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Huang H, Zhu Y, Zhang Y, Hou B, Zhang Q, Shi X, Min J. Dexmedetomidine suppresses the isoflurane-induced neurological damage by upregulating Heme Oxygenase-1 via activation of the mitogen-activated protein kinase kinase 1/extracellular regulated protein kinases 1/nuclear factor erythroid 2-related factor 2 axis in aged rats. Chem Biol Interact 2022; 367:110114. [PMID: 36027947 DOI: 10.1016/j.cbi.2022.110114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022]
Abstract
Dexmedetomidine (DEX) displays a neuroprotective role in aged rats with isoflurane (ISO)-induced cognitive impairment through antioxidant, and anti-inflammatory, and anti-apoptotic effects. Therefore, the present study was performed to define the molecular mechanism of DEX on ISO-induced neurological impairment in aged rats in relation to the MEK1/ERK1/Nrf2/HO-1 axis. The study enrolled elderly patients undergoing ISO anesthesia. Patient cognitive function following treatment with DEX was evaluated using mini-mental state examination (MMSE). The results revealed that DEX supplementation of anesthesia contributed to higher MMSE scores in patients one week post treatment. Rat model of neurological impairment was also induced in 18-month-age Wistar rats by ISO, followed by DEX treatment. Based on the results of Morris water maze experiment, ELISA, and TUNEL and hematoxylin-eosin staining, in vivo experiments confirmed that DEX could reduce the oxidative stress and neurological damage induced by ISO in rats. DEX activated the nuclear factor erythroid 2-related factor (Nrf2)/Heme Oxygenase 1 (HO-1) pathway. DEX upregulated the expression of Nrf2 and HO-1 by activating the MEK1/ERK1 pathway, whereby attenuating the ISO-caused oxidative stress and neurological damage in rats. Collectively, DEX suppresses the ISO-induced neurological impairment in the aged rats by promoting HO-1 through activation of the MEK1/ERK1/Nrf2 axis.
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Affiliation(s)
- Haijin Huang
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, PR China
| | - Yunsheng Zhu
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, PR China
| | - Yang Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, PR China
| | - Benchao Hou
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, PR China
| | - Qin Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, PR China
| | - Xiaoyun Shi
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, PR China
| | - Jia Min
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, PR China.
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Zhang K, Lian N, Ding R, Guo C, Dong X, Li Y, Wei S, Jiao Q, Yu Y, Shen H. Sleep Deprivation Aggravates Cognitive Impairment by the Alteration of Hippocampal Neuronal Activity and the Density of Dendritic Spine in Isoflurane-Exposed Mice. Front Behav Neurosci 2020; 14:589176. [PMID: 33328920 PMCID: PMC7719754 DOI: 10.3389/fnbeh.2020.589176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/20/2020] [Indexed: 12/19/2022] Open
Abstract
Isoflurane contributes to cognitive deficits when used as a general anesthetic, and so does sleep deprivation (SD). Patients usually suffer from insomnia before an operation due to anxiety, fear, and other factors. It remains unclear whether preoperative SD exacerbates cognitive impairment induced by isoflurane. In this study, we observed the effects of pretreated 24-h SD in adult isoflurane-exposed mice on the cognitive behaviors, the Ca2+ signals of dorsal hippocampal CA1 (dCA1) neurons in vivo with fiber photometry, and the density of dendritic spines in hippocampal neurons. Our results showed that in cognitive behavior tasks, short-term memory damages were more severe with SD followed by isoflurane exposure than that with SD or isoflurane exposure separately, and interestingly, severe long-term memory deficits were induced only by SD followed by isoflurane exposure. Only the treatment of SD followed by isoflurane exposure could reversibly decrease the amplitude of Ca2+ signals when mice were freely moving and increase the duration of Ca2+ signals during the long-term memory behavior test. The density of dendritic spines with both SD and isoflurane exposure was lower than that with SD alone. This study suggests that SD should be avoided preoperatively in patients undergoing elective surgery under isoflurane anesthesia.
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Affiliation(s)
- Kai Zhang
- Department of Anesthesia, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Anesthesiology, Tianjin, China
| | - Naqi Lian
- Department of Anesthesia, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Anesthesiology, Tianjin, China
| | - Ran Ding
- Chinese Institute for Brain Research, Beijing (CIBR), Beijing, China
| | - Cunle Guo
- Laboratory of Neurobiology, School of Biomedical Engineering, Tianjin Medical University, Tianjin, China
| | - Xi Dong
- Laboratory of Neurobiology, School of Biomedical Engineering, Tianjin Medical University, Tianjin, China
| | - Yuanyuan Li
- Laboratory of Neurobiology, School of Biomedical Engineering, Tianjin Medical University, Tianjin, China
| | - Sheng Wei
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qingyan Jiao
- Laboratory of Neurobiology, School of Biomedical Engineering, Tianjin Medical University, Tianjin, China
| | - Yonghao Yu
- Department of Anesthesia, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Anesthesiology, Tianjin, China
| | - Hui Shen
- Laboratory of Neurobiology, School of Biomedical Engineering, Tianjin Medical University, Tianjin, China.,Institute of Neurology, Tianjin Medical University General Hospital, Tianjin, China
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Gao T, Liu Y, Zhao Z, Luo Y, Wang L, Wang Y, Yin Y. L-655,708 Does not Prevent Isoflurane-induced Memory Deficits in Old Mice. Transl Neurosci 2019; 10:180-186. [PMID: 31410301 PMCID: PMC6689210 DOI: 10.1515/tnsci-2019-0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/21/2019] [Indexed: 01/07/2023] Open
Abstract
Background General anesthesia and increasing age are two main risk factors for postoperative cognitive dysfunction (POCD). Effective agents for the prevention or treatment of POCD are urgently needed. L-655,708, an inverse agonist of α5 subunit-containing γ-aminobutyric acid subtype A (α5GABAA) receptors, can prevent anesthesia-induced memory deficits in young animals. However, there is a lack of evidence of its efficacy in old animals. Methodology Young (3- to 5-month-old) and old (18- to 20-month-old) mice were given an inhalation of 1.33% isoflurane for 1 hour and their associative memory was evaluated 24 hours after anesthesia using fear-conditioning tests (FCTs). To evaluate the effect of L-655,708, mice received intraperitoneal injections of L-655,708 (0.7 mg/kg) or vehicle 30 minutes before anesthesia. Results Old mice exhibited impaired memory and lower hippocampal α5GABAA levels than young mice under physiological conditions. Pre-injections of L-655,708 significantly alleviated isoflurane-induced memory decline in young mice, but not in old mice. Conclusions L-655,708 is not as effective for the prevention of POCD in old mice as it is in young mice. The use of inverse agonists of α5GABAA in preventing POCD in old patients should be carefully considered.
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Affiliation(s)
- Teng Gao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Yue Liu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Zifang Zhao
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yuan Luo
- State Key Laboratory of Toxicology and Medical Countermeasures, Academy of Military Medical Sciences, Beijing, 100850, China
| | - Lifang Wang
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yongan Wang
- State Key Laboratory of Toxicology and Medical Countermeasures, Academy of Military Medical Sciences, Beijing, 100850, China
| | - Yiqing Yin
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, China
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Abstract
Since histamine (HA) was first synthesized in 1907 and isolated as a bacterial contaminant of an extract of ergot in 1910, its role in health and disease and its molecular mechanism of action have been unraveled, leading to the formulation of an array of drugs with immense therapeutic value. HA is produced by decarboxylation of histidine, and its biological actions are mediated through four HA receptors, namely, H1, H2, H3, and H4 based on their sequence, their link to differential intracellular signaling mechanisms, and their unique pharmacological properties. H1 and H2 receptors have been targeted for treating allergic conditions and peptic ulcers, respectively. The discovery of a third HA receptor subtype (H3R) by molecular biologists in 1983, structurally a member of the G-protein-coupled receptor family, has led to the development of many potent and selective H3 receptor antagonists having the potential to treat a wide spectrum of neurological diseases including postoperative cognitive dysfunction.
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Resch M, Neels T, Tichy A, Palme R, Rülicke T. Impact assessment of tail-vein injection in mice using a modified anaesthesia induction chamber versus a common restrainer without anaesthesia. Lab Anim 2018; 53:190-201. [PMID: 30089439 DOI: 10.1177/0023677218786982] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intravenous (IV) administration in mice is predominantly performed via the lateral tail veins. The technique requires adequate training before it can be used safely and routinely. A novel anaesthesia induction chamber has been developed to simplify the treatment and to facilitate IV injection in mice, particularly for untrained personnel. We have assessed the benefits of the chamber in refining IV injection in isoflurane-anaesthetized mice in direct comparison with the common restrainer method on conscious animals. The body weight, nesting behaviour and concentrations of faecal corticosterone metabolites were taken as indicative of distress induced by the various procedures. The results suggest that both methods of tail-vein injection induce similar levels of momentary stress in the animals, revealed by a short-term increase in the levels of stress hormone metabolites in faeces. A temporary reduction of body weight was observed after IV injection under isoflurane anaesthesia but not for conscious mice injected in the common restrainer. We conclude that the severity of tail-vein injection in mice is 'mild' for both methods. There was no evidence that refining the procedure by using isoflurane anaesthesia in the induction chamber was associated with any benefit.
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Affiliation(s)
- Marlene Resch
- 1 Institute of Laboratory Animal Science, University of Veterinary Medicine Vienna, Austria
| | - Tania Neels
- 1 Institute of Laboratory Animal Science, University of Veterinary Medicine Vienna, Austria
| | - Alexander Tichy
- 2 Bioinformatics and Biostatistics Platform, University of Veterinary Medicine Vienna, Austria
| | - Rupert Palme
- 3 Unit of Physiology, Pathophysiology and Experimental Endocrinology, University of Veterinary Medicine Vienna, Austria
| | - Thomas Rülicke
- 1 Institute of Laboratory Animal Science, University of Veterinary Medicine Vienna, Austria
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Zhong Y, Chen J, Li L, Qin Y, Wei Y, Pan S, Jiang Y, Chen J, Xie Y. PKA-CREB-BDNF signaling pathway mediates propofol-induced long-term learning and memory impairment in hippocampus of rats. Brain Res 2018; 1691:64-74. [DOI: 10.1016/j.brainres.2018.04.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 03/22/2018] [Accepted: 04/19/2018] [Indexed: 02/07/2023]
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Affiliation(s)
- Abhijit S Nair
- Department of Anesthesiology and Pain Management, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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García-Pardo MP, De la Rubia Ortí JE, Aguilar Calpe MA. Differential effects of MDMA and cocaine on inhibitory avoidance and object recognition tests in rodents. Neurobiol Learn Mem 2017; 146:1-11. [PMID: 29081371 DOI: 10.1016/j.nlm.2017.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Drug addiction continues being a major public problem faced by modern societies with different social, health and legal consequences for the consumers. Consumption of psychostimulants, like cocaine or MDMA (known as ecstasy) are highly prevalent and cognitive and memory impairments have been related with the abuse of these drugs. AIM The aim of this work was to review the most important data of the literature in the last 10 years about the effects of cocaine and MDMA on inhibitory avoidance and object recognition tests in rodents. DEVELOPMENT The object recognition and the inhibitory avoidance tests are popular procedures used to assess different types of memory. We compare the effects of cocaine and MDMA administration in these tests, taking in consideration different factors such as the period of life development of the animals (prenatal, adolescence and adult age), the presence of polydrug consumption or the role of environmental variables. Brain structures involved in the effects of cocaine and MDMA on memory are also described. CONCLUSIONS Cocaine and MDMA induced similar impairing effects on the object recognition test during critical periods of lifetime or after abstinence of prolonged consumption in adulthood. Deficits of inhibitory avoidance memory are observed only in adult rodents exposed to MDMA. Psychostimulant abuse is a potential factor to induce memory impairments and could facilitate the development of future neurodegenerative disorders.
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Nair AS, Pulipaka K, Rayani BK. Anesthetic-induced developmental neurotoxicity: causes, prospective studies and possible interventions. Med Gas Res 2017; 7:224-225. [PMID: 29152217 PMCID: PMC5674662 DOI: 10.4103/2045-9912.215754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Abhijit S Nair
- Department of Anesthesiology and Pain Management, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad-500034, Telangana, India
| | - Kaushik Pulipaka
- Department of Anesthesiology and Pain Management, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad-500034, Telangana, India
| | - Basanth Kumar Rayani
- Department of Anesthesiology and Pain Management, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad-500034, Telangana, India
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Hohlbaum K, Bert B, Dietze S, Palme R, Fink H, Thöne-Reineke C. Severity classification of repeated isoflurane anesthesia in C57BL/6JRj mice-Assessing the degree of distress. PLoS One 2017; 12:e0179588. [PMID: 28617851 PMCID: PMC5472303 DOI: 10.1371/journal.pone.0179588] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 06/01/2017] [Indexed: 01/22/2023] Open
Abstract
According to the EU Directive 2010/63, the severity of a procedure has to be classified as mild, moderate or severe. General anesthesia is thought to be mild, but the Directive does not differentiate between single and repeated anesthesia. Therefore, we investigated the impact of repeated administration of isoflurane, the most commonly used inhalation anesthetic, on the well-being of adult C57BL/6JRj mice, in comparison to single administrations and to untreated animals, when applied six times for 45 min at an interval of 3–4 days. For the animals anesthetized, excitations, phases of anesthesia, and vital parameters were monitored. Well-being after anesthesia was assessed using a behavioral test battery including luxury behavior like burrowing and nest building behavior, the Mouse Grimace Scale (MGS), the free exploratory paradigm for anxiety-related behavior, home cage activity and the rotarod test for activity, as well as food intake and body weight. Additionally, hair corticosterone and fecal corticosterone metabolites were measured. Our results show that nest building behavior, home cage activity, body weight, and corticosterone concentrations were not influenced by anesthesia, whereas changes in burrowing behavior, the MGS, food intake, and the free exploratory behavior indicated that the well-being of the mice was more affected by repeated than single isoflurane anesthesia. This effect depended on the sex of the animals, with female mice being more susceptible than male mice. However, repeated isoflurane anesthesia caused only short-term mild distress and impairment of well-being, mainly in the immediate postanesthetic period. Well-being stabilized at 8 days after the last anesthesia, at the latest. Therefore, we conclude that when using our anesthesia protocol, the severity of both single and repeated isoflurane anesthesia in C57BL/6JRj mice can be classified as mild. However, within the mild severity category, repeated isoflurane anesthesia ranks higher than single isoflurane anesthesia. Additionally, our results imply that male and female mice can differently perceive the severity of a procedure.
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Affiliation(s)
- Katharina Hohlbaum
- Institute of Animal Welfare, Animal Behavior and Laboratory Animal Science, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
- Institute of Pharmacology and Toxicology, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
- * E-mail:
| | - Bettina Bert
- Institute of Pharmacology and Toxicology, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Silke Dietze
- Institute of Pharmacology and Toxicology, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Rupert Palme
- Unit of Physiology, Pathophysiology and Experimental Endocrinology, Department of Biomedical Sciences, University of Veterinary Medicine, Vienna, Austria
| | - Heidrun Fink
- Institute of Pharmacology and Toxicology, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Christa Thöne-Reineke
- Institute of Animal Welfare, Animal Behavior and Laboratory Animal Science, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
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11
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Luo T, Wang Y, Qin J, Liu ZG, Liu M. Histamine H3 Receptor Antagonist Prevents Memory Deficits and Synaptic Plasticity Disruption Following Isoflurane Exposure. CNS Neurosci Ther 2017; 23:301-309. [PMID: 28168839 DOI: 10.1111/cns.12675] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/22/2016] [Accepted: 12/24/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Exposure to pharmacological concentration of inhaled anesthetics such as isoflurane can cause short- or long-term cognitive impairments in preclinical studies. The selective antagonists of the histamine H3 receptors are considered as a promising group of novel therapeutic agents for the treatment of cognitive disorders. In this study, we investigated whether ciproxifan, a nonimidazole antagonist of H3 histamine receptors, could overcome the functional and electrophysiological sequela associated with isoflurane anesthesia. METHODS Adult male Sprague Dawley rats were exposed to 1.4% isoflurane or vehicle gas for 2 h. The memory tests (novel object recognition and passive avoidance) as well as in vivo hippocampal excitatory synaptic potentials were recorded 24 h postanesthesia. Locomotor activity, anxiety, and nociception 24 h after isoflurane were also examined. The drugs (ciproxifan 3 mg/kg or saline) were intraperitoneally injected 30 min prior to the behavioral tests or long-term potentiation induction. RESULTS Animals that were previously (24 h) exposed to 1.4% isoflurane for 2 h displayed no preference for novel objects and had impaired retention of a passive avoidance response at 1 h after sample phase. Treating isoflurane-exposed rats with ciproxifan significantly improved the memory performance, as evidenced by an increased discrimination ratio in objects recognition and prolonged retention time in passive avoidance test. Accordingly, hippocampus long-term potentiation was reduced in animals that received isoflurane, while administration of ciproxifan completely abolished the effect of isoflurane exposure on synaptic plasticity. Neither isoflurane nor ciproxifan altered motor performance, anxiety, and nociceptive responses. CONCLUSION These results suggest that H3R in the CNS, probably in the hippocampus, may serve as therapeutic target for improvement of anesthesia-associated cognitive deficits.
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Affiliation(s)
- Tao Luo
- Department of Anesthesiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Ying Wang
- Materials Characterization and Preparation Center, Southern University of Science and Technology, Shenzhen, China
| | - Jian Qin
- Central Laboratory, Wuhan University Renmin Hospital, Wuhan, China
| | - Zhi-Gang Liu
- Department of Anesthesiology, Wuhan University Renmin Hospital, Wuhan, China
| | - Min Liu
- Central Laboratory, Wuhan University Renmin Hospital, Wuhan, China
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Sadek B, Saad A, Sadeq A, Jalal F, Stark H. Histamine H3 receptor as a potential target for cognitive symptoms in neuropsychiatric diseases. Behav Brain Res 2016; 312:415-30. [PMID: 27363923 DOI: 10.1016/j.bbr.2016.06.051] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/22/2016] [Accepted: 06/26/2016] [Indexed: 01/27/2023]
Abstract
The potential contributions of the brain histaminergic system in neurodegenerative diseases, and the possiblity of histamine-targeting treatments is attracting considerable interests. The histamine H3 receptor (H3R) is expressed mainly in the central nervous system, and is, consequently, an attractive pharmacological target. Although recently described clinical trials have been disappointing in attention deficit hyperactivity disorder (ADHD) and schizophrenia (SCH), numerous H3R antagonists, including pitolisant, demonstrate potential in the treatment of narcolepsy, excessive daytime sleepiness associated with cognitive impairment, epilepsy, and Alzheimer's disease (AD). This review focuses on the recent preclinical as well as clinical results that support the relevance of H3R antagonists for the treatment of cognitive symptoms in neuropsychiatric diseases, namely AD, epilepsy and SCH. The review summarizes the role of histaminergic neurotransmission with focus on these brain disorders, as well as the effects of numerous H3R antagonists on animal models and humans.
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Affiliation(s)
- Bassem Sadek
- Department of Pharmacology & Therapeutics, College of Medicine & Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates.
| | - Ali Saad
- Department of Pharmacology & Therapeutics, College of Medicine & Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates
| | - Adel Sadeq
- College of Pharmacy, Al Ain University of Science and Technology, Al Ain, United Arab Emirates
| | - Fakhreya Jalal
- Department of Pharmacology & Therapeutics, College of Medicine & Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates
| | - Holger Stark
- Institute of Pharmaceutical and Medicinal Chemistry, Heinrich Heine University, Universitaetsstr. 1, 40225 Düsseldorf, Germany
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