1
|
Martin H, Coursan A, Lallement J, Di Miceli M, Kandiah J, Raho I, Buttler J, Guilloux JP, De Deurwaerdere P, Layé S, Routh VH, Guiard BP, Magnan C, Cruciani-Guglielmacci C, Fioramonti X. Serotonergic neurons are involved in the counter-regulatory response to hypoglycemia. J Neuroendocrinol 2023; 35:e13344. [PMID: 37857383 DOI: 10.1111/jne.13344] [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: 07/11/2023] [Revised: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES Intensive insulin therapy provides optimal glycemic control in patients with diabetes. However, intensive insulin therapy causes so-called iatrogenic hypoglycemia as a major adverse effect. The ventromedial hypothalamus (VMH) has been described as the primary brain area initiating the counter-regulatory response (CRR). Nevertheless, the VMH receives projections from other brain areas which could participate in the regulation of the CRR. In particular, studies suggest a potential role of the serotonin (5-HT) network. Thus, the objective of this study was to determine the contribution of 5-HT neurons in CRR control. METHODS Complementary approaches have been used to test this hypothesis in quantifying the level of 5-HT in several brain areas by HPLC in response to insulin-induced hypoglycemia, measuring the electrical activity of dorsal raphe (DR) 5-HT neurons in response to insulin or decreased glucose level by patch-clamp electrophysiology; and measuring the CRR hormone glucagon as an index of the CRR to the modulation of the activity of 5-HT neurons using pharmacological or pharmacogenetic approaches. RESULTS HPLC measurements show that the 5HIAA/5HT ratio is increased in several brain regions including the VMH in response to insulin-induced hypoglycemia. Patch-clamp electrophysiological recordings show that insulin, but not decreased glucose level, increases the firing frequency of DR 5-HT neurons in the DR. In vivo, both the pharmacological inhibition of 5-HT neurons by intraperitoneal injection of the 5-HT1A receptor agonist 8-OH-DPAT or the chemogenetic inhibition of these neurons reduce glucagon secretion, suggesting an impaired CRR. CONCLUSION Taken together, these data highlight a new neuronal network involved in the regulation of the CRR. In particular, this study shows that DR 5-HT neurons detect iatrogenic hypoglycemia in response to the increased insulin level and may play an important role in the regulation of CRR.
Collapse
Affiliation(s)
- Hugo Martin
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Adeline Coursan
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | | | - Mathieu Di Miceli
- Worcester Biomedical Research Group, School of Science and the Environment, University of Worcester, Worcester, UK
| | - Janany Kandiah
- Université Paris Cité, BFA, UMR 8251, CNRS, Paris, France
| | - Ilyès Raho
- Université Paris Cité, BFA, UMR 8251, CNRS, Paris, France
| | - Jasmine Buttler
- INCIA, UMR CNRS, Bordeaux University, Neurocampus, Bordeaux, France
| | | | | | - Sophie Layé
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Vanessa H Routh
- Department of Pharmacology, Physiology and Neuroscience, Rutgers, New Jersey Medical School, The State University of New Jersey, Newark, New Jersey, USA
| | - Bruno P Guiard
- Centre de Recherches sur la Cognition Animale (CRCA), Centre de Biologie Intégrative (CBI), Toulouse, France
| | | | | | - Xavier Fioramonti
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| |
Collapse
|
2
|
Bauer MB, Currie KPM. Serotonin and the serotonin transporter in the adrenal gland. VITAMINS AND HORMONES 2023; 124:39-78. [PMID: 38408804 PMCID: PMC11217909 DOI: 10.1016/bs.vh.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
The adrenal glands are key components of the mammalian endocrine system, helping maintain physiological homeostasis and the coordinated response to stress. Each adrenal gland has two morphologically and functionally distinct regions, the outer cortex and inner medulla. The cortex is organized into three concentric zones which secrete steroid hormones, including aldosterone and cortisol. Neural crest-derived chromaffin cells in the medulla are innervated by preganglionic sympathetic neurons and secrete catecholamines (epinephrine, norepinephrine) and neuropeptides into the bloodstream, thereby functioning as the neuroendocrine arm of the sympathetic nervous system. In this article we review serotonin (5-HT) and the serotonin transporter (SERT; SLC6A4) in the adrenal gland. In the adrenal cortex, 5-HT, primarily sourced from resident mast cells, acts as a paracrine signal to stimulate aldosterone and cortisol secretion through 5-HT4/5-HT7 receptors. Medullary chromaffin cells contain a small amount of 5-HT due to SERT-mediated uptake and express 5-HT1A receptors which inhibit secretion. The atypical mechanism of the 5-HT1A receptors and interaction with SERT fine tune this autocrine pathway to control stress-evoked catecholamine secretion. Receptor-independent signaling by SERT/intracellular 5-HT modulates the amount and kinetics of transmitter release from single vesicle fusion events. SERT might also influence stress-evoked upregulation of tyrosine hydroxylase transcription. Transient signaling via 5-HT3 receptors during embryonic development can limit the number of chromaffin cells found in the mature adrenal gland. Together, this emerging evidence suggests that the adrenal medulla is a peripheral hub for serotonergic control of the sympathoadrenal stress response.
Collapse
Affiliation(s)
- Mary Beth Bauer
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, South Broadway, Camden, NJ, United States
| | - Kevin P M Currie
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, South Broadway, Camden, NJ, United States.
| |
Collapse
|
3
|
Ghantarchyan H, Fischer N, Karp D, Hamidi A. Methamphetamine-Induced Hypoglycemia: A Case Report and Literature Review. Cureus 2023; 15:e39158. [PMID: 37332469 PMCID: PMC10275691 DOI: 10.7759/cureus.39158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
We present a rare case of a 34-year-old male patient with a history of schizophrenia who was found to be persistently hypoglycemic after a positive toxicology screen for methamphetamine. The patient has had multiple admissions to the hospital for persistent hypoglycemia and was then transferred to our in-patient behavioral health unit (BHU). At this time, his toxicology screen was negative for methamphetamines. During his stay in the BHU, he was compliant with his psychiatric medications and was euglycemic despite having a poor appetite until he was discharged home. This patient was shortly readmitted to the hospital and found to be severely hypoglycemic and methamphetamine positive. Here, we present this rare case of methamphetamine-induced hypoglycemia. We emphasize our work-up, treatment, and our suggested theory of why methamphetamines are the likely cause of hypoglycemia.
Collapse
Affiliation(s)
| | - Nina Fischer
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - David Karp
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Afshin Hamidi
- Endocrinology and Diabetes, Arrowhead Regional Medical Center, Colton, USA
| |
Collapse
|
4
|
Sanchez-Rangel E, Deajon-Jackson J, Hwang JJ. Pathophysiology and management of hypoglycemia in diabetes. Ann N Y Acad Sci 2022; 1518:25-46. [PMID: 36202764 DOI: 10.1111/nyas.14904] [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: 02/05/2023]
Abstract
In the century since the discovery of insulin, diabetes has changed from an early death sentence to a manageable chronic disease. This change in longevity and duration of diabetes coupled with significant advances in therapeutic options for patients has fundamentally changed the landscape of diabetes management, particularly in patients with type 1 diabetes mellitus. However, hypoglycemia remains a major barrier to achieving optimal glycemic control. Current understanding of the mechanisms of hypoglycemia has expanded to include not only counter-regulatory hormonal responses but also direct changes in brain glucose, fuel sensing, and utilization, as well as changes in neural networks that modulate behavior, mood, and cognition. Different strategies to prevent and treat hypoglycemia have been developed, including educational strategies, new insulin formulations, delivery devices, novel technologies, and pharmacologic targets. This review article will discuss current literature contributing to our understanding of the myriad of factors that lead to the development of clinically meaningful hypoglycemia and review established and novel therapies for the prevention and treatment of hypoglycemia.
Collapse
Affiliation(s)
- Elizabeth Sanchez-Rangel
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jelani Deajon-Jackson
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Janice Jin Hwang
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA.,Division of Endocrinology, Department of Internal Medicine, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
5
|
Cai Y, Li X, Zhou H, Zhou J. The serotonergic system dysfunction in diabetes mellitus. Front Cell Neurosci 2022; 16:899069. [PMID: 35910256 PMCID: PMC9331500 DOI: 10.3389/fncel.2022.899069] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Most peripheral serotonin (5-HT) is synthesized in enterochromaffin cells, and most circulating 5-HT is stored in platelets. As a monoamine, 5-HT has several functions in various non-neuronal and neuronal systems. In the central nervous system, it functions as a neurotransmitter to modulate feeding behavior and mood. Numerous clinical trials have focused on increasing 5-HT activation in the central nervous system, including those involving anti-obesity drugs currently in the market, although severe side effects on peripheral system can lead to the withdrawal of certain drugs. Recent studies have revealed that both the peripheral and central serotonergic systems play a vital role in diabetes and its complications. This review summarizes the roles of the serotonergic system in blood glucose regulation, diabetic macroangiopathy, diabetic peripheral neuropathy, and diabetic encephalopathy, indicating its potential clinical significance as a therapeutic target for the treatment of diabetes and its complications.
Collapse
|
6
|
Fischer LE, Wolfe BM, Fino N, Elman MR, Flum DR, Mitchell JE, Pomp A, Pories WJ, Purnell JQ, Patti ME. Postbariatric hypoglycemia: symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study. Surg Obes Relat Dis 2021; 17:1787-1798. [PMID: 34294589 PMCID: PMC9944569 DOI: 10.1016/j.soard.2021.04.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Postbariatric hypoglycemia (PBH) can be a devastating complication for which current therapies are often incompletely effective. More information is needed regarding frequency, incidence, and risk factors for PBH. OBJECTIVES To examine hypoglycemia symptoms following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) and baseline and in-study risk factors. SETTING Multicenter, at 10 US hospitals in 6 geographically diverse clinical centers. METHODS A prospective, longitudinal cohort study of adults undergoing RYGB or LAGB as part of clinical care between 2006 and 2009 were recruited and followed until January 31, 2015, with baseline and annual postoperative research assessments. We analyzed baseline prevalence and post-operative incidence and frequency of self-reported hypoglycemia symptoms as well as potential preoperative risk factors. RESULTS In all groups, postoperative prevalence of hypoglycemia symptoms was 38.5%. Symptom prevalence increased postoperatively from 2.8%-36.4% after RYGB in patients without preoperative diabetes (T2D), with similar patterns in prediabetes (4.9%-29.1%). Individuals with T2D had higher baseline hypoglycemia symptoms (28.9%), increasing after RYGB (57.9%). Hypoglycemia symptoms were lower after LAGB, with 39.1% reported hypoglycemia symptoms at only 1 postoperative visit with few (4.0%) having persistent symptoms at 6 or more annual visits. Timing of symptoms was not restricted to the postprandial state. Symptoms of severe hypoglycemia were reported in 2.6-3.6% after RYGB. The dominant risk factor for postoperative symptoms was preoperative symptoms; additionally, baseline selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitor use was also associated with increased risk in multivariable analysis. Weight loss and regain were not related to hypoglycemia symptom reporting. CONCLUSION Hypoglycemia symptoms increase over time after RYGB, particularly in patients without diabetes. In a small percentage, symptoms can be persistent or severe and require hospitalization. Preoperative hypoglycemia symptoms and SSRI/SNRI use in RYGB patients without diabetes is associated with increased risk of symptoms.
Collapse
Affiliation(s)
- Laura E. Fischer
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,Correspondence: Laura E. Fischer, M.D., M.S., F.A.C.S., Director, OU Metabolic and Bariatric Surgery Program, Assistant Professor, Department of Surgery, University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Ste 9000, Oklahoma City, OK 73104. (L.E. Fischer)
| | - Bruce M. Wolfe
- Departments of Medicine, Surgery, and the School of Public Health at Oregon Health & Science University, Portland, Oregon
| | - Nora Fino
- Departments of Medicine, Surgery, and the School of Public Health at Oregon Health & Science University, Portland, Oregon
| | - Miriam R. Elman
- Oregon Health and Science – Portland State University School of Public Health, Portland, Oregon
| | - David R. Flum
- Department of Surgery, University of Washington, Seattle, Washington
| | - James E. Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine, Grand Forks, North Dakota
| | - Alfons Pomp
- Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Walter J. Pories
- Metabolic Surgery Research Group, East Carolina University, Greenville, North Carolina
| | - Jonathan Q. Purnell
- Departments of Medicine, Surgery, and the School of Public Health at Oregon Health & Science University, Portland, Oregon
| | - Mary-Elizabeth Patti
- Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | | |
Collapse
|
7
|
Koekkoek LL, Kool T, Eggels L, van der Gun LL, Lamuadni K, Slomp M, Diepenbroek C, Serlie MJ, Kalsbeek A, la Fleur SE. Activation of nucleus accumbens μ-opioid receptors enhances the response to a glycaemic challenge. J Neuroendocrinol 2021; 33:e13036. [PMID: 34528311 PMCID: PMC9286654 DOI: 10.1111/jne.13036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
Opioids are known to affect blood glucose levels but their exact role in the physiological control of glucose metabolism remains unclear. Although there are numerous studies investigating the peripheral effects of opioid stimulation, little is known about how central opioids control blood glucose and which brain areas are involved. One brain area possibly involved is the nucleus accumbens because, as well as being a key site for opioid effects on food intake, it has also been implicated in the control of blood glucose levels. Within the nucleus accumbens, μ-opioid receptors are most abundantly expressed. Therefore, in the present study, we investigated the role of μ-opioid receptors in the nucleus accumbens in the control of glucose metabolism. We show that infusion of the μ-opioid receptor agonist [d-Ala2 , N-MePhe4 , Gly-ol]-enkephalin (DAMGO) in the nucleus accumbens by itself does not affect blood glucose levels, but it enhances the glycaemic response after both an insulin tolerance test, as well as a glucose tolerance test. These findings indicate that the nucleus accumbens plays a role in the central effects of opioids on glucose metabolism, and highlight the possibility of nucleus accumbens μ-opioid receptors as a therapeutic target for enhancing the counter-regulatory response.
Collapse
Affiliation(s)
- Laura L. Koekkoek
- Amsterdam University Medical Center, Location AMCLaboratory of EndocrinologyDepartment of Clinical ChemistryAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam University Medical Center, Location AMCDepartment of Endocrinology and MetabolismAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Metabolism and Reward GroupAn Institute of the Royal Netherlands Academy of Arts and SciencesNetherlands Institute for NeuroscienceAmsterdamThe Netherlands
| | - Tess Kool
- Amsterdam University Medical Center, Location AMCLaboratory of EndocrinologyDepartment of Clinical ChemistryAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam University Medical Center, Location AMCDepartment of Endocrinology and MetabolismAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Metabolism and Reward GroupAn Institute of the Royal Netherlands Academy of Arts and SciencesNetherlands Institute for NeuroscienceAmsterdamThe Netherlands
| | - Leslie Eggels
- Amsterdam University Medical Center, Location AMCLaboratory of EndocrinologyDepartment of Clinical ChemistryAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam University Medical Center, Location AMCDepartment of Endocrinology and MetabolismAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Metabolism and Reward GroupAn Institute of the Royal Netherlands Academy of Arts and SciencesNetherlands Institute for NeuroscienceAmsterdamThe Netherlands
| | - Luna L. van der Gun
- Amsterdam University Medical Center, Location AMCLaboratory of EndocrinologyDepartment of Clinical ChemistryAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam University Medical Center, Location AMCDepartment of Endocrinology and MetabolismAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Metabolism and Reward GroupAn Institute of the Royal Netherlands Academy of Arts and SciencesNetherlands Institute for NeuroscienceAmsterdamThe Netherlands
| | - Khalid Lamuadni
- Amsterdam University Medical Center, Location AMCLaboratory of EndocrinologyDepartment of Clinical ChemistryAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam University Medical Center, Location AMCDepartment of Endocrinology and MetabolismAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Metabolism and Reward GroupAn Institute of the Royal Netherlands Academy of Arts and SciencesNetherlands Institute for NeuroscienceAmsterdamThe Netherlands
| | - Margo Slomp
- Amsterdam University Medical Center, Location AMCLaboratory of EndocrinologyDepartment of Clinical ChemistryAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam University Medical Center, Location AMCDepartment of Endocrinology and MetabolismAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Metabolism and Reward GroupAn Institute of the Royal Netherlands Academy of Arts and SciencesNetherlands Institute for NeuroscienceAmsterdamThe Netherlands
| | - Charlene Diepenbroek
- Amsterdam University Medical Center, Location AMCLaboratory of EndocrinologyDepartment of Clinical ChemistryAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam University Medical Center, Location AMCDepartment of Endocrinology and MetabolismAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Metabolism and Reward GroupAn Institute of the Royal Netherlands Academy of Arts and SciencesNetherlands Institute for NeuroscienceAmsterdamThe Netherlands
| | - Mireillle J. Serlie
- Amsterdam University Medical Center, Location AMCDepartment of Endocrinology and MetabolismAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
| | - Andries Kalsbeek
- Amsterdam University Medical Center, Location AMCLaboratory of EndocrinologyDepartment of Clinical ChemistryAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam University Medical Center, Location AMCDepartment of Endocrinology and MetabolismAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Hypothalamic Integration MechanismsAn Institute of the Royal Netherlands Academy of Arts and SciencesNetherlands Institute for NeuroscienceAmsterdamThe Netherlands
| | - Susanne E. la Fleur
- Amsterdam University Medical Center, Location AMCLaboratory of EndocrinologyDepartment of Clinical ChemistryAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam University Medical Center, Location AMCDepartment of Endocrinology and MetabolismAmsterdam NeuroscienceAmsterdam Gastroenterology, Endocrinology and MetabolismUniversity of AmsterdamAmsterdamThe Netherlands
- Metabolism and Reward GroupAn Institute of the Royal Netherlands Academy of Arts and SciencesNetherlands Institute for NeuroscienceAmsterdamThe Netherlands
| |
Collapse
|
8
|
Agrawal L, Korkutata M, Vimal SK, Yadav MK, Bhattacharyya S, Shiga T. Therapeutic potential of serotonin 4 receptor for chronic depression and its associated comorbidity in the gut. Neuropharmacology 2020; 166:107969. [PMID: 31982703 DOI: 10.1016/j.neuropharm.2020.107969] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/19/2022]
Abstract
The latest estimates from world health organization suggest that more than 450 million people are suffering from depression and other psychiatric conditions. Of these, 50-60% have been reported to have progression of gut diseases. In the last two decades, researchers introduced incipient physiological roles for serotonin (5-HT) receptors (5-HTRs), suggesting their importance as a potential pharmacological target in various psychiatric and gut diseases. A growing body of evidence suggests that 5-HT systems affect the brain-gut axis in depressive patients, which leads to gut comorbidity. Recently, preclinical trials of 5-HT4R agonists and antagonists were promising as antipsychotic and prokinetic agents. In the current review, we address the possible pharmacological role and contribution of 5-HT4R in the pathophysiology of chronic depression and associated gut abnormalities. Physiologically, during depression episodes, centers of the sympathetic and parasympathetic nervous system couple together with neuroendocrine systems to alter the function of hypothalamic-pituitary-adrenal (HPA) axis and enteric nervous system (ENS), which in turn leads to onset of gastrointestinal tract (GIT) disorders. Consecutively, the ENS governs a broad spectrum of physiological activities of gut, such as visceral pain and motility. During the stages of emotional stress, hyperactivity of the HPA axis alters the ENS response to physiological and noxious stimuli. Consecutively, stress-induced flare, swelling, hyperalgesia and altered reflexes in gut eventually lead to GIT disorders. In summary, the current review provides prospective information about the role and mechanism of 5-HT4R-based therapeutics for the treatment of depressive disorder and possible consequences for the gut via brain-gut axis interactions. This article is part of the special issue entitled 'Serotonin Research: Crossing Scales and Boundaries'.
Collapse
Affiliation(s)
- Lokesh Agrawal
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1, 305-8577, Tennodai, Tsukuba, Ibaraki, Japan.
| | - Mustafa Korkutata
- Department of Neurology, Division of Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Sunil Kumar Vimal
- Department of Pharmaceutical Sciences, Southwest University, Chongqing, 400715, PR China
| | - Manoj Kumar Yadav
- School of Integrative and Global Majors, University of Tsukuba, 1-1-1, 305-8577, Tennodai, Tsukuba, Ibaraki, Japan; Department of Anatomy and Embryology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Sanjib Bhattacharyya
- Department of Pharmaceutical Sciences, Southwest University, Chongqing, 400715, PR China
| | - Takashi Shiga
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1, 305-8577, Tennodai, Tsukuba, Ibaraki, Japan; Department of Neurobiology, Faculty of Medicine, University of Tsukuba,1-1-1, Tennodai, Tsukuba, 305-8577, Ibaraki, Japan.
| |
Collapse
|
9
|
Ma Y, Wang Q, Joe D, Wang M, Whim MD. Recurrent hypoglycemia inhibits the counterregulatory response by suppressing adrenal activity. J Clin Invest 2018; 128:3866-3871. [PMID: 30080182 DOI: 10.1172/jci91921] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 06/20/2018] [Indexed: 01/02/2023] Open
Abstract
Hypoglycemia activates the counterregulatory response (CRR), a neural-endocrine reflex that restores euglycemia. Although effective if occasionally activated, repeated induction of the CRR leads to a decline in responsiveness and prolonged exposure to hypoglycemia. The mechanism underlying this impairment is not known. We found that the reduction in epinephrine release that characterizes a suppressed CRR involves a long-lasting form of sympatho-adrenal synaptic plasticity. Using optogenetically evoked catecholamine release, we show that recurrent hypoglycemia reduced the secretory capacity of mouse adrenal chromaffin cells. Single activation of the CRR increased the adrenal levels of tyrosine hydroxylase (TH), the rate-limiting enzyme for catecholamine synthesis, but this was prevented by repeated activation. In contrast, the level of neuropeptide Y (NPY), an adrenal cotransmitter, remained elevated after recurrent hypoglycemia. Inhibition of NPY or Y1 signaling, either transgenically or pharmacologically, prevented the attenuation of both TH expression and epinephrine release. These results indicate that impairment of the CRR involves suppressed activity at the adrenal level. Interfering with the peripheral NPY-dependent negative feedback loop may provide a way to avoid the pathophysiological consequences of recurrent hypoglycemia which are common in the diabetic state.
Collapse
|
10
|
Brindley RL, Bauer MB, Walker LA, Quinlan MA, Carneiro AMD, Sze JY, Blakely RD, Currie KPM. Adrenal serotonin derives from accumulation by the antidepressant-sensitive serotonin transporter. Pharmacol Res 2018; 140:56-66. [PMID: 29894763 DOI: 10.1016/j.phrs.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 12/30/2022]
Abstract
Adrenal chromaffin cells comprise the neuroendocrine arm of the sympathetic nervous system and secrete catecholamines to coordinate the appropriate stress response. Deletion of the serotonin (5-HT) transporter (SERT) gene in mice (SERT-/- mice) or pharmacological block of SERT function in rodents and humans augments this sympathoadrenal stress response (epinephrine secretion). The prevailing assumption is that loss of CNS SERT alters central drive to the peripheral sympathetic nervous system. Adrenal chromaffin cells also prominently express SERT where it might coordinate accumulation of 5-HT for reuse in the autocrine control of stress-evoked catecholamine secretion. To help test this hypothesis, we have generated a novel mouse model with selective excision of SERT in the peripheral sympathetic nervous system (SERTΔTH), generated by crossing floxed SERT mice with tyrosine hydroxylase Cre driver mice. SERT expression, assessed by western blot, was abolished in the adrenal gland but not perturbed in the CNS of SERTΔTH mice. SERT-mediated [3H] 5-HT uptake was unaltered in midbrain, hindbrain, and spinal cord synaptosomes, confirming transporter function was intact in the CNS. Endogenous midbrain and whole blood 5-HT homeostasis was unperturbed in SERTΔTH mice, contrasting with the depleted 5-HT content in SERT-/- mice. Selective SERT excision reduced adrenal gland 5-HT content by ≈ 50% in SERTΔTH mice but had no effect on adrenal catecholamine content. This novel model confirms that SERT expressed in adrenal chromaffin cells is essential for maintaining wild-type levels of 5-HT and provides a powerful tool to help dissect the role of SERT in the sympathetic stress response.
Collapse
Affiliation(s)
- Rebecca L Brindley
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, USA; Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville TN, USA
| | - Mary Beth Bauer
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville TN, USA
| | - L Anne Walker
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville TN, USA
| | - Meagan A Quinlan
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville TN, USA; Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, USA
| | - Ana M D Carneiro
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville TN, USA
| | - Ji-Ying Sze
- Department of Molecular Pharmacology and Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Randy D Blakely
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, USA; Florida Atlantic University Brain Institute, Jupiter, FL, USA
| | - Kevin P M Currie
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, USA; Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville TN, USA.
| |
Collapse
|
11
|
Lontchi-Yimagou E, You JY, Carey M, Gabriely I, Shamoon H, Hawkins M. Potential approaches to prevent hypoglycemia-associated autonomic failure. J Investig Med 2018; 66:641-647. [PMID: 29141871 PMCID: PMC6338223 DOI: 10.1136/jim-2017-000582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 01/27/2023]
Abstract
Clear health benefits are associated with intensive glucose control in type 1 diabetes mellitus (T1DM). However, maintaining near-normal glycemia remains an elusive goal for many patients, in large part owing to the risk of severe hypoglycemia. In fact, recurrent episodes of hypoglycemia lead to 'hypoglycemia-associated autonomic failure' (HAAF), characterized by defective counter-regulatory responses to hypoglycemia. Extensive studies to understand the mechanisms underlying HAAF have revealed multiple potential etiologies, suggesting various approaches to prevent the development of HAAF. In this review, we present an overview of the literature focused on pharmacological approaches that may prevent the development of HAAF. The purported underlying mechanisms of HAAF include: 1) central mechanisms (opioid receptors, ATP-sensitive K+(KATP) channels, adrenergic receptors, serotonin selective receptor inhibitors, γ-aminobuyric acid receptors, N-methyl D-aspartate receptors); 2) hormones (cortisol, estrogen, dehydroepiandrosterone (DHEA) or DHEA sulfate, glucagon-like peptide-1) and 3) nutrients (fructose, free fatty acids, ketones), all of which have been studied vis-à-vis their ability to impact the development of HAAF. A careful review of the current literature reveals many promising therapeutic approaches to treat or reduce this important limitation to optimal glycemic control.
Collapse
Affiliation(s)
- Eric Lontchi-Yimagou
- Diabetes Research and Training Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jee Young You
- Diabetes Research and Training Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michelle Carey
- Diabetes Research and Training Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Center for Drug Evaluation and Research (CDER), US Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Ilan Gabriely
- Diabetes Research and Training Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Harry Shamoon
- Diabetes Research and Training Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Meredith Hawkins
- Diabetes Research and Training Center, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
12
|
Brindley RL, Bauer MB, Blakely RD, Currie KP. Serotonin and Serotonin Transporters in the Adrenal Medulla: A Potential Hub for Modulation of the Sympathetic Stress Response. ACS Chem Neurosci 2017; 8:943-954. [PMID: 28406285 PMCID: PMC5541362 DOI: 10.1021/acschemneuro.7b00026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Serotonin (5-HT) is an important neurotransmitter in the central nervous system where it modulates circuits involved in mood, cognition, movement, arousal, and autonomic function. The 5-HT transporter (SERT; SLC6A4) is a key regulator of 5-HT signaling, and genetic variations in SERT are associated with various disorders including depression, anxiety, and autism. This review focuses on the role of SERT in the sympathetic nervous system. Autonomic/sympathetic dysfunction is evident in patients with depression, anxiety, and other diseases linked to serotonergic signaling. Experimentally, loss of SERT function (SERT knockout mice or chronic pharmacological block) has been reported to augment the sympathetic stress response. Alterations to serotonergic signaling in the CNS and thus central drive to the peripheral sympathetic nervous system are presumed to underlie this augmentation. Although less widely recognized, SERT is robustly expressed in chromaffin cells of the adrenal medulla, the neuroendocrine arm of the sympathetic nervous system. Adrenal chromaffin cells do not synthesize 5-HT but accumulate small amounts by SERT-mediated uptake. Recent evidence demonstrated that 5-HT1A receptors inhibit catecholamine secretion from adrenal chromaffin cells via an atypical mechanism that does not involve modulation of cellular excitability or voltage-gated Ca2+ channels. This raises the possibility that the adrenal medulla is a previously unrecognized peripheral hub for serotonergic control of the sympathetic stress response. As a framework for future investigation, a model is proposed in which stress-evoked adrenal catecholamine secretion is fine-tuned by SERT-modulated autocrine 5-HT signaling.
Collapse
Affiliation(s)
- Rebecca L. Brindley
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary Beth Bauer
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Randy D. Blakely
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, and Florida Atlantic University Brain Institute, Jupiter, FL, USA
| | - Kevin P.M. Currie
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University, Nashville, TN, USA
| |
Collapse
|
13
|
Yokoyama T, Yamamoto Y, Saino T. Serotonin-mediated modulation of acetylcholine-induced intracellular calcium responses in chromaffin cells isolated from the rat adrenal medulla. Neurosci Lett 2017; 644:114-120. [PMID: 28237803 DOI: 10.1016/j.neulet.2017.02.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/07/2017] [Accepted: 02/20/2017] [Indexed: 01/09/2023]
Abstract
We examined serotonin (5-HT)-mediated modulation of acetylcholine (ACh)-induced intracellular Ca2+ ([Ca2+]i) responses in rat adrenal chromaffin cells using calcium imaging. 5-HT did not induce any [Ca2+]i response in clustered chromaffin cells. However, the magnitude of ACh-induced [Ca2+]i increases in the same specimens was inhibited in the presence of 5-HT. ACh-induced [Ca2+]i increases in chromaffin cells were also inhibited by the 5-HT1A receptor agonist, 8-hydroxy-2-(dipropylamino) tetralin hydrobromide, but were not changed by the 5-HT1B, 5-HT2, or 5-HT3 receptor agonists, CP93129, α-methyl-5-HT, or 1-(m-chlorophenyl) biguanide, respectively. RT-PCR analysis detected the expression of all 5-HT receptor subtype mRNAs, except for 5-HT5 receptors, in extracts of the adrenal medulla. Immunohistochemistry revealed that immunoreactivity for 5-HT1A receptor was located in the chromaffin cells immunoreactive for the biosynthetic enzyme for noradrenaline, dopamine β-hydroxylase. These results suggest that 5-HT inhibits ACh-induced excitability in adrenal chromaffin cells via the 5-HT1A receptor in order to reduce catecholamine release during preganglionic sympathetic stimuli.
Collapse
Affiliation(s)
- Takuya Yokoyama
- Department of Anatomy (Cell Biology), Iwate Medical University, Yahaba, Japan.
| | - Yoshio Yamamoto
- Laboratory of Veterinary Anatomy and Cell Biology, Faculty of Agriculture, Iwate University, Morioka, Japan.
| | - Tomoyuki Saino
- Department of Anatomy (Cell Biology), Iwate Medical University, Yahaba, Japan
| |
Collapse
|
14
|
Mikeladze M, Hedrington MS, Joy N, Tate DB, Younk LM, Davis I, Davis SN. Acute Effects of Oral Dehydroepiandrosterone on Counterregulatory Responses During Repeated Hypoglycemia in Healthy Humans. Diabetes 2016; 65:3161-70. [PMID: 27486235 PMCID: PMC5033266 DOI: 10.2337/db16-0406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 07/15/2016] [Indexed: 11/13/2022]
Abstract
We tested the hypothesis that acute administration of oral dehydroepiandrosterone (DHEA) during episodes of repeated hypoglycemia can prevent the development of hypoglycemia-associated neuroendocrine and autonomic failure in healthy humans. Twenty-seven individuals (16 men, 11 women) participated in two separate randomized, single-blind, 2-day protocols. Day 1 consisted of morning and afternoon 2-h hypoglycemic clamps (2.9 mmol/L) with 800 mg of DHEA or placebo administered before each clamp. Day 2 consisted of a single 2-h hypoglycemic clamp (2.9 mmol/L) following either DHEA (1,600 mg) or placebo. A 3-tritiated glucose was used to determine glucose kinetics during hypoglycemia on day 2. Antecedent hypoglycemia with placebo resulted in significant reductions of epinephrine, norepinephrine, glucagon, growth hormone, cortisol, endogenous glucose production, and lipolytic and symptom responses. During hypoglycemia on day 2, DHEA prevented blunting of all neuroendocrine, autonomic nervous system (ANS), metabolic, and symptom counterregulatory responses following hypoglycemia on day 1. In summary, DHEA can acutely preserve a wide range of key neuroendocrine, ANS, and metabolic counterregulatory homeostatic responses during repeated hypoglycemia. We conclude that DHEA may have acute effects to protect against hypoglycemia-associated neuroendocrine and autonomic failure in healthy humans.
Collapse
Affiliation(s)
- Maia Mikeladze
- Department of Medicine, University of Maryland, Baltimore, MD
| | | | - Nino Joy
- Department of Medicine, University of Maryland, Baltimore, MD
| | - Donna B Tate
- Department of Medicine, University of Maryland, Baltimore, MD
| | - Lisa M Younk
- Department of Medicine, University of Maryland, Baltimore, MD
| | - Ian Davis
- Department of Medicine, University of Maryland, Baltimore, MD
| | - Stephen N Davis
- Department of Medicine, University of Maryland, Baltimore, MD
| |
Collapse
|
15
|
Brindley RL, Bauer MB, Blakely RD, Currie KPM. An interplay between the serotonin transporter (SERT) and 5-HT receptors controls stimulus-secretion coupling in sympathoadrenal chromaffin cells. Neuropharmacology 2016; 110:438-448. [PMID: 27544824 DOI: 10.1016/j.neuropharm.2016.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/04/2016] [Accepted: 08/15/2016] [Indexed: 11/16/2022]
Abstract
Adrenal chromaffin cells (ACCs), the neuroendocrine arm of the sympathetic nervous system, secrete catecholamines to mediate the physiological response to stress. Although ACCs do not synthesize 5-HT, they express the serotonin transporter (SERT). Genetic variations in SERT are linked to several CNS disorders but the role(s) of SERT/5-HT in ACCs has remained unclear. Adrenal glands from wild-type mice contained 5-HT at ≈ 750 fold lower abundance than adrenaline, and in SERT(-/-) mice this was reduced by ≈80% with no change in catecholamines. Carbon fibre amperometry showed that SERT modulated the ability of 5-HT1A receptors to inhibit exocytosis. 5-HT reduced the number of amperometric spikes (vesicular fusion events) evoked by KCl in SERT(-/-) cells and wild-type cells treated with escitalopram, a SERT antagonist. The 5-HT1A receptor antagonist WAY100635 blocked the inhibition by 5-HT which was mimicked by the 5-HT1A agonist 8-OH-DPAT but not the 5-HT1B agonist CP93129. There was no effect on voltage-gated Ca(2+) channels, K(+) channels, or intracellular [Ca(2+)] handling, showing the 5-HT receptors recruit an atypical inhibitory mechanism. Spike charge and kinetics were not altered by 5-HT receptors but were reduced in SERT(-/-) cells compared to wild-type cells. Our data reveal a novel role for SERT and suggest that adrenal chromaffin cells might be a previously unrecognized hub for serotonergic control of the sympathetic stress response.
Collapse
Affiliation(s)
- Rebecca L Brindley
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Mary Beth Bauer
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Randy D Blakely
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kevin P M Currie
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA.
| |
Collapse
|
16
|
Lin CC, Tung CS, Liu YP. Escitalopram reversed the traumatic stress-induced depressed and anxiety-like symptoms but not the deficits of fear memory. Psychopharmacology (Berl) 2016; 233:1135-46. [PMID: 26740318 DOI: 10.1007/s00213-015-4194-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/16/2015] [Indexed: 12/22/2022]
Abstract
RATIONALE Posttraumatic stress disorder (PTSD) is a trauma-induced mental disorder characterised by fear extinction dysfunction in which fear circuit monoamines are possibly associated. PTSD often coexists with depressive/anxiety symptoms, and selective serotonin reuptake inhibitors (SSRIs) are recommended to treat PTSD. However, therapeutic mechanisms of SSRIs underlying the PTSD fear symptoms remain unclear. OBJECTIVES Using a rodent PTSD model, we examined the effects of early SSRI intervention in mood and fear dysfunctions with associated changes of monoamines within the fear circuit areas. METHODS A 14-day escitalopram (ESC) regimen (5 mg/kg/day) was undertaken in two separate experiments in rats which previously received a protocol of single prolonged stress (SPS). In experiment 1, sucrose preference and elevated T-maze were used to index anhedonia depression and avoidance/escape anxiety profiles. In experiment 2, the percentage of freezing time was measured in a 3-day fear conditioning paradigm. At the end of our study, tissue levels of serotonin (5-HT) in the medial prefrontal cortex, amygdala, hippocampus, and striatum were measured in experiment 1, and the efflux levels of infralimbic (IL) monoamines were measured in experiment 2. RESULTS In experiment 1, ESC corrected both behavioural (depression/anxiety) and neurochemical (reduced 5-HT tissue levels in amygdala/hippocampus) abnormalities. In experiment 2, ESC was unable to correct the SPS-impaired retrieval of fear extinction. In IL, ESC increased the efflux level of 5-HT but failed to reverse SPS-reduced dopamine (DA) and noradrenaline (NA). CONCLUSIONS PTSD-induced mood dysfunction is psychopathologically different from PTSD-induced fear disruption in terms of disequilibrium of monoamines within the fear circuit areas.
Collapse
Affiliation(s)
- Chen-Cheng Lin
- Department of Physiology and Biophysics, National Defense Medical Center, Taipei, 11490, Taiwan
| | - Che-Se Tung
- Division of Medical Research and Education, Cheng Hsin General Hospital, Taipei, 11220, Taiwan
| | - Yia-Ping Liu
- Department of Physiology and Biophysics, National Defense Medical Center, Taipei, 11490, Taiwan.
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan.
| |
Collapse
|
17
|
Ni D, Khosla SG, Nylen ES. Sertraline-Induced Hypoglycemia in Type 2 Diabetes Patients. AACE Clin Case Rep 2016. [DOI: 10.4158/ep15616.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
18
|
Otlivanchik O, Sanders NM, Dunn-Meynell A, Levin BE. Orexin signaling is necessary for hypoglycemia-induced prevention of conditioned place preference. Am J Physiol Regul Integr Comp Physiol 2015; 310:R66-73. [PMID: 26511522 DOI: 10.1152/ajpregu.00066.2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 10/19/2015] [Indexed: 01/24/2023]
Abstract
While the neural control of glucoregulatory responses to insulin-induced hypoglycemia is beginning to be elucidated, brain sites responsible for behavioral responses to hypoglycemia are relatively poorly understood. To help elucidate central control mechanisms associated with hypoglycemia unawareness, we first evaluated the effect of recurrent hypoglycemia on a simple behavioral measure, the robust feeding response to hypoglycemia, in rats. First, food intake was significantly, and similarly, increased above baseline saline-induced intake (1.1 ± 0.2 g; n = 8) in rats experiencing a first (4.4 ± 0.3; n = 8) or third daily episode of recurrent insulin-induced hypoglycemia (IIH, 3.7 ± 0.3 g; n = 9; P < 0.05). Because food intake was not impaired as a result of prior IIH, we next developed an alternative animal model of hypoglycemia-induced behavioral arousal using a conditioned place preference (CPP) model. We found that hypoglycemia severely blunted previously acquired CPP in rats and that recurrent hypoglycemia prevented this blunting. Pretreatment with a brain penetrant, selective orexin receptor-1 antagonist, SB-334867A, blocked hypoglycemia-induced blunting of CPP. Recurrently hypoglycemic rats also showed decreased preproorexin expression in the perifornical hypothalamus (50%) but not in the adjacent lateral hypothalamus. Pretreatment with sertraline, previously shown to prevent hypoglycemia-associated glucoregulatory failure, did not prevent blunting of hypoglycemia-induced CPP prevention by recurrent hypoglycemia. This work describes the first behavioral model of hypoglycemia unawareness and suggests a role for orexin neurons in mediating behavioral responses to hypoglycemia.
Collapse
Affiliation(s)
- Oleg Otlivanchik
- Graduate School of Biomedical Sciences, Rutgers University, Newark, New Jersey; Department of Neurology, New Jersey Medical School, Rutgers University, Newark, New Jersey
| | | | - Ambrose Dunn-Meynell
- Graduate School of Biomedical Sciences, Rutgers University, Newark, New Jersey; Department of Neurology, New Jersey Medical School, Rutgers University, Newark, New Jersey; Neurology Service, Veterans Affairs Medical Center, East Orange, New Jersey; and
| | - Barry E Levin
- Department of Neurology, New Jersey Medical School, Rutgers University, Newark, New Jersey; Neurology Service, Veterans Affairs Medical Center, East Orange, New Jersey; and
| |
Collapse
|
19
|
Otlivanchik O, Le Foll C, Levin BE. Perifornical hypothalamic orexin and serotonin modulate the counterregulatory response to hypoglycemic and glucoprivic stimuli. Diabetes 2015; 64:226-35. [PMID: 25114294 PMCID: PMC4274798 DOI: 10.2337/db14-0671] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Previous reports suggested an important role for serotonin (5-hydroxytryptamine [5-HT]) in enhancing the counterregulatory response (CRR) to hypoglycemia. To elucidate the sites of action mediating this effect, we initially found that insulin-induced hypoglycemia stimulates 5-HT release in widespread forebrain regions, including the perifornical hypothalamus (PFH; 30%), ventromedial hypothalamus (34%), paraventricular hypothalamus (34%), paraventricular thalamic nucleus (64%), and cerebral cortex (63%). Of these, we focused on the PFH because of its known modulation of diverse neurohumoral and behavioral responses. In awake, behaving rats, bilateral PFH glucoprivation with 5-thioglucose stimulated adrenal medullary epinephrine (Epi) release (3,153%) and feeding (400%), while clamping PFH glucose at postprandial brain levels blunted the Epi response to hypoglycemia by 30%. The PFH contained both glucose-excited (GE) and glucose-inhibited (GI) neurons; GE neurons were primarily excited, while GI neurons were equally excited or inhibited by 5-HT at hypoglycemic glucose levels in vitro. Also, 5-HT stimulated lactate production by cultured hypothalamic astrocytes. Depleting PFH 5-HT blunted the Epi (but not feeding) response to focal PFH (69%) and systemic glucoprivation (39%), while increasing PFH 5-HT levels amplified the Epi response to hypoglycemia by 32%. Finally, the orexin 1 receptor antagonist SB334867A attenuated both the Epi (65%) and feeding (47%) responses to focal PFH glucoprivation. Thus we have identified the PFH as a glucoregulatory region where both 5-HT and orexin modulate the CRR and feeding responses to glucoprivation.
Collapse
Affiliation(s)
- Oleg Otlivanchik
- Graduate School of Biomedical Sciences, Rutgers, Newark, NJ Department of Neurology and Neurosciences, New Jersey Medical School, Rutgers, Newark, NJ
| | - Christelle Le Foll
- Department of Neurology and Neurosciences, New Jersey Medical School, Rutgers, Newark, NJ
| | - Barry E Levin
- Department of Neurology and Neurosciences, New Jersey Medical School, Rutgers, Newark, NJ Neurology Service, Veterans Affairs Medical Center, East Orange, NJ
| |
Collapse
|
20
|
Davis SN, Tate D, Hedrington MS. Mechanisms of hypoglycemia and exercise-associated autonomic dysfunction. TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION 2014; 125:281-292. [PMID: 25125745 PMCID: PMC4112662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
It is well established that diabetes can lead to multiple microvascular and macrovascular complications. Several large scale randomized multicenter studies have shown that intensifying glucose control decreases microvascular and, to a certain extent, macrovascular complications of diabetes. However, intensifying glucose control in both type 1 and type 2 diabetes increases the risk of developing hypoglycemia, one of the most feared complications of people with the disease. The mechanisms responsible for intensive therapy causing increased hypoglycemia in patients with diabetes have been extensively investigated. It is now known that a single episode of hypoglycemia can blunt the body's normal counterregulatory defenses against subsequent hypoglycemia or exercise. Similarly, a single bout of exercise can also blunt counterregulatory responses against subsequent hypoglycemia. Both neuroendocrine and autonomic nervous system responses are reduced by prior hypoglycemia and/or exercise. Work from several laboratories has identified multiple physiologic mechanisms involved in the pathogenesis of this hypoglycemia and exercise-associated counterregulatory failure. By continuing to study these mechanisms, some promising approaches to amplify counterregulatory responses to hypoglycemia are being discovered.
Collapse
Affiliation(s)
- Stephen N. Davis
- Correspondence and reprint requests: Stephen N. Davis, MBBS, FRCP, FACP,
22 S. Greene Street, Room N3W42, Baltimore, MD 21201410-328-2488410-328-8688
| | | | | |
Collapse
|
21
|
Chan O, Sherwin R. Influence of VMH fuel sensing on hypoglycemic responses. Trends Endocrinol Metab 2013; 24:616-24. [PMID: 24063974 PMCID: PMC3909530 DOI: 10.1016/j.tem.2013.08.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/20/2013] [Accepted: 08/27/2013] [Indexed: 12/12/2022]
Abstract
Hypoglycemia produces complex neural and hormonal responses that restore glucose levels to normal. Glucose, metabolic substrates and their transporters, neuropeptides and neurotransmitters alter the firing rate of glucose-sensing neurons in the ventromedial hypothalamus (VMH); these monitor energy status and regulate the release of neurotransmitters that instigate a suitable counter-regulatory response. Under normal physiological conditions, these mechanisms maintain blood glucose concentrations within narrow margins. However, antecedent hypoglycemia and diabetes can lead to adaptations within the brain that impair counter-regulatory responses. Clearly, the mechanisms employed to detect and regulate the response to hypoglycemia, and the pathophysiology of defective counter-regulation in diabetes, are complex and need to be elucidated to permit the development of therapies that prevent or reduce the risk of hypoglycemia.
Collapse
Affiliation(s)
- Owen Chan
- Yale University School of Medicine, Department of Internal Medicine - Section of Endocrinology, New Haven, CT, 06520 U.S.A
| | - Robert Sherwin
- Yale University School of Medicine, Department of Internal Medicine - Section of Endocrinology, New Haven, CT, 06520 U.S.A
| |
Collapse
|
22
|
Affiliation(s)
- Philip E Cryer
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO 63110, USA.
| |
Collapse
|
23
|
Beall C, Ashford ML, McCrimmon RJ. The physiology and pathophysiology of the neural control of the counterregulatory response. Am J Physiol Regul Integr Comp Physiol 2011; 302:R215-23. [PMID: 22071156 DOI: 10.1152/ajpregu.00531.2011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Despite significant technological and pharmacological advancements, insulin replacement therapy fails to adequately replicate β-cell function, and so glucose control in type 1 diabetes mellitus (T1D) is frequently erratic, leading to periods of hypoglycemia. Moreover, the counterregulatory response (CRR) to falling blood glucose is impaired in diabetes, leading to an increased risk of severe hypoglycemia. It is now clear that the brain plays a significant role in the development of defective glucose counterregulation and impaired hypoglycemia awareness in diabetes. In this review, the basic intracellular glucose-sensing mechanisms are discussed, as well as the neural networks that respond to and coordinate the body's response to a hypoglycemic challenge. Subsequently, we discuss how the body responds to repeated hypoglycemia and how these adaptations may explain, at least in part, the development of impaired glucose counterregulation in diabetes.
Collapse
Affiliation(s)
- Craig Beall
- Medical Research Institute, Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, Univ. of Dundee, Dundee, DD1 9SY, United Kingdom
| | | | | |
Collapse
|
24
|
Taugourdeau S, Chiche L, Rouby F, Default A, Boyer M, Castellan D, Lanfranchi MA, Bornet C, Jean R, Harlé JR, Durand JM, Jean-Pastor MJ. [Severe hypoglycemia induced by tramadol: two new cases of an unlisted side effect]. Rev Med Interne 2011; 32:703-5. [PMID: 21855184 DOI: 10.1016/j.revmed.2011.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 05/24/2011] [Accepted: 06/21/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Tramadol is a weak opioid analgesic used as a step two analgesic, approved in France for the treatment of moderate to severe pain in adult patients. The most common side effects are gastrointestinal and neurologic. Hypoglycaemia is an almost unknown side effect. CASE REPORTS We report two patients who presented with severe hypoglycaemia related to oral administration of tramadol in non diabetic patients. The underlying mechanisms of hypoglycaemia induced by tramadol are unclear. The only weak opioid analgesic drug reported to cause hypoglycaemia is propoxyphene, which has been widely used in France. The recent withdrawal of dextropropoxyphene in France might increase the prescriptions of tramadol and healthcare professionals should be aware of the risk of hypoglycaemia. CONCLUSION The risk of hypoglycaemia should be added to the summary of product characteristics of tramadol.
Collapse
Affiliation(s)
- S Taugourdeau
- Centre régional de pharmacovigilance Marseille-Provence-Corse, hôpital Salvator, Assistance publique des Hôpitaux de Marseille, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Affiliation(s)
- Philip E Cryer
- Washington University School of Medicine, St. Louis, Missouri, USA.
| |
Collapse
|
26
|
Affiliation(s)
- Rory J McCrimmon
- Biomedical Research Institute, University of Dundee, Dundee, Scotland.
| | | |
Collapse
|
27
|
Briscoe VJ, Ertl AC, Tate DB, Davis SN. Effects of the selective serotonin reuptake inhibitor fluoxetine on counterregulatory responses to hypoglycemia in individuals with type 1 diabetes. Diabetes 2008; 57:3315-22. [PMID: 18835927 PMCID: PMC2584138 DOI: 10.2337/db08-1000] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 09/18/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Previous work has demonstrated that chronic administration of the serotonin reuptake inhibitor (SSRI) fluoxetine augments counterregulatory responses to hypoglycemia in healthy humans. However, virtually no information exists regarding the effects of fluoxetine on integrated physiological counterregulatory responses during hypoglycemia in type 1 diabetes. Therefore, the specific aim of this study was to test the hypothesis that 6-week use of the SSRI fluoxetine would amplify autonomic nervous system (ANS) counterregulatory responses to hypoglycemia in individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS Eighteen type 1 diabetic patients (14 men/4 women aged 19-48 years with BMI 25 +/- 3 kg/m(2) and A1C 7.0 +/- 0.4%) participated in randomized, double-blind 2-h hyperinsulinemic (9 pmol . kg(-1) . min(-1))-hypoglycemic clamp studies before and after 6 weeks of fluoxetine administration (n = 8) or identical placebo (n = 10). Glucose kinetics was determined by 3-tritiated glucose. Muscle sympathetic nerve activity (MSNA) was determined by microneurography. RESULTS Hypoglycemia (2.8 +/- 0.1 mmol/l) and insulinemia (646 +/- 52 pmol/l) were similar during all clamp studies. ANS, neuroendocrine, and metabolic counterregulatory responses remained unchanged in the placebo group. However, fluoxetine administration significantly (P < 0.05) increased key ANS (epinephrine, norepinephrine, and MSNA), metabolic (endogenous glucose production and lipolysis), and cardiovascular (systolic blood pressure) counterregulatory responses during hypoglycemia. CONCLUSIONS This study has demonstrated that 6-week administration of the SSRI fluoxetine can amplify ANS and metabolic counterregulatory mechanisms during moderate hypoglycemia in patients with type 1 diabetes. These data also suggest that the use of fluoxetine may be useful in increasing epinephrine responses during hypoglycemia in clinical practice.
Collapse
Affiliation(s)
| | - Andrew C. Ertl
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Donna B. Tate
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Stephen N. Davis
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
- Department of Medicine, Veterans Affairs, Nashville, Tennessee
| |
Collapse
|