D-Serine: A Cross Species Review of Safety
Background: D- Serine, a direct, full agonist at the D- serine/glycine modulatory site of the N-methyl-D-aspartate-type glutamate receptors (NMDAR), has been assessed as a treatment for multiple psychiatric and neurological conditions. Based on studies in rats, concerns of nephrotoxicity have limite...
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Published in | Frontiers in psychiatry Vol. 12; p. 726365 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
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10.08.2021
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Abstract | Background:
D-
Serine, a direct, full agonist at the
D-
serine/glycine modulatory site of the N-methyl-D-aspartate-type glutamate receptors (NMDAR), has been assessed as a treatment for multiple psychiatric and neurological conditions. Based on studies in rats, concerns of nephrotoxicity have limited
D-
serine research in humans, particularly using high doses. A review of
D-
serine's safety is timely and pertinent, as
D-
serine remains under active study for schizophrenia, both directly (R61 MH116093) and indirectly through
D-
amino acid oxidase (
D
AAO) inhibitors. The principal focus is on nephrotoxicity, but safety in other physiologic and pathophysiologic systems are also reviewed.
Methods:
Using the search terms “
D-
serine,” “
D-
serine and schizophrenia,” “
D-
serine and safety,” “
D-
serine and nephrotoxicity” in PubMed, we conducted a systematic review on
D-
serine safety.
D-
serine physiology, dose-response and efficacy in clinical studies and
d
AAO inhibitor safety is also discussed.
Results:
When
D-
serine doses >500 mg/kg are used in rats, nephrotoxicity, manifesting as an acute tubular necrosis syndrome, seen within hours of administration is highly common, if not universal. In other species, however,
D
-serine induced nephrotoxicity has not been reported, even in other rodent species such as mice and rabbits. Even in rats,
D-
-serine related toxicity is dose dependent and reversible; and does not appear to be present in rats at doses producing an acute Cmax of <2,000 nmol/mL. For comparison, the Cmax of
D-
serine 120 mg/kg, the highest dose tested in humans, is ~500 nmol/mL in acute dosing. Across all published human studies, only one subject has been reported to have abnormal renal values related to
D-
serine treatment. This abnormality did not clearly map on to the acute tubular necrosis syndrome seen in rats, and fully resolved within a few days of stopping treatment.
D
AAO inhibitors may be nephroprotective.
D-
Serine may have a physiologic role in metabolic, extra-pyramidal, cardiac and other systems, but no other clinically significant safety concerns are revealed in the literature.
Conclusions:
Even before considering human to rat differences in renal physiology, using current FDA guided monitoring paradigms,
D-
serine appears safe at currently studied maximal doses, with potential safety in combination with
D
AAO inhibitors. |
---|---|
AbstractList | Background:D-Serine, a direct, full agonist at the D-serine/glycine modulatory site of the N-methyl-D-aspartate-type glutamate receptors (NMDAR), has been assessed as a treatment for multiple psychiatric and neurological conditions. Based on studies in rats, concerns of nephrotoxicity have limited D-serine research in humans, particularly using high doses. A review of D-serine's safety is timely and pertinent, as D-serine remains under active study for schizophrenia, both directly (R61 MH116093) and indirectly through D-amino acid oxidase (DAAO) inhibitors. The principal focus is on nephrotoxicity, but safety in other physiologic and pathophysiologic systems are also reviewed. Methods: Using the search terms "D-serine," "D-serine and schizophrenia," "D-serine and safety," "D-serine and nephrotoxicity" in PubMed, we conducted a systematic review on D-serine safety. D-serine physiology, dose-response and efficacy in clinical studies and dAAO inhibitor safety is also discussed. Results: When D-serine doses >500 mg/kg are used in rats, nephrotoxicity, manifesting as an acute tubular necrosis syndrome, seen within hours of administration is highly common, if not universal. In other species, however, D-serine induced nephrotoxicity has not been reported, even in other rodent species such as mice and rabbits. Even in rats, D--serine related toxicity is dose dependent and reversible; and does not appear to be present in rats at doses producing an acute Cmax of <2,000 nmol/mL. For comparison, the Cmax of D-serine 120 mg/kg, the highest dose tested in humans, is ~500 nmol/mL in acute dosing. Across all published human studies, only one subject has been reported to have abnormal renal values related to D-serine treatment. This abnormality did not clearly map on to the acute tubular necrosis syndrome seen in rats, and fully resolved within a few days of stopping treatment. DAAO inhibitors may be nephroprotective. D-Serine may have a physiologic role in metabolic, extra-pyramidal, cardiac and other systems, but no other clinically significant safety concerns are revealed in the literature. Conclusions: Even before considering human to rat differences in renal physiology, using current FDA guided monitoring paradigms, D-serine appears safe at currently studied maximal doses, with potential safety in combination with DAAO inhibitors.Background:D-Serine, a direct, full agonist at the D-serine/glycine modulatory site of the N-methyl-D-aspartate-type glutamate receptors (NMDAR), has been assessed as a treatment for multiple psychiatric and neurological conditions. Based on studies in rats, concerns of nephrotoxicity have limited D-serine research in humans, particularly using high doses. A review of D-serine's safety is timely and pertinent, as D-serine remains under active study for schizophrenia, both directly (R61 MH116093) and indirectly through D-amino acid oxidase (DAAO) inhibitors. The principal focus is on nephrotoxicity, but safety in other physiologic and pathophysiologic systems are also reviewed. Methods: Using the search terms "D-serine," "D-serine and schizophrenia," "D-serine and safety," "D-serine and nephrotoxicity" in PubMed, we conducted a systematic review on D-serine safety. D-serine physiology, dose-response and efficacy in clinical studies and dAAO inhibitor safety is also discussed. Results: When D-serine doses >500 mg/kg are used in rats, nephrotoxicity, manifesting as an acute tubular necrosis syndrome, seen within hours of administration is highly common, if not universal. In other species, however, D-serine induced nephrotoxicity has not been reported, even in other rodent species such as mice and rabbits. Even in rats, D--serine related toxicity is dose dependent and reversible; and does not appear to be present in rats at doses producing an acute Cmax of <2,000 nmol/mL. For comparison, the Cmax of D-serine 120 mg/kg, the highest dose tested in humans, is ~500 nmol/mL in acute dosing. Across all published human studies, only one subject has been reported to have abnormal renal values related to D-serine treatment. This abnormality did not clearly map on to the acute tubular necrosis syndrome seen in rats, and fully resolved within a few days of stopping treatment. DAAO inhibitors may be nephroprotective. D-Serine may have a physiologic role in metabolic, extra-pyramidal, cardiac and other systems, but no other clinically significant safety concerns are revealed in the literature. Conclusions: Even before considering human to rat differences in renal physiology, using current FDA guided monitoring paradigms, D-serine appears safe at currently studied maximal doses, with potential safety in combination with DAAO inhibitors. Background: D- Serine, a direct, full agonist at the D- serine/glycine modulatory site of the N-methyl-D-aspartate-type glutamate receptors (NMDAR), has been assessed as a treatment for multiple psychiatric and neurological conditions. Based on studies in rats, concerns of nephrotoxicity have limited D- serine research in humans, particularly using high doses. A review of D- serine's safety is timely and pertinent, as D- serine remains under active study for schizophrenia, both directly (R61 MH116093) and indirectly through D- amino acid oxidase ( D AAO) inhibitors. The principal focus is on nephrotoxicity, but safety in other physiologic and pathophysiologic systems are also reviewed. Methods: Using the search terms “ D- serine,” “ D- serine and schizophrenia,” “ D- serine and safety,” “ D- serine and nephrotoxicity” in PubMed, we conducted a systematic review on D- serine safety. D- serine physiology, dose-response and efficacy in clinical studies and d AAO inhibitor safety is also discussed. Results: When D- serine doses >500 mg/kg are used in rats, nephrotoxicity, manifesting as an acute tubular necrosis syndrome, seen within hours of administration is highly common, if not universal. In other species, however, D -serine induced nephrotoxicity has not been reported, even in other rodent species such as mice and rabbits. Even in rats, D- -serine related toxicity is dose dependent and reversible; and does not appear to be present in rats at doses producing an acute Cmax of <2,000 nmol/mL. For comparison, the Cmax of D- serine 120 mg/kg, the highest dose tested in humans, is ~500 nmol/mL in acute dosing. Across all published human studies, only one subject has been reported to have abnormal renal values related to D- serine treatment. This abnormality did not clearly map on to the acute tubular necrosis syndrome seen in rats, and fully resolved within a few days of stopping treatment. D AAO inhibitors may be nephroprotective. D- Serine may have a physiologic role in metabolic, extra-pyramidal, cardiac and other systems, but no other clinically significant safety concerns are revealed in the literature. Conclusions: Even before considering human to rat differences in renal physiology, using current FDA guided monitoring paradigms, D- serine appears safe at currently studied maximal doses, with potential safety in combination with D AAO inhibitors. Background:D-Serine, a direct, full agonist at the D-serine/glycine modulatory site of the N-methyl-D-aspartate-type glutamate receptors (NMDAR), has been assessed as a treatment for multiple psychiatric and neurological conditions. Based on studies in rats, concerns of nephrotoxicity have limited D-serine research in humans, particularly using high doses. A review of D-serine's safety is timely and pertinent, as D-serine remains under active study for schizophrenia, both directly (R61 MH116093) and indirectly through D-amino acid oxidase (DAAO) inhibitors. The principal focus is on nephrotoxicity, but safety in other physiologic and pathophysiologic systems are also reviewed.Methods: Using the search terms “D-serine,” “D-serine and schizophrenia,” “D-serine and safety,” “D-serine and nephrotoxicity” in PubMed, we conducted a systematic review on D-serine safety. D-serine physiology, dose-response and efficacy in clinical studies and dAAO inhibitor safety is also discussed.Results: When D-serine doses >500 mg/kg are used in rats, nephrotoxicity, manifesting as an acute tubular necrosis syndrome, seen within hours of administration is highly common, if not universal. In other species, however, D-serine induced nephrotoxicity has not been reported, even in other rodent species such as mice and rabbits. Even in rats, D--serine related toxicity is dose dependent and reversible; and does not appear to be present in rats at doses producing an acute Cmax of <2,000 nmol/mL. For comparison, the Cmax of D-serine 120 mg/kg, the highest dose tested in humans, is ~500 nmol/mL in acute dosing. Across all published human studies, only one subject has been reported to have abnormal renal values related to D-serine treatment. This abnormality did not clearly map on to the acute tubular necrosis syndrome seen in rats, and fully resolved within a few days of stopping treatment. DAAO inhibitors may be nephroprotective. D-Serine may have a physiologic role in metabolic, extra-pyramidal, cardiac and other systems, but no other clinically significant safety concerns are revealed in the literature.Conclusions: Even before considering human to rat differences in renal physiology, using current FDA guided monitoring paradigms, D-serine appears safe at currently studied maximal doses, with potential safety in combination with DAAO inhibitors. |
Author | Hasegawa, Hiroshi Kantrowitz, Joshua T. Meftah, Amir |
AuthorAffiliation | 2 New York State Psychiatric Institute , New York City, NY , United States 4 Nathan Kline Institute , Orangeburg, NY , United States 3 Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences , Tokyo , Japan 1 College of Physicians and Surgeons, Columbia University , New York City, NY , United States |
AuthorAffiliation_xml | – name: 2 New York State Psychiatric Institute , New York City, NY , United States – name: 1 College of Physicians and Surgeons, Columbia University , New York City, NY , United States – name: 4 Nathan Kline Institute , Orangeburg, NY , United States – name: 3 Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences , Tokyo , Japan |
Author_xml | – sequence: 1 givenname: Amir surname: Meftah fullname: Meftah, Amir – sequence: 2 givenname: Hiroshi surname: Hasegawa fullname: Hasegawa, Hiroshi – sequence: 3 givenname: Joshua T. surname: Kantrowitz fullname: Kantrowitz, Joshua T. |
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Copyright | Copyright © 2021 Meftah, Hasegawa and Kantrowitz. Copyright © 2021 Meftah, Hasegawa and Kantrowitz. 2021 Meftah, Hasegawa and Kantrowitz |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23 Edited by: Natasa Petronijevic, University of Belgrade, Serbia Reviewed by: Jumpei Sasabe, Keio University, Japan; Kenji Hashimoto, Chiba University, Japan This article was submitted to Psychopharmacology, a section of the journal Frontiers in Psychiatry |
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D-
Serine, a direct, full agonist at the
D-
serine/glycine modulatory site of the N-methyl-D-aspartate-type glutamate receptors (NMDAR), has been... Background:D-Serine, a direct, full agonist at the D-serine/glycine modulatory site of the N-methyl-D-aspartate-type glutamate receptors (NMDAR), has been... |
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