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 inFrontiers in psychiatry Vol. 12; p. 726365
Main Authors Meftah, Amir, Hasegawa, Hiroshi, Kantrowitz, Joshua T.
Format Journal Article
LanguageEnglish
Published Frontiers Media S.A 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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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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Snippet 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...
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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SubjectTerms D-serine
kidney
NMDA–N-methyl-D-aspartate
Psychiatry
safety
schizophrenia
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Title D-Serine: A Cross Species Review of Safety
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https://pubmed.ncbi.nlm.nih.gov/PMC8384137
https://doaj.org/article/dd733f952eb44a788d48a10562b16004
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