Les antipsychotiques atypiques sont des options de traitement de première ligne pour la schizophrénie. Cependant, la prise d’antipsychotiques atypiques, comme l’olanzapine, est associée à des effets secondaires métaboliques : l’augmentation du poids, la dyslipidémie et l’intolérance au glucose. Les mécanismes en lien avec ces effets secondaires sont à ce jour peu connus. Ce mémoire étudie l’évolution de différents paramètres, tant au niveau biométrique (poids, IMC, circonférence abdominale), qu’au niveau sérique (bilan lipidique, glycémie à jeun, insuline, leptine, ghreline) et clinique (mesures des symptômes positifs, négatifs et généraux de la schizophrénie, de même que des comportements alimentaires) chez des sujets schizophrènes, traités pendant 16 semaines avec l’olanzapine. Des examens de résonance magnétique, structurale et fonctionnelle, ont été effectués au début et à la fin du traitement d’olanzapine chez les sujets schizophrènes et chez un groupe de sujets contrôles afin d’identifier les régions cérébrales dont les volumes ou les activations pourraient être associés aux mécanismes d’effets secondaires métaboliques. Nos résultats confirment l’émergence de multiples effets secondaires métaboliques, associés à des modifications des comportements alimentaires, en lien avec la prise d’olanzapine auprès de notre échantillon. Des associations ont été retrouvées entre les changements métaboliques et les volumes de plusieurs régions cérébrales, notamment les hippocampes, les précunei et le gyrus orbitofrontal droit. De plus, des différences en terme d’activations cérébrales entre les sujets contrôles et les patients schizophrènes, qui ont été accentuées par le traitement d’olanzapine, ont aussi été décrites notamment au niveau amygdalien, cérébelleux et des insulas, suggérant l’implication de mécanismes neuronaux dans l’apparition des troubles métaboliques associés aux antipsychotiques atypiques. / Atypical antipsychotics are first line treatment options for schizophrenia. Nevertheless atypical antipsychotics, such as olanzapine, are associated with metabolic adverse effects: weight gain, dyslipidemia and glucose intolerance. Mechanisms underlying these side effects are still poorly understood. This thesis represents a study of the evolution of biometric (body weight, BMI, abdominal circumference), biological (lipid profile, fasting glucose, insulin, leptin, ghrelin) and clinical parameters (positive, negative and general symptoms of schizophrenia as well as eating behavior measures) in schizophrenia patients treated with olanzapine during 16 weeks. Healthy subjects and schizophrenia patients passed structural and functional magnetic resonance examinations (one examination for healthy controls and two examinations for schizophrenia patients, one at the beginning and one after 16 weeks of olanzapine treatment) in order to identify cerebral regions where grey matter volumes or activations could be associated with metabolic side effects mechanisms. Our results confirm that various metabolic adverse effects emerged in our sample of patients during the 16 weeks olanzapine treatment. Eating behavior changes have also been associated with specific metabolic changes. Many associations have been found between cerebral volumes (e.g. bilateral hippocampi and précunei and right orbitofrontal cortex) and metabolic changes. Moreover, cerebral activations differences between healthy controls and schizophrenia patients, that were increased following olanzapine treatment, were also described in the amygdala, cerebellum and insulas, suggesting that neuronal mechanisms were involved in the development of metabolic disorders associated with atypical antipsychotics.

Les antipsychotiques atypiques sont des options de traitement de première ligne pour la schizophrénie. Cependant, la prise d’antipsychotiques atypiques, comme l’olanzapine, est associée à des effets secondaires métaboliques : l’augmentation du poids, la dyslipidémie et l’intolérance au glucose. Les mécanismes en lien avec ces effets secondaires sont à ce jour peu connus. Ce mémoire étudie l’évolution de différents paramètres, tant au niveau biométrique (poids, IMC, circonférence abdominale), qu’au niveau sérique (bilan lipidique, glycémie à jeun, insuline, leptine, ghreline) et clinique (mesures des symptômes positifs, négatifs et généraux de la schizophrénie, de même que des comportements alimentaires) chez des sujets schizophrènes, traités pendant 16 semaines avec l’olanzapine. Des examens de résonance magnétique, structurale et fonctionnelle, ont été effectués au début et à la fin du traitement d’olanzapine chez les sujets schizophrènes et chez un groupe de sujets contrôles afin d’identifier les régions cérébrales dont les volumes ou les activations pourraient être associés aux mécanismes d’effets secondaires métaboliques. Nos résultats confirment l’émergence de multiples effets secondaires métaboliques, associés à des modifications des comportements alimentaires, en lien avec la prise d’olanzapine auprès de notre échantillon. Des associations ont été retrouvées entre les changements métaboliques et les volumes de plusieurs régions cérébrales, notamment les hippocampes, les précunei et le gyrus orbitofrontal droit. De plus, des différences en terme d’activations cérébrales entre les sujets contrôles et les patients schizophrènes, qui ont été accentuées par le traitement d’olanzapine, ont aussi été décrites notamment au niveau amygdalien, cérébelleux et des insulas, suggérant l’implication de mécanismes neuronaux dans l’apparition des troubles métaboliques associés aux antipsychotiques atypiques. / Atypical antipsychotics are first line treatment options for schizophrenia. Nevertheless atypical antipsychotics, such as olanzapine, are associated with metabolic adverse effects: weight gain, dyslipidemia and glucose intolerance. Mechanisms underlying these side effects are still poorly understood. This thesis represents a study of the evolution of biometric (body weight, BMI, abdominal circumference), biological (lipid profile, fasting glucose, insulin, leptin, ghrelin) and clinical parameters (positive, negative and general symptoms of schizophrenia as well as eating behavior measures) in schizophrenia patients treated with olanzapine during 16 weeks. Healthy subjects and schizophrenia patients passed structural and functional magnetic resonance examinations (one examination for healthy controls and two examinations for schizophrenia patients, one at the beginning and one after 16 weeks of olanzapine treatment) in order to identify cerebral regions where grey matter volumes or activations could be associated with metabolic side effects mechanisms. Our results confirm that various metabolic adverse effects emerged in our sample of patients during the 16 weeks olanzapine treatment. Eating behavior changes have also been associated with specific metabolic changes. Many associations have been found between cerebral volumes (e.g. bilateral hippocampi and précunei and right orbitofrontal cortex) and metabolic changes. Moreover, cerebral activations differences between healthy controls and schizophrenia patients, that were increased following olanzapine treatment, were also described in the amygdala, cerebellum and insulas, suggesting that neuronal mechanisms were involved in the development of metabolic disorders associated with atypical antipsychotics.

Patients with schizophrenia are normally treated with one of several antipsychotic medications that differ from one another in the areas of the brain they affect including the dorsal striatum, a subcortical section of the forebrain, and the prefrontal cortex (PFC), located in the anterior part of the frontal lobes. Two different tests of implicit memory, the probabilistic classification learning (PCL) and the Iowa gambling task (IGT), have been shown to rely on the dorsal striatum and the PFC, respectively. Studies have previously shown that patients with schizophrenia treated with antipsychotics that affect the dorsal striatum (e.g., risperidone), have altered performance on the PCL, and those treated with antipsychotics that affect the PFC (e.g., clozapine), have altered performance on the IGT. We tested the hypothesis that patients with schizophrenia treated with olanzapine would have a poorer performance on the IGT, but not the PCL, when compared with controls. This study aimed to clarify conflicting results from prior experiments observing the effects of olanzapine on implicit memory in people with schizophrenia. We also hypothesized that performance of patients taking aripiprazole would be comparable to those taking risperidone, or an FGA; however, we were unable to recruit a sufficient amount of participants to test this hypothesis. Patients with schizophrenia, a mental disorder characterized by a breakdown in relation between thoughts, emotion, and behavior, treated with olanzapine were recruited through local psychiatric clinics or using a newspaper ad. Administration of the Brief Psychiatric Rating Scale (BPRS) and the Mini Mental State Examination (MMSE) preceded a brief questionnaire of demographic information. Participants were tested on the PCL and the IGT using a personal computer. Results revealed poorer performance on both the MMSE and BPRS for patients when compared with controls. Patients taking olanzapine were impaired in learning the PCL but not the IGT when compared with controls. Results suggest that olanzapine acts on the PFC to augment IGT performance but further studies are needed. / Thesis (Master, Neuroscience Studies) -- Queen's University, 2013-07-23 15:09:21.55

A olanzapina é um fármaco antipsicótico atípico utilizado no tratamento da esquizofrenia. Como efeitos adversos relacionados ao seu uso, encontram-se obesidade, hiperlipidemia, Diabetes Mellitus tipo II, entre outros. O presente trabalho avaliou os efeitos adversos passíveis de desenvolvimento em pacientes esquizofrênicos que fazem uso deste medicamento, avaliando o indivíduo antes de começar o tratamento, 30 e 60 dias após o início (T0, T1 e T2) através de dosagens antropométricas (peso, IMC, circunferência abdominal e porcentagens de tecido adiposo no organismo), hemodinâmicas (pressão arterial, frequência cardíaca), perfil lipídico (colesterol total, LDL-col, HDL-col e triglicérides), glicêmico (resistência à insulina HOMA-R, QUICKI e razão G/I; glicemia de jejum) e bioquímico (avaliação da função renal, hepática e dosagem de homocisteína, um marcador de risco cardiovascular). A olanzapina plasmática foi dosada nos mesmos tempos com intenção de se buscar uma correlação de dose-resposta (efeito adverso). A análise estatística foi realizada com auxílio dos \"softwares\" Graphpad Instat e Statgraphics, para o estudo e análise das médias (ANOVA), e análise de comparação múltipla entre os grupos (Tukey-Kramer). O nível de significância foi fixado em p<0,05. Para os grupos sem diferença estatística relevante, foram utilizadas técnicas de estatística descritiva para se observar diferenças mais sutis ou com relevância clínica. As altas concentrações plasmáticas encontradas não foram concordantes com os estudos prévios de outros autores, já que não foram mais propensos a desenvolver ganho de peso. Este efeito adverso foi encontrado no nosso grupo, porém sem apresentar uma correlação direta com a concentração plasmática. / The olanzapine is an atypical antipsychotic drug used to treat schizophrenia. The adverse effects related to its use are obesity, hyperlipidemia, diabetes mellitus type II and others. This study evaluated the adverse effects likely to develop in schizophrenia patients who use this drug, assessing the individual before starting treatment, 30 and 60 days after the start (T0, T1 and T2) by anthropometric measurements (weight, BMI , waist circumference and percentage of fat in the body), hemodynamic (blood pressure, heart rate), lipid profile (total cholesterol, LDL-col, col-HDL and triglycerides), glucose (insulin resistance - HOMA-R, QUICKI, G/I ratio and fasting plasma glucose) and biochemical (measurement of renal function, liver and determination of homocysteine, a marker of cardiovascular risk). The olanzapine plasma was measured at the same time looking for a dose-response (effect) correlation. Statistical analysis was performed using the \"software\" Statgraphics and GraphPad Instat for the study and analysis of means (ANOVA) and analysis of variance between groups (Tukey-Kramer). The significance level was set at p <0.05. For groups without statistical significant difference were used descriptive statistical techniques to observe more subtle differences or clinical relevance. The high plasma concentrations found were not consistent with previous studies of other authors, since there were more likely to develop weight gain. This adverse effect was found in our group, but without a direct correlation with plasma concentration.

The mechanism of weight gain due to treatment with olanzapine, a serotonin receptor antagonist, has not been fully understood. Weight gain and food intake are under the control of neuropeptides/hormones, POMC (proopiomelanocortin), CART (cocaine and amphetamine regulated transcript), AgRP (Agouti-related peptide) and NPY (neuropeptide Y) that are synthesized and secreted from the arcuate nucleus (ARC) of hypothalamus. In this study, the altereration of the ARC neuropeptide/hormone levels both in humans and rats were determined as one of the weight gain mechanism. To examine olanzapine&rsquo / s weight gain effects, male first attack psychotic patients (pre-treatment), were hospitalized and treated for 4 -weeks (post-treatment), (n = 22), and healthy control group (n = 26) were included to the study. Case-control association design was used to analyze the changes in body mass index (BMI), peripheral leptin and the ARC neuropeptides levels. In patients, after 4-weeks of the olanzapine treatment / BMI and the waist circumference were significantly increased with average weight gain of 4.33 kg. In pre-treatment group, NPY levels were significantly lower while &alpha / -MSH, the anorexigenic product of POMC levels were significantly higher vs. control. At post-treatment, both leptin and NPY levels were significantly increased but the CART levels did not change. To further understand the underlying mechanism of olanzapine induced weight gain, the drug was orally administrated to 10 healthy male Wistar rats to analyze both the hypotalamic gene expression and peripheral levels of those candidate neuropeptides. In rats food consumption was increased and hypotalamic mRNA levels of NPY, AgRP and POMC were decreased while CART levels did not show any alteration. Consistent with the expression data, circulating levels of NPY, AgRP and &alpha / -MSH decreased significantly but CART levels were also reduced unexpectedly. In conclusion, it may be presumed that the antagonistic effect of olanzapine on the ARC neurons might be the basis for a disregulation of the neurohormones secretion which may cause weight gain in the treated psychotic patients.

Pharmacogenetics is the study of variability in drug response attributed to genetic variation. Olanzapine (OLA) is a widely used antipsychotic drug for schizophrenia treatment. The pharmacokinetics of OLA display large inter-individual variation leading to multiple-fold differences in drug exposure between patients at a given dose. This variation in turn gives rise to the need of individualized dosing in order to avoid concentration-dependent adverse effects and therapeutic failure. The observed variability has been partially explained by environmental and physiological factors. Genetically determined differences in drug metabolism represent a less studied source of variability. Precluded contribution by cytochrome P450 (CYP) 2D6 calls for evaluation of the other major OLA metabolizing enzymes. The objective of this thesis was to study pharmacogenetic influence of flavin-containing monooxygenase (FMO) 1 and 3, CYP1A2 and uridine diphosphate-glucuronosyltransferase (UGT) 1A4 on therapeutic OLA exposure. We conducted genetic association studies applying gene re-sequencing and genotyping of candidate and tagging SNPs. Patients carrying the FMO1*6 allele displayed increased dose-adjusted concentrations (C/Ds) of OLA, in serum as well as cerebrospinal fluid. Patients who were homozygous for the FMO3 K158-G308 compound variant showed reduced C/Ds of OLA N-oxide metabolite, but no alteration in OLA exposure. This compound variant is expected to have clinical relevance primarily for non-African populations, since low frequencies were detected among native Africans. Deviation in OLA exposure was observed in carrier of a rare FMO3 mutation, predicted in silico to affect gene splicing. Reduced OLA exposure was observed in UGT1A4*3 carriers. The CYP1A2 -163(A) (CYP1A2*1F) variant was not associated with increase in CYP1A2-catalyzed OLA metabolism or reduction in OLA exposure. Correlations were detected for two cis-acting variants within the inter-genetic region of the CYP1A cluster and a trans-acting variant located upstream the locus encoding aryl hydrocarbon receptor. The inconsistent data reported for CYP1A2*1F could be explained by presence of ethnic specific haplotype structures incorporating the -163(A) variant. A continuously improved understanding of the wide range of factors that can influence pharmacokinetics and pharmacodynamics will increase the likelihood of achieving optimal treatment response for individual patients.

Thèse (M.Sc.)--Université Laval, 2008. / Bibliogr. Publié aussi en version électronique dans la Collection Mémoires et thèses électroniques.

Made available in DSpace on 2014-07-29T16:11:45Z (GMT). No. of bitstreams: 1 Dissertacao Julliana Rodrigues Moura.pdf: 204207 bytes, checksum: 56a1561a44aeb00b316511d72cd22e73 (MD5) Previous issue date: 2009-12-14 / Olanzapine is an antipsychotic active ingredient and its marketing in Brazil, in the form of terminated product, is protected by patent up to 2011. As it is recent in the pharmaceutical market and there is not a methodology described in officials forms that is capable of assuring the quality of new formulations, the objective of this paper was to characterize Olanzapine physical-chemical parameters, to develop and validate, in accordance with RE N°899, from May 29 th 2003, the analytical methodology for assay and dissolution and to apply the developed and validated methodologies in the pharmacotechnical development of tablets. It was characterized some physicalchemical parameters of solubility and of light absorption (from 200 to 400nm) in several solvents and it was developed and validated assay and dissolution methodologies by spectrophotometry with ultraviolet detection (UV) and the assay by high efficiency liquid chromatography with ultraviolet detection (HPLC-UV) for the quantification of olanzapine present in film coated tablets of 2.5, 5.0 and 10.0mg. The active ingredient presented a low solubility in water and the wave lengths of maximum light absorption were within the range of 254 and 273nm. For the dissolution methodology by UV spectrophotometry, the parameters were chloride acid 0.1 mol/L as the dissolution media, volume of 1,000mL (5 and 10mg of Olanzapine) and 500mL (2.5mg of Olanzapine), apparatus II (paddles) and a rotation of 50 rpm. The spectrophotometric parameters were chloride acid 0.1 mol/L as blank and 259nm of wave length. For the assay methodology by UV spectrophotometry, it was used as a solvent and as a blank solution chloride acid 0.1 mol/L and a wave length of 259nm. It was used a ProStar 210 UV/VIS VARIAN high efficient liquid chromatographer, a C18 (150x4,6)mm 5&#956;m column in room temperature (25ºC), a flux of 0,8mL/min, a wave length of 254nm and a mobile phase constituted of a mixture of monobasic potassium phosphate buffer 0,01 mol/L pH 2,5 and acetonitrile (70:30) for the assay methodology by HPLC-UV. The results found from the parameters of specificity, linearity, accuracy, precision, quantification and detection limits and stability in the methodologies validations confirm that they were adequate for the purpose proposed. The methodologies developed and validated were applied in Olanzapine determination in several formulation propositions which have been developed and they assisted the pharmacotechnical development team in the definition of the best olanzapine formulation in the 2.5mg strength. / A olanzapina é um fármaco antipsicótico e sua comercialização no Brasil, na forma de produto acabado, está protegida por patente até 2011. Como é recente no mercado farmacêutico e não há descrição da metodologia em formulários oficiais capazes de assegurar a qualidade das novas formulações, o objetivo deste trabalho foi caracterizar os parâmetros físico-químicos da olanzapina, desenvolver e validar, segundo RE N°899, de 29 de maio de 2003, método analítico para doseamento e dissolução e aplicar os métodos desenvolvidos e validados no desenvolvimento farmacotécnico dos comprimidos. Foram caracterizados alguns parâmetros físico-químicos, de solubilidade e de absorção da luz (200 a 400 nm) em diversos solventes e foram desenvolvidos e validados métodos de doseamento e dissolução por espectrofotometria com detecção ultravioleta (UV) e de doseamento por cromatografia líquida de alta eficiência com detecção ultravioleta (HPLC-UV) para quantificação de olanzapina presente em comprimidos revestidos de 2,5, 5,0 e 10,0 mg. O fármaco apresentou baixa solubilidade em água e os comprimentos de onda de máxima absorção da luz ficaram entre 254 e 273 nm. Para o método de dissolução por espectrofotometria UV, os melhores parâmetros foram ácido clorídrico 0,1 mol/L como meio de dissolução, volume de 1.000 mL (5 e 10 mg de Olanzapina) e 500mL (2,5mg de Olanzapina), aparato II (pás) e rotação de 50rpm. Os parâmetros espectrofotométricos foram ácido clorídrico 0,1 mol/L como branco e 259nm de comprimento de onda. Para o método de doseamento por espectrofotometria UV foi utilizado como solvente e solução branco ácido clorídrico 0,1 mol/L e comprimento de onda de 259 nm. Foi utilizado cromatógrafo líquido de alta eficiência ProStar 210 UV/VIS VARIAN, coluna C18 (150x4,6) mm 5&#956;m a temperatura ambiente (25ºC), fluxo de 0,8mL/min, comprimento de onda de 254 nm e fase móvel constituída por uma mistura de tampão fosfato de potássio monobásico 0,01 mol/L pH 2,5 e acetonitrila (70:30) para o método de doseamento por HPLC-UV. Os resultados encontrados dos parâmetros de especificidade, linearidade, exatidão, precisão, limites de quantificação e detecção e estabilidade nas validações dos métodos confirmam que os mesmos foram adequados para a finalidade proposta. Os métodos desenvolvidos e validados foram aplicados na determinação de olanzapina em várias propostas de formulações que foram desenvolvidas e auxiliou a equipe de desenvolvimento farmacotécnico na definição da melhor formulação da olanzapina na concentração de 2,5mg.

A olanzapina é um fármaco antipsicótico atípico utilizado no tratamento da esquizofrenia. Como efeitos adversos relacionados ao seu uso, encontram-se obesidade, hiperlipidemia, Diabetes Mellitus tipo II, entre outros. O presente trabalho avaliou os efeitos adversos passíveis de desenvolvimento em pacientes esquizofrênicos que fazem uso deste medicamento, avaliando o indivíduo antes de começar o tratamento, 30 e 60 dias após o início (T0, T1 e T2) através de dosagens antropométricas (peso, IMC, circunferência abdominal e porcentagens de tecido adiposo no organismo), hemodinâmicas (pressão arterial, frequência cardíaca), perfil lipídico (colesterol total, LDL-col, HDL-col e triglicérides), glicêmico (resistência à insulina HOMA-R, QUICKI e razão G/I; glicemia de jejum) e bioquímico (avaliação da função renal, hepática e dosagem de homocisteína, um marcador de risco cardiovascular). A olanzapina plasmática foi dosada nos mesmos tempos com intenção de se buscar uma correlação de dose-resposta (efeito adverso). A análise estatística foi realizada com auxílio dos \"softwares\" Graphpad Instat e Statgraphics, para o estudo e análise das médias (ANOVA), e análise de comparação múltipla entre os grupos (Tukey-Kramer). O nível de significância foi fixado em p<0,05. Para os grupos sem diferença estatística relevante, foram utilizadas técnicas de estatística descritiva para se observar diferenças mais sutis ou com relevância clínica. As altas concentrações plasmáticas encontradas não foram concordantes com os estudos prévios de outros autores, já que não foram mais propensos a desenvolver ganho de peso. Este efeito adverso foi encontrado no nosso grupo, porém sem apresentar uma correlação direta com a concentração plasmática. / The olanzapine is an atypical antipsychotic drug used to treat schizophrenia. The adverse effects related to its use are obesity, hyperlipidemia, diabetes mellitus type II and others. This study evaluated the adverse effects likely to develop in schizophrenia patients who use this drug, assessing the individual before starting treatment, 30 and 60 days after the start (T0, T1 and T2) by anthropometric measurements (weight, BMI , waist circumference and percentage of fat in the body), hemodynamic (blood pressure, heart rate), lipid profile (total cholesterol, LDL-col, col-HDL and triglycerides), glucose (insulin resistance - HOMA-R, QUICKI, G/I ratio and fasting plasma glucose) and biochemical (measurement of renal function, liver and determination of homocysteine, a marker of cardiovascular risk). The olanzapine plasma was measured at the same time looking for a dose-response (effect) correlation. Statistical analysis was performed using the \"software\" Statgraphics and GraphPad Instat for the study and analysis of means (ANOVA) and analysis of variance between groups (Tukey-Kramer). The significance level was set at p <0.05. For groups without statistical significant difference were used descriptive statistical techniques to observe more subtle differences or clinical relevance. The high plasma concentrations found were not consistent with previous studies of other authors, since there were more likely to develop weight gain. This adverse effect was found in our group, but without a direct correlation with plasma concentration.

Excerpt: Navari and colleagues (July 14 issue)1 report on the use of olanzapine for the prevention of chemotherapy-induced nausea and vomiting.