1
|
Nathan PJ, Millais SB, Godwood A, Dewit O, Cross DM, Liptrot J, Ruparelia B, Jones SP, Bakker G, Maruff PT, Light GA, Brown AJH, Weir MP, Congreve M, Tasker T. A phase 1b/2a multicenter study of the safety and preliminary pharmacodynamic effects of selective muscarinic M 1 receptor agonist HTL0018318 in patients with mild-to-moderate Alzheimer's disease. Alzheimers Dement (N Y) 2022; 8:e12273. [PMID: 35229025 PMCID: PMC8864442 DOI: 10.1002/trc2.12273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 12/22/2021] [Accepted: 01/25/2022] [Indexed: 12/03/2022]
Abstract
Introduction This study examined the safety and pharmacodynamic effects of selective muscarinic M1 receptor orthosteric agonist HTL0018318 in 60 patients with mild‐to‐moderate Alzheimer's disease (AD) on background donepezil 10 mg/day. Methods A randomized, double‐blind, placebo‐controlled 4‐week safety study of HTL0018318 with up‐titration and maintenance phases, observing exploratory effects on electrophysiological biomarkers and cognition. Results Treatment‐emergent adverse events (TEAEs) were mild and less frequently reported during maintenance versus titration. Headache was most commonly reported (7–21%); 0 to 13% reported cholinergic TEAEs (abdominal pain, diarrhea, fatigue, nausea) and two patients discontinued due to TEAEs. At 1 to 2 hours post‐dose, HTL0018318‐related mean maximum elevations in systolic and diastolic blood pressure of 5 to 10 mmHg above placebo were observed during up‐titration but not maintenance. Postive effects of HTL0018318 were found on specific attention and memory endpoints. Discussion HTL0018318 was well tolerated in mild‐to‐moderate AD patients and showed positive effects on attention and episodic memory on top of therapeutic doses of donepezil.
Collapse
Affiliation(s)
- Pradeep J Nathan
- Heptares Therapeutics Ltd Cambridge UK.,Department of Psychiatry University of Cambridge Cambridge UK
| | | | | | | | | | | | | | | | | | | | - Gregory A Light
- Department of Psychiatry University of San Diego San Diego California USA
| | | | | | | | | |
Collapse
|
2
|
Palacios-Filardo J, Udakis M, Brown GA, Tehan BG, Congreve MS, Nathan PJ, Brown AJH, Mellor JR. Author Correction: Acetylcholine prioritises direct synaptic inputs from entorhinal cortex to CA1 by differential modulation of feedforward inhibitory circuits. Nat Commun 2021; 12:7265. [PMID: 34880229 PMCID: PMC8654943 DOI: 10.1038/s41467-021-27351-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jon Palacios-Filardo
- Center for Synaptic Plasticity, School of Physiology, Pharmacology and Neuroscience, University of Bristol, University Walk, Bristol, UK
| | - Matt Udakis
- Center for Synaptic Plasticity, School of Physiology, Pharmacology and Neuroscience, University of Bristol, University Walk, Bristol, UK
| | - Giles A Brown
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abingdon, Cambridge, UK.,OMass Therapeutics Ltd, The Schrödinger Building, Oxford, UK
| | - Benjamin G Tehan
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abingdon, Cambridge, UK.,OMass Therapeutics Ltd, The Schrödinger Building, Oxford, UK
| | - Miles S Congreve
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abingdon, Cambridge, UK
| | - Pradeep J Nathan
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Alastair J H Brown
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abingdon, Cambridge, UK
| | - Jack R Mellor
- Center for Synaptic Plasticity, School of Physiology, Pharmacology and Neuroscience, University of Bristol, University Walk, Bristol, UK.
| |
Collapse
|
3
|
Brown AJH, Bradley SJ, Marshall FH, Brown GA, Bennett KA, Brown J, Cansfield JE, Cross DM, de Graaf C, Hudson BD, Dwomoh L, Dias JM, Errey JC, Hurrell E, Liptrot J, Mattedi G, Molloy C, Nathan PJ, Okrasa K, Osborne G, Patel JC, Pickworth M, Robertson N, Shahabi S, Bundgaard C, Phillips K, Broad LM, Goonawardena AV, Morairty SR, Browning M, Perini F, Dawson GR, Deakin JFW, Smith RT, Sexton PM, Warneck J, Vinson M, Tasker T, Tehan BG, Teobald B, Christopoulos A, Langmead CJ, Jazayeri A, Cooke RM, Rucktooa P, Congreve MS, Weir M, Tobin AB. From structure to clinic: Design of a muscarinic M1 receptor agonist with potential to treatment of Alzheimer's disease. Cell 2021; 184:5886-5901.e22. [PMID: 34822784 DOI: 10.1016/j.cell.2021.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 04/29/2021] [Accepted: 11/01/2021] [Indexed: 12/31/2022]
Abstract
Current therapies for Alzheimer's disease seek to correct for defective cholinergic transmission by preventing the breakdown of acetylcholine through inhibition of acetylcholinesterase, these however have limited clinical efficacy. An alternative approach is to directly activate cholinergic receptors responsible for learning and memory. The M1-muscarinic acetylcholine (M1) receptor is the target of choice but has been hampered by adverse effects. Here we aimed to design the drug properties needed for a well-tolerated M1-agonist with the potential to alleviate cognitive loss by taking a stepwise translational approach from atomic structure, cell/tissue-based assays, evaluation in preclinical species, clinical safety testing, and finally establishing activity in memory centers in humans. Through this approach, we rationally designed the optimal properties, including selectivity and partial agonism, into HTL9936-a potential candidate for the treatment of memory loss in Alzheimer's disease. More broadly, this demonstrates a strategy for targeting difficult GPCR targets from structure to clinic.
Collapse
Affiliation(s)
- Alastair J H Brown
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Sophie J Bradley
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK; The Centre for Translational Pharmacology, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Fiona H Marshall
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Giles A Brown
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Kirstie A Bennett
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Jason Brown
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Julie E Cansfield
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - David M Cross
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK; Cross Pharma Consulting Ltd, 20-22 Wenlock Road, London, N17GU, UK
| | - Chris de Graaf
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Brian D Hudson
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Louis Dwomoh
- The Centre for Translational Pharmacology, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - João M Dias
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - James C Errey
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Edward Hurrell
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Jan Liptrot
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Giulio Mattedi
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Colin Molloy
- The Centre for Translational Pharmacology, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Pradeep J Nathan
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK; Brain Mapping Unit, University of Cambridge, Department of Psychiatry, Herchel Smith Building, Cambridge, CB20SZ, UK
| | - Krzysztof Okrasa
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Greg Osborne
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Jayesh C Patel
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Mark Pickworth
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Nathan Robertson
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Shahram Shahabi
- Eli Lilly & Co, Neuroscience Discovery, Erl Wood Manor, Windlesham, Surrey, GU20 6PH, UK
| | - Christoffer Bundgaard
- Eli Lilly & Co, Neuroscience Discovery, Erl Wood Manor, Windlesham, Surrey, GU20 6PH, UK; H. Lundbeck A/S, Neuroscience Research, Ottiliavej 9, 2500 Valby, Copenhagen, Denmark
| | - Keith Phillips
- Eli Lilly & Co, Neuroscience Discovery, Erl Wood Manor, Windlesham, Surrey, GU20 6PH, UK
| | - Lisa M Broad
- Eli Lilly & Co, Neuroscience Discovery, Erl Wood Manor, Windlesham, Surrey, GU20 6PH, UK
| | - Anushka V Goonawardena
- Center for Neuroscience, Biosciences Division, SRI International, 333 Ravenswood Avenue, Menlo Park, CA 94025, USA
| | - Stephen R Morairty
- Center for Neuroscience, Biosciences Division, SRI International, 333 Ravenswood Avenue, Menlo Park, CA 94025, USA
| | - Michael Browning
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX12JD, UK; P1vital, Manor house, Howbery Buisness Park, Wallingford, OX108BA, UK
| | - Francesca Perini
- Centre for Cognitive Neuroscience - Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Gerard R Dawson
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX12JD, UK
| | - John F W Deakin
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, M139PT UK
| | - Robert T Smith
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Patrick M Sexton
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences and Department of Pharmacology, Monash University, Parkville 3052, Victoria, Australia; ARC Centre for Cryo-electron Microscopy of Membrane Proteins, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville 3052, Victoria, Australia
| | - Julie Warneck
- Protogenia Consulting Ltd, PO-Box 289, Ely, CB79DR, UK
| | - Mary Vinson
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Tim Tasker
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Benjamin G Tehan
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Barry Teobald
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Arthur Christopoulos
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences and Department of Pharmacology, Monash University, Parkville 3052, Victoria, Australia
| | - Christopher J Langmead
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK; Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences and Department of Pharmacology, Monash University, Parkville 3052, Victoria, Australia
| | - Ali Jazayeri
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Robert M Cooke
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Prakash Rucktooa
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Miles S Congreve
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK
| | - Malcolm Weir
- Sosei-Heptares, Steinmetz Building, Granta Park, Cambridge, CB21 6DG, UK.
| | - Andrew B Tobin
- The Centre for Translational Pharmacology, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK.
| |
Collapse
|
4
|
Palacios-Filardo J, Udakis M, Brown GA, Tehan BG, Congreve MS, Nathan PJ, Brown AJH, Mellor JR. Acetylcholine prioritises direct synaptic inputs from entorhinal cortex to CA1 by differential modulation of feedforward inhibitory circuits. Nat Commun 2021; 12:5475. [PMID: 34531380 PMCID: PMC8445995 DOI: 10.1038/s41467-021-25280-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/21/2021] [Indexed: 02/08/2023] Open
Abstract
Acetylcholine release in the hippocampus plays a central role in the formation of new memory representations. An influential but largely untested theory proposes that memory formation requires acetylcholine to enhance responses in CA1 to new sensory information from entorhinal cortex whilst depressing inputs from previously encoded representations in CA3. Here, we show that excitatory inputs from entorhinal cortex and CA3 are depressed equally by synaptic release of acetylcholine in CA1. However, feedforward inhibition from entorhinal cortex exhibits greater depression than CA3 resulting in a selective enhancement of excitatory-inhibitory balance and CA1 activation by entorhinal inputs. Entorhinal and CA3 pathways engage different feedforward interneuron subpopulations and cholinergic modulation of presynaptic function is mediated differentially by muscarinic M3 and M4 receptors, respectively. Thus, our data support a role and mechanisms for acetylcholine to prioritise novel information inputs to CA1 during memory formation.
Collapse
Affiliation(s)
- Jon Palacios-Filardo
- Center for Synaptic Plasticity, School of Physiology, Pharmacology and Neuroscience, University of Bristol, University Walk, Bristol, UK
| | - Matt Udakis
- Center for Synaptic Plasticity, School of Physiology, Pharmacology and Neuroscience, University of Bristol, University Walk, Bristol, UK
| | - Giles A Brown
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abingdon, Cambridge, UK
- OMass Therapeutics Ltd, The Schrödinger Building, Oxford, UK
| | - Benjamin G Tehan
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abingdon, Cambridge, UK
- OMass Therapeutics Ltd, The Schrödinger Building, Oxford, UK
| | - Miles S Congreve
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abingdon, Cambridge, UK
| | - Pradeep J Nathan
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Alastair J H Brown
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abingdon, Cambridge, UK
| | - Jack R Mellor
- Center for Synaptic Plasticity, School of Physiology, Pharmacology and Neuroscience, University of Bristol, University Walk, Bristol, UK.
| |
Collapse
|
5
|
Quattrini G, Marizzoni M, Pizzini FB, Galazzo IB, Aiello M, Didic M, Soricelli A, Albani D, Romano M, Blin O, Forloni G, Golay X, Jovicich J, Nathan PJ, Richardson JC, Salvatore M, Frisoni GB, Pievani M. Convergent and Discriminant Validity of Default Mode Network and Limbic Network Perfusion in Amnestic Mild Cognitive Impairment Patients. J Alzheimers Dis 2021; 82:1797-1808. [PMID: 34219733 DOI: 10.3233/jad-210531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies reported default mode network (DMN) and limbic network (LIN) brain perfusion deficits in patients with amnestic mild cognitive impairment (aMCI), frequently a prodromal stage of Alzheimer's disease (AD). However, the validity of these measures as AD markers has not yet been tested using MRI arterial spin labeling (ASL). OBJECTIVE To investigate the convergent and discriminant validity of DMN and LIN perfusion in aMCI. METHODS We collected core AD markers (amyloid-β 42 [Aβ42], phosphorylated tau 181 levels in cerebrospinal fluid [CSF]), neurodegenerative (hippocampal volumes and CSF total tau), vascular (white matter hyperintensities), genetic (apolipoprotein E [APOE] status), and cognitive features (memory functioning on Paired Associate Learning test [PAL]) in 14 aMCI patients. Cerebral blood flow (CBF) was extracted from DMN and LIN using ASL and correlated with AD features to assess convergent validity. Discriminant validity was assessed carrying out the same analysis with AD-unrelated features, i.e., somatomotor and visual networks' perfusion, cerebellar volume, and processing speed. RESULTS Perfusion was reduced in the DMN (F = 5.486, p = 0.039) and LIN (F = 12.678, p = 0.004) in APOE ɛ4 carriers compared to non-carriers. LIN perfusion correlated with CSF Aβ42 levels (r = 0.678, p = 0.022) and memory impairment (PAL, number of errors, r = -0.779, p = 0.002). No significant correlation was detected with tau, neurodegeneration, and vascular features, nor with AD-unrelated features. CONCLUSION Our results support the validity of DMN and LIN ASL perfusion as AD markers in aMCI, indicating a significant correlation between CBF and amyloidosis, APOE ɛ4, and memory impairment.
Collapse
Affiliation(s)
- Giulia Quattrini
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Moira Marizzoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Laboratory of Biological Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Francesca B Pizzini
- Radiology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | | | | | - Mira Didic
- Aix-Marseille Univ, INSERM, INS, Instit Neurosci des Syst, Marseille, France.,APHM, Timone, Service de Neurologie et Neuropsychologie, Hôpital Timone Adultes, Marseille, France
| | - Andrea Soricelli
- IRCCS SDN, Napoli, Italy.,Department of Sport Sciences, University of Naples Parthenope, Naples, Italy
| | - Diego Albani
- Neuroscience Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Melissa Romano
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Olivier Blin
- Aix-Marseille Univ, INSERM, INS, Instit Neurosci des Syst, DHUNE, Ap-Hm, Marseille, France
| | - Gianluigi Forloni
- Neuroscience Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Xavier Golay
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Jorge Jovicich
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
| | - Pradeep J Nathan
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jill C Richardson
- Neurosciences Therapeutic Area, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, United Kingdom
| | | | - Giovanni B Frisoni
- Memory Clinic and LANVIE-Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Michela Pievani
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | |
Collapse
|
6
|
Colloby SJ, Nathan PJ, Bakker G, Lawson RA, Yarnall AJ, Burn DJ, O'Brien JT, Taylor JP. Spatial Covariance of Cholinergic Muscarinic M 1 /M 4 Receptors in Parkinson's Disease. Mov Disord 2021; 36:1879-1888. [PMID: 33973693 DOI: 10.1002/mds.28564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/01/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is associated with cholinergic dysfunction, although the role of M1 and M4 receptors remains unclear. OBJECTIVE To investigate spatial covariance patterns of cholinergic muscarinic M1 /M4 receptors in PD and their relationship with cognition and motor symptoms. METHODS Some 19 PD and 24 older adult controls underwent 123 I-iodo-quinuclidinyl-benzilate (QNB) (M1 /M4 receptor) and 99m Tc-exametazime (perfusion) single-photon emission computed tomography (SPECT) scanning. We implemented voxel principal components analysis, producing a series of images representing patterns of intercorrelated voxels across individuals. Linear regression analyses derived specific M1 /M4 spatial covariance patterns associated with PD. RESULTS A cholinergic M1 /M4 pattern that converged onto key hubs of the default, auditory-visual, salience, and sensorimotor networks fully discriminated PD patients from controls (F1,41 = 135.4, P < 0.001). In PD, we derived M1 /M4 patterns that correlated with global cognition (r = -0.62, P = 0.008) and motor severity (r = 0.53, P = 0.02). Both patterns emerged with a shared topography implicating the basal forebrain as well as visual, frontal executive, and salience circuits. Further, we found a M1 /M4 pattern that predicted global cognitive decline (r = 0.46, P = 0.04) comprising relative decreased binding within default and frontal executive networks. CONCLUSIONS Cholinergic muscarinic M1 /M4 modulation within key brain networks were apparent in PD. Cognition and motor severity were associated with a similar topography, inferring both phenotypes possibly rely on related cholinergic mechanisms. Relative decreased M1 /M4 binding within default and frontal executive networks could be an indicator of future cognitive decline. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Sean J Colloby
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Pradeep J Nathan
- Department of Psychiatry, University of Cambridge, Herschel Smith Building for Brain & Mind Sciences, Cambridge, United Kingdom
| | - Geor Bakker
- Experimental Medicine, Sosei Heptares, Cambridge, United Kingdom
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - David J Burn
- Population Health Science Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Herschel Smith Building for Brain & Mind Sciences, Cambridge, United Kingdom
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
7
|
Nathan PJ, Bakker G. Lessons learned from using fMRI in the early clinical development of a mu-opioid receptor antagonist for disorders of compulsive consumption. Psychopharmacology (Berl) 2021; 238:1255-1263. [PMID: 31900526 DOI: 10.1007/s00213-019-05427-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 12/06/2019] [Indexed: 01/23/2023]
Abstract
Functional magnetic resonance imaging (fMRI) has been widely used to gain a greater understanding of brain circuitry abnormalities in CNS disorders. fMRI has also been used to examine pharmacological modulation of brain circuity and is increasingly being used in early clinical drug development as functional pharmacodynamic index of target engagement, and to provide early indication of clinical efficacy. In this short review, we summarize data from experimental medicine and early clinical development studies of a mu-opioid receptor antagonist, GSK1521498 developed for disorders of compulsive consumption including binge eating in obesity. We demonstrate how fMRI can be used to answer important questions of early clinical drug development relating to; (1) target engagement, (2) dose response relationships, (3) differential efficacy and (4) prediction of behavioural and clinically relevant outcomes. We also highlight important methodological factors that need to be considered when conducting fMRI studies in drug development given the challenges faced with small sample sizes in Phase 1 and early proof of mechanism studies. While these data highlight the value of fMRI as a biomarker in drug development, its use for making Go/No-go decisions is still faced with challenges given the variability of responses, interpretation of brain activation changes and the limited data linking drug induced changes in brain activity to clinical or behavioural outcome. These challenges need to be addressed to fulfil the promise of fMRI as a tool in clinical drug development.
Collapse
Affiliation(s)
- Pradeep J Nathan
- Experimental Medicine (Neuroscience), Sosei Heptares, Cambridge, UK
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, UK
- The Monash School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Geor Bakker
- Experimental Medicine (Neuroscience), Sosei Heptares, Cambridge, UK.
- Department of Psychiatry and Psychology, Maastricht University, Maastricht, Netherlands.
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| |
Collapse
|
8
|
Bakker C, Prins S, Liptrot J, Hart EP, Klaassen ES, Brown GA, Brown A, Congreve M, Weir M, Marshall FH, Stevens J, Cross DM, Tasker T, Nathan PJ, Groeneveld GJ. Safety, pharmacokinetics and pharmacodynamics of HTL0009936, a selective muscarinic M 1 -acetylcholine receptor agonist: A randomized cross-over trial. Br J Clin Pharmacol 2021; 87:4439-4449. [PMID: 33891333 PMCID: PMC8596821 DOI: 10.1111/bcp.14872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 12/01/2022] Open
Abstract
AIMS HTL0009936 is a selective M1 muscarinic receptor agonist in development for cognitive dysfunction in Alzheimer's disease. Safety, tolerability and pharmacokinetics and exploratory pharmacodynamic effects of HTL0009936 administered by continuous IV infusion at steady state were investigated in elderly subjects with below average cognitive functioning (BACF). METHODS Part A was a four-treatment open label sequential study in healthy elderly investigating 10-83 mg HTL0009936 (IV) and a 24 mg HTL0009936 single oral dose. Part B was a five-treatment randomized, double-blind, placebo and physostigmine controlled cross-over study with IV HTL0009936 in elderly subjects with BACF. Pharmacodynamic assessments were performed using neurocognitive and electrophysiological tests. RESULTS Pharmacokinetics of HTL0009936 showed dose-proportional increases in exposure with a mean half-life of 2.4 hours. HTL0009936 was well-tolerated with transient dose-related adverse events (AEs). Small increases in mean systolic blood pressure of 7.12 mmHg (95% CI [3.99-10.24]) and in diastolic of 5.32 mmHg (95% CI [3.18-7.47]) were noted at the highest dose in part B. Overall, there was suggestive, but no definitive, positive or negative pharmacodynamic effects. Statistically significant effects were observed on P300 with HTL0009936 and adaptive tracking with physostigmine. CONCLUSIONS HTL0009936 showed well-characterized pharmacokinetics and single doses were safe and generally well-tolerated in healthy elderly subjects. Due to physostigmine tolerability issues and subject burden, the study design was changed and some pharmacodynamic assessments (neurocognitive) were performed at suboptimal drug exposures. Therefore no clear conclusions can be made on pharmacodynamic effects of HTL0009936, although an effect on P300 is suggestive of central target engagement.
Collapse
Affiliation(s)
- Charlotte Bakker
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - Samantha Prins
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ellen P Hart
- Centre for Human Drug Research, Leiden, The Netherlands
| | | | | | | | | | | | - Fiona H Marshall
- Sosei Heptares, Cambridge, UK.,MSD Research Laboratories (Merck & Co), Kenilworth, New Jersey, USA
| | - Jasper Stevens
- Centre for Human Drug Research, Leiden, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Pradeep J Nathan
- Sosei Heptares, Cambridge, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK.,School of Psychological Sciences, Monash University, Australia
| | - Geert Jan Groeneveld
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
9
|
Bakker C, Tasker T, Liptrot J, Hart EP, Klaassen ES, Doll RJ, Brown GA, Brown A, Congreve M, Weir M, Marshall FH, Cross DM, Groeneveld GJ, Nathan PJ. Safety, pharmacokinetics and exploratory pro-cognitive effects of HTL0018318, a selective M 1 receptor agonist, in healthy younger adult and elderly subjects: a multiple ascending dose study. Alzheimers Res Ther 2021; 13:87. [PMID: 33883008 PMCID: PMC8061066 DOI: 10.1186/s13195-021-00816-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/23/2021] [Indexed: 12/15/2022]
Abstract
Background The cholinergic system and M1 receptor remain an important target for symptomatic treatment of cognitive dysfunction. The selective M1 receptor partial agonist HTL0018318 is under development for the symptomatic treatment of Dementia’s including Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). We investigated the safety, tolerability, pharmacokinetics and exploratory pharmacodynamics of multiple doses of HTL0018318 in healthy younger adults and elderly subjects. Methods This randomised, double blind, placebo-controlled study was performed, investigating oral doses of 15–35 mg/day HTL0018318 or placebo in 7 cohorts of healthy younger adult (n = 36; 3 cohorts) and elderly (n = 50; 4 cohorts) subjects. Safety, tolerability and pharmacokinetic measurements were performed. Pharmacodynamics were assessed using a battery of neurocognitive tasks and electrophysiological biomarkers of synaptic and cognitive functions. Results HTL0018318 was generally well-tolerated in multiple doses up to 35 mg/day and were associated with mild or moderate cholinergic adverse events. There were modest increases in blood pressure and pulse rate when compared to placebo-treated subjects, with tendency for the blood pressure increase to attenuate with repeated dosing. There were no clinically significant observations or changes in blood and urine laboratory measures of safety or abnormalities in the ECGs and 24-h Holter assessments. HTL0018318 plasma exposure was dose-proportional over the range 15–35 mg. Maximum plasma concentrations were achieved after 1–2 h. The apparent terminal half-life of HTL0018318 was 16.1 h (± 4.61) in younger adult subjects and 14.3 h (± 2.78) in elderly subjects at steady state. HTL0018318 over the 10 days of treatment had significant effects on tests of short-term (working) memory (n-back) and learning (Milner maze) with moderate to large effect sizes. Conclusion Multiple doses of HTL0018138 showed well-characterised pharmacokinetics and were safe and generally well-tolerated in the dose range studied. Pro-cognitive effects on short-term memory and learning were demonstrated across the dose range. These data provide encouraging data in support of the development of HTL0018138 for cognitive dysfunction in AD and DLB. Trial registration Netherlands Trial Register identifier NTR5781. Registered on 22 March 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00816-5.
Collapse
Affiliation(s)
- Charlotte Bakker
- Centre for Human Drug Research (CDHR), Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Tim Tasker
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abington, Cambridge, CB21 6DG, UK
| | - Jan Liptrot
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abington, Cambridge, CB21 6DG, UK
| | - Ellen P Hart
- Centre for Human Drug Research (CDHR), Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Erica S Klaassen
- Centre for Human Drug Research (CDHR), Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Robert Jan Doll
- Centre for Human Drug Research (CDHR), Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | | | - Alastair Brown
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abington, Cambridge, CB21 6DG, UK
| | - Miles Congreve
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abington, Cambridge, CB21 6DG, UK
| | - Malcolm Weir
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abington, Cambridge, CB21 6DG, UK
| | | | | | - Geert Jan Groeneveld
- Centre for Human Drug Research (CDHR), Zernikedreef 8, 2333 CL, Leiden, The Netherlands. .,Leiden University Medical Centre, Leiden, The Netherlands.
| | - Pradeep J Nathan
- Sosei Heptares, Steinmetz Building, Granta Park, Great Abington, Cambridge, CB21 6DG, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK.,School of Psychological Sciences, Monash University, Melbourne, Australia
| |
Collapse
|
10
|
Bakker C, Tasker T, Liptrot J, Hart EP, Klaassen ES, Prins S, van der Doef TF, Brown GA, Brown A, Congreve M, Weir M, Marshall FH, Cross DM, Groeneveld GJ, Nathan PJ. First-in-man study to investigate safety, pharmacokinetics and exploratory pharmacodynamics of HTL0018318, a novel M 1 -receptor partial agonist for the treatment of dementias. Br J Clin Pharmacol 2021; 87:2945-2955. [PMID: 33351971 PMCID: PMC8359307 DOI: 10.1111/bcp.14710] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/23/2022] Open
Abstract
AIMS HTL0018318 is a selective M1 receptor partial agonist currently under development for the symptomatic treatment of cognitive and behavioural symptoms in Alzheimer's disease and other dementias. We investigated safety, tolerability, pharmacokinetics and exploratory pharmacodynamics (PD) of HTL0018318 following single ascending doses. METHODS This randomized, double-blind, placebo-controlled study in 40 healthy younger adult and 57 healthy elderly subjects, investigated oral doses of 1-35 mg HTL0018318. Pharmacodynamic assessments were performed using a battery of neurocognitive tasks and electrophysiological measurements. Cerebrospinal fluid concentrations of HTL0018318 and food effects on pharmacokinetics of HTL0018318 were investigated in an open label and partial cross-over design in 14 healthy subjects. RESULTS Pharmacokinetics of HTL0018318 were well-characterized showing dose proportional increases in exposure from 1-35 mg. Single doses of HTL0018318 were associated with mild dose-related adverse events of low incidence in both younger adult and elderly subjects. The most frequently reported cholinergic AEs included hyperhidrosis and increases in blood pressure up to 10.3 mmHg in younger adults (95% CI [4.2-16.3], 35-mg dose) and up to 11.9 mmHg in elderly subjects (95% CI [4.9-18.9], 15-mg dose). There were no statistically significant effects on cognitive function but the study was not powered to detect small to moderate effect sizes of clinical relevance. CONCLUSION HTL0018318 showed well-characterized pharmacokinetics and following single doses were generally well tolerated in the dose range studied. These provide encouraging data in support of the development for HTL0018318 for Alzheimer's disease and other dementias.
Collapse
Affiliation(s)
| | | | | | - Ellen P Hart
- Centre for Human Drug Research (CDHR), Leiden, Netherlands
| | | | - Samantha Prins
- Centre for Human Drug Research (CDHR), Leiden, Netherlands
| | | | | | | | | | | | | | | | - Geert Jan Groeneveld
- Centre for Human Drug Research (CDHR), Leiden, Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Pradeep J Nathan
- Sosei Heptares, Cambridge, UK.,Department of Psychiatry, University of Cambridge, UK.,School of Psychological Sciences, Monash University, Australia
| |
Collapse
|
11
|
Wessels AM, Edgar CJ, Nathan PJ, Siemers ER, Maruff P, Harrison J. Cognitive Go/No-Go decision-making criteria in Alzheimer's disease drug development. Drug Discov Today 2021; 26:1330-1336. [PMID: 33486115 DOI: 10.1016/j.drudis.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/23/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Go/No-Go decision making in early phase clinical trials is challenging for drug developers working in Alzheimer's disease. Recent negative trial results have been attributed to a lack of efficacy and important safety concerns. Furthermore, demonstrated target engagement has rarely translated into demonstrable clinical efficacy. Cognitive data might provide valuable insights at various points during drug development, and a thoughtful and robust set of decision-making criteria, specified a priori, can and should be applied under many circumstances. This review provides insights into how to utilize cognitive data for Go/No-Go decisions, with an emphasis on how these cognitive criteria differ depending on the context (e.g., stage of development, mechanism of action and trial design).
Collapse
Affiliation(s)
| | | | - Pradeep J Nathan
- Lundbeck, Copenhagen, Denmark; Department of Psychiatry, University of Cambridge, UK; School of Psychological Sciences, Monash University, Australia
| | | | | | - John Harrison
- Metis Cognition Ltd, Kilmington Common, UK; Alzheimer Center AUmc, Amsterdam, The Netherlands; Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| |
Collapse
|
12
|
Colloby SJ, Nathan PJ, McKeith IG, Bakker G, O'Brien JT, Taylor JP. Cholinergic muscarinic M 1/M 4 receptor networks in dementia with Lewy bodies. Brain Commun 2020; 2:fcaa098. [PMID: 32954342 PMCID: PMC7475694 DOI: 10.1093/braincomms/fcaa098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
Cholinergic dysfunction is central in dementia with Lewy bodies, possibly contributing to the cognitive and psychiatric phenotypes of this condition. We investigated baseline muscarinic M1/M4 receptor spatial covariance patterns in dementia with Lewy bodies and their association with changes in cognition and neuropsychiatric symptoms after 12 weeks of treatment with the cholinesterase inhibitor donepezil. Thirty-eight participants (14 cholinesterase inhibitor naive patients, 24 healthy older individuals) underwent 123I-iodo-quinuclidinyl-benzilate (M1/M4 receptor assessment) and 99mTc-exametazime (perfusion) single-photon emission computed tomography scanning. We implemented voxel principal components analysis, producing a series of images representing patterns of inter-correlated voxels across individuals. Linear regression analyses derived specific M1/M4 and perfusion spatial covariance patterns associated with patients. A discreet M1/M4 pattern that distinguished patients from controls (W1,19.7 = 16.7, P = 0.001), showed relative decreased binding in right lateral temporal and insula, as well as relative preserved/increased binding in frontal, precuneus, lingual and cuneal regions, implicating nodes within attention and dorsal visual networks. We then derived from patients an M1/M4 pattern that correlated with a positive change in mini-mental state examination (r = 0.52, P = 0.05), showing relative preserved/increased uptake in prefrontal, temporal pole and anterior cingulate, elements of attention-related networks. We also generated from patients an M1/M4 pattern that correlated with a positive change in neuropsychiatric inventory score (r = 0.77, P = 0.002), revealing relative preserved/increased uptake within a bilateral temporal-precuneal-striatal system. Although in a small sample and therefore tentative, we posit that optimal response of donepezil on cognitive and neuropsychiatric signs in patients with dementia with Lewy bodies were associated with a maintenance of muscarinic M1/M4 receptor expression within attentional/executive and ventral visual network hubs, respectively.
Collapse
Affiliation(s)
- Sean J Colloby
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Pradeep J Nathan
- Experimental Medicine, Neuroscience Therapeutic Area, Sosei Heptares, Steinmetz Building, Granta Park, Cambridge CB21 6DG, UK.,Department of Psychiatry, University of Cambridge, Cambridge CB2 0QC, UK
| | - Ian G McKeith
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Geor Bakker
- Experimental Medicine, Neuroscience Therapeutic Area, Sosei Heptares, Steinmetz Building, Granta Park, Cambridge CB21 6DG, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0QC, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| |
Collapse
|
13
|
Erskine D, Taylor JP, Bakker G, Brown AJH, Tasker T, Nathan PJ. Cholinergic muscarinic M 1 and M 4 receptors as therapeutic targets for cognitive, behavioural, and psychological symptoms in psychiatric and neurological disorders. Drug Discov Today 2019; 24:2307-2314. [PMID: 31499186 DOI: 10.1016/j.drudis.2019.08.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/08/2019] [Accepted: 08/28/2019] [Indexed: 12/13/2022]
Abstract
Cholinergic dysfunction is involved in a range of neurological and psychiatric disorders, including schizophrenia, dementia and Lewy body disease (LBD), leading to widespread use of cholinergic therapies. However, such drugs have focused on increasing the availability of acetylcholine (ACh) generally, with relatively little work done on the muscarinic system and specific muscarinic receptor subtypes. In this review, we provide an overview of the major cholinergic pathways and cholinergic muscarinic receptors in the human brain and evidence for their dysfunction in several neurological and psychiatric disorders. We discuss how the selectivity of cholinergic system dysfunction suggests that targeted cholinergic therapeutics to the muscarinic receptor subtypes will be vital in treating several disorders associated with cognitive dysfunction and behavioural and psychological symptoms.
Collapse
Affiliation(s)
- Daniel Erskine
- Institute of Neuroscience, Newcastle University, Newcastle, UK.
| | | | | | | | | | - Pradeep J Nathan
- Sosei Heptares, Cambridge, UK; Department of Psychiatry, University of Cambridge, Cambridge, UK; School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.
| |
Collapse
|
14
|
Nathan PJ, Bakker G, Godwood A, Vingerhoets C, Caan M, Bloemen O, Booij J, van Amelsvoort T. P3-100: CH 1,2, AND 3 BASAL FOREBRAIN NUCLEI VOLUMES PREDICT FUNCTIONAL SENSITIVITY TO MUSCARINIC M1 RECEPTOR ANTAGONIST BIPERIDEN ON DELAYED WORD RECALL. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Pradeep J. Nathan
- Sosei Heptares; Cambridge United Kingdom
- Cambridge University; Cambridge United Kingdom
- Monash University; Melbourne Australia
| | - Geor Bakker
- Sosei Heptares; Cambridge United Kingdom
- Maastricht University; Maastricht Netherlands
- Amsterdam University Medical Centres; Location AMC; Amsterdam Netherlands
| | | | - Claudia Vingerhoets
- Maastricht University; Maastricht Netherlands
- Amsterdam University Medical Centres; Location AMC; Amsterdam Netherlands
| | - Matthan Caan
- Amsterdam University Medical Centres; Location AMC; Amsterdam Netherlands
| | - Oswald Bloemen
- Maastricht University; Maastricht Netherlands
- GGZ Centraal; Center for Mental Health Care Innova; Amersfoort Netherlands
| | - Jan Booij
- Amsterdam University Medical Centres; Location AMC; Amsterdam Netherlands
| | | |
Collapse
|
15
|
O'Neill BV, Dodds CM, Miller SR, Gupta A, Lawrence P, Bullman J, Chen C, Dewit O, Kumar S, Dustagheer M, Price J, Shabbir S, Nathan PJ. The effects of GSK2981710, a medium-chain triglyceride, on cognitive function in healthy older participants: A randomised, placebo-controlled study. Hum Psychopharmacol 2019; 34:e2694. [PMID: 31124194 DOI: 10.1002/hup.2694] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/07/2019] [Accepted: 03/13/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This double-blind, randomised, placebo-controlled, two-part study assessed the impact of GSK2981710, a medium-chain triglyceride (MCT) that liberates ketone bodies, on cognitive function, safety, and tolerability in healthy older adults. METHODS Part 1 was a four-period dose-selection study (n = 8 complete). Part 2 was a two-period crossover study (n = 80 complete) assessing the acute (Day 1) and prolonged (Day 15) effects of GSK2981710 on cognition and memory-related neuronal activity. Safety and tolerability of MCT supplementation were monitored in both parts of the study. RESULTS The most common adverse event was diarrhoea (100% and 75% of participants in Parts 1 and 2, respectively). Most adverse events were mild to moderate, and 11% participants were withdrawn due to one or more adverse events. Although GSK2981710 (30 g/day) resulted in increased peak plasma β-hydroxybutyrate (BHB) concentrations, no significant improvements in cognitive function or memory-related neuronal activity were observed. CONCLUSION Over a duration of 14 days, increasing plasma BHB levels with daily administration of GSK2981710 had no effects on neuronal activity or cognitive function. This result indicates that modulating plasma ketone levels with GSK2981710 may be ineffective in improving cognitive function in healthy older adults, or the lack of observed effect could be related to several factors including study population, plasma BHB concentrations, MCT composition, or treatment duration.
Collapse
Affiliation(s)
- Barry V O'Neill
- GSK Nutrition, GSK Consumer Healthcare, Brentford, UK.,Respiratory Health, GSK Consumer Healthcare, Nyon, Switzerland
| | - Chris M Dodds
- Department of Psychology, University of Exeter, Exeter, UK
| | - Sam R Miller
- Department of Quantitative Sciences, GlaxoSmithKline, Stevenage, UK
| | - Ashutosh Gupta
- Department of Quantitative Sciences India, GlaxoSmithKline, Bangalore, India
| | | | - Jonathan Bullman
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Stevenage, UK
| | - Chao Chen
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, London, UK
| | - Odile Dewit
- Clinical Unit, GlaxoSmithKline, Cambridge, UK
| | | | | | | | - Shaila Shabbir
- Clinical Pharmacology Study Sciences and Operations, GlaxoSmithKline, Stevenage, UK
| | - Pradeep J Nathan
- Sosei Heptares, Cambridge, UK.,The School of Psychological Sciences, Monash University, Clayton, Australia.,Department of Psychiatry, University of Cambridge, Cambridge, UK
| |
Collapse
|
16
|
Medic N, Kochunov P, Ziauddeen H, Ersche KD, Nathan PJ, Ronan L, Fletcher PC. BMI-related cortical morphometry changes are associated with altered white matter structure. Int J Obes (Lond) 2019; 43:523-532. [PMID: 30568264 PMCID: PMC6462878 DOI: 10.1038/s41366-018-0269-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 10/07/2018] [Accepted: 10/14/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND While gross measures of brain structure have shown alterations with increasing body mass index (BMI), the extent and nature of such changes has varied substantially across studies. Here, we sought to determine whether small-scale morphometric measures might prove more sensitive and reliable than larger scale measures and whether they might offer a valuable opportunity to link cortical changes to underlying white matter changes. To examine this, we explored the association of BMI with millimetre-scale Gaussian curvature, in addition to standard measures of morphometry such as cortical thickness, surface area and mean curvature. We also assessed the volume and integrity of the white matter, using white matter signal intensity and fractional anisotropy (FA). We hypothesised that BMI would be linked to small-scale changes in Gaussian curvature and that this phenomenon would be mediated by changes in the integrity of the underlying white matter. METHODS The association of global measures of T1-weighted cortical morphometry with BMI was examined using linear regression and mediation analyses in two independent groups of healthy young to middle aged human subjects (n1 = 52, n2 = 202). In a third dataset of (n3 = 897), which included diffusion tensor images, we sought to replicate the significant associations established in the first two datasets, and examine the potential mechanistic link between BMI-associated cortical changes and global FA. RESULTS Gaussian curvature of the white matter surface showed a significant, positive association with BMI across all three independent datasets. This effect was mediated by a negative association between the integrity of the white matter and BMI. CONCLUSIONS Increasing BMI is associated with changes in white matter microstructure in young to middle-aged healthy adults. Our results are consistent with a model whereby BMI-linked cortical changes are mediated by the effects of BMI on white matter microstructure.
Collapse
Affiliation(s)
- Nenad Medic
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 8AH, UK
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Peter Kochunov
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hisham Ziauddeen
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 8AH, UK
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Karen D Ersche
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 8AH, UK
| | - Pradeep J Nathan
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 8AH, UK
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Heptares Therapeutics Ltd, Cambridge, UK
| | - Lisa Ronan
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 8AH, UK
| | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 8AH, UK.
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK.
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK.
| |
Collapse
|
17
|
Abbott RA, Skirrow C, Jokisch M, Timmers M, Streffer J, van Nueten L, Krams M, Winkler A, Pundt N, Nathan PJ, Rock P, Cormack FK, Weimar C. Normative data from linear and nonlinear quantile regression in CANTAB: Cognition in mid-to-late life in an epidemiological sample. Alzheimers Dement (Amst) 2018; 11:36-44. [PMID: 30623017 PMCID: PMC6305838 DOI: 10.1016/j.dadm.2018.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction Normative cognitive data can help to distinguish pathological decline from normal aging. This study presents normative data from the Cambridge Neuropsychological Test Automated Battery, using linear regression and nonlinear quantile regression approaches. Methods Heinz Nixdorf Recall study participants completed Cambridge Neuropsychological Test Automated Battery tests: paired-associate learning, spatial working memory, and reaction time. Data were available for 1349-1529 healthy adults aged 57-84 years. Linear and nonlinear quantile regression analyses examined age-related changes, adjusting for sex and education. Quantile regression differentiated seven performance bands (percentiles: 97.7, 93.3, 84.1, 50, 15.9, 6.7, and 2.3). Results Normative data show age-related cognitive decline across all tests, but with quantile regression revealing heterogeneous trajectories of cognitive aging, particularly for the test of episodic memory function (paired-associate learning). Discussion This study presents normative data from Cambridge Neuropsychological Test Automated Battery in mid-to-late life. Quantile regression can model heterogeneity in age-related cognitive trajectories as seen in the paired-associate learning episodic memory measure. The study presents normative cognitive data from the Cambridge Neuropsychological Test Automated Battery in mid-to-late life. Most tasks showed similar decline across performance bands with increasing age. Quantile regression is sensitive for evaluating diverging trajectories with age. Episodic memory showed accelerated decline in the average performance range.
Collapse
Affiliation(s)
| | | | - Martha Jokisch
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Germany
| | - Maarten Timmers
- Janssen Research and Development, a division of Janssen Pharmaceutica N.V., Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Johannes Streffer
- Janssen Research and Development, a division of Janssen Pharmaceutica N.V., Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Luc van Nueten
- Janssen Research and Development, a division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Michael Krams
- Janssen Research and Development LLC, Titusville, NJ, USA
| | - Angela Winkler
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Germany
| | - Noreen Pundt
- Centre for Urban Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | | | - Philippa Rock
- Cambridge Cognition, Tunbridge Court, Bottisham, Cambridge, UK
| | | | - Christian Weimar
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Germany
| |
Collapse
|
18
|
Reijs BLR, Ramakers IHGB, Köhler S, Teunissen CE, Koel-Simmelink M, Nathan PJ, Tsolaki M, Wahlund LO, Waldemar G, Hausner L, Vandenberghe R, Johannsen P, Blackwell A, Vanderstichele H, Verhey F, Visser PJ. Memory Correlates of Alzheimer's Disease Cerebrospinal Fluid Markers: A Longitudinal Cohort Study. J Alzheimers Dis 2018; 60:1119-1128. [PMID: 28984585 DOI: 10.3233/jad-160766] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Performance on episodic, semantic, and working memory tests is impaired in Alzheimer's disease (AD)-type dementia, but it is unclear which type of memory test is most strongly associated with early AD biomarkers in cerebrospinal fluid (CSF), and most useful for monitoring disease progression. OBJECTIVE To examine the association between amyloid-β 1-42 (Aβ42) and tau in CSF with performance on different memory domains at baseline, and how these CSF markers are related with memory decline. METHODS We included 263 individuals with normal cognition, mild cognitive impairment, AD-type dementia, and non-AD dementia from the European EDAR study. Assessment included CSF Aβ42 and t-tau analyses with INNO-BIA AlzBio3 Luminex assay, the CERAD wordlist learning and delayed recall, animal fluency test, and the CANTAB Paired Associates Learning (PAL) and Spatial Working Memory tasks. Follow-up assessments were performed within 3 years after baseline. RESULTS At baseline, decreased CSF Aβ42 correlated most strongly with the PAL total errors adjusted and the wordlist delayed recall and increased CSF t-tau with the wordlist delayed recall. Over time, decreased CSF Aβ42 was associated with decline on the wordlist learning, whereas increased CSF t-tau were associated with decline in scores on the wordlist learning, wordlist delayed recall, and animal fluency. Associations were independent of baseline diagnosis. CONCLUSION Tests assessing episodic verbal and visuospatial memory are most useful for detection of AD pathology. Tests for episodic verbal memory and semantic memory are most useful for tracking memory decline.
Collapse
Affiliation(s)
- Babette L R Reijs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, The Netherlands
| | - Marleen Koel-Simmelink
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, The Netherlands
| | - Pradeep J Nathan
- Department of Psychiatry, University of Cambridge, UK.,School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Magda Tsolaki
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lars-Olof Wahlund
- Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lucrezia Hausner
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, Germany
| | | | - Peter Johannsen
- Danish Dementia Research Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.,Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
19
|
Greenwood LM, Leung S, Michie PT, Green A, Nathan PJ, Fitzgerald P, Johnston P, Solowij N, Kulkarni J, Croft RJ. The effects of glycine on auditory mismatch negativity in schizophrenia. Schizophr Res 2018; 191:61-69. [PMID: 28602646 DOI: 10.1016/j.schres.2017.05.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 11/24/2022]
Abstract
Glycine increases N-methyl-d-aspartate receptor (NMDAR) mediated glutamatergic function. Mismatch negativity (MMN) is a proposed biomarker of glutamate-induced improvements in clinical symptoms, however, the effect of glycine-mediated NMDAR activation on MMN in schizophrenia is not well understood. This study aimed to determine the effects of acute and 6-week chronic glycine administration on MMN in schizophrenia patients. MMN amplitude was compared at baseline between 22 patients (schizophrenia or schizoaffective disorder; receiving stable antipsychotic medication; multi-centre recruitment) and 21 age- and gender-matched controls. Patients underwent a randomised, double-blind, placebo-controlled clinical trial with glycine added to their regular antipsychotic medication (placebo, n=10; glycine, n=12). MMN was reassessed post-45-minutes of first dose (0.2g/kg) and post-6-weeks treatment (incremented to 0.6g/kg/day). Clinical symptoms were assessed at baseline and post-6-weeks treatment. At baseline, duration MMN was smaller in schizophrenia compared to controls. Acute glycine increased duration MMN (compared to placebo), whilst this difference was absent post-6-weeks treatment. Six weeks of chronic glycine administration improved PANSS-Total, PANSS-Negative and PANSS-General symptoms compared to placebo. Smaller baseline duration MMN was associated with greater PANSS-Negative symptoms and predicted (at trend level) PANSS-Negative symptom improvement post-6-weeks glycine treatment (not placebo). These findings support the benefits of chronic glycine administration and demonstrate, for the first time, that acute glycine improves duration MMN in schizophrenia. This result, together with smaller baseline duration MMN predicting greater clinical treatment response, suggests the potential for duration MMN as a biomarker of glycine-induced improvements in negative symptoms in schizophrenia.
Collapse
Affiliation(s)
- Lisa-Marie Greenwood
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.
| | - Sumie Leung
- Centre for Human Psychopharmacology, Swinburne University of Technology, Victoria, Australia
| | - Patricia T Michie
- School of Psychology and Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, Australia; Schizophrenia Research Institute, Sydney, Australia
| | - Amity Green
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
| | - Pradeep J Nathan
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; School of Psychology and Psychiatry, Monash University, Melbourne, Australia
| | - Paul Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
| | - Patrick Johnston
- Department of Psychology and York Neuroimaging Centre, University of York, York, United Kingdom; School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Australia
| | - Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia; Schizophrenia Research Institute, Sydney, Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
| | - Rodney J Croft
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| |
Collapse
|
20
|
Green AE, Fitzgerald PB, Johnston PJ, Nathan PJ, Kulkarni J, Croft RJ. Evidence for a differential contribution of early perceptual and late cognitive processes during encoding to episodic memory impairment in schizophrenia. World J Biol Psychiatry 2017; 18:369-381. [PMID: 27573041 DOI: 10.1080/15622975.2016.1208839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Schizophrenia is characterised by significant episodic memory impairment that is thought to be related to problems with encoding, however the neuro-functional mechanisms underlying these deficits are not well understood. The present study used a subsequent recognition memory paradigm and event-related potentials (ERPs) to investigate temporal aspects of episodic memory encoding deficits in schizophrenia. METHODS Electroencephalographic data was recorded in 24 patients and 19 healthy controls whilst participants categorised single words as pleasant/unpleasant. ERPs were generated to subsequently recognised versus unrecognised words on the basis of a forced-choice recognition memory task. Subsequent memory effects were examined with the late positive component (LPP). Group differences in N1, P2, N400 and LPP were examined for words correctly recognised. RESULTS Patients performed more poorly than controls on the recognition task. During encoding patients had significantly reduced N400 and LPP amplitudes than controls. LPP amplitude correlated with task performance however amplitudes did not differ between patients and controls as a function of subsequent memory. No significant differences in N1 or P2 amplitude or latency were observed. CONCLUSIONS The present results indicate that early sensory processes are intact and dysfunctional higher order cognitive processes during encoding are contributing to episodic memory impairments in schizophrenia.
Collapse
Affiliation(s)
- Amity E Green
- a Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital , Australia
| | - Paul B Fitzgerald
- a Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital , Australia
| | - Patrick J Johnston
- b Department of Psychology and York Neuroimaging Centre , University of York , UK.,c School of Psychology & Counselling, Queensland University of Technology , Australia
| | - Pradeep J Nathan
- d School of Psychology and Psychiatry, Monash University , Australia.,e Brain Mapping Unit, Department of Psychiatry , University of Cambridge , UK
| | - Jayashri Kulkarni
- a Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital , Australia
| | - Rodney J Croft
- f Illawarra Health & Medical Research Institute, University of Wollongong , Australia.,g School of Psychology, University of Wollongong , Australia
| |
Collapse
|
21
|
Affiliation(s)
- Pradeep J. Nathan
- Heptares Therapeutics Ltd and University of Cambridge BioPark Broadwater Road Welwyn Garden City Hertfordshire AL7 3AX, United Kingdom
| |
Collapse
|
22
|
Nathan PJ, Lim YY, Abbott R, Galluzzi S, Marizzoni M, Babiloni C, Albani D, Bartres-Faz D, Didic M, Farotti L, Parnetti L, Salvadori N, Müller BW, Forloni G, Girtler N, Hensch T, Jovicich J, Leeuwis A, Marra C, Molinuevo JL, Nobili F, Pariente J, Payoux P, Ranjeva JP, Rolandi E, Rossini PM, Schönknecht P, Soricelli A, Tsolaki M, Visser PJ, Wiltfang J, Richardson JC, Bordet R, Blin O, Frisoni GB. Association between CSF biomarkers, hippocampal volume and cognitive function in patients with amnestic mild cognitive impairment (MCI). Neurobiol Aging 2017; 53:1-10. [PMID: 28189924 DOI: 10.1016/j.neurobiolaging.2017.01.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/08/2017] [Accepted: 01/10/2017] [Indexed: 12/31/2022]
Abstract
Few studies have examined the relationship between CSF and structural biomarkers, and cognitive function in MCI. We examined the relationship between cognitive function, hippocampal volume and cerebrospinal fluid (CSF) Aβ42 and tau in 145 patients with MCI. Patients were assessed on cognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB), the Geriatric Depression Scale and the Functional Activities Questionnaire. Hippocampal volume was measured using magnetic resonance imaging (MRI), and CSF markers of Aβ42, tau and p-tau181 were also measured. Worse performance on a wide range of memory and sustained attention tasks were associated with reduced hippocampal volume, higher CSF tau and p-tau181 and increased tau/Aβ42 ratio. Memory tasks were also associated with lower ability to conduct functional activities of daily living, providing a link between AD biomarkers, memory performance and functional outcome. These results suggest that biomarkers of Aβ and tau are strongly related to cognitive performance as assessed by the CANTAB, and have implications for the early detection and characterization of incipient AD.
Collapse
Affiliation(s)
- Pradeep J Nathan
- Heptares Therapeutics Ltd, Cambridge, UK; Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, UK.
| | - Yen Ying Lim
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | | | - Samantha Galluzzi
- Lab Alzheimer's Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Moira Marizzoni
- Lab Alzheimer's Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Claudio Babiloni
- Department of Physiology and Pharmacology, University of Rome "La Sapienza", Rome, Italy; IRCCS San Raffaele Pisana of Rome, Italy
| | - Diego Albani
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - David Bartres-Faz
- Department of Psychiatry and Clinical Psychobiology, Faculty of Medicine, University of Barcelona and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Mira Didic
- Aix-Marseille Université, INSERM, INS UMR_S 1106, Marseille, France; Service de Neurologie et Neuropsychologie, APHM Hôpital Timone Adultes, Marseille, France
| | - Lucia Farotti
- Clinica Neurologica, Centro Disturbi della Memoria, Università di Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Lucilla Parnetti
- Clinica Neurologica, Centro Disturbi della Memoria, Università di Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Nicola Salvadori
- Clinica Neurologica, Centro Disturbi della Memoria, Università di Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Bernhard W Müller
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Gianluigi Forloni
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Nicola Girtler
- Department of Neuroscience (DINOGMI), Clinical Neurology, University of Genoa, Genoa, Italy
| | - Tilman Hensch
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Jorge Jovicich
- Center for Mind/Brain Sciences, University of Trento, Rovereto, Trento, Italy
| | - Annebet Leeuwis
- Department of Neurology, Alzheimer Centre, VU Medical Centre, Amsterdam, the Netherlands
| | - Camillo Marra
- Department of Gerontology, Neurosciences and Orthopedics, Institute of Neurology, Catholic University, Policlinic A. Gemelli Foundation, Rome, Italy
| | - José Luis Molinuevo
- Alzheimer's Disease Unit and Other Cognitive Disorders Unit, Hospital Clínic de Barcelona, and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Flavio Nobili
- Department of Neuroscience (DINOGMI), Clinical Neurology, University of Genoa, Genoa, Italy
| | - Jeremie Pariente
- INSERM, Imagerie cérébrale et handicaps neurologiques UMR 825, Toulouse, France
| | - Pierre Payoux
- INSERM, Imagerie cérébrale et handicaps neurologiques UMR 825, Toulouse, France
| | - Jean-Philippe Ranjeva
- Aix-Marseille Université, INSERM, INS UMR_S 1106, Marseille, France; Service de Neurologie et Neuropsychologie, APHM Hôpital Timone Adultes, Marseille, France
| | - Elena Rolandi
- Lab Alzheimer's Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Paolo Maria Rossini
- Department of Gerontology, Neurosciences and Orthopedics, Institute of Neurology, Catholic University, Policlinic A. Gemelli Foundation, Rome, Italy
| | - Peter Schönknecht
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | | | - Magda Tsolaki
- 3rd Neurologic Clinic, Medical School, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pieter Jelle Visser
- Department of Neurology, Alzheimer Centre, VU Medical Centre, Amsterdam, the Netherlands
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany; Department of Psychiatry and Psychotherapy, University Medical Center (UMG), Georg-August-University, Goettingen, Germany
| | | | - Régis Bordet
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Olivier Blin
- Mediterranean Institute of Cognitive Neurosciences (INCM), UMR-CNRS (6193), Aix Marseille University, Marseille, France
| | - Giovanni B Frisoni
- Lab Alzheimer's Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Memory Clinic and LANVIE - Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
| |
Collapse
|
23
|
Spiegelstein O, Stevens J, Van Gerven J, Nathan PJ, Maynard JP, Mayleben DW, Hellriegel E, Yang R. Pharmacokinetics, pharmacodynamics and safety of CEP-26401, a high-affinity histamine-3 receptor antagonist, following single and multiple dosing in healthy subjects. J Psychopharmacol 2016; 30:983-93. [PMID: 27222271 DOI: 10.1177/0269881116645301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
CEP-26401 is a novel orally active, brain-penetrant, high-affinity histamine H3 receptor (H3R) antagonist, with potential therapeutic utility in cognition enhancement. Two randomized, double-blind, placebo-controlled dose escalation studies with single (0.02 to 5 mg) or multiple administration (0.02 to 0.5 mg once daily) of CEP-26401 were conducted in healthy subjects. Plasma and urine samples were collected to investigate CEP-26401 pharmacokinetics. Pharmacodynamic endpoints included a subset of tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and nocturnal polysomnography. Population pharmacokinetic-pharmacodynamic modeling was conducted on one CANTAB and one polysomnography parameter of interest. CEP-26401 was slowly absorbed (median tmax range 3-6 hours) and the mean terminal elimination half-life ranged from 24-60 hours. Steady-state plasma concentrations were achieved within six days of dosing. CEP-26401 exhibits dose- and time-independent pharmacokinetics, and renal excretion is a major elimination pathway. CEP-26401 had a dose-dependent negative effect on sleep, with some positive effects on certain CANTAB cognitive parameters seen at lower concentrations. The derived three compartment population pharmacokinetic model, with first-order absorption and elimination, accurately described the available pharmacokinetic data. CEP-26401 was generally well tolerated up to 0.5 mg/day with most common treatment related adverse events being headache and insomnia. Further clinical studies are required to establish the potential of low-dose CEP-26401 in cognition enhancement.
Collapse
Affiliation(s)
| | | | | | - Pradeep J Nathan
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | - Edward Hellriegel
- Research and Development Teva Pharmaceuticals, West Chester, PA, USA
| | - Ronghua Yang
- Research and Development Teva Pharmaceuticals, West Chester, PA, USA
| |
Collapse
|
24
|
Nathan PJ, Abbott RA, Lim YY, Galluzzi S, Marizzoni M, Bagnoli C, Babiloni C, Bartres-Faz D, Bordet R, Didic M, Farotti L, Forloni G, Jovicich J, Marra C, Molinuevo JL, Nobili F, Pariente J, Parnetti L, Payoux P, Ranjeva JP, Rossini P, Schonknecht P, Hensch T, Soricelli A, Tsolaki M, Visser PJ, Wiltfang J, Blin O, Frisoni GB. P2‐302: CSF Beta‐Amyloid‐ and APOE Ɛ4‐Related Decline in Episodic Memory Over 12 Months Measured using the Cantab in Individuals with Amnestic MCI: Results from the European ADNI Study. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Yen Ying Lim
- The Florey Institute, The University of MelbourneParkvilleAustralia
| | - Samantha Galluzzi
- IRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Moira Marizzoni
- IRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Cristina Bagnoli
- IRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Claudio Babiloni
- Department of Physiology and Pharmacology University of RomeRomeItaly
| | | | - Regis Bordet
- Department of Pharmacology University of Lille Nord de FranceLilleFrance
| | - Mira Didic
- Service de Neurologie et NeuropsychologieMarseilleFrance
| | | | | | | | | | - Jose Luis Molinuevo
- Alzheimer’s Disease Unit and Other Cognitive Disorders Unit, Hospital Clinic de BarcelonaBarcelonaItaly
| | | | | | | | | | - Jean-Philippe Ranjeva
- CIC-UPCET, CHU La Timone, AP-HM, UMR CNRS-Universite de la MediterraneeMarseilleFrance
| | | | - Peter Schonknecht
- Department of Psychiatry and Psychotherapy University Hospital LeipzigLeipzigGermany
| | - Tilman Hensch
- Department of Psychiatry and Psychotherapy University Hospital LeipzigLeipzigGermany
| | - Andrea Soricelli
- Fondazione SDN per la Ricerca e l’Alta Formazione in Diagnostica NucleareNaplesItaly
| | - Magda Tsolaki
- Aristotle University of ThessalonikiThessalonikiGreece
| | - Pieter Jelle Visser
- Department of Neurology Alzheimer Centre, VU Medical CentreAmsterdamNetherlands
| | | | - Olivier Blin
- Mediterranean Institute of Cognitive NeurosciencesMarseilleFrance
| | - Giovanni B. Frisoni
- IRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
- University HospitalsGenevaSwitzerland
| |
Collapse
|
25
|
Abbott RA, Nathan PJ, Lim YY, Galluzzi S, Marizzoni M, Bagnoli C, Bartes-Faz D, Bordet R, Farotti L, Forlini G, Jovicich J, Marra C, Molinuevo JL, Nobili F, Pariente J, Parnetti L, Payoux P, Ranjeva JP, Rossini PM, Schonknecht P, Hensch T, Soricelli A, Tsolaki M, Visser PJ, Wiltgang J, Blin O, Frisoni GB. P3‐315: Differential Effects of Apoe and CSF Amyloid on Memory Impairment in Individuals with Amnestic MCI Using the Cantab Cognitive Battery: Results from the European‐Adni Study. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Yen Ying Lim
- The Florey Institute, The University of MelbourneParkvilleAustralia
| | - Samantha Galluzzi
- IRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Moira Marizzoni
- IRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Cristina Bagnoli
- IRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | | | - Regis Bordet
- Department of Pharmacology University of Lille Nord de FranceLilleFrance
| | | | | | | | | | - José Luis Molinuevo
- Alzheimer’s Disease Unit and Other Cognitive Disorders Unit Hospital Clinic de BarcelonaBarcelonaItaly
| | | | | | | | - Pierre Payoux
- INSERM, Imagerie Cérébrale et Handicaps NeurologiquesToulouseFrance
| | - Jean-Philippe Ranjeva
- CIC-UPCET, CHU La Timone, AP-HM, UMR CNRS-Universite de la MediterraneeMarseilleFrance
| | | | - Peter Schonknecht
- Department of Neuroradiology University Hospital LeipzigLeipzigGermany
| | | | - Andrea Soricelli
- Fondazione SDN per la Ricerca e l’Alta Formazione in Diagnostica NucleareNaplesItaly
| | - Magda Tsolaki
- Aristotle University of ThessalonikiThessalonikiGreece
| | | | | | - Olivier Blin
- Mediterranean Institute of Cognitive NeurosciencesMarseilleFrance
| | | |
Collapse
|
26
|
Outhred T, Das P, Dobson-Stone C, Felmingham KL, Bryant RA, Nathan PJ, Malhi GS, Kemp AH. Impact of 5-HTTLPR on SSRI serotonin transporter blockade during emotion regulation: A preliminary fMRI study. J Affect Disord 2016; 196:11-9. [PMID: 26896742 DOI: 10.1016/j.jad.2016.02.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/16/2016] [Accepted: 02/06/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The short ('S') allele of the serotonin transporter (5-HTT)-linked polymorphic region (5-HTTLPR) is associated with increased negative emotion processing bias, and this polymorphism moderates acute effects of selective serotonin reuptake inhibitor (SSRI) treatment. In this preliminary study, we explore the moderating effect of 5-HTTLPR on the impact of the SSRI, escitalopram during emotion regulation of negative emotional stimuli. METHOD Thirty-six healthy Caucasian, female participants underwent two fMRI scanning sessions following single dose escitalopram and placebo administration separated by a seven-day washout period according to a double-blind, randomized, placebo-controlled crossover design. Functional connectivity analysis was employed with a left (L) amygdala seed and a right interior frontal gyrus (R IFG) target. RESULTS Changes in functional connectivity with emotion regulation and treatment were linearly related to 5-HTTLPR 'L' allele load such that negative R IFG-L amygdala connectivity was increased with an increasing number of 'L' alleles. Therefore, escitalopram may facilitate the effects of reappraisal by enhancing negative functional connectivity, a finding that is greatest in participants homozygous for the 'L' allele and least in those homozygous for the 'S' allele. LIMITATIONS Sub-samples of the homozygote 'S/S' and 'L/L' 5-HTTLPR groupings were small. However, the within-subjects nature of the experiment and observing changes at the individual subject level increases our confidence in the findings of the present study. CONCLUSIONS The present study elucidates a potential neural mechanism by which antidepressant treatment produces differential treatment outcomes dependent on the 5-HTTLPR polymorphism, providing new and important leads for models of antidepressant action.
Collapse
Affiliation(s)
- Tim Outhred
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; Sydney Medical School Northern, University of Sydney, NSW 2006, Australia
| | - Pritha Das
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; Sydney Medical School Northern, University of Sydney, NSW 2006, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, NSW 2065, Australia
| | - Carol Dobson-Stone
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; School of Medical Sciences, University of New South Wales, Kensington, NSW 2033, Australia
| | - Kim L Felmingham
- School of Psychology, University of Tasmania, Hobart, TAS 7001, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Kensington, NSW 2033, Australia
| | - Pradeep J Nathan
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1QB, United Kingdom; School of Psychology and Psychiatry, Monash University, VIC 3800, Australia
| | - Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; Sydney Medical School Northern, University of Sydney, NSW 2006, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, NSW 2065, Australia
| | - Andrew H Kemp
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; Sydney Medical School Northern, University of Sydney, NSW 2006, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, NSW 2065, Australia; Department of Psychology, College of Human and Health Sciences, Swansea University, Vivian Tower, Singleton Park, SWANSEA SA2 8PP, United Kingdom.
| |
Collapse
|
27
|
Roiser JP, Nathan PJ, Mander AP, Adusei G, Zavitz KH, Blackwell AD. Assessment of cognitive safety in clinical drug development. Drug Discov Today 2016; 21:445-53. [PMID: 26610416 PMCID: PMC4863933 DOI: 10.1016/j.drudis.2015.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/21/2015] [Accepted: 11/08/2015] [Indexed: 02/08/2023]
Abstract
Cognitive impairment is increasingly recognised as an important potential adverse effect of medication. However, many drug development programmes do not incorporate sensitive cognitive measurements. Here, we review the rationale for cognitive safety assessment, and explain several basic methodological principles for measuring cognition during clinical drug development, including study design and statistical analysis, from Phase I through to postmarketing. The crucial issue of how cognition should be assessed is emphasized, especially the sensitivity of measurement. We also consider how best to interpret the magnitude of any identified effects, including comparison with benchmarks. We conclude by discussing strategies for the effective communication of cognitive risks.
Collapse
Affiliation(s)
- Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK.
| | - Pradeep J Nathan
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Neuroscience Center of Excellence, inVentiv Health, Maidenhead, UK; School of Psychological Sciences, Monash University, Clayton, Australia
| | - Adrian P Mander
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | | | | | - Andrew D Blackwell
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Cambridge Cognition Limited, Bottisham, Cambridge, UK
| |
Collapse
|
28
|
Abstract
Acute antidepressant administration modulates neural activity consistent with decreases in negative emotion processing bias. However, studies are yet to examine whether treatment facilitates neural activity during reappraisal, an adaptive emotion regulation strategy associated with behavioral treatment response. Here we examine the impact of acute administration on reappraisal of negative stimuli using pharmaco-fMRI. Thirty-six healthy female participants completed two sessions of fMRI scanning, separated by a one-week washout period. A single dose of the selective serotonin reuptake inhibitor, escitalopram (20mg) was administered to participants using a double-blind, randomized, placebo-controlled crossover design. When participants were administered escitalopram (relative to a placebo) and asked to reappraise negative emotional stimuli, left amygdala activation was decreased and right inferior frontal gyrus (R IFG) activation was increased. Also observed was a greater negative left amygdala-R IFG functional connectivity when participants were administered escitalopram relative to placebo, and this change in connectivity was associated with reductions in subjective ratings of valence and arousal of negative stimuli. Further analysis revealed connectivity modulation across multiple frontal regions. Results suggest that the acute effect of a commonly prescribed antidepressant may include facilitating the regulation of negative emotional stimuli, providing new important leads for models of antidepressant action.
Collapse
Affiliation(s)
- Tim Outhred
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, NSW 2065, Australia; SCAN Research and Teaching Unit, School of Psychology, University of Sydney, NSW 2006, Australia
| | - Pritha Das
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, NSW 2065, Australia; CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, NSW 2065, Australia; Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, NSW 2065, Australia
| | - Kim L Felmingham
- School of Psychology, University of Tasmania, Hobart, TAS 7001, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Kensington, NSW 2033, Australia
| | - Pradeep J Nathan
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1QB, United Kingdom; School of Psychology and Psychiatry, Monash University, VIC 3800, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, NSW 2065, Australia; CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, NSW 2065, Australia; Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, NSW 2065, Australia
| | - Andrew H Kemp
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, NSW 2065, Australia; SCAN Research and Teaching Unit, School of Psychology, University of Sydney, NSW 2006, Australia; CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, NSW 2065, Australia; Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, NSW 2065, Australia; Hospital Universitário, University of São Paulo, 05508-000 São Paulo, SP, Brazil.
| |
Collapse
|
29
|
Shellshear L, MacDonald AD, Mahoney J, Finch E, McMahon K, Silburn P, Nathan PJ, Copland DA. Levodopa enhances explicit new-word learning in healthy adults: a preliminary study. Hum Psychopharmacol 2015; 30:341-9. [PMID: 25900350 DOI: 10.1002/hup.2480] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 01/15/2015] [Accepted: 02/09/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE While the role of dopamine in modulating executive function, working memory and associative learning has been established; its role in word learning and language processing more generally is not clear. This preliminary study investigated the impact of increased synaptic dopamine levels on new-word learning ability in healthy young adults using an explicit learning paradigm. METHOD A double-blind, placebo-controlled, between-groups design was used. Participants completed five learning sessions over 1 week with levodopa or placebo administered at each session (five doses, 100 mg). Each session involved a study phase followed by a test phase. Test phases involved recall and recognition tests of the new (non-word) names previously paired with unfamiliar objects (half with semantic descriptions) during the study phase. RESULTS The levodopa group showed superior recall accuracy for new words over five learning sessions compared with the placebo group and better recognition accuracy at a 1-month follow-up for words learnt with a semantic description. CONCLUSIONS These findings suggest that dopamine boosts initial lexical acquisition and enhances longer-term consolidation of words learnt with semantic information, consistent with dopaminergic enhancement of semantic salience.
Collapse
Affiliation(s)
- Leanne Shellshear
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,School of Health and Rehabilitation Sciences, Division of Speech Pathology, The University of Queensland, Brisbane, Australia
| | - Anna D MacDonald
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Jeffrey Mahoney
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, Division of Speech Pathology, The University of Queensland, Brisbane, Australia
| | - Katie McMahon
- UQ Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
| | - Peter Silburn
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Pradeep J Nathan
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, UK.,School of Psychology and Psychiatry, Monash University, Melbourne, Australia
| | - David A Copland
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,School of Health and Rehabilitation Sciences, Division of Speech Pathology, The University of Queensland, Brisbane, Australia
| |
Collapse
|
30
|
Stough C, Downey LA, Lloyd J, Silber B, Redman S, Hutchison C, Wesnes K, Nathan PJ. Corrigendum: Examining the Nootropic Effects of a Special Extract ofBacopa monnieraon Human Cognitive Functioning: 90 day Double-Blind Placebo-Controlled Randomized Trial. Phytother Res 2015. [DOI: 10.1002/ptr.5441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
31
|
Reijs BL, Ramakers IH, Teunissen CE, Nathan PJ, Verhey FR, Tsolaki M, Wahlund LO, Waldemar G, Hausner L, Vandenberghe R, Johannsen P, Blackwell A, Visser PJ. O4‐03‐01: Early detection of Alzheimer's disease (AD)‐related amyloid and tau pathology: A computerized versus a paper‐and‐pencil memory test. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.07.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Babette L.R. Reijs
- Alzheimer Center Limburg, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtNetherlands
| | - Inez H.G.B. Ramakers
- Alzheimer Center Limburg, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtNetherlands
| | | | | | - Frans R.J. Verhey
- Alzheimer Center Limburg, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtNetherlands
| | - Magda Tsolaki
- Aristotle University of ThessalonikiThessalonikiGreece
| | | | - Gunhild Waldemar
- Danish Dementia Research Centre, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Lucrezia Hausner
- Heidelberg UniversityCentral Institute of Mental HealthMannheimGermany
| | | | - Peter Johannsen
- Danish Dementia Research Centre, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Andrew Blackwell
- Cambridge Cognition & University of CambridgeCambridgeUnited Kingdom
| | - Pieter Jelle Visser
- Alzheimer Center Limburg, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtNetherlands
- Alzheimer CenterVU University Medical CenterAmsterdamNetherlands
| |
Collapse
|
32
|
Cormack FK, Barnett JH, Nathan PJ, Blackwell A, Klekociuk SZ, Saunders NL, Summers MJ. O4‐03‐03: What is a normal change in memory? n=1 classification of clinically relevant cognitive decline. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.07.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Pradeep J. Nathan
- Cambridge CognitionCambridgeUnited Kingdom
- Cambridge Cognition & University of CambridgeCambridgeUnited Kingdom
| | - Andrew Blackwell
- Cambridge Cognition & University of CambridgeCambridgeUnited Kingdom
| | | | | | - Mathew J. Summers
- School of MedicineUniversity of TasmaniaHobartAustralia
- School of Social SciencesUniversity of the Sunshine CoastMaroochydore DCAustralia
| |
Collapse
|
33
|
Stough C, Lloyd J, Clarke J, Downey LA, Hutchison CW, Rodgers T, Nathan PJ. Erratum to: The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology (Berl) 2015; 232:2427-2427. [PMID: 26032841 DOI: 10.1007/s00213-015-3965-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C Stough
- Neuropsychology Laboratory, School of Biophysical Science and Electrical Engineering, Victoria, Australia
| | | | | | | | | | | | | |
Collapse
|
34
|
Gorka SM, Fitzgerald DA, Labuschagne I, Hosanagar A, Wood AG, Nathan PJ, Phan KL. Oxytocin modulation of amygdala functional connectivity to fearful faces in generalized social anxiety disorder. Neuropsychopharmacology 2015; 40:278-86. [PMID: 24998619 PMCID: PMC4443941 DOI: 10.1038/npp.2014.168] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 11/09/2022]
Abstract
The neuropeptide oxytocin (OXT) is thought to attenuate anxiety by dampening amygdala reactivity to threat in individuals with generalized social anxiety disorder (GSAD). Because the brain is organized into networks of interconnected areas, it is likely that OXT impacts functional coupling between the amygdala and other socio-emotional areas of the brain. Therefore, the aim of the current study was to examine the effects of OXT on amygdala functional connectivity during the processing of fearful faces in GSAD subjects and healthy controls (HCs). In a randomized, double-blind, placebo (PBO)-controlled, within-subjects design, 18 HCs and 17 GSAD subjects performed a functional magnetic resonance imaging task designed to probe amygdala response to fearful faces following acute intranasal administration of PBO or OXT. Functional connectivity between the amygdala and the rest of the brain was compared between OXT and PBO sessions using generalized psychophysiological interaction analyses. Results indicated that within individuals with GSAD, but not HCs, OXT enhanced functional connectivity between the amygdala and the bilateral insula and middle cingulate/dorsal anterior cingulate gyrus during the processing of fearful faces. These findings suggest that OXT may have broad pro-social implications such as enhancing the integration and modulation of social responses.
Collapse
Affiliation(s)
- Stephanie M Gorka
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA,Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Daniel A Fitzgerald
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA,Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Izelle Labuschagne
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia,School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - Avinash Hosanagar
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA,Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Amanda G Wood
- School of Psychology, University of Birmingham, Birmingham, UK,Child Neuropsychology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Southern Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Pradeep J Nathan
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia,Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA,Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA,Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, USA,Department of Psychiatry, University of Illinois at Chicago, 1747 West Roosevelt Road, IJR/WROB Suite 244, Chicago, IL 60608, USA, Tel: +312 355 5954, Fax: +312 413 1703, E-mail:
| |
Collapse
|
35
|
Kelly E, Mundell SJ, Sava A, Roth AL, Felici A, Maltby K, Nathan PJ, Bullmore ET, Henderson G. The opioid receptor pharmacology of GSK1521498 compared to other ligands with differential effects on compulsive reward-related behaviours. Psychopharmacology (Berl) 2015; 232:305-14. [PMID: 24973897 PMCID: PMC4281354 DOI: 10.1007/s00213-014-3666-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/12/2014] [Indexed: 12/02/2022]
Abstract
RATIONALE The novel opioid receptor antagonist, GSK1421498, has been shown to attenuate reward-driven compulsive behaviours, such as stimulant drug seeking or binge eating, in animals and humans. Here, we report new data on the receptor pharmacology of GSK121498, in comparison to naltrexone, naloxone, 6-β-naltrexol and nalmefene. OBJECTIVES To determine whether the novel opioid antagonist, GSK1521498, is an orthosteric or allosteric antagonist at the μ opioid receptor (MOPr) and whether it has neutral antagonist or inverse agonist properties. METHODS A combination of radioligand binding assays and [(35)S]GTPγS binding assays was employed. RESULTS GSK1521498 completely displaced [(3)H]naloxone binding to MOPr and did not alter the rate of [(3)H]naloxone dissociation from MOPr observations compatible with it binding to the orthosteric site on MOPr. GSK1521498 exhibited inverse agonism when MOPr was overexpressed but not when the level of MOPr expression was low. In parallel studies under conditions of high receptor expression density, naloxone, naltrexone, 6-β-naltrexol and nalmefene exhibited partial agonism, not inverse agonism as has been reported previously for naloxone and naltrexone. In brain tissue from mice receiving a prolonged morphine pre-treatment, GSK1521498 exhibited slight inverse agonism. CONCLUSIONS Differences between GSK1521498 and naltrexone in their effects on compulsive reward seeking are arguably linked to the more selective and complete MOPr antagonism of GSK1521498 versus the partial MOPr agonism of naltrexone. GSK1521498 is also pharmacologically differentiated by its inverse agonist efficacy at high levels of MOPr expression, but this may be less likely to contribute to behavioural differentiation at patho-physiological levels of expression.
Collapse
Affiliation(s)
- Eamonn Kelly
- School of Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD UK
| | - Stuart J. Mundell
- School of Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD UK
| | - Anna Sava
- Aptuit Centre for Drug Discovery & Development, Aptuit Srl., Verona, Italy
| | - Adelheid L. Roth
- Aptuit Centre for Drug Discovery & Development, Aptuit Srl., Verona, Italy
| | - Antonio Felici
- Aptuit Centre for Drug Discovery & Development, Aptuit Srl., Verona, Italy
| | - Kay Maltby
- Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Cambridge, UK ,Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Pradeep J. Nathan
- Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Cambridge, UK ,Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Edward T. Bullmore
- Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Cambridge, UK ,Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Graeme Henderson
- School of Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD UK
| |
Collapse
|
36
|
Clark-Elford R, Nathan PJ, Auyeung B, Mogg K, Bradley BP, Sule A, Müller U, Dudas RB, Sahakian BJ, Baron-Cohen S. Effects of oxytocin on attention to emotional faces in healthy volunteers and highly socially anxious males. Int J Neuropsychopharmacol 2014; 18:pyu012. [PMID: 25552432 PMCID: PMC4368883 DOI: 10.1093/ijnp/pyu012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence suggests that individuals with social anxiety demonstrate vigilance to social threat, whilst the peptide hormone oxytocin is widely accepted as supporting affiliative behaviour in humans. METHODS This study investigated whether oxytocin can affect attentional bias in social anxiety. In a double-blind, randomized, placebo-controlled, within-group study design, 26 healthy and 16 highly socially anxious (HSA) male volunteers (within the HSA group, 10 were diagnosed with generalized social anxiety disorder) were administered 24 IU of oxytocin or placebo to investigate attentional processing in social anxiety. Attentional bias was assessed using the dot-probe paradigm with angry, fearful, happy and neutral face stimuli. RESULTS In the baseline placebo condition, the HSA group showed greater attentional bias for emotional faces than healthy individuals. Oxytocin reduced the difference between HSA and non-socially anxious individuals in attentional bias for emotional faces. Moreover, it appeared to normalize attentional bias in HSA individuals to levels seen in the healthy population in the baseline condition. The biological mechanisms by which oxytocin may be exerting these effects are discussed. CONCLUSIONS These results, coupled with previous research, could indicate a potential therapeutic use of this hormone in treatment for social anxiety.
Collapse
Affiliation(s)
- Rebecca Clark-Elford
- Department of Psychiatry, University of Cambridge, UK (Mrs Clark Elford, Professors Nathan, Mogg, Bradley, Sahakian,and Baron-Cohen, and Drs Auyeung, Sule, Muller, and Dudas ); Cambridge Cognition Ltd, Cambridge, UK (Dr Nathan); School of Psychology and Psychiatry, Monash University, Australia (Dr Nathan); Autism Research Centre, Department of Psychiatry, University of Cambridge, UK (Drs Auyeung and Baron-Cohen); Department of Psychology, University of Edinburgh, UK (Dr Auyeung); South Essex NHS Partnership Trust, UK (Dr Sule); Psychology, University of Southampton, UK (Drs Mogg and Bradley); Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), UK (Drs Müller, Dudas, and Baron-Cohen); MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge (Dr Sahakian).
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Outhred T, Das P, Dobson-Stone C, Felmingham KL, Bryant RA, Nathan PJ, Malhi GS, Kemp AH. The impact of 5-HTTLPR on acute serotonin transporter blockade by escitalopram on emotion processing: preliminary findings from a randomised, crossover fMRI study. Aust N Z J Psychiatry 2014; 48:1115-25. [PMID: 24810870 DOI: 10.1177/0004867414533837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Benefit from antidepressant treatment such as selective serotonin reuptake inhibitors (SSRIs) may depend on individual differences in acute effects on neural emotion processing. The short ('S') allele of the serotonin transporter (5-HTT)-linked polymorphic region (5-HTTLPR) is associated with both negative emotion processing biases and poorer treatment outcomes. Therefore, the aim of the present study was to explore the effects of 5-HTTLPR on the impact of the SSRI escitalopram during processing of positive and negative emotional images, as well as neutral stimuli. METHODS The study employed a double-blind, randomised, placebo-controlled crossover design on 36 healthy Caucasian female participants who underwent functional magnetic resonance imaging (fMRI) scanning following placebo or escitalopram treatment, separated by a 7-day washout period. RESULTS Changes in the left amygdala signal with escitalopram treatment during processing of emotional stimuli were linearly related to the 5-HTTLPR 'S' allele load such that the signal to positive stimuli decreased and the signal to negative stimuli increased with an increasing number of low-expressing 'S' alleles. While 5-HTTLPR subgroups were small in size, individual subject changes with treatment and task condition increase confidence in the findings. CONCLUSIONS While preliminary, our findings comprise the first pharmacogenetic study demonstrating an effect of the 5-HTTLPR 'S' allele load on escitalopram-induced changes in amygdala activity during emotional processing, consistent with a 5-HTT expression dosage model. The present findings have implications for the impact of this polymorphism on antidepressant efficacy in patients with mood and anxiety disorders.
Collapse
Affiliation(s)
- Tim Outhred
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, St Leonards, Australia SCAN Research and Teaching Unit, School of Psychology, University of Sydney, Sydney, Australia
| | - Pritha Das
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, St Leonards, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, St Leonards, Australia
| | - Carol Dobson-Stone
- Neuroscience Research Australia, Randwick, Australia School of Medical Sciences, University of New South Wales, Kensington, Australia
| | | | - Richard A Bryant
- School of Psychology, University of New South Wales, Kensington, Australia
| | - Pradeep J Nathan
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom School of Psychology and Psychiatry, Monash University, Clayton, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, St Leonards, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, St Leonards, Australia
| | - Andrew H Kemp
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, St Leonards, Australia SCAN Research and Teaching Unit, School of Psychology, University of Sydney, Sydney, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, St Leonards, Australia Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
38
|
Grove RA, Harrington CM, Mahler A, Beresford I, Maruff P, Lowy MT, Nicholls AP, Boardley RL, Berges AC, Nathan PJ, Horrigan JP. A randomized, double-blind, placebo-controlled, 16-week study of the H3 receptor antagonist, GSK239512 as a monotherapy in subjects with mild-to-moderate Alzheimer's disease. Curr Alzheimer Res 2014; 11:47-58. [PMID: 24359500 DOI: 10.2174/1567205010666131212110148] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 10/12/2013] [Accepted: 10/25/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Histaminergic H3 receptors may play a role in modulating cholinergic and monoaminergic neurotransmission. This Phase II study evaluated the efficacy and safety of GSK239512, a highly potent, brain penetrant H3 receptor antagonist as monotherapy treatment for subjects with mild-to-moderate probable Alzheimer's disease (AD). METHODS In this 16-week, double-blind, randomized, parallel group study, 196 currently untreated subjects with mild-tomoderate AD (Mini Mental State Examination [MMSE] 16-24) received GSK239512 (n=97); or placebo (n=99) administered orally each morning. After a two-week placebo run-in period GSK239512 was up-titrated over 4 weeks in a flexible manner (10-20-40-80 microgram [µg]) followed by a 12-week Maintenance Phase. Co-primary efficacy endpoints were change from baseline in Episodic Memory and Executive Function/Working Memory composite scores from the CogState neuropsychological test battery (NTB) at Week 16. RESULTS Compared to placebo, GSK239512 improved Episodic Memory at Week 16 (Effect Size [ES] =0.35; p=0.0495). No statistically significant differences were observed on other cognitive domains or on clinical measures including the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADASCog). GSK239512 treatment was associated with mild to moderate adverse events with headache, dizziness and events related to sleep disturbances being the most common and more pronounced in the early titration period when subjects were first being exposed to GSK239512 at the lower 10µg and 20µg doses. There were no clinically relevant changes in other safety parameters. CONCLUSION GSK239512, at doses up to 80µg/day, improved Episodic Memory in patients with mildto- moderate AD. However, no improvements were observed on Executive Function/Working Memory or other domains of cognition. No changes were observed on any of the clinical measures included as secondary endpoints (including ADAS-Cog) indicating that GSK239512 failed to show benefit in this population. GSK239512 had an acceptable safety and tolerability profile. These findings suggest that H3 antagonists may, at most, have modest and selective effects on cognitive function in patients with mild-to-moderate AD.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Joseph P Horrigan
- Neurosciences Therapeutic Area, GlaxoSmithKline, Five Moore Drive, Research Triangle Park, NC, 27709, USA.
| |
Collapse
|
39
|
Dodhia S, Hosanagar A, Fitzgerald DA, Labuschagne I, Wood AG, Nathan PJ, Phan KL. Modulation of resting-state amygdala-frontal functional connectivity by oxytocin in generalized social anxiety disorder. Neuropsychopharmacology 2014; 39:2061-9. [PMID: 24594871 PMCID: PMC4104324 DOI: 10.1038/npp.2014.53] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 01/01/2023]
Abstract
Generalized social anxiety disorder (GSAD) is characterized by aberrant patterns of amygdala-frontal connectivity to social signals of threat and at rest. The neuropeptide oxytocin (OXT) modulates anxiety, stress, and social behaviors. Recent functional neuroimaging studies suggest that these effects are mediated through OXT's effects on amygdala reactivity and/or amygdala-frontal connectivity. The aim of the current study was to examine OXT's effects on amygdala-frontal resting-state functional connectivity (rsFC) in GSAD patients and healthy controls (HCs). In a randomized, double-blind, cross-over design, 18 GSAD and 18 HC participants received intranasal OXT (24 IU or 40.32 μg) or placebo (PBO) before resting-state functional magnetic resonance imaging. In individuals with GSAD, OXT enhanced rsFC of the left and right amygdala with rostral anterior cingulate cortex (ACC)/medial prefrontal cortex (mPFC), and in doing so, reversed (ie, 'normalized') the reduced amygdala-frontal connectivity observed relative to HCs evident on PBO. Higher social anxiety severity in GSAD subjects correlated with lower amygdala-ACC/mPFC connectivity on PBO and higher social anxiety also correlated with greater enhancement in amygdala-frontal connectivity induced by OXT. These findings show that OXT modulates a neural circuit known for social threat processing and emotion regulation, suggesting a neural mechanism by which OXT may have a role in the pathophysiology and treatment of social anxiety disorder.
Collapse
Affiliation(s)
- Sonam Dodhia
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Avinash Hosanagar
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA,Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Daniel A Fitzgerald
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA,Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Izelle Labuschagne
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Amanda G Wood
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia,School of Psychology, University of Birmingham, Birmingham, UK
| | - Pradeep J Nathan
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia,Department of Psychiatry, Cambridge University, Cambridge, UK
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA,Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, USA,Departments of Psychology and Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, USA,Department of Psychiatry, University of Illinois at Chicago, 1747 West Roosevelt Road, IJR/WROB Suite 244, Chicago, IL 60608, USA, Tel: +312 355 5954, E-mail:
| |
Collapse
|
40
|
Outhred T, Das P, Felmingham KL, Bryant RA, Nathan PJ, Malhi GS, Kemp AH. Impact of acute administration of escitalopram on the processing of emotional and neutral images: a randomized crossover fMRI study of healthy women. J Psychiatry Neurosci 2014; 39:267-75. [PMID: 24690370 PMCID: PMC4074238 DOI: 10.1503/jpn.130118] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 11/03/2013] [Accepted: 01/14/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Acute neural effects of antidepressant medication on emotion processing biases may provide the foundation on which clinical outcomes are based. Along with effects on positive and negative stimuli, acute effects on neutral stimuli may also relate to antidepressant efficacy, yet these effects are still to be investigated. The present study therefore examined the impact of a single dose of the selective serotonin reuptake inhibitor escitalopram (20 mg) on positive, negative and neutral stimuli using pharmaco-fMRI. METHODS Within a double-blind, randomized, placebo-controlled crossover design, healthy women completed 2 sessions of treatment administration and fMRI scanning separated by a 1-week washout period. RESULTS We enrolled 36 women in our study. When participants were administered escitalopram relative to placebo, left amygdala activity was increased and right inferior frontal gyrus (IFG) activity was decreased during presentation of positive pictures (potentiation of positive emotion processing). In contrast, escitalopram was associated with decreased left amygdala and increased right IFG activity during presentation of negative pictures (attenuation of negative emotion processing). In addition, escitalopram decreased right IFG activity during the processing of neutral stimuli, akin to the effects on positive stimuli (decrease in negative appraisal). LIMITATIONS Although we used a women-only sample to reduce heterogeneity, our results may not generalize to men. Potential unblinding, which was related to the subjective occurrence of side effects, occurred in the study; however, manipulation check analyses demonstrated that results were not impacted. CONCLUSION These novel findings demonstrate that a single dose of the commonly prescribed escitalopram facilitates a positive information processing bias. These findings provide an important lead for better understanding effects of antidepressant medication.
Collapse
Affiliation(s)
- Tim Outhred
- Outhred, Das, Malhi, Kemp — Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, Australia; Outhred, Kemp — SCAN Research and Teaching Unit, School of Psychology, University of Sydney, Australia; Das, Malhi, Kemp — CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Australia; Das, Malhi, Kemp — Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, Australia; Felmingham — School of Psychology, University of Tasmania, Hobart, Australia; Bryant — School of Psychology, University of New South Wales, Kensington, Australia; Nathan — Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Nathan — School of Psychology and Psychiatry, Monash University, Australia; Kemp — University Hospital, University of São Paulo, São Paulo SP, Brazil
| | - Pritha Das
- Outhred, Das, Malhi, Kemp — Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, Australia; Outhred, Kemp — SCAN Research and Teaching Unit, School of Psychology, University of Sydney, Australia; Das, Malhi, Kemp — CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Australia; Das, Malhi, Kemp — Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, Australia; Felmingham — School of Psychology, University of Tasmania, Hobart, Australia; Bryant — School of Psychology, University of New South Wales, Kensington, Australia; Nathan — Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Nathan — School of Psychology and Psychiatry, Monash University, Australia; Kemp — University Hospital, University of São Paulo, São Paulo SP, Brazil
| | - Kim L. Felmingham
- Outhred, Das, Malhi, Kemp — Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, Australia; Outhred, Kemp — SCAN Research and Teaching Unit, School of Psychology, University of Sydney, Australia; Das, Malhi, Kemp — CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Australia; Das, Malhi, Kemp — Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, Australia; Felmingham — School of Psychology, University of Tasmania, Hobart, Australia; Bryant — School of Psychology, University of New South Wales, Kensington, Australia; Nathan — Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Nathan — School of Psychology and Psychiatry, Monash University, Australia; Kemp — University Hospital, University of São Paulo, São Paulo SP, Brazil
| | - Richard A. Bryant
- Outhred, Das, Malhi, Kemp — Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, Australia; Outhred, Kemp — SCAN Research and Teaching Unit, School of Psychology, University of Sydney, Australia; Das, Malhi, Kemp — CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Australia; Das, Malhi, Kemp — Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, Australia; Felmingham — School of Psychology, University of Tasmania, Hobart, Australia; Bryant — School of Psychology, University of New South Wales, Kensington, Australia; Nathan — Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Nathan — School of Psychology and Psychiatry, Monash University, Australia; Kemp — University Hospital, University of São Paulo, São Paulo SP, Brazil
| | - Pradeep J. Nathan
- Outhred, Das, Malhi, Kemp — Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, Australia; Outhred, Kemp — SCAN Research and Teaching Unit, School of Psychology, University of Sydney, Australia; Das, Malhi, Kemp — CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Australia; Das, Malhi, Kemp — Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, Australia; Felmingham — School of Psychology, University of Tasmania, Hobart, Australia; Bryant — School of Psychology, University of New South Wales, Kensington, Australia; Nathan — Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Nathan — School of Psychology and Psychiatry, Monash University, Australia; Kemp — University Hospital, University of São Paulo, São Paulo SP, Brazil
| | - Gin S. Malhi
- Outhred, Das, Malhi, Kemp — Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, Australia; Outhred, Kemp — SCAN Research and Teaching Unit, School of Psychology, University of Sydney, Australia; Das, Malhi, Kemp — CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Australia; Das, Malhi, Kemp — Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, Australia; Felmingham — School of Psychology, University of Tasmania, Hobart, Australia; Bryant — School of Psychology, University of New South Wales, Kensington, Australia; Nathan — Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Nathan — School of Psychology and Psychiatry, Monash University, Australia; Kemp — University Hospital, University of São Paulo, São Paulo SP, Brazil
| | - Andrew H. Kemp
- Outhred, Das, Malhi, Kemp — Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, Australia; Outhred, Kemp — SCAN Research and Teaching Unit, School of Psychology, University of Sydney, Australia; Das, Malhi, Kemp — CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Australia; Das, Malhi, Kemp — Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Royal North Shore Hospital, Australia; Felmingham — School of Psychology, University of Tasmania, Hobart, Australia; Bryant — School of Psychology, University of New South Wales, Kensington, Australia; Nathan — Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Nathan — School of Psychology and Psychiatry, Monash University, Australia; Kemp — University Hospital, University of São Paulo, São Paulo SP, Brazil
| |
Collapse
|
41
|
Schwab LC, Luo V, Clarke CL, Nathan PJ. Effects of the KIBRA Single Nucleotide Polymorphism on Synaptic Plasticity and Memory: A Review of the Literature. Curr Neuropharmacol 2014; 12:281-8. [PMID: 24851092 PMCID: PMC4023458 DOI: 10.2174/1570159x11666140104001553] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/19/2013] [Accepted: 01/02/2014] [Indexed: 11/25/2022] Open
Abstract
There has been a great deal
of interest recently in genetic effects on neurocognitive performance in the
healthy population. KIBRA –a postsynaptic protein from the WWC family of
proteins– was identified in 2003 in the human brain and kidney and has recently
been associated with memory performance and synaptic plasticity. Through
genome-wide screening, a single nucleotide polymorphism (SNP) was detected in
the ninth intron of KIBRA gene (T→ C substitution) and was implicated in human
memory and the underlying neuronal circuitry. This review presents a synopsis of
the current findings on the effects of the KIBRA SNP on human memory and
synaptic plasticity. Overall the findings suggest impaired memory performance
and less efficient or impaired hippocampal/medial temporal lobe (MTL) activation
in CC homozygotes (in comparison to T carriers) with some differences between
young and older subjects. This review also highlights limitations and potential
sources for variability of studies’ imaging findings along with future
perspectives and implications for the role of KIBRA in memory-related brain
systems.
Collapse
Affiliation(s)
| | - Vincent Luo
- Clinical Unit Cambridge, GlaxoSmithKline, UK
| | | | - Pradeep J Nathan
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, UK; ; School of Psychology and Psychiatry, Monash University, Australia; ; Neuroscience Discovery Medicine, UCB Pharma, Belgium
| |
Collapse
|
42
|
Soltész F, Suckling J, Lawrence P, Tait R, Ooi C, Bentley G, Dodds CM, Miller SR, Wille DR, Byrne M, McHugh SM, Bellgrove MA, Croft RJ, Lu B, Bullmore ET, Nathan PJ. Identification of BDNF sensitive electrophysiological markers of synaptic activity and their structural correlates in healthy subjects using a genetic approach utilizing the functional BDNF Val66Met polymorphism. PLoS One 2014; 9:e95558. [PMID: 24760076 PMCID: PMC3997566 DOI: 10.1371/journal.pone.0095558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/28/2014] [Indexed: 12/18/2022] Open
Abstract
Increasing evidence suggests that synaptic dysfunction is a core pathophysiological hallmark of neurodegenerative disorders. Brain-derived neurotropic factor (BDNF) is key synaptogenic molecule and targeting synaptic repair through modulation of BDNF signalling has been suggested as a potential drug discovery strategy. The development of such "synaptogenic" therapies depend on the availability of BDNF sensitive markers of synaptic function that could be utilized as biomarkers for examining target engagement or drug efficacy in humans. Here we have utilized the BDNF Val66Met genetic polymorphism to examine the effect of the polymorphism and genetic load (i.e. Met allele load) on electrophysiological (EEG) markers of synaptic activity and their structural (MRI) correlates. Sixty healthy adults were prospectively recruited into the three genetic groups (Val/Val, Val/Met, Met/Met). Subjects also underwent fMRI, tDCS/TMS, and cognitive assessments as part of a larger study. Overall, some of the EEG markers of synaptic activity and brain structure measured with MRI were the most sensitive markers of the polymorphism. Met carriers showed decreased oscillatory activity and synchrony in the neural network subserving error-processing, as measured during a flanker task (ERN); and showed increased slow-wave activity during resting. There was no evidence for a Met load effect on the EEG measures and the polymorphism had no effects on MMN and P300. Met carriers also showed reduced grey matter volume in the anterior cingulate and in the (left) prefrontal cortex. Furthermore, anterior cingulate grey matter volume, and oscillatory EEG power during the flanker task predicted subsequent behavioural adaptation, indicating a BDNF dependent link between brain structure, function and behaviour associated with error processing and monitoring. These findings suggest that EEG markers such as ERN and resting EEG could be used as BDNF sensitive functional markers in early clinical development to examine target engagement or drug related efficacy of synaptic repair therapies in humans.
Collapse
Affiliation(s)
- Fruzsina Soltész
- Clinical Unit Cambridge, GlaxoSmithKline, Cambridge, United Kingdom
| | - John Suckling
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, United Kingdom
| | - Phil Lawrence
- Clinical Unit Cambridge, GlaxoSmithKline, Cambridge, United Kingdom
| | - Roger Tait
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, United Kingdom
| | - Cinly Ooi
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, United Kingdom
| | - Graham Bentley
- Clinical Unit Cambridge, GlaxoSmithKline, Cambridge, United Kingdom
| | - Chris M. Dodds
- Department of Psychology, University of Exeter, Exeter, United Kingdom
| | - Sam R. Miller
- Clinical Unit Cambridge, GlaxoSmithKline, Cambridge, United Kingdom
| | - David R. Wille
- Clinical Unit Cambridge, GlaxoSmithKline, Cambridge, United Kingdom
| | - Misha Byrne
- Queensland Brain Institute, University of Queensland, Queensland, Australia
| | - Simon M. McHugh
- Clinical Unit Cambridge, GlaxoSmithKline, Cambridge, United Kingdom
| | - Mark A. Bellgrove
- School of Psychology and Psychiatry, Monash University, Melbourne, Australia
| | - Rodney J. Croft
- Queensland Brain Institute, University of Queensland, Queensland, Australia
| | - Bai Lu
- Tsinghua University Medical School, Beijing, China
| | - Edward T. Bullmore
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, United Kingdom
| | - Pradeep J. Nathan
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, United Kingdom
- School of Psychology and Psychiatry, Monash University, Melbourne, Australia
- New Medicines, UCB Pharma, Brussels, Belgium
| |
Collapse
|
43
|
Ellison-Wright I, Nathan PJ, Bullmore ET, Zaman R, Dudas RB, Agius M, Fernandez-Egea E, Müller U, Dodds CM, Forde NJ, Scanlon C, Leemans A, McDonald C, Cannon DM. Distribution of tract deficits in schizophrenia. BMC Psychiatry 2014; 14:99. [PMID: 24693962 PMCID: PMC4108049 DOI: 10.1186/1471-244x-14-99] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 03/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gray and white matter brain changes have been found in schizophrenia but the anatomical organizing process underlying these changes remains unknown. We aimed to identify gray and white matter volumetric changes in a group of patients with schizophrenia and to quantify the distribution of white matter tract changes using a novel approach which applied three complementary analyses to diffusion imaging data. METHODS 21 patients with schizophrenia and 21 matched control subjects underwent brain magnetic resonance imaging. Gray and white matter volume differences were investigated using Voxel-based Morphometry (VBM). White matter diffusion changes were located using Tract Based Spatial Statistics (TBSS) and quantified within a standard atlas. Tracts where significant regional differences were located were examined using fiber tractography. RESULTS No significant differences in gray or white matter volumetry were found between the two groups. Using TBSS the schizophrenia group showed significantly lower fractional anisotropy (FA) compared to the controls in regions (false discovery rate <0.05) including the genu, body and splenium of the corpus callosum and the left anterior limb of the internal capsule (ALIC). Using fiber tractography, FA was significantly lower in schizophrenia in the corpus callosum genu (p = 0.003). CONCLUSIONS In schizophrenia, white matter diffusion deficits are prominent in medial frontal regions. These changes are consistent with the results of previous studies which have detected white matter changes in these areas. The pathology of schizophrenia may preferentially affect the prefrontal-thalamic white matter circuits traversing these regions.
Collapse
Affiliation(s)
- Ian Ellison-Wright
- Department of Psychiatry, Brain Mapping Unit, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Robinson Way, Cambridge CB2 0SZ, UK,Avon and Wiltshire Mental Health Partnership NHS Trust, Heathwood, Fountain Way, Salisbury SP2 7FD, UK
| | - Pradeep J Nathan
- Department of Psychiatry, Brain Mapping Unit, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Robinson Way, Cambridge CB2 0SZ, UK,School of Psychology and Psychiatry, Monash University, Building 17, Clayton Campus, Wellington Road, Clayton, VIC 3800, Australia,New Medicines, UCB Pharma, Chemin du Foriest B-1420, Braine-l'Alleud, Belgium
| | - Edward T Bullmore
- Department of Psychiatry, Brain Mapping Unit, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Robinson Way, Cambridge CB2 0SZ, UK,GlaxoSmithKline, Clinical Unit Cambridge (CUC), Addenbrooke’s Centre for Clinical Investigation (ACCI), Addenbrooke’s Hospital, Hills Road, PO Box 128, Cambridge CB2 0GG, UK
| | - Rashid Zaman
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 189, Cambridge CB2 2QQ, UK,South Essex Partnership University NHS Foundation Trust (SEPT), The Lodge, The Chase, Wickford, Essex SS11 7XX, United Kingdom
| | - Robert B Dudas
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 189, Cambridge CB2 2QQ, UK,Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge CB21 5EF, UK
| | - Mark Agius
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 189, Cambridge CB2 2QQ, UK,South Essex Partnership University NHS Foundation Trust (SEPT), The Lodge, The Chase, Wickford, Essex SS11 7XX, United Kingdom
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 189, Cambridge CB2 2QQ, UK,Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge CB21 5EF, UK,Behavioural Clinical Neuroscience Institute (BCNI), University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 189, Cambridge CB2 2QQ, UK
| | - Ulrich Müller
- Department of Psychiatry, Brain Mapping Unit, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Robinson Way, Cambridge CB2 0SZ, UK,Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge CB21 5EF, UK
| | - Chris M Dodds
- GlaxoSmithKline, Clinical Unit Cambridge (CUC), Addenbrooke’s Centre for Clinical Investigation (ACCI), Addenbrooke’s Hospital, Hills Road, PO Box 128, Cambridge CB2 0GG, UK
| | - Natalie J Forde
- Clinical Neuroimaging Laboratory, Departments of Anatomy & Psychiatry, College of Medicine, Nursing and Health Sciences, 202 Comerford Suite, Clinical Sciences Institute, National University of Ireland, Galway, Republic of Ireland
| | - Cathy Scanlon
- Clinical Neuroimaging Laboratory, Departments of Anatomy & Psychiatry, College of Medicine, Nursing and Health Sciences, 202 Comerford Suite, Clinical Sciences Institute, National University of Ireland, Galway, Republic of Ireland
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Q.S.459, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Colm McDonald
- Clinical Neuroimaging Laboratory, Departments of Anatomy & Psychiatry, College of Medicine, Nursing and Health Sciences, 202 Comerford Suite, Clinical Sciences Institute, National University of Ireland, Galway, Republic of Ireland
| | - Dara M Cannon
- Clinical Neuroimaging Laboratory, Departments of Anatomy & Psychiatry, College of Medicine, Nursing and Health Sciences, 202 Comerford Suite, Clinical Sciences Institute, National University of Ireland, Galway, Republic of Ireland
| |
Collapse
|
44
|
Forde NJ, Ronan L, Suckling J, Scanlon C, Neary S, Holleran L, Leemans A, Tait R, Rua C, Fletcher PC, Jeurissen B, Dodds CM, Miller SR, Bullmore ET, McDonald C, Nathan PJ, Cannon DM. Structural neuroimaging correlates of allelic variation of the BDNF val66met polymorphism. Neuroimage 2014; 90:280-9. [DOI: 10.1016/j.neuroimage.2013.12.050] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 12/11/2013] [Accepted: 12/16/2013] [Indexed: 01/30/2023] Open
|
45
|
Patel AX, Miller SR, Nathan PJ, Kanakaraj P, Napolitano A, Lawrence P, Koch A, Bullmore ET. Neuroendocrine and sympathetic responses to an orexin receptor antagonist, SB-649868, and alprazolam following insulin-induced hypoglycemia in humans. Psychopharmacology (Berl) 2014; 231:3817-28. [PMID: 24770625 PMCID: PMC4159598 DOI: 10.1007/s00213-014-3520-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 02/24/2014] [Indexed: 02/02/2023]
Abstract
RATIONALE The orexin-hypocretin system is important for translating peripheral metabolic signals and central neuronal inputs to a diverse range of behaviors, from feeding, motivation and arousal, to sleep and wakefulness. Orexin signaling is thus an exciting potential therapeutic target for disorders of sleep, feeding, addiction, and stress. OBJECTIVES/METHODS Here, we investigated the low dose pharmacology of orexin receptor antagonist, SB-649868, on neuroendocrine, sympathetic nervous system, and behavioral responses to insulin-induced hypoglycemic stress, in 24 healthy male subjects (aged 18-45 years; BMI 19.0-25.9 kg/m(2)), using a randomized, double-blind, placebo-controlled, within-subject crossover design. Alprazolam, a licensed benzodiazepine anxiolytic, was used as a positive comparator, as it has previously been validated using the insulin tolerance test (ITT) model in humans. RESULTS Of the primary endpoints, ITT induced defined increases in pulse rate, plasma cortisol, and adrenocorticotropic hormone in the placebo condition, but these responses were not significantly impacted by alprazolam or SB-649868 pre-treatment. Of the secondary endpoints, ITT induced a defined increase in plasma concentrations of adrenaline, noradrenaline, growth hormone (GH), and prolactin in the placebo condition. Alprazolam pre-treatment significantly reduced the GH response to ITT (p < 0.003), the peak electromyography (p < 0.0001) and galvanic skin response (GSR, p = 0.04) to acoustic startle, the resting GSR (p = 0.01), and increased appetite following ITT (p < 0.0005). SB-649868 pre-treatment produced no significant results. CONCLUSION We concluded that the ITT model may be informative for assessing the effects of drugs directly acting on the neuroendocrine or sympathetic nervous systems, but could not be validated for studying low dose orexin antagonist activity.
Collapse
Affiliation(s)
- Ameera X. Patel
- Brain Mapping Unit, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EB UK
| | - Sam R. Miller
- Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke’s Centre for Clinical Investigation, Cambridge, UK
| | - Pradeep J. Nathan
- Brain Mapping Unit, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EB UK ,Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke’s Centre for Clinical Investigation, Cambridge, UK ,School of Psychology and Psychiatry, Monash University, Melbourne, Australia
| | - Ponmani Kanakaraj
- Quantitative Sciences India, GlaxoSmithKline Pharmaceuticals Ltd, Bangalore, India
| | - Antonella Napolitano
- Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke’s Centre for Clinical Investigation, Cambridge, UK
| | - Philip Lawrence
- Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke’s Centre for Clinical Investigation, Cambridge, UK
| | - Annelize Koch
- Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke’s Centre for Clinical Investigation, Cambridge, UK
| | - Edward T. Bullmore
- Brain Mapping Unit, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EB UK ,Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke’s Centre for Clinical Investigation, Cambridge, UK
| |
Collapse
|
46
|
Kaser M, Soltesz F, Lawrence P, Miller S, Dodds C, Croft R, Dudas RB, Zaman R, Fernandez-Egea E, Müller U, Dean A, Bullmore ET, Nathan PJ. Oscillatory underpinnings of mismatch negativity and their relationship with cognitive function in patients with schizophrenia. PLoS One 2013; 8:e83255. [PMID: 24358266 PMCID: PMC3866183 DOI: 10.1371/journal.pone.0083255] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 10/31/2013] [Indexed: 11/23/2022] Open
Abstract
Background Impairments in mismatch negativity (MMN) generation have been consistently reported in patients with schizophrenia. However, underlying oscillatory activity of MMN deficits in schizophrenia and the relationship with cognitive impairments have not been investigated in detail. Time-frequency power and phase analyses can provide more detailed measures of brain dynamics of MMN deficits in schizophrenia. Method 21 patients with schizophrenia and 21 healthy controls were tested with a roving frequency paradigm to generate MMN. Time-frequency domain power and phase-locking (PL) analysis was performed on all trials using short-time Fourier transforms with Hanning window tapering. A comprehensive battery (CANTAB) was used to assess neurocognitive functioning. Results Mean MMN amplitude was significantly lower in patients with schizophrenia (95% CI 0.18 - 0.77). Patients showed significantly lower EEG power (95% CI -1.02 - -0.014) in the ~4-7 Hz frequency range (theta band) between 170 and 210 ms. Patients with schizophrenia showed cognitive impairment in multiple domains of CANTAB. However, MMN impairments in amplitude and power were not correlated with clinical measures, medication dose, social functioning or neurocognitive performance. Conclusion The findings from this study suggested that while MMN may be a useful marker to probe NMDA receptor mediated mechanisms and associated impairments in gain control and perceptual changes, it may not be a useful marker in association with clinical or cognitive changes. Trial-by-trial EEG power analysis can be used as a measure of brain dynamics underlying MMN deficits which also can have implications for the use of MMN as a biomarker for drug discovery.
Collapse
Affiliation(s)
- Muzaffer Kaser
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Bahcesehir University, Istanbul, Turkey
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Fruzsina Soltesz
- GlaxoSmithKline, Clinical Unit Cambridge, Medicines Discovery and Development, Cambridge, United Kingdom
| | - Phil Lawrence
- GlaxoSmithKline, Clinical Unit Cambridge, Medicines Discovery and Development, Cambridge, United Kingdom
| | - Sam Miller
- GlaxoSmithKline, Clinical Unit Cambridge, Medicines Discovery and Development, Cambridge, United Kingdom
| | - Chris Dodds
- GlaxoSmithKline, Clinical Unit Cambridge, Medicines Discovery and Development, Cambridge, United Kingdom
| | - Rodney Croft
- Department of Psychology, University of Wollongong, Wollongong, Australia
| | - Robert B. Dudas
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridge and Peterborough NHS Foundation Trust, United Kingdom
| | - Rashid Zaman
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- South Essex Partnership NHS Foundation Trust, United Kingdom
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Cambridge and Peterborough NHS Foundation Trust, United Kingdom
| | - Ulrich Müller
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridge and Peterborough NHS Foundation Trust, United Kingdom
| | - Anna Dean
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Edward T. Bullmore
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- GlaxoSmithKline, Clinical Unit Cambridge, Medicines Discovery and Development, Cambridge, United Kingdom
- Cambridge and Peterborough NHS Foundation Trust, United Kingdom
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Pradeep J. Nathan
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- School of Psychology and Psychiatry, Monash University, Melbourne, Australia
- Neuroscience Discovery Medicine, UCB Pharma, Brussels, Belgium
| |
Collapse
|
47
|
Nathan PJ, Phan KL, Harmer CJ, Mehta MA, Bullmore ET. Increasing pharmacological knowledge about human neurological and psychiatric disorders through functional neuroimaging and its application in drug discovery. Curr Opin Pharmacol 2013; 14:54-61. [PMID: 24565013 DOI: 10.1016/j.coph.2013.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 11/15/2013] [Accepted: 11/15/2013] [Indexed: 02/02/2023]
Abstract
Functional imaging methods such as fMRI have been widely used to gain greater understanding of brain circuitry abnormalities in CNS disorders and their underlying neurochemical basis. Findings suggest that: (1) drugs with known clinical efficacy have consistent effects on disease relevant brain circuitry, (2) brain activation changes at baseline or early drug effects on brain activity can predict long-term efficacy; and (3) fMRI together with pharmacological challenges could serve as experimental models of disease phenotypes and be used for screening novel drugs. Together, these observations suggest that drug related modulation of disease relevant brain circuitry may serve as a promising biomarker/method for use in drug discovery to demonstrate target engagement, differential efficacy, dose-response relationships, and prediction of clinically relevant changes.
Collapse
Affiliation(s)
- Pradeep J Nathan
- Brain Mapping Unit, Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK; School of Psychology and Psychiatry, Monash University, Australia; New Medicines, UCB Pharma, Belgium.
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, USA; Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, USA
| | | | - Mitul A Mehta
- Department of Neuroimaging, Institute of Psychiatry, King's College London, UK
| | - Edward T Bullmore
- Brain Mapping Unit, Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK; GSK Clinical Unit Cambridge, GlaxoSmithKline, UK
| |
Collapse
|
48
|
Fornito A, Harrison BJ, Goodby E, Dean A, Ooi C, Nathan PJ, Lennox BR, Jones PB, Suckling J, Bullmore ET. Functional dysconnectivity of corticostriatal circuitry as a risk phenotype for psychosis. JAMA Psychiatry 2013; 70:1143-51. [PMID: 24005188 DOI: 10.1001/jamapsychiatry.2013.1976] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Dysregulation of corticostriatal circuitry has long been thought to be critical in the etiology of psychotic disorders, although the differential roles played by dorsal and ventral systems in mediating risk for psychosis have been contentious. OBJECTIVE To use resting-state functional magnetic resonance imaging to characterize disease-related, risk-related, and symptom-related changes of corticostriatal functional circuitry in patients with first-episode psychosis and their unaffected first-degree relatives. DESIGN, SETTING, AND PARTICIPANTS This case-control cross-sectional study was conducted at a specialist early psychosis clinic, GlaxoSmithKline Clinical Unit, and magnetic resonance imaging facility. Nineteen patients with first-episode psychosis, 25 of their unaffected first-degree relatives, and 26 healthy control subjects were included in this study. MAIN OUTCOMES AND MEASURES Voxelwise statistical parametric maps testing differences in the strength of functional connectivity between 6 striatal seed regions of interest (3 caudate and 3 putamen) per hemisphere and all other brain regions. RESULTS Disease-related changes, reflecting differences between patients and control subjects, involved widespread dysregulation of corticostriatal systems characterized most prominently by a dorsal-to-ventral gradient of hypoconnectivity to hyperconnectivity between striatal and prefrontal regions. A similar gradient was evident in comparisons between relatives and control subjects, identifying it as a genetically inherited risk phenotype. In patients, functional connectivity in risk-affected and disease-affected dorsal frontostriatal circuitry correlated with the severity of both positive and negative symptoms. CONCLUSIONS AND RELEVANCE First-episode psychosis is associated with pronounced dysregulation of corticostriatal systems, characterized most prominently by hypoconnectivity of dorsal and hyperconnectivity of ventral frontostriatal circuits. These changes correlate with symptom severity and are also apparent in unaffected first-degree relatives, suggesting that they represent a putative risk phenotype for psychotic illness.
Collapse
Affiliation(s)
- Alex Fornito
- Monash Clinical and Imaging Neuroscience Laboratory, School of Psychology and Psychiatry, Monash University, Clayton, Victoria, Australia2Centre for Neural Engineering, University of Melbourne, Parkville, Victoria, Australia3NICTA Victorian Research Laboratory, University of Melbourne, Parkville, Victoria, Australia4Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Parkville, Victoria, Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Ziauddeen H, Nathan PJ, Dodds C, Maltby K, Miller SR, Waterworth D, Song K, Warren L, Hosking L, Zucchetto M, Bush M, Johnson LV, Sarai B, Mogg K, Bradley BP, Richards DB, Fletcher PC, Bullmore ET. The effects of alcohol on the pharmacokinetics and pharmacodynamics of the selective mu-opioid receptor antagonist GSK1521498 in healthy subjects. J Clin Pharmacol 2013; 53:1078-90. [PMID: 23934621 PMCID: PMC4282435 DOI: 10.1002/jcph.110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/11/2013] [Indexed: 11/27/2022]
Abstract
The mu-opioid system has a key role in hedonic and motivational processes critical to substance addiction. However, existing mu-opioid antagonists have had limited success as anti-addiction treatments. GSK1521498 is a selective and potent mu-opioid antagonist being developed for the treatment of overeating and substance addictions. In this study, 28 healthy participants were administered single doses of GSK1521498 20 mg, ethanol 0.5 g/kg body weight, or both in combination, in a double blind placebo controlled four-way crossover design. The primary objective was to determine the risk of significant adverse pharmacodynamic and pharmacokinetic (PK) interactions. The effects of GSK1521498 on hedonic and consummatory responses to alcohol and the attentional processing of alcohol-related stimuli, and their modulation by the OPRM1 A118G polymorphism were also explored. GSK1521498 20 mg was well tolerated alone and in combination with ethanol. There were mild transient effects of GSK1521498 on alertness and mood that were greater when it was combined with ethanol. These effects were not of clinical significance. There were no effects of GSK1521498 on reaction time, hedonic or consummatory responses. These findings provide encouraging safety and PK data to support continued development of GSK1521498 for the treatment of alcohol addiction.
Collapse
Affiliation(s)
- Hisham Ziauddeen
- Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke's Centre for Clinical Investigations, Cambridge, UK; Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK; Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), Cambridge, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Lim YY, Villemagne VL, Laws SM, Ames D, Pietrzak RH, Ellis KA, Harrington KD, Bourgeat P, Salvado O, Darby D, Snyder PJ, Bush AI, Martins RN, Masters CL, Rowe CC, Nathan PJ, Maruff P. BDNF Val66Met, Aβ amyloid, and cognitive decline in preclinical Alzheimer's disease. Neurobiol Aging 2013; 34:2457-64. [PMID: 23769397 DOI: 10.1016/j.neurobiolaging.2013.05.006] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 03/18/2013] [Accepted: 05/06/2013] [Indexed: 01/06/2023]
Abstract
Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism has previously been implicated in Alzheimer's disease (AD)-related cognitive impairment. We aimed to determine the relationship between BDNF Val66Met and beta-amyloid (Aβ) on cognitive decline, hippocampal atrophy, and Aβ accumulation over 36 months in 165 healthy adults enrolled in the Australian Imaging, Biomarkers and Lifestyle study. In healthy adults with high Aβ, Met carriers showed significant and moderate-to-large declines in episodic memory, executive function, and language, and greater hippocampal atrophy over 36 months, compared with Val/Val homozygotes. BDNF Val66Met was not found to be related to rates of change in cognition or hippocampal volume in healthy adults with low Aβ. BDNF Val66Met did not relate to the amount of Aβ or to the rate of Aβ accumulation in either group. High Aβ levels coupled with Met carriage may be useful prognostic markers of accelerated cognitive decline and hippocampal degeneration in individuals in the preclinical stage of AD.
Collapse
Affiliation(s)
- Yen Ying Lim
- Mental Health Research Institute, The University of Melbourne, Parkville, Victoria, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|