and hippocampus, was less active in binding 5-HT(2) and D(2) receptors, and showed the least affinity for alpha(1) and M(1) receptors. In conclusion, haloperidol and risperidone administered orally selectively bind D(2) and 5-HT(2) receptors, respectively, in the rat brain, while olanzapine binds H(1), 5-HT(2), and D(2) receptors more than alpha(1) and M(1) receptors.     

Effect of chronic infusion of olanzapine and clozapine on food intake and body weight gain in male and female rats

Many antipsychotics cause weight gain in humans, but usually not in rats, when injected once or twice daily. Since blood antipsychotic half-lives are short in rats, compared to humans, chronic administration by constant infusion may be necessary to see consistent weight gain in rats. Male and female rats were implanted with mini-pumps for constant infusion of olanzapine (5 mg/kg/day), clozapine (10 mg/kg/day) or vehicle for 11 days. Food intake and body weight were measured; blood drug levels were measured by HPLC. Olanzapine increased food intake and body weight in female, but not male rats. Serum olanzapine concentrations were 30-35 ng/ml. Clozapine had no effect on food intake or body weight in female or male rats. Serum clozapine concentrations were about 75 ng/ml. Single-dose pharmacokinetic analysis revealed a serum terminal half-life of 1.2-1.5 h for each drug, with no sex differences. Despite the fact that olanzapine and clozapine promote weight gain in humans, these drugs appear to have minimal effects on body weight and food intake in rats, except for a modest effect of olanzapine in female rats, even though therapeutic levels of olanzapine are achieved in serum during chronic infusion. Hence, the rapid clearance of drug following single administration in previous studies cannot explain the weak or absent effects of antipsychotics on weight gain in this species. The rat thus appears to be an inadequate model of weight gain produced by some antipsychotics in humans.     

Monitoring of olanzapine in serum by liquid chromatography–atmospheric pressure chemical ionization mass spectrometry

A selective assay of olanzapine with liquid chromatography atmospheric pressure chemical ionization (LC–APCI–MS, positive ions) is described. The drug and internal standard (ethyl derivative of olanzapine) were isolated from serum using a solid-phase extraction procedure (C₁₈ cartridges). The separation was performed on ODS column in acetonitrile–50 mM ammonium formate buffer, pH 3.0 (25:75). After analysis of mass spectra taken in full scan mode, a selected-ion monitoring detection (SIM) was applied with the following ions: m/z 313 and 256 for olanzapine and m/z 327 and 270 for the internal standard for quantitation. The limit of quantitation was 1 μg/l, the absolute recovery was above 80% at concentration level of 10 to 100 μg/l. The method tested linear in the range from 1 to 1000 μg/l and was applied for therapeutic monitoring of olanzapine in the serum of patients receiving (Zyprexa™) and in one case of olanzapine overdose. Olanzapine in frozen serum samples and in frozen extracts was stable over at least four weeks. The examinations of urine extracts from patients receiving olanzapine revealed peaks of postulated metabolites (glucuronide and N-desmethylolanzapine).     

文拉法辛联合认知行为疗法治疗帕金森病抑郁、认知功能障碍的临床疗效评价

目的:探讨文拉法辛联合认知行为疗法治疗帕金森病(PD)抑郁、认知功能障碍的临床疗效和安全性。方法:选择我院收治的60例PD合并抑郁、认知功能障碍患者并将其随机分为三组,分别为对照组(单用文拉法辛治疗),联合奥氮平组(文拉法辛联合奥氮平),联合认知行为疗法组(文拉法辛联合认知行为疗法),每组20例,于治疗前及治疗后4、8周末采用汉密尔顿抑郁量表(HAMD)进行抑郁程度评定,简易精神状态评价量表(MMSE)和事件相关电位(event-related potentials,ERPs)P300进行认知功能评定。结果:治疗4、8周时,三组的HAMD评分均较治疗前有不同程度下降,P300潜伏期较治疗前有不同程度缩短,P300波幅、MMSE评分有不同程度升高(P0.05),联合奥氮平组和联合认知行为疗法组HAMD评分较对照组明显下降,P300潜伏期较对照组明显缩短,P300波幅、MMSE评分明显升高(P0.05),联合认知行为疗法组HAMD评分较联合奥氮平组明显下降,P300潜伏期明显缩短,P300波幅、MMSE评分明显升高(P0.05)。三组均无特殊不良反应。结论:文拉法辛联合认知行为疗法治疗PD抑郁、认知功能障碍疗效确切,能显著改善患者抑郁症状,提高患者的认知功能,疗效较单用文拉法辛或文拉法辛联合奥氮平治疗更好,且安全性高。     

Metformin ameliorates olanzapine-induced disturbances in POMC neuron number,axonal projection,and hypothalamic leptin resistance

Antipsychotics have been widely accepted as a treatment of choice for psychiatric illnesses such as schizophrenia. While atypical antipsychotics such as aripiprazole are not associated with obesity and diabetes, olanzapine is still widely used based on the anticipation that it is more effective in treating severe schizophrenia than aripiprazole, despite its metabolic side effects. To address metabolic problems, metformin is widely prescribed. Hypothalamic proopiomelanocortin (POMC) neurons have been identified as the main regulator of metabolism and energy expenditure. Although the relation between POMC neurons and metabolic disorders is well established, little is known about the effects of olanzapine and metformin on hypothalamic POMC neurons. In the present study, we investigated the effect of olanzapine and metformin on the hypothalamic POMC neurons in female mice. Olanzapine administration for 5 days significantly decreased Pomc mRNA expression, POMC neuron numbers, POMC projections, and induced leptin resistance before the onset of obesity. It was also observed that coadministration of metformin with olanzapine not only increased POMC neuron numbers and projections but also improved the leptin response of POMC neurons in the olanzapine-treated female mice. These findings suggest that olanzapine-induced hypothalamic POMC neuron abnormality and leptin resistance, which can be ameliorated by metformin administration, are the possible causes of subsequent hyperphagia.     

Effects of atypical antipsychotic drugs on body weight and food intake in dopamine D2 receptor knockout mice

Many atypical antipsychotic drugs cause weight gain, but the mechanism of this weight gain is unclear. To dissect the role of the dopamine D2 receptor (D2R), an important receptor in the pharmacology of antipsychotic drugs, we analyzed the effect of olanzapine, risperidone, and ziprasidone on changes in body weight and food intake in male wild-type (WT) and D2R knockout (D2R^−/−) mice. The oral delivery of atypical antipsychotics, olanzapine (5 and 10 mg/kg), risperidone (0.1 and 1.0 mg/kg) and ziprasidone (10 and 20 mg/kg) in both strains mice for 2 weeks suppressed body weight gain, except for olanzapine treatment in D2R^−/− mice. Olanzapine treatment suppressed body weight gain and decreased food intake in WT mice, but also reduced fat body mass and locomotor activity, whereas D2R^−/− mice did not show these changes. Ziprasidone and risperidone treatment produced similar responses in WT and D2R^−/− mice. These data suggest the involvement of D2R in the effect of olanzapine on metabolic regulation. Further studies are required to explore the implications of D2R activity in antipsychotic-mediated metabolic complications.     

奥氮平诱导大鼠肥胖及其机制研究

目的建立奥氮平诱导的肥胖大鼠模型,并探讨其诱导肥胖的发生机制。方法 SD雌性大鼠20只,随机分为对照组和模型组,模型组大鼠每日黑暗时相前1h灌胃奥氮平(1.2mg/kg),对照组给予等容量蒸馏水。每周称体重1次,测饮水饮食量2次。给药7周时,利用SMART video-tracking system测定大鼠白天和黑暗时相的自主活动,然后处理大鼠,测体长,计算Lee's指数,称脂肪湿重,计算脂肪系数,采用高效液相色谱-电化学检测(HPLC-ECD)法测定大鼠下丘脑神经递质,用ELISA试剂盒测定血清瘦素(leptin)、脂联素(adiponectin,ADP)水平。结果模型组大鼠造模第2周至第7周时体重均明显高于对照组(P0.05或P0.01),饮食量明显增加(P0.01),黑暗时相平均速度、路程明显减少(P0.05),Lee's指数、脂肪湿重、脂肪系数明显升高(P0.05或P0.01),下丘脑5-HT、DA、DOPAC含量明显升高(P0.01或P0.05),血清leptin含量明显升高(P0.01),ADP含量明显降低(P0.01)。结论奥氮平(1.2mg/kg)增加动物摄食量,减少活动量而引起肥胖,此作用与下丘脑神经递质、瘦素和脂联素的调节有着密切联系。     

Brain delivery of olanzapine by intranasal administration of transfersomal vesicles

The aim of this study was to investigate the presence of a possible direct correlation between vesicle elasticity and the amount of drug reaching the brain intranasally. Therefore, transfersomes were developed using phosphatidylcholine (PC) as the lipid matrix and sodium deoxycholate (SDC), Span^® 60, Cremophor^® EL, Brij^® 58, and Brij^® 72 as surfactants. The influence of the type of surfactant and PC-to-surfactant ratio on vesicle morphology, size, membrane elasticity, drug entrapment, and in vitro drug release was studied. The prepared transfersomes were mainly spherical in shape, with diameters ranging from 310 to 885?nm. Transfersomes containing SDC and Span 60 with optimum lipid-to-surfactant molar ratio showed suitable diameters (410 and 380?nm, respectively) and deformability indices (17.68 and 20.76?mL/sec, respectively). Values for absolute drug bioavailability in rat plasma for transfersomes containing SDC and those containing Span 60 were 24.75 and 51.35%, whereas AUC_0–360min values in rat brain were 22,334.6 and 36,486.3?ng/mL/min, respectively. The present study revealed that the deformability index is a parameter having a direct relation with the amount of the drug delivered to the brain by the nasal route.