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Bühner LM, Kapanaiah SKT, Kätzel D. Chronic N-acetylcysteine treatment improves anhedonia and cognition in a mouse model of the schizophrenia prodrome. Front Behav Neurosci 2022; 16:1002223. [PMID: 36225391 PMCID: PMC9548602 DOI: 10.3389/fnbeh.2022.1002223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Schizophrenia is a severe psychiatric disorder whose neurodevelopmental pathogenesis includes a prodromal phase before its diagnostically decisive—namely psychotic—symptoms are present. This prodrome is characterized by cognitive and affective deficits, and it may constitute a critical time period for an early therapeutic intervention to improve or even prevent further disease development. N-acetylcysteine (NAC) is an easily repurposable compound that has recently shown promise in improving non-psychotic symptoms in patients with established schizophrenia. Its therapeutic mechanism may involve the amelioration of circuit abnormalities like a hyper-glutamatergic state and oxidative stress in cortex which have been proposed to drive the pathogenesis of this disease. However, it is currently unknown to what extent NAC can actually improve prodromal aberrations. To investigate this preclinically, we deployed the cyclin-D2 knockout mouse model (CD2-KO) that shares physiological and behavioral abnormalities with the schizophrenia prodrome, including a hyperactive CA1 region, and cognitive and affective deficits. Applying NAC chronically in drinking water (0.9 g/l) during development (∼P22–P70), we found that excessive novelty-induced hyperlocomotion was neither ameliorated during (∼P68) nor after (∼P75) treatment; similarly, T-maze working memory (tested after treatment; ∼P84) was unaffected. However, once chronic NAC treatment was resumed (at approximately P134) in those mice that had received it before, working memory, cognitive flexibility (tested under NAC), and anhedonia (sucrose-preference, tested 1 day after NAC-treatment stopped) were improved in CD2-KO mice. This suggests that chronic NAC treatment may be a therapeutic strategy to improve some cognitive and affective dysfunctions in the schizophrenia prodrome.
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Kätzel D, Wolff AR, Bygrave AM, Bannerman DM. Hippocampal Hyperactivity as a Druggable Circuit-Level Origin of Aberrant Salience in Schizophrenia. Front Pharmacol 2020; 11:486811. [PMID: 33178010 PMCID: PMC7596262 DOI: 10.3389/fphar.2020.486811] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/18/2020] [Indexed: 01/21/2023] Open
Abstract
The development of current neuroleptics was largely aiming to decrease excessive dopaminergic signaling in the striatum. However, the notion that abnormal dopamine creates psychotic symptoms by causing an aberrant assignment of salience that drives maladaptive learning chronically during disease development suggests a therapeutic value of early interventions that correct salience-related neural processing. The mesolimbic dopaminergic output is modulated by several interconnected brain-wide circuits centrally involving the hippocampus and key relays like the ventral and associative striatum, ventral pallidum, amygdala, bed nucleus of the stria terminalis, nucleus reuniens, lateral and medial septum, prefrontal and cingulate cortex, among others. Unraveling the causal relationships between these circuits using modern neuroscience techniques holds promise for identifying novel cellular—and ultimately molecular—treatment targets for reducing transition to psychosis and symptoms of schizophrenia. Imaging studies in humans have implicated a hyperactivity of the hippocampus as a robust and early endophenotype in schizophrenia. Experiments in rodents, in turn, suggested that the activity of its output region—the ventral subiculum—may modulate dopamine release from ventral tegmental area (VTA) neurons in the ventral striatum. Even though these observations suggested a novel circuit-level target for anti-psychotic action, no therapy has yet been developed along this rationale. Recently evaluated treatment strategies—at least in part—target excess glutamatergic activity, e.g. N-acetyl-cysteine (NAC), levetiracetam, and mGluR2/3 modulators. We here review the evidence for the central implication of the hippocampus-VTA axis in schizophrenia-related pathology, discuss its symptom-related implications with a particular focus on aberrant assignment of salience, and evaluate some of its short-comings and prospects for drug discovery.
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Affiliation(s)
- Dennis Kätzel
- Institute for Applied Physiology, Ulm University, Ulm, Germany
| | - Amy R Wolff
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
| | - Alexei M Bygrave
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, United States
| | - David M Bannerman
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
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N-Acetylcysteine for the Treatment of Psychiatric Disorders: A Review of Current Evidence. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2469486. [PMID: 30426004 PMCID: PMC6217900 DOI: 10.1155/2018/2469486] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/09/2018] [Indexed: 01/09/2023]
Abstract
N-acetylcysteine, a sulphur-containing amino acid for the treatment of paracetamol overdose and chronic obstructive pulmonary disease, is a widely available off-the-shelf oral antioxidant supplement in many countries. With the potential to modulate several neurological pathways, including glutamate dysregulation, oxidative stress, and inflammation that can be beneficial to the brain functions, N-acetylcysteine is being explored as an adjunctive therapy for many psychiatric conditions. This narrative review synthesises and presents the current evidence from systematic reviews, meta-analyses, and latest clinical trials on N-acetylcysteine for addiction and substance abuse, schizophrenia, obsessive-compulsive and related disorders, and mood disorders. Good evidence exists to support the use of N-acetylcysteine as an adjunct treatment to reduce the total and negative symptoms of schizophrenia. N-acetylcysteine also appears to be effective in reducing craving in substance use disorders, especially for the treatment of cocaine and cannabis use among young people, in addition to preventing relapse in already abstinent individuals. Effects of N-acetylcysteine on obsessive-compulsive and related disorders, as well as on mood disorders, remain unclear with mixed reviews, even though promising evidence does exist. Larger and better-designed studies are required to further investigate the clinical effectiveness of N-acetylcysteine in these areas. Oral N-acetylcysteine is safe and well tolerated without any considerable adverse effects. Current evidence supports its use as an adjunctive therapy clinically for psychiatric conditions, administered concomitantly with existing medications, with a recommended dosage between 2000 and 2400 mg/day.
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Yolland COB, Phillipou A, Castle DJ, Neill E, Hughes ME, Galletly C, Smith ZM, Francis PS, Dean OM, Sarris J, Siskind D, Harris AWF, Rossell SL. Improvement of cognitive function in schizophrenia with N-acetylcysteine: A theoretical review. Nutr Neurosci 2018; 23:139-148. [DOI: 10.1080/1028415x.2018.1478766] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, Australia
- Psychiatry, Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - David J. Castle
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, Australia
- Psychiatry, Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Erica Neill
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, Australia
- Psychiatry, Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Matthew E. Hughes
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
- Ramsay Health Care (SA) Mental Health, Adelaide, Australia
- Northern Adelaide Local Health Network, Adelaide, Australia
| | - Zoe M. Smith
- School of Life and Environmental Sciences, Deakin University, Waurn Ponds, Australia
| | - Paul S. Francis
- School of Life and Environmental Sciences, Deakin University, Waurn Ponds, Australia
| | - Olivia M. Dean
- Psychiatry, Faculty of Medicine, University of Melbourne, Melbourne, Australia
- IMPACT Strategic Research Centre, Barwon Health, Deakin University, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Jerome Sarris
- NICM Health Research Institute, School of Science and Health, Western Sydney University, Campbelltown, Australia
- Department of Psychiatry, Professorial Unit, The Melbourne Clinic, University of Melbourne, Melbourne, Australia
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Anthony W. F. Harris
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
- Brain Dynamics Centre, The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Susan L. Rossell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, Australia
- Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia
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Durieux AMS, Fernandes C, Murphy D, Labouesse MA, Giovanoli S, Meyer U, Li Q, So PW, McAlonan G. Targeting Glia with N-Acetylcysteine Modulates Brain Glutamate and Behaviors Relevant to Neurodevelopmental Disorders in C57BL/6J Mice. Front Behav Neurosci 2015; 9:343. [PMID: 26696857 PMCID: PMC4677305 DOI: 10.3389/fnbeh.2015.00343] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/23/2015] [Indexed: 01/25/2023] Open
Abstract
An imbalance between excitatory (E) glutamate and inhibitory (I) GABA transmission may underlie neurodevelopmental conditions such as autism spectrum disorder (ASD) and schizophrenia. This may be direct, through alterations in synaptic genes, but there is increasing evidence for the importance of indirect modulation of E/I balance through glial mechanisms. Here, we used C57BL/6J mice to test the hypothesis that striatal glutamate levels can be shifted by N-acetylcysteine (NAC), which acts at the cystine-glutamate antiporter of glial cells. Striatal glutamate was quantified in vivo using proton magnetic resonance spectroscopy. The effect of NAC on behaviors relevant to ASD was examined in a separate cohort. NAC induced a time-dependent decrease in striatal glutamate, which recapitulated findings of lower striatal glutamate reported in ASD. NAC-treated animals were significantly less active and more anxious in the open field test; and NAC-treated females had significantly impaired prepulse inhibition of startle response. This at least partly mimics greater anxiety and impaired sensorimotor gating reported in neurodevelopmental disorders. Thus glial mechanisms regulate glutamate acutely and have functional consequences even in adulthood. Glial cells may be a potential drug target for the development of new therapies for neurodevelopmental disorders across the life-span.
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Affiliation(s)
- Alice M S Durieux
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
| | - Cathy Fernandes
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
| | - Marie Anais Labouesse
- Physiology and Behaviour Laboratory, Swiss Federal Institute of Technology Schwerzenbach, Switzerland
| | - Sandra Giovanoli
- Physiology and Behaviour Laboratory, Swiss Federal Institute of Technology Schwerzenbach, Switzerland ; Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse Zurich, Switzerland
| | - Urs Meyer
- Physiology and Behaviour Laboratory, Swiss Federal Institute of Technology Schwerzenbach, Switzerland ; Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse Zurich, Switzerland
| | - Qi Li
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong Hong Kong, China
| | - Po-Wah So
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
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