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Al Naam Y. The role of serotonin hormone on weight loss maintenance after sleeve gastrectomy: a systematic review. J Med Life 2024; 17:133-140. [PMID: 38813365 PMCID: PMC11131630 DOI: 10.25122/jml-2023-0356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/23/2024] [Indexed: 05/31/2024] Open
Abstract
Surgical interventions, such as laparoscopic sleeve gastrectomy (LSG), are frequently associated with significant weight loss. However, the initiation and maintenance of this weight reduction are multifaceted processes influenced by genetic, psychological, behavioral, dietary, and metabolic factors. This review examined the role of metabolic hormones, specifically serotonin, in sustaining weight loss post-LSG. A systematic evaluation of six research articles obtained from Scopus, PubMed, and Cochrane was conducted, focusing on the role of serotonin in weight loss maintenance. We included randomized controlled trials involving adults over 18 years. Studies lacking an intensive weight regulation approach were excluded. Information was systematically extracted and analyzed from the selected studies, with data on intervention and control groups summarized in tables to compare outcomes one year post-LSG. The findings revealed a complex interplay between serotonin and its role in weight maintenance after sleeve gastrectomy. While some studies demonstrated successful weight loss maintenance with serotonin intervention, the systematic review found no association between serotonin and weight loss maintenance. Factors beyond serotonin levels, including individual motivation, behavioral strategies, and physical activity, were identified as crucial contributors to sustained weight loss. While the results may not demonstrate a recognizable association between serotonin and weight loss maintenance, the significance of this review lies in its contribution to the existing body of knowledge. By synthesizing current evidence, the study adds a nuanced perspective to understanding factors influencing post-LSG outcomes.
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Affiliation(s)
- Yaser Al Naam
- Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
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2
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Erichsen JM, Fadel JR, Reagan LP. Peripheral versus central insulin and leptin resistance: Role in metabolic disorders, cognition, and neuropsychiatric diseases. Neuropharmacology 2022; 203:108877. [PMID: 34762922 PMCID: PMC8642294 DOI: 10.1016/j.neuropharm.2021.108877] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/14/2021] [Accepted: 11/04/2021] [Indexed: 02/06/2023]
Abstract
Insulin and leptin are classically regarded as peptide hormones that play key roles in metabolism. In actuality, they serve several functions in both the periphery and central nervous system (CNS). Likewise, insulin and leptin resistance can occur both peripherally and centrally. Metabolic disorders such as diabetes and obesity share several key features including insulin and leptin resistance. While the peripheral effects of these disorders are well-known (i.e. cardiovascular disease, hypertension, stroke, dyslipidemia, etc.), the CNS complications of leptin and insulin resistance have come into sharper focus. Both preclinical and clinical findings have indicated that insulin and leptin resistance are associated with cognitive deficits and neuropsychiatric diseases such as depression. Importantly, these studies also suggest that these deficits in neuroplasticity can be reversed by restoration of insulin and leptin sensitivity. In view of these observations, this review will describe, in detail, the peripheral and central functions of insulin and leptin and explain the role of insulin and leptin resistance in various metabolic disorders, cognition, and neuropsychiatric diseases.
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Affiliation(s)
- Jennifer M Erichsen
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC, 29208, USA.
| | - Jim R Fadel
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC, 29208, USA
| | - Lawrence P Reagan
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC, 29208, USA; Columbia VA Health Care System, Columbia, SC, 29208, USA
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Bioque M, González-Rodríguez A, Garcia-Rizo C, Cobo J, Monreal JA, Usall J, Soria V, Labad J. Targeting the microbiome-gut-brain axis for improving cognition in schizophrenia and major mood disorders: A narrative review. Prog Neuropsychopharmacol Biol Psychiatry 2021; 105:110130. [PMID: 33045322 DOI: 10.1016/j.pnpbp.2020.110130] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 02/07/2023]
Abstract
Cognitive impairment has been consistently found to be a core feature of serious mental illnesses such as schizophrenia and major mood disorders (major depression and bipolar disorder). In recent years, a great effort has been made in elucidating the biological causes of cognitive deficits and the search for new biomarkers of cognition. Microbiome and gut-brain axis (MGB) hormones have been postulated to be potential biomarkers of cognition in serious mental illnesses. The main aim of this review was to synthesize current evidence on the association of microbiome and gut-brain hormones on cognitive processes in schizophrenia and major mood disorders and the association of MGB hormones with stress and the immune system. Our review underscores the role of the MGB axis on cognitive aspects of serious mental illnesses with the potential use of agents targeting the gut microbiota as cognitive enhancers. However, the current evidence for clinical trials focused on the MGB axis as cognitive enhancers in these clinical populations is scarce. Future clinical trials using probiotics, prebiotics, antibiotics, or faecal microbiota transplantation need to consider potential mechanistic pathways such as the HPA axis, the immune system, or gut-brain axis hormones involved in appetite control and energy homeostasis.
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Affiliation(s)
- Miquel Bioque
- Barcelona Clinic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona (UB), IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, Parc Tauli University Hospital, I3PT. Sabadell, Autonomous University of Barcelona (UAB), CIBERSAM, Barcelona, Spain
| | - Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona (UB), IDIBAPS, CIBERSAM, Barcelona, Spain.
| | - Jesús Cobo
- Department of Mental Health, Parc Tauli University Hospital, I3PT. Sabadell, Autonomous University of Barcelona (UAB), CIBERSAM, Barcelona, Spain
| | - José Antonio Monreal
- Department of Mental Health, Parc Tauli University Hospital, I3PT. Sabadell, Autonomous University of Barcelona (UAB), CIBERSAM, Barcelona, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, University of Barcelona (UB), CIBERSAM, Barcelona, Spain
| | - Virginia Soria
- Department of Psychiatry, Hospital Universitari Bellvitge, Hospitalet de Llobregat, University of Barcelona (UB), IDIBELL, CIBERSAM, Spain
| | | | - Javier Labad
- Department of Mental Health, Parc Tauli University Hospital, I3PT. Sabadell, Autonomous University of Barcelona (UAB), CIBERSAM, Barcelona, Spain
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Tran H, Sagi V, Jarrett S, Palzer EF, Badgaiyan RD, Gupta K. Diet and companionship modulate pain via a serotonergic mechanism. Sci Rep 2021; 11:2330. [PMID: 33526805 PMCID: PMC7851147 DOI: 10.1038/s41598-021-81654-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/08/2021] [Indexed: 01/30/2023] Open
Abstract
Treatment of severe chronic and acute pain in sickle cell disease (SCD) remains challenging due to the interdependence of pain and psychosocial modulation. We examined whether modulation of the descending pain pathway through an enriched diet and companionship could alleviate pain in transgenic sickle mice. Mechanical and thermal hyperalgesia were reduced significantly with enriched diet and/or companionship. Upon withdrawal of both conditions, analgesic effects observed prior to withdrawal were diminished. Serotonin (5-hydroxytryptamine, 5-HT) was found to be increased in the spinal cords of mice provided both treatments. Additionally, 5-HT production improved at the rostral ventromedial medulla and 5-HT accumulated at the dorsal horn of the spinal cord of sickle mice, suggesting the involvement of the descending pain pathway in the analgesic response. Modulation of 5-HT and its effect on hyperalgesia was also investigated through pharmaceutical approaches. Duloxetine, a serotonin-norepinephrine reuptake inhibitor, showed a similar anti-nociceptive effect as the combination of diet and companionship. Depletion of 5-HT through p-chlorophenylalanine attenuated the anti-hyperalgesic effect of enriched diet and companionship. More significantly, improved diet and companionship enhanced the efficacy of a sub-optimal dose of morphine for analgesia in sickle mice. These findings offer the potential to reduce opioid use without pharmacological interventions to develop effective pain management strategies.
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Affiliation(s)
- Huy Tran
- grid.17635.360000000419368657 Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN USA
| | - Varun Sagi
- grid.17635.360000000419368657 Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN USA
| | - Sarita Jarrett
- grid.16753.360000 0001 2299 3507Northwestern University, Evanston, IL USA
| | - Elise F. Palzer
- grid.17635.360000000419368657Biostatistical Design and Analysis Center, Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN USA
| | - Rajendra D. Badgaiyan
- grid.267309.90000 0001 0629 5880Department of Psychiatry, Long School of Medicine, University of Texas Health Science Center, San Antonio, Texas USA
| | - Kalpna Gupta
- grid.17635.360000000419368657 Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN USA ,Hematology/Oncology, Department of Medicine, University of California, Irvine and Southern California Institute for Research and Education, VA Medical Center, 5901 East 7th St, Long Beach, CA 90822 USA
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Role of PPARs in Progression of Anxiety: Literature Analysis and Signaling Pathways Reconstruction. PPAR Res 2020; 2020:8859017. [PMID: 33312191 PMCID: PMC7721491 DOI: 10.1155/2020/8859017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/26/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
Peroxisome proliferator-activated receptor (PPAR) group includes three isoforms encoded by PPARG, PPARA, and PPARD genes. High concentrations of PPARs are found in parts of the brain linked to anxiety development, including hippocampus and amygdala. Among three PPAR isoforms, PPARG demonstrates the highest expression in CNS, where it can be found in neurons, astrocytes, and glial cells. Herein, the highest PPARG expression occurs in amygdala. However, little is known considering possible connections between PPARs and anxiety behavior. We reviewed possible connections between PPARs and anxiety. We used the Pathway Studio software (Elsevier). Signal pathways were created according to previously developed algorithms. SNEA was performed in Pathway Studio. Current study revealed 14 PPAR-regulated proteins linked to anxiety. Possible mechanism of PPAR involvement in neuroinflammation protection is proposed. Signal pathway reconstruction and reviewing aimed to reveal possible connection between PPARG and CCK-ergic system was conducted. Said analysis revealed that PPARG-dependent regulation of MME and ACE peptidase expression may affect levels of nonhydrolysed, i.e., active CCK-4. Impairments in PPARG regulation and following MME and ACE peptidase expression impairments in amygdala may be the possible mechanism leading to pathological anxiety development, with brain CCK-4 accumulation being a key link. Literature data analysis and signal pathway reconstruction and reviewing revealed two possible mechanisms of peroxisome proliferator-activated receptors involvement in pathological anxiety: (1) cytokine expression and neuroinflammation mechanism and (2) regulation of peptidases targeted to anxiety-associated neuropeptides, primarily CCK-4, mechanism.
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Yen JY, Lin HC, Lin PC, Liu TL, Long CY, Ko CH. Leptin and ghrelin concentrations and eating behaviors during the early and late luteal phase in women with premenstrual dysphoric disorder. Psychoneuroendocrinology 2020; 118:104713. [PMID: 32460195 DOI: 10.1016/j.psyneuen.2020.104713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES In this study, we evaluated the changes in leptin and ghrelin concentrations, eating behavior, depression, and impulsivity and their correlations within the luteal phase among women with premenstrual dysphoric disorder (PMDD). METHODS In 63 women with PMDD and 53 healthy controls, we prospectively evaluated serum levels of leptin and ghrelin, Body Mass Index(BMI), and self-reported sweet cravings, cognitive restraint, uncontrolled eating, emotional eating, depression, and impulsivity during the early luteal (EL) and late luteal (LL) phases. RESULTS Compared with the controls, the women with PMDD had higher BMI, higher leptin concentrations in the EL and LL phase, and leptin concentrations increased from the EL to the LL phase. However, there is no significant difference in ghrelin. Women with PMDD increased sweet cravings and uncontrolled eating from EL to LL phase. No significant correlation was observed between the EL-LL changes in leptin or ghrelin concentrations and those in eating behaviors. Both depression and impulsivity correlated with sweet craving and uncontrolled eating. Depression mediated the association between PMDD and uncontrolled eating. The BMI of women with PMDD positively correlated with their EL-LL change in leptin, and LL depression levels and emotional eating. CONCLUSION Young women with PMDD had higher leptin concentrations and BMI in the luteal phase. The LL leptin level was not the primary factor responsible for the increased uncontrolled eating of PMDD. Whether the increased eating and depression in the LL phase contribute to the risk of obesity or hyperleptinemia among women with PMDD need to be evaluated in the future.
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Affiliation(s)
- Ju-Yu Yen
- Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Huang-Chi Lin
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pai-Cheng Lin
- Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheng-Yu Long
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Hung Ko
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Substance Addiction and Behavior Addiction, Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Haleem DJ, Gul S. Circulating leptin, cortisol and gender differences associated with anorexia or obesity in depression. World J Biol Psychiatry 2020; 21:195-202. [PMID: 31347937 DOI: 10.1080/15622975.2019.1648870] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives: To assess the role of circulating cortisol and leptin in depression associated with anorexia or obesity.Methods: Two hundred and fifty depressed patients presenting to the outpatient clinic of a psychiatric hospital and 250 non-depressed healthy volunteers were included in the study. The subjects of both groups were sub-grouped based upon their gender and BMI. Serum cortisol and leptin were determined by using respective ELISA kits.Results: The number of depressed than non-depressed subjects was three-fold higher in obese BMI groups of both genders. There were more depressed than non-depressed subjects in the underweight male BMI groups and in the overweight female BMI groups. There was a BMI-related increase in serum leptin and a decrease in serum cortisol in both genders. Depression in underweight BMI groups of both genders was associated with a decrease in serum leptin and an increase in cortisol. Higher serum leptin in obese BMI group was associated with a decrease in serum cortisol.Conclusions: Obesity is a risk factor for depression. The shift from typical to atypical depression is due to an inhibitory effect of higher circulating leptin on HPA axis activity and subsequent decrease in the lipolytic effects of cortisol.
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Affiliation(s)
- Darakhshan Jabeen Haleem
- Neuroscience Research Laboratory, Dr Panjwani Center for Molecular Medicine & Drug Research (PCMD), International Center for Chemical and Biological Science (ICCBS), University of Karachi, Karachi, Pakistan
| | - Sumera Gul
- Neuroscience Research Laboratory, Dr Panjwani Center for Molecular Medicine & Drug Research (PCMD), International Center for Chemical and Biological Science (ICCBS), University of Karachi, Karachi, Pakistan
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Ambrus L, Westling S. Leptin, Anxiety Symptoms, and Hypothalamic-Pituitary-Adrenal Axis Activity among Drug-Free, Female Suicide Attempters. Neuropsychobiology 2020; 78:145-152. [PMID: 31189176 DOI: 10.1159/000500737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 04/29/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dysregulation of leptin secretion and functioning of the hypothalamic-pituitary-adrenal (HPA) axis may be involved in the pathophysiology of suicide. Preclinical and clinical studies have shown interactions between the HPA axis and leptin. There is also evidence for a negative relationship between leptin and anxiety in humans. However, these possible associations have not been studied in individuals with attempted suicide. OBJECTIVES To examine the relationship between leptin, HPA axis activity, and anxiety in individuals with a recent suicide attempt. METHOD Sixty-nine individuals with a recent suicide attempt (n = 37 females; n = 32 males) were recruited and subjected to the Dexamethasone Suppression Test (DST), lumbar puncture, and evaluation with the Comprehensive Psychopathological Rating Scale from which the Brief Scale for Anxiety (BSA) was derived. Leptin was analyzed in cerebrospinal fluid (CSF) and cortisol in serum. Leptin was corrected for body mass index (BMI) by dividing CSF-leptin by BMI (CSF-leptin/BMI). Due to gender-related differences in leptin secretion and HPA axis activity, calculations were made for males and females separately. RESULTS Significant differences were only found among females; CSF-leptin/BMI levels correlated significantly and negatively with BSA (p < 0.05), pre-DST cortisol, and post-DST serum cortisol at 8 a.m. and 3 p.m. (all p < 0.05). Furthermore, CSF-leptin/BMI was significantly lower in nonsuppressors of dexamethasone as compared to suppressors (p < 0.05). CONCLUSIONS These findings suggest that in females with a recent suicide attempt, low CSF leptin may be related to symptoms of anxiety and a hyperactive HPA axis.
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Affiliation(s)
- Livia Ambrus
- Section of Psychiatry, Department of Clinical Sciences, Clinical Psychiatric Research Center, Lund University, Lund, Sweden,
| | - Sofie Westling
- Section of Psychiatry, Department of Clinical Sciences, Clinical Psychiatric Research Center, Lund University, Lund, Sweden
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Bland T, Zhu M, Dillon C, Sahin GS, Rodriguez-Llamas JL, Appleyard SM, Wayman GA. Leptin Controls Glutamatergic Synaptogenesis and NMDA-Receptor Trafficking via Fyn Kinase Regulation of NR2B. Endocrinology 2020; 161:5678106. [PMID: 31840160 PMCID: PMC7015580 DOI: 10.1210/endocr/bqz030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/10/2019] [Indexed: 01/13/2023]
Abstract
Activation of the leptin receptor, LepRb, by the adipocytokine/neurotrophic factor leptin in the central nervous system has procognitive and antidepressive effects. Leptin has been shown to increase glutamatergic synaptogenesis in multiple brain regions. In contrast, mice that have a mutation in the LepRb gene show abnormal synapse development in the hippocampus as well as deficits in cognition and increased depressive-like symptoms. Leptin increases glutamatergic synaptogenesis, in part, through enhancement of N-methyl-D-aspartic acid (NMDA) receptor function; yet the underlying signaling pathway is not known. In this study, we examine how leptin regulates surface expression of NR2B-containing NMDA receptors in hippocampal neurons. Leptin stimulation increases NR2BY1472 phosphorylation, which is inhibited by the Src family kinase inhibitor, PP1. Moreover, we show that Fyn, a member of the Src family kinases, is required for leptin-stimulated NR2BY1472 phosphorylation. Furthermore, inhibiting Y1472 phosphorylation with either a dominant negative Fyn mutant or an NR2B mutant that lacks the phosphorylation site (NR2BY1472F) blocks leptin-stimulated synaptogenesis. Additionally, we show that LepRb forms a complex with NR2B and Fyn. Taken together, these findings expand our knowledge of the LepRb interactome and the mechanisms by which leptin stimulates glutamatergic synaptogenesis in the developing hippocampus. Comprehending these mechanisms is key for understanding dendritic spine development and synaptogenesis, alterations of which are associated with many neurological disorders.
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Affiliation(s)
- Tyler Bland
- Program in Neuroscience, Department of Integrative Physiology and Neuroscience, Washington State University, Pullman, Washington
| | - Mingyan Zhu
- Program in Neuroscience, Department of Integrative Physiology and Neuroscience, Washington State University, Pullman, Washington
| | - Crystal Dillon
- Program in Neuroscience, Department of Integrative Physiology and Neuroscience, Washington State University, Pullman, Washington
| | - Gulcan Semra Sahin
- Program in Neuroscience, Department of Integrative Physiology and Neuroscience, Washington State University, Pullman, Washington
| | - Jose Luis Rodriguez-Llamas
- Program in Neuroscience, Department of Integrative Physiology and Neuroscience, Washington State University, Pullman, Washington
| | - Suzanne M Appleyard
- Program in Neuroscience, Department of Integrative Physiology and Neuroscience, Washington State University, Pullman, Washington
| | - Gary A Wayman
- Program in Neuroscience, Department of Integrative Physiology and Neuroscience, Washington State University, Pullman, Washington
- Correspondence: Gary A. Wayman, Department of Integrative Physiology and Neuroscience, Program in Neuroscience, Washington State University, Pullman Washington 99164. E-mail:
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Bland T, Sahin GS, Zhu M, Dillon C, Impey S, Appleyard SM, Wayman GA. USP8 Deubiquitinates the Leptin Receptor and Is Necessary for Leptin-Mediated Synapse Formation. Endocrinology 2019; 160:1982-1998. [PMID: 31199479 PMCID: PMC6660906 DOI: 10.1210/en.2019-00107] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/08/2019] [Indexed: 11/19/2022]
Abstract
Leptin has neurotrophic actions in the hippocampus to increase synapse formation and stimulate neuronal plasticity. Leptin also enhances cognition and has antidepressive and anxiolytic-like effects, two hippocampal-dependent behaviors. In contrast, mice lacking leptin or the long form of the leptin receptor (LepRb) have lower cortical volume and decreased memory and exhibit depressive-like behaviors. A number of the signaling pathways regulated by LepRb are known, but how membrane LepRb levels are regulated in the central nervous system is not well understood. Here, we show that the lysosomal inhibitor chloroquine increases LepRb expression in hippocampal cultures, suggesting that LepRb is degraded in the lysosome. Furthermore, we show that leptin increases surface expression of its own receptor by decreasing the level of ubiquitinated LepRbs. This decrease is mediated by the deubiquitinase ubiquitin-specific protease 8 (USP8), which we show is in complex with LepRb. Acute leptin stimulation increases USP8 activity. Moreover, leptin stimulates USP8 gene expression through cAMP response element-binding protein (CREB)-dependent transcription, an effect blocked by expression of a dominant-negative CREB or with short hairpin RNA knockdown of CREB. Increased expression of USP8 causes increased surface localization of LepRb, which in turn enhances leptin-mediated activation of the MAPK kinase/extracellular signal-regulated kinase pathway and CREB activation. Lastly, increased USP8 expression increases glutamatergic synapse formation in hippocampal cultures, an effect dependent on expression of LepRbs. Leptin-stimulated synapse formation also requires USP8. In conclusion, we show that USP8 deubiquitinates LepRb, thus inhibiting lysosomal degradation and enhancing surface localization of LepRb, which are essential for leptin-stimulated synaptogenesis in the hippocampus.
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Affiliation(s)
- Tyler Bland
- Department of Integrated Physiology and Neuroscience, Washington State University, Pullman, Washington
| | - Gulcan Semra Sahin
- Department of Integrated Physiology and Neuroscience, Washington State University, Pullman, Washington
| | - Mingyan Zhu
- Department of Integrated Physiology and Neuroscience, Washington State University, Pullman, Washington
| | - Crystal Dillon
- Department of Integrated Physiology and Neuroscience, Washington State University, Pullman, Washington
| | - Soren Impey
- Oregon Stem Cell Center, Oregon Health and Sciences University, Portland, Oregon
| | - Suzanne M Appleyard
- Department of Integrated Physiology and Neuroscience, Washington State University, Pullman, Washington
| | - Gary A Wayman
- Department of Integrated Physiology and Neuroscience, Washington State University, Pullman, Washington
- Correspondence: Gary A. Wayman, PhD, Department of Integrative Physiology and Neuroscience, Program in Neuroscience, Washington State University, Pullman, Washington 99164. E-mail:
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11
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Xu J, Jiao Y, Xing M, Lin Y, Su Y, Ding W, Zhu C, Peng Y, Qi D, Cui D. Increased plasma leptin as a novel predictor for psychopathological depressive symptoms in chronic schizophrenia. Gen Psychiatr 2018; 31:e100018. [PMID: 30815631 PMCID: PMC6371651 DOI: 10.1136/gpsych-2018-100018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/16/2018] [Accepted: 11/18/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Depressive symptoms are often seen in schizophrenia. The overlap in presentation makes it difficult to distinguish depressive symptoms from the negative symptoms of schizophrenia. The adipokine leptin was found to be altered in both depression and schizophrenia. There are few studies focusing on the prediction of leptin in diagnosis and evaluation of depressive symptoms in schizophrenia. OBJECTIVEAIMS To assess the plasma leptin level in patients with schizophrenia and its relationships with depressive symptoms. METHODS Cross-sectional studies were applied to (1) compare the levels of plasma leptin between schizophrenia (n=74) and healthy controls (n=50); and (2) investigate the relationship between plasma leptin levels and depressive subscores. RESULTS (1) Plasma leptin levels were significantly higher in patients with schizophrenia than in healthy controls. (2) Correlation analysis revealed a significant negative association between leptin levels and the depressed factor scores on the Positive and Negative Syndrome Scale (PANSS). (3) Stepwise multiple regression analyses identified leptin as an influencing factor for depressed factor score on PANSS. CONCLUSION Leptin may serve as a predictor for the depressive symptoms of chronic schizophrenia.
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Affiliation(s)
- Jinjie Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yumei Jiao
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Mengjuan Xing
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yezhe Lin
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yousong Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Wenhua Ding
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Cuizhen Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yanmin Peng
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Dake Qi
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Division of Biomedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Donghong Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
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12
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Van Doorn C, Macht VA, Grillo CA, Reagan LP. Leptin resistance and hippocampal behavioral deficits. Physiol Behav 2017; 176:207-213. [PMID: 28267584 PMCID: PMC10538552 DOI: 10.1016/j.physbeh.2017.03.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 01/05/2023]
Abstract
The adipocyte-derived hormone leptin is an important regulator of body weight and metabolism through activation of brain leptin receptors expressed in regions such as the hypothalamus. Beyond these well described and characterized activities of leptin in the hypothalamus, it is becoming increasingly clear that the central activities of leptin extend to the hippocampus. Indeed, leptin receptors are expressed in the hippocampus where these receptors are proposed to mediate various aspects of hippocampal synaptic plasticity that ultimately impact cognitive function. This concept is supported by studies demonstrating that leptin promotes hippocampal-dependent learning and memory, as well as studies indicating that leptin resistance is associated with deficits in hippocampal-dependent behaviors and in the induction of depressive-like behaviors. The effects of leptin on cognitive/behavioral plasticity in the hippocampus may be regulated by direct activation of leptin receptors expressed in the hippocampus; additionally, leptin-mediated activation of synaptic networks that project to the hippocampus may also impact hippocampal-mediated behaviors. In view of these previous observations, the goal of this review will be to discuss the mechanisms through which leptin facilitates cognition and behavior, as well as to dissect the loci at which leptin resistance leads to impairments in hippocampal synaptic plasticity, including the development of cognitive deficits and increased risk of depressive illness in metabolic disorders such as obesity and type 2 diabetes mellitus (T2DM).
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Affiliation(s)
- Catherine Van Doorn
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC 29208, United States
| | - Victoria A Macht
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC 29208, United States
| | - Claudia A Grillo
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC 29208, United States
| | - Lawrence P Reagan
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC 29208, United States; W.J.B. Dorn VA Medical Center, Columbia, SC 29208, United States.
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Haleem DJ, Sheikh S, Fawad A, Haleem MA. Fasting leptin and glucose in normal weight, over weight and obese men and women diabetes patients with and without clinical depression. Metab Brain Dis 2017; 32:757-764. [PMID: 28197877 DOI: 10.1007/s11011-017-9964-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 01/31/2017] [Indexed: 01/05/2023]
Abstract
A large number of diabetes patients suffer from major depression and are at high risk of mortality. In view of a role of leptin in diabetes, depression and energy homeostasis, the present study concerns circulating levels of leptin in different BMI groups of un-depressed and depressed diabetes patients. Six hundred thirty male and female patients with a primary diagnosis of diabetes were grouped according to BMI and with or without clinical symptoms of depression. Age matched healthy, normal weight male and female volunteers without clinical symptoms of depression or diabetes were taken as controls. Blood samples were obtained after an overnight fast of 12 h. Serum was stored for the determination of leptin and glucose. We found that there were more female than male diabetes patients with comorbid depression. Fasting leptin was higher in normal weight non-diabetes women than men; but comparable in normal weight men and women diabetes patients. Fasting glucose levels were higher in diabetes than non diabetes groups; values were comparable in men and women. Depression was associated with a decrease and increase in leptin respectively in normal-overweight and obese men and women diabetes patients. Glucose levels were also higher in obese depressed than un-depressed diabetes patients. The results suggested that the female gender is at greater risk to comorbid diabetes with depression. Adipo-insular axis plays an important role in diabetes, associated depression and in the greater risk of the female gender to comorbid diabetes with depression.
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Affiliation(s)
- Darakhshan Jabeen Haleem
- Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, University of Karachi, Karachi, 75270, Pakistan
| | - Shehnaz Sheikh
- Department of Biochemistry, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Asher Fawad
- Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan
| | - Muhammad A Haleem
- Department of Biomedical Engineering, Sir Syed University of Engineering and Technology, Karachi, 75300, Pakistan
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Cheema MAR, Nawaz S, Gul S, Salman T, Naqvi S, Dar A, Haleem DJ. Neurochemical and behavioral effects of Nigella sativa and Olea europaea oil in rats. Nutr Neurosci 2016; 21:185-194. [PMID: 27868798 DOI: 10.1080/1028415x.2016.1257417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES In the last few decades, therapeutic uses of medicinal compounds present in food as a normal constituent has risen substantially, largely because of their fewer side effects and adequate efficacy. This study is designed to investigate a role of brain serotonin (5-HT) and dopamine (DA) in the potential nootropic, anxiolytic, and other beneficial effects of Nigella sativa (NS) and Olea europaea (OE) oil in rat models. METHODS Animals were treated with NS and OE oil orally at doses of 0.1 ml/kg and 0.25 ml/kg for 5 weeks. Food intake and body weight change, anxiety-like effects in elevated plus maze and activity in a novel and familiar environment were monitored weekly. Effects on learning and memory after 5 weeks treatment were monitored using Morris water maze test. Neurochemical analysis was carried using HPLC-ECD method. RESULTS NS and OE oil administration enhanced learning and memory in Morris water maze test and the effects were greater in NS than OE oil-treated animals. Low dose of OE oil increased exploration in an open field, higher dose of OE oil and both doses of NS oil produced no consistent effect on open field exploration. Effects of both oils on anxiety-like behavior, food and water intake, and activity in activity box were either not consistent or did not occur. The treatment increased homovanillic acid (HVA). 5-HT levels increased in high dose of NS oil and low dose of OE oil-treated groups. Low dose NS oil decreased 5-HT. DISCUSSION The present study suggests that active components in NS and OE oil may prove useful in treating impaired cognition. OE oil may produce psychostimulant-like effect. Modulation of DA and serotonin neurotransmission seems important in the pharmacological effect of these oils.
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Affiliation(s)
- M Atif Raza Cheema
- a Neuroscience Research Lab, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences , University of Karachi , Karachi 75270 , Pakistan
| | - Shazia Nawaz
- a Neuroscience Research Lab, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences , University of Karachi , Karachi 75270 , Pakistan
| | - Sumera Gul
- a Neuroscience Research Lab, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences , University of Karachi , Karachi 75270 , Pakistan
| | - Tabinda Salman
- a Neuroscience Research Lab, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences , University of Karachi , Karachi 75270 , Pakistan
| | - Sabira Naqvi
- b Pharmacology Section, HEJ Research Institute of Chemistry, International Center for Chemical and Biological Sciences , University of Karachi , Karachi 75270 , Pakistan
| | - Ahsana Dar
- b Pharmacology Section, HEJ Research Institute of Chemistry, International Center for Chemical and Biological Sciences , University of Karachi , Karachi 75270 , Pakistan
| | - Darakhshan J Haleem
- a Neuroscience Research Lab, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences , University of Karachi , Karachi 75270 , Pakistan
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15
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Tyree SM, Munn RGK, McNaughton N. Anxiolytic-like effects of leptin on fixed interval responding. Pharmacol Biochem Behav 2016; 148:15-20. [PMID: 27180106 DOI: 10.1016/j.pbb.2016.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 02/01/2023]
Abstract
Leptin has been shown to affect energy homeostasis, learning and memory, and some models of anxiolytic action. However, leptin has produced inconsistent results in previous non-operant behavioural tests of anxiety. Here, we test the anxiolytic potential of leptin in an operant paradigm that has produced positive results across all classes of anxiolytic so far tested. Rats were tested in the Fixed Interval 60 Seconds (FI60) task following administration of 0/0.5/1.0mg/kg (i.p.) leptin or an active anxiolytic control of 5mg/kg (i.p.) chlordiazepoxide (CDP). By the end of the 14days of testing in the FI60 task, 0.5mg/kg leptin released suppressed responding in a manner similar to CDP, and 1.0mg/kg leptin produced a relative depression in responding, a similar outcome pattern to previously tested 5HT-agonist anxiolytics. This suggests that leptin behaves similarly to established serotonergic anxiolytics such as buspirone and fluoxetine; with the delay in development of effect during testing, and the inverted-U dose-response curve explaining the inconsistent behaviour of leptin in behavioural tests of anxiety, as this type of pattern is common to serotonergic anxiolytics.
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Affiliation(s)
- Susan M Tyree
- Department of Psychology, University of Otago, Dunedin, New Zealand.
| | - Robert G K Munn
- Department of Psychology, University of Otago, Dunedin, New Zealand.
| | - Neil McNaughton
- Department of Psychology, University of Otago, Dunedin, New Zealand.
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16
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Krishna S, Lin Z, de La Serre CB, Wagner JJ, Harn DH, Pepples LM, Djani DM, Weber MT, Srivastava L, Filipov NM. Time-dependent behavioral, neurochemical, and metabolic dysregulation in female C57BL/6 mice caused by chronic high-fat diet intake. Physiol Behav 2016; 157:196-208. [PMID: 26852949 DOI: 10.1016/j.physbeh.2016.02.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/05/2016] [Accepted: 02/03/2016] [Indexed: 02/08/2023]
Abstract
High-fat diet (HFD) induced obesity is associated not only with metabolic dysregulation, e.g., impaired glucose homeostasis and insulin sensitivity, but also with neurological dysfunction manifested with aberrant behavior and/or neurotransmitter imbalance. Most studies have examined HFD's effects predominantly in male subjects, either in the periphery or on the brain, in isolation and after a finite feeding period. In this study, we evaluated the time-course of selected metabolic, behavioral, and neurochemical effects of HFD intake in parallel and at multiple time points in female (C57BL/6) mice. Peripheral effects were evaluated at three feeding intervals (short: 5-6 weeks, long: 20-22 weeks, and prolonged: 33-36 weeks). Central effects were evaluated only after long and prolonged feeding durations; we have previously reported those effects after the short (5-6 weeks) feeding duration. Ongoing HFD feeding resulted in an obese phenotype characterized by increased visceral adiposity and, after prolonged HFD intake, an increase in liver and kidney weights. Peripherally, 5 weeks of HFD intake was sufficient to impair glucose tolerance significantly, with the deleterious effects of HFD being greater with prolonged intake. Similarly, 5 weeks of HFD consumption was sufficient to impair insulin sensitivity. However, sensitivity to insulin after prolonged HFD intake was not different between control, low-fat diet (LFD) and HFD-fed mice, most likely due to age-dependent decrease in insulin sensitivity in the LFD-fed mice. HFD intake also induced bi-phasic hepatic inflammation and it increased gut permeability. Behaviorally, prolonged intake of HFD caused mice to be hypoactive and bury fewer marbles in a marble burying task; the latter was associated with significantly impaired hippocampal serotonin homeostasis. Cognitive (short-term recognition memory) function of mice was unaffected by chronic HFD feeding. Considering our prior findings of short-term (5-6 weeks) HFD-induced central (hyperactivity/anxiety and altered ventral hippocampal neurochemistry) effects and our current results, it seems that in female mice some metabolic/inflammatory dysregulations caused by HFD, such as gut permeability, appear early and persist, whereas others, such as glucose intolerance, are exaggerated with continuous HFD feeding; behaviorally, prolonged HFD consumption mainly affects locomotor activity and anxiety-like responses, likely due to the advanced obesity phenotype; neurochemically, the serotonergic system appears to be most sensitive to continued HFD feeding.
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Affiliation(s)
- Saritha Krishna
- Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - Zhoumeng Lin
- Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - Claire B de La Serre
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, GA, 30602, USA
| | - John J Wagner
- Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - Donald H Harn
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - Lacey M Pepples
- Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - Dylan M Djani
- Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - Matthew T Weber
- Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - Leena Srivastava
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - Nikolay M Filipov
- Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA.
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17
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Sestan-Pesa M, Horvath TL. Metabolism and Mental Illness. Trends Mol Med 2016; 22:174-183. [PMID: 26776095 DOI: 10.1016/j.molmed.2015.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 01/23/2023]
Abstract
Over the past century, overwhelming evidence has emerged pointing to the hypothalamus of the central nervous system (CNS) as a crucial regulator of systemic control of metabolism, including appetite and feeding behavior. Appetite (or hunger) is a fundamental driver of survival, involving complex behaviors governed by various parts of the brain, including the cerebral cortex. Here, we provide an overview of basic metabolic principles affecting the CNS and discuss their relevance to physiological and pathological conditions of higher brain functions. These novel perspectives may well provide new insights into future research strategies to facilitate the development of novel therapies for treating mental illness.
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Affiliation(s)
- Matija Sestan-Pesa
- Program in Integrative Cell Signaling and Neurobiology of Metabolism, Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Tamas L Horvath
- Program in Integrative Cell Signaling and Neurobiology of Metabolism, Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
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Interacting Neural Processes of Feeding, Hyperactivity, Stress, Reward, and the Utility of the Activity-Based Anorexia Model of Anorexia Nervosa. Harv Rev Psychiatry 2016; 24:416-436. [PMID: 27824637 PMCID: PMC5485261 DOI: 10.1097/hrp.0000000000000111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Anorexia nervosa (AN) is a psychiatric illness with minimal effective treatments and a very high rate of mortality. Understanding the neurobiological underpinnings of the disease is imperative for improving outcomes and can be aided by the study of animal models. The activity-based anorexia rodent model (ABA) is the current best parallel for the study of AN. This review describes the basic neurobiology of feeding and hyperactivity seen in both ABA and AN, and compiles the research on the role that stress-response and reward pathways play in modulating the homeostatic drive to eat and to expend energy, which become dysfunctional in ABA and AN.
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