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Tsugiyama LE, Moraes RCM, Moraes YAC, Francis-Oliveira J. Promising new pharmacological targets for depression: The search for efficacy. Drug Discov Today 2023; 28:103804. [PMID: 37865307 DOI: 10.1016/j.drudis.2023.103804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/31/2023] [Accepted: 10/16/2023] [Indexed: 10/23/2023]
Abstract
Pharmacological treatment of major depressive disorder (MDD) still relies on the use of serotonergic drugs, despite their limited efficacy. A few mechanistically new drugs have been developed in recent years, but many fail in clinical trials. Several hypotheses have been proposed to explain MDD pathophysiology, indicating that physiological processes such as neuroplasticity, circadian rhythms, and metabolism are potential targets. Here, we review the current state of pharmacological treatments for MDD, as well as the preclinical and clinical evidence for an antidepressant effect of molecules that target non-serotonergic systems. We offer some insights into the challenges facing the development of new antidepressant drugs, and the prospect of finding more effectiveness for each target discussed.
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Affiliation(s)
- Lucila Emiko Tsugiyama
- Kansai Medical University, Graduate School of Medicine, iPS Cell Applied Medicine, Hirakata, Osaka, Japan
| | - Ruan Carlos Macedo Moraes
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Birmingham, AL, USA; Biomedical Sciences Institute, Department of Human Physiology, Sao Paulo University, Sao Paulo, Brazil
| | | | - Jose Francis-Oliveira
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Birmingham, AL, USA; Biomedical Sciences Institute, Department of Human Physiology, Sao Paulo University, Sao Paulo, Brazil.
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2
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Scuto M, Modafferi S, Rampulla F, Zimbone V, Tomasello M, Spano’ S, Ontario M, Palmeri A, Trovato Salinaro A, Siracusa R, Di Paola R, Cuzzocrea S, Calabrese E, Wenzel U, Calabrese V. Redox modulation of stress resilience by Crocus Sativus L. for potential neuroprotective and anti-neuroinflammatory applications in brain disorders: From molecular basis to therapy. Mech Ageing Dev 2022; 205:111686. [DOI: 10.1016/j.mad.2022.111686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 12/13/2022]
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3
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Riveros ME, Ávila A, Schruers K, Ezquer F. Antioxidant Biomolecules and Their Potential for the Treatment of Difficult-to-Treat Depression and Conventional Treatment-Resistant Depression. Antioxidants (Basel) 2022; 11:540. [PMID: 35326190 PMCID: PMC8944633 DOI: 10.3390/antiox11030540] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
Major depression is a devastating disease affecting an increasing number of people from a young age worldwide, a situation that is expected to be worsened by the COVID-19 pandemic. New approaches for the treatment of this disease are urgently needed since available treatments are not effective for all patients, take a long time to produce an effect, and are not well-tolerated in many cases; moreover, they are not safe for all patients. There is solid evidence showing that the antioxidant capacity is lower and the oxidative damage is higher in the brains of depressed patients as compared with healthy controls. Mitochondrial disfunction is associated with depression and other neuropsychiatric disorders, and this dysfunction can be an important source of oxidative damage. Additionally, neuroinflammation that is commonly present in the brain of depressive patients highly contributes to the generation of reactive oxygen species (ROS). There is evidence showing that pro-inflammatory diets can increase depression risk; on the contrary, an anti-inflammatory diet such as the Mediterranean diet can decrease it. Therefore, it is interesting to evaluate the possible role of plant-derived antioxidants in depression treatment and prevention as well as other biomolecules with high antioxidant and anti-inflammatory potential such as the molecules paracrinely secreted by mesenchymal stem cells. In this review, we evaluated the preclinical and clinical evidence showing the potential effects of different antioxidant and anti-inflammatory biomolecules as antidepressants, with a focus on difficult-to-treat depression and conventional treatment-resistant depression.
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Affiliation(s)
- María Eugenia Riveros
- Centro de Fisiología Celular e Integrativa, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7710162, Chile
| | - Alba Ávila
- Centro de Medicina Regenerativa, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7710162, Chile;
| | - Koen Schruers
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, 6229 Maastricht, The Netherlands;
| | - Fernando Ezquer
- Centro de Medicina Regenerativa, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7710162, Chile;
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4
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Al-Hakeim HK, Twayej AJ, Al-Dujaili AH, Maes M. Plasma Indoleamine-2,3-Dioxygenase (IDO) is Increased in Drug-Naï ve Major Depressed Patients and Treatment with Sertraline and Ketoprofen Normalizes IDO in Association with Pro-Inflammatory and Immune- Regulatory Cytokines. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 19:44-54. [PMID: 31894751 DOI: 10.2174/1871527319666200102100307] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/17/2019] [Accepted: 11/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Major Depression Disorder (MDD) is accompanied by an immune response characterized by increased levels of inflammatory and immune-regulatory cytokines and stimulation of indoleamine-2,3-dioxygenase (IDO). There is also evidence that anti-inflammatory drugs may have clinical efficacy in MDD. METHODS This study examined a) IDO in association with interferon (IFN)-γ, Interleukin (IL)-4 and Transforming Growth Factor (TGF)-β1 in 140 drug-naïve MDD patients and 40 normal controls; and b) the effects of an eight-week treatment of sertraline with or without ketoprofen (a nonsteroidal antiinflammatory drug) on the same biomarkers in 44 MDD patients. RESULTS Baseline IDO, IFN-γ, TGF-β1 and IL-4 were significantly higher in MDD patients as compared with controls. Treatment with sertraline with or without ketoprofen significantly reduced the baseline levels of all biomarkers to levels which were in the normal range (IDO, TGF-β1, and IL-4) or still somewhat higher than in controls (IFN-γ). Ketoprofen add-on had a significantly greater effect on IDO as compared with placebo. The reductions in IDO, IL-4, and TGF-β1 during treatment were significantly associated with those in the BDI-II. CONCLUSION MDD is accompanied by activated immune-inflammatory pathways (including IDO) and the Compensatory Immune-Regulatory System (CIRS). The clinical efficacy of antidepressant treatment may be ascribed at least in part to decrements in IDO and the immune-inflammatory response. These treatments also significantly reduce the more beneficial properties of T helper-2 and T regulatory (Treg) subsets. Future research should develop immune treatments that target the immune-inflammatory response in MDD while enhancing the CIRS.
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Affiliation(s)
| | - Ahmed Jasim Twayej
- Pathological Analysis Department, College of Health and Medical, Al-Kafeel University, Najaf, Iraq
| | | | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.,Department of Psychiatry, Medical University Plovdiv, Plovdiv, Bulgaria.,IMPACT Research Center, Deakin University, Geelong, Australia
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5
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Cyclooxygenase Inhibition Safety and Efficacy in Inflammation-Based Psychiatric Disorders. Molecules 2020; 25:molecules25225388. [PMID: 33217958 PMCID: PMC7698629 DOI: 10.3390/molecules25225388] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022] Open
Abstract
According to the World Health Organization, the major psychiatric and neurodevelopmental disorders include major depression, bipolar disorder, schizophrenia, and autism spectrum disorder. The potential role of inflammation in the onset and progression of these disorders is increasingly being studied. The use of non-steroidal anti-inflammatory drugs (NSAIDs), well-known cyclooxygenase (COX) inhibitors, combined with first-choice specific drugs have been long investigated. The adjunctive administration of COX inhibitors to classic clinical treatments seems to improve the prognosis of people who suffer from psychiatric disorders. In this review, a broad overview of the use of COX inhibitors in the treatment of inflammation-based psychiatric disorders is provided. For this purpose, a critical analysis of the use of COX inhibitors in the last ten years of clinical trials of the major psychiatric disorders was carried out.
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6
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Stachowicz K. Indomethacin, a nonselective cyclooxygenase inhibitor, does not interact with MTEP in antidepressant-like activity, as opposed to imipramine in CD-1 mice. Eur J Pharmacol 2020; 888:173585. [PMID: 32971092 DOI: 10.1016/j.ejphar.2020.173585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 02/03/2023]
Abstract
The contribution of metabotropic glutamate receptors (mGlu receptors) in depression is well known and tested worldwide. Our previous study showed the involvement of the cyclooxygenase-2 (COX-2) pathway in behavioral changes mediated by an antagonist of metabotropic glutamate receptor subtype 5 (mGlu5 receptor) 3-[(2-methyl-1,3-tiazol-4-yl)ethynyl]-pyridine (MTEP). Among others, we have found that chronic concomitant administration of a COX-2 inhibitor and sub-effective dose of MTEP accelerates antidepressant-like activity of MTEP. This paper seeks to explore whether the same effect would be observed with the use of a non-selective COX inhibitor 2-[1-(4-chlorobenzoyl)-5-methoxy-2-methylindol-3-yl]acetic acid (indomethacin). To that end, we have employed experimental procedure implemented in the earlier research. MTEP and indomethacin or MTEP + indomethacin were used chronically for 7 or 14 days. Then, the Porsolt test, tail suspension test and locomotor activity test were performed. Imipramine was used as a reference compound, as its action is connected with mGlu5 receptor. We found that, in contrast to COX-2 inhibition, indomethacin - acting both through COX-1 and COX-2 - did not release antidepressant-like potential of MTEP. The opposite effect was shown when imipramine was used.
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Affiliation(s)
- Katarzyna Stachowicz
- Department of Neurobiology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343, Kraków, Poland.
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7
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Visentin APV, Colombo R, Scotton E, Fracasso DS, da Rosa AR, Branco CS, Salvador M. Targeting Inflammatory-Mitochondrial Response in Major Depression: Current Evidence and Further Challenges. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:2972968. [PMID: 32351669 PMCID: PMC7178465 DOI: 10.1155/2020/2972968] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/26/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
The prevalence of psychiatric disorders has increased in recent years. Among existing mental disorders, major depressive disorder (MDD) has emerged as one of the leading causes of disability worldwide, affecting individuals throughout their lives. Currently, MDD affects 15% of adults in the Americas. Over the past 50 years, pharmacotherapy, psychotherapy, and brain stimulation have been used to treat MDD. The most common approach is still pharmacotherapy; however, studies show that about 40% of patients are refractory to existing treatments. Although the monoamine hypothesis has been widely accepted as a molecular mechanism to explain the etiology of depression, its relationship with other biochemical phenomena remains only partially understood. This is the case of the link between MDD and inflammation, mitochondrial dysfunction, and oxidative stress. Studies have found that depressive patients usually exhibit altered inflammatory markers, mitochondrial membrane depolarization, oxidized mitochondrial DNA, and thus high levels of both central and peripheral reactive oxygen species (ROS). The effect of antidepressants on these events remains unclear. Nevertheless, the effects of ROS on the brain are well known, including lipid peroxidation of neuronal membranes, accumulation of peroxidation products in neurons, protein and DNA damage, reduced antioxidant defenses, apoptosis induction, and neuroinflammation. Antioxidants such as ascorbic acid, tocopherols, and coenzyme Q have shown promise in some depressive patients, but without consensus on their efficacy. Hence, this paper provides a review of MDD and its association with inflammation, mitochondrial dysfunction, and oxidative stress and is aimed at thoroughly discussing the putative links between these events, which may contribute to the design and development of new therapeutic approaches for patients.
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Affiliation(s)
| | - Rafael Colombo
- Instituto de Biotecnologia, Universidade de Caxias do Sul, Caxias do Sul, RS 95070 560, Brazil
| | - Ellen Scotton
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Programa de Pós-Graduação em Farmacologia e Terapêutica, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Débora Soligo Fracasso
- Instituto de Biotecnologia, Universidade de Caxias do Sul, Caxias do Sul, RS 95070 560, Brazil
| | - Adriane Ribeiro da Rosa
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Catia Santos Branco
- Instituto de Biotecnologia, Universidade de Caxias do Sul, Caxias do Sul, RS 95070 560, Brazil
| | - Mirian Salvador
- Instituto de Biotecnologia, Universidade de Caxias do Sul, Caxias do Sul, RS 95070 560, Brazil
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8
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Halaris A, Leonard BE. Unraveling the complex interplay of immunometabolic systems that contribute to the neuroprogression of psychiatric disorders. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.npbr.2019.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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9
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Knight MJ, Mills NT, Baune BT. Contemporary methods of improving cognitive dysfunction in clinical depression. Expert Rev Neurother 2019; 19:431-443. [DOI: 10.1080/14737175.2019.1610395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Matthew J. Knight
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Natalie T. Mills
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Bernhard T. Baune
- Department of Psychiatry and Psychotherapy, University Hospital Münster, University of Münster, Münster, Germany
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10
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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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11
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Veronese N, Koyanagi A, Stubbs B, Solmi M, Fornaro M, Fernandes BF, Muller C, Thompson T, Carvalho AF, Maggi S. Aspirin and incident depressive symptoms: A longitudinal cohort study over 8 years. Int J Geriatr Psychiatry 2018; 33:e193-e198. [PMID: 28782132 PMCID: PMC5773347 DOI: 10.1002/gps.4767] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/12/2017] [Accepted: 07/04/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Aspirin exhibits anti-atherosclerotic and anti-inflammatory properties-two potential risk factors for depression. The relationship between aspirin use and depression, however, remains unclear. We investigated whether the aspirin use is associated with a decreased incidence of depressive symptoms in a large North American cohort. METHODS Data from the Osteoarthritis Initiative dataset, a multicenter, longitudinal study on community-dwelling adults was analyzed. Aspirin use was defined through self-report in the past 30 days and confirmed by a trained interviewer. Incident depressive symptoms were defined as a score of ≥16 in the 20-item Center for Epidemiologic Studies-Depression scale. RESULTS A total of 137 participants (mean age 65 y, 55.5% female) were using aspirin at baseline. Compared with 4003 participants not taking aspirin, no differences in Center for Epidemiologic Studies-Depression at baseline were evident (P = .65). After a median follow-up time of 8 years, the incidence of depressive symptoms was similar in those taking aspirin at baseline (43; 95% CI, 3-60) and in aspirin nonusers (38; 95% CI, 36-41) per 1000 y; log-rank test = 0.63). Based on Cox's regression analysis adjusted for 11 potential confounders, aspirin use was not significantly associated with the development of depressive symptoms (hazard ratio = 1.12; 95% CI, 0.78-1.62; P = .54). Adjustment for propensity scores or the use of propensity score matching did not alter the results. CONCLUSION Our study found that prescription of aspirin offered no significant protection against incident depressive symptoms. Whether aspirin is beneficial in a subgroup of depression with high levels of inflammation remains to be investigated in future studies.
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Affiliation(s)
- Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
- Institute for clinical Research and Education in Medicine (IREM), Padova, Italy
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain
| | - Brendon Stubbs
- South London and Maudsley NHS FoundationTrust, Denmark Hill, London SE5 8AZ, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8 AF, United Kingdom
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Marco Solmi
- Institute for clinical Research and Education in Medicine (IREM), Padova, Italy
- Department of Neurosciences, University of Padova, Padova, Italy
- National Health Care System, Padua Local Unit ULSS 17, Italy
| | - Michele Fornaro
- New York Psychiatric Institute, Columbia University, New York, NY, USA
| | - Brisa F Fernandes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, and Barwon Health, Geelong, Australia; Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Christoph Muller
- Faculty of Education and Health, University of Greenwich, London SE9 2UG, UK
| | - Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London SE9 2UG, UK
| | - André F. Carvalho
- Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
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12
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Association of inflammatory mediators with pain perception. Biomed Pharmacother 2017; 96:1445-1452. [DOI: 10.1016/j.biopha.2017.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 12/31/2022] Open
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13
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Colpo GD, Leboyer M, Dantzer R, Trivedi MH, Teixeira AL. Immune-based strategies for mood disorders: facts and challenges. Expert Rev Neurother 2017; 18:139-152. [PMID: 29179585 DOI: 10.1080/14737175.2018.1407242] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Inflammation seems to play a role in the pathophysiology of mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD). In the last years several studies have shown increased levels of inflammatory and/or immune markers in patients with mood disorders. Accordingly, the immune system has become a target of interest for the development of biomarkers and therapeutics for mood disorders. Areas covered: Here, we review the evidence showing low-grade inflammation in mood disorders and the studies evaluating immune-based strategies for the treatment of these conditions. Expert commentary: Clinical trials with non-steroidal anti-inflammatory drugs, polyunsaturated acids, N-acetylcysteine, anti-cytokines, physical activity and probiotics have provided promising results in terms of antidepressant efficacy in patients with MDD and BD. Regarding stem cells, only studies with animal models have been performed so far with interesting pre-clinical results. Due to the preliminary nature of the results, most of the clinical studies need to be replicated and/or confirmed in larger clinical settings, embracing the highly heterogeneous pathophysiology of mood disorders.
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Affiliation(s)
- Gabriela D Colpo
- a Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School , The University of Texas Health Science Center at Houston - UT Health , Houston , TX , USA
| | - Marion Leboyer
- b Inserm U 955, Department of Psychiatry, AP-HP, DHU PePSY, Groupe Hosp italier Henri Mondor , Créteil University Paris Est Créteil , Paris , France
| | - Robert Dantzer
- c Division of Internal Medicine, Department of Symptom Research , MD Anderson Cancer Center , Houston , TX , USA
| | - Mahdukar H Trivedi
- d Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Antonio L Teixeira
- a Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School , The University of Texas Health Science Center at Houston - UT Health , Houston , TX , USA
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14
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Liu A, Wu Y, Li L, Wang Y. The roles of interleukin‐1 and RhoA signaling pathway in rat epilepsy model treated with low‐frequency electrical stimulation. J Cell Biochem 2017; 119:2535-2544. [DOI: 10.1002/jcb.26415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 09/21/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Ai‐Hua Liu
- Department of NeurologyXuanwu HospitalCapital Medical UniversityBeijingP.R. China
- Beijing Intensive Epilepsy CenterBeijing Key Laboratory of NeuromodulationBeijingP.R. China
| | - Ya‐Ting Wu
- Department of NeurologyXuanwu HospitalCapital Medical UniversityBeijingP.R. China
- Beijing Intensive Epilepsy CenterBeijing Key Laboratory of NeuromodulationBeijingP.R. China
| | - Li‐Ping Li
- Department of NeurologyXuanwu HospitalCapital Medical UniversityBeijingP.R. China
- Beijing Intensive Epilepsy CenterBeijing Key Laboratory of NeuromodulationBeijingP.R. China
| | - Yu‐Ping Wang
- Department of NeurologyXuanwu HospitalCapital Medical UniversityBeijingP.R. China
- Beijing Intensive Epilepsy CenterBeijing Key Laboratory of NeuromodulationBeijingP.R. China
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15
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Kopschina Feltes P, Doorduin J, Klein HC, Juárez-Orozco LE, Dierckx RAJO, Moriguchi-Jeckel CM, de Vries EFJ. Anti-inflammatory treatment for major depressive disorder: implications for patients with an elevated immune profile and non-responders to standard antidepressant therapy. J Psychopharmacol 2017; 31:1149-1165. [PMID: 28653857 PMCID: PMC5606303 DOI: 10.1177/0269881117711708] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Major depressive disorder (MDD) is a prevalent and disabling psychiatric disease with rates of non-responsiveness to antidepressants ranging from 30-50%. Historically, the monoamine depletion hypothesis has dominated the view on the pathophysiology of depression. However, the lack of responsiveness to antidepressants and treatment resistance suggests that additional mechanisms might play a role. Evidence has shown that a subgroup of depressive patients may have an underlying immune deregulation that could explain the lack of therapeutic benefit from antidepressants. Stimuli like inflammation and infection can trigger the activation of microglia to release pro-inflammatory cytokines, acting on two main pathways: (1) activation of the hypothalamic-pituitary adrenal axis, generating an imbalance in the serotonergic and noradrenergic circuits; (2) increased activity of the enzyme indoleamine-2,3-dioxygenase, resulting in depletion of serotonin levels and the production of quinolinic acid. If this hypothesis is proven true, the subgroup of MDD patients with increased levels of pro-inflammatory cytokines, mainly IL-6, TNF-α and IL-1β, might benefit from an anti-inflammatory intervention. Here, we discuss the pre-clinical and clinical studies that have provided support for treatment with non-steroidal anti-inflammatory drugs in depressed patients with inflammatory comorbidities or an elevated immune profile, as well as evidences for anti-inflammatory properties of standard antidepressants.
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Affiliation(s)
- Paula Kopschina Feltes
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
- Instituto de Geriatria e Gerontologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil
| | - Janine Doorduin
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Hans C Klein
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Luis Eduardo Juárez-Orozco
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Rudi AJO Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Cristina M Moriguchi-Jeckel
- Instituto de Geriatria e Gerontologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil
- Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil
| | - Erik FJ de Vries
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
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Wium-Andersen IK, Wium-Andersen MK, Jørgensen MB, Osler M. Anti-inflammatory treatment and risk for depression after first-time stroke in a cohort of 147 487 Danish patients. J Psychiatry Neurosci 2017; 42. [PMID: 28632121 PMCID: PMC5573574 DOI: 10.1503/jpn160244] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Depression is a common complication after stroke, and inflammation may be a pathophysiological mechanism. This study examines whether anti-inflammatory treatment with acetylsalicylic acid (ASA), nonsteroid anti-inflammatory drugs (NSAIDs) or statins influence the risk of depression after stroke. METHODS A register-based cohort including all patients admitted to hospital with a first-time stroke from Jan. 1, 2001, through Dec. 31, 2011, and a nonstroke population with a similar age and sex distribution was followed for depression until Dec. 31, 2014. Depression was defined as having a hospital contact with depression or having filled prescriptions for antidepressant medication. The associations between redeemed prescriptions of ASA, NSAIDs or statins with early- (≤ 1 year after stroke or study entry) and late-onset (> 1 year after stroke or study entry) depression were analyzed using Cox proportional hazard regression. RESULTS We identified 147 487 patients with first-time stroke and 160 235 individuals without stroke for inclusion in our study. Redeemed prescriptions of ASA, NSAIDs or statins after stroke decreased the risk for early-onset depression, especially in patients with ischemic or severe stroke. Patients who received a combination of anti-inflammatory treatments had the lowest risk for early-onset depression. On the other hand, use of ASA or NSAIDs 1 year after stroke increased the risk for late-onset depression, whereas statin use was associated with a tendency toward a decreased risk. LIMITATIONS The study used prescription of antidepressant medication as a proxy measure for depression and did not include anti-inflammatory drugs bought over the counter. CONCLUSION Anti-inflammatory treatment is associated with a lower risk for depression shortly after stroke but a higher risk for late depression. This suggests that inflammation contributes differently to the development of depression after stroke depending on the time of onset.
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Affiliation(s)
- Ida Kim Wium-Andersen
- Correspondence to: Ida Kim Wium-Andersen, Psychiatric Center Ballerup, Maglevænget 2, 2750 Ballerup, Denmark;
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Schmidt FM, Kirkby KC, Lichtblau N. Inflammation and Immune Regulation as Potential Drug Targets in Antidepressant Treatment. Curr Neuropharmacol 2017; 14:674-87. [PMID: 26769225 PMCID: PMC5050395 DOI: 10.2174/1570159x14666160115130414] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/20/2015] [Accepted: 11/04/2015] [Indexed: 12/21/2022] Open
Abstract
Growing evidence supports a mutual relationship between inflammation and major depression. A variety of mechanisms are outlined, indicating how inflammation may be involved in the pathogenesis, course and treatment of major depression. In particular, this review addresses 1) inflammatory cytokines as markers of depression and potential predictors of treatment response, 2) findings that cytokines interact with antidepressants and non-pharmacological antidepressive therapies, such as electroconvulsive therapy, deep brain stimulation and physical activity, 3) the influence of cytokines on the cytochrome (CYP) p450-system and drug efflux transporters, and 4) how cascades of inflammation might serve as antidepressant drug targets. A number of clinical trials have focused on agents with immunmodulatory properties in the treatment of depression, of which this review covers nonsteroidal anti-inflammatory drugs (NSAIDs), cytokine inhibitors, ketamine, polyunsaturated fatty acids, statins and curcumin. A perspective is also provided on possible future immune targets for antidepressant therapy, such as toll-like receptor-inhibitors, glycogen synthase kinase-3 inhibitors, oleanolic acid analogs and minocycline. Concluding from the available data, markers of inflammation may become relevant factors for more personalised planning and prediction of response of antidepressant treatment strategies. Agents with anti-inflammatory properties have the potential to serve as clinically relevant antidepressants. Further studies are required to better define and identify subgroups of patients responsive to inflammatory agents as well as to define optimal time points for treatment onset and duration.
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Affiliation(s)
- Frank M Schmidt
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, D-04103 Leipzig, Germany
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18
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Holtman IR, Bsibsi M, Gerritsen WH, Boddeke HWGM, Eggen BJL, van der Valk P, Kipp M, van Noort JM, Amor S. Identification of highly connected hub genes in the protective response program of human macrophages and microglia activated by alpha B-crystallin. Glia 2017; 65:460-473. [DOI: 10.1002/glia.23104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Inge R. Holtman
- Department of Medical Physiology; University of Groningen, University Medical Center Groningen; Groningen AV the Netherlands
| | | | - Wouter H. Gerritsen
- Department of Pathology; VU University Medical Center; Amsterdam HV the Netherlands
| | - Hendrikus W. G. M. Boddeke
- Department of Medical Physiology; University of Groningen, University Medical Center Groningen; Groningen AV the Netherlands
| | - Bart J. L. Eggen
- Department of Medical Physiology; University of Groningen, University Medical Center Groningen; Groningen AV the Netherlands
| | - Paul van der Valk
- Department of Pathology; VU University Medical Center; Amsterdam HV the Netherlands
| | - Markus Kipp
- Department of Neuroanatomy; University of Munich; Munich Germany
| | - Johannes M. van Noort
- Delta Crystallon BV; Beverwijk ED the Netherlands
- Department of Pathology; VU University Medical Center; Amsterdam HV the Netherlands
| | - Sandra Amor
- Department of Pathology; VU University Medical Center; Amsterdam HV the Netherlands
- Department of Neuroscience and Trauma, Blizard Institute, Barts and the London School of Medicine & Dentistry; Queen Mary University of London; London United Kingdom
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Baune BT. Are Non-steroidal Anti-Inflammatory Drugs Clinically Suitable for the Treatment of Symptoms in Depression-Associated Inflammation? Curr Top Behav Neurosci 2016; 31:303-319. [PMID: 27405497 DOI: 10.1007/7854_2016_19] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aetiology and pathophysiology of depression have long been associated with inflammation, at least in a proportion of patients. Altered cytokine activity in the periphery and in the brain has brought support to a concept of depression-associated inflammation. However, these immunological changes - and inflammation in particular - in depression have only been recently targeted for treatment. Non-steroidal anti-inflammatory drugs (NSAIDs) have been proposed to be of clinical use in the treatment of depression either as monotherapy or as adjuncts in combination with antidepressants. Specifically, selective cyclooxygenase (COX)-2 and non-selective COX inhibitor NSAIDs as adjuncts or monotherapy have been trialled clinically. A limited body of clinical research has been conducted with mixed results so far. Although meta-analyses appear to support the use of NSAIDs in acute depression, the overall effect is mainly biased by the effects of celecoxib for which the best evidence exists to date. Efficacy data of non-selective COX inhibitor NSAIDs on depressive symptoms is limited and out of six studies, only a retrospective analysis shows positive results for non-selective COX inhibitor. Clinical data on aspirin, an irreversible inhibitor of both COX-1 and COX-2, are mainly experimental and hypothetical at this stage, but may be promising in depressed patients with concomitant inflammatory conditions. The main problematic factor is that current evidence rests on trials in acute depression. Because of the dynamic nature of depression, it is important exploring if NSAIDs and other anti-inflammatory treatments may have a preventive role in early stages of depression and for relapse prevention. The possible impact of anti-inflammatory treatments on immune changes in different phases of depression warrants caution for a wide and preventive use of anti-inflammatory agents in depression-associated inflammation.
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Affiliation(s)
- Bernhard T Baune
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, 5005, Australia.
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20
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Vieira ÉLM, de Oliveira GNM, Lessa JMK, Gonçalves AP, Sander JW, Cendes F, Teixeira AL. Interleukin-1β plasma levels are associated with depression in temporal lobe epilepsy. Epilepsy Behav 2015; 53:131-4. [PMID: 26575253 DOI: 10.1016/j.yebeh.2015.09.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 12/14/2022]
Abstract
Inflammatory mediators such as cytokines are likely to contribute to the pathophysiology of epilepsy. Proinflammatory cytokines are also associated with mood disorders, such as major depression. As people with temporal lobe epilepsy (TLE) are at an increased risk of mood disorders, we attempted to evaluate peripheral levels of IL-1β in people with TLE with depression and people with TLE without depression and in healthy controls. In a cross-sectional study, we compared three groups: 21 people with TLE without depression (TLE D-), 18 people with TLE with depression (TLE D+), and 31 controls without depression. A structured clinical interview (MINI-Plus) was used to diagnose current depression, and the Hamilton Depression Rating Scale (HAM-D) was used to quantify depressive symptoms. Plasma levels of IL-1β were significantly higher in people with TLE with depression than in controls (p=0.004) or people with TLE without depression (p=0.006). Interleukin-1beta levels positively correlated with HAM-D scores (Spearman's rho=0.381, p=0.017) in people with TLE. Higher levels of IL-1β in TLE seem to be associated with depression.
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Affiliation(s)
- Érica L M Vieira
- Neuroscience Division, Interdisciplinary Laboratory of Medical Investigation, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Guilherme N M de Oliveira
- Epilepsy Treatment Advanced Centre (NATE), Felício Rocho Hospital, Belo Horizonte, MG, Brazil; Medicine School, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, MG, Brazil
| | - João Marcelo K Lessa
- Neuroscience Division, Interdisciplinary Laboratory of Medical Investigation, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana Paula Gonçalves
- Neuroscience Division, Interdisciplinary Laboratory of Medical Investigation, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Epilepsy Treatment Advanced Centre (NATE), Felício Rocho Hospital, Belo Horizonte, MG, Brazil
| | - Josemir W Sander
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands; NIHR University College London Hospitals, Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Epilepsy Society, Chalfont St Peter SL9 0RJ, UK
| | | | - Antônio Lúcio Teixeira
- Neuroscience Division, Interdisciplinary Laboratory of Medical Investigation, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Chuang DY, Simonyi A, Kotzbauer PT, Gu Z, Sun GY. Cytosolic phospholipase A2 plays a crucial role in ROS/NO signaling during microglial activation through the lipoxygenase pathway. J Neuroinflammation 2015; 12:199. [PMID: 26520095 PMCID: PMC4628268 DOI: 10.1186/s12974-015-0419-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 10/21/2015] [Indexed: 11/10/2022] Open
Abstract
Background Oxidative stress and inflammation are important factors contributing to the pathophysiology of numerous neurological disorders, including Alzheimer’s disease, Parkinson’s disease, acute stroke, and infections of the brain. There is well-established evidence that proinflammatory cytokines and glutamate, as well as reactive oxygen species (ROS) and nitric oxide (NO), are produced upon microglia activation, and these are important factors contributing to inflammatory responses and cytotoxic damage to surrounding neurons and neighboring cells. Microglial cells express relatively high levels of cytosolic phospholipase A2 (cPLA2), an enzyme known to regulate membrane phospholipid homeostasis and release of arachidonic acid (AA) for synthesis of eicosanoids. The goal for this study is to elucidate the role of cPLA2IV in mediating the oxidative and inflammatory responses in microglial cells. Methods Experiments involved primary microglia cells isolated from transgenic mice deficient in cPLA2α or iPLA2β, as well as murine immortalized BV-2 microglial cells. Inhibitors of cPLA2/iPLA2/cyclooxygenase (COX)/lipoxygenase (LOX) were used in BV-2 microglial cell line. siRNA transfection was employed to knockdown cPLA2 expression in BV-2 cells. Griess reaction protocol was used to determine NO concentration, and CM-H2DCF-DA was used to detect ROS production in primary microglia and BV-2 cells. WST-1 assay was used to assess cell viability. Western blotting was used to assess protein expression levels. Immunocytochemical staining for phalloidin against F-actin was used to demonstrate cell morphology. Results In both primary and BV-2 microglial cells, stimulation with lipopolysaccharide (LPS) or interferon gamma (IFNγ) resulted in a time-dependent increase in phosphorylation of cPLA2 together with ERK1/2. In BV-2 cells, LPS- and IFNγ-induced ROS and NO production was inhibited by arachidonyl trifluoromethyl ketone (AACOCF3) and pyrrophenone as well as RNA interference, but not BEL, suggesting a link between cPLA2, and not iPLA2, on LPS/IFNγ-induced nitrosative and oxidative stress in microglial cells. Primary microglial cells isolated from cPLA2α-deficient mice generated significantly less NO and ROS as compared with the wild-type mice. Microglia isolated from iPLA2β-deficient mice did not show a decrease in LPS-induced NO and ROS production. LPS/IFNγ induced morphological changes in primary microglia, and these changes were mitigated by AACOCF3. Interestingly, despite that LPS and IFNγ induced an increase in phospho-cPLA2 and prostaglandin E2 (PGE2) release, LPS- and IFNγ-induced NO and ROS production were not altered by the COX-1/2 inhibitor but were suppressed by the LOX-12 and LOX-15 inhibitors instead. Conclusions In summary, the results in this study demonstrated the role of cPLA2 in microglial activation with metabolic links to oxidative and inflammatory responses, and this was in part regulated by the AA metabolic pathways, namely the LOXs. Further studies with targeted inhibition of cPLA2/LOX in microglia during neuroinflammatory conditions can be valuable to investigate the therapeutic potential in ameliorating neurological disease pathology. Electronic supplementary material The online version of this article (doi:10.1186/s12974-015-0419-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dennis Y Chuang
- Interdisciplinary Neuroscience Program, University of Missouri, Columbia, MO, USA.,Center for Translational Neuroscience, University of Missouri, Columbia, MO, USA.,Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, USA
| | - Agnes Simonyi
- Center for Translational Neuroscience, University of Missouri, Columbia, MO, USA.,Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, USA.,Department of Biochemistry, University of Missouri, Columbia, MO, USA
| | - Paul T Kotzbauer
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Zezong Gu
- Interdisciplinary Neuroscience Program, University of Missouri, Columbia, MO, USA.,Center for Translational Neuroscience, University of Missouri, Columbia, MO, USA.,Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, USA.,Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, USA
| | - Grace Y Sun
- Interdisciplinary Neuroscience Program, University of Missouri, Columbia, MO, USA. .,Center for Translational Neuroscience, University of Missouri, Columbia, MO, USA. .,Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, USA. .,Department of Biochemistry, University of Missouri, Columbia, MO, USA.
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22
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Arabzadeh S, Ameli N, Zeinoddini A, Rezaei F, Farokhnia M, Mohammadinejad P, Ghaleiha A, Akhondzadeh S. Celecoxib adjunctive therapy for acute bipolar mania: a randomized, double-blind, placebo-controlled trial. Bipolar Disord 2015; 17:606-14. [PMID: 26291962 DOI: 10.1111/bdi.12324] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 04/03/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Recent research has focused on the inflammatory cascade as a key culprit in the etiology of bipolar disorder. We hypothesized that celecoxib, via its anti-inflammatory properties, may have a therapeutic role in mood disorder. METHODS Forty-six inpatients with the diagnosis of acute bipolar mania without psychotic features participated in a parallel, randomized, double-blind, placebo-controlled trial, and underwent six weeks of treatment with either celecoxib (400 mg daily) or placebo as an adjunctive treatment to sodium valproate. Patients were evaluated using the Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS). The primary outcome measure with respect to efficacy was the mean decrease in YMRS score from baseline to the study endpoint, which was compared between the two groups. RESULTS A significant difference was observed in the change in YMRS scores on Day 42 compared to baseline in the two groups (p < 0.001). The changes at the endpoint compared to baseline were -29.78 ± 21.78 (mean ± standard deviation) and -21.78 ± 7.16 for the celecoxib and placebo groups, respectively. A significantly higher remission rate was observed in the celecoxib group (87.0%) than the placebo group (43.5%) at Week 6 (p = 0.005). General linear model repeated measures demonstrated a significant effect for the time × treatment interaction on the YMRS scores [F(2.27,99.98) = 6.67, p = 0.001]. CONCLUSIONS Celecoxib is an effective adjuvant therapy in the treatment of manic episodes (without psychotic features) of bipolar mood disorder. The mood-stabilizing role of the drug might be mediated via its action on the inflammatory cascade.
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Affiliation(s)
- Somayeh Arabzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Niusha Ameli
- Qods Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Atefeh Zeinoddini
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Rezaei
- Qods Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mehdi Farokhnia
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Mohammadinejad
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghaleiha
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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23
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Markers of Oxidative Stress and Neuroprogression in Depression Disorder. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:898393. [PMID: 26078821 PMCID: PMC4453280 DOI: 10.1155/2015/898393] [Citation(s) in RCA: 210] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/04/2015] [Indexed: 01/01/2023]
Abstract
Major depression is multifactorial disorder with high prevalence and alarming prognostic in the nearest 15 years. Several mechanisms of depression are known. Neurotransmitters imbalance and imbalance between neuroprogressive and neuroprotective factors are observed in major depression. Depression is accompanied by inflammatory responses of the organism and consequent elevation of proinflammatory cytokines and increased lipid peroxidation are described in literature. Neuropsychiatric disorders including major depression are also associated with telomerase shortening, oxidative changes in nucleotides, and polymorphisms in several genes connected to metabolism of reactive oxygen species. Mitochondrion dysfunction is directly associated with increasing levels of oxidative stress. Oxidative stress plays significant role in pathophysiology of major depression via actions of free radicals, nonradical molecules, and reactive oxygen and nitrogen species. Products of oxidative stress represent important parameters for measuring and predicting of depression status as well as for determining effectiveness of administrated antidepressants. Positive effect of micronutrients, vitamins, and antioxidants in depression treatment is also reviewed.
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24
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Maes M, Nowak G, Caso JR, Leza JC, Song C, Kubera M, Klein H, Galecki P, Noto C, Glaab E, Balling R, Berk M. Toward Omics-Based, Systems Biomedicine, and Path and Drug Discovery Methodologies for Depression-Inflammation Research. Mol Neurobiol 2015; 53:2927-2935. [PMID: 25934103 DOI: 10.1007/s12035-015-9183-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/16/2015] [Indexed: 02/07/2023]
Abstract
Meta-analyses confirm that depression is accompanied by signs of inflammation including increased levels of acute phase proteins, e.g., C-reactive protein, and pro-inflammatory cytokines, e.g., interleukin-6. Supporting the translational significance of this, a meta-analysis showed that anti-inflammatory drugs may have antidepressant effects. Here, we argue that inflammation and depression research needs to get onto a new track. Firstly, the choice of inflammatory biomarkers in depression research was often too selective and did not consider the broader pathways. Secondly, although mild inflammatory responses are present in depression, other immune-related pathways cannot be disregarded as new drug targets, e.g., activation of cell-mediated immunity, oxidative and nitrosative stress (O&NS) pathways, autoimmune responses, bacterial translocation, and activation of the toll-like receptor and neuroprogressive pathways. Thirdly, anti-inflammatory treatments are sometimes used without full understanding of their effects on the broader pathways underpinning depression. Since many of the activated immune-inflammatory pathways in depression actually confer protection against an overzealous inflammatory response, targeting these pathways may result in unpredictable and unwanted results. Furthermore, this paper discusses the required improvements in research strategy, i.e., path and drug discovery processes, omics-based techniques, and systems biomedicine methodologies. Firstly, novel methods should be employed to examine the intracellular networks that control and modulate the immune, O&NS and neuroprogressive pathways using omics-based assays, including genomics, transcriptomics, proteomics, metabolomics, epigenomics, immunoproteomics and metagenomics. Secondly, systems biomedicine analyses are essential to unravel the complex interactions between these cellular networks, pathways, and the multifactorial trigger factors and to delineate new drug targets in the cellular networks or pathways. Drug discovery processes should delineate new drugs targeting the intracellular networks and immune-related pathways.
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Affiliation(s)
- Michael Maes
- IMPACT Research Center, Deakin University, Geelong, Australia.
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, Brazil.
- IMPACT Strategic Research Center, Barwon Health, Deakin University, Geelong, Vic, Australia.
| | - Gabriel Nowak
- Department of Pharmacobiology, Jagiellonian University Medical College, Medyczna 9, 30-688, Kraków, Poland
- Department of Neurobiology, Institute of Pharmacology, Polish Academy of Sciences, Kraków, Poland
| | - Javier R Caso
- Department of Pharmacology, Faculty of Medicine, University Complutense, Centro de Investigación Biomédica en Salud Mental (CIBERSAM) & Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain
| | - Juan Carlos Leza
- Department of Pharmacology, Faculty of Medicine, University Complutense, Centro de Investigación Biomédica en Salud Mental (CIBERSAM) & Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain
| | - Cai Song
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Research Institute for Marine Nutrition and Drugs, Guangdong Ocean University, Zhanjiang, China
| | - Marta Kubera
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Science, Krakow, Poland
| | - Hans Klein
- Department of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Piotr Galecki
- Department of Adult Psychiatry, Medial University of Łódź, Łódź, Poland
| | - Cristiano Noto
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Enrico Glaab
- Luxembourg Centre for Systems Biomedicine, University of Luxemburg, Esch-sur-Alzette, Luxembourg
| | - Rudi Balling
- Luxembourg Centre for Systems Biomedicine, University of Luxemburg, Esch-sur-Alzette, Luxembourg
| | - Michael Berk
- IMPACT Research Center, Deakin University, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
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Eyre HA, Air T, Proctor S, Rositano S, Baune BT. A critical review of the efficacy of non-steroidal anti-inflammatory drugs in depression. Prog Neuropsychopharmacol Biol Psychiatry 2015; 57:11-6. [PMID: 25455584 DOI: 10.1016/j.pnpbp.2014.10.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/14/2014] [Accepted: 10/06/2014] [Indexed: 12/27/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) require further investigation given mixed results regarding efficacy. We critically and systematically reviewed the literature to determine whether selective COX-2 and non-selective COX inhibitor NSAIDs as adjuncts or monotherapy affect depressive symptoms. Electronic databases including Embase, PsycINFO, Ovid Medline, ScienceDirect, Google Scholar and the Cochrane Central Register of Controlled Trials database were searched up to September 2013. We utilised randomised controlled trials (RCTs), cohort studies and an open label study examining the efficacy of NSAIDs as adjuncts or monotherapy on depressive symptoms in subjects without major comorbidities. There were a total of 6 studies exploring the efficacy of selective COX-2 inhibitor NSAIDs on depressive symptoms with a total of 2706 subjects from 6 RCTs. 4 of the RCTs showed a significant effect of NSAIDs; 2 demonstrated no effect. There were a total of 5 studies exploring the efficacy of non-selective COX inhibitor NSAIDs on depressive symptoms with a total of 7978 subjects. There was 1 RCT, 3 cohort studies and 1 open label pilot study. The RCT failed to show a significant result. 1 of the retrospective cohort studies showed a positive result, with the other 2 showing no effect. The pilot study showed a positive result for NSAIDs. These studies demonstrated significant methodological heterogeneity (i.e. age range, sex, presence of antidepressant use, method of depression measure, severity of depressive symptoms, duration and study design (RCT vs. cohort)). The efficacy of NSAIDs on depressive symptoms appears negligible, however firm conclusions are difficult given the inconsistent findings and substantial methodological heterogeneity. Further high quality research is needed to explore NSAID efficacy in clinical and biological subtypes of depression, as monotherapy and adjunct with various antidepressants, and across various ages.
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Affiliation(s)
- Harris A Eyre
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia; Semel Institute for Neuroscience and Human Behavior, UCLA, LA, USA; School of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Tracy Air
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Simon Proctor
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Sebastian Rositano
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Bernhard T Baune
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia.
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Abstract
PURPOSE OF REVIEW This review aims to describe the current understanding of neuroinflammation in neurodegeneration and evaluate the value of various anti-inflammatory treatments. RECENT FINDINGS Inflammation plays important roles in common disease such as dementia and depression. Underlying mechanisms including the role of inflammasomes in these diseases have been recently described. Interventions using Ω-3 polyunsaturated fatty acids, NSAIDs and targeted antagonists (e.g., etanercept) show no convincing clinical efficacy in inflammation-associated depression, cognitive decline and dementia. SUMMARY Therapeutic targeting of inflammation appears to be relevant in brain conditions characterized by neuroinflammation and neurodegeneration, although published anti-inflammatory interventions have shown no relevant clinical efficacy. Newly described pharmacological targets in the neuroinflammation pathways may not only offer a more profound understanding of the underlying pathophysiology but also raise hope for the development of novel pharmacological agents.
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27
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Rosenblat JD, Cha DS, Mansur RB, McIntyre RS. Inflamed moods: a review of the interactions between inflammation and mood disorders. Prog Neuropsychopharmacol Biol Psychiatry 2014; 53:23-34. [PMID: 24468642 DOI: 10.1016/j.pnpbp.2014.01.013] [Citation(s) in RCA: 391] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 12/22/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023]
Abstract
Mood disorders have been recognized by the World Health Organization (WHO) as the leading cause of disability worldwide. Notwithstanding the established efficacy of conventional mood agents, many treated individuals continue to remain treatment refractory and/or exhibit clinically significant residual symptoms, cognitive dysfunction, and psychosocial impairment. Therefore, a priority research and clinical agenda is to identify pathophysiological mechanisms subserving mood disorders to improve therapeutic efficacy. During the past decade, inflammation has been revisited as an important etiologic factor of mood disorders. Therefore, the purpose of this synthetic review is threefold: 1) to review the evidence for an association between inflammation and mood disorders, 2) to discuss potential pathophysiologic mechanisms that may explain this association and 3) to present novel therapeutic options currently being investigated that target the inflammatory-mood pathway. Accumulating evidence implicates inflammation as a critical mediator in the pathophysiology of mood disorders. Indeed, elevated levels of pro-inflammatory cytokines have been repeatedly demonstrated in both major depressive disorder (MDD) and bipolar disorder (BD) patients. Further, the induction of a pro-inflammatory state in healthy or medically ill subjects induces 'sickness behavior' resembling depressive symptomatology. Potential mechanisms involved include, but are not limited to, direct effects of pro-inflammatory cytokines on monoamine levels, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, pathologic microglial cell activation, impaired neuroplasticity and structural and functional brain changes. Anti-inflammatory agents, such as acetyl-salicylic acid (ASA), celecoxib, anti-TNF-α agents, minocycline, curcumin and omega-3 fatty acids, are being investigated for use in mood disorders. Current evidence shows improved outcomes in mood disorder patients when anti-inflammatory agents are used as an adjunct to conventional therapy; however, further research is needed to establish the therapeutic benefit and appropriate dosage.
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Affiliation(s)
- Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Interdisciplinary Laboratory of Clinical Neuroscience (LINC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil; Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada.
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Overlapping biological mechanisms underlying sickle cell disease, stress, and depression: a stress-vulnerability framework. Harv Rev Psychiatry 2014; 22:205-15. [PMID: 24887328 DOI: 10.1097/hrp.0000000000000022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
After participating in this activity, learners should be better able to:1. Evaluate the overlap between sickle cell disease (SCD) and depression.2. Identify sources of psychological stress and biological vulnerabilities toward developing depression in patients with SCD.3. Assess the potential mechanisms underlying SCD, stress, and depression.Depression is a common co-occurring disorder in persons with sickle-cell disease (SCD). Individuals with this chronic illness may be particularly vulnerable to depression. In addition to risk factors for depression specifically related to SCD, these individuals typically experience further psychological stress due to multiple risk factors in their environment. To date, however, little research has focused on the co-occurring biological mechanisms across these conditions and how those mechanisms may interact to produce depressive symptoms. In this review we use a stress-vulnerability framework to describe the sources of psychological stress and the SCD factors that increase the risk of depression. We suggest that several biological factors, such as nitric oxide and cytokines, may play an important role in co-occurring stress, SCD, and depression. The interaction of these factors may be of particular importance for understanding the comorbidity of SCD and depression. Implications for current treatment and future research are discussed.
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Gałecki P, Talarowska M, Bobińska K, Szemraj J. COX-2 gene expression is correlated with cognitive function in recurrent depressive disorder. Psychiatry Res 2014; 215:488-90. [PMID: 24388097 DOI: 10.1016/j.psychres.2013.12.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 12/02/2013] [Accepted: 12/09/2013] [Indexed: 11/30/2022]
Abstract
Cyclooxygenase-2(COX-2) may be a key inflammatory enzyme involved in recurrent depressive disorder(rDD). In rDD group, COX-2 expression were higher and significant correlations occurred between COX-2 expression and cognitive functions. In controls there was no significant association between analysed variables. Thus, the COX-2 enzyme may be important for cognitive functioning in rDD.
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Affiliation(s)
- Piotr Gałecki
- Department of Adult Psychiatry, Medical University of Lodz, Aleksandrowska 159, 91-229 Lodz, Poland.
| | - Monika Talarowska
- Department of Adult Psychiatry, Medical University of Lodz, Aleksandrowska 159, 91-229 Lodz, Poland
| | - Kinga Bobińska
- Department of Adult Psychiatry, Medical University of Lodz, Aleksandrowska 159, 91-229 Lodz, Poland
| | - Janusz Szemraj
- Department of Medical Biochemistry, Medical University of Lodz, Lodz, Poland
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Chemokines and chemokine receptors in mood disorders, schizophrenia, and cognitive impairment: a systematic review of biomarker studies. Neurosci Biobehav Rev 2014; 42:93-115. [PMID: 24513303 DOI: 10.1016/j.neubiorev.2014.02.001] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/22/2013] [Accepted: 02/02/2014] [Indexed: 12/24/2022]
Abstract
The search for immune biomarkers in psychiatric disorders has primarily focused on pro-inflammatory cytokines. Other immune proteins including chemokines have been relatively neglected in such studies. Recent evidence has implicated chemokines in many neurobiological processes potentially relevant to psychiatric disorders, beyond their classical chemotactic functions. These may include neuromodulator effects, neurotransmitter-like effects, and direct/indirect regulation of neurogenesis. This systematic review presents the existing early evidence which supports an association of many chemokines with the psychiatric disorders: depression, bipolar disorder, schizophrenia, mild cognitive impairment and Alzheimer's disease. The non-specific association of chemokines including CXCL8 (IL-8), CCL2 (MCP-1), CCL3 (MIP-1α) and CCL5 (RANTES) with these disorders across diagnostic categories implies a generalised involvement of many chemokine systemic with psychiatric disease. Additional chemokines with great mechanistic relevance including CXCL12 (SDF-1) and CX3CL1 (fractalkine) have been rarely reported in the existing human literature and should be included in future clinical studies. The potential utility of these proteins as pathologically relevant biomarkers or therapeutic targets should be considered by future clinical and translational research.
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Anderson G, Berk M, Dean O, Moylan S, Maes M. Role of immune-inflammatory and oxidative and nitrosative stress pathways in the etiology of depression: therapeutic implications. CNS Drugs 2014; 28:1-10. [PMID: 24150993 DOI: 10.1007/s40263-013-0119-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Accumulating data have led to a re-conceptualization of depression that emphasizes the role of immune-inflammatory processes, coupled to oxidative and nitrosative stress (O&NS). These in turn drive the production of neuroregulatory tryptophan catabolites (TRYCATs), driving tryptophan away from serotonin, melatonin, and N-acetylserotonin production, and contributing to central dysregulation. This revised perspective better encompasses the diverse range of biological changes occurring in depression and in doing so provides novel and readily attainable treatment targets, as well as potential screening investigations prior to treatment initiation. We briefly review the role that immune-inflammatory, O&NS, and TRYCAT pathways play in the etiology, course, and treatment of depression. We then discuss the pharmacological treatment implications arising from this, including the potentiation of currently available antidepressants by the adjunctive use of immune- and O&NS-targeted therapies. The use of such a frame of reference and the treatment benefits attained are likely to have wider implications and utility for depression-associated conditions, including the neuroinflammatory and (neuro)degenerative disorders.
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Renoir T, Hasebe K, Gray L. Mind and body: how the health of the body impacts on neuropsychiatry. Front Pharmacol 2013; 4:158. [PMID: 24385966 PMCID: PMC3866391 DOI: 10.3389/fphar.2013.00158] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/30/2013] [Indexed: 12/24/2022] Open
Abstract
It has long been established in traditional forms of medicine and in anecdotal knowledge that the health of the body and the mind are inextricably linked. Strong and continually developing evidence now suggests a link between disorders which involve Hypothalamic-Pituitary-Adrenal axis (HPA) dysregulation and the risk of developing psychiatric disease. For instance, adverse or excessive responses to stressful experiences are built into the diagnostic criteria for several psychiatric disorders, including depression and anxiety disorders. Interestingly, peripheral disorders such as metabolic disorders and cardiovascular diseases are also associated with HPA changes. Furthermore, many other systemic disorders associated with a higher incidence of psychiatric disease involve a significant inflammatory component. In fact, inflammatory and endocrine pathways seem to interact in both the periphery and the central nervous system (CNS) to potentiate states of psychiatric dysfunction. This review synthesizes clinical and animal data looking at interactions between peripheral and central factors, developing an understanding at the molecular and cellular level of how processes in the entire body can impact on mental state and psychiatric health.
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Affiliation(s)
- Thibault Renoir
- Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health, University of MelbourneMelbourne, VIC, Australia
| | - Kyoko Hasebe
- School of Medicine, Deakin UniversityGeelong, VIC, Australia
| | - Laura Gray
- School of Medicine, Deakin UniversityGeelong, VIC, Australia
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Mills NT, Scott JG, Wray NR, Cohen-Woods S, Baune BT. Research review: the role of cytokines in depression in adolescents: a systematic review. J Child Psychol Psychiatry 2013; 54:816-35. [PMID: 24027786 DOI: 10.1111/jcpp.12080] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND While cytokines have been implicated in the pathophysiology of depression in adults, the potential role in younger age groups such as adolescents is less clear. This article therefore reviews the literature (a) to explore the relationship between cytokines and depression in adolescents, and (b) to examine how cytokines may be related to adolescent depression in the context of other neurobiological theories of depression. METHOD A systematic review of the scientific literature on the subject was conducted in February 2013, searching the Web of Knowledge, PubMed (Medline), PsycInfo and Cochrane electronic databases. RESULTS Eighteen studies were identified measuring both depression or depressive symptoms and cytokines or immune markers in adolescents. Adolescents with depression show age-specific characteristics of the immune and inflammatory system, specifically in NK cell activity and in pro-inflammatory cytokines (such as IL-1β and TNF-α). In addition, the role of cytokines in adolescent depression is influenced by neurodevelopment, hormonal changes, stress and trauma. CONCLUSIONS There may be differences in the neurobiology of adolescent major depressive disorder (MDD) compared with adult MDD. Increased understanding of the role of cytokines in adolescent MDD may lead to improved outcomes in the treatment of adolescent depression.
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Affiliation(s)
- Natalie T Mills
- Genetic Epidemiology, Queensland Institute of Medical Research, Brisbane, Qld, Australia
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Anderson G, Maes M, Berk M. Schizophrenia is primed for an increased expression of depression through activation of immuno-inflammatory, oxidative and nitrosative stress, and tryptophan catabolite pathways. Prog Neuropsychopharmacol Biol Psychiatry 2013; 42:101-14. [PMID: 22930036 DOI: 10.1016/j.pnpbp.2012.07.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/25/2012] [Accepted: 07/26/2012] [Indexed: 02/08/2023]
Abstract
Schizophrenia and depression are two common and debilitating psychiatric conditions. Up to 61% of schizophrenic patients have comorbid clinical depression, often undiagnosed. Both share significant overlaps in underlying biological processes, which are relevant to the course and treatment of both conditions. Shared processes include changes in cell-mediated immune and inflammatory pathways, e.g. increased levels of pro-inflammatory cytokines and a Th1 response; activation of oxidative and nitrosative stress (O&NS) pathways, e.g. increased lipid peroxidation, damage to proteins and DNA; decreased antioxidant levels, e.g. lowered coenzyme Q10, vitamin E, glutathione and melatonin levels; autoimmune responses; and activation of the tryptophan catabolite (TRYCAT) pathway through induction of indoleamine-2,3-dioxygenase. Both show cognitive and neurostructural evidence of a neuroprogressive process. Here we review the interlinked nature of these biological processes, suggesting that schizophrenia is immunologically primed for an increased expression of depression. Such a conceptualization explains, and incorporates, many of the current perspectives on the nature of schizophrenia and depression, and has implications for the nature of classification and treatment of both disorders. An early developmental etiology to schizophrenia, driven by maternal infection, with subsequent impact on offspring immuno-inflammatory responses, creates alterations in the immune pathways, which although priming for depression, also differentiates the two disorders.
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Berk M, Dean O, Drexhage H, McNeil JJ, Moylan S, O'Neil A, Davey CG, Sanna L, Maes M. Aspirin: a review of its neurobiological properties and therapeutic potential for mental illness. BMC Med 2013; 11:74. [PMID: 23506529 PMCID: PMC3751197 DOI: 10.1186/1741-7015-11-74] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 03/18/2013] [Indexed: 12/27/2022] Open
Abstract
There is compelling evidence to support an aetiological role for inflammation, oxidative and nitrosative stress (O&NS), and mitochondrial dysfunction in the pathophysiology of major neuropsychiatric disorders, including depression, schizophrenia, bipolar disorder, and Alzheimer's disease (AD). These may represent new pathways for therapy. Aspirin is a non-steroidal anti-inflammatory drug that is an irreversible inhibitor of both cyclooxygenase (COX)-1 and COX-2, It stimulates endogenous production of anti-inflammatory regulatory 'braking signals', including lipoxins, which dampen the inflammatory response and reduce levels of inflammatory biomarkers, including C-reactive protein, tumor necrosis factor-α and interleukin (IL)--6, but not negative immunoregulatory cytokines, such as IL-4 and IL-10. Aspirin can reduce oxidative stress and protect against oxidative damage. Early evidence suggests there are beneficial effects of aspirin in preclinical and clinical studies in mood disorders and schizophrenia, and epidemiological data suggests that high-dose aspirin is associated with a reduced risk of AD. Aspirin, one of the oldest agents in medicine, is a potential new therapy for a range of neuropsychiatric disorders, and may provide proof-of-principle support for the role of inflammation and O&NS in the pathophysiology of this diverse group of disorders.
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Affiliation(s)
- Michael Berk
- School of Medicine, Deakin University, 75 Pigdon's Road, Waurn Ponds, Geelong, Victoria 3216, Australia.
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