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Chen J, Zhou Y, Lai M, Zhang Y, Hu Y, Zhuang D, Zhou W, Zhang Y. Antidepressant effects of activation of infralimbic cortex via upregulation of BDNF and β-catenin in an estradiol withdrawal model. Psychopharmacology (Berl) 2024; 241:1923-1935. [PMID: 38743109 PMCID: PMC11339133 DOI: 10.1007/s00213-024-06610-z] [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: 02/07/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
RATIONALE Clinical and preclinical studies have demonstrated that estradiol withdrawal after delivery is one of important factors involved in the pathogenesis of postpartum depression (PPD). The infralimbic cortex (IL) is related to anxiety and mood disorders. Whether IL neurons mediate PPD is still unclear. OBJECTIVES This study was to observe the antidepressant effect and expression of BDNF and β-catenin in IL by allopregnanolone (ALLO) treatment or the selective activation or inhibition of IL neurons using a chemogenetic approach in a pseudopregnancy model of PPD. METHODS Administration of estradiol combined with progesterone and the abrupt withdrawal of estradiol simulated the pregnancy and early postpartum periods to induce depression in ovariectomized rats. The relative expression levels of β-catenin and BDNF were observed by western blotting. RESULTS Immobility time was significantly increased in the forced swim test and open-arm movement was reduced in the elevated plus maze test in the estradiol-withdrawn rats. After ALLO treatment, the immobility time were lower and open-arm traveling times higher than those of the estradiol-withdrawn rats. Meanwhile, the expression level of BDNF or β-catenin in the IL was reduced significantly in estradiol-withdrawn rats, which was prevented by treatment with ALLO. The hM3Dq chemogenetic activation of pyramidal neurons in the IL reversed the immobility and open-arm travel time trends in the estradiol-withdrawal rat model, but chemogenetic inhibition of IL neurons failed to affect this. Upregulated BDNF and β-catenin expression and increased c-Fos in the basolateral amygdala were found following IL neuron excitation in model rats. CONCLUSIONS Our results demonstrated that pseudopregnancy and estradiol withdrawal produced depressive-like behavior and anxiety. ALLO treatment or specific excitement of IL pyramidal neurons relieved abnormal behaviors and upregulated BDNF and β-catenin expression in the IL in the PPD model, suggesting that hypofunction of IL neurons may be involved in the pathogenesis of PPD.
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Affiliation(s)
- Jiali Chen
- Department of Obstetrics, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, P. R. China
| | - Yiying Zhou
- Zhejiang Provincial Key Lab of Addiction Research, The Affiliated Kangning Hospital of Ningbo University, Ningbo, 315201, P. R. China
| | - Miaojun Lai
- Zhejiang Provincial Key Lab of Addiction Research, The Affiliated Kangning Hospital of Ningbo University, Ningbo, 315201, P. R. China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, 315201, P. R. China
| | - Yanping Zhang
- Department of Obstetrics, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, P. R. China
| | - Yifang Hu
- Department of Obstetrics, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, P. R. China
| | - Dingding Zhuang
- Zhejiang Provincial Key Lab of Addiction Research, The Affiliated Kangning Hospital of Ningbo University, Ningbo, 315201, P. R. China
| | - Wenhua Zhou
- Zhejiang Provincial Key Lab of Addiction Research, The Affiliated Kangning Hospital of Ningbo University, Ningbo, 315201, P. R. China.
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, 315201, P. R. China.
| | - Yisheng Zhang
- Department of Obstetrics, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, P. R. China.
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Topchiy I, Mohbat J, Folorunso OO, Wang ZZ, Lazcano-Etchebarne C, Engin E. GABA system as the cause and effect in early development. Neurosci Biobehav Rev 2024; 161:105651. [PMID: 38579901 PMCID: PMC11081854 DOI: 10.1016/j.neubiorev.2024.105651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/05/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
GABA is the primary inhibitory neurotransmitter in the adult brain and through its actions on GABAARs, it protects against excitotoxicity and seizure activity, ensures temporal fidelity of neurotransmission, and regulates concerted rhythmic activity of neuronal populations. In the developing brain, the development of GABAergic neurons precedes that of glutamatergic neurons and the GABA system serves as a guide and framework for the development of other brain systems. Despite this early start, the maturation of the GABA system also continues well into the early postnatal period. In this review, we organize evidence around two scenarios based on the essential and protracted nature of GABA system development: 1) disruptions in the development of the GABA system can lead to large scale disruptions in other developmental processes (i.e., GABA as the cause), 2) protracted maturation of this system makes it vulnerable to the effects of developmental insults (i.e., GABA as the effect). While ample evidence supports the importance of GABA/GABAAR system in both scenarios, large gaps in existing knowledge prevent strong mechanistic conclusions.
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Affiliation(s)
- Irina Topchiy
- Division of Basic Neuroscience, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Julie Mohbat
- Division of Basic Neuroscience, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA; School of Life Sciences, Ecole Polytechnique Federale de Lausanne, Lausanne CH-1015, Switzerland
| | - Oluwarotimi O Folorunso
- Division of Basic Neuroscience, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Ziyi Zephyr Wang
- Division of Basic Neuroscience, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | | | - Elif Engin
- Division of Basic Neuroscience, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA.
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Feng YF, Zhou YY, Duan KM. The Role of Extrasynaptic GABA Receptors in Postpartum Depression. Mol Neurobiol 2024; 61:385-396. [PMID: 37612480 DOI: 10.1007/s12035-023-03574-7] [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: 05/31/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
Postpartum depression is a serious disease with a high incidence and severe impact on pregnant women and infants, but its mechanism remains unclear. Recent studies have shown that GABA receptors, especially extrasynaptic receptors, are closely associated with postpartum depression. There are many different structures of GABA receptors, so different types of receptors have different functions, even though they transmit information primarily through GABA. In this review, we focus on the function of GABA receptors, especially extrasynaptic GABA receptors, and their association with postpartum depression. We have shown that the extrasynaptic GABA receptor has a significant impact on the activity and function of neurons through tonic inhibition. The extrasynaptic receptor and its ligands undergo drastic changes during pregnancy and childbirth. Abnormal changes or the body's inability to adjust and recover may be an important cause of postpartum depression. Finally, by reviewing the mechanisms of several novel antidepressants, we suggest that extrasynaptic receptors may be potential targets for the treatment of postpartum depression.
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Affiliation(s)
- Yun Fei Feng
- Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Yin Yong Zhou
- Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Kai Ming Duan
- Third Xiangya Hospital of Central South University, Changsha, 410013, China.
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Ragan CM, Ahmed EI, Vitale EM, Linning-Duffy K, Miller-Smith SM, Maguire J, Lonstein JS. Postpartum State, but Not Maternal Caregiving or Level of Anxiety, Increases Medial Prefrontal Cortex GAD65 and vGAT in Female Rats. Front Glob Womens Health 2022; 2:746518. [PMID: 35211693 PMCID: PMC8861351 DOI: 10.3389/fgwh.2021.746518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Upregulation of the inhibitory neurotransmitter, GABA, is involved in many of the behavioral differences between postpartum and nulliparous female rodents. This is evidenced by studies showing that pharmacological blockade of GABAergic activity impairs maternal caregiving and postpartum affective behaviors. However, the influence of motherhood on the capacity for GABA synthesis or release in the medial prefrontal cortex (mPFC; brain region involved in many social and affective behaviors) is not well-understood. Western blotting was used to compare postpartum and nulliparous rats in protein levels of the 65-kD isoform of glutamic acid decarboxylase (GAD65; synthesizes most GABA released from terminals) and vesicular GABA transporter (vGAT; accumulates GABA into synaptic vesicles for release) in the mPFC. We found that postpartum mothers had higher GAD65 and vGAT compared to virgins, but such differences were not found between maternally sensitized and non-sensitized virgins, indicating that reproduction rather than just the display of maternal caregiving is required. To test whether GAD65 and vGAT levels in the mPFC were more specifically related to anxiety-related behavior within postpartum mothers, we selected 8 low-anxiety and 8 high-anxiety dams based on their time spent in the open arms of an elevated plus maze on postpartum day 7. There were no significant differences between the anxiety groups in either GAD65 or vGAT levels. These data further indicate that frontal cortical GABA is affected by female reproduction and more likely contributes to differences in the display of socioemotional behaviors across, but not within, female reproductive state.
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Affiliation(s)
- Christina M. Ragan
- Neuroscience Program, Michigan State University, East Lansing, MI, United States
- School of Biology and Undergraduate Neuroscience Program, Georgia Institute of Technology, Atlanta, GA, United States
| | - Eman I. Ahmed
- Neuroscience Program, Michigan State University, East Lansing, MI, United States
| | - Erika M. Vitale
- Behavioral Neuroscience Program, Department of Psychology, Michigan State University, East Lansing, MI, United States
| | | | - Stephanie M. Miller-Smith
- Behavioral Neuroscience Program, Department of Psychology, Michigan State University, East Lansing, MI, United States
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, United States
| | - Jamie Maguire
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, United States
| | - Joseph S. Lonstein
- Neuroscience Program, Michigan State University, East Lansing, MI, United States
- Behavioral Neuroscience Program, Department of Psychology, Michigan State University, East Lansing, MI, United States
- *Correspondence: Joseph S. Lonstein
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Chen S, Gao L, Li X, Ye Y. Allopregnanolone in mood disorders: Mechanism and therapeutic development. Pharmacol Res 2021; 169:105682. [PMID: 34019980 DOI: 10.1016/j.phrs.2021.105682] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 01/23/2023]
Abstract
The neuroactive steroid allopregnanolone (ALLO) is an endogenous positive allosteric modulator of GABA type A receptor (GABAAR), and the down-regulation of its biosynthesis have been attributed to the development of mood disorders, such as depression, anxiety and post-traumatic stress disorder (PTSD). ALLO mediated depression/anxiety involves GABAergic mechanisms and appears to be related to brain-derived neurotrophic factor (BDNF), dopamine receptor, glutamate neurotransmission, and Ca2+ channel. In the clinical, brexanolone, as a newly developed intravenous ALLO preparation, has been approved for the treatment of postpartum depression (PPD). In addition, traditional antidepressants such as selective serotonin reuptake inhibitor (SSRI) could reverse ALLO decline. Recently, the translocation protein (TSPO, 18 kDa), which involves in the speed-limiting step of ALLO synthesis, and ALLO derivatization have been identified as new directions for antidepressant therapy. This review provides an overview of ALLO researches in animal model and patients, discusses its role in the development and treatment of depression/anxiety, and directs its therapeutic potential in future.
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Affiliation(s)
- Shiyi Chen
- School of Pharmacy, Hangzhou Medical College (Zhejiang Academy of Medical Sciences), Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Neuropsychiatric Drug Research of Zhejiang Province, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China.
| | - Lijuan Gao
- School of Pharmacy, Hangzhou Medical College (Zhejiang Academy of Medical Sciences), Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Neuropsychiatric Drug Research of Zhejiang Province, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China.
| | - Xiaoyu Li
- School of Pharmacy, Hangzhou Medical College (Zhejiang Academy of Medical Sciences), Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Neuropsychiatric Drug Research of Zhejiang Province, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China.
| | - Yiping Ye
- School of Pharmacy, Hangzhou Medical College (Zhejiang Academy of Medical Sciences), Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Neuropsychiatric Drug Research of Zhejiang Province, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China.
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Schweizer-Schubert S, Gordon JL, Eisenlohr-Moul TA, Meltzer-Brody S, Schmalenberger KM, Slopien R, Zietlow AL, Ehlert U, Ditzen B. Steroid Hormone Sensitivity in Reproductive Mood Disorders: On the Role of the GABA A Receptor Complex and Stress During Hormonal Transitions. Front Med (Lausanne) 2021; 7:479646. [PMID: 33585496 PMCID: PMC7873927 DOI: 10.3389/fmed.2020.479646] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/20/2020] [Indexed: 12/16/2022] Open
Abstract
Women worldwide are two to three times more likely to suffer from depression in their lifetime than are men. Female risk for depressive symptoms is particularly high during the reproductive years between menarche and menopause. The term “Reproductive Mood Disorders” refers to depressive disorders triggered by hormonal fluctuations during reproductive transitions including the perimenarchal phase, the pre-menstrual phase, pregnancy, the peripartum period and the perimenopausal transition. Here we focus on reproductive mood disorders manifesting in adult life. We propose a research agenda that draws together several reproductive mood disorders and investigates which genetic, endocrinological, neural, and psychosocial factors can explain depressive symptoms during phases of hormonal transitions in women. Based on current research it is assumed that some women experience an increased sensitivity to not only fluctuations in reproductive steroids (estrogen and progesterone), but also stress-related steroids. We integrate both dynamics into the concept of “steroid hormone sensitivity,” expanding on the concept of “reproductive hormone sensitivity.” We suggest that a differential response of the stress steroid system including corticosteroids, neurosteroids, like allopregnanolone and the GABA-A Receptor complex, as well as a differential (epi)genetic risk in serotonergic and GABAergic signaling, are moderators or mediators between changes in the reproductive steroid system and the physiological, affective, and cognitive outcomes manifesting in reproductive mood disorders. We point to the lack of research on the role of psychosocial factors in increasing a woman's stress level and at some point also the sensitivity of her stress steroid system within the etiology of Reproductive Mood Disorders. Drawing together the evidence on various reproductive mood disorders we seek to present a basis for the development of more effective pharmacological, social, and psychological treatment interventions and prevention strategies for women susceptible to these disorders. This could pave the way for new research as well as medical and psychological teaching and practice- such as a new type of Practice for Gynecological Psychoneuroendocrinology- with the aim of working on and ultimately offering more integrative forms of support not yet available to women suffering from depression during hormonal transitions. In medical history women have been left alone with this integrative challenge.
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Affiliation(s)
- Sophie Schweizer-Schubert
- Center for Psychosocial Medicine, Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany.,Practice for Psychoendocrinology and Psychotherapy, Heilbronn, Germany
| | | | - Tory A Eisenlohr-Moul
- Women's Mental Health Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | | | - Katja M Schmalenberger
- Center for Psychosocial Medicine, Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany
| | - Radoslaw Slopien
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna-Lena Zietlow
- Center for Psychosocial Medicine, Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulrike Ehlert
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Beate Ditzen
- Center for Psychosocial Medicine, Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany
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Meltzer-Brody S, Kanes SJ. Allopregnanolone in postpartum depression: Role in pathophysiology and treatment. Neurobiol Stress 2020; 12:100212. [PMID: 32435663 PMCID: PMC7231991 DOI: 10.1016/j.ynstr.2020.100212] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 02/06/2023] Open
Abstract
Postpartum depression (PPD) is a unique subtype of major depressive disorder and a substantial contributor to maternal morbidity and mortality. In addition to affecting the mother, PPD can have short- and long-term consequences for the infant and partner. The precise etiology of PPD is unknown, but proposed mechanisms include altered regulation of stress response pathways, such as the hypothalamic-pituitary-adrenal axis, and dysfunctional gamma-aminobutyric acid (GABA) signaling, and functional linkages exist between these pathways. Current PPD pharmacotherapies are not directly related to these proposed pathophysiologies. In this review, we focus on the potential role of GABAergic signaling and the GABAA receptor positive allosteric modulator allopregnanolone in PPD. Data implicating GABAergic signaling and allopregnanolone in PPD are discussed in the context of the development of brexanolone injection, an intravenous formulation of allopregnanolone recently approved by the United States Food and Drug Administration for the treatment of adult women with PPD.
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Affiliation(s)
- Samantha Meltzer-Brody
- Department of Psychiatry, School of Medicine, The University of North Carolina at Chapel Hill, USA
- Corresponding author.
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The brain as a target of hormonal contraceptives: Evidence from animal studies. Front Neuroendocrinol 2019; 55:100799. [PMID: 31614151 DOI: 10.1016/j.yfrne.2019.100799] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022]
Abstract
Hormonal contraceptives are frequently prescribed drugs among women, mainly for their reversible contraceptive purposes but also for beneficial effects in some gynecological pathologies. Despite extensive studies aimed at elucidating the physical effects of hormonal contraceptives and ameliorating some unwanted outcomes, little is known yet about the effects of these drugs on brain function and related behavior, which are known to be modulated by endogenous steroid hormones. We describe the current literature on preclinical studies in animals undertaken to investigate effects of hormonal contraceptives on brain function and behavior. These studies suggest that hormonal contraceptives influence neurohormones, neurotransmitters, neuropeptides, and emotional, cognitive, social and sexual behaviors. Animals allow examination of the basic biological mechanisms of these drugs, devoid of the psychological aspect often associated to hormonal contraceptives' use in women. Understanding the neurobiological effects of these drugs may improve women's health and may help women making informed choices on hormonal contraception.
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Zheng W, Cai DB, Zheng W, Sim K, Ungvari GS, Peng XJ, Ning YP, Wang G, Xiang YT. Brexanolone for postpartum depression: A meta-analysis of randomized controlled studies. Psychiatry Res 2019; 279:83-89. [PMID: 31323375 DOI: 10.1016/j.psychres.2019.07.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To systematically examine the effectiveness, tolerability, and safety of brexanolone infusion in treating postpartum depression (PPD). METHODS Randomized controlled trials (RCTs) were included. RESULTS Two articles reporting 3 RCTs with 4 active arms (n = 267) covering 156 women with PPD receiving brexanolone infusion and 111 women with PPD on placebo were included. Compared with placebo, women suffering from PPD who received brexanolone had significantly greater response that started after 24 h (risk ratio (RR)=1.34, 95%CI 1.03-1.73), peaked at 36 h (RR = 1.50, 95%CI 1.06-2.13, P = 0.02) and lasted until Day 7 (RR = 1.32, 95%CI 1.01-1.73). Similarly, PPD women treated with brexanolone had significantly greater remission starting at 24 h (RR = 1.86, 95%CI 1.03-3.34), peaking at 60 h (RR = 2.20, 95%CI 1.31-3.70) and lasting until 72 h (RR = 1.96, 95%CI 1.41-2.72). Brexanolone infusion led to significantly higher rate of discontinuation for any reasons (RR = 2.68, 95%CI 1.35-5.32). Discontinuation due to intolerability and adverse drug reactions was similar between the active agent and placebo. CONCLUSION A single brexanolone infusion appears to have ultra-rapid antidepressant effect for PPD, lasting for up to 1 week. The short and long-term therapeutic effect of brexanolone needs to be examined in large-scale RCTs.
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Affiliation(s)
- Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Dong-Bin Cai
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Wei Zheng
- School of Medicine, Xiamen University, Xiamen, China
| | - Kang Sim
- Institute of Mental Health, Buangkok Green Medical Park, Singapore
| | - Gabor S Ungvari
- The University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | | | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Avenida da Universidade, 3/F, Building E12, Taipa, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.
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Frieder A, Fersh M, Hainline R, Deligiannidis KM. Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development. CNS Drugs 2019; 33:265-282. [PMID: 30790145 PMCID: PMC6424603 DOI: 10.1007/s40263-019-00605-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Postpartum depression is one of the most common complications of childbirth. Untreated postpartum depression can have substantial adverse effects on the well-being of the mother and child, negatively impacting child cognitive, behavioral, and emotional development with lasting consequences. There are a number of therapeutic interventions for postpartum depression including pharmacotherapy, psychotherapy, neuromodulation, and hormonal therapy among others, most of which have been adapted from the treatment of major depressive disorder outside of the peripartum period. Current evidence of antidepressant treatment for postpartum depression is limited by the small number of randomized clinical trials, underpowered samples, and the lack of long-term follow-up. The peripartum period is characterized by rapid and significant physiological change in plasma levels of endocrine hormones, peptides, and neuroactive steroids. Evidence supporting the role of neuroactive steroids and γ-aminobutyric acid (GABA) in the pathophysiology of postpartum depression led to the investigation of synthetic neuroactive steroids and their analogs as potential treatment for postpartum depression. Brexanolone, a soluble proprietary intravenous preparation of synthetic allopregnanolone, has been developed. A recent series of open-label and placebo-controlled randomized clinical trials of brexanolone in postpartum depression demonstrated a rapid reduction in depressive symptoms, and has led to the submission for regulatory approval to the US Food and Drug Administration (decision due in March 2019). SAGE-217, an allopregnanolone analog, with oral bioavailability, was recently tested in a randomized, double-blind, placebo-controlled phase III study in severe postpartum depression, with reportedly positive results. Finally, a 3β-methylated synthetic analog of allopregnanolone, ganaxolone, is being tested in both intravenous and oral forms, in randomized, double-blind, placebo-controlled phase II studies in severe postpartum depression.
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Affiliation(s)
- Ariela Frieder
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA
| | - Madeleine Fersh
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA
| | - Rachel Hainline
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kristina M Deligiannidis
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA.
- Departments of Psychiatry and Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Feinstein Institute for Medical Research, Manhasset, NY, USA.
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Resting-state functional connectivity, cortical GABA, and neuroactive steroids in peripartum and peripartum depressed women: a functional magnetic resonance imaging and spectroscopy study. Neuropsychopharmacology 2019; 44:546-554. [PMID: 30327498 PMCID: PMC6333815 DOI: 10.1038/s41386-018-0242-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/24/2018] [Accepted: 10/03/2018] [Indexed: 01/17/2023]
Abstract
Postpartum depression (PPD) is associated with abnormalities in resting-state functional connectivity (RSFC) but the underlying neurochemistry is unclear. We hypothesized that peripartum GABAergic neuroactive steroids (NAS) are related to cortical GABA concentrations and RSFC in PPD as compared to healthy comparison women (HCW). To test this, we measured RSFC with fMRI and GABA+/Creatine (Cr) concentrations with proton magnetic resonance spectroscopy (1H MRS) in the pregenual anterior cingulate (pgACC) and occipital cortices (OCC) and quantified peripartum plasma NAS. We examined between-group differences in RSFC and the relationship between cortical GABA+/Cr concentrations with RSFC. We investigated the relationship between NAS, RSFC and cortical GABA+/Cr concentrations. Within the default mode network (DMN) an area of the dorsomedial prefrontal cortex (DMPFC) had greater connectivity with the rest of the DMN in PPD (peak voxel: MNI coordinates (2, 58, 32), p = 0.002) and was correlated to depression scores (peak HAM-D17 voxel: MNI coordinates (0, 60, 34), p = 0.008). pgACC GABA+/Cr correlated positively with DMPFC RSFC in a region spanning the right anterior/posterior insula and right temporal pole (r = +0.661, p = 0.000). OCC GABA+/Cr correlated positively with regions spanning both amygdalae (right amygdala: r = +0.522, p = 0.000; left amygdala: r = +0.651, p = 0.000) as well as superior parietal areas. Plasma allopregnanolone was higher in PPD (p = 0.03) and positively correlated with intra DMPFC connectivity (r = +0.548, p = 0.000) but not GABA+/Cr. These results provide initial evidence that PPD is associated with altered DMN connectivity; cortical GABA+/Cr concentrations are associated with postpartum RSFC and allopregnanolone is associated with postpartum intra-DMPFC connectivity.
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Pelkey KA, Chittajallu R, Craig MT, Tricoire L, Wester JC, McBain CJ. Hippocampal GABAergic Inhibitory Interneurons. Physiol Rev 2017; 97:1619-1747. [PMID: 28954853 DOI: 10.1152/physrev.00007.2017] [Citation(s) in RCA: 495] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/16/2017] [Accepted: 05/26/2017] [Indexed: 12/11/2022] Open
Abstract
In the hippocampus GABAergic local circuit inhibitory interneurons represent only ~10-15% of the total neuronal population; however, their remarkable anatomical and physiological diversity allows them to regulate virtually all aspects of cellular and circuit function. Here we provide an overview of the current state of the field of interneuron research, focusing largely on the hippocampus. We discuss recent advances related to the various cell types, including their development and maturation, expression of subtype-specific voltage- and ligand-gated channels, and their roles in network oscillations. We also discuss recent technological advances and approaches that have permitted high-resolution, subtype-specific examination of their roles in numerous neural circuit disorders and the emerging therapeutic strategies to ameliorate such pathophysiological conditions. The ultimate goal of this review is not only to provide a touchstone for the current state of the field, but to help pave the way for future research by highlighting where gaps in our knowledge exist and how a complete appreciation of their roles will aid in future therapeutic strategies.
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Affiliation(s)
- Kenneth A Pelkey
- Porter Neuroscience Center, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Hatherly Laboratories, University of Exeter, Exeter, United Kingdom; and Sorbonne Universités, UPMC University of Paris, INSERM, CNRS, Neurosciences Paris Seine-Institut de Biologie Paris Seine, Paris, France
| | - Ramesh Chittajallu
- Porter Neuroscience Center, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Hatherly Laboratories, University of Exeter, Exeter, United Kingdom; and Sorbonne Universités, UPMC University of Paris, INSERM, CNRS, Neurosciences Paris Seine-Institut de Biologie Paris Seine, Paris, France
| | - Michael T Craig
- Porter Neuroscience Center, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Hatherly Laboratories, University of Exeter, Exeter, United Kingdom; and Sorbonne Universités, UPMC University of Paris, INSERM, CNRS, Neurosciences Paris Seine-Institut de Biologie Paris Seine, Paris, France
| | - Ludovic Tricoire
- Porter Neuroscience Center, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Hatherly Laboratories, University of Exeter, Exeter, United Kingdom; and Sorbonne Universités, UPMC University of Paris, INSERM, CNRS, Neurosciences Paris Seine-Institut de Biologie Paris Seine, Paris, France
| | - Jason C Wester
- Porter Neuroscience Center, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Hatherly Laboratories, University of Exeter, Exeter, United Kingdom; and Sorbonne Universités, UPMC University of Paris, INSERM, CNRS, Neurosciences Paris Seine-Institut de Biologie Paris Seine, Paris, France
| | - Chris J McBain
- Porter Neuroscience Center, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Hatherly Laboratories, University of Exeter, Exeter, United Kingdom; and Sorbonne Universités, UPMC University of Paris, INSERM, CNRS, Neurosciences Paris Seine-Institut de Biologie Paris Seine, Paris, France
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Postpartum estrogen withdrawal impairs GABAergic inhibition and LTD induction in basolateral amygdala complex via down-regulation of GPR30. Eur Neuropsychopharmacol 2017; 27:759-772. [PMID: 28619359 DOI: 10.1016/j.euroneuro.2017.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/22/2017] [Accepted: 05/29/2017] [Indexed: 01/22/2023]
Abstract
Postpartum estrogen (E2) withdrawal is known to be a particularly vulnerable time for depressive symptoms. In this study, ovariectomized (OVX) mice were treated with co-administration of estradiol benzoate and progesterone (E2/P4) followed by administration of E2 alone (E2) and a subsequent E2 withdrawal (EW) to mimic the hormonal changes during pregnancy and postpartum. The objective of this study was to investigate the influence of E2 withdrawal after hormone-simulated pregnancy on synaptic function and plasticity in basolateral amygdala complex (BLA). In comparison to control mice, EW mice spent less time in the central portion of open-field test and open arms of elevated plus-maze. Excitatory postsynaptic potentials (EPSPs) slopes at external capsule BLA synapse were reduced in E2/P4-mice, recovered in E2-mice, and increased in EW-mice. EW-mice showed a significant increase in duration of EPSPs and paired-pulse inhibition (PPI) with multi-spike responses of EPSPs and impairment of long-term depression (LTD) induction, which were corrected by GABAAR agonist muscimol. Levels of estrogen receptor (ER) GPR30, ERα and ERβ expression in BLA of EW-mice were lower than those in control mice. The bath-application of GPR30 agonist G-1 in BLA of EW-mice recovered the GABAAR-mediated inhibition and LTD indication, but ERβ agonist DPN or ERα agonist PPT could not. A single BLA-injection of G-1 rather than DPN or PPT in EW-mice could partially relieve the anxiety-like behaviors. The results indicate that postpartum E2 withdrawal causes dysfunction of GABAAR-mediated inhibition in the BLA through reducing GPR30 expression, which impairs LTD induction and causes anxiety-like behaviors.
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Osborne LM, Gispen F, Sanyal A, Yenokyan G, Meilman S, Payne JL. Lower allopregnanolone during pregnancy predicts postpartum depression: An exploratory study. Psychoneuroendocrinology 2017; 79:116-121. [PMID: 28278440 PMCID: PMC5420429 DOI: 10.1016/j.psyneuen.2017.02.012] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/08/2017] [Accepted: 02/10/2017] [Indexed: 11/19/2022]
Abstract
Current evidence is mixed on the role of progesterone and its metabolites in perinatal mood and anxiety disorders. We measured second and third trimester (T2 and T3) progesterone (PROG) and allopregnanolone (ALLO) levels by ELISA and postpartum depression (PPD) by clinician interview (DSM-IV criteria) in 60 pregnant women with a prior diagnosis of a mood disorder. Methods included multivariate and logistic regression with general linear mixed effect models. We found that, after adjustment, every additional ng/mL of T2 ALLO resulted in a 63% (95% CI 13% to 84%, p=0.022) reduction in the risk of developing PPD. Our findings extend previous work connecting ALLO and depression within pregnancy, and indicate that the relationship between pregnancy ALLO and PPD is worth further exploration in a larger sample.
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Affiliation(s)
- Lauren M Osborne
- Women's Mood Disorders Center, Johns Hopkins University School of Medicine, United States.
| | - Fiona Gispen
- Women's Mood Disorders Center, Johns Hopkins University School of Medicine, United States
| | - Abanti Sanyal
- Women's Mood Disorders Center, Johns Hopkins University School of Medicine, United States
| | - Gayane Yenokyan
- Women's Mood Disorders Center, Johns Hopkins University School of Medicine, United States
| | - Samantha Meilman
- Women's Mood Disorders Center, Johns Hopkins University School of Medicine, United States
| | - Jennifer L Payne
- Women's Mood Disorders Center, Johns Hopkins University School of Medicine, United States
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Baka J, Csakvari E, Huzian O, Dobos N, Siklos L, Leranth C, MacLusky NJ, Duman RS, Hajszan T. Stress induces equivalent remodeling of hippocampal spine synapses in a simulated postpartum environment and in a female rat model of major depression. Neuroscience 2017; 343:384-397. [PMID: 28012870 PMCID: PMC5421158 DOI: 10.1016/j.neuroscience.2016.12.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 12/11/2016] [Accepted: 12/13/2016] [Indexed: 12/24/2022]
Abstract
Stress and withdrawal of female reproductive hormones are known risk factors of postpartum depression. Although both of these factors are capable of powerfully modulating neuronal plasticity, there is no direct electron microscopic evidence of hippocampal spine synapse remodeling in postpartum depression. To address this issue, hormonal conditions of pregnancy and postpartum period were simulated in ovariectomized adult female Sprague-Dawley rats (n=76). The number of hippocampal spine synapses and the depressive behavior of rats in an active escape task were investigated in untreated control, hormone-withdrawn 'postpartum', simulated proestrus, and hormone-treated 'postpartum' animals. After 'postpartum' withdrawal of gonadal steroids, inescapable stress caused a loss of hippocampal spine synapses, which was related to poor escape performance in hormone-withdrawn 'postpartum' females. These responses were equivalent with the changes observed in untreated controls that is an established animal model of major depression. Maintaining proestrus levels of ovarian hormones during 'postpartum' stress exposure did not affect synaptic and behavioral responses to inescapable stress in simulated proestrus animals. By contrast, maintaining pregnancy levels of estradiol and progesterone during 'postpartum' stress exposure completely prevented the stress-induced loss of hippocampal spine synapses, which was associated with improved escape performance in hormone-treated 'postpartum' females. This protective effect appears to be mediated by a muted stress response as measured by serum corticosterone concentrations. In line with our emerging 'synaptogenic hypothesis' of depression, the loss of hippocampal spine synapses may be a novel perspective both in the pathomechanism and in the clinical management of postpartum affective illness.
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Affiliation(s)
- Judith Baka
- Institute of Biophysics, Biological Research Center, Hungarian Academy of Sciences, Temesvari Krt 62, 6726 Szeged, Hungary
| | - Eszter Csakvari
- Institute of Biophysics, Biological Research Center, Hungarian Academy of Sciences, Temesvari Krt 62, 6726 Szeged, Hungary
| | - Orsolya Huzian
- Institute of Biophysics, Biological Research Center, Hungarian Academy of Sciences, Temesvari Krt 62, 6726 Szeged, Hungary
| | - Nikoletta Dobos
- Institute of Biophysics, Biological Research Center, Hungarian Academy of Sciences, Temesvari Krt 62, 6726 Szeged, Hungary
| | - Laszlo Siklos
- Institute of Biophysics, Biological Research Center, Hungarian Academy of Sciences, Temesvari Krt 62, 6726 Szeged, Hungary
| | - Csaba Leranth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States; Department of Neuroscience, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States
| | - Neil J MacLusky
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, 50 Stone Road E, Guelph, Ontario N1G 2W1, Canada
| | - Ronald S Duman
- Department of Neuroscience, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States; Department of Psychiatry, Yale University School of Medicine, 34 Park Street, New Haven, CT 06508, United States
| | - Tibor Hajszan
- Institute of Biophysics, Biological Research Center, Hungarian Academy of Sciences, Temesvari Krt 62, 6726 Szeged, Hungary; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States.
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Locci A, Porcu P, Talani G, Santoru F, Berretti R, Giunti E, Licheri V, Sanna E, Concas A. Neonatal estradiol exposure to female rats changes GABA A receptor expression and function, and spatial learning during adulthood. Horm Behav 2017; 87:35-46. [PMID: 27769760 DOI: 10.1016/j.yhbeh.2016.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/04/2016] [Accepted: 10/14/2016] [Indexed: 12/27/2022]
Abstract
Exposure of female rats to estradiol during the perinatal period has profound effects on GABAergic neurotransmission that are crucial to establish sexually dimorphic brain characteristics. We previously showed that neonatal β-estradiol 3-benzoate (EB) treatment decreases brain concentrations of the neurosteroid allopregnanolone, a potent positive modulator of extrasynaptic GABAA receptors (GABAAR). We thus evaluated whether neonatal EB treatment affects GABAAR expression and function in the hippocampus of adult female rats. Neonatal EB administration increased the expression of extrasynaptic α4/δ subunit-containing GABAARs and the modulatory action of THIP on tonic currents mediated by these receptors. The same treatment decreased the expression of synaptic α1/α4/γ2 subunit-containing receptors, as well as phasic currents. These effects of neonatal EB treatment are not related to ambient allopregnanolone concentrations per se, given that vehicle-treated rats in diestrus, which have opposite neurosteroid levels than EB-treated rats, show similar changes in GABAARs. Rather, these changes may represent a compensatory mechanism to counteract the long-term reduction in allopregnanolone concentrations, induced by neonatal EB. Given that both α4/δ receptors and allopregnanolone are involved in memory consolidation, we evaluated whether neonatal EB treatment alters performance in the Morris water maze test during adulthood. Neonatal EB treatment decreased the latency and the cumulative search error to reach the platform, as well as thigmotaxis, suggesting improved learning, and also enhanced memory performance during the probe trial. These enduring changes in GABAAR plasticity may be relevant for the regulation of neuronal excitability in the hippocampus and for the etiology of psychiatric disorders that originate in development and show sex differences.
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Affiliation(s)
- Andrea Locci
- Department of Life and Environment Sciences, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy
| | - Patrizia Porcu
- Neuroscience Institute, National Research Council of Italy (CNR), Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy
| | - Giuseppe Talani
- Neuroscience Institute, National Research Council of Italy (CNR), Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy
| | - Francesca Santoru
- Department of Life and Environment Sciences, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy
| | - Roberta Berretti
- Department of Life and Environment Sciences, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy
| | - Elisa Giunti
- Department of Life and Environment Sciences, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy
| | - Valentina Licheri
- Department of Life and Environment Sciences, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy
| | - Enrico Sanna
- Department of Life and Environment Sciences, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy; Neuroscience Institute, National Research Council of Italy (CNR), Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy
| | - Alessandra Concas
- Department of Life and Environment Sciences, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy; Neuroscience Institute, National Research Council of Italy (CNR), Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy.
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Deligiannidis KM, Kroll-Desrosiers AR, Mo S, Nguyen HP, Svenson A, Jaitly N, Hall JE, Barton BA, Rothschild AJ, Shaffer SA. Peripartum neuroactive steroid and γ-aminobutyric acid profiles in women at-risk for postpartum depression. Psychoneuroendocrinology 2016; 70:98-107. [PMID: 27209438 PMCID: PMC4907817 DOI: 10.1016/j.psyneuen.2016.05.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/12/2016] [Accepted: 05/07/2016] [Indexed: 01/21/2023]
Abstract
Neuroactive steroids (NAS) are allosteric modulators of the γ-aminobutyric acid (GABA) system. NAS and GABA are implicated in depression. The peripartum period involves physiologic changes in NAS which may be associated with peripartum depression and anxiety. We measured peripartum plasma NAS and GABA in healthy comparison subjects (HCS) and those at-risk for postpartum depression (AR-PPD) due to current mild depressive or anxiety symptoms or a history of depression. We evaluated 56 peripartum medication-free subjects. We measured symptoms with the Hamilton Depression Rating Scale (HAM-D17), Hamilton Anxiety Rating Scale (HAM-A) and Spielberger State-Trait Anxiety Inventory-State (STAI-S). Plasma NAS and GABA were quantified by liquid chromatography-mass spectrometry. We examined the associations between longitudinal changes in NAS, GABA and depressive and anxiety symptoms using generalized estimating equation methods. Peripartum GABA concentration was 1.9±0.7ng/mL (p=0.004) lower and progesterone and pregnanolone were 15.8±7.5 (p=0.04) and 1.5±0.7ng/mL (p=0.03) higher in AR-PPD versus HCS, respectively. HAM-D17 was negatively associated with GABA (β=-0.14±0.05, p=0.01) and positively associated with pregnanolone (β=0.16±0.06, p=0.01). STAI-S was positively associated with pregnanolone (β=0.11±0.04, p=0.004), allopregnanolone (β=0.13±0.05, p=0.006) and pregnenolone (β=0.02±0.01, p=0.04). HAM-A was negatively associated with GABA (β=-0.12±0.04, p=0.004) and positively associated with pregnanolone (β=0.11±0.05, p=0.05). Altered peripartum NAS and GABA profiles in AR-PPD women suggest that their interaction may play an important role in the pathophysiology of peripartum depression and anxiety.
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Affiliation(s)
- Kristina M. Deligiannidis
- Center for Psychopharmacologic Research & Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, U.S.A.,Women’s Mental Health Program, Departments of Psychiatry and Obstetrics & Gynecology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA 01655, U.S.A.,Corresponding Author: Kristina M. Deligiannidis, M.D. Associate Professor of Psychiatry and Obstetrics & Gynecology Director, Depression Specialty Clinic Reproductive Psychiatrist, Women’s Mental Health Program, University of Massachusetts Medical School/UMass Memorial Medical Center, Center for Psychopharmacologic Research and Treatment, 55 Lake Avenue, North, Worcester, MA 01655, U.S.A. Tel.: (+1) 774.455.4134; Fax: (+1) 508.856.4854
| | - Aimee R. Kroll-Desrosiers
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, U.S.A
| | - Shunyan Mo
- Proteomics and Mass Spectrometry Facility and Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
| | - Hien P. Nguyen
- Proteomics and Mass Spectrometry Facility and Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA 01655, U.S.A
| | - Abby Svenson
- Center for Psychopharmacologic Research & Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA 01655, USA.
| | - Nina Jaitly
- Center for Psychopharmacologic Research & Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA 01655, USA; National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709-2233, USA.
| | - Janet E. Hall
- National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709-2233, U.S.A
| | - Bruce A. Barton
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, U.S.A
| | - Anthony J. Rothschild
- Center for Psychopharmacologic Research & Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, U.S.A
| | - Scott A. Shaffer
- Proteomics and Mass Spectrometry Facility and Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA 01655, U.S.A
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Plasticity of GABAA Receptors during Pregnancy and Postpartum Period: From Gene to Function. Neural Plast 2015; 2015:170435. [PMID: 26413323 PMCID: PMC4568036 DOI: 10.1155/2015/170435] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/27/2015] [Accepted: 08/16/2015] [Indexed: 11/22/2022] Open
Abstract
Pregnancy needs complex pathways that together play a role in proper growth and protection of the fetus preventing its premature loss. Changes during pregnancy and postpartum period include the manifold machinery of neuroactive steroids that plays a crucial role in neuronal excitability by local modulation of specific inhibitory receptors: the GABAA receptors. Marked fluctuations in both blood and brain concentration of neuroactive steroids strongly contribute to GABAA receptor function and plasticity. In this review, we listed several interesting results regarding the regulation and plasticity of GABAA receptor function during pregnancy and postpartum period in rats. The increase in brain levels of neuroactive steroids during pregnancy and their sudden decrease immediately before delivery are causally related to changes in the expression/function of specific GABAA receptor subunits in the hippocampus. These data suggest that alterations in GABAA receptor expression and function may be related to neurological and psychiatric disorders associated with crucial periods in women. These findings could help to provide potential new treatments for these women's disabling syndromes.
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Pluchino N, Santoro A, Casarosa E, Wenger JM, Genazzani AD, Petignat P, Genazzani AR. Advances in neurosteroids: role in clinical practice. Climacteric 2014; 16 Suppl 1:8-17. [PMID: 23848487 DOI: 10.3109/13697137.2013.809647] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The steroidogenic endocrine glands and local synthesis both contribute to the pool of steroids present in the central nervous system and peripheral nervous system. Although the synthesis of neurosteroids in the nervous system is now well established, the spectrum of respective functions in regulating neuronal and glial functions remains to be fully elucidated. From the concept of neurosteroids derives another treatment strategy: the use of pharmaceutical agents that increase the synthesis of endogenous neurosteroids within the nervous system. This approach has so far been hampered by lack of knowledge concerning the regulation of the biosynthetic pathways of neurosteroids and their relationship with sex steroids produced by the peripheral gland or with exogenous steroids. The present review summarizes some of the available clinical and experimental findings supporting the critical role of neurosteroids during fertile life and reproductive aging and their relationship with endogenous and exogenous sex steroids. The brain metabolism of synthetic progestins and the implications of DHEA treatment in postmenopausal women will also be discussed.
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Affiliation(s)
- N Pluchino
- Division of Obstetrics and Gynecology, University of Pisa, Italy
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20
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Monasterio N, Vergara E, Morales T. Hormonal influences on neuroimmune responses in the CNS of females. Front Integr Neurosci 2014; 7:110. [PMID: 24478642 PMCID: PMC3894525 DOI: 10.3389/fnint.2013.00110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 12/25/2013] [Indexed: 11/26/2022] Open
Abstract
Particular reproductive stages such as lactation impose demands on the female. To cope with these demands, her physiology goes through numerous adaptations, for example, attenuation of immune and stress responses. Hormonal fluctuation during lactation exerts a strong influence, inducing neuroplasticity in the hypothalamus and extrahypothalamic regions, and diminishing the stress and inflammatory responses. Thus, hormones confer decreased vulnerability to the female brain. This mini-review focuses on the adaptations of the immune and stress response during maternity, and on the neuroprotective actions of progesterone and prolactin and their effects on inflammation. The importance of pregnancy and lactation as experimental models to study immune responses and disease is also highlighted.
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Affiliation(s)
- Nela Monasterio
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México Santiago de Querétaro, México
| | - Edgar Vergara
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México Ciudad de México, México
| | - Teresa Morales
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México Santiago de Querétaro, México
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Dionisio L, Arias V, Bouzat C, Esandi MDC. GABAA receptor plasticity in Jurkat T cells. Biochimie 2013; 95:2376-84. [PMID: 24012548 DOI: 10.1016/j.biochi.2013.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 08/25/2013] [Indexed: 11/16/2022]
Abstract
GABAA receptors (GABAAR) mediate inhibitory neurotransmission in the human brain. Neurons modify subunit expression, cellular distribution and function of GABAAR in response to different stimuli, a process named plasticity. Human lymphocytes have a functional neuronal-like GABAergic system with GABAAR acting as inhibitors of proliferation. We here explore if receptor plasticity occurs in lymphocytes. To this end, we analyzed human T lymphocyte Jurkat cells exposed to different physiological stimuli shown to mediate plasticity in neurons: GABA, progesterone and insulin. The exposure to 100 μM GABA differently affected the expression of GABAAR subunits measured at both the mRNA and protein level, showing an increase of α1, β3, and γ2 subunits but no changes in δ subunit. Exposure of Jurkat cells to different stimuli produced different changes in subunit expression: 0.1 μM progesterone decreased δ and 0.5 μM insulin increased β3 subunits. To identify the mechanisms underlying plasticity, we evaluated the Akt pathway, which is involved in the phosphorylation of β subunits and receptor translocation to the membrane. A significant increase of phosphorylated Akt and on the expression of β3 subunit in membrane occurred in cells exposed 15 h to GABA. To determine if plastic changes are translated into functional changes, we performed whole cell recordings. After 15 h GABA-exposure, a significantly higher percentage of cells responded to GABA application when compared to 0 and 40 h exposure, thus indicating that the detected plastic changes may have a role in GABA-modulated lymphocyte function. Our results reveal that lymphocyte GABAAR are modified by different stimuli similarly and by similar mechanisms to those in neurons. This property is of significance for the development of future therapies involving pharmacological modulation of the immune response.
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Affiliation(s)
- Leonardo Dionisio
- Instituto de Investigaciones Bioquímicas de Bahía Blanca, UNS-CONICET, Camino La Carrindanga Km7, 8000 Bahía Blanca, Argentina
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Deligiannidis KM, Sikoglu EM, Shaffer SA, Frederick B, Svenson A, Kopoyan A, Kosma C, Rothschild AJ, Moore CM. GABAergic neuroactive steroids and resting-state functional connectivity in postpartum depression: a preliminary study. J Psychiatr Res 2013; 47:816-28. [PMID: 23499388 PMCID: PMC3983790 DOI: 10.1016/j.jpsychires.2013.02.010] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 01/28/2013] [Accepted: 02/17/2013] [Indexed: 10/27/2022]
Abstract
Postpartum depression (PPD) affects up to 1 in 8 women. The early postpartum period is characterized by a downward physiological shift from relatively elevated levels of sex steroids during pregnancy to diminished levels after parturition. Sex steroids influence functional brain connectivity in healthy non-puerperal subjects. This study tests the hypothesis that PPD is associated with attenuation of resting-state functional connectivity (rs-fc) within corticolimbic regions implicated in depression and alterations in neuroactive steroid concentrations as compared to healthy postpartum women. Subjects (n = 32) were prospectively evaluated during pregnancy and in the postpartum with repeated plasma neuroactive steroid measurements and mood and psychosocial assessments. Healthy comparison subjects (HCS) and medication-free subjects with unipolar PPD (PPD) were examined using functional magnetic resonance imaging (fMRI) within 9 weeks of delivery. We performed rs-fc analysis with seeds placed in the anterior cingulate cortex (ACC), and bilateral amygdala (AMYG), hippocampi (HIPP) and dorsolateral prefrontal cortices (DLPFCs). Postpartum rs-fc and perinatal neuroactive steroid plasma concentrations, quantified by liquid chromatography/mass spectrometry, were compared between groups. PPD subjects showed attenuation of connectivity for each of the tested regions (i.e. ACC, AMYG, HIPP and DLPFC) and between corticocortical and corticolimbic regions vs. HCS. Perinatal concentrations of pregnanolone, allopregnanolone and pregnenolone were not different between groups. This is the first report of a disruption in the rs-fc patterns in medication-free subjects with PPD. This disruption may contribute to the development of PPD, at a time of falling neuroactive steroid concentrations.
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Affiliation(s)
- Kristina M. Deligiannidis
- Center for Psychopharmacologic Research & Treatment, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, 01605, USA,Corresponding Author: Kristina M. Deligiannidis, M.D. Assistant Professor of Psychiatry and Obstetrics & Gynecology Director, Depression Specialty Clinic, University of Massachusetts Medical School, 361 Plantation Street, Worcester, MA 01605, Tel: 508.334.7262, Fax: 508.856.4854,
| | - Elif M. Sikoglu
- Center for Comparative Neuroimaging, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - Scott A. Shaffer
- Proteomics and Mass Spectrometry Facility, University of Massachusetts Medical School, Worcester, MA 01545, USA
| | - Blaise Frederick
- Department of Psychiatry, Harvard Medical School, Boston MA 02115/Brain Imaging Center, McLean Hospital, Belmont MA 02478
| | - Abby Svenson
- Center for Psychopharmacologic Research & Treatment, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, 01605, USA
| | - Andre Kopoyan
- Proteomics and Mass Spectrometry Facility, University of Massachusetts Medical School, Worcester, MA 01545, USA
| | - Chelsea Kosma
- Center for Psychopharmacologic Research & Treatment, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, 01605, USA
| | - Anthony J. Rothschild
- Center for Psychopharmacologic Research & Treatment, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, 01605, USA
| | - Constance M. Moore
- Center for Comparative Neuroimaging, University of Massachusetts Medical School, Worcester, MA, 01605, USA
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23
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Genazzani AR, Bucci F, Russo N, Daino D, Santoro AN, Pluchino N. Neurosteroids in clinical practice: implications for women’s health. Horm Mol Biol Clin Investig 2011; 7:413-23. [DOI: 10.1515/hmbci.2011.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 08/09/2011] [Indexed: 11/15/2022]
Abstract
AbstractThe steroidogenic endocrine glands and local synthesis both contribute to the pool of steroids present in the central nervous system (CNS) and peripheral nervous system (PNS). Although the synthesis of neurosteroids in the nervous system is now well established, the spectrum of respective functions in regulating neuronal and glial functions remains to be fully elucidated. From the concept of neurosteroids derives another therapeutical strategy: the use of pharmaceutical agents that increase the synthesis of endogenous neurosteroids within the nervous system. This approach is so far hampered by the lack of knowledge concerning the regulation of the biosynthetic pathways of neurosteroids and their relationship with sex steroids produced by peripheral glands. The present review summarizes some of the available clinical and experimental findings supporting the critical role of neuro-steroids during the fertile life and reproductive aging and their relationship with endogenous and exogenous sex steroids. Brain metabolism of synthethic progestins and the implication of dehydroepiandrosterone (DHEA) treatment in post-menopausal women will be also discussed.
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24
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Hill M, Pařízek A, Kancheva R, Jirásek JE. Reduced progesterone metabolites in human late pregnancy. Physiol Res 2010; 60:225-41. [PMID: 21114373 DOI: 10.33549/physiolres.932077] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In this review, we focused on the intersection between steroid metabolomics, obstetrics and steroid neurophysiology to give a comprehensive insight into the role of sex hormones and neuroactive steroids (NAS) in the mechanism controlling pregnancy sustaining. The data in the literature including our studies show that there is a complex mechanism providing synthesis of either pregnancy sustaining or parturition provoking steroids. This mechanism includes the boosting placental synthesis of CRH with approaching parturition inducing the excessive synthesis of 3beta-hydroxy-5-ene steroid sulfates serving primarily as precursors for placental synthesis of progestogens, estrogens and NAS. The distribution and changing activities of placental oxidoreductases are responsible for the activation or inactivation of the aforementioned steroids, which is compartment-specific (maternal and fetal compartments) and dependent on gestational age, with a tendency to shift the production from the pregnancy-sustaining steroids to the parturition provoking ones with an increasing gestational age. The fetal and maternal livers catabolize part of the bioactive steroids and also convert some precursors to bioactive steroids. Besides the progesterone, a variety of its 5alpha/beta-reduced metabolites may significantly influence the maintenance of human pregnancy, provide protection against excitotoxicity following acute hypoxic stress, and might also affect the pain perception in mother and fetus.
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Affiliation(s)
- M Hill
- Department of Obstetrics and Gynecology of the First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic.
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25
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Forced swim test behavior in postpartum rats. Pharmacol Biochem Behav 2010; 96:402-12. [PMID: 20600244 DOI: 10.1016/j.pbb.2010.06.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 06/01/2010] [Accepted: 06/21/2010] [Indexed: 11/20/2022]
Abstract
This study was undertaken to determine whether depression-like behavior can be observed in gonadally intact females that have experienced normal pregnancy. When tested on the forced swim test (FST) on postpartum days 1-7, previously pregnant rats spent slightly more time immobile, significantly less time swimming and diving, and defecated more than virgin controls. Subchronic treatment with nomifensine (DA reuptake inhibitor, 2.5mg/kg) but not sertraline (serotonin reuptake inhibitor, 10mg/kg) or desipramine (norepinephrine reuptake inhibitor, 10mg/kg) significantly decreased immobility on postpartum day 2. In rats pre-exposed to the FST in mid-pregnancy, neither subchronic nor chronic treatment with desipramine or sertraline decreased immobility on postpartum day 2; in contrast, chronic desipramine significantly decreased immobility in virgin controls. These results indicate that postpartum female rats, compared to virgin controls, show a reduction in some "active coping behaviors" but no significant increase in immobility when tested during the early postpartum period, unlike ovariectomized females that have undergone hormone-simulated pregnancy (HSP). Additionally, immobility that is increased by FST pre-exposure is not readily prevented by treatment with standard antidepressant medications in postpartum females. Depression-like behaviors previously observed in females that have undergone HSP may result from the more dramatic changes in estradiol, prolactin or corticosterone that occur during the early "postpartum" period, compared to the more subtle changes in these hormones that occur in actual postpartum females.
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26
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Hill M, Pařízek A, Velíková M, Kubátová J, Kancheva R, Dušková M, Šimůnková K, Klímková M, Pašková A, Žižka Z, Jirásek JE, Jirkovská M, Stárka L. The distribution of placental oxidoreductase isoforms provides different milieus of steroids influencing pregnancy in the maternal and fetal compartment. Horm Mol Biol Clin Investig 2010; 4:581-600. [DOI: 10.1515/hmbci.2010.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 11/24/2010] [Indexed: 12/27/2022]
Abstract
AbstractUsing information based on the steroid metabolome in maternal and fetal body fluids, we attempted to ascertain whether there is a common mechanism, which is based on the placental distribution of various isoforms of 17β-hydroxysteroid dehydrogenases and aldo-keto reductases. This system simultaneously provides a higher proportion of active progestogens in fetal circulation and a higher proportion of active estrogens and GABAergic steroids in the maternal compartment. The data obtained using gas chromatography-mass spectrometry completely support the aforementioned hypothesis. We confirmed a common trend to higher ratios of steroids with hydroxy-groups in the 3α-, 17β-, and 20α-positions to the corresponding 3-oxo-, 17-oxo-, and 20-oxo-metabolites, respectively, in the maternal blood when compared with the fetal circulation, and the same tendency was obvious in the 3α-hydroxy/3β-hydroxy steroid ratios. A decreasing trend was observed in the ratios of active estrogens and neuro-inhibitory steroids to their inactive counterparts in fetal and maternal body fluids. This was probably associated with a limited capacity of placental oxidoreductases in the converting of estrone to estradiol during the transplacental passage. Although we observed a decreasing trend in pregnancy-sustaining steroids with increasing gestational age, we recorded rising levels of estradiol and particularly of estriol, regardless of the limited capacity of placental oxidoreductases. Besides the estradiol, which is generally known as an active estrogen, estriol may be of importance for the termination of pregnancy with respect to its excessive concentrations near term which allows its binding to estrogen receptors.
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Abstract
After five editions, the congress on "Steroids and Nervous System" held in Torino, Italy, represents an important international event for researchers involved in this field aimed to recapitulate mechanisms, physiological and pharmacological effects of neuroactive steroids. The present review introduces manuscripts collected in this supplement issue which are based on new interesting findings such as the influence of sex steroids on cannabinoid-regulated biology, the role of steroids in pain, the importance of co-regulators in steroidal mechanisms and the understanding of new non classical mechanism, the emerging role of vitamin D as a neuroactive steroid and the pathogenetic mechanisms mediated by glucocorticoid receptors. Finally, we have integrated these aspects with an update on some of the several and important observations recently published on this hot topic.
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