Absence of fever following intrahypothalamic injections of prostaglandins in sheep

Susceptibility to Treatment-Resistant Depression Within Families

Importance

Antidepressant responses and the phenotype of treatment-resistant depression (TRD) are believed to have a genetic basis. Genetic susceptibility between the TRD phenotype and other psychiatric disorders has also been established in previous genetic studies, but population-based cohort studies have not yet provided evidence to support these outcomes.

Objective

To estimate the TRD susceptibility and the susceptibility between TRD and other psychiatric disorders within families in a nationwide insurance cohort with extremely high coverage and comprehensive health care data.

Design, Setting, and Participants

This cohort study assessed data from the Taiwan national health insurance database across entire population (N = 26 554 001) between January 2003 and December 2017. Data analysis was performed from August 2021 to April 2023. TRD was defined as having experienced at least 3 distinct antidepressant treatments in the current episode, each with adequate dose and duration, based on the prescribing records. Then, we identified the first-degree relatives of individuals with TRD (n = 34 467). A 1:4 comparison group (n = 137 868) of first-degree relatives of individuals without TRD was arranged for the comparison group, matched by birth year, sex, and kinship.

Main Outcomes and Measures

Modified Poisson regression analyses were performed and adjusted relative risks (aRRs) and 95% CIs were calculated for the risk of TRD, the risk of other major psychiatric disorders, and different causes of mortality.

Results

This study included 172 335 participants (88 330 male and 84 005 female; mean [SD] age at beginning of follow-up, 22.9 [18.1] years). First-degree relatives of individuals with TRD had lower incomes, more physical comorbidities, higher suicide mortality, and increased risk of developing TRD (aRR, 9.16; 95% CI, 7.21-11.63) and higher risk of other psychiatric disorders than matched control individuals, including schizophrenia (aRR, 2.36; 95% CI, 2.10-2.65), bipolar disorder (aRR, 3.74; 95% CI, 3.39-4.13), major depressive disorder (aRR, 3.65; 95% CI, 3.44-3.87), attention-deficit/hyperactivity disorders (aRR, 2.38; 95% CI, 2.20-2.58), autism spectrum disorder (aRR, 2.26; 95% CI, 1.86-2.74), anxiety disorder (aRR, 2.71; 95% CI, 2.59-2.84), and obsessive-compulsive disorder (aRR, 3.14; 95% CI, 2.70-3.66). Sensitivity and subgroup analyses validated the robustness of the findings.

Conclusions and Relevance

To our knowledge, this study is the largest and perhaps first nationwide cohort study to demonstrate TRD phenotype transmission across families and coaggregation with other major psychiatric disorders. Patients with a family history of TRD had an increased risk of suicide mortality and tendency toward antidepressant resistance; therefore, more intensive treatments for depressive symptoms might be considered earlier, rather than antidepressant monotherapy.

Response of newborn and adult sheep to pyrogens: relation between fever and brain eicosanoid changes

We investigated whether the weak febrile response to pyrogens in newborns is due to a diminished activation of the putative pyrogen mediator, prostaglandin (PG)E2. Indwelling cannulas in the third ventricle of lambs (age, 5-31 days) and adult ewes were used to collect cerebrospinal fluid (CSF) for radioimmunoassay of PGE2. Intravenous (i.v.) endotoxin caused a smaller increase in body temperature but a larger increase in CSF PGE2 in lambs compared to adults. PGE2 by intracarotid infusion raised body temperature in 5 of 7 trials in 3 lambs and in 4 of 4 trials in 1 adult. Endotoxin given intracerebroventricularly (i.c.v.) induced a rise in temperature and CSF PGE2 in the lamb but, in the adult, these responses were delayed and smaller. Interleukin-1 i.c.v. and PGE2 i.c.v. were weak pyretic agents at both ages. We conclude that the lamb's diminished febrile response to endotoxin i.v. is not caused by a lesser rise in CSF PGE2, rather it may be due, at least in part, to reduced responsiveness to this putative mediator. Regardless of age, the sheep differs from other species in that pyrogen/PGE2 coupling occurs primarily at a site in brain that is better accessible from blood than CSF.

Fever: causes and consequences

The present review distinguishes pathogenic, neurogenic, and psychogenic fever, but focuses largely on pathogenic fever, the hallmark of infectious disease. The data presented show that a complex cascade of events underlies pathogenic fever, which in broad outline - and with frank disregard of contradictory data - can be described as follows. An invading microorganism releases endotoxin that stimulates macrophages to synthesize a variety of pyrogenic compounds called cytokines. Carried in blood, these cytokines reach the perivascular spaces of the organum vasculosum laminae terminalis (OVLT) and other regions near the brain where they promote the synthesis and release of prostaglandin (PGE2). This prostaglandin then penetrates the blood-brain barrier to evoke the autonomic and behavioral responses characteristic of fever. But then once expressed, fever does not continue unchecked; endogenous antipyretics likely act on the septum to limit the rise in body temperature. The present review also examines fever-resistance in neonates, the blunting of fever in the aged, and the behaviorally induced rise in body temperature following infection in ectotherms. And finally it takes up the question of whether fever enhances immune responsiveness, and through such enhancement contributes to host survival.

Examination of the subdiencephalic rat brain for sites mediating PGE1-induced pyrexia

The subdiencephalic rat brain was mapped for sites capable of mediating prostaglandin-induced pyrexia. In conscious rats, PGE1, 200 ng in a volume of 1 microliter, was injected unilaterally into 412 sites between the midmesencephalon and the caudal medulla. Injections into only 12 sites caused a reproducible, short-latency core temperature increase of at least 0.5 degrees C. None of these was located in the paramedian brainstem, which was considered a likely site of PGE1 action because of the presence there of thermosensitive and pyrogen-sensitive neurons. Rather, the reactive loci were found in the hippocampus (5 sites) and in the vicinity of the cochlear nuclei (7 sites). Injections into only 2 sites in the latter region failed to produce pyrexia. In the hippocampus, however, injections at 31 sites in the same frontal planes as the reactive loci produced no effect. The possibility that the active hippocampal sites were associated with a distribution of injectate to PGE1-sensitive neurons located within hippocampal cleavage planes rather than in a circumscribed region is discussed.

Changes in body temperature after administration of acetylcholine, histamine, morphine, prostaglandins and related agents

This survey, the second in a series, presents extensive tabulations of literature, primarily since 1965, on thermoregulatory effects of cholinergic agonists and antagonists, histamine and H1- and H2-receptor antagonists, narcotic analgesics and antagonists in both non-tolerant and tolerant subjects and of prostaglandins and related agents. The information listed includes the species used, route of administration and dose of drug, the environmental temperature at which the experiments were performed, the number of tests, the direction and magnitude of body temperature change and remarks on the presence of special conditions, such as age or lesions, or on the influence of other drugs, such as antagonists, on the response to the primary drug.

Effects on fluid balance induced by non-febrile intracerebroventricular infusions of PGE2, PGF2alpha, and arachidonic acid in the goat

Prostaglandins (PG) E2, F2 alpha (30 ng/kg . min-1) and arachidonic acid (150 and 300 ng/kg . min-1) were infused for 30 min into the lateral cerebral ventricle of conscious hydrated and non-hydrated goats. Like previously shown as concerns PGE1 PGE2 was found to inhibit the water diuresis and cause some increase in the renal sodium excretion in the hydrated animal, and to elicit thirst in the non-hydrated goat. The effects of PGE2 were enhanced when hypertonic (0.25 M) NaCl was simultaneously infused into the ventricle. The antidiuretic effect of PGF2 alpha was less pronounced, and drinking only occasionally occurred when this PG was infused into the non-hydrated animal. Only a weak, post-infusion reduction of the water diuresis was observed when arachidonic acid was administered into the hydrated goat. Neither the PG:s, nor arachidonic acid affected the temperature regulation of the animals. The possibility is discussed that the lack of febrile response was due to the choice of platinum-iridium as material for the cerebral implantations. It is suggested that PGE2 might have interacted with CSF Na+ in stimulating juxtaventricular receptors involved in the control of fluid balance. The experiments do not support the concept that PG:s of the E series constitute a cerebral humoral link in pyrogen-induced fever.