Šupić, Gordana

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CYP2C19 slow metabolizer phenotype is associated with lower antidepressant efficacy and tolerability

Joković, Danilo; Milosavljević, Filip; Stojanović, Zvezdana; Šupić, Gordana; Vojvodić, Danilo; Uzelac, Bojana; Jukić, Marin; Petković Ćurčin, Aleksandra

(Elsevier Ireland Ltd, 2022)

TY  - JOUR
AU  - Joković, Danilo
AU  - Milosavljević, Filip
AU  - Stojanović, Zvezdana
AU  - Šupić, Gordana
AU  - Vojvodić, Danilo
AU  - Uzelac, Bojana
AU  - Jukić, Marin
AU  - Petković Ćurčin, Aleksandra
PY  - 2022
UR  - https://farfar.pharmacy.bg.ac.rs/handle/123456789/4080
AB  - The inter-individual variability in CYP2C19-mediated metabolism may affect the antidepressant treatment. The aim of this study is to evaluate differences in antidepressant efficacy and tolerability between different CYP2C19 metabolizer categories in inpatients suffering from major depressive disorder. The cohort was divided into experimental groups based on CYP2C19 genotype and it contained 24 slow (SMs), 41 normal (NMs), and 37 fast metabolizers (FMs). Efficacy and tolerability were assessed at baseline, and after two and four weeks as a follow- up. The primary efficacy measurement was the change from baseline in Hamilton’s Depression Rating Scale (HAMD), while the primary tolerability measurement was the Toronto Side-Effects Scale (TSES) intensity scores at the last visit. The reduction in HAMD score was 36% less pronounced and response rate was exceedingly less prevalent (75% lower) in SMs, compared with NMs. The TSES intensity score was increased in SMs, compared with NMs, by 43% for central nervous system and by 22% for gastrointestinal adverse drug reactions. No sig- nificant differences in measured parameters were observed between NMs and FMs. Compared with NM and RM, lower antidepressant efficacy and tolerability was observed in SMs; this association is likely connected with the lower SM capacity to metabolize antidepressant drugs.
PB  - Elsevier Ireland Ltd
T2  - Psychiatry Research
T1  - CYP2C19 slow metabolizer phenotype is associated with lower antidepressant efficacy and tolerability
VL  - 312
DO  - 10.1016/j.psychres.2022.114535
ER  - 
@article{
author = "Joković, Danilo and Milosavljević, Filip and Stojanović, Zvezdana and Šupić, Gordana and Vojvodić, Danilo and Uzelac, Bojana and Jukić, Marin and Petković Ćurčin, Aleksandra",
year = "2022",
abstract = "The inter-individual variability in CYP2C19-mediated metabolism may affect the antidepressant treatment. The aim of this study is to evaluate differences in antidepressant efficacy and tolerability between different CYP2C19 metabolizer categories in inpatients suffering from major depressive disorder. The cohort was divided into experimental groups based on CYP2C19 genotype and it contained 24 slow (SMs), 41 normal (NMs), and 37 fast metabolizers (FMs). Efficacy and tolerability were assessed at baseline, and after two and four weeks as a follow- up. The primary efficacy measurement was the change from baseline in Hamilton’s Depression Rating Scale (HAMD), while the primary tolerability measurement was the Toronto Side-Effects Scale (TSES) intensity scores at the last visit. The reduction in HAMD score was 36% less pronounced and response rate was exceedingly less prevalent (75% lower) in SMs, compared with NMs. The TSES intensity score was increased in SMs, compared with NMs, by 43% for central nervous system and by 22% for gastrointestinal adverse drug reactions. No sig- nificant differences in measured parameters were observed between NMs and FMs. Compared with NM and RM, lower antidepressant efficacy and tolerability was observed in SMs; this association is likely connected with the lower SM capacity to metabolize antidepressant drugs.",
publisher = "Elsevier Ireland Ltd",
journal = "Psychiatry Research",
title = "CYP2C19 slow metabolizer phenotype is associated with lower antidepressant efficacy and tolerability",
volume = "312",
doi = "10.1016/j.psychres.2022.114535"
}
Joković, D., Milosavljević, F., Stojanović, Z., Šupić, G., Vojvodić, D., Uzelac, B., Jukić, M.,& Petković Ćurčin, A.. (2022). CYP2C19 slow metabolizer phenotype is associated with lower antidepressant efficacy and tolerability. in Psychiatry Research
Elsevier Ireland Ltd., 312.
https://doi.org/10.1016/j.psychres.2022.114535
Joković D, Milosavljević F, Stojanović Z, Šupić G, Vojvodić D, Uzelac B, Jukić M, Petković Ćurčin A. CYP2C19 slow metabolizer phenotype is associated with lower antidepressant efficacy and tolerability. in Psychiatry Research. 2022;312.
doi:10.1016/j.psychres.2022.114535 .
Joković, Danilo, Milosavljević, Filip, Stojanović, Zvezdana, Šupić, Gordana, Vojvodić, Danilo, Uzelac, Bojana, Jukić, Marin, Petković Ćurčin, Aleksandra, "CYP2C19 slow metabolizer phenotype is associated with lower antidepressant efficacy and tolerability" in Psychiatry Research, 312 (2022),
https://doi.org/10.1016/j.psychres.2022.114535 . .
1
7
4

CYP2C19 slow metabolizer phenotype is associated with lower antidepressant efficacy and tolerability: clinical study on 102 inpatients

Joković, Danilo; Milosavljević, Filip; Stojanović, Zvezdana; Šupić, Gordana; Vojvodić, Danilo; Jukić, Marin; Uzelac, Bojana; Petković-Ćurčić, Aleksandra

(Elsevier, 2022)

TY  - CONF
AU  - Joković, Danilo
AU  - Milosavljević, Filip
AU  - Stojanović, Zvezdana
AU  - Šupić, Gordana
AU  - Vojvodić, Danilo
AU  - Jukić, Marin
AU  - Uzelac, Bojana
AU  - Petković-Ćurčić, Aleksandra
PY  - 2022
UR  - https://farfar.pharmacy.bg.ac.rs/handle/123456789/4730
AB  - Introduction: Available antidepressants are not always effective and the discovery of new antidepressants is slow. Since most antidepressants are metabolized by polymorphic CYP450 liver enzymes, it has been hypothesized that personalized dosing that takes into the account genotype-predicted CYP450 enzyme capacity may improve their effectiveness [1]. Even though it is well known that CYP450 polymorphism impacts plasma levels of many antidepressants [2,3], available evidence on the impact of CYP450 polymorphism on antidepressant efficacy and tolerability is insufficiently strong and often conflicting.

Aim: The aim of this study was to test if CYP2C19 genotype influences efficacy and tolerability of antidepressant therapy in the cohort of 102 inpatients.

Methods: The study was performed at the Military Medical Academy in Belgrade, Serbia. Patients hospitalized for depression and treated with at least one antidepressant were included if they signed the informed consent form. Patients were monitored at the hospital admission and after two and four weeks of follow-up. The drug efficacy was measured with HAM-D (Hamilton depression rating) scale, while tolerability was monitored by TSES (Toronto Side-effects scale) [4]. Patients were retrospectively genotyped for CYP2C19 after the study completion and subsequently categorized as Slow (SM), Normal (NM), or Fast metabolizers (FM). Differences between CYP2C19 metabolizer groups at week four were compared with ANCOVA for HAM-D score, Kruskal-Wallis test for TSES and binary-logistic regression for response rate. Individual adverse reactions were analysed with post-hoc Man-Whitney test.

Results: In total, 102 patients were included; 41 were NM controls, 24 were SM and 37 were RM. Most commonly prescribed primary antidepressants were escitalopram (n=20), trazodone (n=14), mirtazapine (n=12), sertraline (n=12) and venlafaxine (n=10). The fluoxetine-equivalent doses were the not different across groups (p>0.1). While all categories experienced significant reduction in HAMD score during 4 weeks, compared with NMs, the reduction was 36% ([CI95%: 20% - 52%], p<0.0001) less pronounced among SMs. Similarly, response rate was 75% lower in SMs compared with NMs (NM: 34/41 vs SM: 5/24, p<0.0001); response was defined as ≥50% reduction in HAMD score [5]. Finally, SM patients had higher median intensity scores than NMs at week 4 (NM median: 2.5 [IQR: 2.0 - 3.2] vs SM median: 3.2 [IQR: 2.8 - 3.7]; p=0.021, q=0.042). Post hoc analysis revealed that increased burden of nervousness, agitation, and dyspepsia contributed the most to the worse tolerability in SMs. There were no significant differences between FM and NM patients in any of the measured outcomes.

Conclusions: This study revealed that, in the cohort of inpatients treated with heterogeneous antidepressants, the reduced CYP2C19 metabolic capacity is associated with worse therapy efficacy and tolerability, whereas the increased CYP2C19 metabolic capacity is not. Therefore, it is likely that SM group does not receive the appropriate treatment under standard psychiatric practice, which is in most cases unaware of the patients’ CYP2C19 genotype. Even though this study does not have sufficient power for an unequivocal conclusion related to the need of pre-emptive CYP2C19 genotyping of antidepressant treated patients, it contributes to the body of already existing evidence on the clinical usefulness of CYP2C19 genotyping in psychiatry.
PB  - Elsevier
C3  - Neuroscience Applied
T1  - CYP2C19 slow metabolizer phenotype is associated with lower antidepressant efficacy and tolerability: clinical study on 102 inpatients
VL  - 1
IS  - Supplement 2
SP  - 54
EP  - 55
DO  - 10.1016/j.nsa.2022.100217
ER  - 
@conference{
author = "Joković, Danilo and Milosavljević, Filip and Stojanović, Zvezdana and Šupić, Gordana and Vojvodić, Danilo and Jukić, Marin and Uzelac, Bojana and Petković-Ćurčić, Aleksandra",
year = "2022",
abstract = "Introduction: Available antidepressants are not always effective and the discovery of new antidepressants is slow. Since most antidepressants are metabolized by polymorphic CYP450 liver enzymes, it has been hypothesized that personalized dosing that takes into the account genotype-predicted CYP450 enzyme capacity may improve their effectiveness [1]. Even though it is well known that CYP450 polymorphism impacts plasma levels of many antidepressants [2,3], available evidence on the impact of CYP450 polymorphism on antidepressant efficacy and tolerability is insufficiently strong and often conflicting.

Aim: The aim of this study was to test if CYP2C19 genotype influences efficacy and tolerability of antidepressant therapy in the cohort of 102 inpatients.

Methods: The study was performed at the Military Medical Academy in Belgrade, Serbia. Patients hospitalized for depression and treated with at least one antidepressant were included if they signed the informed consent form. Patients were monitored at the hospital admission and after two and four weeks of follow-up. The drug efficacy was measured with HAM-D (Hamilton depression rating) scale, while tolerability was monitored by TSES (Toronto Side-effects scale) [4]. Patients were retrospectively genotyped for CYP2C19 after the study completion and subsequently categorized as Slow (SM), Normal (NM), or Fast metabolizers (FM). Differences between CYP2C19 metabolizer groups at week four were compared with ANCOVA for HAM-D score, Kruskal-Wallis test for TSES and binary-logistic regression for response rate. Individual adverse reactions were analysed with post-hoc Man-Whitney test.

Results: In total, 102 patients were included; 41 were NM controls, 24 were SM and 37 were RM. Most commonly prescribed primary antidepressants were escitalopram (n=20), trazodone (n=14), mirtazapine (n=12), sertraline (n=12) and venlafaxine (n=10). The fluoxetine-equivalent doses were the not different across groups (p>0.1). While all categories experienced significant reduction in HAMD score during 4 weeks, compared with NMs, the reduction was 36% ([CI95%: 20% - 52%], p<0.0001) less pronounced among SMs. Similarly, response rate was 75% lower in SMs compared with NMs (NM: 34/41 vs SM: 5/24, p<0.0001); response was defined as ≥50% reduction in HAMD score [5]. Finally, SM patients had higher median intensity scores than NMs at week 4 (NM median: 2.5 [IQR: 2.0 - 3.2] vs SM median: 3.2 [IQR: 2.8 - 3.7]; p=0.021, q=0.042). Post hoc analysis revealed that increased burden of nervousness, agitation, and dyspepsia contributed the most to the worse tolerability in SMs. There were no significant differences between FM and NM patients in any of the measured outcomes.

Conclusions: This study revealed that, in the cohort of inpatients treated with heterogeneous antidepressants, the reduced CYP2C19 metabolic capacity is associated with worse therapy efficacy and tolerability, whereas the increased CYP2C19 metabolic capacity is not. Therefore, it is likely that SM group does not receive the appropriate treatment under standard psychiatric practice, which is in most cases unaware of the patients’ CYP2C19 genotype. Even though this study does not have sufficient power for an unequivocal conclusion related to the need of pre-emptive CYP2C19 genotyping of antidepressant treated patients, it contributes to the body of already existing evidence on the clinical usefulness of CYP2C19 genotyping in psychiatry.",
publisher = "Elsevier",
journal = "Neuroscience Applied",
title = "CYP2C19 slow metabolizer phenotype is associated with lower antidepressant efficacy and tolerability: clinical study on 102 inpatients",
volume = "1",
number = "Supplement 2",
pages = "54-55",
doi = "10.1016/j.nsa.2022.100217"
}
Joković, D., Milosavljević, F., Stojanović, Z., Šupić, G., Vojvodić, D., Jukić, M., Uzelac, B.,& Petković-Ćurčić, A.. (2022). CYP2C19 slow metabolizer phenotype is associated with lower antidepressant efficacy and tolerability: clinical study on 102 inpatients. in Neuroscience Applied
Elsevier., 1(Supplement 2), 54-55.
https://doi.org/10.1016/j.nsa.2022.100217
Joković D, Milosavljević F, Stojanović Z, Šupić G, Vojvodić D, Jukić M, Uzelac B, Petković-Ćurčić A. CYP2C19 slow metabolizer phenotype is associated with lower antidepressant efficacy and tolerability: clinical study on 102 inpatients. in Neuroscience Applied. 2022;1(Supplement 2):54-55.
doi:10.1016/j.nsa.2022.100217 .
Joković, Danilo, Milosavljević, Filip, Stojanović, Zvezdana, Šupić, Gordana, Vojvodić, Danilo, Jukić, Marin, Uzelac, Bojana, Petković-Ćurčić, Aleksandra, "CYP2C19 slow metabolizer phenotype is associated with lower antidepressant efficacy and tolerability: clinical study on 102 inpatients" in Neuroscience Applied, 1, no. Supplement 2 (2022):54-55,
https://doi.org/10.1016/j.nsa.2022.100217 . .
1

Association of bone fracture type and degree of callus formation with leptin concentration in children with long bone fractures

Paunović, Zoran; Stanojević, Ivan; Abazović, Džihan; Rakić, Mia; Stanković, Nikola; Đukić, Mirjana; Milutinović, Sanja; Starčević, Srđan; Šupić, Gordana; Vojvodić, Danilo; Kovačević, Milena; Marić, Dušan

(Belgrade : Military Medical Academy, INI, 2021)

TY  - JOUR
AU  - Paunović, Zoran
AU  - Stanojević, Ivan
AU  - Abazović, Džihan
AU  - Rakić, Mia
AU  - Stanković, Nikola
AU  - Đukić, Mirjana
AU  - Milutinović, Sanja
AU  - Starčević, Srđan
AU  - Šupić, Gordana
AU  - Vojvodić, Danilo
AU  - Kovačević, Milena
AU  - Marić, Dušan
PY  - 2021
UR  - https://farfar.pharmacy.bg.ac.rs/handle/123456789/3816
AB  - Background/Aim. Recent studies indicate that adipokines have an important role in bone physiology and pathology. Recent data indicate that adipokine leptin functions as a regulator of bone growth at multiple levels, systemically and locally. So far, it has been shown that leptin influences bone volume and bone mineral density in a population with metabolic and/or hormonal abnormality. Data concerning leptin values in non-obese children with fractures are scarce. Methods. This study included 93 non-obese children with long bone fractures (LBF), 14 children with short bone fractures (SBF), and 19 healthy children. Leptin concentration was determined in two blood samples (day 0 and day 21) and analyzed according to gender, fracture type, anatomical localization of the fracture, fracture topography, callus formation, and the healing outcome. Results. Children with LBF demonstrated significantly increased leptin levels compared to the control group (both day 0/day 21). In the control group, girls had significantly more leptin than boys. Leptin value was significantly influenced by anatomical localization since boys and girls with humerus fracture and girls with femur fracture had the highest average leptin concentration in the initial sample. Boys with incomplete callus formation had the highest leptin concentration (both day 0/day 21), significantly elevated compared to boys' samples in the control group, boys' samples with an intermediary and well-formed callus, and also increased compared to the initial samples of girls with incomplete callus. Better callus formation in girls was associated with an increment of leptin concentrations in the second over the initial sample. Girls with partially and satisfactorily formed callus had significantly increased leptin concentration in the second sample (day 21) compared to the boys' group. Conclusion. Leptin concentration was significantly increased (both samples) in children with LBF compared to children with SBF and corresponding controls. Leptin concentration was highly influenced by gender. High blood leptin concentrations in boys or low leptin concentrations in girls immediately upon fracture could be used to identify groups of children with incomplete callus formation.
AB  - Uvod/Cilj.Novijestudije  pokazuju  da  adipokini  imaju važnu  ulogu  u  fiziologiji  i  patologiji  kostiju.  Takođe, najnoviji podaci pokazuju da adipokin leptin funkcioniše kao regulator rasta kostiju sistemski i lokalno. Pokazano je da  leptin  utiče  na  volumen  kostiju  i  mineralnu  gustinu kostiju  u  populaciji  sa  metaboličkom  i/ili  hormonskom abnormalnošću.  Podaci  o  vrednostima  leptina  kod negojazne dece sa frakturama su oskudni. Metode. U ovu studijubil a su uključena93 negojazna deteta sa prelomima dugih kostiju (LBF), 14 dece sa prelomima malih kostiju (SBF) i 19 zdrave dece. Koncentracija leptina određena je u 2 uzorka krvi (0. danai 21  . dana) i analizirana prema polu,  tipu  frakture,  lokalizaciji  anatomske  frakture, topografiji frakture, formiranju kalusa i ishodu zarastanja.Rezultati.Deca sa LBF imala su značajnopovećane nivoeleptina u poređenju sa kontrolnom grupom u oba   uzorka krvi (   0. dana/21 . dana). U kontrolnoj grupi devojčice su imale značajno više nivoe    leptina od dečaka. Na vrednost leptina  značajno  je  uticala  anatomska  lokalizacija, jer  su dečaci i devojčice sa prelomom humerusa i devojčice sa prelomom  femura  imali  najveću  prosečnu  koncentraciju leptina  u  početnom  uzorku.  Dečaci  sa  nepotpuno for miranim kalusom imali su najveću koncentraciju leptina (u oba   uzorka, 0. dana/21. dana),značajno višuu odnosu na  kontrolne  uzorke  dečaka,  uzorke  dečaka  s intermedijarnim  i  dobro  formiranim  kalusom,  a  takođe višu    u  odnosu  na koncentracije  leptina  u početnim uzorcima djevojčica  s  nepotpunim  kalusom.  Bolje formiranje  kalusa  kod  devojčica  je bilo  povezano  sa poveć   anjem koncentracije leptina u drugom (21. dan) u odnosu na početni uzorak(0.  dan). Devojčice sa delimično i zadovoljavajuće formiranim kalusom imale su značajno višu   koncentraciju leptina u drugom uzorku (21. dan  )  u  odnosu  na  grupu  dečaka. Zaključak.  Koncentracija leptina je značajno povećana (u oba uzorkakrvi  ) kod dece sa LBF u poređenju sa decom sa SBF i odgovarajućim kontrolama.  Koncentracija  leptina  je  zavisna  od  pola. Visok    nivo   leptina u krvi    kod dečaka ili niska koncentracija leptina  kod  devojčica  odmah  nakon  preloma  može  se koristiti  za  identifikaciju  grupa  dece  sa  nepotpunim formiranjem kalusa.
PB  - Belgrade : Military Medical Academy, INI
T2  - Vojnosanitetski pregled
T1  - Association of bone fracture type and degree of callus formation with leptin concentration in children with long bone fractures
T1  - Povezanost tipa preloma kosti i stepena formiranja kalusa sa koncentracijom leptina kod dece sa prelomima dugih kostiju
VL  - 78
IS  - 2
SP  - 192
EP  - 201
DO  - 10.2298/VSP190314062P
ER  - 
@article{
author = "Paunović, Zoran and Stanojević, Ivan and Abazović, Džihan and Rakić, Mia and Stanković, Nikola and Đukić, Mirjana and Milutinović, Sanja and Starčević, Srđan and Šupić, Gordana and Vojvodić, Danilo and Kovačević, Milena and Marić, Dušan",
year = "2021",
abstract = "Background/Aim. Recent studies indicate that adipokines have an important role in bone physiology and pathology. Recent data indicate that adipokine leptin functions as a regulator of bone growth at multiple levels, systemically and locally. So far, it has been shown that leptin influences bone volume and bone mineral density in a population with metabolic and/or hormonal abnormality. Data concerning leptin values in non-obese children with fractures are scarce. Methods. This study included 93 non-obese children with long bone fractures (LBF), 14 children with short bone fractures (SBF), and 19 healthy children. Leptin concentration was determined in two blood samples (day 0 and day 21) and analyzed according to gender, fracture type, anatomical localization of the fracture, fracture topography, callus formation, and the healing outcome. Results. Children with LBF demonstrated significantly increased leptin levels compared to the control group (both day 0/day 21). In the control group, girls had significantly more leptin than boys. Leptin value was significantly influenced by anatomical localization since boys and girls with humerus fracture and girls with femur fracture had the highest average leptin concentration in the initial sample. Boys with incomplete callus formation had the highest leptin concentration (both day 0/day 21), significantly elevated compared to boys' samples in the control group, boys' samples with an intermediary and well-formed callus, and also increased compared to the initial samples of girls with incomplete callus. Better callus formation in girls was associated with an increment of leptin concentrations in the second over the initial sample. Girls with partially and satisfactorily formed callus had significantly increased leptin concentration in the second sample (day 21) compared to the boys' group. Conclusion. Leptin concentration was significantly increased (both samples) in children with LBF compared to children with SBF and corresponding controls. Leptin concentration was highly influenced by gender. High blood leptin concentrations in boys or low leptin concentrations in girls immediately upon fracture could be used to identify groups of children with incomplete callus formation., Uvod/Cilj.Novijestudije  pokazuju  da  adipokini  imaju važnu  ulogu  u  fiziologiji  i  patologiji  kostiju.  Takođe, najnoviji podaci pokazuju da adipokin leptin funkcioniše kao regulator rasta kostiju sistemski i lokalno. Pokazano je da  leptin  utiče  na  volumen  kostiju  i  mineralnu  gustinu kostiju  u  populaciji  sa  metaboličkom  i/ili  hormonskom abnormalnošću.  Podaci  o  vrednostima  leptina  kod negojazne dece sa frakturama su oskudni. Metode. U ovu studijubil a su uključena93 negojazna deteta sa prelomima dugih kostiju (LBF), 14 dece sa prelomima malih kostiju (SBF) i 19 zdrave dece. Koncentracija leptina određena je u 2 uzorka krvi (0. danai 21  . dana) i analizirana prema polu,  tipu  frakture,  lokalizaciji  anatomske  frakture, topografiji frakture, formiranju kalusa i ishodu zarastanja.Rezultati.Deca sa LBF imala su značajnopovećane nivoeleptina u poređenju sa kontrolnom grupom u oba   uzorka krvi (   0. dana/21 . dana). U kontrolnoj grupi devojčice su imale značajno više nivoe    leptina od dečaka. Na vrednost leptina  značajno  je  uticala  anatomska  lokalizacija, jer  su dečaci i devojčice sa prelomom humerusa i devojčice sa prelomom  femura  imali  najveću  prosečnu  koncentraciju leptina  u  početnom  uzorku.  Dečaci  sa  nepotpuno for miranim kalusom imali su najveću koncentraciju leptina (u oba   uzorka, 0. dana/21. dana),značajno višuu odnosu na  kontrolne  uzorke  dečaka,  uzorke  dečaka  s intermedijarnim  i  dobro  formiranim  kalusom,  a  takođe višu    u  odnosu  na koncentracije  leptina  u početnim uzorcima djevojčica  s  nepotpunim  kalusom.  Bolje formiranje  kalusa  kod  devojčica  je bilo  povezano  sa poveć   anjem koncentracije leptina u drugom (21. dan) u odnosu na početni uzorak(0.  dan). Devojčice sa delimično i zadovoljavajuće formiranim kalusom imale su značajno višu   koncentraciju leptina u drugom uzorku (21. dan  )  u  odnosu  na  grupu  dečaka. Zaključak.  Koncentracija leptina je značajno povećana (u oba uzorkakrvi  ) kod dece sa LBF u poređenju sa decom sa SBF i odgovarajućim kontrolama.  Koncentracija  leptina  je  zavisna  od  pola. Visok    nivo   leptina u krvi    kod dečaka ili niska koncentracija leptina  kod  devojčica  odmah  nakon  preloma  može  se koristiti  za  identifikaciju  grupa  dece  sa  nepotpunim formiranjem kalusa.",
publisher = "Belgrade : Military Medical Academy, INI",
journal = "Vojnosanitetski pregled",
title = "Association of bone fracture type and degree of callus formation with leptin concentration in children with long bone fractures, Povezanost tipa preloma kosti i stepena formiranja kalusa sa koncentracijom leptina kod dece sa prelomima dugih kostiju",
volume = "78",
number = "2",
pages = "192-201",
doi = "10.2298/VSP190314062P"
}
Paunović, Z., Stanojević, I., Abazović, D., Rakić, M., Stanković, N., Đukić, M., Milutinović, S., Starčević, S., Šupić, G., Vojvodić, D., Kovačević, M.,& Marić, D.. (2021). Association of bone fracture type and degree of callus formation with leptin concentration in children with long bone fractures. in Vojnosanitetski pregled
Belgrade : Military Medical Academy, INI., 78(2), 192-201.
https://doi.org/10.2298/VSP190314062P
Paunović Z, Stanojević I, Abazović D, Rakić M, Stanković N, Đukić M, Milutinović S, Starčević S, Šupić G, Vojvodić D, Kovačević M, Marić D. Association of bone fracture type and degree of callus formation with leptin concentration in children with long bone fractures. in Vojnosanitetski pregled. 2021;78(2):192-201.
doi:10.2298/VSP190314062P .
Paunović, Zoran, Stanojević, Ivan, Abazović, Džihan, Rakić, Mia, Stanković, Nikola, Đukić, Mirjana, Milutinović, Sanja, Starčević, Srđan, Šupić, Gordana, Vojvodić, Danilo, Kovačević, Milena, Marić, Dušan, "Association of bone fracture type and degree of callus formation with leptin concentration in children with long bone fractures" in Vojnosanitetski pregled, 78, no. 2 (2021):192-201,
https://doi.org/10.2298/VSP190314062P . .