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Dudhabhate BB, Awathale SN, Choudhary AG, Subhedar NK, Kokare DM. Deep brain stimulation targeted at lateral hypothalamus-medial forebrain bundle reverses depressive-like symptoms and related cognitive deficits in rat: Role of serotoninergic system. Neuroscience 2024; 556:96-113. [PMID: 39103042 DOI: 10.1016/j.neuroscience.2024.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/12/2024] [Accepted: 07/31/2024] [Indexed: 08/07/2024]
Abstract
The aim of the study is to understand the rationale behind the application of deep brain stimulation (DBS) in the treatment of depression. Male Wistar rats, rendered depressive with chronic unpredictable mild stress (CUMS) were implanted with electrode in the lateral hypothalamus-medial forebrain bundle (LH-MFB) and subjected to deep brain stimulation (DBS) for 4 h each day for 14 days. DBS rats, as well as controls, were screened for a range of parameters indicative of depressive state. Symptomatic features noticed in CUMS rats like the memory deficit, anhedonia, reduction in body weight and 5-hydroxytryptamine (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) levels in mPFC and elevated plasma corticosterone were reversed in rats subjected to DBS. DBS arrested CUMS induced degeneration of 5-HT cells in interfascicular region of dorsal raphe nucleus (DRif) and fibers in LH-MFB and induced dendritic proliferation in mPFC neurons. MFB is known to serve as a major conduit for the DRif-mPFC serotoninergic pathway. While the density of serotonin fibers in the LH-MFB circuit was reduced in CUMS, it was upregulated in DBS-treated rats. Furthermore, microinjection of 5-HT1A receptor antagonist, WAY100635 into mPFC countered the positive effects of DBS like the antidepressant and memory-enhancing action. In this background, we suggest that DBS at LH-MFB may exercise positive effect in depressive rats via upregulation of the serotoninergic system. While these data drawn from the experiments on rat provide meaningful clues, we suggest that further studies aimed at understanding the usefulness of DBS at LH-MFB in humans may be rewarding.
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Affiliation(s)
- Biru B Dudhabhate
- Department of Pharmaceutical Sciences, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440 033, India
| | - Sanjay N Awathale
- Shri Vile Parle Kelavani Mandal's Institute of Pharmacy, Dhule 424 001, Maharashtra, India
| | - Amit G Choudhary
- Department of Pharmaceutical Sciences, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440 033, India
| | - Nishikant K Subhedar
- Indian Institute of Science Education and Research (IISER), Dr. Homi Bhabha Road, Pune 411 008, India
| | - Dadasaheb M Kokare
- Department of Pharmaceutical Sciences, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440 033, India.
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2
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Zielinski JM, Reisert M, Sajonz BEA, Teo SJ, Thierauf-Emberger A, Wessolleck J, Frosch M, Spittau B, Leupold J, Döbrössy MD, Coenen VA. In Search for a Pathogenesis of Major Depression and Suicide-A Joint Investigation of Dopamine and Fiber Tract Anatomy Focusing on the Human Ventral Mesencephalic Tegmentum: Description of a Workflow. Brain Sci 2024; 14:723. [PMID: 39061463 PMCID: PMC11275155 DOI: 10.3390/brainsci14070723] [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: 06/18/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Major depressive disorder (MDD) is prevalent with a high subjective and socio-economic burden. Despite the effectiveness of classical treatment methods, 20-30% of patients stay treatment-resistant. Deep Brain Stimulation of the superolateral branch of the medial forebrain bundle is emerging as a clinical treatment. The stimulation region (ventral tegmental area, VTA), supported by experimental data, points to the role of dopaminergic (DA) transmission in disease pathology. This work sets out to develop a workflow that will allow the performance of analyses on midbrain DA-ergic neurons and projections in subjects who have committed suicide. Human midbrains were retrieved during autopsy, formalin-fixed, and scanned in a Bruker MRI scanner (7T). Sections were sliced, stained for tyrosine hydroxylase (TH), digitized, and integrated into the Montreal Neurological Institute (MNI) brain space together with a high-resolution fiber tract atlas. Subnuclei of the VTA region were identified. TH-positive neurons and fibers were semi-quantitatively evaluated. The study established a rigorous protocol allowing for parallel histological assessments and fiber tractographic analysis in a common space. Semi-quantitative readings are feasible and allow the detection of cell loss in VTA subnuclei. This work describes the intricate workflow and first results of an investigation of DA anatomy in VTA subnuclei in a growing naturalistic database.
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Affiliation(s)
- Jana M. Zielinski
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße 64, 79106 Freiburg i.Br., Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße 64, 79106 Freiburg i.Br., Germany
- Medical Faculty of University of Freiburg, 79106 Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center—University of Freiburg, 79106 Freiburg, Germany
| | - Bastian E. A. Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße 64, 79106 Freiburg i.Br., Germany
- Medical Faculty of University of Freiburg, 79106 Freiburg, Germany
| | - Shi Jia Teo
- Medical Faculty of University of Freiburg, 79106 Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center—University of Freiburg, 79106 Freiburg, Germany
| | - Annette Thierauf-Emberger
- Medical Faculty of University of Freiburg, 79106 Freiburg, Germany
- Institute of Forensic Medicine, Medical Center of Freiburg University, 79104 Freiburg, Germany
| | - Johanna Wessolleck
- Medical Faculty of University of Freiburg, 79106 Freiburg, Germany
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional, Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany
| | - Maximilian Frosch
- Medical Faculty of University of Freiburg, 79106 Freiburg, Germany
- Institute of Neuropathology, Medical Center of Freiburg University, 79106 Freiburg, Germany
| | - Björn Spittau
- Medical School OWL, Anatomy and Cell Biology, Bielefeld University, 33501 Bielefeld, Germany
- Institute for Anatomy and Cell Biology, Department of Molecular Embryologie, Faculty of Medicine, Freiburg University, 79104 Freiburg, Germany
| | - Jochen Leupold
- Medical Faculty of University of Freiburg, 79106 Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center—University of Freiburg, 79106 Freiburg, Germany
| | - Máté D. Döbrössy
- Medical Faculty of University of Freiburg, 79106 Freiburg, Germany
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional, Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Faculty of Biology, University of Freiburg, 79104 Freiburg, Germany
| | - Volker A. Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße 64, 79106 Freiburg i.Br., Germany
- Medical Faculty of University of Freiburg, 79106 Freiburg, Germany
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional, Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Center for Deep Brain Stimulation, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Center for Basics in Neuromodulation, Medical Faculty of Freiburg University, 79106 Freiburg, Germany
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3
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Zhang KK, Matin R, Gorodetsky C, Ibrahim GM, Gouveia FV. Systematic review of rodent studies of deep brain stimulation for the treatment of neurological, developmental and neuropsychiatric disorders. Transl Psychiatry 2024; 14:186. [PMID: 38605027 PMCID: PMC11009311 DOI: 10.1038/s41398-023-02727-5] [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: 01/17/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 04/13/2024] Open
Abstract
Deep brain stimulation (DBS) modulates local and widespread connectivity in dysfunctional networks. Positive results are observed in several patient populations; however, the precise mechanisms underlying treatment remain unknown. Translational DBS studies aim to answer these questions and provide knowledge for advancing the field. Here, we systematically review the literature on DBS studies involving models of neurological, developmental and neuropsychiatric disorders to provide a synthesis of the current scientific landscape surrounding this topic. A systematic analysis of the literature was performed following PRISMA guidelines. 407 original articles were included. Data extraction focused on study characteristics, including stimulation protocol, behavioural outcomes, and mechanisms of action. The number of articles published increased over the years, including 16 rat models and 13 mouse models of transgenic or healthy animals exposed to external factors to induce symptoms. Most studies targeted telencephalic structures with varying stimulation settings. Positive behavioural outcomes were reported in 85.8% of the included studies. In models of psychiatric and neurodevelopmental disorders, DBS-induced effects were associated with changes in monoamines and neuronal activity along the mesocorticolimbic circuit. For movement disorders, DBS improves symptoms via modulation of the striatal dopaminergic system. In dementia and epilepsy models, changes to cellular and molecular aspects of the hippocampus were shown to underlie symptom improvement. Despite limitations in translating findings from preclinical to clinical settings, rodent studies have contributed substantially to our current knowledge of the pathophysiology of disease and DBS mechanisms. Direct inhibition/excitation of neural activity, whereby DBS modulates pathological oscillatory activity within brain networks, is among the major theories of its mechanism. However, there remain fundamental questions on mechanisms, optimal targets and parameters that need to be better understood to improve this therapy and provide more individualized treatment according to the patient's predominant symptoms.
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Affiliation(s)
- Kristina K Zhang
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rafi Matin
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - George M Ibrahim
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
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Miguel Telega L, Ashouri Vajari D, Stieglitz T, Coenen VA, Döbrössy MD. New Insights into In Vivo Dopamine Physiology and Neurostimulation: A Fiber Photometry Study Highlighting the Impact of Medial Forebrain Bundle Deep Brain Stimulation on the Nucleus Accumbens. Brain Sci 2022; 12:brainsci12081105. [PMID: 36009169 PMCID: PMC9406226 DOI: 10.3390/brainsci12081105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 11/16/2022] Open
Abstract
New technologies, such as fiber photometry, can overcome long-standing methodological limitations and promote a better understanding of neuronal mechanisms. This study, for the first time, aimed at employing the newly available dopamine indicator (GRABDA2m) in combination with this novel imaging technique. Here, we present a detailed methodological roadmap leading to longitudinal repetitive transmitter release monitoring in in vivo freely moving animals and provide proof-of-concept data. This novel approach enables a fresh look at dopamine release patterns in the nucleus accumbens, following the medial forebrain bundle (mfb) DBS in a rodent model. Our results suggest reliable readouts of dopamine levels over at least 14 days of DBS-induced photometric measurements. We show that mfb-DBS can elicit an increased dopamine response during stimulation (5 s and 20 s DBS) compared to its baseline dopamine activity state, reaching its maximum peak amplitude in about 1 s and then recovering back after stimulation. The effect of different DBS pulse widths (PWs) also suggests a potential differential effect on this neurotransmitter response, but future studies would need to verify this. Using the described approach, we aim to gain insights into the differences between pathological and healthy models and to elucidate more exhaustively the mechanisms under which DBS exerts its therapeutic action.
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Affiliation(s)
- Lidia Miguel Telega
- Laboratory of Stereotaxy and Interventional Neurosciences (SIN), Department of Stereotactic and Functional Neurosurgery, University Freiburg Medical Center, 79106 Freiburg im Breisgau, Germany
- Department of Stereotactic and Functional Neurosurgery, University Freiburg Medical Center, 79106 Freiburg im Breisgau, Germany
- Faculty of Biology, University of Freiburg, 79104 Freiburg im Breisgau, Germany
- BrainLinks-BrainTools, IMBIT (Institute for Machine-Brain Interfacing Technology), University of Freiburg, 79110 Freiburg im Breisgau, Germany
| | - Danesh Ashouri Vajari
- BrainLinks-BrainTools, IMBIT (Institute for Machine-Brain Interfacing Technology), University of Freiburg, 79110 Freiburg im Breisgau, Germany
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering (IMTEK), University of Freiburg, 79110 Freiburg im Breisgau, Germany
| | - Thomas Stieglitz
- BrainLinks-BrainTools, IMBIT (Institute for Machine-Brain Interfacing Technology), University of Freiburg, 79110 Freiburg im Breisgau, Germany
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering (IMTEK), University of Freiburg, 79110 Freiburg im Breisgau, Germany
- Bernstein Center Freiburg, University of Freiburg, 79104 Freiburg im Breisgau, Germany
| | - Volker A. Coenen
- Laboratory of Stereotaxy and Interventional Neurosciences (SIN), Department of Stereotactic and Functional Neurosurgery, University Freiburg Medical Center, 79106 Freiburg im Breisgau, Germany
- Department of Stereotactic and Functional Neurosurgery, University Freiburg Medical Center, 79106 Freiburg im Breisgau, Germany
- BrainLinks-BrainTools, IMBIT (Institute for Machine-Brain Interfacing Technology), University of Freiburg, 79110 Freiburg im Breisgau, Germany
- Faculty of Medicine, University of Freiburg, 79110 Freiburg im Breisgau, Germany
- Center for Basics in Neuromodulation, University of Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Máté D. Döbrössy
- Laboratory of Stereotaxy and Interventional Neurosciences (SIN), Department of Stereotactic and Functional Neurosurgery, University Freiburg Medical Center, 79106 Freiburg im Breisgau, Germany
- Department of Stereotactic and Functional Neurosurgery, University Freiburg Medical Center, 79106 Freiburg im Breisgau, Germany
- Faculty of Biology, University of Freiburg, 79104 Freiburg im Breisgau, Germany
- Center for Basics in Neuromodulation, University of Freiburg, 79106 Freiburg im Breisgau, Germany
- Correspondence:
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Gardner W, Fuchs F, Durieux L, Bourgin P, Coenen VA, Döbrössy M, Lecourtier L. Slow Wave Sleep Deficits in the Flinders Sensitive Line Rodent Model of Depression: Effects of Medial Forebrain Bundle Deep-Brain Stimulation. Neuroscience 2022; 498:31-49. [PMID: 35750113 DOI: 10.1016/j.neuroscience.2022.06.023] [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: 03/05/2022] [Revised: 05/20/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
Major Depressive Disorder (MDD) is an affective disorder typically accompanied by sleep disturbances. Deep brain stimulation (DBS) of the medial forebrain bundle (MFB) is an emerging intervention for treatment-resistant depression, but its effect on sleep has not been closely examined. Here we aimed to characterise sleep deficits in the Flinders sensitive line, an established rodent model of depression, and investigate the consequences of MFB stimulation on sleep-related phenotypes. Rats were implanted with bilateral stimulation electrodes in the MFB, surface electrodes to record electrocorticography and electromyography for sleep scoring and electrodes within the prelimbic cortex, nucleus accumbens (NAc) and dorsal hippocampus. Recordings of sleep and oscillatory activity were conducted prior to and following twenty-four hours of MFB stimulation. Behavioural anti-depressant effects were monitored using the forced swim test. Previously unreported abnormalities in the Flinders sensitive line rats were observed during slow wave sleep, including decreased circadian amplitude of its rhythm, a reduction in slow wave activity and elevated gamma band oscillations. Previously established rapid eye movement sleep deficits were replicated. MFB stimulation had anti-depressant effects on behavioural phenotype, but did not significantly impact sleep architecture; it suppressed elevated gamma activity during slow wave sleep in the electrocorticogram and prelimbic cortex signals. Diverse abnormalities in Flinders sensitive line rats emphasise slow wave sleep as a state of dysfunction in affective disorders. MFB stimulation is able to affect behaviour and sleep physiology without influencing sleep architecture. Gamma modulation may represent a component of antidepressant mechanism.
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Affiliation(s)
- Wilf Gardner
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital of Freiburg University and Medical Faculty of Freiburg University, Germany; Faculty of Biology, Albert-Ludwigs-Universität-Freiburg, Freiburg, Germany; Laboratoire de Neurosciences Cognitives et Adaptatives, University of Strasbourg, Strasbourg, France
| | - Fanny Fuchs
- Inovarion, Paris, France; Institut des Neurosciences Cellulaires et Intégratives, University of Strasbourg, Strasbourg France
| | - Laura Durieux
- Laboratoire de Neurosciences Cognitives et Adaptatives, University of Strasbourg, Strasbourg, France
| | - Patrice Bourgin
- Institut des Neurosciences Cellulaires et Intégratives, University of Strasbourg, Strasbourg France; Centre des troubles du sommeil - CIRCSom, Strasbourg University Hospitals, Strasbourg, France
| | - Volker A Coenen
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital of Freiburg University and Medical Faculty of Freiburg University, Germany; Center for Basics in Neuromodulation, Freiburg University, Freiburg, Germany; Center for Deep Brain Stimulation, Freiburg University, Freiburg, Germany
| | - Máté Döbrössy
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital of Freiburg University and Medical Faculty of Freiburg University, Germany; Faculty of Biology, Albert-Ludwigs-Universität-Freiburg, Freiburg, Germany; Dept of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Germany.
| | - Lucas Lecourtier
- Laboratoire de Neurosciences Cognitives et Adaptatives, University of Strasbourg, Strasbourg, France.
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Bühning F, Miguel Telega L, Tong Y, Pereira J, Coenen V, Döbrössy M. Electrophysiological and molecular effects of bilateral deep brain stimulation of the medial forebrain bundle in a rodent model of depression. Exp Neurol 2022; 355:114122. [DOI: 10.1016/j.expneurol.2022.114122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/10/2022] [Accepted: 05/18/2022] [Indexed: 11/04/2022]
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Coenen VA, Schlaepfer TE, Sajonz BEA, Reinacher PC, Döbrössy MD, Reisert M. "The Heart Asks Pleasure First"-Conceptualizing Psychiatric Diseases as MAINTENANCE Network Dysfunctions through Insights from slMFB DBS in Depression and Obsessive-Compulsive Disorder. Brain Sci 2022; 12:438. [PMID: 35447971 PMCID: PMC9028695 DOI: 10.3390/brainsci12040438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
More than a decade ago, deep brain stimulation (DBS) of the superolateral medial forebrain bundle (slMFB), as part of the greater MFB system, had been proposed as a putative yet experimental treatment strategy for therapy refractory depression (TRD) and later for obsessive-compulsive disorders (OCD). Antidepressant and anti-OCD efficacy have been shown in open case series and smaller trials and were independently replicated. The MFB is anato-physiologically confluent with the SEEKING system promoting euphoric drive, reward anticipation and reward; functions realized through the mesocorticolimbic dopaminergic system. Growing clinical experience concerning surgical and stimulation aspects from a larger number of patients shows an MFB functionality beyond SEEKING and now re-informs the scientific rationale concerning the MFB's (patho-) physiology. In this white paper, we combine observations from more than 75 cases of slMFB DBS. We integrate these observations with a selected literature review to provide a new neuroethological view on the MFB. We here formulate a re-interpretation of the MFB as the main structure of an integrated SEEKING/MAINTENANCE circuitry, allowing for individual homeostasis and well-being through emotional arousal, basic and higher affect valence, bodily reactions, motor programing, vigor and flexible behavior, as the basis for the antidepressant and anti-OCD efficacy.
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Affiliation(s)
- Volker A. Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Center for Deep Brain Stimulation, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional, Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany
| | - Thomas E. Schlaepfer
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Center for Deep Brain Stimulation, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Department of Interventional Biological Psychiatry, Medical Center of University of Freiburg, 79106 Freiburg, Germany
| | - Bastian E. A. Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
| | - Peter C. Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Fraunhofer Institute for Laser Technology (ILT), 52074 Aachen, Germany
| | - Máté D. Döbrössy
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional, Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Faculty of Biology, University of Freiburg, 79104 Freiburg, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center of University of Freiburg, 79106 Freiburg, Germany
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Yuen J, Rusheen AE, Price JB, Barath AS, Shin H, Kouzani AZ, Berk M, Blaha CD, Lee KH, Oh Y. Biomarkers for Deep Brain Stimulation in Animal Models of Depression. Neuromodulation 2022; 25:161-170. [PMID: 35125135 PMCID: PMC8655028 DOI: 10.1111/ner.13483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/20/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Despite recent advances in depression treatment, many patients still do not respond to serial conventional therapies and are considered "treatment resistant." Deep brain stimulation (DBS) has therapeutic potential in this context. This comprehensive review of recent studies of DBS for depression in animal models identifies potential biomarkers for improving therapeutic efficacy and predictability of conventional DBS to aid future development of closed-loop control of DBS systems. MATERIALS AND METHODS A systematic search was performed in Pubmed, EMBASE, and Cochrane Review using relevant keywords. Overall, 56 animal studies satisfied the inclusion criteria. RESULTS Outcomes were divided into biochemical/physiological, electrophysiological, and behavioral categories. Promising biomarkers include biochemical assays (in particular, microdialysis and electrochemical measurements), which provide real-time results in awake animals. Electrophysiological tests, showing changes at both the target site and downstream structures, also revealed characteristic changes at several anatomic targets (such as the medial prefrontal cortex and locus coeruleus). However, the substantial range of models and DBS targets limits the ability to draw generalizable conclusions in animal behavioral models. CONCLUSIONS Overall, DBS is a promising therapeutic modality for treatment-resistant depression. Different outcomes have been used to assess its efficacy in animal studies. From the review, electrophysiological and biochemical markers appear to offer the greatest potential as biomarkers for depression. However, to develop closed-loop DBS for depression, additional preclinical and clinical studies with a focus on identifying reliable, safe, and effective biomarkers are warranted.
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Affiliation(s)
- Jason Yuen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong VIC 3216, Australia
| | - Aaron E. Rusheen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Medical Scientist Training Program, Mayo Clinic, Rochester, MN 55905, USA
| | - J. Blair Price
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Hojin Shin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Abbas Z. Kouzani
- School of Engineering, Deakin University, Geelong VIC 3216, Australia
| | - Michael Berk
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong VIC 3216, Australia
| | - Charles D. Blaha
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kendall H. Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Yoonbae Oh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
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9
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Tong Y, Pfeiffer L, Serchov T, Coenen VA, Döbrössy MD. Optogenetic stimulation of ventral tegmental area dopaminergic neurons in a female rodent model of depression: The effect of different stimulation patterns. J Neurosci Res 2022; 100:897-911. [PMID: 35088434 DOI: 10.1002/jnr.25014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 11/25/2021] [Accepted: 01/02/2022] [Indexed: 12/27/2022]
Abstract
Major depressive disorder is one of the most common mental disorders, and more than 300 million of people suffer from depression worldwide. Recent clinical trials indicate that deep brain stimulation of the superolateral medial forebrain bundle (mfb) can have rapid and long-term antidepressant effects in patients with treatment-resistant depression. However, the mechanisms of action are elusive. In this study, using female rats, we demonstrate the antidepressant effects of selective optogenetic stimulation of the ventral tegmental area's dopaminergic (DA) neurons passing through the mfb and compare different stimulation patterns. Chronic mild unpredictable stress (CMUS) induced depressive-like, but not anxiety-like phenotype. Short-term and long-term stimulation demonstrated antidepressant effect (OSST) and improved anxiolytic effect (EPM), while long-term stimulation during CMUS induction prevented depressive-like behavior (OSST and USV) and improved anxiolytic effect (EPM). The results highlight that long-term accumulative stimulation on DA pathways is required for antidepressant and anxiolytic effect.
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Affiliation(s)
- Yixin Tong
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany.,Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Lisa Pfeiffer
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany.,Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Tsvetan Serchov
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany.,Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany.,Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Volker A Coenen
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany.,Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in Neuromodulation, Freiburg University, Freiburg, Germany
| | - Máté D Döbrössy
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany.,Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
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10
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Deep brain stimulation of the "medial forebrain bundle": a strategy to modulate the reward system and manage treatment-resistant depression. Mol Psychiatry 2022; 27:574-592. [PMID: 33903731 DOI: 10.1038/s41380-021-01100-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/21/2021] [Accepted: 04/01/2021] [Indexed: 02/02/2023]
Abstract
The medial forebrain bundle-a white matter pathway projecting from the ventral tegmental area-is a structure that has been under a lot of scrutinies recently due to its implications in the modulation of certain affective disorders such as major depression. In the following, we will discuss major depression in the context of being a disorder dependent on multiple relevant networks, the pathological performance of which is responsible for the manifestation of various symptoms of the disease which extend into emotional, motivational, physiological, and also cognitive domains of daily living. We will focus on the reward system, an evolutionarily conserved pathway whose underperformance leads to anhedonia and lack of motivation, which are key traits in depression. In the field of deep brain stimulation (DBS), different "hypothesis-driven" targets have been chosen as the subject of clinical trials on efficacy in the treatment-resistant depressed patient. The "medial forebrain bundle" is one such target for DBS, and has had remarkably rapid success in alleviating depressive symptoms, improving anhedonia and motivation. We will review what we have learned from pre-clinical animal studies on defining this white matter tract, its connectivity, and the complex molecular (i.e., neurotransmitter) mechanisms by which its modulation exerts its effects. Imaging studies in the form of tractographic depictions have elucidated its presence in the human brain. Such has led to ongoing clinical trials of DBS targeting this pathway to assess efficacy, which is promising yet still lack in sufficient numbers. Ultimately, one must confirm the mechanism of action and validate proof of antidepressant effect in order to have such treatment become mainstream, to promote widespread improvement in the quality of life of suffering patients.
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11
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Coenen VA, Döbrössy MD, Teo SJ, Wessolleck J, Sajonz BEA, Reinacher PC, Thierauf-Emberger A, Spittau B, Leupold J, von Elverfeldt D, Schlaepfer TE, Reisert M. Diverging prefrontal cortex fiber connection routes to the subthalamic nucleus and the mesencephalic ventral tegmentum investigated with long range (normative) and short range (ex-vivo high resolution) 7T DTI. Brain Struct Funct 2021; 227:23-47. [PMID: 34482443 PMCID: PMC8741702 DOI: 10.1007/s00429-021-02373-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
Uncertainties
concerning anatomy and function of cortico-subcortical projections have arisen during the recent years. A clear distinction between cortico-subthalamic (hyperdirect) and cortico-tegmental projections (superolateral medial forebrain bundle, slMFB) so far is elusive. Deep Brain Stimulation (DBS) of the slMFB (for major depression, MD and obsessive compulsive disorders, OCD) has on the one hand been interpreted as actually involving limbic (prefrontal) hyperdirect pathways. On the other hand slMFB’s stimulation region in the mesencephalic ventral tegmentum is said to impact on other structures too, going beyond the antidepressant (or anti OCD) efficacy of sole modulation of the cortico-tegmental reward-associated pathways. We have here used a normative diffusion MRT template (HCP, n = 80) for long-range tractography and augmented this dataset with ex-vivo high resolution data (n = 1) in a stochastic brain space. We compared this data with histological information and used the high resolution ex-vivo data set to scrutinize the mesencephalic tegmentum for small fiber pathways present. Our work resolves an existing ambiguity between slMFB and prefrontal hyperdirect pathways which—for the first time—are described as co-existent. DBS of the slMFB does not appear to modulate prefrontal hyperdirect cortico-subthalamic but rather cortico-tegmental projections. Smaller fiber structures in the target region—as far as they can be discerned—appear not to be involved in slMFB DBS. Our work enfeebles previous anatomical criticism and strengthens the position of the slMFB DBS target for its use in MD and OCD.
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Affiliation(s)
- Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany. .,Medical Faculty of Freiburg University, Freiburg, Germany. .,Center for Deep Brain Stimulation, Medical Center of Freiburg University, Freiburg, Germany. .,Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany.
| | - Máté D Döbrössy
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Medical Faculty of Freiburg University, Freiburg, Germany.,Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany
| | - Shi Jia Teo
- Medical Faculty of Freiburg University, Freiburg, Germany.,Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Johanna Wessolleck
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany
| | - Bastian E A Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Medical Faculty of Freiburg University, Freiburg, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Medical Faculty of Freiburg University, Freiburg, Germany.,Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - Annette Thierauf-Emberger
- Medical Faculty of Freiburg University, Freiburg, Germany.,Institute of Forensic Medicine, Medical Center of Freiburg University, Freiburg, Germany
| | - Björn Spittau
- Anatomy and Cell Biology, Medical School OWL, Bielefeld University, Bielefeld, Germany.,Institute for Anatomy and Cell Biology, Department of Molecular Embryologie, Faculty of Medicine, Freiburg University, Freiburg, Germany
| | - Jochen Leupold
- Medical Faculty of Freiburg University, Freiburg, Germany.,Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Dominik von Elverfeldt
- Medical Faculty of Freiburg University, Freiburg, Germany.,Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Thomas E Schlaepfer
- Medical Faculty of Freiburg University, Freiburg, Germany.,Center for Deep Brain Stimulation, Medical Center of Freiburg University, Freiburg, Germany.,Division of Interventional Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical Center of Freiburg University, Freiburg, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Medical Faculty of Freiburg University, Freiburg, Germany.,Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
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12
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Dandekar MP, Diaz AP, Rahman Z, Silva RH, Nahas Z, Aaronson S, Selvaraj S, Fenoy AJ, Sanches M, Soares JC, Riva-Posse P, Quevedo J. A narrative review on invasive brain stimulation for treatment-resistant depression. ACTA ACUST UNITED AC 2021; 44:317-330. [PMID: 34468549 PMCID: PMC9169472 DOI: 10.1590/1516-4446-2021-1874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/22/2021] [Indexed: 12/20/2022]
Abstract
While most patients with depression respond to pharmacotherapy and psychotherapy, about one-third will present treatment resistance to these interventions. For patients with treatment-resistant depression (TRD), invasive neurostimulation therapies such as vagus nerve stimulation, deep brain stimulation, and epidural cortical stimulation may be considered. We performed a narrative review of the published literature to identify papers discussing clinical studies with invasive neurostimulation therapies for TRD. After a database search and title and abstract screening, relevant English-language articles were analyzed. Vagus nerve stimulation, approved by the U.S. Food and Drug Administration as a TRD treatment, may take several months to show therapeutic benefits, and the average response rate varies from 15.2-83%. Deep brain stimulation studies have shown encouraging results, including rapid response rates (> 30%), despite conflicting findings from randomized controlled trials. Several brain regions, such as the subcallosal-cingulate gyrus, nucleus accumbens, ventral capsule/ventral striatum, anterior limb of the internal capsule, medial-forebrain bundle, lateral habenula, inferior-thalamic peduncle, and the bed-nucleus of the stria terminalis have been identified as key targets for TRD management. Epidural cortical stimulation, an invasive intervention with few reported cases, showed positive results (40-60% response), although more extensive trials are needed to confirm its potential in patients with TRD.
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Affiliation(s)
- Manoj P Dandekar
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Alexandre P Diaz
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Ziaur Rahman
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Ritele H Silva
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Ziad Nahas
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Scott Aaronson
- Clinical Research Programs, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Sudhakar Selvaraj
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Albert J Fenoy
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Deep Brain Stimulation Program, Department of Neurosurgery, McGovern Medical School, UTHealth, Houston, TX, USA
| | - Marsal Sanches
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Jair C Soares
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Joao Quevedo
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil.,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth, Houston, TX, USA
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13
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Döbrössy MD, Ramanathan C, Ashouri Vajari D, Tong Y, Schlaepfer T, Coenen VA. Neuromodulation in Psychiatric disorders: Experimental and Clinical evidence for reward and motivation network Deep Brain Stimulation: Focus on the medial forebrain bundle. Eur J Neurosci 2020; 53:89-113. [PMID: 32931064 DOI: 10.1111/ejn.14975] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 07/24/2020] [Accepted: 08/27/2020] [Indexed: 12/28/2022]
Abstract
Deep brain stimulation (DBS) in psychiatric illnesses has been clinically tested over the past 20 years. The clinical application of DBS to the superolateral branch of the medial forebrain bundle in treatment-resistant depressed patients-one of several targets under investigation-has shown to be promising in a number of uncontrolled open label trials. However, there are remain numerous questions that need to be investigated to understand and optimize the clinical use of DBS in depression, including, for example, the relationship between the symptoms, the biological substrates/projections and the stimulation itself. In the context of precision and customized medicine, the current paper focuses on clinical and experimental research of medial forebrain bundle DBS in depression or in animal models of depression, demonstrating how clinical and scientific progress can work in tandem to test the therapeutic value and investigate the mechanisms of this experimental treatment. As one of the hypotheses is that depression engenders changes in the reward and motivational networks, the review looks at how stimulation of the medial forebrain bundle impacts the dopaminergic system.
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Affiliation(s)
- Máté D Döbrössy
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany.,Center for Basics in Neuromodulation, Freiburg University, Freiburg, Germany
| | - Chockalingam Ramanathan
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Danesh Ashouri Vajari
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Yixin Tong
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Thomas Schlaepfer
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Interventional Biological Psychiatry, University Hospital Freiburg, Freiburg, Germany
| | - Volker A Coenen
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany.,Center for Basics in Neuromodulation, Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany
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