This article is a commentary on:
Aripiprazole disrupts cellular synchrony in the suprachiasmatic nucleus and enhances entrainment to environmental light–dark cycles in mice
Tsuyoshi KitajimaA Commentary on
Aripiprazole disrupts cellular synchrony in the suprachiasmatic nucleus and enhances entrainment to environmental light–dark cycles in mice
by Li, R., Masuda, K., Ono, D., Kanbayashi, T., Hirano, A., and Sakurai, T. (2023). Front. Neurosci. 17:1201137. doi: 10.3389/fnins.2023.1201137
1 Introduction
Among circadian rhythm sleep–wake disorders (CRSWDs), delayed sleep–wake phase disorder (DSWPD) is particularly disabling for the youth. It has been reported that aripiprazole, a second-generation antipsychotic, advances the sleep phase in DSWPD (Takaki and Ujike, 2014; Tashiro, 2017; Omori et al., 2018; Konishi et al., 2022). Although this needs to be supported by further evidence, it may be a potent therapeutic option. In a previous issue of Frontiers in Neuroscience, Li et al. (2023) reported that aripiprazole swiftly reset locomotor rhythm of mice following an acute shift in the light–dark cycle. Additionally, they demonstrated ex vivo that aripiprazole loosened the synchronization of cellular oscillations in mice suprachiasmatic nucleus (SCN) slices via 5-HT1AR action, leading to a reduction in the amplitude of SCN oscillation. Moreover, the authors discussed that its resetting action on mice's locomotor rhythm may be the central origin, and this scheme might also be applied to human DSWPD.
The findings of this study seem quite valuable, providing new insight into effects of aripiprazole on the circadian regulatory system. The concept that the damping of SCN oscillation amplitude may bring flexibility to circadian adaptation has been claimed by another mouse study (Noguchi et al., 2020). Moreover, there has also been an argument that people with lower circadian amplitude may have better adaptation to night-shift work (Radosević-Vidacek et al., 1993). However, we need to further consider whether the aripiprazole's action on human DSWPD can be attributable to change of the SCN function, as well as the possibility of its direct action on sleep-wake cycle in both of mice and humans.
2 Mechanism of resetting the mice circadian rhythm by aripiprazole
Li et al. demonstrated separately that aripiprazole reset the locomotor rhythm of mice, and dampened the oscillation amplitude in mice SCN; thus, they did not directly prove that the results in vivo were attributable to functional change in the SCN. Honma and Honma (2009) demonstrated that methamphetamine, a dopaminergic stimulant, drives the sleep–wake cycle independent of the SCN in rats. As aripiprazole is a dopamine partial agonist, the possibility that this agent directly modulates the sleep–wake cycle of mice needs to be discussed.
3 Application of the results of this study to human CRSWDs
Aripiprazole dosage used in this study was much higher in both in vivo and ex vivo experiments than that in human clinical usage. However, the reported dose required for human DSWPD is 0.5–3 mg a day (Omori et al., 2018), which is much lower than that for human schizophrenia or bipolar disorder (6–30 mg a day). The ex vivo experiments in this study revealed that aripiprazole did not dampen the amplitude of SCN at a relatively low dose (Li et al., 2023). Thus, it is unclear whether such a low dose of aripiprazole for DSWPD could modulate the oscillation of the SCN in humans. If this were true, a relatively higher dose of aripiprazole would have been more effective for DSWPD.
Another point would be how the dampened amplitude of the SCN oscillation can promote the sleep-wake's adaptation to the light-dark cycle in human CRSWDs. If the phase of the SCN rhythm itself becomes more flexible to shift, the mechanism should be “top-down,” as discussed below. If the SCN loses the sleep-wake cycle regulation and lets the cycle shift rapidly, this may also make it more irregular, like in patients with SCN lesions (Attarian, 2009; DelRosso et al., 2014).
4 Discussion
If aripiprazole has efficacy for DSWPD, there might be alternative mechanisms other than the direct effect on the SCN. One of them is that it might promote earlier awakening in the morning, possibly by dopamine partial agonism, and the patient can be exposed to light at that time. One of the hypotheses of DSWPD etiology is that a later sleep phase would mask the phase advance zone of the phase response curve for light (Uchiyama et al., 2000a). Aripiprazole might uncover the critical time zone for light and advance the phase of the central pacemaker. Another explanation is that aripiprazole modulates the sleep–wake cycle independently of the central pacemaker. There is another hypothesis of DSWPD etiology that its patients have a slow build-up of sleep homeostasis, leading to a delayed sleep–wake cycle (Uchiyama et al., 2000b; American Academy of Sleep Medicine, 2023). A similar mechanism has been proposed for depression (Borbély et al., 2016), and interestingly, aripiprazole is also effective for depression at a relatively low dose. Thus, aripiprazole might enhance the building up of sleep homeostasis and expedite the sleep–wake cycle. The last one might be behavioral modulation; for example, aripiprazole might stabilize impulsivity that might exacerbate bedtime procrastination, specifically in people with a tendency of attention deficit. These “bottom-up” mechanisms might account for the action of aripiprazole on DSWPD rather than the modulation of the “top–down” circadian control.
Recent studies have reported that over 40% of DSWPD patients do not have a delayed melatonin rhythm (Duffy et al., 2021; American Academy of Sleep Medicine, 2023). If aripiprazole has “top–down” action for the human circadian system, it would be more effective for patients with delayed melatonin rhythm, or if its action is “bottom–up,” this would be the opposite. This should be investigated in future studies. Similarly, it is claimed that non-24-h sleep–wake rhythm disorder (N24SWD) with a far longer sleep–wake cycle period (≥30 h) than the range of human intrinsic circadian period is not considered to be primarily driven by the central circadian pacemaker (Emens et al., 2022). And it is notable that aripiprazole was reported to be effective in a case with N24SWD and major depressive disorder, whose sleep–wake cycle period was 33.4 h (Matsui et al., 2017).
Thus, we should carefully discuss whether the action of aripiprazole on human circadian rhythm is directly related to the SCN. Further studies are needed to address this, and these may also contribute to further elucidating the etiology of CRSWDs.
Author contributions
TK: Writing—original draft, Writing—review & editing.
Funding
The author declares that financial support was received for the research, authorship, and/or publication of this article. This study was funded by Grant-in-Aid for Department in School of Medicine, Fujita Health University.
Acknowledgments
The author thanks Dr. Kume (Nagoya City University) for assistance with the interpretations of the dosage of aripiprazole in animal experiments.
Conflict of interest
TK has received speaker's honoraria from Eisai, Mitsubishi Tanabe, Otsuka, Takeda, Eli Lilly, MSD, Meiji, Yoshitomi, Fukuda, Sumitomo, Shionogi, Viatris, and Novo Nordisk and has received a research grant from Eisai, MSD, and Takeda, outside the submitted work.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
American Academy of Sleep Medicine (2023). International Classification of Sleep Disorders[[Inline Image]], 3rd ed., text revision. Darien, IL: American Academy of Sleep Medicine.
Attarian, H. (2009). Circadian rhythm disruption and reverse paradoxical insomnia after intraventricular hemorrhage. Sleep Med. 10, 932–934. doi: 10.1016/j.sleep.2009.02.004
Borbély, A. A., Daan, S., Wirz-Justice, A., and Deboer, T. (2016). The two-process model of sleep regulation: a reappraisal. J. Sleep Res. 25, 131–143. doi: 10.1111/jsr.12371
DelRosso, L. M., Hoque, R., James, S., Gonzalez-Toledo, E., and Chesson, A. L. Jr. (2014). Sleep-wake pattern following gunshot suprachiasmatic damage. J. Clin. Sleep Med. 10, 443–445. doi: 10.5664/jcsm.3628
Duffy, J. F., Abbott, S. M., Burgess, H. J., Crowley, S. J., Emens, J. S., Epstein, L. J., et al. (2021). Workshop report. Circadian rhythm sleep-wake disorders: gaps and opportunities. Sleep 44:zsaa281. doi: 10.1093/sleep/zsaa281
Emens, J. S., St Hilaire, M. A., Klerman, E. B., Brotman, D. J., Lin, A. L., Lewy, A. J., et al. (2022). Behaviorally and environmentally induced non-24-hour sleep-wake rhythm disorder in sighted patients. J. Clin. Sleep Med. 18, 453–459. doi: 10.5664/jcsm.9612
Honma, K., and Honma, S. (2009). The SCN-independent clocks, methamphetamine and food restriction. Eur. J. Neurosci. 30, 1707–1717. doi: 10.1111/j.1460-9568.2009.06976.x
Konishi, N., Kumagai, H., Sawatari, H., Hoshino, T., Murase, Y., Yamaguchi, M., et al. (2022). Efficacy of a combination therapy for difficulties waking up in non-school-attending students. J. Clin. Med. 11:3271. doi: 10.3390/jcm11123271
Li, R., Masuda, K., Ono, D., Kanbayashi, T., Hirano, A., Sakurai, T., et al. (2023). Aripiprazole disrupts cellular synchrony in the suprachiasmatic nucleus and enhances entrainment to environmental light-dark cycles in mice. Front. Neurosci. 17:1201137. doi: 10.3389/fnins.2023.1201137
Matsui, K., Takaesu, Y., Inoue, T., Inada, K., and Nishimura, K. (2017). Effect of aripiprazole on non-24-hour sleep-wake rhythm disorder comorbid with major depressive disorder: a case report. Neuropsychiatr Dis Treat 13, 1367–1371. doi: 10.2147/NDT.S136628
Noguchi, T., Harrison, E. M., Sun, J., May, D., Ng, A., Welsh, D. K., et al. (2020). Circadian rhythm bifurcation induces flexible phase resetting by reducing circadian amplitude. Eur. J. Neurosci. 51, 2329–2342. doi: 10.1111/ejn.14086
Omori, Y., Kanbayashi, T., Sagawa, Y., Imanishi, A., Tsutsui, K., Takahashi, Y., et al. (2018). Low dose of aripiprazole advanced sleep rhythm and reduced nocturnal sleep time in the patients with delayed sleep phase syndrome: an open-labeled clinical observation. Neuropsychiatr. Dis. Treat. 14, 1281–1286. doi: 10.2147/NDT.S158865
Radosević-Vidacek, B., Kaliterna, L., and Prizmić, Z. (1993). Individual differences in circadian rhythm parameters and short-term tolerance to shiftwork: a follow-up study. Ergonomics 36, 117–123. doi: 10.1080/00140139308967862
Takaki, M., and Ujike, H. (2014). Aripiprazole is effective for treatment of delayed sleep phase syndrome. Clin. Neuropharmacol. 37, 123–124. doi: 10.1097/WNF.0000000000000035
Tashiro, T. (2017). Improvement of a patient's circadian rhythm sleep disorders by aripiprazole was associated with stabilization of his bipolar illness. J. Sleep Res. 26, 247–250. doi: 10.1111/jsr.12496
Uchiyama, M., Okawa, M., Shibui, K., Kim, K., Tagaya, H., Kudo, Y., et al. (2000a). Altered phase relation between sleep timing and core body temperature rhythm in delayed sleep phase syndrome and non-24-hour sleep-wake syndrome in humans. Neurosci. Lett. 294, 101–104. doi: 10.1016/S0304-3940(00)01551-2
Keywords: aripiprazole, circadian rhythm sleep-wake disorders, delayed sleep-wake phase disorder, suprachiasmatic nucleus, sleep-wake cycle
Citation: Kitajima T (2024) Commentary: Aripiprazole disrupts cellular synchrony in the suprachiasmatic nucleus and enhances entrainment to environmental light–dark cycles in mice. Front. Neurosci. 18:1371195. doi: 10.3389/fnins.2024.1371195
Received: 16 January 2024; Accepted: 08 April 2024;
Published: 19 April 2024.
Edited by:
Mark Stephen Kindy, United States Department of Veterans Affairs, United StatesReviewed by:
Oliver Rawashdeh, The University of Queensland, AustraliaCopyright © 2024 Kitajima. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Tsuyoshi Kitajima, dHN1eW9zaGkmI3gwMDA0MDtmdWppdGEtaHUuYWMuanA=