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Shin H, Kim J, Choi SR, Kang DW, Moon JY, Roh DH, Bae M, Hwang J, Kim HW. Antinociceptive effect of intermittent fasting via the orexin pathway on formalin-induced acute pain in mice. Sci Rep 2023; 13:20245. [PMID: 37985842 PMCID: PMC10661460 DOI: 10.1038/s41598-023-47278-3] [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: 08/14/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023] Open
Abstract
It has been suggested that stress responses induced by fasting have analgesic effects on nociception by elevating the levels of stress-related hormones, while there is limited understanding of pain control mechanisms. Here, we investigated whether acute or intermittent fasting alleviates formalin-induced pain in mice and whether spinal orexin A (OXA) plays a role in this process. 6, 12, or 24 h acute fasting (AF) and 12 or 24 h intermittent fasting (IF) decreased the second phase of pain after intraplantar formalin administration. There was no difference in walking time in the rota-rod test and distance traveld in the open field test in all groups. Plasma corticosterone level and immobility time in the forced swim test were increased after 12 h AF, but not after 12 h IF. 12 h AF and IF increased not only the activation of OXA neurons in the lateral hypothalamus but also the expression of OXA in the lateral hypothalamus and spinal cord. Blockade of spinal orexin 1 receptor with SB334867 restored formalin-induced pain and spinal c-Fos immunoreactivity that were decreased after 12 h IF. These results suggest that 12 h IF produces antinociceptive effects on formalin-induced pain not by corticosterone elevation but by OXA-mediated pathway.
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Affiliation(s)
- Hyunjin Shin
- Department of Physiology and Medical Science, College of Medicine and Brain Research Institute, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Jaehyuk Kim
- Department of Physiology and Medical Science, College of Medicine and Brain Research Institute, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
- CNS Team, N-DIC, Hwaseong, 18469, Korea
| | - Sheu-Ran Choi
- Department of Pharmacology, Catholic Kwandong University College of Medicine, Gangneung, 25601, Korea
| | - Dong-Wook Kang
- Department of Physiology and Medical Science, College of Medicine and Brain Research Institute, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Ji-Young Moon
- Animal Protection and Welfare Division, Animal and Plant Quarantine Agency, Gimcheon, 39660, Korea
| | - Dae-Hyun Roh
- Department of Oral Physiology, School of Dentistry, Kyung Hee University, Seoul, 02447, Korea
| | - Miok Bae
- Preclinical Research Center, Chungnam National University Hospital, Daejeon, 35015, Korea
| | - Jungmo Hwang
- Department of Orthopaedic Surgery, College of Medicine, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea.
| | - Hyun-Woo Kim
- Department of Physiology and Medical Science, College of Medicine and Brain Research Institute, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea.
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2
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Wang Z, Huang Y, Zhou Z, Huang J, He Y, Qiu P. Local iron deficiency in the substantia nigra directly contributes to hyperlocomotion phenotypes. Neurobiol Dis 2022; 168:105693. [PMID: 35304229 DOI: 10.1016/j.nbd.2022.105693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/24/2022] [Accepted: 03/12/2022] [Indexed: 12/31/2022] Open
Abstract
Brain iron is precisely regulated, and disrupted brain iron homeostasis is implicated in neuropsychological disease. Mounting evidence connects the iron status of the substantia nigra (SN) with locomotion-related neural symptomatology. Researchers in this field have long speculated that iron deficiency in the SN directly causes the high-locomotion symptoms observed in neuropsychiatric disorders. However, no direct experimental evidence of a causal relationship has been presented. To explore the relationship between iron deficiency in the SN and locomotion-related phenotypes, we stereotaxically injected the well-documented iron chelator, deferiprone (DFP) into the SN of mice to induce regional brain iron deprivation and subsequently performed behavioral tests. Altered expression of iron metabolism-related molecules was detected in the brain regions with interventions, and behavioral changes were observed. Targeted iron chelation effectively decreased the local iron content of the SN. Among the brain regions examined, only DFP injected into the SN resulted in the hyperlocomotion phenotype. Upon SN iron chelation, transferrin receptor (Tfr) expression was found to be upregulated. Conversely, viral vector-mediated SN-Tfr knockdown was sufficient to induce SN iron deficiency and mimic the hyperlocomotion phenotype. All locomotion changes had a significant negative correlation with iron alteration in the SN. Furthermore, SN iron disturbance also contributed to poor sleep efficiency. Thus, SN iron deficiency directly contributed to triggering both hyperlocomotion and sleep disturbances. This study offers a promising research and therapeutic direction for iron-linked neuropsychiatric diseases.
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Affiliation(s)
- Zhuo Wang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
| | - Yanjun Huang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Zhihua Zhou
- Department of Neurology, The first affiliated hospital, School of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou 510080, China
| | - Jian Huang
- School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China
| | - Yitong He
- School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China
| | - Pingming Qiu
- School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China.
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3
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Wang XX, Feng Y, Tan EK, Ondo WG, Wu YC. Stroke-related restless legs syndrome: epidemiology, clinical characteristics and pathophysiology. Sleep Med 2022; 90:238-248. [DOI: 10.1016/j.sleep.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/23/2022] [Accepted: 02/01/2022] [Indexed: 12/24/2022]
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4
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Mogavero MP, Mezzapesa DM, Savarese M, DelRosso LM, Lanza G, Ferri R. Morphological analysis of the brain subcortical gray structures in restless legs syndrome. Sleep Med 2021; 88:74-80. [PMID: 34740168 DOI: 10.1016/j.sleep.2021.10.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although several studies have shown the involvement of specific structures of the central nervous system, the dopaminergic system, and iron metabolism in restless legs syndrome (RLS), the exact location and extent of its anatomical substrate is not yet known. The scope of this new study was to investigate the brain subcortical gray structures, by means of structural magnetic resonance imaging (MRI) studies, in RLS patients in order to assess the presence of any volume or shape abnormalities involving these structures. METHODS Thirty-three normal controls (24 females and nine males) and 45 RLS patients (34 females and 11 males) were retrospectively recruited and underwent a 1.5 Tesla MRI study with two-dimensional T1 sequences in the sagittal plane. Post-processing was performed by means of the Functional Magnetic Resonance Imaging of the Brain Analysis Group Integrated Registration and Segmentation Tool (FIRST) software, and both volumetric and morphological analyses of the thalamus, caudate, putamen, globus pallidus, brainstem, hippocampus, and amygdala, bilaterally, were carried out. RESULTS A statistically significant volumetric reduction in the left amygdala and left globus pallidus was found in subjects with RLS, as well as large surface morphological alterations affecting the amygdala bilaterally and other less widespread surface changes in both hippocampi, the right caudate, the left globus pallidus, and the left putamen. CONCLUSIONS These findings seem to indicate that the basic mechanisms of RLS might include a pathway involving not only the hypothalamus-spinal dopaminergic circuit (nucleus A11), but also pathways including the basal ganglia and structures that are part of the limbic system; moreover, structural alterations in RLS seem to concern the morphology as well as the volume of the above structures. The role of basal ganglia in the complex neurophysiological and neurochemical mechanism of RLS needs to carefully reconsidered.
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Affiliation(s)
- Maria P Mogavero
- Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Italy
| | - Domenico M Mezzapesa
- Neurology Unit and Stroke Center, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Mariantonietta Savarese
- Neurology Unit and Stroke Center, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Lourdes M DelRosso
- Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Department of Neurology I.C., Oasi Research Institute - IRCCS, Troina, Italy
| | - Raffaele Ferri
- Department of Neurology I.C., Oasi Research Institute - IRCCS, Troina, Italy.
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5
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Katunina EA, Titova NV, Katunin DA, Bagmanyan SD, Pogorova AR. [Restless legs syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:106-113. [PMID: 33728859 DOI: 10.17116/jnevro2021121021106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Restless legs syndrome (RLS) is seen widely in clinical practice. RLS commonly occurs at night time and presents with unpleasant or uncomfortable sensations in the legs that causes an urge to move them. This article describes the epidemiology, risk factors and pathophysiology of RLS. There is a detailed description of clinical presentations, diagnostic criteria and also management of RLS.
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Affiliation(s)
- E A Katunina
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - N V Titova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - D A Katunin
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - S D Bagmanyan
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A R Pogorova
- Pirogov Russian National Research Medical University, Moscow, Russia
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6
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Lavigne GJ, Herrero Babiloni A, Mayer P, Daoust R, Martel MO. Thoughts on the 2019 American Academy of Sleep Medicine position statement on chronic opioid therapy and sleep. J Clin Sleep Med 2020; 16:831-833. [PMID: 32052741 DOI: 10.5664/jcsm.8368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Gilles J Lavigne
- Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Faculty of Dental Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Alberto Herrero Babiloni
- Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Faculty of Dental Medicine, Université de Montréal, Montréal, Québec, Canada.,Division of Experimental Medicine, McGill University, Montréal, Québec, Canada
| | - Pierre Mayer
- Respiratory Medicine and Sleep, Centre Hospitalier de l'Universite de Montreal, Montréal, Québec, Canada
| | - Raoul Daoust
- Faculty of Medicine, University of Montreal, Montreal, Québec, Canada.,Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Marc O Martel
- Faculty of Dentistry and Department of Anesthesia, McGill University, Montréal, Québec, Canada
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7
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Why Are Women Prone to Restless Legs Syndrome? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010368. [PMID: 31935805 PMCID: PMC6981604 DOI: 10.3390/ijerph17010368] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 12/17/2022]
Abstract
Restless legs syndrome is a relatively common neurologic disorder considerably more prevalent in women than in men. It is characterized by an inactivity-induced, mostly nocturnal, uncomfortable sensation in the legs and an urge to move them to make the disagreeable sensation disappear. Some known genes contribute to this disorder and the same genes contribute to an overlapping condition—periodic leg movements that occur during sleep and result in insomnia. Dopamine and glutamate transmission in the central nervous system are involved in the pathophysiology, and an iron deficiency has been shown in region-specific areas of the brain. A review of the literature shows that pregnant women are at particular risk and that increased parity is a predisposing factor. Paradoxically, menopause increases the prevalence and severity of symptoms. This implies a complex role for reproductive hormones. It suggests that changes rather than absolute levels of estrogen may be responsible for the initiation of symptoms. Both iron (at relatively low levels in women) and estrogen (at relatively high oscillating levels in women) influence dopamine and glutamate transmission, which may help to explain women’s vulnerability to this condition. The syndrome is comorbid with several disorders (such as migraine, depression, and anxiety) to which women are particularly prone. This implies that the comorbid condition or its treatment, or both, contribute to the much higher prevalence in women than in men of restless legs syndrome.
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8
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Sauerbier A, Sivakumar C, Klingelhoefer L, Martinez-Martin P, Perkins L, Inniss R, Rizos A, Trivedi D, Leta V, Wan YM, Parry M, van Wamelen D, Reichmann H, Chaudhuri KR. Restless legs syndrome - the under-recognised non-motor burden: a questionnaire-based cohort study. Postgrad Med 2019; 131:473-478. [DOI: 10.1080/00325481.2019.1658506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Anna Sauerbier
- Parkinson Foundation Centre of Excellence, King’s College Hospital, London, UK
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Chaamanti Sivakumar
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Pablo Martinez-Martin
- National Center of Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Lauren Perkins
- Mid Essex Hospital Services NHS Trust, Broomfield Hospital, UK
| | - Rona Inniss
- Parkinson Foundation Centre of Excellence, King’s College Hospital, London, UK
| | - Alexandra Rizos
- Parkinson Foundation Centre of Excellence, King’s College Hospital, London, UK
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Dhaval Trivedi
- Parkinson Foundation Centre of Excellence, King’s College Hospital, London, UK
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Valentina Leta
- Parkinson Foundation Centre of Excellence, King’s College Hospital, London, UK
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Yi Min Wan
- Parkinson Foundation Centre of Excellence, King’s College Hospital, London, UK
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Psychiatry, Ng Teng Fong General Hospital, Singapore
| | - Miriam Parry
- Parkinson Foundation Centre of Excellence, King’s College Hospital, London, UK
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Daniel van Wamelen
- Parkinson Foundation Centre of Excellence, King’s College Hospital, London, UK
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Heinz Reichmann
- Department of Neurology, Technical University Dresden, Dresden, Germany
| | - K Ray Chaudhuri
- Parkinson Foundation Centre of Excellence, King’s College Hospital, London, UK
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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9
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Gao J, Wang Q, Huang Y, Tang K, Yang X, Cao Z. In Silico Study of Anti-Insomnia Mechanism for Suanzaoren Prescription. Front Pharmacol 2019; 10:925. [PMID: 31507421 PMCID: PMC6713715 DOI: 10.3389/fphar.2019.00925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/22/2019] [Indexed: 01/15/2023] Open
Abstract
Insomnia is a common and widespread sleeping disorder caused by various risk factors. Though beneficial, conventional treatments of insomnia have significant limitations. As an alternative treatment, Chinese herbal formula Suanzaoren prescription (SZRP), composed of Suanzaoren [seeds of Ziziphus jujuba var. spinosa (Bunge) Hu ex H.F.Chow] and four additional herbs, has been reported with significant anti-insomnia effects. Yet the anti-insomnia mechanism of the herb formulae remains unknown. In this study, we attempted to extrapolate the holistic anti-insomnia mechanism of SZRP through herbal targeting and network pharmacology. The results indicated that the ingredients of Suanzaoren can target multi-neurotransmitter receptors at synapse interface, which was reported to be associated with sedative and hypnotic effects, while the four additional herbs can hit multiple pathways downstream of membrane neurotransmitters. Furthermore, the four additional herbs showed highly cooperative targeting patterns in the paralleled and cross-talked pathways related to inflammatory regulation and endocrine system, which may contribute to the additional relief of insomnia caused by inflammation, anxiety, or endocrine disorder. The interesting complementary mechanism we found among the herbal groups of SZRP may provide an example to study Chinese herbal formula and offers clues to future design of anti-insomnia strategy.
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Affiliation(s)
- Jian Gao
- Shanghai 10th People’s Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Qiming Wang
- Shanghai 10th People’s Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Yuwei Huang
- Shanghai 10th People’s Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Kailin Tang
- Shanghai 10th People’s Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Xue Yang
- Department of Traditional Chinese Medicine, Yangpu Hospital, School of Medicine, TongJi University, Shanghai, China
| | - Zhiwei Cao
- Shanghai 10th People’s Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China
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10
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Zhu XY, Wu TT, Wang HM, Ni LY, Li X, Liu Y, Zhang XJ, Chen YJ, Cui XX, Ondo WG, Wu YC. Clinical features and subtypes of restless legs syndrome in Chinese population: a study of 359 patients. Sleep Med 2019; 59:15-23. [DOI: 10.1016/j.sleep.2019.01.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/14/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
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11
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Karroum EG. Painful Willis-Ekbom disease: unbearable and distinct form of restless legs? Scand J Pain 2019; 19:429-431. [DOI: 10.1515/sjpain-2019-2013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Elias Georges Karroum
- Department of Neurology , The George Washington University School of Medicine and Health Sciences , 2150 Pennsylvania Ave, NW 9th Floor , Washington, DC 20037 , USA
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12
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13
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Gärtner J, Jaroslawski K, Becker G, Boehlke C. Improvement of Restless Legs Syndrome Under Treatment of Cancer Pain With Morphine and Fentanyl. Front Neurol 2019; 10:457. [PMID: 31133964 PMCID: PMC6517474 DOI: 10.3389/fneur.2019.00457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/15/2019] [Indexed: 01/01/2023] Open
Abstract
Restless-Legs-Syndrome (RLS), also known as Willis-Ekbom disease, is a sleep- and rest related disorder characterized by the unpleasant urge to move the legs. Pharmacological therapy is mainly based on dopamine-agonists and delta-2-alpha calcium channel ligands. Also, randomized-controlled-trials (RCTs) reported effectiveness of oral oxycodone (in combination with naloxone), and intrathecal opioids have also been administered for this indication. In the case reported here, a patient with advanced pancreatic cancer was referred to an acute palliative care unit for the treatment of cancer-related pain. Yet, in thorough exploration of her symptom burden, the patient reported that she felt her quality of life had been predominantly limited by symptoms other than cancer pain. Her medical history and neurological examination revealed that these symptoms were most obviously caused by severe RLS. In the years before, pharmacological therapies with dopamine-agonists and delta-2-alpha calcium channel ligands were initiated, but failed to relieve the RLS. In the palliative care ward, intravenous morphine was successfully titrated to treat her cancer pain. Concurrently, the patient also experienced almost complete relief from her RLS-symptoms and an increase in quality of life. The amelioration of her RLS-symptoms continued after morphine therapy was switched from intravenous to oral administration. Even after the patient was dismissed to home care and opioid rotation to transdermal fentanyl, symptom control of RLS remained excellent. To our knowledge, this is the first report of successfully treating RLS with intravenous and oral morphine. Since morphine is more easily available worldwide and the cost of morphine therapy is substantially lower compared to oxycodone/naloxone, comparisons to morphine may be an intriguing option for future RCTs.
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Affiliation(s)
- Jan Gärtner
- Palliative Care Center Hildegard, Basel, Switzerland
| | | | - Gerhild Becker
- Faculty of Medicine, Medical Center, Clinic for Palliative Medicine, University of Freiburg, Freiburg, Germany
| | - Christopher Boehlke
- Faculty of Medicine, Medical Center, Clinic for Palliative Medicine, University of Freiburg, Freiburg, Germany
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14
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Cortés A, Casadó-Anguera V, Moreno E, Casadó V. The heterotetrameric structure of the adenosine A 1-dopamine D 1 receptor complex: Pharmacological implication for restless legs syndrome. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2019; 84:37-78. [PMID: 31229177 DOI: 10.1016/bs.apha.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Dopaminergic and purinergic signaling play a pivotal role in neurological diseases associated with motor symptoms, including Parkinson's disease (PD), multiple sclerosis, amyotrophic lateral sclerosis, Huntington disease, Restless Legs Syndrome (RLS), spinal cord injury (SCI), and ataxias. Extracellular dopamine and adenosine exert their functions interacting with specific dopamine (DR) or adenosine (AR) receptors, respectively, expressed on the surface of target cells. These receptors are members of the family A of G protein-coupled receptors (GPCRs), which is the largest protein superfamily in mammalian genomes. GPCRs are target of about 40% of all current marketed drugs, highlighting their importance in clinical medicine. The striatum receives the densest dopamine innervations and contains the highest density of dopamine receptors. The modulatory role of adenosine on dopaminergic transmission depends largely on the existence of antagonistic interactions mediated by specific subtypes of DRs and ARs, the so-called A2AR-D2R and A1R-D1R interactions. Due to the dopamine/adenosine antagonism in the CNS, it was proposed that ARs and DRs could form heteromers in the neuronal cell surface. Therefore, adenosine can affect dopaminergic signaling through receptor-receptor interactions and by modulations in their shared intracellular pathways in the striatum and spinal cord. In this work we describe the allosteric modulations between GPCR protomers, focusing in those of adenosine and dopamine within the A1R-D1R heteromeric complex, which is involved in RLS. We also propose that the knowledge about the intricate allosteric interactions within the A1R-D1R heterotetramer, may facilitate the treatment of motor alterations, not only when the dopamine pathway is hyperactivated (RLS, chorea, etc.) but also when motor function is decreased (SCI, aging, PD, etc.).
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Affiliation(s)
- Antoni Cortés
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain; Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Verònica Casadó-Anguera
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain; Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Estefanía Moreno
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain; Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Vicent Casadó
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain; Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, Barcelona, Spain.
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Abstract
Substance P (SP) is a highly conserved member of the tachykinin peptide family that is widely expressed throughout the animal kingdom. The numerous members of the tachykinin peptide family are involved in a multitude of neuronal signaling pathways, mediating sensations and emotional responses (Steinhoff et al. in Physiol Rev 94:265–301, 2014). In contrast to receptors for classical transmitters, such as glutamate (Parsons et al. in Handb Exp Pharmacol 249–303, 2005), only a minority of neurons in certain brain areas express neurokinin receptors (NKRs) (Mantyh in J Clin Psychiatry 63:6–10, 2002). SP is also expressed by a variety of non-neuronal cell types such as microglia, as well as immune cells (Mashaghi et al. in Cell Mol Life Sci 73:4249–4264, 2016). SP is an 11-amino acid neuropeptide that preferentially activates the neurokinin-1 receptor (NK1R). It transmits nociceptive signals via primary afferent fibers to spinal and brainstem second-order neurons (Cao et al. in Nature 392:390–394, 1998). Compounds that inhibit SP’s action are being investigated as potential drugs to relieve pain. More recently, SP and NKR have gained attention for their role in complex psychiatric processes. It is a key goal in the field of pain research to understand mechanisms involved in the transition between acute pain and chronic pain. The influence of emotional and cognitive inputs and feedbacks from different brain areas makes pain not only a perception but an experience (Zieglgänsberger et al. in CNS Spectr 10:298–308, 2005; Trenkwaldner et al. Sleep Med 31:78–85, 2017). This review focuses on functional neuronal plasticity in spinal dorsal horn neurons as a major relay for nociceptive information.
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Zucconi M, Galbiati A, Rinaldi F, Casoni F, Ferini-Strambi L. An update on the treatment of Restless Legs Syndrome/Willis-Ekbom Disease: prospects and challenges. Expert Rev Neurother 2018; 18:705-713. [PMID: 30095315 DOI: 10.1080/14737175.2018.1510773] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) is a sleep disorder characterized by an urge to move the legs, frequently associated or triggered by unpleasant sensations in the lower limbs that affects approximately 2.5% of adults. Therapy and management of RLS/WED require long-term interventions, since the typical manifestation of this disorder is chronic. Areas covered: In this review, we provide an update regarding the treatment of RLS/WED with particular attention to future challenges for its management. We reviewed a large variety of treatments studied in clinical trials and supported by the most updated guidelines. Alongside with first-line interventions other pharmacological options including opioids, benzodiazepines, iron therapy, and newly studied drugs are discussed. Furthermore, due to the occurrence of augmentation and worsening of symptoms we also reviewed the development of non-pharmacologic alternatives. Expert commentary: The management of RLS/WED is a challenge because of different long-term issues. Several complications, such as loss of the therapeutic effect of dopaminergic or non-dopaminergic agents and augmentation, are still unsolved concerns. However, the development of new drugs acting on adenosinergic and glutamatergic neurotransmission seems promising. Randomized controlled trials are needed in order to recognize effectiveness of new drugs or non-pharmacological treatment strategies.
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Affiliation(s)
- Marco Zucconi
- a Department of Clinical Neurosciences, Neurology - Sleep Disorders Center , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Andrea Galbiati
- a Department of Clinical Neurosciences, Neurology - Sleep Disorders Center , IRCCS San Raffaele Scientific Institute , Milan , Italy.,b Faculty of Psychology , "Vita-Salute" San Raffaele University , Milan , Italy
| | - Fabrizio Rinaldi
- a Department of Clinical Neurosciences, Neurology - Sleep Disorders Center , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Francesca Casoni
- a Department of Clinical Neurosciences, Neurology - Sleep Disorders Center , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Luigi Ferini-Strambi
- a Department of Clinical Neurosciences, Neurology - Sleep Disorders Center , IRCCS San Raffaele Scientific Institute , Milan , Italy.,b Faculty of Psychology , "Vita-Salute" San Raffaele University , Milan , Italy
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Ferré S, García-Borreguero D, Allen RP, Earley CJ. New Insights into the Neurobiology of Restless Legs Syndrome. Neuroscientist 2018; 25:113-125. [PMID: 30047288 DOI: 10.1177/1073858418791763] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Restless legs syndrome (RLS) is a common sensorimotor disorder, whose basic components include a sensory experience, akathisia, and a sleep-related motor sign, periodic leg movements during sleep (PLMS), both associated with an enhancement of the individual's arousal state. The present review attempts to integrate the major clinical and experimental neurobiological findings into a heuristic pathogenetic model. The model also integrates the recent findings on RLS genetics indicating that RLS has aspects of a genetically moderated neurodevelopmental disorder involving mainly the cortico-striatal-thalamic-cortical circuits. Brain iron deficiency (BID) remains the key initial pathobiological factor and relates to alterations of iron acquisition by the brain, also moderated by genetic factors. Experimental evidence indicates that BID leads to a hyperdopaminergic and hyperglutamatergic states that determine the dysfunction of cortico-striatal-thalamic-cortical circuits in genetically vulnerable individuals. However, the enhanced arousal mechanisms critical to RLS are better explained by functional changes of the ascending arousal systems. Recent experimental and clinical studies suggest that a BID-induced hypoadenosinergic state provides the link for a putative unified pathophysiological mechanism for sensorimotor signs of RLS and the enhanced arousal state.
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Affiliation(s)
- Sergi Ferré
- 1 National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | | | - Richard P Allen
- 3 Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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Abstract
Neuropathic pain is associated with sleep disturbances, and in turn poor sleep quality leads to increased pain sensitivity, so it is essential to assess sleep alongside neuropathic pain. Responses to drugs are inconsistent and identifying the best treatment option that will reduce pain and improve sleep quality remains challenging for clinicians. Anticonvulsants such as pregabalin and gabapentin improve neuropathic pain and have a positive effect on comorbid sleep disturbances. Opioids and antidepressants are effective in reducing pain but can exacerbate sleep disturbances. FUNDING Pfizer, Italy.
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Abstract
Purpose of review Sleep disorders are among the most challenging non-motor features of Parkinson's disease (PD) and significantly affect quality of life. Research in this field has gained recent interest among clinicians and scientists and is rapidly evolving. This review is dedicated to sleep and circadian dysfunction associated with PD. Recent findings Most primary sleep disorders may co-exist with PD; majority of these disorders have unique features when expressed in the PD population. Summary We discuss the specific considerations related to the common sleep problems in Parkinson's disease including insomnia, rapid eye movement sleep behavior disorder, restless legs syndrome, sleep disordered breathing, excessive daytime sleepiness and circadian rhythm disorders. Within each of these sleep disorders, we present updated definitions, epidemiology, etiology, diagnosis, clinical implications and management. Furthermore, areas of potential interest for further research are outlined.
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Högl B, Lohner H, Mikus G, Huff H. Acute and painful exacerbation of RLS and PLM induced by opioid interaction - withdrawal syndrome. Sleep Med 2017; 36:186-187. [PMID: 28662817 DOI: 10.1016/j.sleep.2017.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/15/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Austria.
| | - Hanns Lohner
- Department of Neurology, RoMed Klinikum Rosenheim, Germany
| | - Gerd Mikus
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital of Heidelberg, Germany
| | - Helmut Huff
- Department of Internal Medicine 2, RoMed Klinikum Rosenheim, Germany
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