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Abrams KB, Folger IT, Cullen NA, Wichlinski LJ. Biochemical challenges for testing novel anti-panic drugs in humans. Pharmacol Biochem Behav 2024; 242:173825. [PMID: 39009088 DOI: 10.1016/j.pbb.2024.173825] [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: 05/18/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/17/2024]
Abstract
Current medications for panic disorder each carry significant limitations that indicate the need for novel anxiolytics. The high costs and low success rates of drug development demand that testing trials be efficient. Lab panicogenic challenges in humans allow for the rapid biochemical induction of panic symptoms and hence an efficient means of testing potential anti-panic drugs. This paper describes ideal characteristics of lab panicogens, reviews the validity and utility of various biochemical panicogenic agents, identifies key outcome measures for studies of novel anti-panic drugs, and makes broad recommendations for labs wishing to perform such studies. We conclude by presenting a four-tiered hierarchy of panicogens that matches each against ideal characteristics and reflects our recommendations for their laboratory use.
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Affiliation(s)
- Kenneth B Abrams
- Department of Psychology, Carleton College, United States of America.
| | - Isabel T Folger
- Department of Psychology, Carleton College, United States of America
| | - Nancy A Cullen
- Department of Psychology, Carleton College, United States of America
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Guan X, Cao P. Brain Mechanisms Underlying Panic Attack and Panic Disorder. Neurosci Bull 2024; 40:795-814. [PMID: 37477800 PMCID: PMC11178723 DOI: 10.1007/s12264-023-01088-9] [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: 02/06/2023] [Accepted: 04/23/2023] [Indexed: 07/22/2023] Open
Abstract
Panic disorder is a psychiatric disorder characterized by recurrent panic attacks, with a prevalence of ~ 4% in the general population, causing heavy personal and socioeconomic burdens. The similarities of animal defense responses to clinical panic attack symptoms in humans make it possible to translate neuroanatomical pathways identified in animal studies to panic disorder in humans. Therefore, in this review we first present a basic overview of panic disorder in humans including the main subtypes, models commonly used to trigger panic attacks, related hypotheses, the neurotransmitter systems that may be involved, and the current clinical treatments to give the reader a comprehensive understanding of panic disorder. The animal section introduces the models that trigger panic-like behavior in animals and the brain regions that may be involved, providing insights for future elucidation of the neural circuit mechanisms behind panic attacks.
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Affiliation(s)
- Xuyan Guan
- Tsinghua Institute of Multidisciplinary Biomedical Research, Tsinghua University, Beijing, 102206, China.
- National Institute of Biological Sciences (NIBS), Beijing, 102206, China.
| | - Peng Cao
- Tsinghua Institute of Multidisciplinary Biomedical Research, Tsinghua University, Beijing, 102206, China
- National Institute of Biological Sciences (NIBS), Beijing, 102206, China
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Goettel M, Fuertig R, Mack SR, Just S, Sharma V, Wunder A, den Boer J. Effect of BI 1358894 on Cholecystokinin-Tetrapeptide (CCK-4)-Induced Anxiety, Panic Symptoms, and Stress Biomarkers: A Phase I Randomized Trial in Healthy Males. CNS Drugs 2023; 37:1099-1109. [PMID: 38019356 PMCID: PMC10703963 DOI: 10.1007/s40263-023-01042-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Depression, anxiety, and/or panic disorder are often comorbid and have a complex etiology mediated through the same neuronal network. Cholecystokinin-tetrapeptide (CCK-4), a synthetic analog of the endogenous neuropeptide cholecystokinin (CCK), is thought to be implicated in this network. The CCK-4 challenge model is an accepted method of investigating the pathophysiology of panic and has been shown to mediate neuronal activation via the transient receptor potential canonical (TRPC) ion channels. OBJECTIVES This study aimed to assess the pharmacodynamic effects of BI 1358894, a small-molecule inhibitor of TRPC ion channel members 4 and 5 (TRPC4/5), on CCK-4-induced anxiety/panic-like symptoms and evaluate circuit engagement. METHODS Twenty healthy male CCK-4-sensitive volunteers entered a Phase I, double blind, randomized, two-way cross-over, single dose, placebo-controlled trial. Randomization was to oral BI 1358894 100 mg in the fed state followed by oral placebo in the fed state, or vice versa. Treatments were administered 5 h prior to intravenous CCK-4 50 µg. The primary endpoint was maximum change from baseline of the Panic Symptom Scale (PSS) sum intensity score after CCK-4 injection. Further endpoints included the emotional faces visual analog score (EVAS), the Spielberger State-Trait Anxiety Inventory (STAI), plasma adrenocorticotropic hormone (ACTH), and serum cortisol values. The safety and tolerability of BI 1358894 was assessed based on a number of parameters including occurrence of adverse events (AEs). All pharmacodynamic, pharmacokinetic, and safety endpoints were analyzed using descriptive statistics. RESULTS Single oral doses of BI 1358894 were generally well tolerated by the healthy male volunteers included in this study. Adjusted mean maximum change from baseline in PSS sum intensity score was 24.4 % lower in volunteers treated with BI 1358894 versus placebo, while adjusted mean maximum change from baseline of EVAS was reduced by 19.2 % (BI 1358894 vs placebo). The STAI total score before CCK-4 injection was similar in both groups (placebo: 25.1; BI 1358894: 24.3). Relative to placebo, BI 1358894 reduced CCK-4-induced mean maximum plasma ACTH and serum cortisol values by 58.6 % and 27.3 %, respectively. Investigator-assessed drug-related AEs were reported for 13/20 participants (65.0 %). There were no serious or severe AEs, AEs of special interest, AEs leading to discontinuation of trial medication, or deaths. CONCLUSIONS Overall, BI 1358894 reduced psychological and physiological responses to CCK-4 compared with placebo, as measured by PSS, subjective EVAS and objectively measured stress biomarkers. BI 1358894 had a positive safety profile, and single oral doses were well tolerated by the healthy volunteers. This trial (NCT03904576/1402-0005) was registered on Clinicaltrials.gov on 05.04.19.
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Affiliation(s)
- Markus Goettel
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Str. 65, 88400, Biberach an der Riss, Germany.
| | - Rene Fuertig
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Str. 65, 88400, Biberach an der Riss, Germany
| | - Salome Rebecca Mack
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Str. 65, 88400, Biberach an der Riss, Germany
| | - Stefan Just
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Str. 65, 88400, Biberach an der Riss, Germany
| | - Vikas Sharma
- Boehringer Ingelheim International GmbH, Ingelheim-am-Rhein, Germany
| | - Andreas Wunder
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Str. 65, 88400, Biberach an der Riss, Germany
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Müller JC, Walter C, Leibold N, Wiedemann K, Kellner M, Demiralay C. Copeptin response to panic provocation with CO 2 in healthy adults. J Psychiatr Res 2023; 165:225-232. [PMID: 37517243 DOI: 10.1016/j.jpsychires.2023.07.006] [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: 05/28/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023]
Abstract
Repeated panic attacks are the core symptom of panic disorder and severely stressful for patients. Additional to the psychological response, the physiological symptoms are an important aspect of the experienced panic. However, data on the extent of hypothalamic-pituitary-adrenal (HPA)-axis activation during panic attacks is inconsistent. Therefore, in the present study, we aimed at investigating the stress-axis activity in more detail by including Copeptin (CoP) as a stable surrogate parameter for the vasopressinergic hypothalamic activity during experimentally induced panic attacks in healthy adults (N = 21). During a placebo-controlled panic challenge with 35% CO2 compared to normal air inhalation, we measured CoP and the peripheral effector hormones Adrenocorticotropic Releasing Hormone (ACTH) and cortisol in plasma along with the psychological response to panic anxiety. We analyzed hormonal secretion patterns, their correlations and individual panic ratings over time and explored differences between female and male participants. We found a significant CO2-induced increase of CoP plasma levels and psychological panic symptoms after CO2-administration, while no positive correlations of CoP levels with the peripheral HPA-axis hormones and with panic symptoms were present. No differences between female and male participants concerning their psychological response nor their baseline CoP levels, the release of CoP or its increase during the experiment were found. CoP could be a sensitive indicator for an organism's physiologic acute hypothalamic response during stress and panic attacks.
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Affiliation(s)
- Jana Christina Müller
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martini Straße 52, 20251, Hamburg, Germany.
| | - Charlotte Walter
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martini Straße 52, 20251, Hamburg, Germany
| | - Nicole Leibold
- Department of Psychiatry and Neuropsychology, Maastricht University, P.O. Box 616 (location Vijverdal), 6200, MD, Maastricht, Netherlands
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martini Straße 52, 20251, Hamburg, Germany
| | - Michael Kellner
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martini Straße 52, 20251, Hamburg, Germany; Department of Psychiatry and Psychotherapy, University Hospital rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, München, Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martini Straße 52, 20251, Hamburg, Germany; Oberberg Tagesklinik Hamburg, Hermannstraße, 20095, Hamburg, Germany
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Moser S, Martins J, Czamara D, Lange J, Müller-Myhsok B, Erhardt A. DNA-methylation dynamics across short-term, exposure-containing CBT in patients with panic disorder. Transl Psychiatry 2022; 12:46. [PMID: 35105872 PMCID: PMC8807826 DOI: 10.1038/s41398-022-01802-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/04/2022] [Accepted: 01/12/2022] [Indexed: 11/09/2022] Open
Abstract
Interaction of genetic predispositions and environmental factors via epigenetic mechanisms have been hypothesized to play a central role in Panic Disorder (PD) aetiology and therapy. Cognitive Behavioral Therapy (CBT), including exposure interventions, belong to the most efficient treatments of PD although its biological mechanism of action remains unknown. For the first time, we explored the dynamics and magnitude of DNA-methylation and immune cell-type composition during CBT (n = 38) and the therapeutic exposure intervention (n = 21) to unravel their biological correlates and identify possible biomarkers of therapy success. We report transient regulation of the CD4 + T-Cells, Natural Killers cells, Granulocytes during exposure and a significant change in the proportions of CD4 + T cells, CD8 + T cells and B-Cells and Granulocytes during therapy. In an epigenome-wide association study we identified cg01586609 located in a CpG island and annotated to the serotonin receptor 3 A (HTR3A) to be differentially methylated during fear exposure and regulated at gene expression level with significant differences between remitters and non-remitters (p = 0.028). We moreover report cg01699630 annotated to ARG1 to undergo long lasting methylation changes during therapy (paired t test, genome-wide adj.p value = 0.02). This study reports the first data-driven biological candidates for epigenetically mediated effects of acute fear exposure and CBT in PD patients. Our results provide evidence of changes in the serotonin receptor 3 A methylation and expression during fear exposure associated with different long-term CBT trajectories and outcome, making it a possible candidate in the search of markers for therapy success. Finally, our results add to a growing body of evidence showing immune system changes associated with PD.
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Affiliation(s)
- Sylvain Moser
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany. .,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany.
| | - Jade Martins
- grid.419548.50000 0000 9497 5095Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Darina Czamara
- grid.419548.50000 0000 9497 5095Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Jennifer Lange
- grid.419548.50000 0000 9497 5095Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Bertram Müller-Myhsok
- grid.419548.50000 0000 9497 5095Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany ,grid.10025.360000 0004 1936 8470Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Angelika Erhardt
- grid.419548.50000 0000 9497 5095Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany ,grid.8379.50000 0001 1958 8658Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
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Lactate infusion as therapeutical intervention: a scoping review. Eur J Pediatr 2022; 181:2227-2235. [PMID: 35304646 PMCID: PMC9110504 DOI: 10.1007/s00431-022-04446-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 02/02/2023]
Abstract
UNLABELLED Traditionally, clinicians consider lactate as a waste product of anaerobic glycolysis. Interestingly, research has shown that lactate may serve as an alternative fuel for the brain to protect it against harm. The increasing scientific awareness of the potential beneficial side of lactate, however, is entering the clinic rather slowly. Following this, and realizing that the application of potential novel therapeutic strategies in pediatric populations often lags behind the development in adults, this review summarizes the key data on therapeutic use of intravenous infusion of sodium lactate in humans. PubMed and clinicaltrial.gov were searched up until November 2021 focusing on interventional studies in humans. Thirty-four articles were included in this review, with protocols of lactate infusion in adults with diabetes mellitus, traumatic brain injury, Alzheimer's disease, and cardiac disease. One study on lactate infusion in children was also included. Results of our literature search show that sodium lactate can be safely administrated, without major side effects. Additionally, the present literature clearly shows the potential benefits of therapeutic lactate infusion under certain pathological circumstances, including rather common clinical conditions like traumatic brain injury. CONCLUSION This review shows that lactate is a save, alternative energy source for the adult brain warranting studies on the potential therapeutic effects of sodium lactate infusion in children. WHAT IS KNOWN • Lactate is generally considered a waste product of anaerobic glycolysis. However, lactate also is an alternative fuel for different organs, including the brain. • Lactate infusion is not incorporated in standard care for any patient population. WHAT IS NEW • Thirty-four studies investigated the therapeutic use of intravenous sodium lactate in different patient populations, all with different study protocols. • Literature shows that lactate infusion may have beneficial effects in case of hypoglycemia, traumatic brain injury, and cardiac failure without the risk of major side effects.
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Role of PPARs in Progression of Anxiety: Literature Analysis and Signaling Pathways Reconstruction. PPAR Res 2020; 2020:8859017. [PMID: 33312191 PMCID: PMC7721491 DOI: 10.1155/2020/8859017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/26/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
Peroxisome proliferator-activated receptor (PPAR) group includes three isoforms encoded by PPARG, PPARA, and PPARD genes. High concentrations of PPARs are found in parts of the brain linked to anxiety development, including hippocampus and amygdala. Among three PPAR isoforms, PPARG demonstrates the highest expression in CNS, where it can be found in neurons, astrocytes, and glial cells. Herein, the highest PPARG expression occurs in amygdala. However, little is known considering possible connections between PPARs and anxiety behavior. We reviewed possible connections between PPARs and anxiety. We used the Pathway Studio software (Elsevier). Signal pathways were created according to previously developed algorithms. SNEA was performed in Pathway Studio. Current study revealed 14 PPAR-regulated proteins linked to anxiety. Possible mechanism of PPAR involvement in neuroinflammation protection is proposed. Signal pathway reconstruction and reviewing aimed to reveal possible connection between PPARG and CCK-ergic system was conducted. Said analysis revealed that PPARG-dependent regulation of MME and ACE peptidase expression may affect levels of nonhydrolysed, i.e., active CCK-4. Impairments in PPARG regulation and following MME and ACE peptidase expression impairments in amygdala may be the possible mechanism leading to pathological anxiety development, with brain CCK-4 accumulation being a key link. Literature data analysis and signal pathway reconstruction and reviewing revealed two possible mechanisms of peroxisome proliferator-activated receptors involvement in pathological anxiety: (1) cytokine expression and neuroinflammation mechanism and (2) regulation of peptidases targeted to anxiety-associated neuropeptides, primarily CCK-4, mechanism.
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Kellner M, Zwanzger P, Rupprecht R, Eser D, Yassouridis A, Wiedemann K. Copeptin in CCK-4-induced panic in healthy man: Sexual dimorphisms in secretion pattern and panic response, but no correlation of copeptin with panic symptoms. Psychoneuroendocrinology 2019; 110:104433. [PMID: 31525566 DOI: 10.1016/j.psyneuen.2019.104433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
Copeptin, the C-terminal part of the hypothalamic arginine vaspopressin (AVP) precursor, closely mirrors the production of AVP and was proposed as an easily measured novel marker of the individual stress level in man. First data in male volunteers proposed copeptin as a potential endocrine surrogate marker of cholecystokinin-tetrapeptide (CCK-4)-induced panic. We tried to replicate these pilot data and to extend them to the other sex. 46 healthy human subjects (29 men, 17 women) were given an intravenous bolus of 50 μg CCK-4. Basal and stimulated plasma copeptin was measured and panic symptoms were assessed using the Acute Panic Inventory (API). Basal copeptin was significantly lower in women vs. men, while men showed a significantly higher CCK-4-induced increase of copeptin. In contrast, female subjects displayed a signifcantly higher increase of API ratings by CCK-4. No significant correlations of panic symptoms and copeptin release induced by CCK-4 could be found, neither in man, nor in women, nor in the total sample. A sexual dimorphism in copeptin secretion and in panic response was demonstrated. Prior unexpected findings of copeptin release as an objective read-out of panic could not be replicated. The role of the vasopressinergic system in panic anxiety needs further study in panic patients and in healthy man, using also other panic provocation paradigms.
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Affiliation(s)
- Michael Kellner
- University Medical Center Hamburg-Eppendorf, Dept. of Psychiatry and Psychotherapy, Hamburg, Germany; Herford Hospital, Dept. of Psychiatry, Psychotherapy & Psychosomatics, Herford, Germany.
| | - Peter Zwanzger
- kbo-Inn-Salzach-Hospital, Wasserburg am Inn, Germany; Ludwig Maximilian University, Dept. of Psychiatry and Psychotherapy, Munich, Germany
| | - Rainer Rupprecht
- University of Regensburg, Dept. of Psychiatry and Psychotherapy, Regensburg, Germany
| | - Daniela Eser
- Ludwig Maximilian University, Dept. of Psychiatry and Psychotherapy, Munich, Germany
| | | | - Klaus Wiedemann
- University Medical Center Hamburg-Eppendorf, Dept. of Psychiatry and Psychotherapy, Hamburg, Germany
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Intermittent living; the use of ancient challenges as a vaccine against the deleterious effects of modern life - A hypothesis. Med Hypotheses 2018; 120:28-42. [PMID: 30220336 DOI: 10.1016/j.mehy.2018.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/25/2018] [Accepted: 08/04/2018] [Indexed: 12/19/2022]
Abstract
Chronic non-communicable diseases (CNCD) are the leading cause of mortality in developed countries. They ensue from the sum of modern anthropogenic risk factors, including high calorie nutrition, malnutrition, sedentary lifestyle, social stress, environmental toxins, politics and economic factors. Many of these factors are beyond the span of control of individuals, suggesting that CNCD are inevitable. However, various studies, ours included, show that the use of intermittent challenges with hormetic effects improve subjective and objective wellbeing of individuals with CNCD, while having favourable effects on immunological, metabolic and behavioural indices. Intermittent cold, heat, fasting and hypoxia, together with phytochemicals in multiple food products, have widespread influence on many pathways related with overall health. Until recently, most of the employed challenges with hormetic effects belonged to the usual transient live experiences of our ancestors. Our hypothesis; we conclude that, whereas the total inflammatory load of multi-metabolic and psychological risk factors causes low grade inflammation and aging, the use of intermittent challenges, united in a 7-10 days lasting hormetic intervention, might serve as a vaccine against the deleterious effects of chronic low grade inflammation and it's metabolic and (premature) aging consequences.
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Jahangard L, Solgy R, Salehi I, Taheri SK, Holsboer-Trachsler E, Haghighi M, Brand S. Cholecystokinin (CCK) level is higher among first time suicide attempters than healthy controls, but is not associated with higher depression scores. Psychiatry Res 2018; 266:40-46. [PMID: 29803785 DOI: 10.1016/j.psychres.2018.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/26/2018] [Accepted: 05/11/2018] [Indexed: 11/19/2022]
Abstract
Suicide and suicide attempts are dramatic events for both the individuals concerned and for their social environments. Efforts have been made to identify reliable biological predictors of suicide and suicide attempts. In the present study, we focused on one potential marker, cholecystokinin (CCK), among first time suicide attempters. A total of 25 suicide attempters (mean age: 30 years; 80% females) and 23 healthy controls were enrolled in the present cross-sectional study. Experts rated participants' symptoms of depression (Hamilton Depression Rating Scale; HDRS). Blood levels of CCK levels were assessed. Suicide attempters had CCK levels 22.67 times higher and HDRS scores 14.33 higher than healthy controls. CCK levels were only weakly associated with HDRS scores. CCK appears to be a fairly reliable biomarker for suicide attempts. However, CCK levels were not associated with depression scores, making it difficult to match biological markers to depressive behaviour.
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Affiliation(s)
- Leila Jahangard
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rahmat Solgy
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Iraj Salehi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Kazem Taheri
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Edith Holsboer-Trachsler
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland
| | - Mohammad Haghighi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Serge Brand
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland; University of Basel, Department of Sport, Exercise, and Health, Division of Sport and Psychosocial Health, Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Psychiatry Department, Substance Abuse Prevention Research Center and Sleep Disorders Research Center, Kermanshah, Iran.
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Kellner M, Muhtz C, Nowack S, Leichsenring I, Wiedemann K, Yassouridis A. Effects of 35% carbon dioxide (CO 2) inhalation in patients with post-traumatic stress disorder (PTSD): A double-blind, randomized, placebo-controlled, cross-over trial. J Psychiatr Res 2018; 96:260-264. [PMID: 29128558 DOI: 10.1016/j.jpsychires.2017.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/25/2017] [Accepted: 10/27/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with post-traumatic stress disorder (PTSD) two open pilot studies about the effects of 35% carbon dioxide (CO2) exist. One shows an augmented panicogenic and anxiogenic response (Muhtz et al., 2011), the other does not (Talesnik et al. 2007). We further characterized the CO2 reactivity in PTSD using for the first time placebo-controlled and double-blind conditions. METHODS In 20 patients with PTSD we assessed panic, anxiety, dissociative and PTSD symptoms after a single vital capacity inhalation of 35% CO2 compared to a placebo gas condition in a within-participant cross-over, placebo-controlled, double-blind and randomized design. RESULTS Inhalation of 35% CO2 versus placebo provoked significantly increased panic, anxiety, dissociative and PTSD symptoms. The reaction to placebo gas was minimal. Order of inhalation, patients' sex or age did not influence the results. The panic and anxiety response under CO2 was considerably higher in the PTSD patients than in healthy controls from our previous open study. CONCLUSIONS The results corroborate that our preceding findings of an increased CO2 reactivity in patients with PTSD are not false positive due to the open design or the lack of placebo control. Replication in a larger number of PTSD patients and matched control subjects is needed. The potential role of childhood traumatisation, psychiatric comorbidity, psychotropic medication and trait dissociation in prior contradictory reports should be clarified.
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Affiliation(s)
- Michael Kellner
- University Hospital Hamburg-Eppendorf, Dept. of Psychiatry and Psychotherapy, Martinistrasse 52, 20246 Hamburg, Germany; Hospital Herford, Dept. of Psychiatry, Psychotherapy and Psychosomatics, Schwarzenmoorstraße 70, 32049 Herford, Germany.
| | - Christoph Muhtz
- University Hospital Hamburg-Eppendorf, Dept. of Psychiatry and Psychotherapy, Martinistrasse 52, 20246 Hamburg, Germany; Schön Hospital Hamburg Eilbek, Department of Psychosomatics, Dehnhaide 120, 22081 Hamburg, Germany
| | - Sven Nowack
- University Hospital Hamburg-Eppendorf, Dept. of Psychiatry and Psychotherapy, Martinistrasse 52, 20246 Hamburg, Germany
| | - Irina Leichsenring
- University Hospital Hamburg-Eppendorf, Dept. of Psychiatry and Psychotherapy, Martinistrasse 52, 20246 Hamburg, Germany
| | - Klaus Wiedemann
- University Hospital Hamburg-Eppendorf, Dept. of Psychiatry and Psychotherapy, Martinistrasse 52, 20246 Hamburg, Germany
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Demiralay C, Agorastos A, Yassouridis A, Jahn H, Wiedemann K, Kellner M. Copeptin - A potential endocrine surrogate marker of CCK-4-induced panic symptoms? Psychoneuroendocrinology 2017; 76:14-18. [PMID: 27871026 DOI: 10.1016/j.psyneuen.2016.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 11/05/2016] [Accepted: 11/05/2016] [Indexed: 11/24/2022]
Abstract
Intravenous cholecystokinin-tetrapeptide (CCK-4) administration reliably and dose-dependently provokes panic anxiety in man, accompanied by adrenocorticotropic hormone (ACTH) and cortisol release. Preclinical findings suggest that behavioral and endocrine effects of CCK-4 are mediated via corticotropin-releasing hormone (CRH) release. Anxiogenic stimulation of the central CCK-receptors in man was shown to increase as well vasopressin (AVP), which acts synergistically with CRH as pituitary-adrenocortical axis stimulator during stress. Copeptin (CoP), the C-terminal part of pre-pro-AVP, is released in an equimolar ratio to AVP. It is more stable in the circulation and easier to determine than AVP and it was found to closely mirror the production of AVP. So far, CoP secretion has not been characterized during panic provocation. In 30 healthy male human subjects, we repeatedly measured CoP in plasma during a panic challenge and studied its correlation to Acute Panic Inventory (API) ratings and plasma ACTH and cortisol. CoP levels correlated positively with the increase in API ratings (r=0.41, p=0.03), while ACTH or cortisol did not (r=0.08, p=0.68 and r=0.12, p=0.53, respectively). CoP levels correlated also positively with ACTH (r=0.48, p=0.009) and cortisol (r=0.48, p=0.01) concentrations throughout the CCK-4 challenge. As expected, we found a positive correlation between plasma ACTH and cortisol levels (r=0.57, p=0.001). A vasopressinergic activation during CCK-4 induced panic was demonstrated, which was correlated positively to panic symptoms and pituitary-adrenocortical release. Our findings suggest a role of CoP as a potential surrogate marker of CCK-4 panic symptoms. Further studies are needed to replicate our results and to further clarify the role of CoP as a stress-sensitive hormone in different panic paradigms as well as in panic patients.
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Affiliation(s)
- Cüneyt Demiralay
- University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany.
| | - Agorastos Agorastos
- University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | | | - Holger Jahn
- University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Klaus Wiedemann
- University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Michael Kellner
- University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
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Sant’Ana AB, Weffort LF, de Oliveira Sergio T, Gomes RC, Frias AT, Matthiesen M, Vilela-Costa HH, Yamashita PSDM, Vasconcelos AT, de Bortoli V, Del-Ben CM, Zangrossi H. Panic-modulating effects of alprazolam, moclobemide and sumatriptan in the rat elevated T-maze. Behav Brain Res 2016; 315:115-22. [DOI: 10.1016/j.bbr.2016.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 01/10/2023]
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Agorastos A, Kellner M, Stiedl O, Muhtz C, Wiedemann K, Demiralay C. Blunted autonomic reactivity to pharmacological panic challenge under long-term escitalopram treatment in healthy men. Int J Neuropsychopharmacol 2014; 18:pyu053. [PMID: 25522396 PMCID: PMC4376541 DOI: 10.1093/ijnp/pyu053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Central serotonergic pathways influence brain areas involved in vagal cardiovascular regulation and, thereby, influence sympathetic efferent activity. Selective serotonin reuptake inhibitors (SSRIs) affect multiple serotonergic pathways, including central autonomic pathways. However, only a few studies have assessed SSRI-mediated effects on autonomic reactivity in healthy individuals using heart rate variability (HRV). METHODS The present study assessed the influence of long-term treatment with escitalopram (ESC) on autonomic reactivity to an intravenous application of 50 µg cholecystokinin tetrapeptide (CCK-4) in 30 healthy young men using a double-blind, placebo (PLA)-controlled, randomized, within-subject cross-over design. Main outcome measures were time- and frequency-domain HRV parameters, assessed at both baseline and immediately after CCK-4 application. RESULTS Results showed substantial effects for the treatment × CCK-4 challenge interaction with respect to heart rate (p < 0.001; pη(2) = 0.499), SDNN (p < 0.001; pη(2) = 576), RMSSD (p = 0.015; pη(2) = 194), NN50% (p = 0.008; pη(2) = 0.224), and LF% (p = 0.014; pη(2) = 0.196), and moderate effects with respect HF% (p = 0.099; pη(2) = 0.094), with PLA subjects showing a higher increase in HR and SDNN and a higher decrease in RMSSD, NN50, LF and HF than subjects in the ESC condition. Thus, ESC treatment significantly blunted the autonomic reactivity to CCK-4. Secondary analysis indicated no effect of the 5-HTTLPR polymorphism on CCK-4-induced autonomic response. CONCLUSIONS Our results support findings suggesting an effect of SSRI treatment on autonomic regulation and provide evidence that ESC treatment is associated with blunted autonomic reactivity in healthy men.
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Affiliation(s)
- Agorastos Agorastos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz).
| | - Michael Kellner
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Oliver Stiedl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Christoph Muhtz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
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Paul ED, Johnson PL, Shekhar A, Lowry CA. The Deakin/Graeff hypothesis: focus on serotonergic inhibition of panic. Neurosci Biobehav Rev 2014; 46 Pt 3:379-96. [PMID: 24661986 PMCID: PMC4170046 DOI: 10.1016/j.neubiorev.2014.03.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/15/2014] [Accepted: 03/01/2014] [Indexed: 12/20/2022]
Abstract
The Deakin/Graeff hypothesis proposes that different subpopulations of serotonergic neurons through topographically organized projections to forebrain and brainstem structures modulate the response to acute and chronic stressors, and that dysfunction of these neurons increases vulnerability to affective and anxiety disorders, including panic disorder. We outline evidence supporting the existence of a serotonergic system originally discussed by Deakin/Graeff that is implicated in the inhibition of panic-like behavioral and physiological responses. Evidence supporting this panic inhibition system comes from the following observations: (1) serotonergic neurons located in the 'ventrolateral dorsal raphe nucleus' (DRVL) as well as the ventrolateral periaqueductal gray (VLPAG) inhibit dorsal periaqueductal gray-elicited panic-like responses; (2) chronic, but not acute, antidepressant treatment potentiates serotonin's panicolytic effect; (3) contextual fear activates a central nucleus of the amygdala-DRVL/VLPAG circuit implicated in mediating freezing and inhibiting panic-like escape behaviors; (4) DRVL/VLPAG serotonergic neurons are central chemoreceptors and modulate the behavioral and cardiorespiratory response to panicogenic agents such as sodium lactate and CO2. Implications of the panic inhibition system are discussed.
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Affiliation(s)
- Evan D Paul
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA.
| | - Philip L Johnson
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA.
| | - Anantha Shekhar
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA.
| | - Christopher A Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA.
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The 5-HTTLPR genotype modulates heart rate variability and its adjustment by pharmacological panic challenge in healthy men. J Psychiatr Res 2014; 50:51-8. [PMID: 24342768 DOI: 10.1016/j.jpsychires.2013.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/25/2013] [Accepted: 11/29/2013] [Indexed: 01/01/2023]
Abstract
Abnormal serotonin transporter (5-HTT) function and autonomic nervous system (ANS) dysregulation has been proposed in panic disorder. However, in contrast to hypothalamo-pituitary-adrenocortical (HPA) functioning, ANS reactivity during panic response has yet not been investigated in humans with respect to the 5-HTT genotype. The present study assessed the influence of challenging by cholecystokinin tetrapeptide (CCK-4) on heart rate variability (HRV) measures, to monitor autonomic reactivity and its relationship to 5-HTT-linked polymorphic region (5-HTTLPR) genotypes. We hypothesized substantial effects of the 5-HTTLPR genotype on autonomic reactivity. We studied 30 healthy young men, 15 of each with the long/long (l/l) or short/short (s/s) genotype for the 5-HTTLPR. All participants received an intravenous application of 50 μg CCK-4. HRV measures were assessed in both groups at baseline and immediately after CCK-4 application. Our results indicated lower parasympathetic activity in s/s carriers during baseline, time and frequency domain measures. CCK-4 application significantly enhanced the sympathetic tone in both groups, leading to diminished group differences. A significant treatment by genotype effect indicated reduced autonomic reactivity to CCK-4 challenge in the s/s compared to l/l carriers. Our findings show enhanced sympathetic and/or diminished cardiac vagal activity under basal conditions and blunted autonomic reactivity in s/s vs. l/l carriers. Our study provides novel data supporting claims that the s/s genotype represents a genetic vulnerability factor associated with inadequate hyporeactivity to stress and extends current knowledge on the impact of the central serotonergic activity on the sympathoadrenal pathway.
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Moreira FA, Gobira PH, Viana TG, Vicente MA, Zangrossi H, Graeff FG. Modeling panic disorder in rodents. Cell Tissue Res 2013; 354:119-25. [DOI: 10.1007/s00441-013-1610-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 03/06/2013] [Indexed: 10/27/2022]
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