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Witkowski S, White Q, Shreyer S, Garcia RL, Brown DE, Sievert LL. Acute increases in physical activity and temperature are associated with hot flash experience in midlife women. Menopause 2024; 31:600-607. [PMID: 38814193 PMCID: PMC11213681 DOI: 10.1097/gme.0000000000002373] [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] [Indexed: 05/31/2024]
Abstract
OBJECTIVE This study determined the association between acute changes in physical activity, temperature, and humidity and 24-hour subjective and objective hot flash experience. METHODS Data collection occurred during the cooler months of the year in Western Massachusetts (October-April). Women aged 45-55 across three menopause stages (n = 270) were instrumented with ambulatory monitors to continuously measure hot flashes, physical activity, temperature, and humidity for 24 hours. Objective hot flashes were assessed via sternal skin conductance, and subjective hot flashes were recorded by pressing an event marker and data logging. Physical activity was measured with wrist-worn accelerometers and used to define sleep and wake periods. Logistic multilevel modeling was used to examine the differences in physical activity, humidity, and temperature in the 10 minutes preceding a hot flash versus control windows when no hot flashes occurred. The odds of hot flashes were considered separately for objective and subjective hot flashes as well as for wake and sleep periods. RESULTS Data from 188 participants were included in the analyses. There was a significantly greater odds of a hot flash following acute increases in physical activity for objective waking hot flashes (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.17-1.47; P < 0.001) and subjective waking hot flashes (OR, 1.16; 95% CI, 1.0-1.33; P = 0.03). Acute increases in the actigraphy signal were associated with significantly higher odds of having an objective (OR, 1.17; 95% CI, 1.03-1.35; P < 0.01) or subjective (OR, 1.72; 95% CI, 1.52-2.01; P < 0.001) sleeping hot flash. Increases in temperature were significantly related to the odds of subjective sleeping hot flashes only (OR, 1.38; 95% CI, 1.15-1.62; P < 0.001). There was no evidence for a relationship between humidity and odds of experiencing any hot flashes. CONCLUSION These results indicate that acute increases in physical activity increase the odds of hot flashes that are objectively measured and subjectively reported during waking and sleeping periods. Temperature increases were only related to subjectively reported nighttime hot flashes.
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Affiliation(s)
| | - Quinn White
- Statistical & Data Sciences, Smith College, Northampton, MA
| | - Sofiya Shreyer
- Department of Anthropology, University of Massachusetts, Amherst, MA
| | - Randi L Garcia
- Statistical & Data Sciences, Smith College, Northampton, MA
| | - Daniel E Brown
- Department of Anthropology, University of Hawaii at Hilo, Hilo, HI
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2
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Szukiewicz D. Current Insights in Prolactin Signaling and Ovulatory Function. Int J Mol Sci 2024; 25:1976. [PMID: 38396659 PMCID: PMC10889014 DOI: 10.3390/ijms25041976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Prolactin (PRL) is a pleiotropic hormone released from lactotrophic cells of the anterior pituitary gland that also originates from extrapituitary sources and plays an important role in regulating lactation in mammals, as well as other actions. Acting in an endocrine and paracrine/autocrine manner, PRL regulates the hypothalamic-pituitary-ovarian axis, thus influencing the maturation of ovarian follicles and ovulation. This review provides a detailed discussion of the current knowledge on the role of PRL in the context of ovulation and ovulatory disorders, particularly with regard to hyperprolactinemia, which is one of the most common causes of infertility in women. Much attention has been given to the PRL structure and the PRL receptor (PRLR), as well as the diverse functions of PRLR signaling under normal and pathological conditions. The hormonal regulation of the menstrual cycle in connection with folliculogenesis and ovulation, as well as the current classifications of ovulation disorders, are also described. Finally, the state of knowledge regarding the importance of TIDA (tuberoinfundibular dopamine), KNDγ (kisspeptin/neurokinin B/dynorphin), and GnRH (gonadotropin-releasing hormone) neurons in PRL- and kisspeptin (KP)-dependent regulation of the hypothalamic-pituitary-gonadal (HPG) axis in women is reviewed. Based on this review, a rationale for influencing PRL signaling pathways in therapeutic activities accompanying ovulation disorders is presented.
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Affiliation(s)
- Dariusz Szukiewicz
- Department of Biophysics, Physiology & Pathophysiology, Faculty of Health Sciences, Medical University of Warsaw, 02-004 Warsaw, Poland
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3
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Affiliation(s)
- Simone Elder
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
- Shady Grove Fertility, Greenwood Village, CO, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA.
- Shady Grove Fertility, Greenwood Village, CO, USA.
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4
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Grant AD, Kriegsfeld LJ. Neural substrates underlying rhythmic coupling of female reproductive and thermoregulatory circuits. Front Physiol 2023; 14:1254287. [PMID: 37753455 PMCID: PMC10518419 DOI: 10.3389/fphys.2023.1254287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
Coordinated fluctuations in female reproductive physiology and thermoregulatory output have been reported for over a century. These changes occur rhythmically at the hourly (ultradian), daily (circadian), and multi-day (ovulatory) timescales, are critical for reproductive function, and have led to the use of temperature patterns as a proxy for female reproductive state. The mechanisms underlying coupling between reproductive and thermoregulatory systems are not fully established, hindering the expansion of inferences that body temperature can provide about female reproductive status. At present, numerous digital tools rely on temperature to infer the timing of ovulation and additional applications (e.g., monitoring ovulatory irregularities and progression of puberty, pregnancy, and menopause are developed based on the assumption that reproductive-thermoregulatory coupling occurs across timescales and life stages. However, without clear understanding of the mechanisms and degree of coupling among the neural substrates regulating temperature and the reproductive axis, whether such approaches will bear fruit in particular domains is uncertain. In this overview, we present evidence supporting broad coupling among the central circuits governing reproduction, thermoregulation, and broader systemic physiology, focusing on timing at ultradian frequencies. Future work characterizing the dynamics of reproductive-thermoregulatory coupling across the lifespan, and of conditions that may decouple these circuits (e.g., circadian disruption, metabolic disease) and compromise female reproductive health, will aid in the development of strategies for early detection of reproductive irregularities and monitoring the efficacy of fertility treatments.
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Affiliation(s)
| | - Lance J. Kriegsfeld
- Department of Psychology, University of California, Berkeley, CA, United States
- The Helen Wills Neuroscience Institute, University of California, Berkeley, CA, United States
- Department of Integrative Biology, University of California, Berkeley, CA, United States
- Graduate Group in Endocrinology, University of California, Berkeley, CA, United States
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5
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Domingues TE, Diniz E Magalhães CO, Szawka RE, Reis AM, Henriques PC, da Costa Silva KS, Costa SP, Silva SB, Ferreira da Fonseca S, Rodrigues CM, Dias Peixoto MF, Coimbra CC, Mendonça VA, Scheidet PHF, Sampaio KH, Lacerda ACR. Prior aerobic physical training modulates neuropeptide expression and central thermoregulation after ovariectomy in the rat. Mol Cell Endocrinol 2022; 558:111756. [PMID: 36084853 DOI: 10.1016/j.mce.2022.111756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
This study compared the effects of aerobic physical training and estradiol (E2) replacement on central pathways involved with thermoregulation in ovariectomized rats. Rats were assigned to untrained ovariectomized treated with placebo (UN-OVX), untrained ovariectomized treated with E2 (E2-OVX), and trained ovariectomized (TR-OVX) groups. Tail skin temperature (TST), internal temperature (Tint), and basal oxygen consumption (VO2) were recorded. Neuronal activity, brain expression of Kiss1, NKB and Prodyn, and central norepinephrine (NE) levels were measured. UN-OVX had the highest TST. Compared to UN-OVX rats, TR-OVX and E2-OVX had lower Fos expression in the paraventricular and arcuate (ARC) nuclei, and lower double labeling for Tyrosine Hydroxylase and Fos in the brainstem. Compared to UN-OVX, only TR-OVX group exhibited lower kisspeptin (Kiss1), neurokinin B (NKB), and prodynorphin expression in the ARC and higher central NE levels. Aerobic physical training before menopause may prevent the heat dissipation imbalance induced by reduction of E2, through central NE release, modulation of Kiss1, NKB and prodynorphin expression in neurons from ARC nucleus.
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Affiliation(s)
- Talita Emanuela Domingues
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil; Laboratório de Fisiologia do Exercício - LAFIEX - CIPq Saúde. Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Caíque Olegário Diniz E Magalhães
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil; Laboratório de Fisiologia do Exercício - LAFIEX - CIPq Saúde. Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil; Laboratório Experimental de Treinamento Físico - LETFis - Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Raphael Escorsim Szawka
- Laboratório de Endocrinologia e Metabolismo, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Adelina Martha Reis
- Laboratório de Endocrinologia e Metabolismo, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Patrícia Costa Henriques
- Laboratório de Endocrinologia e Metabolismo, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Kaoma Stephani da Costa Silva
- Laboratório de Endocrinologia e Metabolismo, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Sabrina Paula Costa
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil; Laboratório de Fisiologia do Exercício - LAFIEX - CIPq Saúde. Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil; Programa de Pós-Grduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Sara Barros Silva
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil; Laboratório de Fisiologia do Exercício - LAFIEX - CIPq Saúde. Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil; Programa de Pós-Grduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Sueli Ferreira da Fonseca
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil; Laboratório de Fisiologia do Exercício - LAFIEX - CIPq Saúde. Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Cíntia Maria Rodrigues
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marco Fabrício Dias Peixoto
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil; Laboratório de Fisiologia do Exercício - LAFIEX - CIPq Saúde. Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Cândido Celso Coimbra
- Laboratório de Endocrinologia e Metabolismo, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Vanessa Amaral Mendonça
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil; Laboratório de Fisiologia do Exercício - LAFIEX - CIPq Saúde. Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil; Programa de Pós-Grduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Pedro Henrique Figueiredo Scheidet
- Laboratório de Fisiologia do Exercício - LAFIEX - CIPq Saúde. Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil; Programa de Pós-Grduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Kinulpe Honorato Sampaio
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil; Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Ana Cristina Rodrigues Lacerda
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil; Laboratório de Fisiologia do Exercício - LAFIEX - CIPq Saúde. Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil; Programa de Pós-Grduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
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6
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Fonseca CS, Aquino NSS, Goncalves GKN, Drummond LR, Hipolito LTM, Silva JF, Silva KSC, Henriques PC, Domingues TE, Lacerda ACR, Guatimosim S, Coimbra CC, Szawka RE, Reis AM. Norepinephrine modulation of heat dissipation in female rats lacking estrogen. J Neuroendocrinol 2022; 34:e13188. [PMID: 36306200 DOI: 10.1111/jne.13188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/10/2022] [Accepted: 07/15/2022] [Indexed: 11/27/2022]
Abstract
Postmenopausal hot flushes are caused by lack of estradiol (E2) but their neuroendocrine basis is still poorly understood. Here, we investigated the interrelationship between norepinephrine and hypothalamic neurons, with emphasis on kisspeptin neurons in the arcuate nucleus (ARC), as a regulatory pathway in the vasomotor effects of E2. Ovariectomized (OVX) rats displayed increased tail skin temperature (TST), and this increase was prevented in OVX rats treated with E2 (OVX + E2). Expression of Fos in the hypothalamus and the number of ARC kisspeptin neurons coexpressing Fos were increased in OVX rats. Likewise, brainstem norepinephrine neurons of OVX rats displayed higher Fos immunoreactivity associated with the increase in TST. In the ARC, the density of dopamine-ß-hydroxylase (DBH)-immunoreactive (ir) fibers was not altered by E2 but, importantly, DBH-ir terminals were found in close apposition to kisspeptin cells, revealing norepinephrine inputs to ARC kisspeptin neurons. Intracerebroventricular injection of the α2-adrenergic agonist clonidine (CLO) was used to reduce central norepinephrine release, confirmed by the decreased 3-methoxy-4-hydroxyphenylglycol/norepinephrine ratio in the preoptic area and ARC. Accordingly, CLO treatment in OVX rats reduced ARC Kiss1 mRNA levels and TST to the values of OVX + E2 rats. Conversely, CLO stimulated Kiss1 expression in the anteroventral periventricular nucleus (AVPV) and increased luteinizing hormone secretion. These findings provide evidence that augmented heat dissipation in OVX rats involves the increase in central norepinephrine that modulates hypothalamic areas related to thermoregulation, including ARC kisspeptin neurons. This neuronal network is suppressed by E2 and its imbalance may be implicated in the vasomotor symptoms of postmenopausal hot flushes.
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Affiliation(s)
- Cristina S Fonseca
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Nayara S S Aquino
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gleisy K N Goncalves
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas R Drummond
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Laisa T M Hipolito
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Juneo F Silva
- Centro de Microscopia Eletronica, Departamento de Ciencias Biologicas, Universidade Estadual de Santa Cruz, Ilheus, Brazil
| | - Kaoma S C Silva
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Patricia C Henriques
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Talita E Domingues
- Faculdade de Ciencias Biologicas e da Saude, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Ana C R Lacerda
- Faculdade de Ciencias Biologicas e da Saude, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Silvia Guatimosim
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Candido C Coimbra
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Raphael E Szawka
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Adelina M Reis
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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7
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Xu C, Xie Y, Zhong T, Liang S, Guan H, Long Z, Cao H, Xing L, Xue X, Zhan Y. A self-powered wearable brain-machine-interface system for real-time monitoring and regulating body temperature. NANOSCALE 2022; 14:12483-12490. [PMID: 35983766 DOI: 10.1039/d2nr03115a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Heat stroke that may cause acute central nervous system dysfunction, multiple organ dysfunction and even death has become a typical health problem in tropical developing countries. The primary goal of heat stroke treatment is to lower core body temperature, which necessitates physical or medical cooling in time. Here, we design a new self-powered wearable brain-machine-interface system for real-time monitoring and regulating body temperature. This system can monitor body temperature in real time and transmit neural electrical stimulation signals into specific brain regions to lower the body temperature. The whole system can work without an external power supply and be powered by the body itself through the piezoelectric effect. The system comprises a temperature detecting unit, a power supply unit, a data processing module, and a brain stimulator. Demonstration of the system with stimulation electrodes implanted in the median preoptic nucleus brain region in mice reveals an evident decrease in body temperature (1.0 °C within 15 min). This self-powered strategy provides a new concept for future treatment of heat stroke and can extend the application of brain-machine-interface systems in medical care.
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Affiliation(s)
- Chengze Xu
- School of Physics, University of Electronic Science and Technology of China, Chengdu 611731, China.
| | - Yan Xie
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
| | - Tianyan Zhong
- School of Physics, University of Electronic Science and Technology of China, Chengdu 611731, China.
| | - Shan Liang
- School of Physics, University of Electronic Science and Technology of China, Chengdu 611731, China.
| | - Hongye Guan
- School of Physics, University of Electronic Science and Technology of China, Chengdu 611731, China.
| | - Zhihe Long
- Department of Mechanical Engineering, City University of Hong Kong, Hong Kong 999077, China
| | - Hanyu Cao
- Xiamen University, Xiamen 361005, China
| | - Lili Xing
- School of Physics, University of Electronic Science and Technology of China, Chengdu 611731, China.
| | - Xinyu Xue
- School of Physics, University of Electronic Science and Technology of China, Chengdu 611731, China.
| | - Yang Zhan
- CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Key Laboratory of Translational Research for Brain Diseases, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences; Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, 518055, China.
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8
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Tahara A, Takamatsu H, Ohtake A, Tanaka-Amino K, Kaku S. Effects of neurokinin 3 receptor antagonist fezolinetant on hot flash-like symptoms in ovariectomized rats. Eur J Pharmacol 2021; 905:174207. [PMID: 34048742 DOI: 10.1016/j.ejphar.2021.174207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022]
Abstract
The majority of women experience vasomotor symptoms (VMS), such as hot flashes and night sweats, during the menopausal transition. Recent evidence strongly suggests a connection between neurokinin 3 (NK3) receptor signaling and VMS associated with menopause. The NK3 receptor antagonist fezolinetant is currently in phase 3 development for treatment of moderate to severe VMS associated with menopause. We investigated the pharmacological effects of repeated administration of fezolinetant on levels of sex hormones and gonadotropins, neuronal activity in the hypothalamus, and skin temperature as an index of hot flash-like symptoms in ovariectomized rats as a model of menopause. Ovariectomized rats exhibited several typical menopausal symptoms: hyperphagia, increased body weight, significantly decreased plasma estradiol levels, increased luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, and significantly increased skin temperature. Increased c-Fos expression (an indirect marker of neuronal activity) in median preoptic nucleus (MnPO) hypothalamic neurons was also observed in ovariectomized rats. Repeated oral administration of fezolinetant (1-10 mg/kg, twice daily) for 1 week dose-dependently reduced plasma LH levels without affecting estradiol or FSH levels, inhibited the activation of MnPO neurons, and attenuated hot flash-like symptoms. In addition, fezolinetant dose-dependently reduced hyperphagia and weight gain in ovariectomized rats. These preclinical findings suggest that fezolinetant attenuates hot flash-like symptoms via inhibition of neuronal activity in the MnPO of ovariectomized rats and provides further support for the ongoing clinical development of fezolinetant for the treatment of VMS associated with menopause.
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Affiliation(s)
- Atsuo Tahara
- Drug Discovery Research, Astellas Pharma Inc., Ibaraki, Japan.
| | | | - Akiyoshi Ohtake
- Drug Discovery Research, Astellas Pharma Inc., Ibaraki, Japan
| | | | - Seiji Kaku
- Drug Discovery Research, Astellas Pharma Inc., Ibaraki, Japan
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9
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Zhang Z, DiVittorio JR, Joseph AM, Correa SM. The Effects of Estrogens on Neural Circuits That Control Temperature. Endocrinology 2021; 162:6262699. [PMID: 33939822 PMCID: PMC8237993 DOI: 10.1210/endocr/bqab087] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Indexed: 12/17/2022]
Abstract
Declining and variable levels of estrogens around the time of menopause are associated with a suite of metabolic, vascular, and neuroendocrine changes. The archetypal adverse effects of perimenopause are vasomotor symptoms, which include hot flashes and night sweats. Although vasomotor symptoms are routinely treated with hormone therapy, the risks associated with these treatments encourage us to seek alternative treatment avenues. Understanding the mechanisms underlying the effects of estrogens on temperature regulation is a first step toward identifying novel therapeutic targets. Here we outline findings in rodents that reveal neural and molecular targets of estrogens within brain regions that control distinct components of temperature homeostasis. These insights suggest that estrogens may alter the function of multiple specialized neural circuits to coordinate the suite of changes after menopause. Thus, defining the precise cells and neural circuits that mediate the effects of estrogens on temperature has promise to identify strategies that would selectively counteract hot flashes or other negative side effects without the health risks that accompany systemic hormone therapies.
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Affiliation(s)
- Zhi Zhang
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Laboratory of Neuroendocrinology, Brain Research Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Johnathon R DiVittorio
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Alexia M Joseph
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Stephanie M Correa
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Laboratory of Neuroendocrinology, Brain Research Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
- Correspondence: Stephanie Correa, Ph.D., UCLA Dept. of Integrative Biology and Physiology 2028 Terasaki Life Sciences Building, 610 Charles E Young Drive East, Box 957239 Los Angeles, CA 90095, USA.
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10
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Depypere H, Lademacher C, Siddiqui E, Fraser GL. Fezolinetant in the treatment of vasomotor symptoms associated with menopause. Expert Opin Investig Drugs 2021; 30:681-694. [PMID: 33724119 DOI: 10.1080/13543784.2021.1893305] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Although international clinical practice guidelines recognize a continued role for menopausal hormone therapy (HT), particularly for symptomatic women <60 years of age or within 10 years of menopause, safety and tolerability concerns have discouraged HT use due to potential links with a perceived increased risk of hormone-dependent cancers, and an established risk of stroke and venous thromboembolism. There is therefore a need for safe, effective non-hormonal therapy for relief of menopausal vasomotor symptoms (VMS).Areas covered: This narrative review summarizes the dataset accrued for fezolinetant, a neurokinin-3 receptor (NK3R) antagonist in clinical development for menopause-associated VMS.Expert opinion: Altered signaling in neuroendocrine circuits at menopause leads to VMS wherein NK3R activity plays a key role to modulate the thermoregulatory center in a manner conducive to triggering the 'hot flash' response. Thus, a new generation of NK3R antagonists has entered clinical development to specifically target the mechanistic basis of VMS. Fezolinetant is the most advanced NK3R antagonist in terms of stage of clinical development. Results to date have demonstrated rapid and substantial reduction in VMS frequency and severity and associated improvements in health-related quality of life. NK3R antagonists offer a non-hormonal alternative to HT for the treatment of menopause-related VMS.
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Affiliation(s)
- Herman Depypere
- Breast and Menopause Clinic, University Hospital, Ghent, Belgium
| | | | - Emad Siddiqui
- Medical Affairs, Astellas Pharma Medical and Development, Chertsey, UK
| | - Graeme L Fraser
- Former Chief Scientific Officer of Ogeda SA, Gosselies, Belgium and Consultant for Astellas Pharma Inc
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11
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Fleischer AW, Schalk JC, Wetzel EA, Hanson AM, Sem DS, Donaldson WA, Frick KM. Long-term oral administration of a novel estrogen receptor beta agonist enhances memory and alleviates drug-induced vasodilation in young ovariectomized mice. Horm Behav 2021; 130:104948. [PMID: 33571507 PMCID: PMC8680219 DOI: 10.1016/j.yhbeh.2021.104948] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/09/2020] [Accepted: 01/19/2021] [Indexed: 01/11/2023]
Abstract
Development of estrogen therapies targeting the β (ERβ) but not α (ERα) estrogen receptor is critically needed for the treatment of negative menopausal symptoms, as ERα activation increases health risks like cancer. Here, we determined the effects of long-term oral treatment with EGX358, a novel highly selective ERβ agonist, on memory, vasodilation, and affect in young ovariectomized mice. Mice were orally gavaged daily for 9 weeks with vehicle, 17β-estradiol (E2), the ERβ agonist diarylpropionitrile (DPN), or EGX358 at doses that enhance memory when delivered acutely. Tail skin temperature was recorded as a proxy for vasodilation following injection of vehicle or senktide, a tachykinin receptor 3 agonist used to model hot flashes. Anxiety-like behavior was assessed in the open field (OF) and elevated plus maze (EPM), and depression-like behavior was measured in the tail suspension (TST) and forced swim tests (FST). Finally, memory was assessed in object recognition (OR) and object placement (OP) tasks. E2, DPN, and EGX358 reduced senktide-mediated increases in tail skin temperature compared to vehicle. All three treatments also enhanced memory in the OR and OP tasks, whereas vehicle did not. Although E2 increased time spent in the center of the OF, no other treatment effects were observed in the OF, EPM, TST, or FST. These data suggest that long-term ERβ activation can reduce hot flash-like symptoms and enhance spatial and object recognition memories in ovariectomized mice. Thus, the highly selective ERβ agonist EGX358 may be a promising avenue for reducing menopause-related hot flashes and memory dysfunction.
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Affiliation(s)
- Aaron W Fleischer
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, United States of America.
| | - Jayson C Schalk
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, United States of America.
| | - Edward A Wetzel
- Department of Chemistry, Marquette University, Milwaukee, WI 53201-1881, United States of America.
| | - Alicia M Hanson
- Department Pharmaceutical Sciences, Concordia University Wisconsin, Mequon, WI 53097, United States of America; Center for Structure-Based Drug Design and Development, Concordia University Wisconsin, Mequon, WI 53097, United States of America.
| | - Daniel S Sem
- Department Pharmaceutical Sciences, Concordia University Wisconsin, Mequon, WI 53097, United States of America; Center for Structure-Based Drug Design and Development, Concordia University Wisconsin, Mequon, WI 53097, United States of America.
| | - William A Donaldson
- Department of Chemistry, Marquette University, Milwaukee, WI 53201-1881, United States of America.
| | - Karyn M Frick
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, United States of America.
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12
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Porter DT, Goodman RL, Hileman SM, Lehman MN. Evidence that synaptic plasticity of glutamatergic inputs onto KNDy neurones during the ovine follicular phase is dependent on increasing levels of oestradiol. J Neuroendocrinol 2021; 33:e12945. [PMID: 33713519 PMCID: PMC7959185 DOI: 10.1111/jne.12945] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/12/2021] [Accepted: 01/26/2021] [Indexed: 01/09/2023]
Abstract
Neurones in the arcuate nucleus co-expressing kisspeptin, neurokinin B (NKB) and dynorphin (KNDy) play a critical role in the control of gonadotrophin-releasing hormone (GnRH) and luteinising hormone (LH) secretion. In sheep, KNDy neurones mediate both steroid-negative- and -positive-feedback during pulsatile and preovulatory surge secretions of GnRH/LH, respectively. In addition, KNDy neurones receive glutamatergic inputs expressing vGlut2, a glutamate transporter that serves as a marker for those terminals, from both KNDy neurones and other populations of glutamatergic neurones. Previous work reported higher numbers of vGlut2-positive axonal inputs onto KNDy neurones during the LH surge than in luteal phase ewes. In the present study, we further examined the effects of the ovarian steroids progesterone (P) and oestradiol (E2 ) on glutamatergic inputs to KNDy neurones. Ovariectomised (OVX) ewes received either no further treatment (OVX) or steroid treatments that mimicked the luteal phase (low E2 + P), and early (low E2 ) or late follicular (high E2 ) phases of the oestrous cycle (n = 4 or 5 per group). Brain sections were processed for triple-label immunofluorescent detection of NKB/vGlut2/synaptophysin and analysed using confocal microscopy. We found higher numbers of vGlut2 inputs onto KNDy neurones in high E2 compared to the other three treatment groups. These results suggest that synaptic plasticity of glutamatergic inputs onto KNDy neurones during the ovine follicular phase depend on increasing levels of E2 required for the preovulatory GnRH/surge. These synaptic changes likely contribute to the positive-feedback action of oestrogen on GnRH/LH secretion and thus the generation of the preovulatory surge in the sheep.
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Affiliation(s)
- Danielle T. Porter
- Neuroscience Graduate Program, Dept. of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center
| | | | | | - Michael N. Lehman
- Brain Health Research Institute and Department of Biological Sciences, Kent State University
- Corresponding author and reprint requests to: Michael N. Lehman, Brain Health Research Institute, Kent State University, 251K Integrated Sciences Building, Kent, Ohio, 44242-0001 USA, Phone: 330-672-2732;
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13
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Prague JK. Neurokinin 3 receptor antagonists - prime time? Climacteric 2021; 24:25-31. [PMID: 33135940 DOI: 10.1080/13697137.2020.1834530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 02/08/2023]
Abstract
Vasomotor symptoms (hot flushes, flashes, night sweats) occur in the majority of menopausal women, and are reported as being of the highest symptom priority as they often persist over many years and can be highly disruptive. Hormone therapy is the most effective available treatment but is not without risk if taken long term, and is sometimes contraindicated; for example, in women with a personal or family history of breast cancer, which is the most common female cancer worldwide. Other treatment alternatives are not as efficacious, can cause side effects, and/or are not widely available. A new, effective, targeted treatment could therefore benefit millions of women worldwide. This became possible to investigate after accumulated evidence from both animal and human models implicated heightened signaling of a hypothalamic neuropeptide together with its receptor (neurokinin B/NK3R) in the etiology of sex-steroid-deficient vasomotor symptoms. Four clinical trials of three chemically distinct oral NK3R antagonists for the treatment of menopausal flushes have since completed and published, which consistently demonstrate efficacy and tolerability of these agents. These suggest great promise to change practice in the future if ongoing further larger-scale studies of longer duration confirm the same; as, estrogen exposure will no longer be required to effectively and safely treat vasomotor symptoms.
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Affiliation(s)
- J K Prague
- Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter Hospital, Exeter, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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14
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Nakamura S, Miwa M, Morita Y, Ohkura S, Yamamura T, Wakabayashi Y, Matsuyama S. Neurokinin 3 receptor-selective agonist, senktide, decreases core temperature in Japanese Black cattle. Domest Anim Endocrinol 2021; 74:106522. [PMID: 32841888 DOI: 10.1016/j.domaniend.2020.106522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/25/2020] [Accepted: 07/08/2020] [Indexed: 11/27/2022]
Abstract
Heat stress disrupts reproductive function in cattle. In summer, high ambient temperature and humidity elevate core body temperature, which is considered to be detrimental to reproductive abilities in cattle. Neurokinin B (NKB) is a factor that generates pulsatile GnRH and subsequent LH secretion in mammals. Recent studies have reported that NKB-neurokinin 3 receptor (NK3R) signaling is associated with heat-defense responses in rodents. The present study aimed to clarify the role of NKB-NK3R signaling in thermoregulation in cattle. We examined the effects of an NK3R-selective agonist, senktide, on vaginal temperature as an indicator of core body temperature in winter and summer. In both seasons, continuous infusion of senktide for 4 h immediately decreased vaginal temperature, and the mean temperature change in the senktide-treated group was significantly lower than that of both vehicle- and GnRH-treated groups. Administration of GnRH induced LH elevation, but there was no significant difference in vaginal temperature change between GnRH- and vehicle-treated groups. Moreover, we investigated the effects of senktide on ovarian temperature. Senktide treatment seemed to suppress the increase in ovarian temperature from 2 h after the beginning of administration, although the difference between groups was not statistically significant. Taken together, these results suggest that senktide infusion caused a decline in the vaginal temperature of cattle, in both winter and summer seasons, and this effect was not due to the gonadotropin-releasing action of senktide. These findings provide new therapeutic options for senktide to support both heat-defense responses and GnRH/LH pulse generation.
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Affiliation(s)
- S Nakamura
- Division of Animal Feeding and Management Research, Institute of Livestock and Grassland Science, NARO, Nasushiobara, Japan; Faculty of Veterinary Medicine, Okayama University of Science, Imabari, Japan
| | - M Miwa
- Division of Animal Feeding and Management Research, Institute of Livestock and Grassland Science, NARO, Nasushiobara, Japan; Division of Grassland Farming, Institute of Livestock and Grassland Science, NARO, Nasushiobara, Japan; Agricultural AI Research Office, Research Center for Agricultural Information Technology, NARO, Tsukuba, Japan
| | - Y Morita
- Laboratory of Animal Production Science, Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya, Japan
| | - S Ohkura
- Laboratory of Animal Production Science, Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya, Japan
| | - T Yamamura
- Agricultural AI Research Office, Research Center for Agricultural Information Technology, NARO, Tsukuba, Japan; Division of Animal Breeding and Reproduction Research, Institute of Livestock and Grassland Science, NARO, Tsukuba, Japan
| | - Y Wakabayashi
- Division of Animal Breeding and Reproduction Research, Institute of Livestock and Grassland Science, NARO, Tsukuba, Japan
| | - S Matsuyama
- Division of Animal Feeding and Management Research, Institute of Livestock and Grassland Science, NARO, Nasushiobara, Japan; Laboratory of Animal Production Science, Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya, Japan.
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15
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Modi M, Dhillo WS. The neuroendocrinology of the preoptic area in menopause: Symptoms and therapeutic strategies. HANDBOOK OF CLINICAL NEUROLOGY 2021; 179:455-460. [PMID: 34225982 DOI: 10.1016/b978-0-12-819975-6.00029-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The preoptic area of the hypothalamus is the central hub of thermoregulation in mammals, coordinating autonomic heat-effector pathways in response to sensory information from the ambient and internal environment. This aims to maintain temperature homeostasis at a predetermined thermoregulatory set-point. However, hormonal and neuronal changes during the menopause, including estrogen deficiency, disrupt these normal thermoregulatory responses. This results in abnormal activation of heat dissipation effectors, manifesting clinically as hot flush symptoms. Neurokinin B (NKB) signaling via the neurokinin-3 receptor (NK3R) within the preoptic area is thought to play an important role in the pathophysiology of hot flushes. Therefore attenuation of the NKB/NK3R signaling pathway has garnered much interest as a novel therapeutic target for the amelioration of menopausal hot flushes. Recent clinical trials have demonstrated that NK3R antagonists can produce rapid and sustained improvements in hot flush frequency, severity, and quality of life, without the need for estrogen exposure. Therefore NK3R antagonists are fast emerging as a safe and efficacious alternative to hormone replacement therapy, the current gold standard of treatment.
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Affiliation(s)
- Manish Modi
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Waljit Singh Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom.
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16
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Tabarean IV. Neurotensin induces hypothermia by activating both neuronal neurotensin receptor 1 and astrocytic neurotensin receptor 2 in the median preoptic nucleus. Neuropharmacology 2020; 171:108069. [PMID: 32275927 DOI: 10.1016/j.neuropharm.2020.108069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 12/13/2022]
Abstract
Neurotensin (NTS) is a neuropeptide acting as a neuromodulator in the brain and is a very potent hypothermic agent. However, the cellular mechanisms of actions are not fully understood. Here we report that NTS increases the firing rate of preoptic GABAergic neurons by activating both neurotensin receptor 1 (NTSR1) and neurotensin receptor 2 (NTSR2), expressed by neurons and astrocytes, respectively. Downstream of NTSR1 the neuropeptide activated an inward current, calcium release from intracellular stores and, postsynaptically, increased frequency and amplitude of inhibitory synaptic events. NTSR2 activation in astrocytes resulted in increased excitatory input in preoptic GABAergic neurons, an effect which was dependent upon the activation of P2X4 receptors. We also found that neuromedin N acted as a selective agonist at the NTSR1. Surprisingly, activation of both NTSR1 and NTSR2 in the median preoptic nucleus was required for activating a full hypothermic response.
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Affiliation(s)
- Iustin V Tabarean
- Scintillon Institute, 6868 Nancy Ridge Drive, San Diego, 92121, CA, USA.
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17
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Sun Y, Yang Q, Bai W, Wang W, Li Y, Luo X, Wang S, Jia J, Wang K, Qin L. Changes in skin temperature of ovariectomized rats under different incubation temperatures. Geriatr Gerontol Int 2020; 20:621-628. [PMID: 32237028 DOI: 10.1111/ggi.13913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/10/2020] [Accepted: 03/07/2020] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to investigate changes in skin temperature in the main body regions of ovariectomized rats under different incubation temperatures to identify regions that are similar to hot flashes experienced by menopausal women. METHODS A total of 96 adult female Sprague-Dawley rats were randomly divided into sham, ovariectomized and ovariectomized with estrogen treatment groups, with treatment lasting for 4 weeks. After 3 weeks of treatment, each group was randomly divided into five subgroups and placed in separate incubators set at 4, 15, 25, and 37°C. Changes in the skin temperature in seven main regions (head, neck, chest, abdomen, back, tail, and paws) for four time intervals (0-3 min, 3-5 min, 5-10 min and 10-15 min) were monitored using infrared thermography. RESULTS All rats showed rapid changes in skin temperature followed by a gradual slowdown under different incubation temperatures. However, changes in ovariectomized rats were significantly different from that in normal rats, and changes on the back, tail and paws were more rapid and lasted longer. Estrogen treatment effectively controlled these abnormalities of ovariectomized rats. CONCLUSIONS Temperature responses in the back, tail and paws in ovariectomized rats might be similar to the face, neck and upper chest in menopausal women, where the symptoms of hot flashes are most obvious, which suggests that the back, tail and paws could be regarded as the focus of research on hot flashes, and offer theoretical foundations for mechanisms behind the occurrence of hot flashes in specific regions. Geriatr Gerontol Int 2020; ••: ••-••.
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Affiliation(s)
- Yanrong Sun
- Department of Anatomy and Histoembryology, School of Basic Medical Science, Peking University Health Science Center, Beijing, China
| | - Qiyue Yang
- Department of Anatomy and Histoembryology, School of Basic Medical Science, Peking University Health Science Center, Beijing, China
| | - Wenpei Bai
- Department of Gynecology and Obstetrics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Wenjuan Wang
- Department of Anatomy and Histoembryology, School of Basic Medical Science, Peking University Health Science Center, Beijing, China
| | - Yao Li
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Xiaofeng Luo
- Department of Stomatology, General Hospital of Armed Police, Beijing, China
| | - Sinan Wang
- Department of Stomatology, General Hospital of Armed Police, Beijing, China
| | - Jing Jia
- Department of Stomatology, General Hospital of Armed Police, Beijing, China
| | - Ke Wang
- Department of Anatomy and Histoembryology, School of Basic Medical Science, Peking University Health Science Center, Beijing, China
| | - Lihua Qin
- Department of Anatomy and Histoembryology, School of Basic Medical Science, Peking University Health Science Center, Beijing, China
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18
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Prague JK, Abbara A, Comninos AN, Jayasena CN, Higham CE, Adaway J, Keevil BG, Veldhuis JD, Dhillo WS. Neurokinin 3 Receptor Antagonists Do Not Increase FSH or Estradiol Secretion in Menopausal Women. J Endocr Soc 2019; 4:bvz009. [PMID: 32318647 PMCID: PMC7159071 DOI: 10.1210/jendso/bvz009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/13/2019] [Indexed: 01/19/2023] Open
Abstract
Background Neurokinin 3 receptor (NK3R) antagonism is a promising novel treatment for menopausal flashes. However, to avoid adverse hormonal effects it is clinically important to first confirm whether gonadotropin and estradiol concentrations change as a result of their administration. Methods Single-center, randomized, double-blind, placebo-controlled, crossover trial of an oral NK3R antagonist (MLE4901) in 28 women aged 40 to 62 years, experiencing >7 hot flashes/24 h; some bothersome or severe (Clinicaltrials.gov, NCT02668185). Weekly serum gonadotropins and estradiol levels were measured using commercially available automated immunoassays a priori. Serum estradiol was also measured post hoc using a highly sensitive direct assay by liquid chromatography tandem mass spectrometry. Hormone levels were compared by the paired sample t tests or by the Wilcoxon matched-pairs signed rank test, as appropriate for the distribution of the data. Results Mean (standard deviation) serum follicle-stimulating hormone (FSH) concentration was not significantly increased when taking MLE4901 (72.07 ± 19.81 IU/L) compared to placebo (70.03 ± 19.56 IU/L), P = .26. Serum estradiol was also not significantly altered, irrespective of which assay method was used (median interquartile range of serum estradiol by immunoassay: placebo 36 ± 3 pmol/L, MLE4901 36 ± 1 pmol/L, P = .21; median serum highly sensitive estradiol: placebo 12 ± 16 pmol/L, MLE4901 13 ± 15 pmol/L, P = .70). However, mean (standard deviation) serum luteinizing hormone concentration significantly decreased with MLE4901 (27.63 ± 9.76 IU/L) compared to placebo (30.26 ± 9.75 IU/L), P = .0024. Implication NK3R antagonists do not increase serum estradiol or FSH despite their reduction in hot flashes. This is clinically significant and highly reassuring for women who have a contraindication to conventional hormone therapy such as prior/existing breast cancer and/or thromboembolism.
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Affiliation(s)
- Julia K Prague
- Section of Endocrinology & Investigative Medicine, Imperial College, London, UK
| | - Ali Abbara
- Section of Endocrinology & Investigative Medicine, Imperial College, London, UK
| | | | - Channa N Jayasena
- Section of Endocrinology & Investigative Medicine, Imperial College, London, UK
| | - Claire E Higham
- Department of Endocrinology, The Christie NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jo Adaway
- Biochemistry Department, Wythenshawe Hospital, Wythenshawe, UK.,School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Brian G Keevil
- Biochemistry Department, Wythenshawe Hospital, Wythenshawe, UK.,School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Waljit S Dhillo
- Section of Endocrinology & Investigative Medicine, Imperial College, London, UK
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19
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Yin W, Borniger JC, Wang X, Maguire SM, Munselle ML, Bezner KS, Tesfamariam HM, Garcia AN, Hofmann HA, Nelson RJ, Gore AC. Estradiol treatment improves biological rhythms in a preclinical rat model of menopause. Neurobiol Aging 2019; 83:1-10. [PMID: 31585360 DOI: 10.1016/j.neurobiolaging.2019.08.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 01/14/2023]
Abstract
The perimenopausal transition at middle age is often associated with hot flashes and sleep disruptions, metabolic changes, and other symptoms. Whereas the mechanisms for these processes are incompletely understood, both aging (AG) and a loss of ovarian estrogens play contributing roles. Furthermore, the timing of when estradiol (E) treatment should commence and for how long are key clinical questions in the management of symptoms. Using a rat model of surgical menopause, we determined the effects of regimens of E treatment with differing time at onset and duration of treatment on diurnal rhythms of activity and core temperature and on food intake and body weight. Reproductively mature (MAT, ∼4 months) or AG (∼11 months) female rats were ovariectomized, implanted intraperitoneally with a telemetry device, and given either a vehicle (V) or E subcutaneous capsule implantation. Rats were remotely recorded for 10 days per month for 3 (MAT) or 6 (AG) months. To ascertain whether delayed onset of treatment affected rhythms, a subset of AG-V rats had their capsules switched to E at the end of 3 months. Another set of AG-E rats had their capsules removed at 3 months to determine whether beneficial effects of E would persist. Overall, activity and temperature mesor, robustness, and amplitude declined with AG. Compared to V treatment, E-treated rats showed (1) better maintenance of body weight and food intake; (2) higher, more consolidated activity and temperature rhythms; and (3) higher activity and temperature robustness and amplitude. In the AG arm of the study, switching treatment from V to E or E to V quickly reversed these patterns. Thus, the presence of E was the dominant factor in determining stability and amplitude of locomotor activity and temperature rhythms. As a whole, the results show benefits of E treatment, even with a delay, on biological rhythms and physiological functions.
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Affiliation(s)
- Weiling Yin
- Division of Pharmacology and Toxicology, The University of Texas at Austin, Austin, TX, USA
| | - Jeremy C Borniger
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Xutong Wang
- Division of Pharmacology and Toxicology, The University of Texas at Austin, Austin, TX, USA; Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - Sean M Maguire
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - Mercedes L Munselle
- Division of Pharmacology and Toxicology, The University of Texas at Austin, Austin, TX, USA
| | - Kelsey S Bezner
- Division of Pharmacology and Toxicology, The University of Texas at Austin, Austin, TX, USA
| | - Haben M Tesfamariam
- Division of Pharmacology and Toxicology, The University of Texas at Austin, Austin, TX, USA
| | - Alexandra N Garcia
- Psychology Department, The University of Texas at Austin, Austin, TX, USA
| | - Hans A Hofmann
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA; Institute for Neuroscience, The University of Texas at Austin, Austin, TX, USA
| | - Randy J Nelson
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Andrea C Gore
- Division of Pharmacology and Toxicology, The University of Texas at Austin, Austin, TX, USA; Psychology Department, The University of Texas at Austin, Austin, TX, USA; Institute for Neuroscience, The University of Texas at Austin, Austin, TX, USA.
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20
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Odai T, Terauchi M, Hirose A, Kato K, Akiyoshi M, Miyasaka N. Severity of hot flushes is inversely associated with dietary intake of vitamin B 6 and oily fish. Climacteric 2019; 22:617-621. [PMID: 31104511 DOI: 10.1080/13697137.2019.1609440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: This study investigated the links between the severity of vasomotor symptoms (VMS) and the dietary consumption of a variety of nutrients. Method: A cross-sectional analysis of the first-visit records of 262 women aged 40-65 years was conducted. The severity of their hot flushes (HF) and night sweats (NS) and their dietary consumption of nutrients were evaluated using the Menopausal Health-Related Quality of Life Questionnaire and the brief-type self-administered Diet History Questionnaire, respectively. The relationships between severity of HF/NS and dietary intake were analyzed separately for 43 major nutrients. We then evaluated different food items as sources of the nutrients. Results: After adjustment for age, body mass index, menopausal status, and background factors significantly related to VMS, only vitamin B6 (VB6) was significantly related to severity of HF (adjusted odds ratio per 10 μg/MJ in VB6 intake, 0.92; 95% confidence interval, 0.86-0.97). Moreover, a significant inverse relationship was found between the consumption of oily fish as a source of VB6 and the severity of HF. Conclusions: VB6 and oily fish intake is inversely associated with the severity of HF in middle-aged women. Therefore, increased intake of VB6 could help attenuate HF.
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Affiliation(s)
- T Odai
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University , Tokyo , Japan
| | - M Terauchi
- Department of Women's Health, Tokyo Medical and Dental University , Tokyo , Japan
| | - A Hirose
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University , Tokyo , Japan.,Department of Women's Health, Tokyo Medical and Dental University , Tokyo , Japan
| | - K Kato
- Department of Women's Health, Tokyo Medical and Dental University , Tokyo , Japan
| | - M Akiyoshi
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University , Tokyo , Japan
| | - N Miyasaka
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University , Tokyo , Japan
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21
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Krajewski-Hall SJ, Miranda Dos Santos F, McMullen NT, Blackmore EM, Rance NE. Glutamatergic Neurokinin 3 Receptor Neurons in the Median Preoptic Nucleus Modulate Heat-Defense Pathways in Female Mice. Endocrinology 2019; 160:803-816. [PMID: 30753503 PMCID: PMC6424091 DOI: 10.1210/en.2018-00934] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/04/2019] [Indexed: 01/06/2023]
Abstract
We have proposed that arcuate neurons coexpressing kisspeptin, neurokinin B, and dynorphin (KNDy neurons) contribute to hot flushes via projections to neurokinin 3 receptor (NK3R)-expressing neurons in the median preoptic nucleus (MnPO). To characterize the thermoregulatory role of MnPO NK3R neurons in female mice, we ablated these neurons using injections of saporin toxin conjugated to a selective NK3R agonist. Loss of MnPO NK3R neurons increased the core temperature (TCORE) during the light phase, with the frequency distributions indicating a regulated shift in the balance point. The increase in TCORE in the ablated mice occurred despite changes in the ambient temperature and regardless of estrogen status. We next determined whether an acute increase in ambient temperature or higher TCORE would induce Fos in preoptic enhanced green fluorescent protein (EGFP)-immunoreactive neurons in Tacr3-EGFP mice. Fos activation was increased in the MnPO but no induction of Fos was found in NK3R (EGFP-immunoreactive) neurons. Thus, MnPO NK3R neurons are not activated by warm thermosensors in the skin or viscera and are not warm-sensitive neurons. Finally, RNAscope was used to determine whether Tacr3 (NK3R) mRNA was coexpressed with vesicular glutamate transporter 2 or vesicular γ-aminobutyric acid (GABA) transporter mRNA, markers of glutamatergic and GABAergic neurotransmission, respectively. In the MnPO, 94% of NK3R neurons were glutamatergic, but in the adjacent medial preoptic area, 97% of NK3R neurons were GABAergic. Thus, NK3R neurons in the MnPO are glutamatergic and play a role in reducing TCORE but are not activated by warm thermal stimuli (internal or external). These findings suggest that KNDy neurons modulate thermosensory pathways for heat defense indirectly via a subpopulation of glutamatergic MnPO neurons that express NK3R.
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Affiliation(s)
| | | | - Nathaniel T McMullen
- Department of Cellular and Molecular Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Elise M Blackmore
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona
| | - Naomi E Rance
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona
- Department of Cellular and Molecular Medicine, University of Arizona College of Medicine, Tucson, Arizona
- Department of Neurology, University of Arizona College of Medicine, Tucson, Arizona
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, Arizona
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22
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Kanaya M, Iwata K, Ozawa H. Distinct dynorphin expression patterns with low- and high-dose estrogen treatment in the arcuate nucleus of female rats. Biol Reprod 2018; 97:709-718. [PMID: 29069289 DOI: 10.1093/biolre/iox131] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/20/2017] [Indexed: 01/25/2023] Open
Abstract
Kisspeptin (KISS1; encoded by Kiss1) neurons in the arcuate nucleus (ARC) coexpress tachykinin 3 (TAC3; also known as neurokinin B) and dynorphin A (PDYN). Accordingly, they are termed KNDy neurons and considered to be crucial in generating pulsatile release of gonadotropin-releasing hormone. Accumulating evidence suggests that Kiss1 and Tac3 are negatively regulated by estrogen. However, it has not been fully determined whether and how estrogen modulates Pdyn and PDYN. Here, we examined the expression of Pdyn mRNA and PDYN by in situ hybridization and immunohistochemistry, respectively, in the ARC of female rats after ovariectomy (OVX) and OVX plus low- or high-dose beta-estradiol (E2) replacement. We also investigated the effect of E2 on expression of Kiss1, KISS1, Tac3, and TAC3. Furthermore, colocalization of PDYN and estrogen receptor alpha (ESR1) was determined. Subsequently, we found that low-dose E2 treatment had no effect on Pdyn mRNA-expressing cells, but increased PDYN-immunoreactive (ir) cell numbers. In contrast, high-dose E2 treatment resulted in prominent reductions in both Pdyn mRNA-expressing and PDYN-ir cell numbers. Changes induced by low or high doses of E2 were similarly observed in the expression of Kiss1, KISS1, Tac3, and TAC3. The majority of PDYN-ir neurons coexpressed ESR1 in all groups. Our results indicate that E2 regulates the expression of PDYN, as well as KISS1 and TAC3, with regulation by E2 differing according to its levels.
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Affiliation(s)
- Moeko Kanaya
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kinuyo Iwata
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Hitoshi Ozawa
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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23
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Prague JK, Roberts RE, Comninos AN, Clarke S, Jayasena CN, Mohideen P, Lin VH, Stern TP, Panay N, Hunter MS, Webber LC, Dhillo WS. Neurokinin 3 receptor antagonism rapidly improves vasomotor symptoms with sustained duration of action. Menopause 2018; 25:862-869. [PMID: 29533369 PMCID: PMC6092106 DOI: 10.1097/gme.0000000000001090] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Seventy percent of postmenopausal women experience vasomotor symptoms, which can be highly disruptive and persist for years. Hormone therapy and other treatments have variable efficacy and/or side effects. Neurokinin B signaling increases in response to estrogen deficiency and has been implicated in hot flash (HF) etiology. We recently reported that a neurokinin 3 receptor (NK3R) antagonist reduces HF in postmenopausal women after 4 weeks of treatment. In this article we report novel data from that study, which shows the detailed time course of this effect. METHODS Randomized, double-blind, placebo-controlled, single-center, crossover trial of an oral NK3R antagonist (MLE4901) for vasomotor symptoms in women aged 40 to 62 years, experiencing ≥7 HF/24 hours some of which were reported as bothersome or severe (Clinicaltrials.gov NCT02668185). Thirty-seven women were randomized and included in an intention-to-treat analysis. To ascertain the therapeutic profile of MLE4901, a post hoc time course analysis was completed. RESULTS By day 3 of treatment with MLE4901, HF frequency reduced by 72% (95% CI, -81.3 to -63.3%) compared with baseline (51 percentage point reduction compared with placebo, P < 0.0001); this effect size persisted throughout the 4-week dosing period. HF severity reduced by 38% compared with baseline by day 3 (95% CI, -46.1 to -29.1%) (P < 0.0001 compared with placebo), bother by 39% (95% CI, -47.5 to -30.1%) (P < 0.0001 compared with placebo), and interference by 61% (95% CI, -79.1 to -43.0%) (P = 0.0006 compared with placebo); all continued to improve throughout the 4-week dosing period (to -44%, -50%, and -70%, respectively by day 28, all P < 0.0001 compared with placebo). CONCLUSIONS NK3R antagonism rapidly relieves vasomotor symptoms without the need for estrogen exposure.
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Affiliation(s)
- Julia K. Prague
- Department of Investigative Medicine, Imperial College London, United Kingdom
| | - Rachel E. Roberts
- Department of Investigative Medicine, Imperial College London, United Kingdom
| | | | - Sophie Clarke
- Department of Investigative Medicine, Imperial College London, United Kingdom
| | - Channa N. Jayasena
- Department of Investigative Medicine, Imperial College London, United Kingdom
| | | | | | | | - Nicholas Panay
- Department of Gynaecology, Queen Charlotte's & Chelsea Hospital and Chelsea & Westminster Hospital, London, United Kingdom
- Institute of Reproductive and Development Biology, Imperial College London, United Kingdom
| | - Myra S. Hunter
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Lorraine C. Webber
- Emerging Innovations Unit, Scientific Partnering and Alliances, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Waljit S. Dhillo
- Department of Investigative Medicine, Imperial College London, United Kingdom
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24
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Abstract
The thermoregulatory functions may vary with age. Thermosensitivity is active in neonates and children; both heat production and heat loss effector mechanisms are functional but easily exhaustable. Proportional and lasting defense against thermal challenges is difficult, and both hypothermia and hyperthermia may easily develop. Febrile or hypothermic responses to infections or endotoxin can also develop, together with confusion. In small children febrile convulsions may be dangerous. In old age the resting body temperature may be lower than in young adults. Further, thermosensitivity decreases, the thresholds for activating skin vasomotor and evaporative responses or metabolism are shifted, and responses to thermal challenges are delayed or insufficient: both hypothermia and hyperthermia may develop easily. Infection-induced fevers are often limited or absent, or replaced by hypothermia. Various types of brain damage may induce special forms of hypothermia, hyperthermia, or severe fever. Impaired mental state often accompanies hypothermia and hyperthermia, and may occasionally be a dominant feature of infection (instead of the most commonly observed fever). Aging brings about a turning point in women's life: the menopause. The well-known influence of regular hormonal cycles on the thermoregulation of a woman of fertile age gives way to menopausal hot flushes caused by estrogen withdrawal. Not all details of this thermoregulatory anomaly are fully understood yet.
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25
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Krajewski-Hall SJ, Blackmore EM, McMinn JR, Rance NE. Estradiol alters body temperature regulation in the female mouse. Temperature (Austin) 2017; 5:56-69. [PMID: 29687044 DOI: 10.1080/23328940.2017.1384090] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022] Open
Abstract
Hot flushes are due to estrogen withdrawal and characterized by the episodic activation of heat dissipation effectors. Recent studies (in humans and rats) have implicated neurokinin 3 (NK3) receptor signaling in the genesis of hot flushes. Although transgenic mice are increasingly used for biomedical research, there is limited information on how 17β-estradiol and NK3 receptor signaling alters thermoregulation in the mouse. In this study, a method was developed to measure tail skin temperature (TSKIN) using a small data-logger attached to the surface of the tail, which, when combined with a telemetry probe for core temperature (TCORE), allowed us to monitor thermoregulation in freely-moving mice over long durations. We report that estradiol treatment of ovariectomized mice reduced TCORE during the light phase (but not the dark phase) while having no effect on TSKIN or activity. Estradiol also lowered TCORE in mice exposed to ambient temperatures ranging from 20 to 36°C. Unlike previous studies in the rat, estradiol treatment of ovariectomized mice did not reduce TSKIN during the dark phase. Subcutaneous injections of an NK3 receptor agonist (senktide) in ovariectomized mice caused an acute increase in TSKIN and a reduction in TCORE, consistent with the activation of heat dissipation effectors. These changes were reduced by estradiol, suggesting that estradiol lowers the sensitivity of central thermoregulatory pathways to NK3 receptor activation. Overall, we show that estradiol treatment of ovariectomized mice decreases TCORE during the light phase, reduces the thermoregulatory effects of senktide and modulates thermoregulation differently than previously described in the rat.
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Affiliation(s)
- Sally J Krajewski-Hall
- Departments of Pathology (S.J.K-H., E.M.B., J.R.M. and N.E.R.), Cellular and Molecular Medicine (N.E.R.), Neurology (N.E.R.) and the Evelyn F. McKnight Brain Institute (N.E.R.) University of Arizona College of Medicine, Tucson, AZ, USA
| | - Elise M Blackmore
- Departments of Pathology (S.J.K-H., E.M.B., J.R.M. and N.E.R.), Cellular and Molecular Medicine (N.E.R.), Neurology (N.E.R.) and the Evelyn F. McKnight Brain Institute (N.E.R.) University of Arizona College of Medicine, Tucson, AZ, USA
| | - Jessi R McMinn
- Departments of Pathology (S.J.K-H., E.M.B., J.R.M. and N.E.R.), Cellular and Molecular Medicine (N.E.R.), Neurology (N.E.R.) and the Evelyn F. McKnight Brain Institute (N.E.R.) University of Arizona College of Medicine, Tucson, AZ, USA
| | - Naomi E Rance
- Departments of Pathology (S.J.K-H., E.M.B., J.R.M. and N.E.R.), Cellular and Molecular Medicine (N.E.R.), Neurology (N.E.R.) and the Evelyn F. McKnight Brain Institute (N.E.R.) University of Arizona College of Medicine, Tucson, AZ, USA
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26
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Prague JK, Dhillo WS. Treating hot flushes with a neurokinin 3 receptor antagonist. Oncotarget 2017; 8:106153-106154. [PMID: 29290928 PMCID: PMC5739713 DOI: 10.18632/oncotarget.22383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 11/08/2017] [Indexed: 01/05/2023] Open
Affiliation(s)
- Julia K Prague
- Waljit S. Dhillo: Department of Investigative Medicine, Imperial College London, London, UK
| | - Waljit S Dhillo
- Waljit S. Dhillo: Department of Investigative Medicine, Imperial College London, London, UK
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27
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Prague JK, Dhillo WS. Neurokinin 3 receptor antagonism – the magic bullet for hot flushes? Climacteric 2017; 20:505-509. [DOI: 10.1080/13697137.2017.1385598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J. K. Prague
- Department of Investigative Medicine, Imperial College London, London, UK
| | - W. S. Dhillo
- Department of Investigative Medicine, Imperial College London, London, UK
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28
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Krull AA, Larsen SA, Clifton DK, Neal-Perry G, Steiner RA. A Comprehensive Method To Quantify Adaptations by Male and Female Mice With Hot Flashes Induced by the Neurokinin B Receptor Agonist Senktide. Endocrinology 2017; 158:3259-3268. [PMID: 28531316 PMCID: PMC5659681 DOI: 10.1210/en.2017-00142] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/17/2017] [Indexed: 12/27/2022]
Abstract
Vasomotor symptoms (VMS; or hot flashes) plague millions of reproductive-aged men and women who have natural or iatrogenic loss of sex steroid production. Many affected individuals are left without treatment options because of contraindications to hormone replacement therapy and the lack of equally effective nonhormonal alternatives. Moreover, development of safer, more effective therapies has been stymied by the lack of an animal model that recapitulates the hot-flash phenomenon and enables direct testing of hypotheses regarding the pathophysiology underlying hot flashes. To address these problems, we developed a murine model for hot flashes and a comprehensive method for measuring autonomic and behavioral thermoregulation in mice. We designed and constructed an instrument called a thermocline that produces a thermal gradient along which mice behaviorally adapt to a thermal challenge to their core body temperature set point while their thermal preference over time is tracked and recorded. We tested and validated this murine model for VMS by administration of a TRPV1 agonist and a neurokinin B receptor agonist, capsaicin and senktide, respectively, to unrestrained mice and observed their autonomic and behavioral responses. Following both treatments, the mice exhibited a VMS-like response characterized by a drop in core body temperature and cold-seeking behavior on the thermocline. Senktide also caused a rise in tail skin temperature and increased Fos expression in the median preoptic area, a hypothalamic temperature control center. This dynamic model may be used to fully explore the cellular and molecular bases for VMS and to develop and test new therapeutic options.
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Affiliation(s)
- Ashley A. Krull
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington 98195
- Department of Physiology & Biophysics, University of Washington, Seattle, Washington 98195
- Graduate Program in Neuroscience, University of Washington, Seattle, Washington 98195
| | - Sarah A. Larsen
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington 98195
| | - Donald K. Clifton
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington 98195
| | - Genevieve Neal-Perry
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington 98195
| | - Robert A. Steiner
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington 98195
- Department of Physiology & Biophysics, University of Washington, Seattle, Washington 98195
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29
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Prague JK, Roberts RE, Comninos AN, Clarke S, Jayasena CN, Nash Z, Doyle C, Papadopoulou DA, Bloom SR, Mohideen P, Panay N, Hunter MS, Veldhuis JD, Webber LC, Huson L, Dhillo WS. Neurokinin 3 receptor antagonism as a novel treatment for menopausal hot flushes: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389:1809-1820. [PMID: 28385352 PMCID: PMC5439024 DOI: 10.1016/s0140-6736(17)30823-1] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Hot flushes affect 70% of menopausal women and often severely impact physical, psychosocial, sexual, and overall wellbeing. Hormone replacement therapy is effective but is not without risk. Neurokinin B signalling is increased in menopausal women, and has been implicated as an important mediator of hot flushes. METHODS This phase 2, randomised, double-blind, placebo-controlled, single-centre, crossover trial assessed the effectiveness of an oral neurokinin 3 receptor antagonist (MLE4901) on menopausal hot flushes. Eligible participants were healthy women aged 40-62 years, having seven or more hot flushes in every 24 h of which some were reported as being severe or bothersome, who had not had a menstrual period for at least 12 months, and who had not been taking any medication shown to improve menopausal flushes in the preceding 8 weeks. Participants received 4 weeks of MLE4901 (40 mg, orally, twice daily) and placebo (orally, twice daily) in random order separated by a 2 week washout period. Randomisation was completed by a central computer, and participants were allocated to treatment number in numerical order. The primary outcome was the total number of hot flushes during the final week of both treatment periods. Analyses were by intention to treat and per protocol using generalised linear mixed models and standard crossover analysis. All analyses were prespecified in the study protocol. The trial is registered at ClinicalTrials.gov, number NCT02668185. FINDINGS 68 women were screened between Feb 3 and Oct 10, 2016, of which 37 were randomly assigned and included in an intention-to-treat analysis. 28 participants completed the trial and were included in a per-protocol analysis. MLE4901 significantly reduced the total weekly number of hot flushes by 45 percentage points (95% CI 22-67) compared with the placebo (intention-to-treat adjusted means: placebo 49·01 [95% CI 40·81-58·56] vs MLE4901 19·35 [15·99-23·42]; adjusted estimate of difference 29·66 [17·39-42·87], p<0·0001). Treatment was well tolerated. Three participants developed a transaminase rise (alanine aminotransferase 4·5-5·9 times the upper limit of normal) with a normal bilirubin 28 days after starting MLE4901, which normalised within 90 days. INTERPRETATION Treatment with a neurokinin 3 receptor antagonist (MLE4901) could be practice changing as it safely and effectively relieves hot flush symptoms without the need for oestrogen exposure. Larger scale studies of longer duration are now indicated. FUNDING UK Medical Research Council and National Institute for Health Research.
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Affiliation(s)
- Julia K Prague
- Department of Investigative Medicine, Imperial College London, London, UK
| | - Rachel E Roberts
- Department of Investigative Medicine, Imperial College London, London, UK
| | | | - Sophie Clarke
- Department of Investigative Medicine, Imperial College London, London, UK
| | - Channa N Jayasena
- Department of Investigative Medicine, Imperial College London, London, UK
| | - Zachary Nash
- Department of Investigative Medicine, Imperial College London, London, UK
| | - Chedie Doyle
- Department of Investigative Medicine, Imperial College London, London, UK
| | | | - Stephen R Bloom
- Department of Investigative Medicine, Imperial College London, London, UK
| | | | - Nicholas Panay
- Department of Gynaecology, Queen Charlotte's & Chelsea Hospital and Chelsea and Westminster Hospital, London, UK; Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Lorraine C Webber
- Scientific Partnering & Alliances, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Melbourn, UK
| | - Les Huson
- Division of Experimental Medicine, Imperial College London, London, UK
| | - Waljit S Dhillo
- Department of Investigative Medicine, Imperial College London, London, UK.
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30
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Fraser GL, Hoveyda HR, Clarke IJ, Ramaswamy S, Plant TM, Rose C, Millar RP. The NK3 Receptor Antagonist ESN364 Interrupts Pulsatile LH Secretion and Moderates Levels of Ovarian Hormones Throughout the Menstrual Cycle. Endocrinology 2015; 156:4214-25. [PMID: 26305889 DOI: 10.1210/en.2015-1409] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Women's health disorders such as uterine fibroids and endometriosis are currently treated by GnRH modulators that effectively suppress the hypothalamic-pituitary-gonadal axis. The neurokinin-3 receptor (NK3R) is an alternative target with an important role in the modulation of this axis. In this report, we demonstrate that systemic administration of an NK3R antagonist (ESN364) prolongs the LH interpulse interval in ovarectomized ewes and significantly lowers plasma LH and FSH concentrations in castrated nonhuman primates (Macaca fascicularis). Moreover, daily oral dosing of ESN364 throughout the menstrual cycle in M fascicularis lowered plasma estradiol levels in a dose-dependent manner, although nadir levels of estradiol were maintained well above menopausal levels. Nevertheless, estradiol levels during the follicular phase were sufficiently inhibited at all doses to preclude the triggering of ovulation as evidenced by the absence of the LH surge and failure of a subsequent luteal phase rise in plasma progesterone concentrations, consistent with the absence of normal cycle changes in the uterus. Apart from the point at surge, FSH levels were not altered over the course of the menstrual cycle. These effects of ESN364 were reversible upon cessation of drug treatment. Together these data support the proposed role of neurokinin B-NK3R signaling in the control of pulsatile GnRH secretion. Furthermore, in contrast to GnRH antagonists, NK3R antagonists induce a partial suppression of estradiol and thereby offer a viable therapeutic approach to the treatment of ovarian sex hormone disorders with a mitigated risk of menopausal-like adverse events in response to long-term drug exposure.
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Affiliation(s)
- Graeme L Fraser
- Euroscreen SA (G.L.F., H.R.H.), 6041 Gosselies, Belgium; Department of Physiology (I.J.C.), Monash University, Clayton 3800, Victoria, Australia; Department of Obstetrics, Gynecology, and Reproductive Sciences (S.R., T.M.P.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213; Covance Laboratories GmbH (C.R.), 48163 Münster, Germany; Mammal Research Unit (R.P.M.), University of Pretoria and Medical Research Center Receptor Biology Unit, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, 7701 Cape Town, South Africa
| | - Hamid R Hoveyda
- Euroscreen SA (G.L.F., H.R.H.), 6041 Gosselies, Belgium; Department of Physiology (I.J.C.), Monash University, Clayton 3800, Victoria, Australia; Department of Obstetrics, Gynecology, and Reproductive Sciences (S.R., T.M.P.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213; Covance Laboratories GmbH (C.R.), 48163 Münster, Germany; Mammal Research Unit (R.P.M.), University of Pretoria and Medical Research Center Receptor Biology Unit, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, 7701 Cape Town, South Africa
| | - Iain J Clarke
- Euroscreen SA (G.L.F., H.R.H.), 6041 Gosselies, Belgium; Department of Physiology (I.J.C.), Monash University, Clayton 3800, Victoria, Australia; Department of Obstetrics, Gynecology, and Reproductive Sciences (S.R., T.M.P.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213; Covance Laboratories GmbH (C.R.), 48163 Münster, Germany; Mammal Research Unit (R.P.M.), University of Pretoria and Medical Research Center Receptor Biology Unit, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, 7701 Cape Town, South Africa
| | - Suresh Ramaswamy
- Euroscreen SA (G.L.F., H.R.H.), 6041 Gosselies, Belgium; Department of Physiology (I.J.C.), Monash University, Clayton 3800, Victoria, Australia; Department of Obstetrics, Gynecology, and Reproductive Sciences (S.R., T.M.P.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213; Covance Laboratories GmbH (C.R.), 48163 Münster, Germany; Mammal Research Unit (R.P.M.), University of Pretoria and Medical Research Center Receptor Biology Unit, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, 7701 Cape Town, South Africa
| | - Tony M Plant
- Euroscreen SA (G.L.F., H.R.H.), 6041 Gosselies, Belgium; Department of Physiology (I.J.C.), Monash University, Clayton 3800, Victoria, Australia; Department of Obstetrics, Gynecology, and Reproductive Sciences (S.R., T.M.P.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213; Covance Laboratories GmbH (C.R.), 48163 Münster, Germany; Mammal Research Unit (R.P.M.), University of Pretoria and Medical Research Center Receptor Biology Unit, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, 7701 Cape Town, South Africa
| | - Claudia Rose
- Euroscreen SA (G.L.F., H.R.H.), 6041 Gosselies, Belgium; Department of Physiology (I.J.C.), Monash University, Clayton 3800, Victoria, Australia; Department of Obstetrics, Gynecology, and Reproductive Sciences (S.R., T.M.P.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213; Covance Laboratories GmbH (C.R.), 48163 Münster, Germany; Mammal Research Unit (R.P.M.), University of Pretoria and Medical Research Center Receptor Biology Unit, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, 7701 Cape Town, South Africa
| | - Robert P Millar
- Euroscreen SA (G.L.F., H.R.H.), 6041 Gosselies, Belgium; Department of Physiology (I.J.C.), Monash University, Clayton 3800, Victoria, Australia; Department of Obstetrics, Gynecology, and Reproductive Sciences (S.R., T.M.P.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213; Covance Laboratories GmbH (C.R.), 48163 Münster, Germany; Mammal Research Unit (R.P.M.), University of Pretoria and Medical Research Center Receptor Biology Unit, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, 7701 Cape Town, South Africa
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