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Haidary M, Arif S, Hossaini D, Madadi S, Akbari E, Rezayee H. Pain-Insomnia-Depression Syndrome: Triangular Relationships, Pathobiological Correlations, Current Treatment Modalities, and Future Direction. Pain Ther 2024; 13:733-744. [PMID: 38814408 PMCID: PMC11255165 DOI: 10.1007/s40122-024-00614-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/10/2024] [Indexed: 05/31/2024] Open
Abstract
Pain-insomnia-depression syndrome (PIDS) is a complex triad of chronic pain, insomnia, and depression that has profound effects on an individual's quality of life and mental health. The pathobiological context of PIDS involves complex neurobiological and physiological mechanisms, including alterations in neurotransmitter systems and impaired pain processing pathways. The first-line therapeutic approaches for the treatment of chronic pain, depression, and insomnia are a combination of pharmacological and non-pharmacological therapies. In cases where patients do not respond adequately to these treatments, additional interventions such as deep brain stimulation (DBS) may be required. Despite advances in understanding and treatment, there are still gaps in knowledge that need to be addressed. To improve our understanding, future research should focus on conducting longitudinal studies to uncover temporal associations, identify biomarkers and genetic markers associated with PIDS, examine the influence of psychosocial factors on treatment responses, and develop innovative interventions that address the complex nature of PIDS. The aim of this study is to provide a comprehensive overview of these components and to discuss their underlying pathobiological relationships.
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Affiliation(s)
- Murtaza Haidary
- Medical Research and Technology Center, Khatam Al-Nabieen University, Kabul, Afghanistan.
| | - Shamim Arif
- Medical Research Center, Kateb University, Kabul, Afghanistan
| | - Dawood Hossaini
- Department of Biology and Microbiology, Faculty of Medical Laboratory Technology, Khatam Al-Nabieen University, Kabul, Afghanistan
| | - Shekiba Madadi
- Medical Research Center, Kateb University, Kabul, Afghanistan
| | - Elham Akbari
- Department of Biology and Microbiology, Faculty of Medical Laboratory Technology, Khatam Al-Nabieen University, Kabul, Afghanistan
| | - Hossain Rezayee
- Department of Chemistry and Biochemistry, Faculty of Medical Laboratory Technology, Khatam Al-Nabieen University, Kabul, Afghanistan
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Hu XH, Yu KY, Li XX, Zhang JN, Jiao JJ, Wang ZJ, Cai HY, Wang L, He YX, Wu MN. Selective Orexin 2 Receptor Blockade Alleviates Cognitive Impairments and the Pathological Progression of Alzheimer's Disease in 3xTg-AD Mice. J Gerontol A Biol Sci Med Sci 2024; 79:glae115. [PMID: 38682858 DOI: 10.1093/gerona/glae115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Indexed: 05/01/2024] Open
Abstract
The orexin system is closely related to the pathogenesis of Alzheimer's disease (AD). Orexin-A aggravates cognitive dysfunction and increases amyloid β (Aβ) deposition in AD model mice, but studies of different dual orexin receptor (OXR) antagonists in AD have shown inconsistent results. Our previous study revealed that OX1R blockade aggravates cognitive deficits and pathological progression in 3xTg-AD mice, but the effects of OX2R and its potential mechanism in AD have not been reported. In the present study, OX2R was blocked by oral administration of the selective OX2R antagonist MK-1064, and the effects of OX2R blockade on cognitive dysfunction and neuropsychiatric symptoms in 3xTg-AD mice were evaluated via behavioral tests. Then, immunohistochemistry, western blotting, and ELISA were used to detect Aβ deposition, tau phosphorylation, and neuroinflammation, and electrophysiological and wheel-running activity recording were recorded to observe hippocampal synaptic plasticity and circadian rhythm. The results showed that OX2R blockade ameliorated cognitive dysfunction, improved LTP depression, increased the expression of PSD-95, alleviated anxiety- and depression-like behaviors and circadian rhythm disturbances in 3xTg-AD mice, and reduced Aβ pathology, tau phosphorylation, and neuroinflammation in the brains of 3xTg-AD mice. These results indicated that chronic OX2R blockade exerts neuroprotective effects in 3xTg-AD mice by reducing AD pathology at least partly through improving circadian rhythm disturbance and the sleep-wake cycle and that OX2R might be a potential target for the prevention and treatment of AD; however, the potential mechanism by which OX2R exerts neuroprotective effects on AD needs to be further investigated.
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Affiliation(s)
- Xiao-Hong Hu
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Key Laboratory of Cellular Physiology in Shanxi Province, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Kai-Yue Yu
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Key Laboratory of Cellular Physiology in Shanxi Province, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Xin-Xin Li
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Key Laboratory of Cellular Physiology in Shanxi Province, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Jin-Nan Zhang
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Key Laboratory of Cellular Physiology in Shanxi Province, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Juan-Juan Jiao
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Key Laboratory of Cellular Physiology in Shanxi Province, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Zhao-Jun Wang
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Key Laboratory of Cellular Physiology in Shanxi Province, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Hong-Yan Cai
- Department of Microbiology and Immunology, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Lei Wang
- Department of Geriatrics, Shanxi Bethune Hospital, Taiyuan, People's Republic of China
| | - Ye-Xin He
- Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, People's Republic of China
| | - Mei-Na Wu
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Key Laboratory of Cellular Physiology in Shanxi Province, Shanxi Medical University, Taiyuan, People's Republic of China
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Liu D, Zheng X, Hui Y, Xu Y, Du J, Du Z, Che Y, Wu F, Yu G, Zhang J, Gong X, Guo G. Lateral hypothalamus orexinergic projection to the medial prefrontal cortex modulates chronic stress-induced anhedonia but not anxiety and despair. Transl Psychiatry 2024; 14:149. [PMID: 38493173 PMCID: PMC10944479 DOI: 10.1038/s41398-024-02860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
Chronic stress-induced anxiodepression is a common health problem, however its potential neurocircuitry mechanism remains unclear. We used behavioral, patch-clamp electrophysiology, chemogenetic, and optogenetic approaches to clarify the response of the lateral hypothalamus (LH) and the medial prefrontal cortex (mPFC) to stress, confirmed the structural connections between the LH and mPFC, and investigated the role of the LH-mPFC pathway in chronic stress-induced anxiodepression symptoms. Unpredictable chronic mild stress (UCMS) caused anxiodepression-like behaviors, including anxiety, anhedonia, and despair behaviors. We discovered that the activity of the LH and mPFC was both increased after restraint stress (RS), a stressor of UCMS. Then we found that the orexinergic neurons in the LH predominantly project to the glutamatergic neurons in the mPFC, and the excitability of these neurons were increased after UCMS. In addition, overactivated LH orexinergic terminals in the mPFC induced anhedonia but not anxiety and despair behaviors in naive mice. Moreover, chemogenetically inhibited LH-mPFC orexinergic projection neurons and blocked the orexin receptors in the mPFC alleviated anhedonia but not anxiety and despair behaviors in UCMS-treated mice. Our study identified a new neurocircuit from LH orexinergic neurons to mPFC and revealed its role in regulating anhedonia in response to stress. Overactivation of LHOrx-mPFC pathway selectively mediated chronic stress-induced anhedonia. In normal mice, the LHOrx-mPFC pathway exhibits relatively low activity. However, after chronic stress, the activity of orexinergic neuron in LH is overactivated, leading to an increased release of orexin into the mPFC. This heightened orexin concentration results in increased excitability of the mPFC through OX1R and OX2R, consequently triggering anhedonia.
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Affiliation(s)
- Danlei Liu
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510632, China
- Department of Gastroenterology, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Xuefeng Zheng
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510632, China
| | - Yuqing Hui
- Department of Gastroenterology, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Yuanyuan Xu
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510632, China
| | - Jinjiang Du
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510632, China
| | - Zean Du
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510632, China
| | - Yichen Che
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510632, China
| | - Fengming Wu
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510632, China
| | - Guangyin Yu
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510632, China
| | - Jifeng Zhang
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510632, China.
| | - Xiaobing Gong
- Department of Gastroenterology, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
| | - Guoqing Guo
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510632, China.
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Brotschi C, Bolli MH, Gatfield J, Roch C, Sifferlen T, Treiber A, Williams JT, Boss C. Pyrazole derivatives as selective orexin-2 receptor antagonists (2-SORA): synthesis, structure-activity-relationship, and sleep-promoting properties in rats. RSC Med Chem 2024; 15:344-354. [PMID: 38283232 PMCID: PMC10809354 DOI: 10.1039/d3md00573a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/20/2023] [Indexed: 01/30/2024] Open
Abstract
Selective orexin 2 receptor antagonists (2-SORA) such as seltorexant (15) are in clinical development for the treatment of insomnia and other conditions such as depression. Herein, we report our structure-activity-relationship (SAR) optimization efforts starting from an HTS hit (1) (N-(1-((5-acetylfuran-2-yl)methyl)-1H-pyrazol-4-yl)-5-(m-tolyl)oxazole-4-carboxamide) that was derived from an unrelated in-house GPCR-agonist program. Medicinal chemistry efforts focused on the optimization of orexin 2 receptor (OX2R) antagonistic activity, stability in liver microsomes, time dependent CYP3A4 inhibition, and aqueous solubility. Compounds were assessed for their brain-penetrating potential in in vivo experiments to select the most promising compounds for our in vivo sleep model. Our lead optimization efforts led to the discovery of the potent, brain penetrating and orally active, 2-SORA (N-(1-(2-(5-methoxy-1H-pyrrolo[3,2-b]pyridin-3-yl)ethyl)-1H-pyrazol-4-yl)-5-(m-tolyl)oxazole-4-carboxamide) 43 with efficacy in a sleep model in rats comparable to 15.
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Affiliation(s)
- Christine Brotschi
- Idorsia Pharmaceuticals Ltd, Drug Discovery and Preclinical Development Hegenheimermattweg 91 4123 Allschwil Basel-Landschaft Switzerland
| | - Martin H Bolli
- Idorsia Pharmaceuticals Ltd, Drug Discovery and Preclinical Development Hegenheimermattweg 91 4123 Allschwil Basel-Landschaft Switzerland
| | - John Gatfield
- Idorsia Pharmaceuticals Ltd, Drug Discovery and Preclinical Development Hegenheimermattweg 91 4123 Allschwil Basel-Landschaft Switzerland
| | - Catherine Roch
- Idorsia Pharmaceuticals Ltd, Drug Discovery and Preclinical Development Hegenheimermattweg 91 4123 Allschwil Basel-Landschaft Switzerland
| | - Thierry Sifferlen
- Idorsia Pharmaceuticals Ltd, Drug Discovery and Preclinical Development Hegenheimermattweg 91 4123 Allschwil Basel-Landschaft Switzerland
| | - Alexander Treiber
- Idorsia Pharmaceuticals Ltd, Drug Discovery and Preclinical Development Hegenheimermattweg 91 4123 Allschwil Basel-Landschaft Switzerland
| | - Jodi T Williams
- Idorsia Pharmaceuticals Ltd, Drug Discovery and Preclinical Development Hegenheimermattweg 91 4123 Allschwil Basel-Landschaft Switzerland
| | - Christoph Boss
- Idorsia Pharmaceuticals Ltd, Drug Discovery and Preclinical Development Hegenheimermattweg 91 4123 Allschwil Basel-Landschaft Switzerland
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Wang L, Wang R, Song M, Lu W, Li N, Gao Y, Huang F, Liu B, Chen H, An C, Wang X. Association between peripheral orexin A/B levels and depression with childhood trauma. J Affect Disord 2023; 340:592-597. [PMID: 37385389 DOI: 10.1016/j.jad.2023.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Orexin dysfunction has previously been demonstrated to be associated with depression. However, no studies reported the different effects of orexin A/B on depression with and without childhood trauma (CT). In this study,we assessed the correlation between expression of orexin A/B and depression severity in major depressive disorder (MDD) patients and healthy controls. METHODS A total of 97 MDD patients and 51 healthy controls were recruited in this study. According to the total scores of childhood trauma questionnaire (CTQ), the MDD patients were further divided into two subgroups, MDD with CT and MDD without CT. The 17-item Hamilton Depression Scale (HAMD-17), and plasma orexin A and orexin B concentrations were measured in all participants using enzyme-linked immunosorbent assay. RESULTS Orexin B plasma levels were significantly higher in MDD patients with CT and without CT than that in the healthy control group (P < 0.05), whereas there was no statistical difference between the two depression groups. After adjusting age and BMI for covariates, the LASSO regression revealed significant association between the plasma orexin B levels and the total scores of HAMD (β = 3.348), CTQ (β = 2.005). There was no difference in plasma orexin A levels among three groups (P > 0.05). CONCLUSIONS Although peripheral orexin B levels are associated with the depression, rather than orexin A, CT appear to play a role in the association between orexin B levels and depression. China Clinical Trial Registration Center (Registration No.: ChiCTR2000039692).
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Affiliation(s)
- Lan Wang
- Mental Health Center, The First Hospital of Hebei Medical University, Hebei Clinical Medical Research Center for Mental Disorders, Hebei technical Innovation Center for Mental Health Assessment and Intervention, 89 Donggang Road, Shijiazhuang 050031, China
| | - Ran Wang
- Mental Health Center, The First Hospital of Hebei Medical University, Hebei Clinical Medical Research Center for Mental Disorders, Hebei technical Innovation Center for Mental Health Assessment and Intervention, 89 Donggang Road, Shijiazhuang 050031, China
| | - Mei Song
- Mental Health Center, The First Hospital of Hebei Medical University, Hebei Clinical Medical Research Center for Mental Disorders, Hebei technical Innovation Center for Mental Health Assessment and Intervention, 89 Donggang Road, Shijiazhuang 050031, China
| | - Wenting Lu
- Mental Health Center, The First Hospital of Hebei Medical University, Hebei Clinical Medical Research Center for Mental Disorders, Hebei technical Innovation Center for Mental Health Assessment and Intervention, 89 Donggang Road, Shijiazhuang 050031, China
| | - Na Li
- Mental Health Center, The First Hospital of Hebei Medical University, Hebei Clinical Medical Research Center for Mental Disorders, Hebei technical Innovation Center for Mental Health Assessment and Intervention, 89 Donggang Road, Shijiazhuang 050031, China
| | - Yuanyuan Gao
- Mental Health Center, The First Hospital of Hebei Medical University, Hebei Clinical Medical Research Center for Mental Disorders, Hebei technical Innovation Center for Mental Health Assessment and Intervention, 89 Donggang Road, Shijiazhuang 050031, China
| | - Fanfan Huang
- Mental Health Center, The First Hospital of Hebei Medical University, Hebei Clinical Medical Research Center for Mental Disorders, Hebei technical Innovation Center for Mental Health Assessment and Intervention, 89 Donggang Road, Shijiazhuang 050031, China
| | - Bufan Liu
- Mental Health Center, The First Hospital of Hebei Medical University, Hebei Clinical Medical Research Center for Mental Disorders, Hebei technical Innovation Center for Mental Health Assessment and Intervention, 89 Donggang Road, Shijiazhuang 050031, China
| | - Huan Chen
- Mental Health Center, The First Hospital of Hebei Medical University, Hebei Clinical Medical Research Center for Mental Disorders, Hebei technical Innovation Center for Mental Health Assessment and Intervention, 89 Donggang Road, Shijiazhuang 050031, China
| | - Cuixia An
- Mental Health Center, The First Hospital of Hebei Medical University, Hebei Clinical Medical Research Center for Mental Disorders, Hebei technical Innovation Center for Mental Health Assessment and Intervention, 89 Donggang Road, Shijiazhuang 050031, China.
| | - Xueyi Wang
- Mental Health Center, The First Hospital of Hebei Medical University, Hebei Clinical Medical Research Center for Mental Disorders, Hebei technical Innovation Center for Mental Health Assessment and Intervention, 89 Donggang Road, Shijiazhuang 050031, China.
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Fagan HA, Baldwin DS. Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions. Expert Rev Neurother 2023:1-14. [PMID: 37183813 DOI: 10.1080/14737175.2023.2211767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Generalized Anxiety Disorder (GAD) is a common psychiatric condition, characterized by the presence of general apprehensiveness and excessive worry. Current management consists of a range of pharmacological and psychological treatments. However, many patients do not respond to first-line pharmacological treatments and novel anxiolytic drugs are being developed. AREAS COVERED In this review, the authors first discuss the diagnostic criteria and epidemiology of GAD. The effective pharmacological treatments for GAD and their tolerability are addressed. Current consensus guidelines for treatment of GAD are discussed, and maintenance treatment, the management of treatment resistance, and specific management of older adults and children/adolescents are considered. Finally, novel anxiolytics under development are discussed, with a focus on those which have entered clinical trials. EXPERT OPINION A range of effective treatments for GAD are available, particularly duloxetine, escitalopram, pregabalin, quetiapine, and venlafaxine. There is a limited evidence base to support the further pharmacological management of patients with GAD who have not responded to initial treatment. Although many novel anxiolytics have progressed to clinical trials, translation from animal models has been mostly unsuccessful. However, the potential of several compounds including certain psychedelics, ketamine, oxytocin, and agents modulating the orexin, endocannabinoid, and immune systems merits further study.
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Affiliation(s)
- Harry A Fagan
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- College Keep, Southern Health NHS Foundation Trust, Southampton, UK
| | - David S Baldwin
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- College Keep, Southern Health NHS Foundation Trust, Southampton, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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