Increased hippocampal volume and gene expression following cognitive behavioral therapy in PTSD

Polysaccharides from Polygonatum cyrtonema Hua prevent post-traumatic stress disorder behaviors in mice: Mechanisms from the perspective of synaptic injury, oxidative stress, and neuroinflammation

ETHNOPHARMACOLOGICAL RELEVANCE

According to traditional Chinese medicine (TCM) theory, post-traumatic stress disorder (PTSD) is a kind of depression syndrome, and its occurrence is related to deficiencies of the heart and kidney. Polygonatum cyrtonema Hua replenishes Qi and blood and tonifies the five zang organs, so it is widely used in TCM as a prescription for the treatment of depression syndrome. The polysaccharides in P. cyrtonema Hua (PSP) are the main active components of the herb, but the effects of PSP on PTSD and the mechanisms remain unclear.

AIM OF THE STUDY

To investigate the preventive effect of PSP on PTSD-like behaviors and to determine the mechanisms.

METHODS

We used behavioral tests to evaluate PTSD-like behaviors in mice. Synaptic changes were assessed by transmission electron microscopy. Hematoxylin-eosin staining was used to assess pathological changes to the hippocampus, and immunofluorescence staining was used to observe changes in astrocytes. Serum corticosterone (CORT), cytokine, and hippocampal oxidation-related indicator levels were evaluated by ELISA. We detected the expression levels of synaptic, oxidative, and inflammation-related proteins in the hippocampus by western blotting.

RESULTS

Single prolonged stress (SPS)-modeled mice exhibited significant PTSD-like phenotypes, including increased fear memory acquisition and anxiety-like behaviors. These behavioral changes were prevented by PSP administration. Compared to controls, SPS modeling increased serum CORT, cytokine, and hippocampal malondialdehyde levels; decreased superoxide dismutase activity; and caused losses in pyramidal neurons, astrocytes, and synapses in the CA1 region. At the molecular level, the expression of brain-derived neurotrophic factor, postsynaptic density protein 95, nuclear factor erythroid 2-related factor 2 (Nrf2), phospho-tyrosine kinase receptor B, activity-regulated cytoskeleton-associated protein, heme oxygenase-1 (HO-1), and GluA1 decreased in SPS mice compared with the control group, while the expression of NOD-like receptor protein 3 (NLRP3), GluN2B, and apoptosis-associated speck-like protein increased in SPS mice. Treatment with PSP counteracted these abnormal changes. Importantly, ML385, an Nrf2 inhibitor, blocked PSP's ability to ameliorate PTSD behaviors and abnormal protein expression. The NLRP3 inhibitor MCC950 reduced the PTSD-like behaviors and normalized protein expression in SPS mice.

CONCLUSION

PSP prevents SPS-induced PTSD-like behaviors and synaptic damage by regulating oxidative stress and NLRP3-mediated inflammation, probably in an Nrf2/HO-1 signaling pathway-dependent manner.

Depression in post-traumatic stress disorder

Major depressive disorder (MDD) symptoms commonly occur after trauma-exposure, both alone and in combination with post-traumatic stress disorder (PTSD). This article reviews recent research on comorbidity between these disorders, including its implications for symptom severity and response to treatment. Despite considerable symptom overlap, the two disorders represent distinct constructs and depend, at least in part, on separate biological mechanisms. Both, however, are also clearly related to stress psychopathology. We recommend that more research focus specifically on the study of individual differences in symptom expression in order to identify distinct subgroups of individuals and develop targeted treatments. However, a barrier to this line of inquiry is the trend of excluding particular patients from clinical trials of new interventions based on symptom severity or comorbidity. Another obstacle is the overreliance on self-report measures in human research. We argue that developing computer-based behavioral measures in order to supplement self-report can help address this challenge. Furthermore, we propose that these measures can help tie findings from human and non-human animal research. A number of paradigms have been used to model MDD-and PTSD-like behavior in animals. These models remain valuable for understanding the biological basis of these disorders in humans and for identifying potential interventions, but they have been underused for the study of comorbidity. Although the interpretation of animal behavior remains a concern, we propose that this can also be overcome through the development of close human analogs to animal paradigms.

Plasminogen Activator Inhibitor-1 (PAI-1) deficiency predisposes to depression and resistance to treatments

Major depressive disorder (MDD) is one of the most frequent psychiatric illnesses, leading to reduced quality of life, ability to work and sociability, thus ranking among the major causes of disability and morbidity worldwide. To date, genetic and environmental determinants of MDD remain mostly unknown. Here, we investigated whether and how the Plasminogen Activator Inhibitor-1 (PAI-1) may contribute to MDD. We first examined the phenotype of PAI-1 knockout (PAI-1−/−) and wild-type (PAI-1+/+) male mice with a range of behavioral tests assessing depressive-like behaviors (n = 276). We next investigated the mechanisms relating PAI-1 to MDD using molecular, biochemical and pharmacological analyzes. We demonstrate here that PAI-1 plays a key role in depression by a mechanism independent of the tissue-type Plasminogen Activator (tPA) – Brain-Derived Neurotrophic Factor (BDNF) axis, but associated with impaired metabolisms of serotonin and dopamine. Our data also reveal that PAI-1 interferes with therapeutic responses to selective serotonin reuptake inhibitors (escitalopram, fluoxetine). We thus highlight a new genetic preclinical model of depression, with the lack of PAI-1 as a factor of predisposition to MDD. Altogether, these original data reveal that PAI-1 should be now considered as a key player of MDD and as a potential target for the development of new drugs to cure depressive patients resistant to current treatments.

Electroacupuncture Pretreatment Ameliorates PTSD-Like Behaviors in Rats by Enhancing Hippocampal Neurogenesis via the Keap1/Nrf2 Antioxidant Signaling Pathway

Electroacupuncture (EA) pretreatment is a clinically useful therapy for several brain disorders. However, whether and via which exact molecular mechanisms it ameliorates post-traumatic stress disorder (PTSD) remains unclear. In the present study, rats received EA stimulation for seven consecutive days before exposure to enhanced single prolonged stress (ESPS). Anxiety-like and fear learning behaviors; hippocampal neurogenesis; the expression of nuclear factor erythroid 2-related factor 2 (Nrf2), Kelch-like ECH-associated protein 1 (keap1), and heme oxygenase 1 (HO-1); and the activity of AMP-activated kinase (AMPK) were evaluated at 14 days after ESPS. EA pretreatment improved hippocampal neurogenesis and ameliorated anxiety-like behaviors in ESPS-treated rats. EA pretreatment also increased the expression of Nrf2 and HO-1 and the activity of AMPK. Furthermore, Nrf2 knockdown by a short hairpin RNA affected anxiety-like behaviors and expression of neuroprotective markers (BDNF, DCX) in a manner similar to ESPS alone and dampened the neuroprotective effects of EA pretreatment. In contrast, Keap1 knockdown increased the expression of HO-1, improved hippocampal neurogenesis, and alleviated PTSD-like behaviors. Altogether, our results suggest that EA pretreatment ameliorates ESPS-induced anxiety-like behaviors and prevents hippocampal neurogenesis disruption in a rat model of PTSD possibly through regulation of the keap1/Nrf2 antioxidant defense pathway.

Acceptability of a Plasticity-Focused Serious Game Intervention for Posttraumatic Stress Disorder: User Requirements Analysis

Background

Trauma-focused cognitive behavioral therapy (TF-CBT) is a first-line treatment for posttraumatic stress disorder (PTSD). Despite a solid evidence base, TF-CBT response and attrition rates vary considerably. Plasticity-focused interventions, including the use of serious games, have the potential to improve TF-CBT response and treatment retention.

Objective

The aim of this study was to assess the acceptability of a mobile phone–delivered plasticity-focused serious game to improve response to TF-CBT for PTSD, and carry out a user requirements analysis should the development of a prototype be warranted.

Methods

We conducted 2 one-to-one interviews (n=2), one focus group involving service users who had received a diagnosis of PTSD (n=3) and one focus group involving psychological trauma service clinicians (n=4).

Results

We found that the concept of a plasticity-focused mobile phone intervention for PTSD is acceptable to patients and clinicians. Service users and clinicians both believed that the usage should be guided by a therapist, and both contributed useful inputs regarding the audiovisual aspects of the proposed serious game. It was accepted that the game would not be suitable for all patients and that clinicians would need to appropriately prescribe the usage of the game.

Conclusions

The findings highlight the acceptability of the proposed serious game and clarify the user requirements for such an intervention. It is the intention of the authors to carry out a user experience evaluation using a prototype serious game in a clinical population.

Epigenetic Regulation of Infant Neurobehavioral Outcomes

During fetal development and early-infancy, environmental signals can induce epigenetic changes that alter neurobehavioral development and later-life mental health. Several neurodevelopmental genetic diseases influence epigenetic regulatory genes and genomic imprinting. Recently, brain epigenetic marks have been involved in idiopathic neurodevelopmental disorders including autism spectrum disorders (ASD). The placenta is an important regulator of the intrauterine environment that links maternal and fetal nervous systems. Placental epigenetic signatures have been associated with neurodevelopment of healthy newborns quantified through the NICU Network Neurobehavioral Scales (NNNS). Associations have been observed for DNA methylation of genes involved in cortisol (NR3C1, HSD11B), serotonin (HTR2A), and metabolic (LEP) pathways. Dysregulation of imprinted genes and microRNAs has also been associated with neurobehavior assessed by NNNS. Further analysis is needed to characterize the mechanisms by which the epigenome influences neurodevelopment, and the connection between this dysregulation and mental health disorders. In the future, epigenetic marks could serve as functional biomarkers of mental health and cognitive function.