Study protocol: exercise training for treating major depressive disorder in multiple sclerosis

BACKGROUND

Major depressive disorder (MDD) is prevalent, yet sub-optimally treated among persons with multiple sclerosis (MS). We propose that exercise training may be a promising approach for treating depression in persons with MS who have MDD. Our primary hypothesis predicts a reduction in depression severity immediately after an exercise training intervention compared with minimal change in an attention control condition, and the reduction will be maintained during a follow-up period.

METHODS

This study involves a parallel-group, assessor-blinded RCT that examines the effect of a 4-month home-based exercise training intervention on depression severity in a sample of persons with MS who have MDD based on the MINI International Neuropsychiatric Interview. The primary outcomes of depression severity are the Patient Health Questionnaire-9 and Hamilton Depression Rating Scale. Participants (N = 146) will be recruited from within 200 miles of the University of Illinois at Chicago and randomized (1:1) into either a home-based exercise training condition or control condition with concealed allocation. The exercise training and social-contact, attention control (i.e., stretching) conditions will be delivered remotely over a 4-month period and supported through eight, 1:1 Zoom-based behavioral coaching sessions guided by social-cognitive theory and conducted by persons who are uninvolved in screening, recruitment, random assignment, and outcome assessment. We will collect outcome data at 0, 4 and 8 months using treatment-blinded assessors, and data analyses will involve intent-to-treat principles.

DISCUSSION

If successful, the proposed study will provide the first Class I evidence supporting a home-based exercise training program for treating MDD in persons with MS. This is critical as exercise training would likely have positive secondary effects on symptoms, cognition, and quality of life, and provide a powerful, behavioral approach for managing the many negative outcomes of MDD in MS. The program in the proposed research is accessible and scalable for broad treatment of depression in MS, and provides the potential for integration in the clinical management of MS.

TRIAL REGISTRATION

The trial was registered on September 10, 2021 at clinicaltrials.gov with the identifier NCT05051618. The registration occurred before we initiated recruitment on June 2, 2023.

Regulation of Macrophage Activation by a Novel Splice Variant of the Voltage-gated Sodium Channel NaV1.5 (135.27)

Novel splice variants of the voltage-gated sodium channels, NaV1.5 and NaV1.6, are expressed in human monocyte-derived macrophages and THP-1 cells, a human monocytic cell line. Our prior work demonstrated that macrophage NaV1.5 localizes to the late endosome in primed human macrophages and differentiated THP-1 cells and regulates endosomal acidification and phagocytosis. Here we show that macrophage NaV1.5 regulates intracellular signaling associated with cell priming. THP-1 cells that express NaV1.5 (wild type and control shRNA cells) and those that do not (NaV1.5 shRNA-mediated knockdown) were differentiated with phorbol ester for 3 days and then primed sequentially with interferon-gamma and LPS. Analysis of global mRNA expression using Affymetrix oligonucleotide arrays demonstrated decreased expression of several inflammatory response genes and increased expression of a pro-survival growth factor in NaV1.5 knockdown cells. These results were confirmed by real time PCR analysis. In addition, shRNA-mediated knockdown of macrophage NaV1.5 inhibited LPS-mediated activation of the transcription factor NFkappaB and stimulation-induced apoptosis. Preliminary experiments suggest that knockdown of NaV1.5 prevents a decrease in cytosolic calcium that is necessary for optimal activation of NFkappaB. These results suggest that a variant of human NaV1.5 may regulate intracellular signaling during macrophage priming.

This work is support by an award from the National Multiple Sclerosis Society (RG-3888) and the National Institutes of Health (K02-NS047457-01).

Exacerbation of experimental autoimmune encephalomyelitis after withdrawal of phenytoin and carbamazepine

OBJECTIVE

In vitro observations and studies in murine experimental autoimmune encephalomyelitis (EAE) have shown protective effects of sodium channel blockers on central nervous system axons and improved clinical status when treatment is continued throughout the period of observation. Several clinical studies of sodium channel blockers are under way in patients with multiple sclerosis. Here we asked whether a protective effect would persist after withdrawal of a sodium channel blocker.

METHODS

We studied a mouse model of myelin oligodendrocyte glycoprotein-induced EAE treated with phenytoin or carbamazepine.

RESULTS

Both phenytoin and carbamazepine significantly improved the clinical course of the disease. Withdrawal of phenytoin resulted in acute exacerbation, accompanied by a significantly increased inflammatory infiltrate within the central nervous system and the death of nearly 60% of EAE mice. There were no clinical worsening or deaths in control mice after withdrawal of phenytoin. Withdrawal of carbamazepine led to acute worsening of EAE symptoms, increased inflammatory infiltrate, and was associated with the death of 8% of mice.

INTERPRETATION

These results, together with results showing effects of sodium channel blockers in immune cells, raise questions about the long-term effects of sodium channel blockers in neuroinflammatory disorders, and suggest that clinical studies of sodium channel blockers in these disorders should be planned carefully.

Enhanced susceptibility to endotoxic shock and impaired STAT3 signaling in CD31-deficient mice

Platelet endothelial cell adhesion molecule-1 (PECAM-1, CD31), an adhesion molecule expressed on hematopoietic and endothelial cells, mediates apoptosis, cell proliferation, and migration and maintains endothelial integrity in addition to its roles as a modulator of lymphocyte and platelet signaling and facilitator of neutrophil transmigration. Recent data suggest that CD31 functions as a scaffolding protein to regulate phosphorylation of the signal transducers and activators of transcription (STAT) family of signaling molecules, particularly STAT3 and STAT5. STAT3 regulates the acute phase response to innate immune stimuli such as lipopolysaccharide (LPS) and promotes recovery from LPS-induced septic shock. Here we demonstrate that CD31-deficient mice have reduced survival during endotoxic LPS-induced shock. As compared to wild-type controls, CD31-deficient mice showed enhanced vascular permeability; increased apoptotic cell death in liver, kidney, and spleen; and elevated levels of serum tumor necrosis factor alpha (TNF-alpha), interferon gamma (IFNgamma), MCP-1, MCP-5, sTNRF, and IL-6. In response to LPS in vivo and in vitro, splenocytes and endothelial cells from knockout mice had reduced levels of phosphorylated STAT3. These results suggest that CD31 is necessary for maintenance of endothelial integrity and prevention of apoptosis during septic shock and for STAT3-mediated acute phase responses that promote survival during septic shock.

Development of resistance to lead encephalopathy during maturation in the rat pup

The purpose of this study was to determine the maturational period during which the rat pup becomes resistant to the toxic effects of lead on the brain. Pups were fed lead, as lead acetate, by esophageal catheter for 14 days beginning at various ages between 14-24 days. The daily lead doses, which produced a hemorrhagic cerebellar encephalopathy in at least 50% of pups, were 400 micrograms Pb/g body weight for animals fed from 14 days of age, 800 micrograms/g for animals fed from 16 days, and 1600 micrograms/g for animals fed from 18 days. In contrast, pups fed even higher lead doses beginning at 20 days showed only a patchy cerebellar edema by light microscopy while pups fed from 24 days had normal cerebellums by light microscopy. The encephalopathic lead doses in the younger pups resulted in the same cerebellar lead concentrations (about 30 micrograms/g protein) as the higher lead doses fed pups beginning at 20 ot 24 days. When corrected for blood lead concentrations, the cerebellar lead concentrations were 20-25% higher in the encephalopathic compared to the older encephalopathy-resistant animals. This difference may be accounted for by cerebellar hemorrhages in the younger animals. Polarographic studies showed inhibition of respiration in cerebellar slices from animals fed lead from 14 days of age but not in animals fed from 20 or 24 days of age. Our results that, during the encephalopathy-sensitive age period, a critical cerebellar concentration of lead is associated with the encephalopathy. Resistance to lead encephalopathy in older animals, with similar cerebellar lead concentrations, may be related to a capacity to sequester lead in new cellular locations away from its site of action on aerobic energy metabolism.