ABSTRACT
SUMMARY: Anti-depressants are used largely, but have serious side effects. We show that both selective serotonin re-uptake inhibitors (SSRIs) and tricyclic anti-depressants (TCAs) increase the risk of hip/femur fracture and that this risk is time related and depends on the degree of serotonin transporter inhibition. This should be considered when prescribing anti-depressants to patients. INTRODUCTION: Anti-depressants are known to have serious side effects. We examined the association between the use of anti-depressants and the risk of hip/femur fractures with a special focus on the relation with the degree of 5-hydroxytryptamine transporter (5-HTT) inhibition and the duration of use. METHODS: A case-control study was conducted within the Dutch PHARMO-RLS database. Cases (n = 6,763) were adult patients with a first hip/femur fracture during the study period. For each case, four controls (n = 26341) were matched by age, gender and geographic region. RESULTS: The risk of hip/femur fracture increased with current use of SSRIs (adjusted odds ratio (OR(adj)) 2.35 [95% confidence interval (CI) 1.94-2.84]) and TCAs (ORadj 1.76 [95% CI 1.45-2.15]). The risk of hip/femur fracture declined rapidly after discontinuation of use. The risk of hip/femur fracture increased as the degree of 5-HTT inhibition of all anti-depressants increased from OR(adj) 1.64 [95% CI 1.14-2.35] for drugs with low 5-HTT inhibition to OR(adj) 2.31 [95% CI 1.94-2.76] for those with high 5-HTT inhibiting properties. CONCLUSION: Current use of both SSRIs and TCAs increase hip/femur fracture risk. Further studies are needed to elucidate the mechanistic pathways and the relation with the underlying pathophysiology. Until then, the elevated fracture risk should be considered when prescribing anti-depressants.
Subject(s)
Antidepressive Agents/adverse effects , Femoral Fractures/chemically induced , Hip Fractures/chemically induced , Adolescent , Adult , Aged , Antidepressive Agents/administration & dosage , Antidepressive Agents, Tricyclic/administration & dosage , Antidepressive Agents, Tricyclic/adverse effects , Drug Administration Schedule , Epidemiologic Methods , Female , Femoral Fractures/epidemiology , Hip Fractures/epidemiology , Humans , Male , Middle Aged , Netherlands/epidemiology , Selective Serotonin Reuptake Inhibitors/administration & dosage , Selective Serotonin Reuptake Inhibitors/adverse effects , Young AdultABSTRACT
Neuronal differentiation from totipotent precursors in vitro, is thought to require two signals: first a biophysical state (cellular aggregation) followed by a biochemical signal (retinoic acid treatment). In investigating the properties of retinoic acid-differentiated embryonic stem cell lines. However, we noted that retinoic acid treatment without prior aggregation, is sufficient to induce expression of the neuronal markers GAP-43 and NF-165. In agreement, immunohistochemistry revealed the presence of GAP-43 positive cells in these embryonic stem cell monolayers after three days of retinoic acid (RA) treatment. Furthermore an NF-165 positive subpopulation of cells was clearly observed after 4-5 days of RA treatment. The expression of these neuronal markers coincided with the appearance of electrically excitable cells, as assayed with whole cell patch clamp recording. We conclude that for neuronal differentiation of totipotent embryonic stem cells in vitro, one biochemical signal, i.e. retinoic acid treatment, is sufficient.
Subject(s)
Neurons/cytology , Stem Cells/cytology , Action Potentials , Animals , Cell Aggregation , Cell Differentiation/drug effects , Cell Line , GAP-43 Protein , Membrane Glycoproteins/analysis , Mice , Nerve Tissue Proteins/analysis , Neurons/physiology , Patch-Clamp Techniques , Stem Cells/physiology , Tretinoin/pharmacologyABSTRACT
In the present study, we have investigated the function of the receptor protein tyrosine phosphatase alpha (RPTP alpha) in the neuronal differentiation of E14-embryonic stem (E14-ES) cells. RNAase protection and western blot analysis revealed that E14-ES cells up regulate RPTP alpha expression upon neuronal differentiation with retinoic acid. Overexpression of RPTP alpha, by stable DNA transfection, and subsequent differentiation with retinoic acid, resulted in a temporally enhanced expression of the neuronal markers GAP-43 and NF-164. Electrophysiological experiments demonstrated that RPTP alpha overexpression also enhanced the development of neurotransmitter responses during differentiation. These results indicate that RPTP alpha plays an important role in the cascade of molecular events that lead to the formation of neurons.
