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Lithium Accumulation in Erythrocytes of Manic-Depressive Patients: An in vivo Twin Study

Published online by Cambridge University Press:  29 January 2018

Julien Mendlewicz ,
Paul Verbanck ,
Paul Linkowski  and
Jean Wilmotte
Julien Mendlewicz
Affiliation:
Civil Hospital, Charleroi, Department of Psychiatry, Free University of Brussels, Erasme University Hospital, 808, Route de Lennick, Brussels 1070, Belgium
Paul Verbanck
Affiliation:
Civil Hospital, Charleroi, Department of Psychiatry, Free University of Brussels, Erasme University Hospital, 808, Route de Lennick, Brussels 1070, Belgium
Paul Linkowski
Affiliation:
Civil Hospital, Charleroi, Department of Psychiatry, Free University of Brussels, Erasme University Hospital, 808, Route de Lennick, Brussels 1070, Belgium
Jean Wilmotte
Affiliation:
Civil Hospital, Charleroi, Department of Psychiatry, Free University of Brussels, Erasme University Hospital, 808, Route de Lennick, Brussels 1070, Belgium
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Summary

Genetic factors play an important role in drug metabolism and drug response. In order to investigate genetic variables in lithium prophylaxis and lithium distribution across the erythrocyte in manic-depression, we have examined forty-two pairs of twins monozygotic (n = 25) and dizygotic (n = 17) with manic-depression. Concordant twins as a group show better lithium prophylaxis than do discordant twins. These results are consistent with previously published family studies of affective illness suggesting a positive relationship between genetic background and success of lithium prophylaxis.

Lithium distribution across the red blood cell (RBC) was assessed by estimating lithium RBC/plasma ratios. The lithium ratio's intrapair differences in both groups of twins were minimal with a high heritability index suggesting that genetic factors play a role in lithium ion distribution. A high linear correlation was found between lithium ratio and plasma lithium and there was no difference in lithium ratios according to sex, affective state and response to lithium. The distribution of lithium ratios was homogenous in the lithium responders' population but this was not the case in the non-responders, suggesting biological heterogeneity of lithium distribution in lithium failures. The implications of these results are discussed as they relate to the genetic determinates of lithium prophylaxis in manic-depressive illness.

These results indicate that lithium ratios are of limited value in lithium maintenance therapy. Our lithium kinetic data, however, are consistent with the concept of a lithium extrusion mechanism from red blood cells.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 133 , Issue 5 , November 1978 , pp. 436 - 444
Copyright
Copyright © Royal College of Psychiatrists, 1978 

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