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Lin CC, Huang TL. SIGIRR and TNFAIP3 Are Differentially Expressed in Both PBMC and TNF-α Secreting Cells of Patients With Major Depressive Disorder. Front Psychiatry 2021; 12:698257. [PMID: 34393859 PMCID: PMC8356912 DOI: 10.3389/fpsyt.2021.698257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Major depressive disorder (MDD) is associated with the activation of the immune/inflammatory system. TNF-α is associated with MDD and poor treatment response. Toll-like receptors (TLR) are responsible in innate immune response, and is associated with MDD and antidepressant response. Some negative regulators of TLR pathway such as SOCS1, TOLLIP, SIGIRR, TNFAIP3, and MyD88s, are reported to be differentially expressed in the peripheral blood samples of patients of MDD. Methods: We recruited patients with MDD and healthy controls, collect their demographic data, and measured their mRNA levels of negative TLR regulators, using peripheral blood mononuclear cells (PBMC) and isolated TNF-α secreting cells. Clinical symptoms were evaluated using Halmiton Depression Rating Scale (Ham-D). Some patients were evaluated again after 4 weeks of antidepressant treatment. Results: Forty-seven patients with MDD and 52 healthy controls were recruited. Between the PBMC samples of 37 MDD patients and 42 controls, mRNA levels of SOCS1, SIGIRR, TNFAIP3, and MyD88s were significantly different. Between TNF-α secreting cells of 10 MDD patients and 10 controls, mRNA levels of SIGIRR and TNFAIP3 were significantly different. Change of Ham-D score only correlated significantly with TOLLIP mRNA level after treatment. Conclusion: SIGIRR and TNFAIP3, two negative regulators of TLR immune response pathways, were differentially expressed in both PBMC and TNF-α secreting cells of patients with MDD as compared to healthy controls. The negative regulations of innate immune response could contribute to the underlying mechanism of MDD.
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Affiliation(s)
- Chin-Chuen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tiao-Lai Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Genomic and Proteomic Core Laboratory, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Real AG, Fontanari AMV, Costa AB, Soll BMB, Bristot G, de Oliveira LF, Kamphorst AM, Schneider MA, Lobato MIR. Gender dysphoria: prejudice from childhood to adulthood, but no impact on inflammation. A cross-sectional controlled study. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2021; 43:37-46. [PMID: 33681906 PMCID: PMC7932037 DOI: 10.47626/2237-6089-2020-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 05/04/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Gender dysphoria (GD) is characterized by a marked incongruence between experienced gender and one's gender assigned at birth. Transsexual individuals present a higher prevalence of psychiatric disorders when compared to non-transsexual populations, and it has been proposed that minority stress, i.e., discrimination or prejudice, has a relevant impact on these outcomes. Transsexuals also show increased chances of having experienced maltreatment during childhood. Interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor-alpha (TNF-α) are inflammatory cytokines that regulate our immune system. Imbalanced levels in such cytokines are linked to history of childhood maltreatment and psychiatric disorders. We compared differences in IL-1β, IL-6, IL-10 and TNF-α levels and exposure to traumatic events in childhood and adulthood in individuals with and without GD (DSM-5). METHODS Cross-sectional controlled study comparing 34 transsexual women and 31 non-transsexual men. They underwent a thorough structured interview, assessing sociodemographic information, mood and anxiety symptoms, childhood maltreatment, explicit discrimination and suicidal ideation. Inflammatory cytokine levels (IL-1β, IL-6, IL-10 and TNF-α) were measured by multiplex immunoassay. RESULTS Individuals with GD experienced more discrimination (p = 0.002) and childhood maltreatment (p = 0.046) than non-transsexual men. Higher suicidal ideation (p < 0.001) and previous suicide attempt (p = 0.001) rates were observed in transsexual women. However, no differences were observed in the levels of any cytokine. CONCLUSIONS These results suggest that transsexual women are more exposed to stressful events from childhood to adulthood than non-transsexual men and that GD per se does not play a role in inflammatory markers.
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Affiliation(s)
- André Gonzales Real
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Anna Martha Vaitses Fontanari
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Angelo Brandelli Costa
- Departamento de PsicologiaPontifícia Universidade Católica do Rio Grande do SulPorto AlegreRSBrazilDepartamento de Psicologia, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
| | - Bianca Machado Borba Soll
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Giovana Bristot
- INCT Translacional em MedicinaHospital de Clinicas de Porto AlegreUFRGSPorto AlegreRSBrazil Laboratório de Psiquiatria Molecular, INCT Translacional em Medicina, Hospital de Clinicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em BioquímicaUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Bioquímica, UFRGS, Porto Alegre, RS, Brazil.
| | - Larissa Fagundes de Oliveira
- INCT Translacional em MedicinaHospital de Clinicas de Porto AlegreUFRGSPorto AlegreRSBrazil Laboratório de Psiquiatria Molecular, INCT Translacional em Medicina, Hospital de Clinicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil.
| | - Ana Maria Kamphorst
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Maiko Abel Schneider
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Maria Inês Rodrigues Lobato
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
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Strawbridge R, Marwood L, King S, Young AH, Pariante CM, Colasanti A, Cleare AJ. Inflammatory Proteins and Clinical Response to Psychological Therapy in Patients with Depression: An Exploratory Study. J Clin Med 2020; 9:jcm9123918. [PMID: 33276697 PMCID: PMC7761611 DOI: 10.3390/jcm9123918] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022] Open
Abstract
In people with depression, immune dysfunctions have been linked with treatment non-response, but examinations of psychological therapy outcomes, particularly longitudinal biomarker studies, are rare. This study investigated relationships between inflammation, depressive subtypes and clinical outcomes to psychological therapy. Adults with depression (n = 96) were assessed before and after a course of naturalistically-delivered psychological therapy. In total, 32 serum inflammatory proteins were examined alongside therapy outcomes and depressive subtypes (somatic/cognitive symptom subtype, and bipolar/unipolar depression). Overall, 49% of participants responded to treatment. High levels of tumour necrosis factor (TNFα), interleukin-6 (IL-6) and soluble intracellular adhesion molecule-1 (sICAM1), and low interferon-γ (IFNγ), preceded a poorer response to therapy. After therapy, non-responders had elevated c-reactive protein (CRP), thymus and activation-regulated chemokine (TARC) and macrophage chemoattractant protein-4 (MCP4), and attenuated IFNy. Non-somatic depressive symptoms were universally not associated with proteins, while somatic-depressive symptom severity was positively correlated with several pro-inflammatory markers. In the somatic subgroup only, IL-6 and serum amyloid alpha (SAA) decreased between pre- and post-therapy timepoints. Regardless of treatment response, IL-7, IL-8, IL-15 and IL-17 increased over time. These results suggest that inflammation is associated with somatic symptoms of depression and non-response to psychological therapy. Future work may enhance the prospective prediction of treatment-response by examining larger samples of individuals undertaking standardised treatment programmes.
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Affiliation(s)
- Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London SE5 8AZ, UK; (L.M.); (S.K.); (A.H.Y.); (C.M.P.); (A.J.C.)
- Correspondence:
| | - Lindsey Marwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London SE5 8AZ, UK; (L.M.); (S.K.); (A.H.Y.); (C.M.P.); (A.J.C.)
| | - Sinead King
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London SE5 8AZ, UK; (L.M.); (S.K.); (A.H.Y.); (C.M.P.); (A.J.C.)
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London SE5 8AZ, UK; (L.M.); (S.K.); (A.H.Y.); (C.M.P.); (A.J.C.)
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
| | - Carmine M. Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London SE5 8AZ, UK; (L.M.); (S.K.); (A.H.Y.); (C.M.P.); (A.J.C.)
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
| | - Alessandro Colasanti
- Department of Neuroscience, Brighton and Sussex Medical School, Sussex University, Brighton BN1 9PX, UK;
| | - Anthony J. Cleare
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London SE5 8AZ, UK; (L.M.); (S.K.); (A.H.Y.); (C.M.P.); (A.J.C.)
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
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Tafseer S, Gupta R, Ahmad R, Jain S, Bhatia MS, Gupta LK. Bupropion monotherapy alters neurotrophic and inflammatory markers in patients of major depressive disorder. Pharmacol Biochem Behav 2020; 200:173073. [PMID: 33186562 DOI: 10.1016/j.pbb.2020.173073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 09/25/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Emerging hypotheses in the pathophysiology of major depressive disorder (MDD) indicate the role of neurotrophic factors and inflammation. This study assessed the association between therapeutic response of bupropion and serum brain-derived neurotrophic factor (BDNF) and tumour necrosis factor-α (TNF-α) levels in patients with MDD. METHODS Thirty patients (aged 18 to 60 years) with MDD diagnosed by DSM-5 criteria, with Hamilton Depression Rating scale (HAM-D) score ≥ 20 were included in the study. Patients were given bupropion sustained release (SR) in the doses of 150 mg once daily. All patients were followed up for 12 weeks. RESULTS HAM-D score at the start of the treatment was 25.57 ± 1.85 which significantly reduced to 10.8 ± 4.24 at 12 weeks of treatment. The serum BDNF level increased significantly (p < 0.05) from 2.42 ± 0.19 ng/ml to 2.97 ± 0.10 ng/ml and the levels of serum TNF-α reduced significantly (p < 0.05) from 4.45 ± 0.95 pg/ml to 2.11 ± 0.84 pg/ml at 12 weeks of treatment, in responders to treatment. CONCLUSION The results of our study suggest that bupropion SR monotherapy is effective and well tolerated in MDD patients with moderate to severe depression, and its therapeutic efficacy is accompanied by an increase in serum BDNF levels and a decrease in serum TNF-α levels.
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Affiliation(s)
- Sana Tafseer
- Department of Pharmacology, University College of Medical Sciences & Guru Teg Bahadur Hospital, New Delhi 110095, India
| | - Rachna Gupta
- Department of Pharmacology, University College of Medical Sciences & Guru Teg Bahadur Hospital, New Delhi 110095, India.
| | - Rafat Ahmad
- Department of Biochemistry, University College of Medical Sciences & Guru Teg Bahadur Hospital, New Delhi 110095, India
| | - Seema Jain
- Department of Pharmacology, University College of Medical Sciences & Guru Teg Bahadur Hospital, New Delhi 110095, India
| | - M S Bhatia
- Department of Psychiatry, University College of Medical Sciences & Guru Teg Bahadur Hospital, New Delhi 110095, India
| | - Lalit K Gupta
- Department of Pharmacology, Lady Hardinge Medical College & Smt. S.K. Hospital, New Delhi, India
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Parkinson JT, Foley ÉM, Jadon DR, Khandaker GM. Depression in patients with spondyloarthritis: prevalence, incidence, risk factors, mechanisms and management. Ther Adv Musculoskelet Dis 2020; 12:1759720X20970028. [PMID: 33224281 PMCID: PMC7649919 DOI: 10.1177/1759720x20970028] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022] Open
Abstract
Depression is a major neuropsychiatric disorder common in patients with rheumatological conditions including spondyloarthritis (SpA). It is associated with higher disease activity, functional impairment, poor treatment response and quality of life in patients with musculoskeletal disorders. Using ankylosing spondylitis (AS) and psoriatic arthritis (PsA) as examples, we have reviewed the evidence regarding the burden, risk factors, potential mechanisms and clinical management of depression in spondyloarthritis. The prevalence of depression is higher in patients with AS and PsA compared with the general population, with evidence of moderate/severe depression in about 15% of patients with AS or PsA. Mild depression is even more common and estimated to be present in about 40% of patients with AS. In addition to conventional risk factors such as stressful life events and socioeconomic deprivation, increased risk of depression in SpA may be associated with disease-related factors, such as disease activity, poor quality of life, fatigue, and sleep disturbances. Emerging evidence implicates inflammation in the aetiology of depression, which could also be a shared mechanism for depression and chronic inflammatory conditions such as AS and PsA. It is imperative for clinicians to actively assess and treat depression in SpA, as this could improve treatment adherence, quality of life, and overall long-term clinical and occupational outcomes. The use of validated tools can aid recognition and management of depression in rheumatology clinics. Management of depression in SpA, especially when to refer to specialist mental health services, are discussed.
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Affiliation(s)
- Joel T. Parkinson
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Cambridge Biomedical Campus, Robinson Way, Cambridge, Cambridgeshire CB2 0SZ, UK
| | - Éimear M. Foley
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Deepak R. Jadon
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Medicine, University of Cambridge, UK
| | - Golam M. Khandaker
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Jia X, Gao Z, Hu H. Microglia in depression: current perspectives. SCIENCE CHINA-LIFE SCIENCES 2020; 64:911-925. [PMID: 33068286 DOI: 10.1007/s11427-020-1815-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022]
Abstract
Major depressive disorder (MDD) is a prevalent psychiatric disease that involves malfunctions of different cell types in the brain. Accumulating studies started to reveal that microglia, the primary resident immune cells, play an important role in the development and progression of depression. Microglia respond to stress-triggered neuroinflammation, and through the release of proinflammatory cytokines and their metabolic products, microglia may modulate the function of neurons and astrocytes to regulate depression. In this review, we focused on the role of microglia in the etiology of depression. We discussed the dynamic states of microglia; the correlative and causal evidence of microglial abnormalities in depression; possible mechanisms of how microglia sense depression-related stress and modulate depression state; and how antidepressive therapies affect microglia. Understanding the role of microglia in depression may shed light on developing new treatment strategies to fight against this devastating mental illness.
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Affiliation(s)
- Xiaoning Jia
- Department of Psychiatry of First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.,The MOE Frontier Science Center for Brain Research and Brain-Machine Integration, Zhejiang University School of Brain Science and Brain Medicine, Hangzhou, 310012, China
| | - Zhihua Gao
- The MOE Frontier Science Center for Brain Research and Brain-Machine Integration, Zhejiang University School of Brain Science and Brain Medicine, Hangzhou, 310012, China. .,NHC and CAMS Key Laboratory of Medical Neurobiology, Mental Health Center, Zhejiang University, Hangzhou, 310058, China. .,Department of Neurobiology and Department of Neurology of Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Hailan Hu
- Department of Psychiatry of First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China. .,The MOE Frontier Science Center for Brain Research and Brain-Machine Integration, Zhejiang University School of Brain Science and Brain Medicine, Hangzhou, 310012, China. .,NHC and CAMS Key Laboratory of Medical Neurobiology, Mental Health Center, Zhejiang University, Hangzhou, 310058, China. .,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou, 510515, China. .,Fountain-Valley Institute for Life Sciences, Guangzhou, 510530, China. .,Research Units of Brain Mechanisms Underlying Emotion and Emotion disorders, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Berk A, Yılmaz İ, Abacıoğlu N, Kaymaz MB, Karaaslan MG, Kuyumcu Savan E. Antidepressant effect of Gentiana olivieri Griseb. in male rats exposed to chronic mild stress. Libyan J Med 2020; 15:1725991. [PMID: 32048914 PMCID: PMC7034455 DOI: 10.1080/19932820.2020.1725991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The flowering parts of Gentiana olivieri, known as ‘Afat’ in the southeastern Anatolia region of Turkey, are used as a tonic, an appetizer, and for the treatment of several mental disorders, including depression. The purpose of this study is to investigate the antidepressant effect of G. olivieri ethanol extract (GOEE) in a chronic mild stress-induced rat model, which was used to mimic a depressive state in humans, and to compare the effect with that of imipramine. Methods: Male Sprague-Dawley rats were randomly divided into six groups: control, stress, treated with imipramine (positive control) and treated with GOEE at three different (200, 500, 1000 mg/kg) doses groups. The rats in all groups, except the control group, were exposed to chronic mild stress. At the end of the 3-week experimental period, biochemical and behavioral parameters were examined. Results: The results showed that treatment with GOEE or imipramine significantly improved rats’ sucrose consumption which was diminished by chronic mild stress, restored serum levels of corticosterone and proinflammatory cytokines (interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)), prevented the increase of liver index of rats. Moreover, in the hippocampus tissue, decreased serotonin and noradrenaline levels were significantly increased by treatment with GOEE or imipramine, and antioxidant parameters (thiobarbituric acid reactive substances (TBARS), superoxide dismutase (SOD), and glutathione (GSH)) were significantly improved by treatment with GOEE though not with imipramine. Conclusion: The data demonstrate that G. olivieri may exert its antidepressant activity by improving monoaminergic system disorders, and by favorably affecting the antioxidant, inflammatory and the endocrine mechanisms.
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Affiliation(s)
- Ahmet Berk
- Department of Pharmacy, Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
| | - İsmet Yılmaz
- Department of Pharmacology, Faculty of Pharmacy, Inonu University, Malatya, Turkey
| | - Nurettin Abacıoğlu
- Department of Pharmacology, Faculty of Pharmacy, Near East University, Mersin, Turkey
| | | | | | - Ebru Kuyumcu Savan
- Department of Basic Pharmaceutical Sciences, Faculty of Pharmacy, İnönü University, Malatya, Turkey
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Wang J, Xu S, Chen X, Wang L, Li J, Li G, Zhang B. Antidepressant effect of EGCG through the inhibition of hippocampal neuroinflammation in chronic unpredictable mild stress-induced depression rat model. J Funct Foods 2020. [DOI: 10.1016/j.jff.2020.104106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Osimo EF, Pillinger T, Rodriguez IM, Khandaker GM, Pariante CM, Howes OD. Inflammatory markers in depression: A meta-analysis of mean differences and variability in 5,166 patients and 5,083 controls. Brain Behav Immun 2020; 87:901-909. [PMID: 32113908 PMCID: PMC7327519 DOI: 10.1016/j.bbi.2020.02.010] [Citation(s) in RCA: 392] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/30/2020] [Accepted: 02/20/2020] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE The magnitude and variability of cytokine alterations in depression are not clear. OBJECTIVE To perform an up to date meta-analysis of mean differences of immune markers in depression, and to quantify and test for evidence of heterogeneity in immune markers in depression by conducting a meta-analysis of variability to ascertain whether only a sub-group of patients with depression show evidence of inflammation. DATA SOURCES Studies that reported immune marker levels in peripheral blood in patients with depression and matched healthy controls in the MEDLINE database from inception to August 29th 2018 were examined. STUDY SELECTION Case-control studies that reported immune marker levels in peripheral blood in patients with depression and healthy controls were selected. DATA EXTRACTION AND SYNTHESIS Means and variances (SDs) were extracted for each measure to calculate effect sizes, which were combined using multivariate meta-analysis. MAIN OUTCOMES AND MEASURES Hedges g was used to quantify mean differences. Relative variability of immune marker measurements in patients compared with control groups as indexed by the coefficient of variation ratio (CVR). RESULTS A total of 107 studies that reported measurements from 5,166 patients with depression and 5,083 controls were included in the analyses. Levels of CRP (g = 0.71; 95%CI: 0.50-0.92; p < 0.0001); IL-3 (g = 0.60; 95%CI: 0.31-0.89; p < 0.0001); IL-6 (g = 0.61; 95%CI: 0.39-0.82; p < 0.0001); IL-12 (g = 1.18; 95%CI: 0.74-1.62; p < 0.0001); IL-18 (g = 1.97; 95%CI: 1.00-2.95; p < 0.0001); sIL-2R (g = 0.71; 95%CI: 0.44-0.98; p < 0.0001); and TNFα (g = 0.54; 95%CI: 0.32-0.76; p < 0.0001) were significantly higher in patients with depression. These findings were robust to a range of potential confounds and moderators. Mean-scaled variability, measured as CVR, was significantly lower in patients with depression for CRP (CVR = 0.85; 95%CI: 0.75-0.98; p = 0.02); IL-12 (CVR = 0.61; 95%CI: 0.46-0.80; p < 0.01); and sIL-2R (CVR = 0.85; 95%CI: 0.73-0.99; p = 0.04), while it was unchanged for IL-3, IL-6, IL-18, and TNF α. CONCLUSIONS AND RELEVANCE Depression is confirmed as a pro-inflammatory state. Some of the inflammatory markers elevated in depression, including CRP and IL-12, show reduced variability in patients with depression, therefore supporting greater homogeneity in terms of an inflammatory phenotype in depression. Some inflammatory marker elevations in depression do not appear due to an inflamed sub-group, but rather to a right shift of the immune marker distribution.
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Affiliation(s)
- Emanuele F. Osimo
- MRC London Institute of Medical Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK,Department of Psychiatry, University of Cambridge, Cambridge, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Toby Pillinger
- MRC London Institute of Medical Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK,Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Golam M. Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Carmine M. Pariante
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,National Institute for Health Research, Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, London, UK,The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London SE5 9RT, UK
| | - Oliver D. Howes
- MRC London Institute of Medical Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK,Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,Corresponding author at: MRC London Institute of Medical Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK.
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Bruno A, Dolcetti E, Rizzo FR, Fresegna D, Musella A, Gentile A, De Vito F, Caioli S, Guadalupi L, Bullitta S, Vanni V, Balletta S, Sanna K, Buttari F, Stampanoni Bassi M, Centonze D, Mandolesi G. Inflammation-Associated Synaptic Alterations as Shared Threads in Depression and Multiple Sclerosis. Front Cell Neurosci 2020; 14:169. [PMID: 32655374 PMCID: PMC7324636 DOI: 10.3389/fncel.2020.00169] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022] Open
Abstract
In the past years, several theories have been advanced to explain the pathogenesis of Major Depressive Disorder (MDD), a neuropsychiatric disease that causes disability in general population. Several theories have been proposed to define the MDD pathophysiology such as the classic "monoamine-theory" or the "glutamate hypothesis." All these theories have been recently integrated by evidence highlighting inflammation as a pivotal player in developing depressive symptoms. Proinflammatory cytokines have been indeed claimed to contribute to stress-induced mood disturbances and to major depression, indicating a widespread role of classical mediators of inflammation in emotional control. Moreover, during systemic inflammatory diseases, peripherally released cytokines circulate in the blood, reach the brain and cause anxiety, anhedonia, social withdrawal, fatigue, and sleep disturbances. Accordingly, chronic inflammatory disorders, such as the inflammatory autoimmune disease multiple sclerosis (MS), have been associated to higher risk of MDD, in comparison with overall population. Importantly, in both MS patients and in its experimental mouse model, Experimental Autoimmune Encephalomyelitis (EAE), the notion that depressive symptoms are reactive epiphenomenon to the MS pathology has been recently challenged by the evidence of their early manifestation, even before the onset of the disease. Furthermore, in association to such mood disturbance, inflammatory-dependent synaptic dysfunctions in several areas of MS/EAE brain have been observed independently of brain lesions and demyelination. This evidence suggests that a fine interplay between the immune and nervous systems can have a huge impact on several neurological functions, including depressive symptoms, in different pathological conditions. The aim of the present review is to shed light on common traits between MDD and MS, by looking at inflammatory-dependent synaptic alterations associated with depression in both diseases.
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Affiliation(s)
- Antonio Bruno
- Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Ettore Dolcetti
- Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Francesca Romana Rizzo
- Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Diego Fresegna
- Synaptic Immunopathology Lab, IRCCS San Raffaele Pisana, Rome, Italy
| | - Alessandra Musella
- Synaptic Immunopathology Lab, IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Sciences and Quality of Life Promotion, University of Rome San Raffaele, Rome, Italy
| | | | - Francesca De Vito
- Unit of Neurology, Mediterranean Neurological Institute IRCCS Neuromed, Pozzilli, Italy
| | - Silvia Caioli
- Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Livia Guadalupi
- Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Silvia Bullitta
- Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
- Synaptic Immunopathology Lab, IRCCS San Raffaele Pisana, Rome, Italy
| | - Valentina Vanni
- Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
- Synaptic Immunopathology Lab, IRCCS San Raffaele Pisana, Rome, Italy
| | - Sara Balletta
- Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Krizia Sanna
- Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Fabio Buttari
- Unit of Neurology, Mediterranean Neurological Institute IRCCS Neuromed, Pozzilli, Italy
| | | | - Diego Centonze
- Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
- Unit of Neurology, Mediterranean Neurological Institute IRCCS Neuromed, Pozzilli, Italy
| | - Georgia Mandolesi
- Synaptic Immunopathology Lab, IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Sciences and Quality of Life Promotion, University of Rome San Raffaele, Rome, Italy
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Chaves RDC, Mallmann ASV, de Oliveira NF, Capibaribe VCC, da Silva DMA, Lopes IS, Valentim JT, Barbosa GR, de Carvalho AMR, Fonteles MMDF, Gutierrez SJC, Barbosa Filho JM, de Sousa FCF. The neuroprotective effect of Riparin IV on oxidative stress and neuroinflammation related to chronic stress-induced cognitive impairment. Horm Behav 2020; 122:104758. [PMID: 32304685 DOI: 10.1016/j.yhbeh.2020.104758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cognitive impairment is identified as one of the diagnostic criteria for major depressive disorder and can extensively affect the quality of life of patients. Based on these findings, this study aimed to investigate the possible effects of Riparin IV (Rip IV) on cognitive impairment induced by chronic administration of corticosterone in mice. METHODS Female Swiss mice were divided into four groups: control (Control), corticosterone (Cort), Riparin IV (Cort + Rip IV), and Fluvoxamine (Cort + Flu). Three groups were administered corticosterone (20 mg/kg) subcutaneously during the 22-day study, while the control group received only vehicle. After the 14th day, the groups were administered medications: Riparin IV (Rip IV), fluvoxamine (Flu), or distilled water, by gavage, 1 h after the subcutaneous injections. After treatment, mice underwent behavioral testing, and brain areas were removed for oxidative stress and cytokine content assays. RESULTS The results revealed that Cort-treated mice developed a cognitive impairment and exhibited a neuroinflammatory profile with an oxidative load and Th1/Th2 cytokine imbalance. Rip IV treatment significantly ameliorated the cognitive deficit induced by Cort and displayed a neuroprotective effect. CONCLUSION The antidepressant-like ability of Rip IV treatment against chronic Cort-induced stress may be due to its potential to mitigate inflammatory damage and oxidative stress. The antioxidant and anti-inflammatory effect observed indicates Rip IV as a possible drug for antidepressant treatment of non-responsive patients with severe and cognitive symptoms.
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Affiliation(s)
- Raquell de Castro Chaves
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Auriana Serra Vasconcelos Mallmann
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Natália Ferreira de Oliveira
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Victor Celso Cavalcanti Capibaribe
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Daniel Moreira Alves da Silva
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Iardja Stéfane Lopes
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - José Tiago Valentim
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Giovanna Riello Barbosa
- Multi-User Facility, Drug Research and Development Center, Federal University of Ceará, Brazil
| | - Alyne Mara Rodrigues de Carvalho
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Stanley Juan Chavez Gutierrez
- Laboratory of Pharmaceutical Chemistry, Department of Biochemistry and Pharmacology, Federal University of Piauí, Teresina, Piauí, Brazil
| | - José Maria Barbosa Filho
- Laboratory of Pharmaceutical Technology, Department of Pharmaceutical Science, Federal University of Paraiba, João Pessoa, Paraiba, Brazil
| | - Francisca Cléa Florenço de Sousa
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
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The Association Between Vascular Inflammation and Depressive Disorder. Causality, Biomarkers and Targeted Treatment. Pharmaceuticals (Basel) 2020; 13:ph13050092. [PMID: 32408603 PMCID: PMC7281196 DOI: 10.3390/ph13050092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/09/2020] [Accepted: 05/10/2020] [Indexed: 12/18/2022] Open
Abstract
Diabetes, obesity, atherosclerosis, and myocardial infarction are frequently co-morbid with major depressive disorder. In the current review, it is argued that vascular inflammation is a factor that is common to all disorders and that an endothelial dysfunction of the blood-brain barrier could be involved in the induction of depression symptoms. Biomarkers for vascular inflammation include a high plasma level of C-reactive protein, soluble cell-adhesion molecules, von Willebrand factor, aldosterone, and proinflammatory cytokines like interleukin-6 or tumor necrosis factor α. A further possible biomarker is flow-mediated dilation of the brachial artery. Treatment of vascular inflammation is expected to prevent or to reduce symptoms of depression. Several tentative treatments for this form of depression can be envisioned: eicosapentaenoic acid (EPA), valproate, Vagus-nerve stimulation, nicotinic α7 agonists, and agonists of the cannabinoid CB2-receptor.
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63
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Zhou X, Wang J, Lu Y, Chen C, Hu Y, Liu P, Dong X. Anti-depressive effects of Kai-Xin-San on lipid metabolism in depressed patients and CUMS rats using metabolomic analysis. JOURNAL OF ETHNOPHARMACOLOGY 2020; 252:112615. [PMID: 31991203 DOI: 10.1016/j.jep.2020.112615] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/11/2020] [Accepted: 01/22/2020] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In this study, in order to explore potential depressive biomarkers and potential regulatory targets of KXS on depression, we assessed the effects of Kai-Xin-San (KXS) on lipid metabolism in depressed patients (DPs) and rats exposed to chronic and unpredictable mild stress (CUMS). MATERIALS AND METHODS Serum samples were collected from DPs, DPs with 8 weeks of KXS treatment (KXS) and healthy controls (HCs), and non-targeted lipidomics was used to analyze the effect of KXS on serum lipid metabolites in DPs. Based on UPLC-Q-TOF/MS technology, differential metabolites were validated in a large sample size. The potential regulatory network of KXS was analyzed by bioinformatic analysis, and the expressions of proteins in serum were verified using western boltting analysis. Moreover, effects of KXS on serum lipid and lipid metabolism-related hormone levels in CUMS rats were detected by enzyme-linked immunosorbent assay and enzymatic method. RESULTS We validated that the levels of six serum lipid metabolites (N-Desmethylcitalopram (HMDB14021), PC(14:1(9Z)/24:0) (HMDB07926), PC(P-18:1(11Z)/20:0) (HMDB11281), PC(O-18:0/20:4(8Z,11Z,14Z,17Z)) (HMDB13420), PC(16:0/P-18:0) (HMDB07995) and PC(16:0/P-18:1(11Z)) (HMDB07996)) between HC/DP groups and between DP/KXS groups were significantly different. Among these six metabolites, HMDB07995, HMDB07996, HMDB13420 and HMDB11281 were highly sensitive and specific for depression and KXS treatment by receiver operating characteristic (ROC) curve analysis. matrix metalloproteinases (MMPs) including MMP2 and MMP9, apolipoproteins (Apo) including APOA1 and APOC1 were up-regulated and apolipoproteins (Apo) including APOB, APOD and APOE, phospholipid transfer protein (PLTP), Paraoxonase 1 (PON1) were down-regulated in DPs, and KXS treatment could reverse these changes. In CUMS rats, KXS could increase the open-field score, sucrose preference and body weight, and reduce immobility time. Furthermore, KXS increased the serum levels of the above-mentioned six metabolites, reduced serum total cholesterol (TCH), triglyceride (TG) and free fatty acid (FFA) levels and increased the serum high-density lipoprotein cholesterol (HDL-C) level in CUMS rats. In addition, leptin and ghrelin were down-regulated by KXS. CONCLUSIONS The results suggested that KXS exerted antidepressant effects by regulating the signaling pathways involved in lipid metabolism disorders. The lipid metabolites might be potential biomarkers of depression and possible targets for KXS-based treatment of depression.
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Affiliation(s)
- Xiaojiang Zhou
- Medical School of Chinese PLA, Beijing, 100853, China; Department of Clinical Pharmacology, Pharmacy Care Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jin Wang
- Department of Clinical Pharmacology, Pharmacy Care Center, Chinese PLA General Hospital, Beijing, 100853, China; Department of Chinese Medicine, Shanxi University of Traditional Chinese Medicine, Jinzhong, Shanxi, China
| | - Yupan Lu
- Department of Clinical Pharmacology, Pharmacy Care Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Chao Chen
- Department of Clinical Pharmacology, Pharmacy Care Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yuan Hu
- Department of Clinical Pharmacology, Pharmacy Care Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ping Liu
- Department of Clinical Pharmacology, Pharmacy Care Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Xianzhe Dong
- Department of Pharmacy, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
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Zhou Y, Cong Y, Liu H. Folic acid ameliorates depression-like behaviour in a rat model of chronic unpredictable mild stress. BMC Neurosci 2020; 21:1. [PMID: 31941442 PMCID: PMC6961331 DOI: 10.1186/s12868-020-0551-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/08/2020] [Indexed: 12/25/2022] Open
Abstract
Background Depression is characterized by significant and low mood. Classical antidepressants are still not adequate in treating depression because of undesirable side effects. Folic acid, a member of the vitamin B complex, in considered to be strongly associated with the function and development of the central nervous system. Thus, in this study, we established a model of depression through chronic unpredictable mild stress (CUMS) in rats and assessed the antidepressant effects and mechanisms of folic acid. Methods Sprague–Dawley rats were randomly divided into four groups: control, chronic unpredictable mild stress (CUMS), CUMS treated with folic acid, and CUMS treated with citalopram. Rats were assessed in terms of weight change, open-field test and sucrose preference. Homocysteine, monoamine neurotransmitters, interleukin-6, brain-derived neurotrophic factor (BDNF), β-endorphin levels in the serum and brains of rats were analysed. Results Folic acid exhibited antidepressant-like effects in open-field and sucrose preference tests. Folic acid treatment effectively increased the levels of monoamine neurotransmitters, BDNF and β-endorphin, interleukin-6 and homocysteine levels were also significantly suppressed by folic acid administration. Conclusions These findings serve as preclinical evidence that folic acid plays an antidepressant-like role in several pathways involving monoamine neurotransmitters. Thus, folic acid may be used as a potential antidepressant.
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Affiliation(s)
- Yue Zhou
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, No 22 Qixiangtai Road, Heping District, Tianjin, 300070, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Yu Cong
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, No 22 Qixiangtai Road, Heping District, Tianjin, 300070, China.,Tianjin Medical University Chu Hsien-l Memorial Hospital, Tianjin, China
| | - Huan Liu
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, No 22 Qixiangtai Road, Heping District, Tianjin, 300070, China. .,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.
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Inflammation and the dimensions of depression: A review. Front Neuroendocrinol 2020; 56:100800. [PMID: 31654681 DOI: 10.1016/j.yfrne.2019.100800] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/22/2019] [Accepted: 10/20/2019] [Indexed: 12/15/2022]
Abstract
Patients with depressive disorders show a wide range of clinical manifestations including cognitive and neurovegetative symptoms. Importantly, these symptoms can differ in terms of biological etiology, and deconstructing depression into specific symptoms may provide valuable insight into the underlying neurobiology. Little research has examined inflammation in the context of depressive dimensions. Here we conduct a narrative review of the existing literature (21 studies) to elucidate whether the depression-inflammation link is symptom specific. Overall, there is evidence that an association exists between neurovegetative symptoms of depression and inflammation, independent of cognitive symptoms. The same cannot be said of cognitive symptoms and inflammation. There is also some evidence of gender differences in the directionality of the relationship between depression and inflammation. Potential explanations for these findings, limitations of the existing literature and recommendations for future research design are discussed.
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Effects of immunomodulatory drugs on depressive symptoms: A mega-analysis of randomized, placebo-controlled clinical trials in inflammatory disorders. Mol Psychiatry 2020; 25:1275-1285. [PMID: 31427751 PMCID: PMC7244402 DOI: 10.1038/s41380-019-0471-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/14/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022]
Abstract
Activation of the innate immune system is commonly associated with depression. Immunomodulatory drugs may have efficacy for depressive symptoms that are co-morbidly associated with inflammatory disorders. We report a large-scale re-analysis by standardized procedures (mega-analysis) of patient-level data combined from 18 randomized clinical trials conducted by Janssen or GlaxoSmithKline for one of nine disorders (N = 10,743 participants). Core depressive symptoms (low mood, anhedonia) were measured by the Short Form Survey (SF-36) or the Hospital Anxiety and Depression Scale (HADS), and participants were stratified into high (N = 1921) versus low-depressive strata based on baseline ratings. Placebo-controlled change from baseline after 4-16 weeks of treatment was estimated by the standardized mean difference (SMD) over all trials and for each subgroup of trials targeting one of 7 mechanisms (IL-6, TNF-α, IL-12/23, CD20, COX2, BLγS, p38/MAPK14). Patients in the high depressive stratum showed modest but significant effects on core depressive symptoms (SMD = 0.29, 95% CI [0.12-0.45]) and related SF-36 measures of mental health and vitality. Anti-IL-6 antibodies (SMD = 0.8, 95% CI [0.20-1.41]) and an anti-IL-12/23 antibody (SMD = 0.48, 95% CI [0.26-0.70]) had larger effects on depressive symptoms than other drug classes. Adjustments for physical health outcome marginally attenuated the average treatment effect on depressive symptoms (SMD = 0.20, 95% CI: 0.06-0.35), but more strongly attenuated effects on mental health and vitality. Effects of anti-IL-12/23 remained significant and anti-IL-6 antibodies became a trend after controlling for physical response to treatment. Novel immune-therapeutics can produce antidepressant effects in depressed patients with primary inflammatory disorders that are not entirely explained by treatment-related changes in physical health.
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Roman M, Irwin MR. Novel neuroimmunologic therapeutics in depression: A clinical perspective on what we know so far. Brain Behav Immun 2020; 83:7-21. [PMID: 31550500 PMCID: PMC6940145 DOI: 10.1016/j.bbi.2019.09.016] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/11/2019] [Accepted: 09/20/2019] [Indexed: 12/27/2022] Open
Abstract
Depression, one of the most common mental health disorders, is among the leading causes of health-related disability worldwide. Although antidepressant treatment has been available for decades, depression remains largely refractory to the prevailing limited treatment approach of monoamine transmission modulation. Fortunately, recent evidence points to a link between depression and inflammatory factors within the innate and the adaptive immune system. The purpose of this review is to evaluate current and potential clinical immunotherapies for depression, as contextually focused by an immunologic lens of the pathophysiologic mechanisms of depression. The utility of pro-inflammatory cytokines (primarily interleukin-1β, interleukin -6 and tumor necrosis factor-α) is considered in their role as screening biomarkers in prediction of treatment response or nonresponse. The evidence base of numerous recent clinical studies is discussed as related to their antidepressant efficacy and favorable safety profile, with consideration of multiple agents that target inflammatory mechanisms linked to depression including nonsteroidal anti-inflammatory pathways (i.e., aspirin, celecoxib), cytokine antagonism (i.e., etanercept, infliximab), N-methyl-D-aspartate receptor (NMDA) receptor antagonism (i.e., ketamine), and modulation of kynurenine pathways (i.e., minocycline). Additionally, new and exciting directions in targeting inflammatory mechanisms in the treatment of depression are underway, and future investigation is also warranted to explore the utility of inflammation in diagnosing depression, guiding clinical treatment decision-making, and monitoring disease burden and relapse risk.
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Affiliation(s)
- Michael Roman
- University of Pennsylvania, Psychiatry Residency Program, Philadelphia, PA, United States
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA, United States.
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Farrell K, Houle JD. Systemic Inhibition of Soluble Tumor Necrosis Factor with XPro1595 Exacerbates a Post-Spinal Cord Injury Depressive Phenotype in Female Rats. J Neurotrauma 2019; 36:2964-2976. [PMID: 31064292 PMCID: PMC6791477 DOI: 10.1089/neu.2019.6438] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Spinal cord injury (SCI) is associated with a three-fold risk of major depressive disorder compared with the general population. Current antidepressant therapy is often not as effective in this patient population, suggesting the need for a more efficacious therapeutic target. The goal of this study was to elucidate the role of inflammatory cytokine tumor necrosis factor (TNF) in the dorsal raphe nucleus (DRN, the principle source of serotonin to the brain) in the development and possible treatment of depression after SCI. A depressive phenotype following moderate T9 contusion was identified in adult female rats using a battery of behavioral tests (forced swim test, sucrose preference test, novel object recognition test, open field locomotion, and social exploration). Data revealed two clusters of injured rats (58%) that exhibit increased immobility in the forced swim test, indicating depressive phenotype or a melancholic-depressive phenotype with concomitant decrease in sucrose preference. ElevatedTNF levels in the DRN of these two clusters correlated with increased immobility in the forced swim test. We then tested the efficacy of soluble TNF inhibition with XPro1595 treatment to prevent the depressive phenotype after SCI. Subcutaneous (s.c.) delivery of XPro1595 caused an exacerbation of depressive phenotype, with all treated clusters exhibiting increased forced swim immobility compared with saline-treated non-depressed rats. Intracerebroventricular (i.c.v.) administration of the drug did not prevent or enhance the development of depression after injury. These results suggest a complex role for TNF-based neuroinflammation in SCI-induced depression that needs to be further explored, perhaps in conjunction with a broader targeting of additional post-SCI inflammatory cytokines.
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Affiliation(s)
- Kaitlin Farrell
- Department of Neurobiology and Anatomy, Marion Murray Spinal Cord Research Center, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - John D. Houle
- Department of Neurobiology and Anatomy, Marion Murray Spinal Cord Research Center, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Zhu X, Tao Q, Sun-Waterhouse D, Li W, Liu S, Cui C. γ-[Glu]n-Trp ameliorates anxiety/depression-like behaviors and its anti-inflammatory effect in an animal model of anxiety/depression. Food Funct 2019; 10:5544-5554. [PMID: 31424471 DOI: 10.1039/c9fo01467e] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study compared the abilities of γ-[Glu]n-Trp (EW) and whey protein hydrolysate (WPH) with a high ratio of Trp : 5 large neutral amino acids (5LNAAs) to reverse chronic restraint stress-corticosterone injection induced anxiety/depression-like behaviors in C57BL/6 male mice. EW was synthesized using l-glutaminase from Bacillus amyloliquefaciens. Acid protease, trypsin, pancreatin or flavorzyme was used to produce WPHs. The WPH with the highest Trp/5LNAAs ratio (17.38%; by trypsin) was selected for animal trials. EW (dose 2.0, 5.0 or 10.0 mg kg-1 d-1) and WPH (dose 0.5, 1.0 or 2.0 mg g-1 d-1) reversed behavioral dysfunctions, suppressed serum inflammatory cytokines (TNF-α, IL-6, IL-1β and IFN-γ), and reduced the activity of indoleamine 2,3-dioxygenase (key rate-limiting enzyme of the kynurenine pathway) while increasing the activity of tryptophan hydroxylase (key rate-limiting enzyme of the serotonin pathway) in the hypothalamus, hippocampus and prefrontal cortex, with EW acting more effectively. EW could also increase body weight gain and might act more effectively via the kynurenine pathway. These findings are of significance to promote the future practical application of kokumi γ-[Glu]n-Trp peptides.
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Affiliation(s)
- Xiping Zhu
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China.
| | - Qian Tao
- Infinitus, (China) Co., Ltd., Guangzhou 510640, China
| | - Dongxiao Sun-Waterhouse
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China.
| | - Wenzhi Li
- Infinitus, (China) Co., Ltd., Guangzhou 510640, China
| | - Shuo Liu
- Infinitus, (China) Co., Ltd., Guangzhou 510640, China
| | - Chun Cui
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China.
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Selective effects of acute low-grade inflammation on human visual attention. Neuroimage 2019; 202:116098. [PMID: 31415883 DOI: 10.1016/j.neuroimage.2019.116098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/04/2019] [Accepted: 08/11/2019] [Indexed: 12/20/2022] Open
Abstract
Illness is often accompanied by perceived cognitive sluggishness, a symptom that may stem from immune system activation. The current study used electroencephalography (EEG) to assess how inflammation affected three different distinct attentional processes: alerting, orienting and executive control. In a double-blinded placebo-controlled within-subjects design (20 healthy males, mean age = 24.5, SD = 3.4), Salmonella typhoid vaccination (0.025 mg; Typhim Vi, Sanofi Pasteur) was used to induce transient mild inflammation, while a saline injection served as a placebo-control. Participants completed the Attention Network Test with concurrent EEG recorded 6 h post-injection. Analyses focused on behavioral task performance and on modulation of oscillatory EEG activity in the alpha band (9-12 Hz) for alerting as well as orienting attention and frontal theta band (4-8 Hz) for executive control. Vaccination induced mild systemic inflammation, as assessed by interleukin-6 (IL-6) levels. While no behavioral task performance differences between the inflammation and placebo condition were evident, inflammation caused significant alterations to task-related brain activity. Specifically, inflammation produced greater cue-induced suppression of alpha power in the alerting aspect of attention and individual variation in the inflammatory response was significantly correlated with the degree of alpha power suppression. Notably, inflammation did not affect orienting (i.e., alpha lateralization) or executive control (i.e., frontal theta activity). These results reveal a unique neurophysiological sensitivity to acute mild inflammation of the neural network that underpins attentional alerting functions. Observed in the absence of performance decrements, these novel findings suggest that acute inflammation requires individuals to exert greater cognitive effort when preparing for a task in order to maintain adequate behavioral performance.
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Carboni L, McCarthy DJ, Delafont B, Filosi M, Ivanchenko E, Ratti E, Learned SM, Alexander R, Domenici E. Biomarkers for response in major depression: comparing paroxetine and venlafaxine from two randomised placebo-controlled clinical studies. Transl Psychiatry 2019; 9:182. [PMID: 31375659 PMCID: PMC6677721 DOI: 10.1038/s41398-019-0521-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/19/2019] [Accepted: 06/20/2019] [Indexed: 02/08/2023] Open
Abstract
The identification of biomarkers of response might speed drug development and set the premises to assist clinical practice in psychiatry. In this work, we evaluated a panel of peripheral biomarkers (including IL-6, IL-10, TNF-α, TNFRII, BDNF, CRP, MMP9 and PAI1) in depressed patients receiving paroxetine, venlafaxine, or placebo. Samples were obtained from two randomised placebo-controlled studies evaluating the efficacy and tolerability of a novel drug candidate, using either paroxetine or venlafaxine as active comparators. In both studies, the biomarker candidates were analysed in plasma collected at randomization and after 10 weeks of treatment with either placebo or active comparator (for a total of 106 and 108 subjects in the paroxetine and venlafaxine study, respectively). Data were obtained by multiplexing sandwich-ELISA system. Data were subjected to statistical analysis to assess their correlation with baseline severity and with response outcome. Increases in biomarker levels were correlated with reduction in depression severity for TNF-α, IL-6 IL-10 and CRP. Response to paroxetine treatment correlated with baseline IL-10, IL-6 and TNF-α levels, with the strongest signal being observed in males. In the venlafaxine study, a correlation was observed only between CRP level at randomisation and response, suggesting differences between the two active treatments and the two studies. Our investigations suggest that a combination of pro- and anti-inflammatory cytokines may predict response outcome in patients treated with paroxetine. The potential for IL-10, IL-6 and TNF-α as response biomarkers for a wider range of antidepressants warrants further investigations in clinical trials with other monoamine reuptake inhibitors.
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Affiliation(s)
- Lucia Carboni
- 0000 0004 1757 1758grid.6292.fDepartment of Pharmacy and Biotechnology, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Dennis J. McCarthy
- Indipendent Consultant, Clinical Pharmacology and Translational Science, Newark, DE USA
| | | | - Michele Filosi
- 0000 0004 1937 0351grid.11696.39Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | | | - Emiliangelo Ratti
- 0000 0004 0447 7762grid.419849.9Neuroscience Therapeutic Area Unit, Takeda, Boston, MA USA
| | - Susan M. Learned
- grid.504165.3Global Medicines Development, Indivior, Inc., Richmond, VA USA
| | - Robert Alexander
- 0000 0004 0447 7762grid.419849.9Neuroscience Therapeutic Area Unit, Takeda, Boston, MA USA
| | - Enrico Domenici
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy. .,Fondazione The Microsoft Research-University of Trento Centre for Computational and Systems Biology (COSBI), Rovereto, TN, Italy.
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Trojan E, Chamera K, Bryniarska N, Kotarska K, Leśkiewicz M, Regulska M, Basta-Kaim A. Role of Chronic Administration of Antidepressant Drugs in the Prenatal Stress-Evoked Inflammatory Response in the Brain of Adult Offspring Rats: Involvement of the NLRP3 Inflammasome-Related Pathway. Mol Neurobiol 2019; 56:5365-5380. [PMID: 30610610 PMCID: PMC6614144 DOI: 10.1007/s12035-018-1458-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/17/2018] [Indexed: 12/24/2022]
Abstract
Evidence indicates that adverse experiences in early life may be a factor for immune disturbances leading to the depression in adulthood. Recently, a pivotal role in the pathogenesis of depression has been assigned to the activation of the brain Nod-like receptor pyrin-containing 3 (NLRP3) inflammasome. We investigated the impact of chronic treatment with antidepressant drugs on the behavioral disturbances and the levels of proinflammatory factors in the hippocampus and frontal cortex of adult male rats after prenatal stress exposure. Next, we explored the involvement of the NLRP3 inflammasome-related pathways in the mechanism of antidepressant action. Our study confirmed that chronic antidepressant treatment attenuated depression-like disturbances and exerted an anxiolytic action. All antidepressants diminished the prenatal stress-induced increase in IL-1β in both brain areas, while IL-18 only in the hippocampus. Moreover, tianeptine administration diminished the increase in CCR2 levels in both brain areas, while in the hippocampus, tianeptine, along with venlafaxine CCL2 and iNOS levels. Next, we observed that in the hippocampus, tianeptine and fluoxetine suppressed upregulation of TLR4. Furthermore, venlafaxine suppressed NFкB p65-subunit phosphorylation, while fluoxetine enhanced the IкB level. Importantly, in the hippocampus, all antidepressants normalized evoked by stress changes in caspase-1 level, while tianeptine and venlafaxine also affect the levels of ASC and NLRP3 subunits. Our results provide new evidence that chronic administration of antidepressants exerts anti-inflammatory effects more pronounced in the hippocampus, through suppression of the NLRP3 inflammasome activation. These effects are accompanied by an improvement in the behavioral dysfunctions evoked by prenatal stress.
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Affiliation(s)
- Ewa Trojan
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smętna St., 31-343, Kraków, Poland
| | - Katarzyna Chamera
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smętna St., 31-343, Kraków, Poland
| | - Natalia Bryniarska
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smętna St., 31-343, Kraków, Poland
| | - Katarzyna Kotarska
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smętna St., 31-343, Kraków, Poland
| | - Monika Leśkiewicz
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smętna St., 31-343, Kraków, Poland
| | - Magdalena Regulska
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smętna St., 31-343, Kraków, Poland
| | - Agnieszka Basta-Kaim
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smętna St., 31-343, Kraków, Poland.
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Novel Treatment Targets Based on Insights in the Etiology of Depression: Role of IL-6 Trans-Signaling and Stress-Induced Elevation of Glutamate and ATP. Pharmaceuticals (Basel) 2019; 12:ph12030113. [PMID: 31362361 PMCID: PMC6789839 DOI: 10.3390/ph12030113] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/10/2019] [Accepted: 07/26/2019] [Indexed: 12/11/2022] Open
Abstract
Inflammation and psychological stress are risk factors for major depression and suicide. Both increase central glutamate levels and activate the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Both factors also affect the function of the chloride transporters, Na-K-Cl-cotransporter-1 (NKCC1) and K-Cl-cotransporter-2 (KCC2), and provoke interleukin-6 (IL-6) trans-signaling. This leads to measurable increases in circulating corticosteroids, catecholamines, anxiety, somatic and psychological symptoms, and a decline in cognitive functions. Recognition of the sequence of pathological events allows the prediction of novel targets for therapeutic intervention. Amongst others, these include blockade of the big-K potassium channel, blockade of the P2X4 channel, TYK2-kinase inhibition, noradrenaline α2B-receptor antagonism, nicotinic α7-receptor stimulation, and the Sgp130Fc antibody. A better understanding of downstream processes evoked by inflammation and stress also allows suggestions for tentatively better biomarkers (e.g., SERPINA3N, MARCKS, or 13C-tryptophan metabolism).
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Lisitsyna TA, Veltishchev DY, Lila AM, Nasonov EL. Interleukin 6 as a pathogenic factor mediating clinical manifestations and a therapeutic target for rheumatic diseases and depressive disorders. RHEUMATOLOGY SCIENCE AND PRACTICE 2019. [DOI: 10.14412/1995-4484-2019-318-327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The review summarizes current idea on the key role of interleukin 6 (IL-6) in the pathogenesis of rheumatic diseases (RDs) and depressive disorders. It considers in detail the mechanisms by which IL6 induces the clinical and laboratory manifestations of RDs and depression; the influence of precipitating and predisposing stress factors, including childhood mental traumas, which increase the risk of RDs and depression, on IL-6 production. Particular attention is paid to the consideration of prospects for using IL-6 inhibitors in the therapy of depression.
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Affiliation(s)
| | - D. Yu. Veltishchev
- Moscow Research Institute of Psychiatry, Branch, V.P. Serbsky National Medical Research Center of Psychiatry and Narcology, Ministry of Health of Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
| | - A. M. Lila
- V.A. Nasonova Research Institute of Rheumatology
| | - E. L. Nasonov
- V.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
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Grygiel-Górniak B, Limphaibool N, Puszczewicz M. Cytokine secretion and the risk of depression development in patients with connective tissue diseases. Psychiatry Clin Neurosci 2019; 73:302-316. [PMID: 30719813 DOI: 10.1111/pcn.12826] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/16/2019] [Accepted: 02/01/2019] [Indexed: 12/14/2022]
Abstract
Research in the past two decades has revolutionized our understanding of depressive illnesses. Proinflammatory cytokines have become a point of interest in the interconnecting areas of neuropsychiatric and autoimmune diseases. The cytokine hypothesis of depression suggests that pro-inflammatory cytokines play a primary role in the mediation of the pathophysiological characteristics of major depression, in which an inflammatory process may be induced by external and internal stressors, such as psychological and inflammatory diseases, respectively. The higher prevalence of depression, particularly in patients with chronic autoimmune connective tissue disorders (CTD), suggests that depression may present a dysfunctional adaptation of cytokine-induced sickness, which could manifest in times of an exacerbated activation of the innate immune system. Inflammation is thought to contribute to the development of clinical depression through its ability to induce sickness behaviors corresponding to the neurovegetative features of depression, through the dysregulation of the hypothalamic-pituitary-adrenal axis, alterations in neurotransmitter synthesis and reuptake, and through its involvement in the neuroprogression pathways. This review explores the complex interrelationships in which inflammatory responses alter neuroendocrine and neuropsychological regulation contributing to depressive symptoms in CTD. The prevalence and characteristics of depression, and its correlation to the levels of inflammatory cytokines and disease activity among different CTD will be reviewed.
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Affiliation(s)
- Bogna Grygiel-Górniak
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Nattakarn Limphaibool
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Mariusz Puszczewicz
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
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NPY Receptor 2 Mediates NPY Antidepressant Effect in the mPFC of LPS Rat by Suppressing NLRP3 Signaling Pathway. Mediators Inflamm 2019; 2019:7898095. [PMID: 31736656 PMCID: PMC6815592 DOI: 10.1155/2019/7898095] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/28/2019] [Indexed: 01/13/2023] Open
Abstract
Accumulated evidences show that neuroinflammation play a pivotal role in the pathogenesis of depression. Neuropeptide Y (NPY) and its receptors have been demonstrated to have anti-inflammative as well as antidepressant effects. In the present study, the ability of NPY to modulate depressive-like behaviors induced by lipopolysaccharides (LPS) in rats and the receptors and signaling mechanisms involved were investigated. Continuous injection LPS (i.p) for 4 days led to development of depressive-like behaviors in rats, accompanied with M1-type microglia activation and increased levels of IL-1β as well as decreased levels of NPY and Y2R expression in the mPFC selectively. Local injection of NPY into the medial prefrontal cortex (mPFC) ameliorated the depression-like behaviors and suppressed the NLRP3 inflammasome signaling pathway. Y2R agonist PYY (3-36) mimicked and Y2R antagonist BIIE0246 abolished the NPY effects in the mPFC. All these results suggest that NPY and Y2R in the mPFC are involved in the pathophysiology of depression and NPY plays an antidepressant role in the mPFC mainly via Y2R, which suppresses the NLRP3 signaling pathway, in LPS-induced depression model rats.
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Milenkovic VM, Stanton EH, Nothdurfter C, Rupprecht R, Wetzel CH. The Role of Chemokines in the Pathophysiology of Major Depressive Disorder. Int J Mol Sci 2019; 20:E2283. [PMID: 31075818 PMCID: PMC6539240 DOI: 10.3390/ijms20092283] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 12/19/2022] Open
Abstract
Major depressive disorder (MDD) is a debilitating condition, whose high prevalence and multisymptomatic nature set its standing as a leading contributor to global disability. To better understand this psychiatric disease, various pathophysiological mechanisms have been proposed, including changes in monoaminergic neurotransmission, imbalance of excitatory and inhibitory signaling in the brain, hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, and abnormalities in normal neurogenesis. While previous findings led to a deeper understanding of the disease, the pathogenesis of MDD has not yet been elucidated. Accumulating evidence has confirmed the association between chronic inflammation and MDD, which is manifested by increased levels of the C-reactive protein, as well as pro-inflammatory cytokines, such as Interleukin 1 beta, Interleukin 6, and the Tumor necrosis factor alpha. Furthermore, recent findings have implicated a related family of cytokines with chemotactic properties, known collectively as chemokines, in many neuroimmune processes relevant to psychiatric disorders. Chemokines are small (8-12 kDa) chemotactic cytokines, which are known to play roles in direct chemotaxis induction, leukocyte and macrophage migration, and inflammatory response propagation. The inflammatory chemokines possess the ability to induce migration of immune cells to the infection site, whereas their homeostatic chemokine counterparts are responsible for recruiting cells for their repair and maintenance. To further support the role of chemokines as central elements to healthy bodily function, recent studies suggest that these proteins demonstrate novel, brain-specific mechanisms including the modulation of neuroendocrine functions, chemotaxis, cell adhesion, and neuroinflammation. Elevated levels of chemokines in patient-derived serum have been detected in individuals diagnosed with major depressive disorder, bipolar disorder, and schizophrenia. Furthermore, despite the considerable heterogeneity of experimental samples and methodologies, existing biomarker studies have clearly demonstrated the important role of chemokines in the pathophysiology of psychiatric disorders. The purpose of this review is to summarize the data from contemporary experimental and clinical studies, and to evaluate available evidence for the role of chemokines in the central nervous system (CNS) under physiological and pathophysiological conditions. In light of recent results, chemokines could be considered as possible peripheral markers of psychiatric disorders, and/or targets for treating depressive disorders.
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Affiliation(s)
- Vladimir M Milenkovic
- Department of Psychiatry and Psychotherapy, Molecular Neurosciences, University of Regensburg, D-93053 Regensburg, Germany.
| | - Evan H Stanton
- Department of Psychiatry and Psychotherapy, Molecular Neurosciences, University of Regensburg, D-93053 Regensburg, Germany.
| | - Caroline Nothdurfter
- Department of Psychiatry and Psychotherapy, Molecular Neurosciences, University of Regensburg, D-93053 Regensburg, Germany.
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, Molecular Neurosciences, University of Regensburg, D-93053 Regensburg, Germany.
| | - Christian H Wetzel
- Department of Psychiatry and Psychotherapy, Molecular Neurosciences, University of Regensburg, D-93053 Regensburg, Germany.
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Zhang J, Yue Y, Thapa A, Fang J, Zhao S, Shi W, Yang Z, Li Y, Yuan Y. Baseline serum C-reactive protein levels may predict antidepressant treatment responses in patients with major depressive disorder. J Affect Disord 2019; 250:432-438. [PMID: 30878656 DOI: 10.1016/j.jad.2019.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/15/2019] [Accepted: 03/03/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Inflammation has been shown previously to predict antidepressant treatment response. This retrospective study was conducted to test if the baseline serum C-reactive protein (CRP) levels could predict antidepressant treatment responses in a Chinese sample. METHODS 75 adult inpatients (26 male, 49 female) with major depressive disorder (MDD) diagnosed according to DSM-5 were included in this study. Sociodemographic and clinical features, baseline CRP levels, 17-item Hamilton Depression Rating Scale (HDRS-17) and Hamilton Anxiety Rating Scale (HARS) scores assessed at baseline and weeks 1, 2, 3 and 4 were then collected. Afterwards patients were divided into two groups: the low CRP group (baseline CRP < 1 mg/L, n = 47) and the high CRP group (baseline CRP ≥ 1 mg/L, n = 28). Depression severity and treatment response were compared between the two groups. RESULTS Repeated-measures ANOVA showed a significant group * assessments interaction in HDRS-17 scores (F = 4.754; p = 0.005). Post-hoc test showed that the two groups differed in HDRS-17 scores at week 4 (F = 6.698; p = 0.012), with the low CRP group having lower HDRS-17 scores than the high CRP group. Moreover, the low CRP group exhibited higher percent reduction in HDRS-17 scores at week 3 (F = 5.016; p = 0.028) and week 4 (F = 9.865; p = 0.003) as compared to the high CRP group. Cox proportional hazard model showed that the remission rate was higher in the low CRP group (p = 0.010). LIMITATIONS Patients received uncontrolled antidepressant therapy and the sample size was limited. CONCLUSIONS Baseline serum CRP levels may predict antidepressant treatment responses in patients with MDD and patients with higher levels of CRP were less likely to get remission.
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Affiliation(s)
- Jun Zhang
- Department of Clinical Psychology, Changshu Third People's Hospital, Changshu Mental Health Center, Changshu, China, 215500
| | - Yingying Yue
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China, 210009
| | - Ashok Thapa
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China, 210009
| | - Jianzhong Fang
- Department of Clinical Psychology, Changshu Third People's Hospital, Changshu Mental Health Center, Changshu, China, 215500
| | - Shengjun Zhao
- Department of Clinical Psychology, Changshu Third People's Hospital, Changshu Mental Health Center, Changshu, China, 215500
| | - Weihua Shi
- Department of Clinical Psychology, Changshu Third People's Hospital, Changshu Mental Health Center, Changshu, China, 215500
| | - Zhong Yang
- Department of Clinical Psychology, Changshu Third People's Hospital, Changshu Mental Health Center, Changshu, China, 215500
| | - Yanfang Li
- Department of Information, Changshu Third People's Hospital, Changshu Mental Health Center, Changshu, China, 215500
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China, 210009.
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Mazza MG, Tringali AGM, Rossetti A, Botti RE, Clerici M. Cross-sectional study of neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratios in mood disorders. Gen Hosp Psychiatry 2019; 58:7-12. [PMID: 30818102 DOI: 10.1016/j.genhosppsych.2019.02.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Neutrophil-lymphocyte, monocyte-lymphocyte and platelet-lymphocyte ratio are inexpensive and reproducible biomarkers of inflammation found to be elevated in mood disorders. This study aimed to compare inflammatory ratios between bipolar disorder and major depressive disorder and between bipolar disorder manic episodes and bipolar disorder depressive episodes. METHOD We included 142 Caucasian patients (major depressive disorder: n = 36; bipolar disorder manic episode: n = 66; bipolar disorder depressive episode: n = 40). We measured white blood cells, neutrophils, lymphocytes, monocytes, platelets, glucose, and total cholesterol. Neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio were calculated. RESULTS Neutrophil-lymphocyte ratio and monocyte-lymphocyte ratio were significantly higher in bipolar disorder manic episodes when compared to bipolar disorder depressive episodes and major depressive disorder episodes after adjustment for age, sex, body mass index, and smoking. CONCLUSION To our knowledge, our study is the first one to compare inflammatory ratios between different bipolar disorder phases and major depressive disorder episodes. In accord with previous studies on other inflammatory mediators, we found higher neutrophil-lymphocyte and monocyte-lymphocyte ratios in bipolar manic episodes, suggesting that inflammatory changes occur especially during acute episodes of mania.
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Affiliation(s)
- Mario Gennaro Mazza
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, MB, Italy.
| | | | - Aurora Rossetti
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, MB, Italy
| | | | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, MB, Italy
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80
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Xu Y, Wei H, Zhu Y, Zhu Y, Zhang N, Qin J, Zhu X, Yu M, Li Y. Potential serum biomarkers for the prediction of the efficacy of escitalopram for treating depression. J Affect Disord 2019; 250:307-312. [PMID: 30875673 DOI: 10.1016/j.jad.2019.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/03/2019] [Accepted: 03/03/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although several pharmacological treatment options for depression are currently available, a large proportion of patients still do not achieve a complete remission or respond adequately to the initial antidepressant prescribed for reasons that remain relatively unknown. This study explored the application of serum biomarkers to the predict the efficacy of escitalopram for treating depression, to guide clinical drug selection. METHOD In this study, 306 patients suffering from depression were treated with escitalopram (10 mg) for 6 weeks. After 6 weeks of treatment, the patients were divided into an escitalopram-sensitive group (ES, n = 172) and an escitalopram-insensitive group (EIS, n = 134) according their HAMD-24 scores after 6 weeks of treatment. Serum samples from all participants were collected on the first day, and 10 different serum biomarkers were analysed. Data from 100 patients in the ES group and 100 patients in the EIS group were then used to build a logistic regression model, and a receiver operating characteristic (ROC) curve was drawn. To validate the accuracy of our model, another 72 patients in the ES group and 34 patients in the EIS group were studied. RESULTS Of the 10 selected serum biomarkers, 4 were screened to build the regression model. BDNF, FGF-2, TNF-α and 5-HT. The regression equation was Z = 1/[1 + e-(-5.065+0.145 (BDNF)+0.029 (FGF-2)-0.368 (TNF-α)+0.813 (5-HT))], and the 4 biomarkers-combined detection achieved an AUC (area under the ROC curve) of 0.929 and a predictive accuracy of 88.70%. LIMITATION Decision support tools based on our combined biomarker prediction models hold comparatively great promises; however, they need to be validated on a much larger scales than current studies provide. CONCLUSION The logistic regression model and ROC curves based of the serum biomarkers used in this study provide a more reliable means to predict the efficacy of escitalopram in patients with depression, and provide clinical evidence for drug selection.
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Affiliation(s)
- Yuhao Xu
- Department of Neurology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China; Department of Neuroimaging laboratory, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Hong Wei
- Department of Neurology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China; Department of Neuroimaging laboratory, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Yuanyuan Zhu
- Department of Neurology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China; Department of Neuroimaging laboratory, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Yan Zhu
- Department of Radiology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China; Department of Neuroimaging laboratory, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Ningning Zhang
- Department of Radiology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China; Department of Neuroimaging laboratory, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Jiasheng Qin
- Department of Radiology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China; Department of Neuroimaging laboratory, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Xiaolan Zhu
- Department of Central Laboratory, The Fourth Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China.
| | - Ming Yu
- Department of Neurology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China.
| | - Yuefeng Li
- Department of Radiology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China; Department of Neuroimaging laboratory, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, China; Department of Central Laboratory, The Fourth Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China.
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Niraula A, Witcher KG, Sheridan JF, Godbout JP. Interleukin-6 Induced by Social Stress Promotes a Unique Transcriptional Signature in the Monocytes That Facilitate Anxiety. Biol Psychiatry 2019; 85:679-689. [PMID: 30447911 PMCID: PMC6440848 DOI: 10.1016/j.biopsych.2018.09.030] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Interleukin-6 (IL-6) is elevated in circulation with chronic stress and may contribute to neurobehavioral complications. We have reported that repeated social defeat stress in mice caused recruitment of proinflammatory monocytes to the brain and triggered the onset of anxiety-like behavior. Therefore, the purpose of this study was to determine the role of IL-6 signaling in the peripheral immune response, neuroinflammation, and anxiety following stress. METHODS Wild-type and IL-6 knockout mice were subjected to repeated social defeat, and immune and behavioral parameters were determined 14 hours later. RESULTS Although monocyte release and recruitment to the brain during stress were maintained in the IL-6 knockout mice, anxiety and social avoidance were prevented. NanoString analysis of fluorescence-activated cell-sorted blood monocytes (CD11b+/Ly6Chi) and brain monocytes (CD11b+/CD45hi) revealed a unique pattern of immune-related gene expression that was dependent on stress and IL-6. For instance, blood monocytes after stress had a transcriptional signature and immune profile consistent with priming, which was attenuated in monocytes from IL-6 knockout stress mice. Moreover, the monocytes recruited to the brain and associated with the development of anxiety had a transcriptional signature (enhanced IL-1β, CD14, Mmp9, Myd88, Ager, and Stat3) that was dependent on IL-6. CONCLUSIONS Here, we show the effects of IL-6 on the transcriptional signature of monocytes in circulation and brain after stress. Overall, robust increases in IL-6 after stress induced a primed profile in monocytes that were recruited to the brain and propagated IL-1-mediated inflammation and anxiety.
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Affiliation(s)
- Anzela Niraula
- Division of Biosciences, The Ohio State University, Columbus, Ohio; Department of Neuroscience, The Ohio State University, Columbus, Ohio; Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio
| | - Kristina G Witcher
- Division of Biosciences, The Ohio State University, Columbus, Ohio; Department of Neuroscience, The Ohio State University, Columbus, Ohio; Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio
| | - John F Sheridan
- Division of Biosciences, The Ohio State University, Columbus, Ohio; Department of Neuroscience, The Ohio State University, Columbus, Ohio; Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio; Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, Ohio.
| | - Jonathan P Godbout
- Division of Biosciences, The Ohio State University, Columbus, Ohio; Department of Neuroscience, The Ohio State University, Columbus, Ohio; Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio; Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, Ohio.
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82
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Peripheral blood lymphocyte subpopulations in patients with bipolar disorder type II. Sci Rep 2019; 9:5869. [PMID: 30971748 PMCID: PMC6458153 DOI: 10.1038/s41598-019-42482-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/02/2019] [Indexed: 12/17/2022] Open
Abstract
We investigated the phenotype of peripheral blood lymphocytes of patients with bipolar disorder type II in different phases of the disease in order to check whether there are specific changes in the immune parameters. Lymphocytes subpopulations were analyzed ex vivo with flow cytometry in patients in euthymic, depression or hypomanic phase of the disease and compared with healthy controls. All BD patients were characterized by lower percentage of CD3+CD4+ and CD3+CD8+ cells compared with healthy people. But only patients in depression and remission had higher percentage of B cells (CD19+ cells) compared with healthy people. The percentage of CD4+CD25+ and CD8+CD25+ cells was decreased in patients in hypomanic phase compared with healthy control. Patients in remission were characterized by increased concentrations of IL-6 and IL-10 and decreased level of TNF in blood serum. Significant correlations between immunologic parameters and the results of Hamilton or Young scale have also been found. Our results demonstrate that there are significant differences in lymphocyte subpopulations which depend on the phase of the disease the patient is currently in.
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83
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Druzhkova T, Pochigaeva K, Yakovlev A, Kazimirova E, Grishkina M, Chepelev A, Guekht A, Gulyaeva N. Acute stress response to a cognitive task in patients with major depressive disorder: potential metabolic and proinflammatory biomarkers. Metab Brain Dis 2019; 34:621-629. [PMID: 30564974 DOI: 10.1007/s11011-018-0367-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023]
Abstract
Responses of the hypothalamic-pituitary-adrenal axis (HPAA), immune system and metabolic pathways are involved in adaptation to stress, while alterations in these responses have been implicated in the development of major depressive disorder (MDD). Multiple laboratory indices are known to react in response to the acute stress, however, no valid biomarkers have been reported, which can differentiate stress response in depressed individuals. The aim of this study was to assess changes in a set of laboratory parameters in patients with MDD in response to a moderate mental stress and to find potential markers of altered stress reactivity associated with depression. A group of 33 MDD patients and 43 control subjects underwent clinical evaluation to assess depression and anxiety symptoms, as well as heart rate variability (HRV) analysis. Participants were asked to perform a time constrained cognitive task, and selected hormones (cortisol, ACTH), cytokines (IL-6, IL-1β, TNF-α), neurotrophic factors (BDNF, CNTF) and metabolic parameters (glucose, cholesterol, triglycerides) were measured before and 60 min after the task performance. HRV analysis showed increased sympathetic input in MDD patients. The MDD group manifested an elevated HPAA activity as well as IL-6 and CNTF levels at baseline. A specific stress-induced increase in glucose and TNF-α was revealed in the MDD group, which was absent in control subjects. The data confirm the impairments of stress response in MDD and suggest that the reaction of simple metabolic and pro-inflammatory indices to a mild stressogenic challenge may be indicative of a depressive state.
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Affiliation(s)
- Tatiana Druzhkova
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Ksenia Pochigaeva
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Aleksander Yakovlev
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
- Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova street 5a, Moscow, Russian Federation, 117485
| | - Evdokia Kazimirova
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
- Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova street 5a, Moscow, Russian Federation, 117485
| | - Maria Grishkina
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Aleksey Chepelev
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Alla Guekht
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Natalia Gulyaeva
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation.
- Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova street 5a, Moscow, Russian Federation, 117485.
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84
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Liao JF, Hsu CC, Chou GT, Hsu JS, Liong MT, Tsai YC. Lactobacillus paracasei PS23 reduced early-life stress abnormalities in maternal separation mouse model. Benef Microbes 2019; 10:425-436. [PMID: 30882243 DOI: 10.3920/bm2018.0077] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Maternal separation (MS) has been developed as a model for inducing stress and depression in studies using rodents. The concept of the gut-brain axis suggests that gut health is essential for brain health. Here, we present the effects of administration of a probiotic, Lactobacillus paracasei PS23 (PS23), to MS mice against psychological traits including anxiety and depression. The administration of live and heat-killed PS23 cells showed positive behavioural effects on MS animals, where exploratory tendencies and mobility were increased in behavioural tests, indicating reduced anxiety and depression compared to the negative control mice (P<0.05). Mice administered with both live and heat-killed PS23 cells also showed lower serum corticosterone levels accompanied by higher serum anti-inflammatory interleukin 10 (IL-10) levels, compared to MS separated mice (P<0.05), indicating a stress-elicited response affiliated with increased immunomodulatory properties. Assessment of neurotransmitters in the brain hippocampal region revealed that PS23 affected the concentrations of dopaminergic metabolites differently than the control, suggesting that PS23 may have improved MS-induced stress levels via neurotransmitter pathways, such as dopamine or other mechanisms not addressed in the current study. Our study illustrates the potential of a probiotic in reversing abnormalities induced by early life stress and could be an alternative for brain health along the gut-brain axis.
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Affiliation(s)
- J F Liao
- 1 Institute of Biochemistry and Molecular Biology, National Yang-Ming University, No.155, Sec.2, Linong Street, Beitou Dist., Taipei 11221, Taiwan ROC
| | - C C Hsu
- 2 Bened Biomedical Co., Ltd., 2F-2, No.129, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei 10448, Taiwan ROC
| | - G T Chou
- 1 Institute of Biochemistry and Molecular Biology, National Yang-Ming University, No.155, Sec.2, Linong Street, Beitou Dist., Taipei 11221, Taiwan ROC
| | - J S Hsu
- 2 Bened Biomedical Co., Ltd., 2F-2, No.129, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei 10448, Taiwan ROC
| | - M T Liong
- 3 School of Industrial Technology, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - Y C Tsai
- 4 Microbiome Research Center, National Yang-Ming University, No.155, Sec.2, Linong Street, Beitou Dist., Taipei 11221, Taiwan ROC
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85
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Feng M, Crowley NA, Patel A, Guo Y, Bugni SE, Luscher B. Reversal of a Treatment-Resistant, Depression-Related Brain State with the Kv7 Channel Opener Retigabine. Neuroscience 2019; 406:109-125. [PMID: 30858110 DOI: 10.1016/j.neuroscience.2019.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 12/27/2022]
Abstract
Neuroinflammation is associated with increased vulnerability to diverse psychiatric conditions, including treatment-resistant major depressive disorder (MDD). Here we assessed whether high fat diet (HFD) induced neuroinflammation may be suitable to model a treatment-resistant depressive-like brain state in mice. Male and female mice were fed a HFD for 18 weeks, followed by quantitation of glucose tolerance, inflammatory markers of brain tissue (TNFα, IL-6, IL-1β, Iba-1), neural excitability in the prelimbic cortex (PLC), as well as assessment of emotional reactivity and hedonic behavior in a battery of behavioral tests. In addition, we assessed the behavioral responsiveness of mice to fluoxetine, desipramine, ketamine, and the Kv7 channel opener and anticonvulsant retigabine. HFD exposure led to glucose intolerance and neuroinflammation in male mice, with similar but non-significant trends in females. Neuroinflammation of males was associated with anxious-depressive-like behavior and defects in working memory, along with neural hyperexcitability and increased Ih currents of pyramidal cells in the PLC. The behavioral changes were largely resistant to chronic treatment with fluoxetine and desipramine, as well as ketamine. By contrast, retigabine (also known as ezogabine) normalized neural excitability and Ih currents recorded from slices of HFD-treated animals and significantly ameliorated most of the behavioral impairments, without effects in control diet exposed animals. Thus, treatment resistant depressive-like brain states that are associated with chronic neuroinflammation may involve hyperexcitability of pyramidal neurons and may be effectively treated by retigabine.
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Affiliation(s)
- Mengyang Feng
- Department of Biology, Pennsylvania State University, University Park, PA 16802; Center for Molecular Investigation of Neurological Disorders (CMIND), The Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802
| | - Nicole A Crowley
- Department of Biology, Pennsylvania State University, University Park, PA 16802; Center for Molecular Investigation of Neurological Disorders (CMIND), The Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802
| | - Akshilkumar Patel
- Department of Biology, Pennsylvania State University, University Park, PA 16802; Center for Molecular Investigation of Neurological Disorders (CMIND), The Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802
| | - Yao Guo
- Department of Biology, Pennsylvania State University, University Park, PA 16802; Center for Molecular Investigation of Neurological Disorders (CMIND), The Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802
| | - Sierra E Bugni
- Department of Biology, Pennsylvania State University, University Park, PA 16802; Center for Molecular Investigation of Neurological Disorders (CMIND), The Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802
| | - Bernhard Luscher
- Department of Biology, Pennsylvania State University, University Park, PA 16802; Department of Biochemistry & Molecular Biology, Pennsylvania State University, University Park, PA 16802; Center for Molecular Investigation of Neurological Disorders (CMIND), The Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802.
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86
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Chu AL, Stochl J, Lewis G, Zammit S, Jones PB, Khandaker GM. Longitudinal association between inflammatory markers and specific symptoms of depression in a prospective birth cohort. Brain Behav Immun 2019; 76:74-81. [PMID: 30414442 PMCID: PMC6363967 DOI: 10.1016/j.bbi.2018.11.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Low-grade inflammation is associated with depression, but studies of specific symptoms are relatively scarce. Association between inflammatory markers and specific symptoms may provide insights into potential mechanism of inflammation-related depression. Using longitudinal data, we have tested whether childhood serum interleukin 6 (IL-6) and C-reactive protein (CRP) levels are associated with specific depressive symptoms in early adulthood. METHODS In the ALSPAC birth cohort, serum IL-6 and CRP levels were assessed at age 9 years and 19 depressive symptoms were assessed at age 18 years. We used modified Poisson generalised linear regression with robust error variance to estimate the risk ratio (RR) and 95% confidence interval (95% CI) for each depressive symptom. In addition, we used confirmatory factor analysis to create two continuous latent variables representing somatic/neurovegetative and psychological dimension scores. Structural equation modelling was used to test the associations between IL-6 and these dimension scores. RESULTS Based on data from 2731 participants, IL-6 was associated with diurnal mood variation, concentration difficulties, fatigue and sleep disturbances. The adjusted RRs for these symptoms at age 18 years for participants in top, compared with bottom, third of IL-6 at age 9 years were 1.75 (95% CI, 1.13-2.69) for diurnal mood variation, 1.50 (95% CI, 1.11-2.02) for concentration difficulties, 1.31 (95% CI, 1.12-1.54) for fatigue, and 1.24 (95% CI, 1.01-1.52) for sleep disturbances. At dimension level, IL-6 was associated with both somatic/neurovegetative (β = 0.059, SE = 0.024, P = 0.013) and psychological (β = 0.056, SE = 0.023, P = 0.016) scores. CONCLUSIONS Inflammation is associated with specific symptoms of depression. Associations with so-called somatic/neurovegetative symptoms of depression such as fatigue, sleep disturbances and diurnal mood variation indicate that these symptoms could be useful treatment targets and markers of treatment response in clinical trials of anti-inflammatory treatment for depression.
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Affiliation(s)
- Alexander L Chu
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jan Stochl
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Department of Kinanthropology, Charles University, Prague, Czech Republic
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Stan Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Peter B Jones
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Golam M Khandaker
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
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87
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Brás JP, Pinto S, Almeida MI, Prata J, von Doellinger O, Coelho R, Barbosa MA, Santos SG. Peripheral Biomarkers of Inflammation in Depression: Evidence from Animal Models and Clinical Studies. Methods Mol Biol 2019; 2011:467-492. [PMID: 31273717 DOI: 10.1007/978-1-4939-9554-7_28] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Depression is a highly prevalent psychiatric condition, with over 300 million sufferers, and is an important comorbidity for other conditions, like cardiovascular disorders or diabetes. Therapy is largely based on psychotherapy and/or pharmacological intervention, particularly aimed at altering neurotransmitter levels in the central nervous system, but inadequate response to treatment remains a significant clinical problem. Herein, evidence supporting a molecular link between inflammation and depression will be discussed, particularly the increased prevalence of depression in chronic inflammatory diseases and the evidence on the use of anti-inflammatory drugs to treat depression. Moreover, the potential for the levels of peripheral inflammatory molecules to act as depression biomarkers, in the diagnosis and monitoring of depression will be examined, considering clinical- and animal model-based evidence.
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Affiliation(s)
- J P Brás
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - S Pinto
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Centro Hospitalar Universitário São João, Porto, Portugal
| | - M I Almeida
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal
| | - J Prata
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Psychiatry and Mental Health, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - O von Doellinger
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Psychiatry and Mental Health, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - R Coelho
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Centro Hospitalar Universitário São João, Porto, Portugal
| | - M A Barbosa
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - S G Santos
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
- INEB-Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal.
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
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88
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Sethi R, Gómez-Coronado N, Walker AJ, Robertson OD, Agustini B, Berk M, Dodd S. Neurobiology and Therapeutic Potential of Cyclooxygenase-2 (COX-2) Inhibitors for Inflammation in Neuropsychiatric Disorders. Front Psychiatry 2019; 10:605. [PMID: 31551825 PMCID: PMC6738329 DOI: 10.3389/fpsyt.2019.00605] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 07/30/2019] [Indexed: 12/15/2022] Open
Abstract
Neuropsychiatric disorders, such as depression, bipolar disorder, schizophrenia, obsessive-compulsive disorder, and neurodevelopmental disorders such as autism spectrum disorder, are associated with significant illness burden. Accumulating evidence supports an association between these disorders and inflammation. Consequently, anti-inflammatory agents, such as the cyclooxygenase-2 inhibitors, represent a novel avenue to prevent and treat neuropsychiatric illness. In this paper, we first review the role of inflammation in psychiatric pathophysiology including inflammatory cytokines' influence on neurotransmitters, the hypothalamic-pituitary-adrenal axis, and microglial mechanisms. We then discuss how cyclooxygenase-2-inhibitors influence these pathways with potential therapeutic benefit, with a focus on celecoxib, due to its superior safety profile. A search was conducted in PubMed, Embase, and PsychINFO databases, in addition to Clinicaltrials.gov and the Stanley Medical Research Institute trial registries. The results were presented as a narrative review. Currently available outcomes for randomized controlled trials up to November 2017 are also discussed. The evidence reviewed here suggests cyclooxygenase-2 inhibitors, and in particular celecoxib, may indeed assist in treating the symptoms of neuropsychiatric disorders; however, further studies are required to assess appropriate illness stage-related indication.
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Affiliation(s)
- Rickinder Sethi
- Department of Psychiatry, Western University, London, ON, Canada
| | - Nieves Gómez-Coronado
- Unidad de Gestión Clinica Salud Mental, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Adam J Walker
- IMPACT Strategic Research Centre, Deakin University, Geelong, VIC, Australia
| | - Oliver D'Arcy Robertson
- IMPACT Strategic Research Centre, Deakin University, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Bruno Agustini
- IMPACT Strategic Research Centre, Deakin University, Geelong, VIC, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, Deakin University, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Seetal Dodd
- IMPACT Strategic Research Centre, Deakin University, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
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89
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Inflammatory Profiles in Depressed Adolescents Treated with Fluoxetine: An 8-Week Follow-up Open Study. Mediators Inflamm 2018; 2018:4074051. [PMID: 30662368 PMCID: PMC6312587 DOI: 10.1155/2018/4074051] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/30/2018] [Accepted: 08/28/2018] [Indexed: 12/17/2022] Open
Abstract
Changes in cytokine levels in major depression and during treatment have been reported in adults. However, few studies have examined cytokine levels in an adolescent sample despite this being a common age of onset. Methods. We measured proinflammatory (IL-2, IFN-γ, IL-1β, TNF-α, IL-6, IL-12, and IL-15) and anti-inflammatory (IL-4, IL-5, IL-13, IL-1Ra, and IL-10) cytokine serum levels in 22 adolescents with major depression and 18 healthy volunteers. Cytokines were measured by multiplex bead-based immunoassays at baseline, and 4 and 8 weeks after commencement of fluoxetine administration in the clinical group. Results. Compared to healthy volunteers, adolescents with major depression at baseline showed significant increases in all pro- and anti-inflammatory cytokines, except IL-1Ra and IL-10. Significant changes were observed in fluoxetine treatment compared to baseline: proinflammatory cytokines IFN-γ, IL-1β, TNF-α, IL-6, IL-12, and IL-15 were decreased only at week 4 whereas IL-2 was increased only at week 8; anti-inflammatory cytokines IL-4 and IL-5 were increased at week 8 while IL-1Ra was reduced only at week 4. There were no significant correlations between cytokine levels and symptomatic improvement in HDRS. Discussion. The results suggest a significant interplay between cytokine levels, the depressive state, and the stage of treatment with an SSRI. To the best of our knowledge, this is the first report in depressed adolescents with elevated IL-12, IL-13, and IL-15 levels. Further studies are necessary to clarify the role and mechanisms of altered cytokine levels in the pathogenesis and physiopathology of major depressive disorder.
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90
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Rengasamy M, McClain L, Gandhi P, Segreti AM, Brent D, Peters D, Pan L. Associations of plasma interleukin-6 with plasma and cerebrospinal fluid monoamine biosynthetic pathway metabolites in treatment-resistant depression. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.npbr.2018.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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91
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Qin Y, Wang N, Zhang X, Han X, Zhai X, Lu Y. IDO and TDO as a potential therapeutic target in different types of depression. Metab Brain Dis 2018; 33:1787-1800. [PMID: 30014175 DOI: 10.1007/s11011-018-0290-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/10/2018] [Indexed: 12/20/2022]
Abstract
Depression is highly prevalent worldwide and a leading cause of disabilty. However, the medications currently available to treat depression fail to adequately relieve depressive symptoms for a large number of patients. Research into the aberrant overactivation of the kynurenine pathway and the production of various active metabolites has brought new insight into the progression of depression. IDO and TDO are the first and rate-limiting enzymes in the kynurenine pathway and regulate the production of active metabolites. There is substantial evidence that TDO and IDO enzyme are activated during depression, and therefore, IDO and TDO inhibitors have been identified as ideal therapeutic targets for depressive disorder. Hence, this review will focus on the kynurenine branch of tryptophan metabolism and describe the role of IDO and TDO in the pathology of depression. In addition, this review will compare the relative imbalance between KYNA and neurotoxic kynurenine metabolites in different psychiatric disorders. Finally, this review is also directed toward assessing whether IDO and TDO are potential therapeutic target in depression associated with other diseases such as diabetes and/or cancer, as well as the development of potent IDO and TDO inhibitors.
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Affiliation(s)
- Yanjie Qin
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Nanxi Wang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xinlin Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xuemei Han
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xuejia Zhai
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Yongning Lu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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92
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Fan C, Song Q, Wang P, Li Y, Yang M, Liu B, Yu SY. Curcumin Protects Against Chronic Stress-induced Dysregulation of Neuroplasticity and Depression-like Behaviors via Suppressing IL-1β Pathway in Rats. Neuroscience 2018; 392:92-106. [DOI: 10.1016/j.neuroscience.2018.09.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 12/24/2022]
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93
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Abstract
Purpose of Review To update clinicians on the field of psychoneuroimmunology with respect to depression. Recent Findings A significant subset of patients with depression may have illness to which dysfunction of the immune system, typically viewed as inflammation, makes a significant contribution. Normal sickness behavior may sometimes manifest abnormally as mood episodes. Early evidence suggests that interventions that reduce inflammation may improve symptoms in these patients and that they may also respond differently to standard pharmacotherapy. Summary Treatment of patients with depression should consider inflammatory status, as part of medical and psychiatric health. Recommendations for healthy diet and exercise are important for all patients but may be more important for patients who have clinical evidence of inflammation. Methods of identifying patients in the inflammatory subgroup and treating them with therapy targeted specifically at the immune system are still experimental but likely to impact care for depression in the future.
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Affiliation(s)
- Marisa Toups
- University of Texas Dell Medical School, Department of Psychiatry, 1701 Trinity Street, Austin Tx 78712
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Balter LJT, Hulsken S, Aldred S, Drayson MT, Higgs S, Veldhuijzen van Zanten JJCS, Raymond JE, Bosch JA. Low-grade inflammation decreases emotion recognition - Evidence from the vaccination model of inflammation. Brain Behav Immun 2018; 73:216-221. [PMID: 29742460 DOI: 10.1016/j.bbi.2018.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 12/11/2022] Open
Abstract
The ability to adequately interpret the mental state of another person is key to complex human social interaction. Recent evidence suggests that this ability, considered a hallmark of 'theory of mind' (ToM), becomes impaired by inflammation. However, extant supportive empirical evidence is based on experiments that induce not only inflammation but also induce discomfort and sickness, factors that could also account for temporary social impairment. Hence, an experimental inflammation manipulation was applied that avoided this confound, isolating effects of inflammation and social interaction. Forty healthy male participants (mean age = 25, SD = 5 years) participated in this double-blind placebo-controlled crossover trial. Inflammation was induced using Salmonella Typhi vaccination (0.025 mg; Typhim Vi, Sanofi Pasteur, UK); saline-injection was used as a control. About 6 h 30 m after injection in each condition, participants completed the Reading the Mind in the Eyes Test (RMET), a validated test for assessing how well the mental states of others can be inferred through observation of the eyes region of the face. Vaccination induced systemic inflammation, elevating IL-6 by +419% (p < .001), without fever, sickness symptoms (e.g., nausea, light-headedness), or mood changes (all p's > .21). Importantly, compared to placebo, vaccination significantly reduced RMET accuracy (p < .05). RMET stimuli selected on valence (positive, negative, neutral) provided no evidence of a selective impact of treatment. By utilizing an inflammation-induction procedure that avoided concurrent sicknesses or symptoms in a double-blinded design, the present study provides further support for the hypothesis that immune activation impairs ToM. Such impairment may provide a mechanistic link explaining social-cognitive deficits in psychopathologies that exhibit low-grade inflammation, such as major depression.
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Affiliation(s)
- Leonie J T Balter
- School of Psychology, University of Birmingham, Birmingham, UK; Psychology Department, Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Sasha Hulsken
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Psychology Department, Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Sarah Aldred
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Mark T Drayson
- Institute of Immunity and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham, UK
| | | | - Jane E Raymond
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Jos A Bosch
- Psychology Department, Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
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95
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Clemens V, Regen F, Le Bret N, Heuser I, Hellmann-Regen J. Anti-inflammatory effects of minocycline are mediated by retinoid signaling. BMC Neurosci 2018; 19:58. [PMID: 30241502 PMCID: PMC6151010 DOI: 10.1186/s12868-018-0460-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 09/17/2018] [Indexed: 01/23/2023] Open
Abstract
Background Minocycline is a lipophilic tetracycline of increasing appeal in neuroscience as it inhibits microglial activation, a mechanism involved in numerous neuropsychiatric disorders. Own data point towards retinoid-mediated effects of minocycline in murine brain and skin, and towards a vicious cycle of neuroinflammation which is driven by microglial activation-induced breakdown of local retinoids such as retinoic acid (RA). We therefore sought to study minocycline’s anti-inflammatory effects on human microglial-like monocyte-derived cells in the context of retinoid signaling. Results As hypothesized, minocycline exposure resulted in a substantial increase of RA levels in the human monocytic cell line THP-1. While pro-inflammatory stimulation with lipopolysaccharides resulted in increased tryptophane-degrading indoleamine-2,3-dioxygenase IDO-expression and TNF-α levels in primary human monocyte-derived microglial-like cells, this effect was attenuated by minocycline only in the presence of retinoids. The anti-inflammatory effects of minocycline on TNF-α expression were completely abolished by a pharmacological blockage of retinoic acid receptors (RARs) using BMS-493 and unaffected by selectively blocking retinoid-X-receptors using UVI-3003. Conclusions Our data indicate for the first time a RA-dependent, anti-inflammatory effect for minocycline in human microglial-like cells via inhibition of local RA turnover. The RA-dependent mode of action for minocycline appears to be predominantly mediated through RAR-signaling.
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Affiliation(s)
- Vera Clemens
- Section Clinical Neurobiology, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Francesca Regen
- Section Clinical Neurobiology, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Nathalie Le Bret
- Section Clinical Neurobiology, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Isabella Heuser
- Section Clinical Neurobiology, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Julian Hellmann-Regen
- Section Clinical Neurobiology, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
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96
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Khandaker GM, Oltean BP, Kaser M, Dibben CRM, Ramana R, Jadon DR, Dantzer R, Coles AJ, Lewis G, Jones PB. Protocol for the insight study: a randomised controlled trial of single-dose tocilizumab in patients with depression and low-grade inflammation. BMJ Open 2018; 8:e025333. [PMID: 30244217 PMCID: PMC6157523 DOI: 10.1136/bmjopen-2018-025333] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Observational studies indicate a potentially causal role for interleukin 6 (IL-6), a proinflammatory cytokine, in pathogenesis of depression, but interventional studies based on patients with depression have not been conducted. Tocilizumab, anti-inflammatory drug, is a humanised monoclonal antibody that inhibits IL-6 signalling and is licensed in the UK for treatment of rheumatoid arthritis. The main objectives of this study are to test whether IL-6 contributes to the pathogenesis of depression and to examine potential mechanisms by which IL-6 affects mood and cognition. A secondary objective is to compare depressed participants with and without evidence of low-grade systemic inflammation. METHODS AND ANALYSIS This is a proof-of-concept, randomised, parallel-group, double-blind, placebo-controlled clinical trial. Approximately 50 participants with International Classification of Diseases 10th revision (ICD-10) diagnosis of depression who have evidence of low-grade inflammation, defined as serum high-sensitivity C reactive protein (hs-CRP) level ≥3 mg/L, will receive either a single intravenous infusion of tocilizumab or normal saline. Blood samples, behavioural and cognitive measures will be collected at baseline and after infusion around day 7, 14 and 28. The primary outcome is somatic symptoms score around day 14 postinfusion. In addition, approximately, 50 depressed participants without low-grade inflammation (serum hs-CRP level <3 mg/L) will complete the same baseline assessments as the randomised cohort. ETHICS AND DISSEMINATION The study has been approved by the South Central-Oxford B Research Ethics Committee (REC) (Reference: 18/SC/0118). Study findings will be published in peer-review journals. Findings will be also disseminated by conference/departmental presentations and by social and traditional media. TRIAL REGISTRATION NUMBER ISRCTN16942542; Pre-results.
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Affiliation(s)
- Golam M Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Bianca P Oltean
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Muzaffer Kaser
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | | | - Rajini Ramana
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Deepak R Jadon
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Robert Dantzer
- Department of Symptom Research, MD Anderson Cancer Centre, University of Texas in Houston, Houston, Texas, USA
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
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97
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Huang MH, Chen MH, Tu PC, Bai YM, Su TP, Yang BH, Liu RS, Li CT. Elevated tumor necrosis factor-alpha receptor subtype 1 and the association with abnormal brain function in treatment-resistant depression. J Affect Disord 2018; 235:250-256. [PMID: 29660639 DOI: 10.1016/j.jad.2018.04.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/06/2018] [Accepted: 04/04/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) patients have shown elevated plasma levels of pro-inflammatory biomarkers compared to healthy controls. We hypothesized increased serum tumor necrosis factor-alpha receptor subtype 1 (TNF-α R1) is more associated with impaired brain function in patients with treatment-resistant depression (TRD) than those without TRD. METHODS 34 MDD patients and 34 healthy subjects were recruited and we separated MDD patients to TRD group (n = 20) and non-TRD (n = 14) group. Pro-inflammatory cytokines were assessed by enzyme-linked immunosorbent assays. A standardized uptake values (SUV) of glucose metabolism measured by 18F-FDG positron-emission-tomography (PET) was applied to all subjects for subsequent region-of- interest analyses and whole-brain voxel-wise analyses. 18F-FDG-PET measures glucose uptake into astrocytes in response to glutamate release from neuronal cells, and was thus used as a proxy measure to quantify glutamatergic neurotransmission in the human brain. RESULTS Post-hoc analysis revealed that TRD group had higher serum concentrations of TNF-α R1 compared to healthy control or non-TRD group. In the MDD group, higher serum concentrations of TNF-α R1 significantly correlated with decreased SUV in anterior cingulate cortex (ACC) and bilateral caudate nucleus. The ROI analysis further supported the negative correlations of plasma TNF-α R1 and SUV in the ACC and caudate nucleus. Such correlation is more consistent in TRD group than in non-TRD and HC groups. LIMITATION Glutamate neurotransmission and the effect of chronic stress on glutamate release in the brain were not measured directly. CONCLUSIONS Increased TNF-α R1 was associated with impaired glutamatergic neurotransmission of caudate nucleus and ACC in MDD patients, particularly in the TRD.
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Affiliation(s)
- Mao-Hsuan Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, 112, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, 112, Taiwan
| | - Pei-Chi Tu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, 112, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, 112, Taiwan
| | - Ya Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, 112, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, 112, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, 112, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, 112, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan; Department of Psychiatry, Cheng-Hsin General Hospital, Taiwan 112
| | - Bang-Hung Yang
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ren-Shyan Liu
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, 112, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, 112, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan.
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98
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Kagawa S, Mihara K, Suzuki T, Nagai G, Nakamura A, Nemoto K, Kondo T. Both Serum Brain-Derived Neurotrophic Factor and Interleukin-6 Levels Are Not Associated with Therapeutic Response to Lamotrigine Augmentation Therapy in Treatment-Resistant Depressive Disorder. Neuropsychobiology 2018; 75:145-150. [PMID: 29332095 DOI: 10.1159/000484665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/24/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Serum levels of brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) were prospectively monitored in relation with therapeutic response to lamotrigine augmentation therapy in 46 (15 males and 31 females) inpatients with treatment-resistant depressive disorder during an 8-week treatment with lamotrigine using an open-study design. METHODS The subjects were 46 depressed patients who had already shown insufficient response to at least 3 psychotropics including antidepressants, mood stabilizers, and atypical antipsychotics. The diagnoses were major depressive disorder (n = 19), bipolar I disorder (n = 6), and bipolar II disorder (n = 22). The final doses of lamotrigine were 100 mg/day for 26 subjects who were not taking valproate and 75 mg/day for 20 subjects taking valproate, respectively. Depressive symptoms were evaluated by the Montgomery-Åsberg Depression Rating Scale (MADRS) before and after the 8-week treatment. Blood sampling was performed before the start of lamotrigine treatment and at week 8. Serum BDNF and IL-6 levels were measured using quantitative sandwich enzyme immunoassays. RESULTS No significant changes in serum BDNF or IL-6 levels during the 8-week lamotrigine treatment were observed in the total of subjects, responders or nonresponders. There was no significant correlation between the changes in serum BDNF or IL-6 levels and the percent improvement in MADRS scores in the overall subjects. CONCLUSION The present study suggests that the acute effect of lamotrigine augmentation therapy for a major depressive episode is not related to either BDNF or IL-6, at least in patients with treatment-resistant depressive disorder.
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Affiliation(s)
- Shoko Kagawa
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kazuo Mihara
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takeshi Suzuki
- Department of Hospital Pharmacy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Goyo Nagai
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Akifumi Nakamura
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kenji Nemoto
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tsuyoshi Kondo
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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99
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Druzhkova TA, Pochigaeva KI, Yakovlev AA, Gersamia AG, Guekht AB, Gulyaeva NV. [Effects of childhood trauma on the biochemical correlates of stress in men and women with nonpsychotic mental disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:10-14. [PMID: 30040795 DOI: 10.17116/jnevro20181186110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To investigate gender differences in biochemical characteristics in patients with nonpsychotic mental disorders, and to study their association with childhood trauma. MATERIAL AND METHODS Women (n=308) and men (92) between 18 and 45 years of age, without serious somatic comorbidities, were examined. Laboratory evaluation included markers of hypothalamic-pituitary-adrenal axis activity (cortisol), hypothalamic-pituitary-thyroid system (TSH), proinflammatory cytokines (Il-1β and Il-6) and the brain derived neurotrophic factor (BDNF). All participants underwent psychometric testing, which included the Child Abuse and Trauma Scale (CATS), Beck and Hamilton depression scale (HAM-D) and Spielberger Anxiety Inventory (STAI). Correlations were studied between the biochemical parameters and total CATS scores and severity of depression and anxiety in subgroups of women and men with a depressive disorder. RESULTS AND CONCLUSION The men and women in the total study population significantly differed by representation of the different diagnostic classes, which was reflected by differing levels of depressive and anxiety symptoms. The main finding was a correlation between the level of childhood trauma and morning serum cortisol levels in men with depressive disorder, which was absent in women.
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Affiliation(s)
- T A Druzhkova
- Moscow Research and Clinical Center for Neuropsychiatry, Healthcare Department of Moscow, Moscow, Russia
| | - K I Pochigaeva
- Moscow Research and Clinical Center for Neuropsychiatry, Healthcare Department of Moscow, Moscow, Russia
| | - A A Yakovlev
- Moscow Research and Clinical Center for Neuropsychiatry, Healthcare Department of Moscow, Moscow, Russia; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - A G Gersamia
- Moscow Research and Clinical Center for Neuropsychiatry, Healthcare Department of Moscow, Moscow, Russia
| | - A B Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Healthcare Department of Moscow, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - N V Gulyaeva
- Moscow Research and Clinical Center for Neuropsychiatry, Healthcare Department of Moscow, Moscow, Russia; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
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100
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Kakeda S, Watanabe K, Katsuki A, Sugimoto K, Igata N, Ueda I, Igata R, Abe O, Yoshimura R, Korogi Y. Relationship between interleukin (IL)-6 and brain morphology in drug-naïve, first-episode major depressive disorder using surface-based morphometry. Sci Rep 2018; 8:10054. [PMID: 29968776 PMCID: PMC6030126 DOI: 10.1038/s41598-018-28300-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 06/20/2018] [Indexed: 12/26/2022] Open
Abstract
There is a growing body of evidence to support the involvement of proinflammatory cytokines in the pathophysiology of depression; however, no previous studies have examined the relationship between cytokines and the brain morphology of patients with major depressive disorder (MDD). We therefore evaluated the relationship between serum cytokine levels and cortical thinning during the first depressive episode in drug-naïve patients with MDD. We measured the serum cytokine levels (IL-1β, IL-6, IFN-γ, and TNFα), and whole-brain cortical thickness and hippocampal subfield volumes on brain magnetic resonance imaging (MRI) using surface-based morphometry in 40 patients with MDD and 47 healthy volunteers (controls). Only the serum IL-6 level was significantly higher in patients with MDD than in controls. The prefrontal cortex (PFC) thickness was significantly reduced in patients with MDD, and showed a significant inverse correlation with the serum IL-6 level. Although high serum IL-6 levels were correlated with reduced left subiculum and right CA1, CA3, CA4, GC-DG, subiculum, and whole hippocampus volumes, the presence or absence of MDD had no effect on the volume of any hippocampal subfields. Our results suggest that IL-6 may play a key role in the morphological changes in the PFC during the early stage of MDD.
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Affiliation(s)
- Shingo Kakeda
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | - Keita Watanabe
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Asuka Katsuki
- Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koichiro Sugimoto
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Natsuki Igata
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Issei Ueda
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ryohei Igata
- Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Reiji Yoshimura
- Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yukunori Korogi
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
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